Chapter 10 Management of Discomfort

Chapter 10  Management of Discomfort

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, “My contractions are so strong that I don’t know what to do.” The nurse should:
a.
Assess for fetal well-being.
b.
Encourage the woman to lie on her side.
c.
Disturb the woman as little as possible.
d.
Recognize that pain is personalized for each individual.

ANS: D

Feedback
A
This scenario includes no information that would indicate fetal distress or a logical reason to be overly concerned about the well-being of the fetus.
B
The left lateral position is used to alleviate fetal distress, not maternal stress.
C
The nurse has an obligation to provide physical, emotional, and psychosocial care and support to the laboring woman. This woman clearly needs support.
D
Each woman’s pain during childbirth is unique and is influenced by a variety of physiologic, psychosocial, and environmental factors. A critical issue for the nurse is how support can make a difference in the pain of the woman during labor and birth.

DIF: Cognitive Level: Application REF: 285
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

2. Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory?
a.
Massaging the woman’s back
b.
Changing the woman’s position
c.
Giving the prescribed medication
d.
Encouraging the woman to rest between contractions

ANS: A

Feedback
A
According to the gate-control theory, pain sensations travel along sensory nerve pathways to the brain; however, only a limited number of sensations, or messages, can travel through these nerve pathways at one time. Distraction techniques such as massage or stroking, music, focal points, and imagery reduce or completely block the capacity of nerve pathways to transmit pain. These distractions are thought to work by closing down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished.
B
Changing the woman’s position does not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.
C
Administering the prescribed medication will not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.
D
Although rest should be encouraged between contractions, this does not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.

DIF: Cognitive Level: Comprehension REF: 287
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation

3. A woman in labor has just received an epidural block. The most important nursing intervention is to:
a.
Limit parenteral fluids.
b.
Monitor the fetus for possible tachycardia.
c.
Monitor the maternal blood pressure for possible hypotension.
d.
Monitor the maternal pulse for possible bradycardia.

ANS: C

Feedback
A
Intravenous fluids are increased for a woman receiving an epidural to prevent hypotension.
B
The nurse observes for signs of fetal bradycardia.
C
The most important nursing intervention for a woman who has received an epidural block is to monitor the maternal blood pressure frequently for signs of hypotension.
D
The nurse monitors for signs of maternal tachycardia secondary to hypotension.

DIF: Cognitive Level: Application REF: 304
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation

4. A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should:
a.
Notify the woman’s physician.
b.
Tell the woman to slow the pace of her breathing.
c.
Administer oxygen via a mask or nasal cannula.
d.
Help her breathe into a paper bag.

ANS: D

Feedback
A
This woman is experiencing the side effects of hyperventilation, which include the symptoms of light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.
B
This woman is experiencing the side effects of hyperventilation, which include the symptoms of light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.
C
This woman is experiencing the side effects of hyperventilation, which include the symptoms of light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.
D
Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis.

DIF: Cognitive Level: Application REF: 291
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation

5. A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman’s intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman’s hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman?
a.
She is too far dilated.
b.
She is anemic.
c.
She has thrombocytopenia.
d.
She is septic.

ANS: C

Feedback
A
Typically epidural analgesia/anesthesia is used in the laboring woman when a regular labor pattern has been achieved, as evidenced by progressive cervical change.
B
The laboratory values show that the woman’s hemoglobin and hematocrit are in the normal range.
C
The platelet count indicates thrombocytopenia (low platelets), which is a contraindication to epidural analgesia/anesthesia.
D
The laboratory values show a slight increase in the WBC count; this is not uncommon in laboring women.

DIF: Cognitive Level: Analysis REF: 306
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis