Study Guide Answer Key Chapter 71
chapter
Study Guide Answer Key
Learning Activities
1. c, e, d, a, b
2. a. Dilation and stretching of the cervix
b. Reduced uterine blood supply during con-
tractions
c. Pressure of the fetus on pelvic structures
d. Stretching of the vagina and perineum
3. a. Prelabor changes can help the cervix efface
and dilate most readily.
b. Pelvic size and shape influence how read-
ily a fetus descends; may favor normal
fetal position or cause fetus to remain in an
unfavorable position.
c. Short, intense labor may cause greater pain
because each contraction does so much
work of effacement, dilation, and fetal
descent. Rapid labor limits pharmacologic
pain control choices and can make it dif-
ficult for a woman to use learned skills to
cope with labor.
d. Fatigue reduces pain tolerance and reduces
the womans ability to use coping skills
that she may have learned.
e. Unfavorable fetal presentations or posi-
tions (such as occiput posterior) can put
added pressure on sensitive areas and can
prolong labor.
4. Moderate anxiety or fear heightens a womans
interest in learning pain management tech-
niques. Excessive anxiety reduces uterine
blood flow, makes contractions less effective,
and increases muscle tension that interferes
with the powers of uterine contractions.
5. a. Reduces fear of the unknown that would
increase muscle tension and therefore pain;
release tension to increase effectiveness of
uterine contractions and serve as a distrac-
tion
b. Conditioning exercises to prepare the body
for birth and relieve discomforts such as
back discomfort
c. Collect this information about specific
classes at your clinical facility.
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7
6. a. Provide pain management before pharma-
cologic methods can be instituted.
b. Provide pain control for pain that remains
after medications.
c. Realistic option if the woman arrives in
advanced labor, too late to give narcotic
analgesia or institute an epidural block.
7. a. Relaxation is basic to all other methods,
because it releases tension that inhibits
normal labor. Relaxation techniques also
occupy the mind, providing distraction.
b. (1) Adjust environment for comfort; (2) hy-
gienic measures; (3) water therapy; (4) ori-
enting to room and procedures, processes
of birth; (5) watch for muscle tension and
teaching partner same; (6) change position;
(7) specific guidance to relax. See also Box
7-1.
8. a. Breathe slowly, especially when exhaling,
breathe into cupped hands, place a moist
washcloth over mouth and nose, hold
breath for a few seconds before exhaling.
b. Blow in short breaths when the urge to
push occurs.
9. a. Physician who specializes in anesthesia
administration
b. Registered nurse who has completed ad-
ditional schooling and taken a certification
test to become an advanced-practice nurse
in the administration of anesthesia
10. Narcotic analgesics can cause respiratory
depression, usually affecting the newborn.
Narcotic administration over 1 hour from birth
reduces the amount that would affect the in-
fant at the time of birth. Not often given late in
labor as epidural is now preferred.
11. Naloxone (Narcan) is used to reverse respi-
ratory depression, usually in the newborn,
caused by maternal opioid drugs. Naloxone is
not effective against nonopioid hypoxia. Nal-
oxone can be given IV through a peripheral
vein or through the umbilical vein immediately
after the babys birth. Naloxone can be given
1
2Study Guide Answer Key Chapter 7
through an endotracheal tube during resuscita-
tion. The use of naloxone in a woman who is
opioid-dependent can cause withdrawal syn-
drome in the mother or neonate.
12. See also Table 7-2.
a. Local infiltration:
i. Administered in perineum, where epi-
siotomy will be done
ii. Numbness of injection area only
iii. Few risks to mother or fetus/newborn
iv. Ensure no allergy to -caine drugs or
dental anesthetics
b. Pudendal block:
i. Local anesthesia administered through
vagina (most common) or perineum
to block pudendal nerves that are near
the two ischial tuberosities
ii. Numbness for perineal area; often
combined with local infiltration for
better perineal numbness
iii. Few adverse effects; may cause vaginal
hematoma
iv. Ensure no allergy to caine drugs or
dental anesthetics
c. Epidural block:
i. Given through catheter into epidural
space by continuous or intermittent
injection
ii. Loss of sensation and some or all
movement below level of block
iii. Maternal hypotension with possible
fetal hypoxia, urinary retention; oc-
casional dural puncture (wet tap) with
spinal headache
iv. Determine if woman has conditions
that might contraindicate block (pp.
166, 169), ensure no allergy to -caine
drugs or dental anesthetics, IV fluid
bolus prior to block, monitor blood
pressure/FHR at least every 5 minutes
until stable, then at intervals pre-
scribed by facility; observe perineum
for crowning without sensation to
push
d. Subarachnoid block:
i. Similar to epidural block, but is given
as a one-time injection into the subdu-
ral space
ii. Loss of sensation below level of block
iii. Same as epidural, although hypoten-
sion is often more pronounced; spinal
headache more likely
iv. Same as epidural; watch for spinal
headache symptoms (headache that is
worse when upright and less or nonex-
istent when lying down)
13. Subarachnoid space, nothing
Elsevier items and derived items 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
14. -caine drugs or dental anesthetics; these are
related to most local anesthetics used in local
or regional blocks
15. Vomiting with aspiration of gastric contents;
cricoid pressure until the endotracheal tube is
in place
16. Epidural narcotics have a varied but prolonged
duration of action. Therefore, maternal respi-
ratory depression or sedation may affect the
woman long after the nurse might believe
these drug effects had ceased.
Review Questions
1. Answer: 2
Rationale: Heat application (2) can block pain
transmission. Relaxation, breathing, or distrac-
tion techniques (1, 3, and 4) can complement
heat application.
2. Answer: 4
Rationale: For the unprepared woman in early
labor, orientation to her environment and ex-
plaining simply what to expect (4) during labor
can reduce anxiety/fear about the unknown.
While providing pain relief as needed (1) is a
goal, the stem does not indicate a need for it
nowthis option is premature. Determining
her reasons (2) may be seen as judgmental and
is unnecessary at this point. Admission assess-
ments should be done as quickly as possible;
there is no indication that the womans tension
is out of control at this time (3).
3. Answer: 1
Rationale: Butorphanol has mixed narcotic and
narcotic-antagonist effects. Giving the drug af-
ter a pure opioid such as heroin can precipitate
a withdrawal reaction in mother and infant (1).
Respiratory depression (2) is less for this drug
than most pure opioids. Butorphanol is actu-
ally less effective for most women in late labor
(3). The drug can be reversed with naloxone
(4), although it is not usually needed.
4. Answer: 2
Rationale: All opioid narcotics can cause respi-
ratory depression (2), which is more likely to
occur in the newborn infant than in the adult.
Convulsions (1) are not a probable adverse or
side effect. If anything, activity will usually be
depressed after a maternal opioid (3). Consti-
pation (4) can occur, but it is most likely in the
mother. It is not the immediate problem, either.
5. Answer: 1
Rationale: Epidural block can be given after la-
bor is established to reduce pain for both labor
and birth (1). It can be used if cesarean birth be-
comes necessary in most cases. Potential fetal
risks primarily related to maternal hypotension
 Study Guide Answer Key Chapter 73

(2 and 3). Urge to push may be reduced (4) in (4). The sensations shes experiencing are re-
some women. lated to hyperventilation, not an urge to push
6. Answer: 3 (2).
Rationale: Assessment for return of sensation 13. Answer: 3
(3) helps the nurse know when it is safe for Rationale: If she needs to remain flat briefly to
the woman to ambulate. Ambulation within 2 allow the drug to disperse, put a small pillow
hours (1) is too soon for most women, both in under her right hip (3). This allows the uterus
terms of their surgery and the anesthetic. The to fall away from the large vessels while letting
outward curve of the back (2) is only needed the anesthetic agent disperse evenly and take
during administration. Keeping flat in bed for effect and helps prevent supine hypotensive
several hours (4) may or may not be ordered. syndrome. Lying flat with no pillow (1) is not
7. Answer: 3 a good preventive measure for this. Upright
Rationale: A blood patch uses a small amount with legs over the side of the bed (2) is usually
of the womans blood to seal the hole where used only for initiation of the epidural. A head-
spinal fluid is leaking and may provide dra- dependent position (4) could cause the block to
matic relief from postspinal headache (3). go higher than desired.
Blood patch does not relieve hypotension, re- 14. Answer: 1
spiratory depression, or prolonged numbness Rationale: Epidural anesthesia has varying ef-
(1, 2, and 4). fects on movement. Two hours after vaginal
8. Answer: 1 birth, she may be able to ambulate with assis-
Rationale: Epidural narcotics can cause delayed tance, but her movement and sensation should
respiratory depression (1) for as long as 24 be checked first (1). The nurse has already
hours after administration. Nausea and vomit- assessed her bladder as full (2). Many women
ing (2) may have any of a number of causes, cannot feel the urge to urinate immediately
but are not usually specifically associated with after birth, even with no anesthetic at all. An
epidural narcotics. Blood pressure is usually indwelling catheter (3) is not yet indicated. Her
stable (3) by the time the epidural narcotics bladder has been assessed as full and interven-
are given post-cesarean birth. Headache (4) is tions should proceed (4).
mostly associated with a subarachnoid block. 15. Answer: 4
9. Answer: 2 Rationale: A pulse oximeter (4) provides con-
Rationale: Cricoid pressure (Sellicks maneu- stant objective readouts of the womans oxygen
ver) blocks ejection of stomach contents during levels. An abnormal blood pressure can affect
intubation, which prevents aspiration (2). The oxygen levels, but does not provide informa-
maneuver has no direct effect on stomach acid tion about them (1). Cyanosis and restlessness
secretion, blood loss, or musculoskeletal injury (2) are less objective evidence of poor oxygen-
(1, 3, and 4). ation. A side-lying position can promote good
10. Answer: 3 oxygenation by reducing the risk for aspira-
Rationale: Prepared childbirth classes are pri- tion, but cannot determine oxygen levels (3).
marily designed to give the woman and her
partner tools they can use during labor (3). She
may or may not avoid pain medications (1) in Case Studies
labor. Her partner can usually remain with her 1. a. Hyperventilation
whether or not they had classes (2). Classes do b. Have her breathe into her own cupped
not directly reduce complications (4). hands, a paper bag, or something similar to
11. Answer: 2 rebreathe some of the carbon dioxide lost
Rationale: Sacral pressure (2) helps relieve in rapid inhaling and exhaling, restoring
discomfort of back labor, which often oc- the correct pH balance.
curs when the fetus is in an occiput posterior c. Jill is at an appropriate time for the epidur-
position. Effleurage, thermal stimulation, and al. Maternal vital signs and fetal heart rate
patterned breathing (1, 3, and 4) use the gate (FHR) evaluations are the most vital before
control theory to block pain impulses and also and after the epidural block.
provide distraction. d. Coaching her to push when she feels the
12. Answer: 3 urge or giving more specific instructions
Rationale: Exhaling slowly into the cupped if she does not feel the urge. Continue
hands (3) conserves some of the carbon dioxide monitoring maternal vital signs and FHR
that is being exhaled excessively during hyper- to identify possible hypotension or non-
ventilation. Breathing more rapidly (1) would reassuring FHR. Observe her perineum
worsen these sensations, which are not normal

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4Study Guide Answer Key Chapter 7

because she may not feel the effects of fetal
descent or crowning.
2. Nursing interventions would be individual-
ized to the specific woman and her response to
pain, but may include:
a. Relaxation techniques (See also p. 160,
Box 7-1, and general comfort measures in
Chapter 6): breathing techniques, shower-
ing, frequent changes of position, walking,
massage, and others
b. Adjusting environment as woman desires:
light, temperature, who is in the room,
sounds (silence fetal monitor if she wishes)
c. To reduce fatigue, help her use the simplest
breathing techniques as long as possible
rather than moving quickly to the more
detailed and intense techniques.
2. The womans early postpartum course ap-
pears to be normal but her movement and/or
sensation may not have returned sufficiently to
allow safe ambulation. All patients should be
evaluated individually for their ability to safely
walk if there are any factors that could impair
ambulation. If, after evaluation, it seems safe
to allow her to walk, the nurse should accom-
pany her (as with all women the first time they
ambulate after birth). If she is very large, two
nurses should help her. Otherwise, she should
use a bedpan.
Applying Knowledge
Answers will vary.

Thinking Critically
1. General anesthesia causes loss of conscious-
ness with loss of sensation of pain, reducing a
womans ability to participate in the birth and
have the earliest contact with her baby. The
hazards of the potential maternal and newborn
complications (regurgitation with aspiration
of gastric contents; newborn respiratory de-
pression) along with improvement of regional
blocks that avoid these complications have
made general anesthetics used in only a few
selected instances.

Elsevier items and derived items 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.