NURS 326
NURS 326 Maternity Exam 2 Study
Questions and Answers 2026
pain during childbirth
increases the demand for oxygen and alters placental exchange of O2 and CO2
visceral pain
slow, deep pain, poorly localized.
dominates in first stage of labor with uterine contractions (tissue ischemia) and
cervical dilation
somatic pain
faster, sharp pain, precisely located.
dominates during transitional phase of stage 1 and stage 2 of labor
descending fetus puts direct pressure on maternal tissues (distention of vagina and
perineum)
physiologic effects of pain
increase in metabolic rate and oxygen demand
increased production of catecholamines, cortisol, and glucagon
less oxygen/waste exchange for the fetus = decreased placental perfusion
psychological effects of pain
no interaction with infant
unpleasant memories
inadequate feelings of partner
factors influencing pain response
physiological factors
culture
NURS 326
,NURS 326
anxiety
past experience
comfort
support
environment
gate-control theory of pain
non-pharmacologic pain management methods
childbirth preparation methods
relaxation/breathing techniques
hyperventilation
effleurage and counter-pressure
music
hydrotherapy
aromatherapy
biofeedback
acupressure/acupuncture
application of heat and cold
therapeutic touch/massage
hypnosis
pharmacologic pain management
analgesia and anesthesia.
withheld until the active phase of labor (reduces risk of slowing labor progression)
opioids used during active labor, then withheld and non-opioids that will not cross
the placenta are used
How does pain medication effect the fetus?
decreases FHR variability
if given in second stage of labor it can lead to CV and respiratory depression of the
newborn
NURS 326
,NURS 326
have NARCAN ready
opioid analgesics
Butorphanol (Stadol) 1mg q3hrs, early stage 1 labor (1-3cm dilated), relaxes mom
between contractions rather than pain relief
Meperidine (Demerol) 12.5-50mg q2-4hrs IV, not given/early labor
Fentanyl (Sublimaze) 50-100mcg, commonly used with epidural
Nalbuphine (Nubain) 10mg q3-6hrs IV
adjunctive drugs
Promethazine (Phenergan), narcotic potentiating effect, 12.5-25mg q2-4hrs IV
SLOW push
Hydroxyzine (Vistaril), narcotic potentiating effect, 25-100mg IM Z-track ONLY
Nalaxone (Narcan), narcotic antagonist
nursing care for analgesia administration
baseline maternal VS and FHR prior to administration
assess phase of labor
determine client's desire for analgesia and support informed choice
obtain MD or CNM order for medication
administer med IV when possible or IM (IV push slowly at beginning of the
contraction to decrease amount of medication to placenta)
DO NOT GIVE PO MEDS due to decreased GI absorption and motility
narcotic administration
NURS 326
, NURS 326
Contraindicated after end of active/beginning of transition phase of stage 1
Narcan at bedside
nurse management of epidural administration
1L IV fluid received before placement**
Monitor maternal HoTN**** (biggest risk of epidural)
bladder assessment
bedrest
continuous monitoring of FHT and record at intervals with maternal VS
Maternal VS q1-2min for first 15 min, then q15min after initial dose
subarachnoid (spinal) anesthesia
used for c-sections
risk for spinal HA : treatment is blood patch: 10-15mL of maternal blood into the
epidural space, MUST remain FLAT for 6-8hrs after delivery
long term pain control - duramorph
epidural (regional block) anesthesia
common persistent OP (occiput posterior position)
also called BACK LABOR: relaxes pelvic floor muscles needed to rotate fetus to
OA, stop continuous infusion in stage 2 to increase effectiveness of pushing
common to allow mother to labor down:
allow fetus to descend further into the vaginal canal (+2-+3 station) before having
mom push
regional blocks commonly associated with
NURS 326
NURS 326 Maternity Exam 2 Study
Questions and Answers 2026
pain during childbirth
increases the demand for oxygen and alters placental exchange of O2 and CO2
visceral pain
slow, deep pain, poorly localized.
dominates in first stage of labor with uterine contractions (tissue ischemia) and
cervical dilation
somatic pain
faster, sharp pain, precisely located.
dominates during transitional phase of stage 1 and stage 2 of labor
descending fetus puts direct pressure on maternal tissues (distention of vagina and
perineum)
physiologic effects of pain
increase in metabolic rate and oxygen demand
increased production of catecholamines, cortisol, and glucagon
less oxygen/waste exchange for the fetus = decreased placental perfusion
psychological effects of pain
no interaction with infant
unpleasant memories
inadequate feelings of partner
factors influencing pain response
physiological factors
culture
NURS 326
,NURS 326
anxiety
past experience
comfort
support
environment
gate-control theory of pain
non-pharmacologic pain management methods
childbirth preparation methods
relaxation/breathing techniques
hyperventilation
effleurage and counter-pressure
music
hydrotherapy
aromatherapy
biofeedback
acupressure/acupuncture
application of heat and cold
therapeutic touch/massage
hypnosis
pharmacologic pain management
analgesia and anesthesia.
withheld until the active phase of labor (reduces risk of slowing labor progression)
opioids used during active labor, then withheld and non-opioids that will not cross
the placenta are used
How does pain medication effect the fetus?
decreases FHR variability
if given in second stage of labor it can lead to CV and respiratory depression of the
newborn
NURS 326
,NURS 326
have NARCAN ready
opioid analgesics
Butorphanol (Stadol) 1mg q3hrs, early stage 1 labor (1-3cm dilated), relaxes mom
between contractions rather than pain relief
Meperidine (Demerol) 12.5-50mg q2-4hrs IV, not given/early labor
Fentanyl (Sublimaze) 50-100mcg, commonly used with epidural
Nalbuphine (Nubain) 10mg q3-6hrs IV
adjunctive drugs
Promethazine (Phenergan), narcotic potentiating effect, 12.5-25mg q2-4hrs IV
SLOW push
Hydroxyzine (Vistaril), narcotic potentiating effect, 25-100mg IM Z-track ONLY
Nalaxone (Narcan), narcotic antagonist
nursing care for analgesia administration
baseline maternal VS and FHR prior to administration
assess phase of labor
determine client's desire for analgesia and support informed choice
obtain MD or CNM order for medication
administer med IV when possible or IM (IV push slowly at beginning of the
contraction to decrease amount of medication to placenta)
DO NOT GIVE PO MEDS due to decreased GI absorption and motility
narcotic administration
NURS 326
, NURS 326
Contraindicated after end of active/beginning of transition phase of stage 1
Narcan at bedside
nurse management of epidural administration
1L IV fluid received before placement**
Monitor maternal HoTN**** (biggest risk of epidural)
bladder assessment
bedrest
continuous monitoring of FHT and record at intervals with maternal VS
Maternal VS q1-2min for first 15 min, then q15min after initial dose
subarachnoid (spinal) anesthesia
used for c-sections
risk for spinal HA : treatment is blood patch: 10-15mL of maternal blood into the
epidural space, MUST remain FLAT for 6-8hrs after delivery
long term pain control - duramorph
epidural (regional block) anesthesia
common persistent OP (occiput posterior position)
also called BACK LABOR: relaxes pelvic floor muscles needed to rotate fetus to
OA, stop continuous infusion in stage 2 to increase effectiveness of pushing
common to allow mother to labor down:
allow fetus to descend further into the vaginal canal (+2-+3 station) before having
mom push
regional blocks commonly associated with
NURS 326
