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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.
Correct Answer: B,E
Rationale: 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.
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A patient who received an epidural block asks why her blood pressure is taken so often. What is the nurse's 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.
Correct Answer: D
Rationale: The hypotension that accompanies an epidural block may cause inadequate perfusion of the placenta, leading to fetal hypoxia.
A laboring patient requests hot and cold applications be applied to her abdomen for pain control. How will this intervention act to control pain?
- A. By increasing endorphin production
- B. By facilitating effacement and dilation
- C. By producing increasing pain tolerance
- D. By stimulation of large nerve fibers
Correct Answer: D
Rationale: 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.
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
Correct Answer: B
Rationale: The major adverse effect of general anesthesia is aspiration of stomach contents.
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.
Correct Answer: A,C
Rationale: To prevent the risk for injury related to epidural anesthesia, the nurse should assess 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.
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?
- A. Frequently asking for ice chips
- B. Facial grimacing
- C. Changing positions in bed
- D. Covering her face with her hands
Correct Answer: B
Rationale: Facial grimacing may be an indicator of unexpressed pain.