Chapter 17 Maximizing Comfort for the Laboring Woman

Chapter 17  Maximizing Comfort for the Laboring Woman

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, “My contractions are so strong, I don’t know what to do.” Before making a plan of care, what should the nurse’s first action be?
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
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. 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. The left lateral position is used to alleviate fetal distress, not maternal stress. The nurse has an obligation to provide physical, emotional, and psychosocial care and support to the laboring woman. This client clearly needs support.

DIF: Cognitive Level: Apply REF: p. 381 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Physiologic Integrity, Psychosocial Integrity

2. A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide at this time?
a.
Notify the woman’s health care provider.
b.
Administer the prescribed narcotic analgesic.
c.
Assure her that her labor will be over soon.
d.
Assist her with simple breathing and relaxation instructions.

ANS: D
By reducing tension and stress, both focusing and relaxation techniques will allow the woman in labor to rest and conserve energy for the task of giving birth. For those who have had no preparation, instruction in simple breathing and relaxation can be given in early labor and is often successful. The nurse can independently perform many functions in labor and birth, such as teaching and support. Pain medication may be an option for this client. However, the initial response of the nurse should include teaching the client about her options. The length of labor varies among individuals, but the first stage of labor is the longest. At 3 cm of dilation with contractions every 5 minutes, this woman has a significant amount of labor yet to experience.

DIF: Cognitive Level: Apply REF: p. 386
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory?
a.
Massage the woman’s back.
b.
Change the woman’s position.
c.
Give the prescribed medication.
d.
Encourage the woman to rest between contractions.

ANS: A
According to the gate-control theory, pain sensations travel along sensory nerve pathways to the brain, but 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 the 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. Changing the woman’s position, administering pain medication, and resting between contractions do not reduce or block the capacity of the nerve pathways to transmit pain using the gate-control theory.

DIF: Cognitive Level: Apply REF: p. 383
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

4. Breathing patterns are taught to laboring women. Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes?
a.
Slow-paced breathing
b.
Deep abdominal breathing
c.
Modified-paced breathing
d.
Patterned-paced breathing

ANS: A
Slow-paced breathing is approximately one half the woman’s normal breathing rate and is used during the early stages of labor when a woman can no longer walk or talk through her contractions. No such pattern called deep abdominal breathing exists in childbirth preparation. Modified-paced breathing is shallow breathing that is twice the woman’s normal breathing rate. It is used when labor progresses and the woman can no longer maintain relaxation through paced breathing. Patterned-pace breathing is a fast, 4:1 breathe, breathe, breathe, blow pattern that is used during the transitional phase of labor just before pushing and delivery.

DIF: Cognitive Level: Understand REF: p. 387
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

5. A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate?
a.
Fentanyl (Sublimaze)
b.
Promethazine (Phenergan)
c.
Naloxone (Narcan)
d.
Nalbuphine (Nubain)

ANS: C
An opioid antagonist can be given to the newborn as one part of the treatment for neonatal narcosis, which is a state of central nervous system (CNS) depression in the newborn produced by an opioid. Opioid antagonists, such as naloxone (Narcan), can promptly reverse the CNS depressant effects, especially respiratory depression. Fentanyl (Sublimaze), promethazine (Phenergan), and nalbuphine (Nubain) do not act as opioid antagonists to reduce the postnatal effects of meperidine on the neonate.

DIF: Cognitive Level: Apply REF: p. 395
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity