Obstetric Nurse Test Obstetric Nurse Pain Management in Labor 2 — Questions and Answers
Question 1: Combined spinal-epidural (CSE) analgesia in labor is characterized by:
- Slower onset than epidural alone
- Rapid initial pain relief while preserving the ability to ambulate (Correct answer)
- Higher risk of fetal bradycardia than standard epidural
- Requiring larger total doses of local anesthetic
Correct answer: Rapid initial pain relief while preserving the ability to ambulate
CSE provides fast-acting spinal analgesia via a smaller intrathecal opioid dose while preserving motor function, allowing ambulatory labor ("walking epidural").
Question 2: Effleurage as a labor comfort measure is best described as:
- Deep sacral massage between contractions
- Light rhythmic stroking of the abdomen during contractions (Correct answer)
- Cold pack application to the perineum
- Sustained pressure on lumbar trigger points
Correct answer: Light rhythmic stroking of the abdomen during contractions
Effleurage is a light, circular stroking massage over the abdomen performed during contractions that stimulates large sensory fibers and may inhibit pain signal transmission via gate control theory.
Question 3: When monitoring a patient using hydrotherapy (water immersion) for labor pain relief, the nurse's priority assessment is:
- Limiting immersion to 15-minute intervals
- Monitoring water temperature to prevent maternal and fetal hyperthermia (Correct answer)
- Restricting use to patients with intact membranes only
- Ensuring the patient is in active labor before entry
Correct answer: Monitoring water temperature to prevent maternal and fetal hyperthermia
Water temperature above 37.5°C can cause maternal hyperthermia, which leads to fetal tachycardia and increases metabolic demand; maintaining water at or below body temperature is essential.
Question 4: Which local anesthetic agent is most commonly used in continuous epidural infusions for labor analgesia?
- Lidocaine 2%
- Low-concentration bupivacaine or ropivacaine (Correct answer)
- Tetracaine 0.5%
- Chloroprocaine 3%
Correct answer: Low-concentration bupivacaine or ropivacaine
Dilute bupivacaine (0.0625–0.125%) or ropivacaine, often combined with fentanyl, provides effective sensory blockade with minimal motor block, allowing ambulation during labor.
Question 5: A patient with an epidural reports a "hot spot" — an area of persistent pain despite the epidural running. The nurse's first action is:
- Discontinue the epidural and switch to IV opioids
- Reposition the patient and notify the anesthesia provider (Correct answer)
- Independently increase the epidural infusion rate
- Administer IV ketorolac for the breakthrough pain
Correct answer: Reposition the patient and notify the anesthesia provider
Repositioning may redistribute epidural solution to cover the unblocked area; the anesthesia provider should then be notified to assess catheter placement and adjust the regimen.
Question 6: Patient-controlled epidural analgesia (PCEA) differs from a standard continuous epidural infusion because it:
- Eliminates the need for a background continuous infusion
- Allows the patient to self-administer bolus doses within preset safety limits (Correct answer)
- Permits the patient to adjust the continuous rate independently
- Requires more total anesthetic medication per hour
Correct answer: Allows the patient to self-administer bolus doses within preset safety limits
PCEA allows patient-initiated bolus doses on demand within programmed lockout intervals, giving patients control over their pain management and often improving satisfaction with fewer total drug doses.
Question 7: A patient asks about nitrous oxide (N2O) for labor pain. Which statement by the nurse is most accurate?
- Nitrous oxide completely eliminates labor pain
- It reduces pain perception and anxiety without eliminating sensation (Correct answer)
- It should not be used after 8 cm cervical dilation
- It causes significant respiratory depression in the newborn
Correct answer: It reduces pain perception and anxiety without eliminating sensation
Inhaled 50% nitrous oxide blunts pain perception and reduces anxiety through CNS effects but does not provide complete analgesia; it is rapidly exhaled and does not accumulate in the neonate.
Obstetric Nurse Test Obstetric Nurse Pain Management in Labor 2
Combined spinal-epidural (CSE) analgesia in labor is characterized by: