Obstetric Nurse Test Obstetric Nurse Pain Management in Labor 1 — Questions and Answers
Question 1: Which method of analgesia provides the most complete pain relief during active labor?
- IV opioid analgesia
- Epidural analgesia (Correct answer)
- Nitrous oxide inhalation
- Intrathecal opioids alone
Correct answer: Epidural analgesia
Epidural analgesia delivers continuous local anesthetic and opioid to the epidural space, providing superior and sustained pain relief compared to systemic or inhaled alternatives.
Question 2: Before epidural placement in a laboring patient, which assessment is most critical for patient safety?
- Cervical dilation
- Platelet count and coagulation status (Correct answer)
- Blood glucose level
- Urine protein level
Correct answer: Platelet count and coagulation status
Coagulopathy is a contraindication to epidural placement because it increases the risk of epidural hematoma, a potentially catastrophic complication.
Question 3: A laboring patient received IV fentanyl 50 mcg 20 minutes ago. Which assessment is the nurse's highest priority?
- Cervical dilation progress
- Maternal respiratory rate and sedation level (Correct answer)
- Contraction frequency and duration
- Fetal station
Correct answer: Maternal respiratory rate and sedation level
Opioids cause dose-dependent respiratory depression; monitoring maternal respiratory rate and level of sedation is the priority to detect this potentially life-threatening effect.
Question 4: A patient's blood pressure drops to 88/54 mmHg immediately after epidural analgesia is initiated. The priority nursing intervention is:
- Administer IV epinephrine 1 mg immediately
- Increase IV fluid rate and position patient in left lateral tilt (Correct answer)
- Discontinue the epidural catheter
- Administer naloxone IV
Correct answer: Increase IV fluid rate and position patient in left lateral tilt
Epidural-induced hypotension results from sympathetic blockade causing vasodilation; IV fluid bolus and left lateral positioning to relieve aortocaval compression are the first-line interventions.
Question 5: Which condition is a contraindication to epidural analgesia during labor?
- Nulliparity at term
- Active coagulopathy or thrombocytopenia below 70,000/mm³ (Correct answer)
- Cervical dilation greater than 6 cm
- Gestational age of 37 weeks
Correct answer: Active coagulopathy or thrombocytopenia below 70,000/mm³
Active coagulopathy markedly increases the risk of epidural hematoma, which can compress the spinal cord and cause permanent neurological injury.
Question 6: Which non-pharmacological labor pain relief technique involves applying firm pressure to the sacral area during contractions?
- Effleurage
- Counter-pressure (Correct answer)
- Hydrotherapy
- Acupuncture
Correct answer: Counter-pressure
Counter-pressure involves applying firm manual pressure to the lower back or sacrum, which helps relieve the intense back pain common in labor, especially with an occiput posterior fetus.
Question 7: Which medication is used to reverse opioid-induced respiratory depression in a laboring patient or newborn?
- Flumazenil (Romazicon)
- Naloxone (Narcan) (Correct answer)
- Neostigmine
- Atropine
Correct answer: Naloxone (Narcan)
Naloxone is a pure opioid antagonist that rapidly reverses respiratory depression, sedation, and analgesia caused by opioid medications.
Obstetric Nurse Test Obstetric Nurse Pain Management in Labor 1
Which method of analgesia provides the most complete pain relief during active labor?