Introductory Maternity and Pediatric Nursing by N. Jayne Klossner Nancy Hatfield test bank

Introductory Maternity and Pediatric Nursing  by N. Jayne Klossner Nancy Hatfield  test bank
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Description

Name: __________________________ Date: _____________

Client Needs:  D-2
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  4
Page and Header:  193, Pain Management Principles and Techniques
1.
Jane and her husband have attended childbirth preparation classes and they feel very hopeful and optimistic about having a natural childbirth. As Jane progresses to 8cm dilation, she can no longer endure the pain at the peak of each contraction and she begs the nurse for an epidural. How can the nurse best help Jane?
A)
Suggest a less extreme alternative such as a sedative
B)
Support Janes decision and call the obstetrician to discuss the epidural with Jane
C)
Gently remind Jane of her goal of natural childbirth, encouraging her and helping her to focus her breathing
D)
Ask Janes husband to gently remind her of their goal of natural childbirth and to encourage her to focus on using the breathing and imagery techniques they learned in childbirth class together
Ans:
B

Feedback:

Pain is subjective and only what the patient experiences. The nurse should support the desire of the patient. Sedatives would be counterproductive as they may slow the labor process. It would be inappropriate to negate her feelings and remind her of earlier goals; that is the job of the support person and should be left up him or her to decide what to say and when to say it.

Client Needs:  D-2
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  8
Page and Header:  192, Pain Management Principles and Techniques
2.
Marie, a 21-year-old first-time mother in the second stage of labor, has been moaning and screaming and generally vocal throughout her labor. Her husband is distraught seeing his wife this way and comes to the nurse asking that his wife receive more pain medication. How should the nurse respond?
A)
Assist Marie with breathing and imagery techniques in an attempt to calm her down
B)
Reassure the first-time father that Marie will be fine and offer to stay with her while he takes a walk
C)
Page the obstetrician to evaluate Maries pain and administer an appropriate increase in her pain medication
D)
Ask Marie to describe the intensity of her pain on a scale of 0 to 10
Ans:
D

Feedback:

Before any pain medication can be administered, the pain must be assessed and the patient must request the medication, not the spouse. After the pain has been assessed, you can determine if calming techniques would be appropriate or not, but not before the assessment. Do not encourage the mothers support person to leave; he or she is necessary for the psychological wellbeing of the mother. Do not page the obstetrician until you have assessed the mother and determine that she does in fact need more medication.

Client Needs:  D-4
Cognitive Level:  Analysis
Integrated Process:  Nursing Care
Objective:  4
Page and Header:  196, Pain Management Principles and Techniques
3.
Erin, a 19-year-old first-time mother in the second stage of labor who has been given an epidural, reports severe, unrelenting abdominal pain and rates it as 10 on a scale of 0 to 10. As the nurse, what should you do?
A)
Proceed with standard care; the nurse knows that this is typical in the second stage of labor and that younger women and those who are first-time mothers are more likely to report severe pain.
B)
Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication.
C)
Call the anesthetist, who is responsible for managing the epidural and should be monitoring Erins pain.
D)
Discuss with Erin the additional pain medication options available to her at this stage in her labor so that she can choose which option she prefers.
Ans:
B

Feedback:

After an epidural is in place, if the women reports unrelenting pain, the provider must assess the situation for a complication. This is not a standard reaction; pain should come in waves, and should not be unrelenting. Wait for the obstetrician to page the anesthetist. Do not leave the decision up to the mother; rather, trust the experts.

Client Needs:  D-4
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  6
Page and Header:  185, The Pain of Labor and Childbirth
4.
Sarah has just arrived at the hospital, in early labor, showing signs of extreme anxiety over the birth to come. Why is it so important that the nurse help Sarah relax?
A)
Sarahs anxiety will increase her blood pressure, increasing her risk with an epidural
B)
This is the time at which the nurse must establish that she is in control; she will be taking care of Sarah and Sarah needs to trust the nurse
C)
Sarahs anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus
D)
Sarah needs to sleep now so that she can save her energy for the later stages of labor
Ans:
C

Feedback:

Anxiety out of control can decrease the oxygen of the mother by increasing her respiratory rate and increasing the demand on her body, and have a negative impact on the fetus. Encourage control of the anxiety. Anxiety will not negatively affect the action of the epidural. It is premature to be stern with the patient. While it is preferable that she save her energy, it is not damaging to her or to the fetus if she does not sleep.

Client Needs:  D-2
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  10
Page and Header:  196, Pain Management Principles and Techniques
5.
Betsy is recovering from a standard delivery. The nurse has just removed Betsys epidural catheter and applied a sterile pressure dressing. What is it important for the nurse to do now?
A)
Assess return of sensory and motor functions to the lower extremities
B)
Help Betsy to get up and walk around immediately
C)
Let Betsy rest and recover while keeping her legs slightly elevated
D)
Make sure that Betsy receives plenty of fluids
Ans:
A

Feedback:

After removal of the epidural catheter and medication is terminated, the nurse needs to assess for return of motor function to ambulate the mother. The mother will not be able to walk for some time; at least until the medication wears off. Do not elevate the legs; you want to maintain normal circulation. Fluids are important, but they are not related to the epidural or to the metabolism of the medication.

Client Needs:  A-1
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  6
Page and Header:  187, Pain Management Principles and Techniques
6.
Nancy has presented in the early phase of labor. Shes experiencing abdominal pain and shows signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage?
A)
Immersing Nancy in warm water in a pool or hot tub
B)
Practicing effleurage on the abdomen
C)
Administering a sedative such as secobarbital (Seconal) or pentobarbital (Nembutal)
D)
Administering an opioid such as meperidine (Demerol) or fentanyl (Sublimaze)
Ans:
B

Feedback:

In early labor, the less medication use the better, allow use of nonpharmacologic management and control the pain with gate theory. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opiods should be limited as they too may slow the progression of labor.

Client Needs:  D-4
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  10
Page and Header:  193, Pain Management Principles and Techniques
7.
Susan is in labor with her second child. She knows that she will want epidural anesthesia and she has already signed her consent form. What must the nurse do before Susan receives the epidural?
A)
Review Susans medical history and laboratory results, and interview Susan to confirm all information is accurate and up to date
B)
Place Susan in the fetal position on the table and keep her steady so that she wont move during the procedure
C)
Administer a fluid bolus through the IV line to reduce the risk of hypotension
D)
Prepare a sterile field with the supplies and medications that will be needed
Ans:
C

Feedback:

Epidurals can cause vasodilatation and result in hypotensive episodes, IV fluid bolus prior to epidural placement can help prevent the hypotensive episode. She has signed the consent form, so it is unnecessary to interview her again. Do not place her in the fetal position or prep the site until the anesthesiologist arrives; then, assist them.

Client Needs:  D-2
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  10
Page and Header:  195, Pain Management Principles and Techniques
8.
The nurse is assisting Monica through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist?
A)
Dry, cracked lips
B)
Urinary retention
C)
Rapid progress of labor
D)
Inability to push
Ans:
D

Feedback:

If she is not able to push, her epidural dose may be adjusted to decrease the impact on the sensory system. Dry lips indicate that she may need fluids, so you should give her some ice chips or a drink of water. Urinary retention and rapidly progressing labor should be directly reported to the obstetrician, not the anesthesiologist.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Assessment
Objective:  9
Page and Header:  191, Pain Management Principles and Techniques
9.
At which time during a womans labor might the nurse assist with a pudendal block?
A)
Early stage labor
B)
Before dilation only
C)
Just before delivery
D)
Just after delivery
Ans:
C

Feedback:

Pudendal block is a local block in the perineal area and is used to numb for delivery. Application before labor begins or while it is in the early stages would be counterproductive, as the patient would not have proper feeling and would have a harder time pushing. After delivery it is pointless; the most painful part is over.

Client Needs:  A-2
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  8
Page and Header:  195, Pain Management Principles and Techniques
10.
Jennifer has just received IV sedation. What must the nurse tell Jennifer to do?
A)
Ambulate only with assistance from the nurse or caregiver
B)
Ambulate within 15 minutes to prevent spinal headache
C)
Sit on the edge of the bed with her feet dangling before ambulating
D)
Remain in bed for at least 30 minutes
Ans:
A

Feedback:

The patient may have decrease sensory from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.

Client Needs:  D-1
Cognitive Level:  Comprehension
Integrated Process:  Nursing Process
Objective:  5
Page and Header:  188, Pain Management Principles and Techniques
11.
A woman is experiencing back labor and complains of intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain?
A)
Effleurage of the abdomen during the contraction
B)
Conscious relaxation/guided imagery in low fowlers
C)
Counter pressure against the sacrum
D)
Pant-blow (breaths and puffs breathing techniques)
Ans:
C

Feedback:

Counter pressure against the sacrum is a way to provide support and comfort for a women having intense back labor. Effleurage is ineffective for true back labor, as is conscious relaxation. Breathing will not diminish the pain of back labor.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  5
Page and Header:  188, Pain Management Principles and Techniques
12.
The following are nursing measures commonly offered to women in labor. Which nursing intervention would probably be most effective in applying the gate control theory for relief of labor pain?
A)
Encourage the woman to rest between contractions
B)
Change the womans position
C)
Give the prescribed medication
D)
Massage for the womans back
Ans:
D

Feedback:

Gate-control is based on the idea of distraction or redirection of the conduction of impulses up the neural pathways. Massage redirects the paths of sensation away from the pain to the other area. Encouragement is a form of psychological support. Position change will only distract the patient. Medication should be withheld until all non-pharmacological treatments have been exhausted.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  8
Page and Header:  191, Pain Management Principles and Techniques
13.
The patient is G1 P0, in the second stage of labor and is at 2+ station and in anticipation of delivery within the hour. Her epidural did not work and she is begging for Demerol. Which is the most appropriate action by the nurse?
A)
At the nurses station call the anesthetist to retry the epidural
B)
Call the doctor and obtain a reduced dose of Demerol
C)
Give the Demerol because she needs pain relief now
D)
Encourage her through the contractions and explain not giving the Demerol
Ans:
D

Feedback:

At this point, any medication would be contraindicated as it would pass to the fetus and may cause respiratory depression. The nurse will have to work with the mother through the contractions and pushing. The patient has progressed too far to retry the epidural medication. No Demerol should be given due to the risk to the fetus.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Communication & documentation
Objective:  6
Page and Header:  186, Pain Management Principles and Techniques
14.
What should the nurses best response be to help the patient remain calm and cooperative during delivery?
A)
The baby is coming. Relax and everything will turn out fine.
B)
Do you want me to call in your family?
C)
Even though the baby is coming, the doctor will be here soon.
D)
The baby is coming. Ill explain whats happening and guide you.
Ans:
D

Feedback:

The nurse is not to leave the side of the patient, to keep her clam she needs to explain all procedures and discuss all events to the mother. An explanation will give the mother something else to think about, plus it will assure her that everything is going well.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  5
Page and Header:  188, Pain Management Principles and Techniques
15.
Which instructions should be given by the nurse to the patient in the second stage of labor to facilitate natural childbirth?
A)
Use a squatting position and use the squat bar for support
B)
Stay low on her back to ease the back pain
C)
Use the valsalva maneuver for effective pushing
D)
Ask for privacy and have just the partner present
Ans:
A

Feedback:

The position is very important during labor. The woman needs to be in a position of comfort. Allowing the woman to assume the most comfortable position will facilitate natural childbirth. The valsalva maneuver may result in dangerous increases in blood pressure, so be sure to instruct the mother to breathe as she pushes. The nurse should not intervene with who comes in or what family members are present unless she is asked, or unless the visitation is upsetting the mother.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Caring
Objective:  3
Page and Header:  184, The Pain of Labor and Childbirth
16.
Which of the following would be the best way the nurse can facilitate an effective birth plan for the patient to achieve adequate pain relief?
A)
The client has the baby without any analgesic or anesthetic
B)
The health care provider decides the best pain relief for the mother and family
C)
Client priorities and preferences are incorporated into the plan
D)
The nurse prescribes alternative methods of pain relief
Ans:
C

Feedback:

The nurse and the patient would work together; the nurse needs to seek information on the desires of the patient and work to achieve the desired level of pain control for the labor and delivery experience.

Client Needs:  D-4
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  10
Page and Header:  193, Pain Management Principles and Techniques
17.
A woman in labor at the hospital has just received an epidural block. Which intervention is priority before and during epidural placement?
A)
Increase oral fluids every hour to prevent dehydration
B)
Provide adequate IV fluids to maintain her blood pressure
C)
Monitor temperature every four hours and give Tylenol if 100.4
D)
Monitor the maternal apical pulse for Bradycardia
Ans:
B

Feedback:

The patient will need to have a bolus of IV fluids prior to and then maintained during the epidural to be prepared in the event of the hypotensive episodes that may accompany epidural placement. The hypotensive event is transitory, and increasing oral hydration is unnecessary and may lead to nausea later. Monitor the mothers body temperature, but wait for instructions from the doctor as to when to administer medication. Bradycardia is not a common side effect of epidural medication.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  5
Page and Header:  186, Pain Management Principles and Techniques
18.
The nurse instructs the client about skin massage and the gate control theory of pain. Which of the following statements would be appropriate for the nurse to include for patient understanding of the nonpharmacological pain relief methods?
A)
The gating mechanism is located at the pain site
B)
Pain perception is decreased if anxiety is present
C)
The gating mechanism opens so all the stimuli pass through to the brain
D)
A technique to prevent the painful stimuli from entering the brain
Ans:
D

Feedback:

Gate-control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location. Gate control does not need to be applied directly to the site of the pain. Anxiety heightens the painful feelings. Gating blocks the flow of painful stimuli to the sensory centers in the brain.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Teaching & learning
Objective:  7
Page and Header:  191, Pain Management Principles and Techniques
19.
The laboring patient who is at 3cm dilation and 25 percent effaced is asking for analgesia. The nurse explains the analgesia is usually not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice.
A)
This would cause fetal depression in utero
B)
This may prolong labor and increase complications
C)
The effects would wear off before delivery
D)
This can lead to maternal hypertension
Ans:
B

Feedback:

Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The patient should be offered nonpharmacologic options at this point until she is in active labor. At this point in labor, the fetus would not be affected by analgesia. The effects would wear off and the drug would need to be re-administered, which would increase the risk to the fetus. There is no link between maternal hypertension and analgesia.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  4
Page and Header:  185, Pain Management Principles and Techniques
20.
The patient is 5 cm dilated, 80 percent effaced, and 0 station. Her contractions are increasing to every 23 minutes, lasting 50 seconds. The client is increasingly uncomfortable. She is apprehensive but appropriate and focused on her breathing and relaxation. Select the most appropriate nursing diagnosis for the client.
A)
Risk for altered tissue perfusion related to breathing techniques
B)
Impaired gas exchange related to prolonged contractions
C)
Pain related to increasing frequency and intensity of contractions
D)
Ineffective individual coping related to fear and anxiety
Ans:
C

Feedback:

The patient is coping well, breathing without problem and using breathing techniques for management of labor pain. The most appropriate diagnosis at this point is related to pain management. There is no indication of altered perfusion, impaired gas exchange, or ineffective coping by the patient. All is normal.

Client Needs:  D-1
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  2
Page and Header:  185, The Pain of Labor and Childbirth
21.
Pain is multi-factorial for women in labor. Which of the following is a psychosocial influence for a woman in labor?
A)
stretching of cervix
B)
decent of fetus into birth canal
C)
pressure in the perineum
D)
fear of pain during labor
Ans:
D

Feedback:

Fear of pain during labor is the only factor listed that is psychosocial, the others are physical.

Client Needs:  A-1
Cognitive Level:  Analysis
Integrated Process:  Caring
Objective:  4
Page and Header:  185, Pain Management Principles and Techniques
22.
What is the primary role of the nurse in pain management for a nurse working with labor patients?
A)
Provide any medication the patient request
B)
Dictate the pain management during labor for the best outcome
C)
Work with the labor patient to plan pain management options
D)
Monitor the patient for active labor and suggest she have an epidural to have increased satisfaction with her delivery experience
Ans:
C

Feedback:

The role of the nurse is to work with the patient and plan with the nurse the pain management technique desired by the patient to meet the level of expectation for the patient. Pain is subjective and each woman has a right to her own labor plan.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Caring
Objective:  5
Page and Header:  186, Pain Management Principles and Techniques
23.
The labor patient is prepared for natural childbirth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacological pain management is this considered?
A)
Relaxation technique
B)
Continuous labor support
C)
Attention focusing
D)
Hypnosis
Ans:
C

Feedback:

Attention focusing is the use of an object or picture or image for the woman to reflect and focus internally or externally during labor to distract her from the labor pain. A relaxation technique would be sitting in warm water or having a massage. Continuous labor support comes from the coach or partner. Hypnosis is a psychological state.

Client Needs:  A-1
Cognitive Level:  Comprehension
Integrated Process:  Teaching & learning
Objective:  5
Page and Header:  190, Pain Management Principles and Techniques
24.
Newer methods of pain control are under investigation, one under study is the use of intradermal water injection. Where is the water injected for pain control in a labor patient?
A)
Upper back
B)
Lower back
C)
Sacral area
D)
Illiac crest
Ans:
B

Feedback:

This method of pain relief is considered nonpharmacologic in nature, it does not use medication to relieve the pain. Sterile water is injected under the skin to activate the gate-theory of pain control. Injections are placed in the lower back.

Client Needs:  D-2
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  7
Page and Header:  191, Pain Management Principles and Techniques
25.
A woman in latent labor for the past 12 hours is requesting medication to help her rest. What medication should the provider prescribe?
A)
Secobarbital (Seconal)
B)
Meperidine (Demoral)
C)
Fentanyl (Sublimaze)
D)
Morphine
Ans:
A

Feedback:

In the latent phase of labor, sedatives can be prescribed to assist a patient to rest. Use of analgesics in early labor may stop labor and are not recommended.

Client Needs:  D-2
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  8
Page and Header:  191, Pain Management Principles and Techniques
26.
Opiods are often used in labor for pharmacologic pain management. A patient in the transition phase of labor is requesting fentanyl (Sublimaze) for pain. How should the nurse respond to her request?
A)
I will page the provider and ask for your pain medication.
B)
You are so close to delivery, dont you want to have natural child birth?
C)
Pain medication given now might cause the baby to have slow respirations and is not recommended, lets try to focus and breathe.
D)
Rather than use fentanyl, we can ask the provider to order another analgesic at this point.
Ans:
C

Feedback:

Once the woman has entered into the transition phase of labor, she is considered to be imminent for delivery. Any opioid medication might pass to the fetus and is not recommended due to the effects of respiratory compromise. The nurse will need to encourage nonpharmacologic methods at this point and should not consult the provider. The nurse should also remain supportive of the mother.

Client Needs:  D-2
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  9
Page and Header:  191, Pain Management Principles and Techniques
27.
A woman dilated to 10 centimeters and feeling the urge to have a bowel movement is refusing to push, she is screaming it hurts down there too much to push. What is the option the nurse should suggest at this point for pain management to facilitate pushing?
A)
Epidural anesthesia
B)
Pudendal block
C)
Paracervial block
D)
Parenteral medication
Ans:
B

Feedback:

The patient is too far dilated to have any parenteral medication or an epidural block. The best option is a local block or a pudendal block that will numb the vaginal wall to block the pain sensation to the pudendal nerve. The paracervical block is only used in the first stage of labor and this patient is in the second stage.

Client Needs:  D-4
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  10
Page and Header:  195, Pain Management Principles and Techniques
28.
After administration of epidural anesthesia during labor, the patient develops a temperature of 100.1F. The patients husband is asking if she is getting sick. How should the nurse respond to the patient and her husband?
A)
We will have to take her temperature every 30 minutes and might start antibiotics.
B)
This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour.
C)
Can you tell me if you have been exposed to any illnesses you might be developing?
D)
Due to the length of your labor, you might be dehydrated and that may cause your temperature to rise, lets get you something to drink.
Ans:
B

Feedback:

A common side effect of epidural anesthesia is elevated temperature during labor. The patient needs frequent assessment and to be observed for any other signs or symptoms of an infection, but it is premature to start antibiotics. If the mother has been exposed to any illness, it would be in the history. Oral fluids would not be advisable as they may result in nausea later.

Client Needs:  D-2
Cognitive Level:  Analysis
Integrated Process:  Nursing Process
Objective:  11
Page and Header:  196, Pain Management Principles and Techniques
29.
A patient of 41 weeks gestation has been in labor for 18 hours and the fetus is now showing signs of distress. The anesthesiologist has recommended a general anesthetic, the patient cannot have an epidural due to prior back surgery. The nurse should plan to administer which medication prior to taking the patient to the operating room?
A)
Pain medication
B)
Non-steroidal anti-inflammatory
C)
Antacid
D)
Sedative
Ans:
C

Feedback:

Prior to intubation for a general surgery, the patient should receive a dose of antacid to decrease the risk of aspiration of acidic stomach contents. Pain medication, NSAIDS, and sedative medications should not be given prior to a general anesthetic.

Client Needs:  A-1
Cognitive Level:  Application
Integrated Process:  Nursing Process
Objective:  2
Page and Header:  184, The Pain of Labor and Childbirth
30.
Which type of pain is always associated with the first stage of labor?
A)
Stretching of the perineum
B)
Stretching of the cervix
C)
Back ache
D)
Pelvic bone pain
Ans:
B

Feedback:

The first stage of labor is when the cervix is dilating. The woman in labor will have pain from the stretching and dilation of the cervix. Not all women will experience backache or pelvic bone pain. Stretching of the perineum is associated with the second stage of labor.

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