Chapter 22 Pharmacologic Pain Management
1) Which of the following is a common barbiturate used in labor?
1. Seconal
2. Valium
3. Phenergan
4. Vistaril
Answer: 1
Explanation: 1. The most common barbiturates used in labor are secobarbital
(Seconal) and zolpidem tartrate (Ambien).
Page Ref: 544
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum
and Newborn Care
Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple
dimensions of patient centered care. | AACN Essentials Competencies: IX. 3.
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical
management, and nursing management across the health-illness continuum,
across lifespan, and in all healthcare settings. | NLN Competencies: Context
and Environment: Apply professional standards; show accountability for
nursing judgment and actions; develop advocacy skills. | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 2 Describe the use of systemic analgesics to promote pain
relief during labor.
MNL LO: 3.3.3 Examine the use, advantages, and disadvantages of
,anesthesia and analgesia for pain relief.
1
Copyright 2016 Pearson Education, Inc.
2) The nurse is assessing a client before administering an analgesic. What are
some of the factors the nurse should consider?
Note: Credit will be given only if all correct choices and no incorrect choices
are selected.
Select all that apply.
1. The client is willing to receive medication after being advised about it.
2. The clients vital signs are stable.
3. The partner agrees to use of the medication.
4. The client has no known allergies to the medication.
5. The client is aware of the contraindications of the medication.
Answer: 1, 2, 4, 5
Explanation: 1. Medication should be explained to the client before it is
administered.
2. Vital signs need to be stable before any analgesic medication is
administered.
4. Ask the client about allergies before administering any medications.
5. Clients should always be aware of the contraindications of the medication.
Page Ref: 543
Cognitive Level: Evaluating
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences,
and expressed needs as part of clinical interview, implementation of care
plan, and evaluation of care. | AACN Essentials Competencies: IX. 1.
Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Context and Environment: Apply
professional standards; show accountability for nursing judgment and
,actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 1 Discuss the nurses role in supporting pharmaceutical
pain relief measures in labor.
MNL LO: 3.3.3 Examine the use, advantages, and disadvantages of
anesthesia and analgesia for pain relief.
2
Copyright 2016 Pearson Education, Inc.
3) A client in labor is requesting pain medication. The nurse assesses her
labor status first, focusing on which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices
are selected.
Select all that apply.
1. Contraction pattern
2. Amount of cervical dilatation
3. When the labor began
4. Whether the membranes are intact or ruptured
5. Fetal presenting part
Answer: 1, 2, 5
Explanation: 1. The client should have a good contraction pattern before
receiving an analgesic.
2. The nurse should evaluate the amount of cervical dilatation before
analgesic medication is administered.
5. If normal parameters are absent or if nonreassuring maternal or fetal
factors are present, the nurse may need to complete further assessments with
the physician/CNM.
Page Ref: 543
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences,
and expressed needs as part of clinical interview, implementation of care
, plan, and evaluation of care. | AACN Essentials Competencies: IX. 1.
Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Context and Environment: Apply
professional standards; show accountability for nursing judgment and
actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 1 Discuss the nurses role in supporting pharmaceutical pain
relief measures in labor.
MNL LO: 3.3.3 Examine the use, advantages, and disadvantages of
anesthesia and analgesia for pain relief.
3
Copyright 2016 Pearson Education, Inc.
4) A woman in active labor is given nalbuphine hydrochloride (Nubain) 14
mg IV for pain relief. Half an hour later, her respirations are at 8 per minute.
The physician would likely order which medication for this client?
1. Narcan
2. Reglan
3. Benadryl
4. Vistaril
Answer: 1
Explanation: 1. Narcan is useful for respiratory depression caused by
nalbuphine (Nubain).
Page Ref: 547
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of
strategies to reduce risk of harm to self or others. | AACN Essentials
Competencies: IX. 8. Implement evidence-based nursing interventions as
appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Context and
1) Which of the following is a common barbiturate used in labor?
1. Seconal
2. Valium
3. Phenergan
4. Vistaril
Answer: 1
Explanation: 1. The most common barbiturates used in labor are secobarbital
(Seconal) and zolpidem tartrate (Ambien).
Page Ref: 544
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum
and Newborn Care
Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple
dimensions of patient centered care. | AACN Essentials Competencies: IX. 3.
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical
management, and nursing management across the health-illness continuum,
across lifespan, and in all healthcare settings. | NLN Competencies: Context
and Environment: Apply professional standards; show accountability for
nursing judgment and actions; develop advocacy skills. | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 2 Describe the use of systemic analgesics to promote pain
relief during labor.
MNL LO: 3.3.3 Examine the use, advantages, and disadvantages of
,anesthesia and analgesia for pain relief.
1
Copyright 2016 Pearson Education, Inc.
2) The nurse is assessing a client before administering an analgesic. What are
some of the factors the nurse should consider?
Note: Credit will be given only if all correct choices and no incorrect choices
are selected.
Select all that apply.
1. The client is willing to receive medication after being advised about it.
2. The clients vital signs are stable.
3. The partner agrees to use of the medication.
4. The client has no known allergies to the medication.
5. The client is aware of the contraindications of the medication.
Answer: 1, 2, 4, 5
Explanation: 1. Medication should be explained to the client before it is
administered.
2. Vital signs need to be stable before any analgesic medication is
administered.
4. Ask the client about allergies before administering any medications.
5. Clients should always be aware of the contraindications of the medication.
Page Ref: 543
Cognitive Level: Evaluating
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences,
and expressed needs as part of clinical interview, implementation of care
plan, and evaluation of care. | AACN Essentials Competencies: IX. 1.
Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Context and Environment: Apply
professional standards; show accountability for nursing judgment and
,actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 1 Discuss the nurses role in supporting pharmaceutical
pain relief measures in labor.
MNL LO: 3.3.3 Examine the use, advantages, and disadvantages of
anesthesia and analgesia for pain relief.
2
Copyright 2016 Pearson Education, Inc.
3) A client in labor is requesting pain medication. The nurse assesses her
labor status first, focusing on which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices
are selected.
Select all that apply.
1. Contraction pattern
2. Amount of cervical dilatation
3. When the labor began
4. Whether the membranes are intact or ruptured
5. Fetal presenting part
Answer: 1, 2, 5
Explanation: 1. The client should have a good contraction pattern before
receiving an analgesic.
2. The nurse should evaluate the amount of cervical dilatation before
analgesic medication is administered.
5. If normal parameters are absent or if nonreassuring maternal or fetal
factors are present, the nurse may need to complete further assessments with
the physician/CNM.
Page Ref: 543
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences,
and expressed needs as part of clinical interview, implementation of care
, plan, and evaluation of care. | AACN Essentials Competencies: IX. 1.
Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Context and Environment: Apply
professional standards; show accountability for nursing judgment and
actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 1 Discuss the nurses role in supporting pharmaceutical pain
relief measures in labor.
MNL LO: 3.3.3 Examine the use, advantages, and disadvantages of
anesthesia and analgesia for pain relief.
3
Copyright 2016 Pearson Education, Inc.
4) A woman in active labor is given nalbuphine hydrochloride (Nubain) 14
mg IV for pain relief. Half an hour later, her respirations are at 8 per minute.
The physician would likely order which medication for this client?
1. Narcan
2. Reglan
3. Benadryl
4. Vistaril
Answer: 1
Explanation: 1. Narcan is useful for respiratory depression caused by
nalbuphine (Nubain).
Page Ref: 547
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of
strategies to reduce risk of harm to self or others. | AACN Essentials
Competencies: IX. 8. Implement evidence-based nursing interventions as
appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Context and
