Nokea
The nerve block used in labor that provides anesthesia to the lower vagina and perineum is referred to as a(n)
- A. local.
- B. epidural.
- C. pudendal.
- D. spinal block.
Correct Answer: C
Rationale: The correct answer is C: pudendal. Pudendal nerve block is specifically used to provide anesthesia to the lower vagina and perineum during labor. This block targets the pudendal nerve, which innervates these areas, providing effective pain relief for childbirth.
A local anesthetic is more general and may not specifically target the lower vagina and perineum. Epidural anesthesia is typically used to provide pain relief during labor but does not specifically target the lower vagina and perineum. A spinal block provides anesthesia for a larger area including the lower abdomen and legs, not specifically the lower vagina and perineum.
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A patient in active labor requests an epidural for pain management. What is the nurse's most appropriate intervention at this juncture?
- A. Assess the fetal heart rate pattern over the next 30 minutes.
- B. Take the patient's blood pressure every 5 minutes for 15 minutes.
- C. Determine the patient's contraction pattern for the next 30 minutes.
- D. Initiate an IV infusion of lactated Ringer's solution at 2000 mL/hour over 30 minutes.
Correct Answer: C
Rationale: The correct answer is C: Determine the patient's contraction pattern for the next 30 minutes. This is the most appropriate intervention as understanding the patient's contraction pattern is crucial in determining the stage of labor and the need for interventions like epidural. Assessing fetal heart rate (A) is important but not the immediate priority. Taking blood pressure (B) every 5 minutes is excessive and not directly related to the request for an epidural. Initiating an IV infusion of lactated Ringer's solution (D) is unnecessary and not indicated for pain management in labor. In summary, choice C is correct as it directly addresses the patient's current condition and guides further pain management decisions.
Which patient presentation is an acceptable indication for serial oxytocin induction of labor?
- A. Multiple fetuses
- B. Polyhydramnios
- C. History of long labors
- D. Past 42 weeks of gestation
Correct Answer: D
Rationale: Rationale:
1. Past 42 weeks of gestation increases the risk of stillbirth.
2. Oxytocin can help initiate labor to reduce the risk.
3. Induction at this stage is considered safe and beneficial.
4. Other choices are not direct indications for oxytocin induction and may have different management strategies.
Summary:
- A: Multiple fetuses and polyhydramnios may require different approaches.
- B: History of long labors may not necessarily indicate the need for oxytocin induction.
The nurse is providing care to a patient in the active phase of the first stage of labor. The patient is crying out loudly with each contraction. What is the nurse's most respectful approach for this patient?
- A. Ask the patient's labor coach if this is a usual expression of pain for her.
- B. Refer to the patient's chart to determine any orders for pain medication.
- C. Tell the patient that she is disturbing the other laboring patients on the unit.
- D. Encourage the patient to try to suppress her noisiness during contractions.
Correct Answer: A
Rationale: Step-by-step rationale for why Answer A is correct:
1. Asking the patient's labor coach shows respect for the patient's support person and acknowledges their insight into the patient's usual behavior.
2. It allows the nurse to gather information about the patient's pain expression without assuming or judging the situation.
3. This approach promotes patient-centered care and involves the patient's primary support system in decision-making.
4. It fosters open communication and partnership between the nurse, patient, and labor coach, enhancing the overall quality of care.
Summary:
- Option B is incorrect because pain medication should not be assumed without assessing the patient's current pain level first.
- Option C is incorrect as it lacks empathy and disregards the patient's emotional state during labor.
- Option D is incorrect as it suggests suppressing a natural response to pain, which may not be beneficial for the patient's coping mechanism.
For which patient should the oxytocin (Pitocin) infusion be discontinued immediately?
- A. A patient in transition with contractions every 2 minutes lasting 90 seconds each
- B. A patient in early labor with contractions every 5 minutes lasting 40 seconds each
- C. A patient in active labor with contractions every 3 minutes lasting 60 seconds each
- D. A patient in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each
Correct Answer: A
Rationale: The correct answer is A because a patient in transition with contractions every 2 minutes lasting 90 seconds each is experiencing very intense and frequent contractions, indicating high uterine activity. Discontinuing oxytocin infusion is crucial in this scenario to prevent hyperstimulation, which can lead to fetal distress or uterine rupture.
Choice B is incorrect because the patient is in early labor and the contractions are less frequent and less intense compared to the correct answer. Choice C is incorrect as the patient in active labor with contractions every 3 minutes lasting 60 seconds each is not as intense as the patient in transition in the correct answer. Choice D is incorrect because although the contractions are frequent and lasting longer, the intensity described in choice A is more concerning and requires immediate discontinuation of oxytocin infusion.
While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include which of the following? (Select all that apply.)
- A. Culture
- B. Anxiety and fear
- C. Support systems
- D. Preparation for childbirth
Correct Answer: A
Rationale: Rationale: Culture can significantly impact a woman's perception and experience of pain during labor due to cultural beliefs, practices, and attitudes towards childbirth. Cultural norms and values can influence pain management preferences, coping mechanisms, and communication styles. Understanding the patient's cultural background is crucial for providing culturally competent care and addressing her psychosocial needs.
Summary of other choices:
B: Anxiety and fear - While anxiety and fear can influence a woman's pain experience, they are not specific to psychosocial factors related to culture.
C: Support systems - Support systems can affect a woman's labor experience, but they do not specifically relate to the influence of psychosocial factors such as culture.
D: Preparation for childbirth - Although preparation for childbirth can impact pain perception, it is not directly related to the influence of psychosocial factors like culture.