A nurse is caring for a client who is dilated to 10 cm and pushing. Which of the following pain-management measures should the nurse identify as a safe option for the client?
Butorphanol tartrate
Pudendal block
Naloxone hydrochloride
Spinal anesthesia
The Correct Answer is B
Rationale:
A. Butorphanol tartrate: This opioid analgesic can cause respiratory depression in the newborn if given too close to delivery. At 10 cm dilation and during pushing, it's generally too late to administer systemic opioids safely.
B. Pudendal block: A pudendal block provides localized perineal anesthesia and is safe for use during the second stage of labor when the client is fully dilated and pushing. It effectively reduces pain from stretching and pressure without affecting uterine contractions or fetal status.
C. Naloxone hydrochloride: Naloxone is not a pain-management measure; it is an opioid antagonist used to reverse opioid-induced respiratory depression. It does not provide analgesia and is not administered for pain relief during labor.
D. Spinal anesthesia: Spinal anesthesia is typically administered prior to a planned cesarean birth or late in the first stage of labor. It is not appropriate once the client is fully dilated and actively pushing, as it could delay delivery and complicate maternal positioning.
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Related Questions
Correct Answer is B
Explanation
Rationale:
A. Limit teaching sessions about the procedure to 20 min: Preschoolers have short attention spans, but 20 minutes is still too long for teaching at this developmental stage. Teaching should be concise and focused, ideally lasting only a few minutes just before the procedure.
B. Explain in simple terms how the procedure will affect the child: Preschoolers benefit from clear, age-appropriate explanations that help them understand what to expect. Using simple language and concrete terms reduces fear and builds trust with the nurse.
C. Ask the parents to wait outside the room during the procedure: Parents often provide comfort and reassurance during stressful experiences. Unless they are interfering or the child requests otherwise, their presence can help reduce the child’s anxiety.
D. Instruct the child in deep-breathing methods prior to the procedure: While relaxation techniques are helpful for older children, preschoolers may have difficulty understanding and following deep-breathing instructions. Simple distraction methods are often more effective.
Correct Answer is D
Explanation
Rationale:
A. Hypotension: Hypotension is typically associated with decreased preload and low PAWP rather than elevated values. An elevated PAWP reflects increased pressure in the left heart, which does not occur with simple hypotension alone.
B. Hypovolemia: Hypovolemia leads to decreased circulating blood volume, reducing preload and PAWP. It is typically marked by low filling pressures, not elevated wedge pressures.
C. Cardiogenic shock: Although cardiogenic shock can be associated with elevated PAWP due to poor cardiac output and fluid backup, it is not as specific a marker as left ventricular failure, which directly affects PAWP.
D. Left ventricular failure: Elevated PAWP reflects increased pressure in the left atrium and pulmonary circulation, which is a hallmark of left-sided heart failure. This elevation occurs because the failing left ventricle cannot efficiently pump blood forward.
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