Chapter 19 Pharmacologic Pain Management

Chapter 19   Pharmacologic Pain Management

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1) The laboring client has rated her pain at 9 on a scale of 1 to 10, and she requests IV pain medication. She has refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol) for administration to the client. Which action should the nurse complete next?

1. Advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.
2. Offer the woman epidural anesthesia once more and describe the effectiveness of this method of labor pain control.
3. Obtain maternal vital signs and assess the fetal heart rate (FHR).
4. Administer oxygen via face mask at 6 to 10 liters per minute.

Answer:  1

Explanation:  1. Prior to administration of medication, the nurse must explain the pharmacologic effects of the medication and obtain consent for administration.

2. The woman has refused epidural anesthesia but is authorized to receive butorphanol tartrate. The nurse’s next step is to advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.
3. Prior to obtaining maternal vital signs and assessing FHR, the nurse should advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.
4. Routine oxygen administration is not indicated for administration of butorphanol tartrate to an asymptomatic patient in labor. The nurse’s next step is to advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.

Page Ref: 390

Cognitive Level:  Evaluating

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 19.1-Describe the use, administration, dose, onset of action, adverse effects, and contraindications of systemic drugs that promote pain relief during labor in determining the nursing care management of the woman in labor and her fetus.

MNL LO:  Examine the use, advantages, and disadvantages of anesthesia and analgesia for pain relief.

2) A client has just been admitted for labor and delivery. She is having mild contractions every 15 minutes lasting 30 seconds. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands that:

1. In order to respect her wishes, no medication will be given.
2. Pain relief will allow a more enjoyable birth experience.
3. The use of medications allows the patient to rest and be less fatigued.
4. Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

Answer:  4

Explanation:  1. It is important to respect the client’s wishes when possible. Once the effects are explained, it is still the client’s choice whether to receive medication.

2. While pain relief can lead to a more enjoyable experience, it might be the view of the nurse but not the mother.
3. While pain relief can allow the mother to be less fatigued, it might be the view of the nurse but not the mother.
4. The decision not to medicate should be an informed one, and it is possible that the client does not know about the effects pain and stress can have on the fetus. Once the effects are explained, it is still the client’s choice whether to receive medication.

Page Ref: 390

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity | Pharmacological and Parenteral Therapies

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 19.1-Describe the use, administration, dose, onset of action, adverse effects, and contraindications of systemic drugs that promote pain relief during labor in determining the nursing care management of the woman in labor and her fetus.

MNL LO:  Explain the unique nature of the pain associated with labor and birth.

3) The nurse has presented a teaching session on pain relief options to a prenatal class. Which client statement indicates that additional teaching is needed?

1. “An epidural can be continuous or one dose.”
2. “General anesthesia is usually recommended for a client who delivers by way of cesarean section.”
3. “Narcotics can be given through a client’s epidural infusion catheter.”
4. “A pudendal block usually works well to control pain during episiotomy repair.”

Answer:  2

Explanation:  1. Epidural anesthesia can be administered in a single dose or via continuous infusion.

2. Compared to general anesthesia, spinal anesthesia is usually the anesthetic of choice indicated in the management of clients undergoing cesarean section.
3. To provide analgesia for approximately 24 hours after the birth, the analgesia provider may inject an opioid, such as morphine sulfate (Duramorph) or fentanyl (Sublimaze), into the epidural space immediately after the birth
4. A pudendal block technique is given in the second stage of labor for the provision of perineal anesthesia for the latter part of the first stage of labor, the second stage, birth, and episiotomy repair.

Page Ref: 401

Cognitive Level:  Evaluating

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 19.2-Compare the major types of regional analgesia and anesthesia, including area affected, advantages, disadvantages, contraindications, techniques, and nursing care management of the laboring woman and her fetus.

MNL LO:  Explain the management of the childbearing family undergoing a cesarean birth.

4) The charge nurse is reviewing the plans of care for four laboring clients. Which care plan requires immediate reconsideration for revision?

1. Administration of epidural anesthesia to a woman who is in the first stage of labor and has a shellfish allergy
2. Administration of a spinal anesthetic to a woman who is scheduled for vaginal delivery of her baby
3. Administration of epidural anesthesia to a woman with a history of vomiting secondary to hyperemesis gravidarum
4. Administration of a spinal anesthetic to a woman with a history of irritable bowel syndrome (IBS)

Answer:  3

Explanation:  1. A lumbar epidural relieves pain associated with the first and second stages of labor. An allergy to shellfish is not a contraindication to epidural anesthesia.

2. Spinal anesthetics may be used to provide anesthesia for cesarean birth and occasionally for vaginal birth.
3. Contraindications to epidural anesthesia include severe hypovolemia of any etiology. This patient with hyperemesis gravidarum should be evaluated for severity of dehydration prior to administration of epidural anesthesia.
4. IBS does not represent a contraindication to spinal anesthesia.

Page Ref: 395

Cognitive Level:  Evaluating

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 19.2-Compare the major types of regional analgesia and anesthesia, including area affected, advantages, disadvantages, contraindications, techniques, and nursing care management of the laboring woman and her fetus.

MNL LO:  Compare the use of various regional anesthetics/analgesia used to relieve pain during labor.