Chapter 14: Maximizing Comfort for the Laboring Woman Perry: Maternal Child Nursing Care, 6th Edition

Chapter 14:
Maximizing Comfort
for the Laboring
Woman Perry:
Maternal Child
Nursing Care, 6th
Edition
1. An 18-year-old pregnant woman, gravida
1, is admitted to the labor and birth unit
with moderate contractions every 5
minutes that last 40 seconds. The woman
states, "My contractions are so strong that I
don't know what to do with myself." The
nurse should:
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 for
each individual. - ANSWER-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. Assessing for fetal wellbeing 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
patient clearly needs support.
2. Nursing care measures are commonly
offered to women in labor. Which nursing
measure reflects application of the gatecontrol 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 - ANSWER-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 nerve pathways to transmit
pain. These distractions are thought to work
by closing down a hypothetic gate in the
spinal cord and thus preventing pain signals
from reaching the brain. The perception of
pain is thereby diminished. Changing the
woman's position, giving prescribed
medication, and encouraging rest do not
reduce or block the capacity of nerve
pathways to transmit pain using the gatecontrol theory.
3. A laboring woman received an opioid
agonist (meperidine) intravenously 90
minutes before she gave birth. Which
medication should be available to reduce
the postnatal effects of Demerol on the
neonate?
a. Fentanyl (Sublimaze)
b. Promethazine (Phenergan)
c. Naloxone (Narcan)
d. Nalbuphine (Nubain) - ANSWER-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 (Narcan) 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 Demerol on the
neonate. Although meperidine (Demerol) is
a low-cost medication and readily available,
the use of Demerol in labor has been
controversial because of its effects on the
neonate.