Chapter 18: Pain Management During Labour
MULTIPLE CHOICE
1. An 18-year-old pregnant woman, gravida 1, is admitted to the labour 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.” What should the nurse do?
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 physiological,
psychosocial, and environmental factors. A critical issue for the nurse is how support can make
a difference in the pain of the woman during labour and birth. Assessing for fetal well-being
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 labouring woman. This patient clearly needs support.
DIF: Cognitive Level: Application REF: p. 460 | p. 464 OBJ:
Nursing Process: Diagnosis
2. Nursing care measures are commonly offered to women in labour. 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
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 nerve pathways to transmit pain. These
distractions are thought to work by closing down a hypothetical 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, giving prescribed medication, and encouraging rest do not
reduce or block the capacity of nerve pathways to transmit pain, according to the gate-control
theory.
DIF: Cognitive Level: Comprehension REF: p. 464
OBJ: Nursing Process: Implementation
3. A woman in active labour receives an analgesic, an opioid agonist. Which medication relieves
severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors;
and may even relax the cervix but should be used cautiously in women with cardiac disease?
a.
b. Promethazine (Phenergan)
c. Sufentanil citrate (Sufenta)
d. Nalbuphine (Nubain) Meperidi
ne (Demerol)
ANS: A
Meperidine hydrochloride (Demerol) used to be the most commonly used opioid agonist
analgesic for women in labour, but it is no longer the preferred choice because other
medications have fewer adverse effects. Sufentanil citrate (Sufenta) is becoming the most
commonly used opioid agonist analgesic for women in labour. Phenergan is an ataractic
(tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but
has few of the undesirable effects of those drugs. Nubain is an opioid agonist-antagonist
analgesic.
DIF: Cognitive Level: Comprehension REF: pp. 475-476
OBJ: Nursing Process: Implementation
4. A labouring woman received fentanyl citrate (Sublimaze) intravenously 90 minutes before she gave
birth. Which medication should be available to reduce the postnatal effects of Sublimaze on the
neonate?
a.
Meperidine (Demerol)
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. Demerol is no longer recommended for
use in Canada. Promethazine and nalbuphine do not act as opioid antagonists to reduce the
postnatal effects of Sublimaze on the neonate.
DIF: Cognitive Level: Knowledge REF: p. 477 |Medication Guide
OBJ: Nursing Process: Planning | Nursing Process: Implementation
5. A woman in labour has just received an epidural block. What is the most important nursing
intervention?
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
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. Intravenous fluids
are increased for a woman receiving an epidural to prevent hypotension. The nurse observes
for signs of fetal bradycardia. The nurse monitors for signs of maternal tachycardia secondary
to hypotension.
DIF: Cognitive Level: Application REF: p. 479
OBJ: Nursing Process: Implementation
6. The nurse should be aware that a plan to achieve adequate pain relief without maternal risk is
most effective if which occurs?
MULTIPLE CHOICE
1. An 18-year-old pregnant woman, gravida 1, is admitted to the labour 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.” What should the nurse do?
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 physiological,
psychosocial, and environmental factors. A critical issue for the nurse is how support can make
a difference in the pain of the woman during labour and birth. Assessing for fetal well-being
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 labouring woman. This patient clearly needs support.
DIF: Cognitive Level: Application REF: p. 460 | p. 464 OBJ:
Nursing Process: Diagnosis
2. Nursing care measures are commonly offered to women in labour. 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
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 nerve pathways to transmit pain. These
distractions are thought to work by closing down a hypothetical 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, giving prescribed medication, and encouraging rest do not
reduce or block the capacity of nerve pathways to transmit pain, according to the gate-control
theory.
DIF: Cognitive Level: Comprehension REF: p. 464
OBJ: Nursing Process: Implementation
3. A woman in active labour receives an analgesic, an opioid agonist. Which medication relieves
severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors;
and may even relax the cervix but should be used cautiously in women with cardiac disease?
a.
b. Promethazine (Phenergan)
c. Sufentanil citrate (Sufenta)
d. Nalbuphine (Nubain) Meperidi
ne (Demerol)
ANS: A
Meperidine hydrochloride (Demerol) used to be the most commonly used opioid agonist
analgesic for women in labour, but it is no longer the preferred choice because other
medications have fewer adverse effects. Sufentanil citrate (Sufenta) is becoming the most
commonly used opioid agonist analgesic for women in labour. Phenergan is an ataractic
(tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but
has few of the undesirable effects of those drugs. Nubain is an opioid agonist-antagonist
analgesic.
DIF: Cognitive Level: Comprehension REF: pp. 475-476
OBJ: Nursing Process: Implementation
4. A labouring woman received fentanyl citrate (Sublimaze) intravenously 90 minutes before she gave
birth. Which medication should be available to reduce the postnatal effects of Sublimaze on the
neonate?
a.
Meperidine (Demerol)
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. Demerol is no longer recommended for
use in Canada. Promethazine and nalbuphine do not act as opioid antagonists to reduce the
postnatal effects of Sublimaze on the neonate.
DIF: Cognitive Level: Knowledge REF: p. 477 |Medication Guide
OBJ: Nursing Process: Planning | Nursing Process: Implementation
5. A woman in labour has just received an epidural block. What is the most important nursing
intervention?
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
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. Intravenous fluids
are increased for a woman receiving an epidural to prevent hypotension. The nurse observes
for signs of fetal bradycardia. The nurse monitors for signs of maternal tachycardia secondary
to hypotension.
DIF: Cognitive Level: Application REF: p. 479
OBJ: Nursing Process: Implementation
6. The nurse should be aware that a plan to achieve adequate pain relief without maternal risk is
most effective if which occurs?
