NM 704 EXAM 4 ACTUAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS
VERIFIED GRADED A+
Epidural: Mode of Action - (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 - (answer)most effective pain relief, high levels of satisfaction
Epidural: Contraindications - (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 - (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 - (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 - (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) - (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
, NM 704 EXAM 4 ACTUAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS
VERIFIED GRADED A+
Morphine (timing of administration and side effx) - (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) - (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) - (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) - (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) - (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? - (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? - (answer)BP: q15 min (check
between contractions)
Temp, pulse, RR: q60 min
VERIFIED GRADED A+
Epidural: Mode of Action - (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 - (answer)most effective pain relief, high levels of satisfaction
Epidural: Contraindications - (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 - (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 - (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 - (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) - (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
, NM 704 EXAM 4 ACTUAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS
VERIFIED GRADED A+
Morphine (timing of administration and side effx) - (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) - (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) - (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) - (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) - (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? - (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? - (answer)BP: q15 min (check
between contractions)
Temp, pulse, RR: q60 min
