C 7

Chapter 07: Nursing Management of Pain During Labor and Birth
MULTIPLE CHOICE
1. A nurse is teaching a childbirth preparation class. The group is discussing individual
expression of labor pain. What statement is accurate about a patients expression of pain?
It reduces the patients perception of pain.
It is intensified by the vertex position of the fetus.
It is influenced by culture.
It can be completely controlled by nonpharmacological techniques.
a.
b.
c.
d.
ANS: C
Culture influences how women feel about birth and what is an acceptable response to pain.
DIF: Cognitive Level: Comprehension
REF: Page 161
OBJ: 3
TOP: Cultural Influences on Pain
KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. What chemical substance(s) produced in the body acts as a natural pain reliever?
a. Endorphins
b. Morphine
c. Codeine
d. Atropine
ANS: A
Endorphins are natural body substances that are similar to morphine and may explain why
laboring women need smaller doses of analgesia.
DIF: Cognitive Level: Knowledge
REF: Page 160
OBJ: 1
TOP: Endorphins KEY: Nursing Process Step: N/A
3. A nurse instructs a womans labor coach to comfort her by firmly pressing on her lower back.
What is this technique?

Sacral pressure
Distraction
Effleurage
Conscious relaxation
a.
b.
c.
d.
ANS: A
Sacral pressure refers to firm pressure against the lower back to relieve some of the pain of
back labor.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Knowledge

REF: Page 160, Box 7-1
6
TOP: Nonpharmacological Pain Management
Nursing Process Step: Implementation
NCLEX: Physiological Integrity: Basic Care and Comfort
4. A woman who is 6 cm dilated has the urge to push. What will the nurse instruct the woman to
do during the contraction?

a. Use slow-paced breathing.
b. Hold her breath and push.

c. Blow in short breaths.
d. Use rapid-paced breathing.
ANS: C
If a laboring woman feels the urge to push before the cervix is fully dilated, then she is taught
to blow in short breaths to avoid bearing down.
DIF: Cognitive Level: Application
REF: Page 163
OBJ: 4
TOP: Stair-Step Breathing Pattern
KEY: Nursing Process Step: Implementation
5. Several hours into labor, a woman complains of dizziness, numbness, and tingling of her
hands and mouth. What does the nurse recognize these symptoms signify?
Hypertension
Anxiety
Anoxia
Hyperventilation
a.
b.
c.
d.
ANS: D
Hyperventilation is sometimes a problem if a woman is breathing rapidly.

DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Comprehension

4
TOP: Hyperventilation
Nursing Process Step: Data Collection
NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
6. What is the most appropriate nursing action to take when a laboring woman hyperventilates?
a. Help her breathe into her cupped hands.
b. Place her flat on her back.
c. Initiate oxygen at 2 liters via mask.
d. Notify the doctor.
ANS: A
Measures to combat hyperventilation include breathing into cupped hands or a paper bag or
holding breath for a few seconds. All of these techniques decrease PCO2.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Application

4
TOP: Nonpharmacological Pain Management
NCLEX: Physiological Integrity: Reduction of Risk
7. A woman in the transition phase of labor requests a narcotic analgesic medication for pain
relief. What should the nurse explain regarding giving a narcotic analgesic medication at this
stage of labor?
a. It can cause medication given at later stages to be ineffective.
b. It will have no complications for the mother or infant.
c. It may result in respiratory depression to the newborn.
d. It will speed up labor and increase pain.
ANS: C
The risk of narcotic analgesics is that they cross the placenta and can cause fetal respiratory
depression.
REF: Page 164-165
OBJ: 7
TOP: Opioids
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk
8. What would the nurse guide a labor coach to do to comfort a woman tensing her muscles with
contractions?
Offer warm liquids to the patient.
Encourage the patient to pant.
Engage the patient in conversation.
Assist the patient to the knee-chest position.
a.
b.
c.
d.
ANS: B
Panting relaxes the abdominal wall and distracts the patient. It would not be helpful to offer
fluids or to attempt conversation during contractions. Walking intensifies contractions.
REF: Page 163
OBJ: 4
TOP: Panting
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
9. A woman in labor will receive general anesthesia prior to cesarean section. The nurse reminds
the patient that food and fluids need to be restricted for several hours prior to delivery. What
will this prevent?
a. Nausea and vomiting
b. Vomiting and aspiration
c. Abdominal cramping
d. Intestinal obstruction
ANS: B
The major adverse effect of general anesthesia is aspiration of stomach contents.

DIF:
OBJ:
KEY:
MSC:

REF: Page 166, Table 7-2
7
TOP: General Anesthesia
Nursing Process Step: Evaluation
10. What assessment should be taken immediately after the anesthesiologist administers an
epidural block to a laboring woman?

Bladder for distention
Blood pressure
Sensation in the lower extremities
Intravenous fluid flow rate
a.
b.
c.
d.
ANS: B
Blood pressure is checked every 5 minutes when the epidural block is first begun. Bladder
assessment is also important but not an initial assessment.
OBJ: 6
TOP: Epidural Block

11. A woman in labor has had an epidural block for pain relief. The nurse will be assessing
carefully for what associated side effect of this type of regional anesthesia?
Reduced fetal heart rate
Long, intense contractions
Sudden leg cramps
Bladder distention
a.
b.
c.
d.
ANS: D
A side effect of an epidural block is urine retention because the anesthesia interferes with the
womans ability to have an urge to void. The patient may have to be catheterized.
DIF:
OBJ:
KEY:
MSC:

7
TOP: Epidural Block
12. Which narcotic antagonist is used to reverse narcotic-induced respiratory depression?

a. Hydroxyzine (Vistaril)
b. Phenobarbital
c. Naloxone (Narcan)
d. Nitrous oxide
ANS: C
Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics.

REF: Page 165
OBJ: 7 | 8
TOP: Narcotic Antagonist
13. The nurse is preparing a teaching plan for a woman receiving a subarachnoid block before
delivery. What nursing action will be included in this plan to prevent the associated side effect
of this type of anesthesia?
a. Restrict oral fluids.
b. Keep legs flexed.
c. Walk with assistance as soon as possible.
d. Lie flat for several hours.
ANS: D
The woman would be advised to remain flat for several hours after the block to decrease the
chance of postspinal headache.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Application

7
TOP: Subarachnoid Block
Nursing Process Step: Planning
14. A woman requests a pudendal block to manage her labor pain. What statement by the woman
indicates a need for further explanation about the pudendal block?

a. Im having a contraction. Can I get the pudendal block now?
b. Ill get the pudendal block right before I deliver.
c. The nurse midwife will insert the needles into my vagina.

d. It takes a few minutes after the medicine is administered to make me feel numb.
ANS: A
The pudendal block does not block pain from contractions and is given just before birth.
DIF:
OBJ:
KEY:
MSC:

7
TOP: Pudendal Block
Nursing Process Step: Evaluation
15. An 18-year-old primigravida is 4 cm dilated and her contractions are 5 minutes apart. She
received little prenatal care and had no childbirth preparation. She is crying loudly and
shouting, Please give me something for the pain. I cant take the pain! What is the priority
nursing diagnosis?
a. Pain related to uterine contractions
b. Knowledge deficit related to the birth experience
c. Ineffective coping related to inadequate preparation for labor
d. Risk for injury related to lack of prenatal care
ANS: A
The most important issue for this woman, at this time, is effective pain management.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Analysis

REF: Page 170, Nursing Care Plan 7-1
3
TOP: Pain as a Priority
Nursing Process Step: Nursing Diagnosis
16. The nurse who encourages the gate control theory of pain control would advise a woman in
labor and her partner to use which nonpharmacological method of pain management?
Slow abdominal breathing
Guided relaxation
Listening to music
Massage
a.
b.
c.
d.
ANS: D
According to the gate control theory, stimulating large-diameter nerve fibers temporarily
interferes with conduction of impulses through small-diameter fibers. Massage is a technique
that stimulates large-diameter fibers and closes the gate.
DIF: Cognitive Level: Analysis
REF: Page 159
OBJ: 5
TOP: Gate Control
17. When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an
epidural for delivery. What is a contraindication to an epidural block?

Abnormal clotting
Previous cesarean delivery
History of migraine headaches
History of diabetes mellitus
a.
b.
c.
d.
ANS: A
An epidural block is not used if a woman has abnormal blood clotting.

DIF:
OBJ:
KEY:
MSC:

REF: Page 166, Table 7-2 | Page 168
7
TOP: Epidural Block
18. The nurse coaches the primigravida not to bear down until the cervix is completely dilated.
What may premature bearing down cause?

Increased use of oxygen
Cervical laceration
Uterine rupture
Compression of the cord
a.
b.
c.
d.
ANS: B
Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix.
REF: Page 163
OBJ: 3
TOP: Cervical Laceration
19. What is the Dick-Read method of childbirth preparation based on?
a. Mild sedation throughout labor
b. Relaxation techniques
c. Skin stimulation
d. Deep massage
ANS: B
The Dick-Read method depends on the use of relaxation techniques to reduce the discomforts
of labor.
REF: Page 161
OBJ: 5
TOP: Dick-Read Method
20. The nurse is instructing a Lamaze class on abdominal breathing and tells a patient that her
baseline respiratory rate is 22 breaths per minute. What should be the patients rate while
performing slow breathing?
a. 9
b. 11
c. 15
d. 20
ANS: B
The range of respirations should be no lower than half of the base rate and no more rapid than
double the base rate.
DIF:
OBJ:
KEY:
MSC:

5
TOP: Lamaze Method
21. What is the least amount of sensation that one perceives as pain?
a. Tolerance
b. Threshold
c. Level
d. Abatement
ANS: B
Pain threshold is the least amount of sensation that one perceives as pain. Thresholds are
different for each individual.
REF: Page 159
OBJ: 1
TOP: Pain Threshold
22. The nurse is caring for a laboring patient who is not reporting pain. What sign would alert the
nurse of the need for pain relief?

Frequently asking for ice chips
Facial grimacing
Changing positions in bed
Covering her face with her hands
a.
b.
c.
d.
ANS: B
Facial grimacing may be an indicator of unexpressed pain.

REF: Page 164
OBJ: 3
TOP: Nonverbal Pain Expressing
23. A patient who received an epidural block asks why her blood pressure is taken so often. What
is the nurses best response to explain the frequent blood pressure assessments?
a. They ensure that unsafe levels of hypertension do not occur.
b. They help assess for the need for further pain relief.
c. They monitor the progress of labor.
d. They ensure adequate placental perfusion.
ANS: D
The hypotension that accompanies an epidural block may cause inadequate perfusion of the
placenta, leading to fetal hypoxia.
DIF:
OBJ:
KEY:
MSC:

7
TOP: Disadvantage of Epidural Block
24. A laboring patient requests hot and cold applications be applied to her abdomen for pain
control. How will this intervention act to control pain?

By increasing endorphin production
By facilitating effacement and dilation
By producing increasing pain tolerance
By stimulation of large nerve fibers
a.
b.
c.
d.
ANS: D
The gate control theory explains how pain impulses reach the brain for interpretation. It
supports several nonpharmacological methods of pain control. According to this theory, pain
is transmitted through small-diameter nerve fibers. However, the stimulation of large-diameter
nerve fibers temporarily interferes with the conduction of impulses through small-diameter
fibers. Techniques to stimulate large-diameter fibers and close the gate to painful impulses
include massage, palm and fingertip pressure, and heat and cold applications.
DIF:
OBJ:
KEY:
MSC:

REF: Page 159, 162
3
TOP: Nonpharmacological Pain Relief
25. When caring for the laboring patient, the nurse determines that the fetus is located in the right
occiput posterior (ROA). What will the nurse anticipate?

Urinary retention
Severe lower back pain
A shorter labor process
Nausea
a.
b.
c.
d.
ANS: B
If the fetal occiput is in a posterior pelvic quadrant, each contraction pushes it against the
mothers sacrum, resulting in persistent and poorly relieved back pain (back labor). Labor is
often longer with this fetal position.
REF: Page 161
OBJ: 3
TOP: Maternal Condition
MULTIPLE RESPONSE
26. What typical types of classes are available to help expectant parents prepare for parenthood?
(Select all that apply.)

Infant care
Breastfeeding
Gestational diabetes
Sources of financial aid
Yoga
a.
b.
c.
d.
e.
ANS: A, B, C
Prenatal classes include such topics as infant care, breastfeeding, gestational diabetes,
exercising, and sibling and grandparent preparation. Yoga and financial information are not
traditional content for prenatal instruction.
DIF:
OBJ:
KEY:
MSC:

REF: Page 157-158, Health Promotion
2
TOP: Prenatal Classes
NCLEX: Psychosocial Integrity: Coping and Adaptation
27. What breathing techniques would the nurse teach the prenatal patient to help her focus during
labor in order to reduce pain? (Select all that apply.)

a. First stage breathing
b.
c.
d.
e.
Abdominal breathing
Fourth stage breathing
Modified pace breathing
Patterned paced breathing
ANS: A, B, D, E
First stage breathing includes the techniques of modified pace breathing and patterned paced
breathing, which are types of abdominal breathing techniques. These patterns of breathing will
help a woman in labor to focus and reduce pain perception. The fourth stage of labor is the
woman's recovery stage and does not require a breathing technique.
REF: Page 163
OBJ: 5
TOP: Breathing Exercises
28. How does the pain of childbirth differ from other types of pain? (Select all that apply.)
a. Childbirth pain is part of a normal process.
b. Childbirth pain seldom needs narcotic relief.
c. Position changes relieve pain and facilitate delivery.
d. Childbirth pain declines following birth.
e. Childbirth pain is self-limited.
ANS: A, C, D, E
Childbirth pain differs from other types of pain because it is part of a normal, natural, and
expected process, can be relieved by change of position, declines immediately following birth,
and is self-limiting. Childbirth pain requires pharmacological management with narcotics in
many cases.
REF: Page 159
OBJ: 3
TOP: Childbirth Pain
KEY: Nursing Process Step: Planning
29. Which are nonpharmacological forms of pain relief? (Select all that apply.)
a. Skin stimulation
b. Diversion and distraction
c. Breathing techniques
d. Exercise
e. Yoga
ANS: A, B, C
Skin stimulation, diversion and distraction, and breathing techniques are the bases of
nonpharmacological pain control. Although exercise and practices such as yoga and Pilates
are beneficial, they are not means of pain control.
DIF:
OBJ:
KEY:
MSC:

REF: Page 160, Box 7-1 | Page 162
5
TOP: Nonpharmacological Pain Control
30. Which position(s) and exercise(s) will the nurse teach as beneficial in combating discomfort
in the later stages of pregnancy? (Select all that apply.)

a. Leg lifts
b.
c.
d.
e.
Pelvic rock
Tailor sitting
Sit-ups
Shoulder curling
ANS: B, C, E
Pelvic rock, tailor sitting, and shoulder curling are beneficial to the muscles that will have to
adapt to the extra weight and changed posture of later pregnancy. Leg lifts and sit-ups are not
beneficial because they both increase intraabdominal pressure.
DIF:
OBJ:
KEY:
MSC:

REF: Page 158, Chapter 4
6
TOP: Helpful Exercises
NCLEX: Physiological Integrity: Physiological Adaptation
31. The nurse is providing a conference on nonpharmacological pain control methods. What
major advantages of nonpharmacological pain control methods will the nurse include in the
presentation? (Select all that apply.)
a. They sedate the mother.
b. They do not slow labor.
c. They do not dull the excitement of the birth experience.
d. They do not have the potential to cause allergic reactions.
e. They do not have to be delayed until labor is well established.
ANS: B, C, D, E
All the options mentioned are benefits of nonpharmacological pain control methods with the
exception of sedating the mother.
DIF:
TOP:
KEY:
MSC:

REF: Page 161
OBJ: 4
Advantages of Nonpharmacological Pain Control
32. The nurse is caring for a woman with epidural anesthesia for pain control during a vaginal
delivery. A risk for injury related to epidural anesthesia has been identified by the nursing
staff. What interventions are appropriate for the nurse to implement related to this diagnosis?
(Select all that apply.)
a. Assess leg movement and sensation before ambulating.
b. Administer antibiotic as ordered.
c. Observe for signs of impending birth.
d. Provide sacral pressure as needed.
e. Assess fetal position frequently.
ANS: A, C
To prevent the risk for injury related to epidural anesthesia the nurse should asses for
movement, sensation, and leg strength before ambulating, ambulate cautiously with an
assistant, assist the woman to change positions regularly, and observe for signs that birth may
be near: increase in bloody show, perineal bulging, and/or crowning.
REF: Page 172
OBJ: 8
TOP: Epidural Anesthesia
33. The physician has ordered Fentanyl (Sublimaze) for a woman in labor and has asked the nurse
to provide patient education. What will the nurse include in the educational plan? (Select all
that apply.)
a. Onset is slow.
b. Duration is short.
c. Administration is by mouth.
d. No known side effects.
e. It is not the same drug as sufentanil.
ANS: B, E
Fentanyl has a rapid onset and short duration of action. Fentanyl, sufentanil, and alfentanil are
not the same drugs. Fentanyl can cause respiratory depression but less than meperidine. It is
not administered by mouth.
DIF:
OBJ:
KEY:
MSC:

8
TOP: Narcotic Analgesia
COMPLETION
34. The amount of pain a person is willing to endure is referred to as ______________
______________.
ANS:
pain tolerance
Pain tolerance is the amount of pain a person is willing to endure. Pain threshold is the point
at which pain is perceived. Pain threshold is relatively consistent from person to person, but
pain tolerance differs greatly.
REF: Page 159
OBJ: 1
TOP: Pain Tolerance
KEY:
35. The massage technique that stimulates the large-diameter fibers in order to block impulses
from the small-diameter fibers is ____________________.

ANS:
effleurage
Effleurage stimulates the large-diameter fibers and blocks the pain impulses from the smalldiameter fibers.
REF: Page 159, Figure 7-3 | Page 162
OBJ: 6
TOP: Effleurage
36. The ______________ ___________, also called the psychoprophylactic method, is the basis
of most childbirth preparation classes in the United States.
ANS:
Lamaze method
The Lamaze method, also called the psychoprophylactic method, is the basis of most
childbirth preparation classes in the United States.
REF: Page 161
OBJ: 5
TOP: Childbirth Preparation

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Chapter 07: Nursing Management of Pain During Labor and Birth

What is this technique?

Cognitive Level: Knowledge

do during the contraction?

b. Hold her breath and push.

Hyperventilation is sometimes a problem if a woman is breathing rapidly.

Cognitive Level: Comprehension

Cognitive Level: Application

The major adverse effect of general anesthesia is aspiration of stomach contents.

Cognitive Level: Comprehension

epidural block to a laboring woman?

MSC: NCLEX: Physiological Integrity: Reduction of Risk

Cognitive Level: Knowledge

12. Which narcotic antagonist is used to reverse narcotic-induced respiratory depression?

Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics.

Cognitive Level: Application

indicates a need for further explanation about the pudendal block?

c. The nurse midwife will insert the needles into my vagina.

Cognitive Level: Comprehension

Cognitive Level: Analysis

epidural for delivery. What is a contraindication to an epidural block?

An epidural block is not used if a woman has abnormal blood clotting.

Cognitive Level: Comprehension

What may premature bearing down cause?

Cognitive Level: Comprehension

nurse of the need for pain relief?

Facial grimacing may be an indicator of unexpressed pain.

Cognitive Level: Comprehension

control. How will this intervention act to control pain?

Cognitive Level: Comprehension

occiput posterior (ROA). What will the nurse anticipate?

(Select all that apply.)

Cognitive Level: Knowledge

labor in order to reduce pain? (Select all that apply.)

Cognitive Level: Knowledge

in the later stages of pregnancy? (Select all that apply.)

Cognitive Level: Comprehension

Cognitive Level: Knowledge

Cognitive Level: Comprehension

from the small-diameter fibers is ____________________.

of most childbirth preparation classes in the United States.

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