Labor & Delivery Exam (New 2023/2024 Update) Questions and Verified Answers| 100% Correct | Graded A

Labor & Delivery Exam (New 2023/2024 Update) Questions and Verified Answers| 100% Correct | Graded A QUESTION Four clients in labor are requesting pain relief. The nurse understands that which client can safely receive a dose of IV butorphanol tartrate, an opioid agonist -antagonist, at this time? 1. Multipara at 6 cm dilation with recent heroin use 2. Multipara at 9 cm dilation with an urge to push 3. Nullipara at 3 cm dilation desiring to ambulate 4. Nullipara at 7 cm dilation moaning with contractions Answer: 4. Nullipara at 7 cm dilation moaning with contractions Opioid agonist-antagonist medications used in labor include butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain). Maternal adverse effects include sedation, dizziness, and nausea. Butorphanol tartrate crosses the placental barrier, peaking in 30-60 minutes; its duration of action is approximately 2-4 hours. If given near the time of birth, there is a risk for newborn respiratory depression, which may require naloxone (Narcan) to reverse the effects. IV opioids are safest for clients who will give birth 2-4 hours after administration so that the opioid effect has time to wear off before the birth. IV opioids are also best for clients in active labor or those with a well-established contraction pattern because opioid administration may slow labor progression in the latent phase (Option 4). Educational objective: Opioid agonist-antagonist medications (eg, butorphanol tartrate [Stadol]) are most appropriate for clients in active labor with no contraindications (eg, imminent birth, opioid dependence). Opioids have maternal adverse effects (eg, sedation, dizziness, slow labor progression) and may cause newborn respiratory depression. QUESTION A laboring client weighing 187 lb is 5 cm dilated and having contractions every 2-3 minutes. The client rates the pain at 7 out of 10. Nalbuphine hydrochloride 10 mg/70 kg IV push × 1 is prescribed by the health care provider. Nalbuphine hydrochloride 10 mg/1 mL is available. How many milliliters does the nurse administer? Record your answer using one decimal place. Answer: 1.2 QUESTION A laboring client, gravida 3 para 2, is admitted to the labor unit reporting severe perineal pressure and urgently requesting pain relief. The client's cervix is 10 cm dilated and 100% effaced, with the fetal head at 0 station. Which pain management technique is most appropriate for this client's report of perineal pressure? 1. Epidural anesthesia 2. Hydrotherapy 3. IV narcotics 4. Pudendal nerve block Answer: 4. Pudendal nerve block A pudendal nerve block infiltrates local anesthesia (ie, lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva. When birth is imminent, a pudendal block provides the best pain relief with the least maternal/newborn side effects and could be administered quickly by the health care provider. It does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor (Option 4). In clients without an epidural, pudendal blocks may be used in preparation for forceps-assisted birth or laceration repair. (Option 1) An epidural can be administered in the first or early second stage of labor but may not be a feasible option in late second stage when birth is imminent. A multiparous client may give birth before the epidural can be administered or before the epidural takes adequate effect (20-30 minutes). Educational objective: A pudendal nerve block can provide pain relief for clients experiencing perineal pressure in the late second stage of labor. It may also be used in preparation for forceps- assisted birth or laceration repair in clients without an epidural. It does not provide relief of contraction pain. QUESTION A nurse is participating in an obstetrical emergency simulation in which the health care provider announces shoulder dystocia. Which of the following interventions should the assisting nurse implement? Select all that apply. 1. Assist maternal pushing efforts by applying fundal pressure during each contraction 2. Document the time the fetal head was born 3. Flex the client's legs back against the abdomen and apply downward pressure above the