Pain Management

A nurse is discussing visceral pain during labor with a newly licensed nurse. Which of the following causes of pain stated by the newly licensed nurse would require follow up from the nurse?

• Cervical dilation

• Nerve stimulation

• Stretching of the pelvic muscles

• Uterine contractions

Answer explanation

Cervical dilation is incorrect. Cervical dilation leads to visceral pain which is the expected pain during the first stage of labor. Nerve stimulation is incorrect. Nerve stimulation causes visceral pain which is the expected pain during the first stage of labor. Stretching of the pelvic muscles is correct. Stretching of the pelvic muscles is somatic pain and would be expected to be experienced in the second stage of labor. Uterine contractions is incorrect. Uterine contractions lead to visceral pain which is the expected pain during the first stage of labor.

A nurse is assessing a laboring patient's perception of pain. Which of the following should be included in the assessment? Select all that apply.

• Comfort

• Anxiety

• Pain

• Respirations

• Length of labor

Answer explanation

Comfort is correct. Client comfort should be assessed because it can influence their perception of pain. Anxiety is correct. Anxiety should be assessed because it can influence a client's perception of pain. Pain is correct. Pain should be assessed because it can influence a client's perception of pain. Respirations are incorrect. Changes in respirations can be an indicator of pain but does not influence a client’s perception of pain. Length of labor is correct. Length of labor should be assessed because it can influence a client's perception of pain.

A patient is discussing incorporating cultural practices into their pain management during labor with a nurse. Which of the following statements by the nurse is most appropriate?

• We will work with you to incorporate the practices that are safe for you and your fetus.

• There are specific pain management options that you need to use.

• It is better to use pain management options that have been researched.

• You will need to discuss this with the provider.

Answer explanation

“We will work with you to incorporate the practices that are safe for you and your fetus.” is correct. This is a therapeutic response because the nurse and providers are working with the client to incorporate cultural practices if they are safe. “There are specific pain management options that you need to use.” is incorrect. This is not a therapeutic response. The nurse and providers should work with the client to incorporate cultural practices if they are safe. “It is better to use pain management options that have been researched.” is incorrect. This is not a therapeutic response because the nurse and providers should work with the client to incorporate cultural practices if they are safe. “You will need to discuss this with the provider.” is incorrect. The nurse and provider should discuss any pain options with the client, not just the nurse.

While caring for a patient in labor a nurse notices the patient begins to appear restless and vocalizes an increase in worrying thoughts. Which of the following findings would the nurse expect to happen with this situation?

• Increase in oxytocin

• Decrease in labor pain

• Arrest of labor

• Decrease in catecholamines

Answer explanation

Increase in oxytocin is incorrect. The client appears to be experiencing anxiety. Anxiety would cause a decrease in oxytocin levels. Decrease in labor pain is incorrect. The client appears to be experiencing anxiety. Labor pain would increase with an increase in anxiety. Arrest of labor is correct. The client appears to be experiencing anxiety. It is possible for anxiety to prevent labor from progressing. Decrease in catecholamines is incorrect. The client appears to be experiencing anxiety. Anxiety would cause an increase in catecholamines.

A nurse is educating a patient on the benefits of support during labor. Which of the following benefits should the nurse include in their teaching? Select all that apply.

• Decrease in pain

• Improved experience

• Better fetal outcomes

• Improved maternal outcomes

• Increase in anxiety

Answer explanation

Decrease in pain is correct. Support during labor can decrease the client’s pain. Improved experience is correct. Support during labor can improve the client’s labor and birth experience. Better fetal outcomes is correct. Support during labor can improve fetal outcomes. Improved maternal outcomes is correct. Support during labor can improve maternal outcomes. Increase in anxiety is incorrect. Support persons can cause the client to have an increase in anxiety this is not a benefit.

A nurse is caring for a multigravida patient who expresses concerns about their epidural not working during their first labor. Which of the following factors will be most influential on the patient's pain management during labor?

• Previous experiences

• Support

• Culture

• Environment

Answer explanation

Previous experiences is correct. The client’s pain during labor will be influenced by their previous experience of no achieving pain control with an epidural during their first labor and birth. Support is incorrect. Support can influence pain, but inability to achieve pain relief with an epidural during their first labor would be a previous experience most likely to influence their future labor pain management. Culture is incorrect. Culture can influence pain, but inability to achieve pain relief with an epidural during their first labor would be a previous experience most likely to influence their future labor pain management. Environment is incorrect.

A nurse is caring for a patient in labor and would like to provide an environment that will help decrease the patient's pain. Which of the following should the nurse include? Select all that apply.

• Calm in the patient's room

• Maintain privacy

• Effective communication

• Continuity of care

• Making choices for the patient

Answer explanation

Calm in the patient’s room is correct. Keeping the client’s room calm will provide a positive atmosphere that will help decrease pain. Maintaining privacy is correct. Maintaining privacy will provide a positive atmosphere that will help decrease pain. Effective communication is correct. Communicating effectively with the client will provide a positive atmosphere that will help decrease pain. Continuity of care is correct. Providing continuity of care will provide a positive atmosphere that will help decrease pain. Making choices for the patient is incorrect. The nurse should allow the client to make choices during labor and support those choices to provide a positive environment.

A nurse is providing education to a patient who is intrapartum with a history of anxiety and a previous traumatic birth regarding how to control anxiety during labor. Which of the following should the nurse suggest helping control anxiety?

• Making decisions for the patient

• Lack of communication

• Previous experiences

• Support from care partner

Answer explanation

Making decisions for the patient is incorrect. The client needs to have the ability to make decisions to improve their anxiety. Lack of communication is incorrect. Lack of communication can have a negative impact on the client’s anxiety. Previous experiences is incorrect. Previous experiences can have both a positive and negative effect on a client’s anxiety. However, reflection on the client’s previous experience of a traumatic birth will likely produce more anxiety. Support from care partner is correct. Support from the client's care partner, a doula, or a nurse can help decrease the client’s anxiety. 

A patient is considering using relaxation and breathing techniques for pain management during labor. Which of the following options should the nurse offer? Select all that apply.

• Acupressure

• Effleurage

• Bradley method

• Lamaze method

• Yoga

Answer explanation

Acupressure is incorrect. Acupressure is a type of massage that can be used for pain management. Effleurage is incorrect. Effleurage is a type of massage that can be used for pain management.  The Bradley method is correct. The Bradley method incorporates breathing techniques to aid in pain management. The Lamaze method is correct. The Lamaze method incorporates breathing techniques to aid in pain management. Yoga is correct. Yoga is a relaxation technique that also includes breathing practice to aid in pain management.

A nurse is providing education to a patient about the Bradley method for pain management. Which of the following statements by the patient requires follow up by the nurse?

• This method incorporates exercise and nutrition during pregnancy.

• I can use this method at any time without training.

• During the training I will learn to trust my body.

• I will learn how to focus on deep breathing during labor.

Answer explanation

“This method incorporates exercise and nutrition during pregnancy.” is incorrect. The Bradley method does incorporate exercise and nutrition during pregnancy. “I can use this method at any time without training.” is correct. The Bradley method requires approximately 12 weeks of training before labor. “During the training I will learn to trust my body.” is incorrect. The Bradley method teaches clients how to trust their body. “I will learn how to focus on deep breathing during labor.” is incorrect. The Bradley method encourages the client to focus on their breathing.