NM 704 FINAL PAPER 2026 QUESTIONS WITH
FULL SOLUTIONS
◉ Epidural: Benefits. Answer: most effective pain relief, high levels
of satisfaction
◉ Epidural: Contraindications. Answer: Absolute contraindication:
declining an epidural, inability to cooperate for placement, skin or
soft tissue infection at site of needle placement, frank coagulopathy,
untreated sepsis, maternal hemoinstability.
Relative contraindications: coagulopathy, thrombocytopenia, space
occupying brain lesion, heparin therapy, neurologic disease of spinal
cord
◉ Epidural: Effects on baby. Answer: FHR decels d/t decreased
blood flow to uterus. Anesthetic drugs and opioids lipid soluble -
may cross BBB, but depends on concentration in maternal blood.
Poor 5 min Apgars and low umbilical artery pH similar between
epidural and no epidural. No neurological differences observed.
◉ Epidural: Relationship to maternal fever. Answer: Relationship to
intrapartum maternal fever: increase in incidence demonstrated w/
epidurals. Fever over 100.4 can occur after approx. 4 hours (based
on trend of elevation). R/t decrease in heat dissipation through
,sweating d/t sympathetic block OR may indicate chorio. Must be
treated for chorio, infant must have sepsis work up.
◉ Epidural: Possible Complications. Answer: Postprocedural
puncture headache, back pain (unknown etiology). Adverse effects
to performance: epidural abscess, hematoma, neuro injury, total
spinal anesthesia. SE of anesthetic: hypotension, urinary
retention/bladder distension, leg numbness and weakness.
Associated w/ prolonged second stage, increase in operative vaginal
births, no increase in cesarean rates
◉ Demerol (timing of administration and side effx). Answer:
Demerol generally is not recommended for peripartum analgesia
because its active metabolite, normeperidine, has a prolonged half-
life in adults and a half-life of up to 72 hours in the neonate; the
normeperidine effect cannot be antagonized by naloxone
◉ Morphine (timing of administration and side effx). Answer:
Crosses the placenta and may have adverse effects for the fetus or
newborn. This may be reflected in loss of variability in the fetal heart
rate (FHR), reduction in the FHR baseline, neonatal respiratory
depression, or neurobehavioral changes. Drug elimination takes
longer in newborns than in adults, so effects may be prolonged,
particularly if administered near the time of delivery.
◉ Nubain (timing of administration and side effx). Answer:
Nalbuphine and butorphanol are mixed agonist-antagonists and,
, therefore, are associated with less respiratory depression for an
equianalgesic dose. May trigger withdrawal symptoms or reduce
analgesic effects in those receiving opioid agonist therapy.
◉ Stadol (timing of administration and side effx). Answer: Maternal
ceiling effect on respiratory depression and analgesia. Fetal
transient pseudo-sinusoidal FHR. May precipitate acute withdrawal
syndrome in opiate-dependent mother and baby.
◉ Fentanyl (timing of administration and side effx). Answer: Short
acting; less effective than morphine or Demerol, but very few side
effects noted. With higher doses or prolonged infusions, becomes
longer lasting. Transient decreased FHR variability or pseudo-
sinusoidal pattern.
◉ Remifentanil (timing of administration and side effx). Answer:
Remifentanil is an ultra-short-acting opioid without active
metabolites. Its pharmacokinetics allow for easy titration during
labor and for less risk of respiratory depression in the newborn.
Administered by PCA, better relief than other opioids
◉ What components should be monitored to evaluate the well-being
of mother and baby during 2nd stage of labor?. Answer: Vital signs,
FHR, nutrition and hydration, bladder distention, pain/comfort,
coping, level of fatigue
FULL SOLUTIONS
◉ Epidural: Benefits. Answer: most effective pain relief, high levels
of satisfaction
◉ Epidural: Contraindications. Answer: Absolute contraindication:
declining an epidural, inability to cooperate for placement, skin or
soft tissue infection at site of needle placement, frank coagulopathy,
untreated sepsis, maternal hemoinstability.
Relative contraindications: coagulopathy, thrombocytopenia, space
occupying brain lesion, heparin therapy, neurologic disease of spinal
cord
◉ Epidural: Effects on baby. Answer: FHR decels d/t decreased
blood flow to uterus. Anesthetic drugs and opioids lipid soluble -
may cross BBB, but depends on concentration in maternal blood.
Poor 5 min Apgars and low umbilical artery pH similar between
epidural and no epidural. No neurological differences observed.
◉ Epidural: Relationship to maternal fever. Answer: Relationship to
intrapartum maternal fever: increase in incidence demonstrated w/
epidurals. Fever over 100.4 can occur after approx. 4 hours (based
on trend of elevation). R/t decrease in heat dissipation through
,sweating d/t sympathetic block OR may indicate chorio. Must be
treated for chorio, infant must have sepsis work up.
◉ Epidural: Possible Complications. Answer: Postprocedural
puncture headache, back pain (unknown etiology). Adverse effects
to performance: epidural abscess, hematoma, neuro injury, total
spinal anesthesia. SE of anesthetic: hypotension, urinary
retention/bladder distension, leg numbness and weakness.
Associated w/ prolonged second stage, increase in operative vaginal
births, no increase in cesarean rates
◉ Demerol (timing of administration and side effx). Answer:
Demerol generally is not recommended for peripartum analgesia
because its active metabolite, normeperidine, has a prolonged half-
life in adults and a half-life of up to 72 hours in the neonate; the
normeperidine effect cannot be antagonized by naloxone
◉ Morphine (timing of administration and side effx). Answer:
Crosses the placenta and may have adverse effects for the fetus or
newborn. This may be reflected in loss of variability in the fetal heart
rate (FHR), reduction in the FHR baseline, neonatal respiratory
depression, or neurobehavioral changes. Drug elimination takes
longer in newborns than in adults, so effects may be prolonged,
particularly if administered near the time of delivery.
◉ Nubain (timing of administration and side effx). Answer:
Nalbuphine and butorphanol are mixed agonist-antagonists and,
, therefore, are associated with less respiratory depression for an
equianalgesic dose. May trigger withdrawal symptoms or reduce
analgesic effects in those receiving opioid agonist therapy.
◉ Stadol (timing of administration and side effx). Answer: Maternal
ceiling effect on respiratory depression and analgesia. Fetal
transient pseudo-sinusoidal FHR. May precipitate acute withdrawal
syndrome in opiate-dependent mother and baby.
◉ Fentanyl (timing of administration and side effx). Answer: Short
acting; less effective than morphine or Demerol, but very few side
effects noted. With higher doses or prolonged infusions, becomes
longer lasting. Transient decreased FHR variability or pseudo-
sinusoidal pattern.
◉ Remifentanil (timing of administration and side effx). Answer:
Remifentanil is an ultra-short-acting opioid without active
metabolites. Its pharmacokinetics allow for easy titration during
labor and for less risk of respiratory depression in the newborn.
Administered by PCA, better relief than other opioids
◉ What components should be monitored to evaluate the well-being
of mother and baby during 2nd stage of labor?. Answer: Vital signs,
FHR, nutrition and hydration, bladder distention, pain/comfort,
coping, level of fatigue
