Chapter 20 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Chapter 20 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Chapter 20_LO01_Q01

The laboring client has rated her pain at 9 on a scale of 1–10, and requests IV pain medication. Which statement is most important for the nurse to make? “Narcotic medications:

1. “May make you unsteady. You need to ask for help when you get up.”
2. “Have a very rapid onset, and begin to work in 2–3 minutes.”
3. “Are metabolized by your body, so they don’t last as long as an epidural.”
4. “May cause sleepiness in the baby that can be reversed with Narcan.”

Correct Answer: 1

Rationale:

1. Being unsteady when getting up is a common side effect of narcotic medications, and a safety issue; to prevent falls, it is important that clients receiving IV narcotics ask for assistance when they are getting up.
2. Although this is a true statement, safety and fall prevention are more important.
3. Although this is a true statement, safety and fall prevention are more important.
4. Although this is a true statement, safety and fall prevention are more important. The client might not know that respiratory depression can occur, or understand what “reversal” is. This is technical information that the client has not asked for.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 20.1 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.

Chapter 20_LO01_Q02

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 allow the client 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

Rationale:

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.

Cognitive Level: Application

Category of Client Need:  Physiological Integrity: Pharmacological and Parental Therapies

Nursing Process: Planning

Learning Outcome: 20.1 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.

Chapter 20_LO02 _Q03

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

1. “An epidural can be continuous or one dose.”
2. “A spinal is usually used for a cesarean birth.”
3. “Pudendal blocks are effective when a vacuum is needed.”
4. “Local anesthetics provide good labor pain relief.”

Correct Answer: 4

Rationale:

1. Epidurals can be given either as a bolus or as a continuous infusion.
2. Spinals are anesthesia, and are commonly used for cesarean birth.
3. Pudendal blocks eliminate or decrease sensation of the vagina and perineum, and are effective when vacuum or forceps are used, as well as during episiotomy or laceration repair.
4. Local anesthetics are not used for labor pain relief. They are used prior to episiotomy and for laceration repair.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 20.2 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.

Chapter 20_LO02 _Q04

A pregnant woman at 16 weeks’ gestation is diagnosed with hyperemesis gravidarum. She has been admitted to the floor from the Emergency Department. Which issue should receive priority for the nurse planning care?

1. Fluid volume deficit
2. Constipation
3. Decreased pulse rate
4. Knowledge deficit

Answer: 1

Rationale:

1. The newly admitted client with hyperemesis gravidarum has been experiencing excessive vomiting, and is in a fluid volume deficit state. Because no pre-existing cardiac condition is present, the body has compensated for this fluid loss.
2. Constipation is more likely to be a problem in later pregnancy; however, if constipation were present, it would be a lower priority than would fluid volume deficit.
3. The pulse rate would be increased due to hypovolemia.
4. Knowledge deficit is a psychosocial need, and therefore will not be a top priority when providing care to this client.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 20.2 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.