Chapter 20 Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition

Chapter 20 Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Question 1

Type: MCSA

The laboring patient has rated her pain at 9 on a scale of 1–10, 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 patient. 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.

Correct Answer: 1

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

Rationale 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.

Rationale 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.

Rationale 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.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO01 – 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.

Question 2

Type: MCSA

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

Correct Answer: 4

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

Rationale 2: While pain relief can lead to a more enjoyable experience, it might be the view of the nurse but not the mother.

Rationale 3: While pain relief can allow the mother to be less fatigued, it might be the view of the nurse but not the mother.

Rationale 4: The decision not to medicate should be an informed one, and it is possible that the patient does not know about the effects pain and stress can have on the fetus. Once the effects are explained, it is still the patient’s choice whether to receive medication.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO01 – 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.

Question 3

Type: MCSA

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

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

Correct Answer: 2

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

Rationale 2: Compared to general anesthesia, spinal anesthesia is usually the anesthetic of choice indicated in the management of patients undergoing cesarean section.

Rationale 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

Rationale 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.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO02 – 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.