NM 704 Exam 4 Questions With Correct
Answers
Epidural: Mode of Action - CORRECT ANSWER✔✔-when an anesthetic drug is
| | | | | | | | | | |
placed in the epidural space, impulses traveling in the sensory and motor nerves
| | | | | | | | | | | | |
in contact with the drug are blocked
| | | | | |
Epidural: Benefits - CORRECT ANSWER✔✔-most effective pain relief, high levels
| | | | | | | | | |
of satisfaction
|
Epidural: Contraindications - CORRECT ANSWER✔✔-Absolute contraindication:
| | | | | |
declining an epidural, inability to cooperate for placement, skin or soft tissue
| | | | | | | | | | | |
infection at site of needle placement, frank coagulopathy, untreated sepsis,
| | | | | | | | | |
maternal hemoinstability. |
Relative contraindications: coagulopathy, thrombocytopenia, space occupying
| | | | | |
brain lesion, heparin therapy, neurologic disease of spinal cord
| | | | | | | |
Epidural: Effects on baby - CORRECT ANSWER✔✔-FHR decels d/t decreased blood
| | | | | | | | | |
flow to uterus. Anesthetic drugs and opioids lipid soluble - may cross BBB, but
| | | | | | | | | | | | | | |
depends on concentration in maternal blood. Poor 5 min Apgars and low
| | | | | | | | | | | |
umbilical artery pH similar between epidural and no epidural. No neurological
| | | | | | | | | | |
differences observed. |
,Epidural: Relationship to maternal fever - CORRECT ANSWER✔✔-Relationship to
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intrapartum maternal fever: increase in incidence demonstrated w/ epidurals.
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Fever over 100.4 can occur after approx. 4 hours (based on trend of elevation).
| | | | | | | | | | | | | |
R/t decrease in heat dissipation through sweating d/t sympathetic block OR may
| | | | | | | | | | | |
indicate chorio. Must be treated for chorio, infant must have sepsis work up.
| | | | | | | | | | | |
Epidural: Possible Complications - CORRECT ANSWER✔✔-Postprocedural
| | | | | |
puncture headache, back pain (unknown etiology). Adverse effects to
| | | | | | | | |
performance: epidural abscess, hematoma, neuro injury, total spinal anesthesia.
| | | | | | | | |
SE of anesthetic: hypotension, urinary retention/bladder distension, leg
| | | | | | | |
numbness and weakness. Associated w/ prolonged second stage, increase in
| | | | | | | | | |
operative vaginal births, no increase in cesarean rates
| | | | | | |
Demerol (timing of administration and side effx) - CORRECT ANSWER✔✔-
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Demerol generally is not recommended for peripartum analgesia because its
| | | | | | | | | |
active metabolite, normeperidine, has a prolonged half-life in adults and a half-
| | | | | | | | | | |
life of up to 72 hours in the neonate; the normeperidine effect cannot be
| | | | | | | | | | | | | |
antagonized by naloxone | |
Morphine (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Crosses the placenta and may have adverse effects for the fetus or newborn. This
| | | | | | | | | | | | | |
may be reflected in loss of variability in the fetal heart rate (FHR), reduction in the
| | | | | | | | | | | | | | |
FHR baseline, neonatal respiratory depression, or neurobehavioral changes. Drug
| | | | | | | | | |
elimination takes longer in newborns than in adults, so effects may be prolonged,
| | | | | | | | | | | | |
particularly if administered near the time of delivery.
| | | | | | |
Nubain (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Nalbuphine and butorphanol are mixed agonist-antagonists and, therefore, are
| | | | | | | | |
associated with less respiratory depression for an equianalgesic dose. May trigger
| | | | | | | | | |
, withdrawal symptoms or reduce analgesic effects in those receiving opioid
| | | | | | | | | | |
agonist therapy. |
Stadol (timing of administration and side effx) - CORRECT ANSWER✔✔-Maternal
| | | | | | | | | |
ceiling effect on respiratory depression and analgesia. Fetal transient pseudo-
| | | | | | | | |
sinusoidal FHR. May precipitate acute withdrawal syndrome in opiate-dependent
| | | | | | | | |
mother and baby. | |
Fentanyl (timing of administration and side effx) - CORRECT ANSWER✔✔-Short
| | | | | | | | | |
acting; less effective than morphine or Demerol, but very few side effects noted.
| | | | | | | | | | | | |
With higher doses or prolonged infusions, becomes longer lasting. Transient
| | | | | | | | | |
decreased FHR variability or pseudo-sinusoidal pattern.
| | | | |
Remifentanil (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Remifentanil is an ultra-short-acting opioid without active metabolites. Its
| | | | | | | | |
pharmacokinetics allow for easy titration during labor and for less risk of | | | | | | | | | | | |
respiratory depression in the newborn. Administered by PCA, better relief than
| | | | | | | | | | |
other opioids
|
What components should be monitored to evaluate the well-being of mother and
| | | | | | | | | | |
baby during 2nd stage of labor? - CORRECT ANSWER✔✔-Vital signs, FHR,
| | | | | | | | | | | |
nutrition and hydration, bladder distention, pain/comfort, coping, level of fatigue
| | | | | | | | |
How often should mom's vital signs be assessed in second stage labor? -
| | | | | | | | | | | | |
CORRECT ANSWER✔✔-BP: q15 min (check between contractions)
| | | | | |
Temp, pulse, RR: q60 min
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Answers
Epidural: Mode of Action - CORRECT ANSWER✔✔-when an anesthetic drug is
| | | | | | | | | | |
placed in the epidural space, impulses traveling in the sensory and motor nerves
| | | | | | | | | | | | |
in contact with the drug are blocked
| | | | | |
Epidural: Benefits - CORRECT ANSWER✔✔-most effective pain relief, high levels
| | | | | | | | | |
of satisfaction
|
Epidural: Contraindications - CORRECT ANSWER✔✔-Absolute contraindication:
| | | | | |
declining an epidural, inability to cooperate for placement, skin or soft tissue
| | | | | | | | | | | |
infection at site of needle placement, frank coagulopathy, untreated sepsis,
| | | | | | | | | |
maternal hemoinstability. |
Relative contraindications: coagulopathy, thrombocytopenia, space occupying
| | | | | |
brain lesion, heparin therapy, neurologic disease of spinal cord
| | | | | | | |
Epidural: Effects on baby - CORRECT ANSWER✔✔-FHR decels d/t decreased blood
| | | | | | | | | |
flow to uterus. Anesthetic drugs and opioids lipid soluble - may cross BBB, but
| | | | | | | | | | | | | | |
depends on concentration in maternal blood. Poor 5 min Apgars and low
| | | | | | | | | | | |
umbilical artery pH similar between epidural and no epidural. No neurological
| | | | | | | | | | |
differences observed. |
,Epidural: Relationship to maternal fever - CORRECT ANSWER✔✔-Relationship to
| | | | | | | | |
intrapartum maternal fever: increase in incidence demonstrated w/ epidurals.
| | | | | | | | |
Fever over 100.4 can occur after approx. 4 hours (based on trend of elevation).
| | | | | | | | | | | | | |
R/t decrease in heat dissipation through sweating d/t sympathetic block OR may
| | | | | | | | | | | |
indicate chorio. Must be treated for chorio, infant must have sepsis work up.
| | | | | | | | | | | |
Epidural: Possible Complications - CORRECT ANSWER✔✔-Postprocedural
| | | | | |
puncture headache, back pain (unknown etiology). Adverse effects to
| | | | | | | | |
performance: epidural abscess, hematoma, neuro injury, total spinal anesthesia.
| | | | | | | | |
SE of anesthetic: hypotension, urinary retention/bladder distension, leg
| | | | | | | |
numbness and weakness. Associated w/ prolonged second stage, increase in
| | | | | | | | | |
operative vaginal births, no increase in cesarean rates
| | | | | | |
Demerol (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Demerol generally is not recommended for peripartum analgesia because its
| | | | | | | | | |
active metabolite, normeperidine, has a prolonged half-life in adults and a half-
| | | | | | | | | | |
life of up to 72 hours in the neonate; the normeperidine effect cannot be
| | | | | | | | | | | | | |
antagonized by naloxone | |
Morphine (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Crosses the placenta and may have adverse effects for the fetus or newborn. This
| | | | | | | | | | | | | |
may be reflected in loss of variability in the fetal heart rate (FHR), reduction in the
| | | | | | | | | | | | | | |
FHR baseline, neonatal respiratory depression, or neurobehavioral changes. Drug
| | | | | | | | | |
elimination takes longer in newborns than in adults, so effects may be prolonged,
| | | | | | | | | | | | |
particularly if administered near the time of delivery.
| | | | | | |
Nubain (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Nalbuphine and butorphanol are mixed agonist-antagonists and, therefore, are
| | | | | | | | |
associated with less respiratory depression for an equianalgesic dose. May trigger
| | | | | | | | | |
, withdrawal symptoms or reduce analgesic effects in those receiving opioid
| | | | | | | | | | |
agonist therapy. |
Stadol (timing of administration and side effx) - CORRECT ANSWER✔✔-Maternal
| | | | | | | | | |
ceiling effect on respiratory depression and analgesia. Fetal transient pseudo-
| | | | | | | | |
sinusoidal FHR. May precipitate acute withdrawal syndrome in opiate-dependent
| | | | | | | | |
mother and baby. | |
Fentanyl (timing of administration and side effx) - CORRECT ANSWER✔✔-Short
| | | | | | | | | |
acting; less effective than morphine or Demerol, but very few side effects noted.
| | | | | | | | | | | | |
With higher doses or prolonged infusions, becomes longer lasting. Transient
| | | | | | | | | |
decreased FHR variability or pseudo-sinusoidal pattern.
| | | | |
Remifentanil (timing of administration and side effx) - CORRECT ANSWER✔✔-
| | | | | | | | |
Remifentanil is an ultra-short-acting opioid without active metabolites. Its
| | | | | | | | |
pharmacokinetics allow for easy titration during labor and for less risk of | | | | | | | | | | | |
respiratory depression in the newborn. Administered by PCA, better relief than
| | | | | | | | | | |
other opioids
|
What components should be monitored to evaluate the well-being of mother and
| | | | | | | | | | |
baby during 2nd stage of labor? - CORRECT ANSWER✔✔-Vital signs, FHR,
| | | | | | | | | | | |
nutrition and hydration, bladder distention, pain/comfort, coping, level of fatigue
| | | | | | | | |
How often should mom's vital signs be assessed in second stage labor? -
| | | | | | | | | | | | |
CORRECT ANSWER✔✔-BP: q15 min (check between contractions)
| | | | | |
Temp, pulse, RR: q60 min
| | | |
