Chapter 17: Maximizing Comfort for the Laboring Woman
MULTIPLE CHOICE
1. An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit
with moderate contractions every 5 minutes that last 40 seconds. The client states, “My
contractions are so strong, I don’t know what to do.” What should the nurse’s first action
be?
a. Assess for fetal well-being.
b. Encourage the woman to lie on her side.
c. Disturb the woman as little as possible.
d. Recognize that pain is personalized
ANS: D
Each woman’s pain during childbirth is unique and is influenced by a variety of physiologic,
psychosocial, and environmental factors. A critical issue for the nurse is how support can
make a difference in the pain of the woman during labor and birth. This scenario includes no
information that would indicate fetal distress or a logical reason to be overly concerned
about the well-being of the fetus. The left lateral position is used to alleviate fetal distress,
not maternal stress. The nurse has an obligation to provide physical, emotional, and
psychosocial care and support to the laboring woman. This client clearly needs support.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Diagnosis
MSC: Client Needs: PhysiN
olUoR cI
giS teG
InN ityB, .
grT PC chMosocial Integrity
s yO
2. A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5
minutes. She is groaning and perspiring excessively; she states that she did not attend
childbirth classes. What is the optimal intervention for the nurse to provide initially?
a. Notify the woman’s health care provider.
b. Administer the prescribed narcotic analgesic.
c. Assure her that her labor will be over soon.
d. Assist her with simple breathing and relaxation instructions.
ANS: D
By reducing tension and stress, both focusing, and relaxation techniques will allow the
woman in labor to rest and conserve energy for the task of giving birth. For those who have
had no preparation, instruction in simple breathing and relaxation can be given in early labor
and is often successful. The nurse can independently perform many functions in labor and
birth, such as teaching and support. Pain medication may be an option for this client.
However, the initial response of the nurse should include teaching the client about her
options. The length of labor varies among individuals, but the first stage of labor is the
longest. Providing false assurances will only cause the client more emotional distress. At 3
cm of dilation with contractions every 5 minutes, this woman has a significant amount of
labor yet to experience.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
,3. Nursing care measures are commonly offered to women in labor. Which nursing measure
reflects the application of the gate-control theory?
a. Massaging the woman’s back.
b. Changing the woman’s position.
c. Giving the prescribed medication.
d. Encouraging the woman to rest between contractions.
ANS: A
According to the gate-control theory, pain sensations travel along sensory nerve pathways to
the brain, but only a limited number of sensations, or messages, can travel through these
nerve pathways at one time. Distraction techniques, such as massage or stroking, music,
focal points, and imagery, reduce or completely block the capacity of the nerve pathways to
transmit pain. These distractions are thought to work by closing down a hypothetic gate in
the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain
is thereby diminished. Changing the woman’s position, administering pain medication, and
resting between contractions do not reduce or block the capacity of the nerve pathways to
transmit pain using the gate-control theory.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
4. Which breathing pattern should the nurse support for the woman and her coach during the
latent phase of the first stage of labor if the couple has attended childbirth preparation
classes?
a. Slow-paced breathing
b. Deep abdominal breathN inU
g RSINGTB.COM
c. Modified-paced breathing
d. Patterned-paced breathing
ANS: A
Slow-paced breathing is approximately one half the woman’s normal breathing rate and is
used during the early stages of labor when a woman can no longer walk or talk through her
contractions. No such pattern called deep abdominal breathing exists in childbirth
preparation. Modified-paced breathing is shallow breathing that is twice the woman’s
normal breathing rate. It is used when labor progresses, and the woman can no longer
maintain relaxation through paced breathing. Patterned-pace breathing is a fast, 4:1 breathe,
breathe, breathe, blow pattern that is used during the transitional phase of labor just before
pushing and delivery.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
5. A laboring woman has received meperidine intravenously (IV), 90 minutes before giving
birth. Which medication should be available to reduce the postnatal effects of meperidine on
the neonate?
a. Fentanyl
b. Promethazine
c. Naloxone
d. Nalbuphine
, ANS: C
An opioid antagonist can be given to the newborn as one part of the treatment for neonatal
narcosis, which is a state of central nervous system (CNS) depression in the newborn
produced by an opioid. Opioid antagonists, such as naloxone, can promptly reverse the CNS
depressant effects, especially respiratory depression. Fentanyl, promethazine, and
nalbuphine do not act as opioid antagonists to reduce the postnatal effects of meperidine on
the neonate.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
6. A client is in early labor, and her nurse is discussing the pain relief options she is
considering. The client states that she wants an epidural “no matter what!” What is the
nurse’s best response?
a. “I’ll make sure you get your epidural.”
b. “You may only have an epidural if your physician allows it.”
c. “You may only have an epidural if you are going to deliver vaginally.”
d. “The type of analgesia or anesthesia used is determined, in part, by the stage of
your labor and the method of birth.”
ANS: D
To avoid suppressing the progress of labor, pharmacologic measures for pain relief are
generally not implemented until labor has advanced to the active phase of the first stage and
the cervix is dilated approximately 4 to 5 cm. A plan of care is developed for each woman
that addresses her particular clinical and nursing problems. The nurse collaborates with the
primary health care providerNUand
RSthe
INlab
GT B. wOoman in selecting features of care relevant to
oring
the woman and her family. The decision whether to use an epidural to relieve labor pain is
multifactorial. The nurse should not make a blanket statement guaranteeing the client one
pharmacologic option over another until a complete history and physical examination has
been obtained. A physician’s order is required for pharmacologic options for pain
management. However, expressing this requirement is not the nurse’s best response. An
epidural is an effective pharmacologic pain management option for many laboring women.
It can also be used for anesthesia control if the woman undergoes an operative delivery.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
7. A first-time mother is concerned about the type of medications she will receive during labor.
The client is in a fair amount of pain and is nauseated. In addition, she appears to be very
anxious. The nurse explains that opioid analgesics are often used along with sedatives. How
should the nurse phrase the rationale for this medication combination?
a. “The two medications, together, reduce complications.”
b. “Sedatives enhance the effect of the pain medication.”
c. “The two medications work better together, enabling you to sleep until you have
the baby.”
d. “This is what your physician has ordered for you.”
MULTIPLE CHOICE
1. An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit
with moderate contractions every 5 minutes that last 40 seconds. The client states, “My
contractions are so strong, I don’t know what to do.” What should the nurse’s first action
be?
a. Assess for fetal well-being.
b. Encourage the woman to lie on her side.
c. Disturb the woman as little as possible.
d. Recognize that pain is personalized
ANS: D
Each woman’s pain during childbirth is unique and is influenced by a variety of physiologic,
psychosocial, and environmental factors. A critical issue for the nurse is how support can
make a difference in the pain of the woman during labor and birth. This scenario includes no
information that would indicate fetal distress or a logical reason to be overly concerned
about the well-being of the fetus. The left lateral position is used to alleviate fetal distress,
not maternal stress. The nurse has an obligation to provide physical, emotional, and
psychosocial care and support to the laboring woman. This client clearly needs support.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Diagnosis
MSC: Client Needs: PhysiN
olUoR cI
giS teG
InN ityB, .
grT PC chMosocial Integrity
s yO
2. A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5
minutes. She is groaning and perspiring excessively; she states that she did not attend
childbirth classes. What is the optimal intervention for the nurse to provide initially?
a. Notify the woman’s health care provider.
b. Administer the prescribed narcotic analgesic.
c. Assure her that her labor will be over soon.
d. Assist her with simple breathing and relaxation instructions.
ANS: D
By reducing tension and stress, both focusing, and relaxation techniques will allow the
woman in labor to rest and conserve energy for the task of giving birth. For those who have
had no preparation, instruction in simple breathing and relaxation can be given in early labor
and is often successful. The nurse can independently perform many functions in labor and
birth, such as teaching and support. Pain medication may be an option for this client.
However, the initial response of the nurse should include teaching the client about her
options. The length of labor varies among individuals, but the first stage of labor is the
longest. Providing false assurances will only cause the client more emotional distress. At 3
cm of dilation with contractions every 5 minutes, this woman has a significant amount of
labor yet to experience.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
,3. Nursing care measures are commonly offered to women in labor. Which nursing measure
reflects the application of the gate-control theory?
a. Massaging the woman’s back.
b. Changing the woman’s position.
c. Giving the prescribed medication.
d. Encouraging the woman to rest between contractions.
ANS: A
According to the gate-control theory, pain sensations travel along sensory nerve pathways to
the brain, but only a limited number of sensations, or messages, can travel through these
nerve pathways at one time. Distraction techniques, such as massage or stroking, music,
focal points, and imagery, reduce or completely block the capacity of the nerve pathways to
transmit pain. These distractions are thought to work by closing down a hypothetic gate in
the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain
is thereby diminished. Changing the woman’s position, administering pain medication, and
resting between contractions do not reduce or block the capacity of the nerve pathways to
transmit pain using the gate-control theory.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
4. Which breathing pattern should the nurse support for the woman and her coach during the
latent phase of the first stage of labor if the couple has attended childbirth preparation
classes?
a. Slow-paced breathing
b. Deep abdominal breathN inU
g RSINGTB.COM
c. Modified-paced breathing
d. Patterned-paced breathing
ANS: A
Slow-paced breathing is approximately one half the woman’s normal breathing rate and is
used during the early stages of labor when a woman can no longer walk or talk through her
contractions. No such pattern called deep abdominal breathing exists in childbirth
preparation. Modified-paced breathing is shallow breathing that is twice the woman’s
normal breathing rate. It is used when labor progresses, and the woman can no longer
maintain relaxation through paced breathing. Patterned-pace breathing is a fast, 4:1 breathe,
breathe, breathe, blow pattern that is used during the transitional phase of labor just before
pushing and delivery.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
5. A laboring woman has received meperidine intravenously (IV), 90 minutes before giving
birth. Which medication should be available to reduce the postnatal effects of meperidine on
the neonate?
a. Fentanyl
b. Promethazine
c. Naloxone
d. Nalbuphine
, ANS: C
An opioid antagonist can be given to the newborn as one part of the treatment for neonatal
narcosis, which is a state of central nervous system (CNS) depression in the newborn
produced by an opioid. Opioid antagonists, such as naloxone, can promptly reverse the CNS
depressant effects, especially respiratory depression. Fentanyl, promethazine, and
nalbuphine do not act as opioid antagonists to reduce the postnatal effects of meperidine on
the neonate.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
6. A client is in early labor, and her nurse is discussing the pain relief options she is
considering. The client states that she wants an epidural “no matter what!” What is the
nurse’s best response?
a. “I’ll make sure you get your epidural.”
b. “You may only have an epidural if your physician allows it.”
c. “You may only have an epidural if you are going to deliver vaginally.”
d. “The type of analgesia or anesthesia used is determined, in part, by the stage of
your labor and the method of birth.”
ANS: D
To avoid suppressing the progress of labor, pharmacologic measures for pain relief are
generally not implemented until labor has advanced to the active phase of the first stage and
the cervix is dilated approximately 4 to 5 cm. A plan of care is developed for each woman
that addresses her particular clinical and nursing problems. The nurse collaborates with the
primary health care providerNUand
RSthe
INlab
GT B. wOoman in selecting features of care relevant to
oring
the woman and her family. The decision whether to use an epidural to relieve labor pain is
multifactorial. The nurse should not make a blanket statement guaranteeing the client one
pharmacologic option over another until a complete history and physical examination has
been obtained. A physician’s order is required for pharmacologic options for pain
management. However, expressing this requirement is not the nurse’s best response. An
epidural is an effective pharmacologic pain management option for many laboring women.
It can also be used for anesthesia control if the woman undergoes an operative delivery.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
7. A first-time mother is concerned about the type of medications she will receive during labor.
The client is in a fair amount of pain and is nauseated. In addition, she appears to be very
anxious. The nurse explains that opioid analgesics are often used along with sedatives. How
should the nurse phrase the rationale for this medication combination?
a. “The two medications, together, reduce complications.”
b. “Sedatives enhance the effect of the pain medication.”
c. “The two medications work better together, enabling you to sleep until you have
the baby.”
d. “This is what your physician has ordered for you.”
