Quiz 10: Managing pain during labour

Please choose the one, most correct answer to each question or statement.

1. Analgesia means:
   • The relief of pain
   • Relieving anxiety
   • Putting the patient to sleep
   • All of the above
2. Anaesthesia means:
   • The relief of pain
   • Relieving anxiety
   • Loss of all sensation
   • Putting the patient to sleep
3. Which of the following statements is correct?
   • All patients experience severe pain during labour.
   • The severity of pain experienced during labour varies widely between different patients.
   • Pain is only experienced during labour when the cervix is almost fully dilated.
   • Pain is only experienced when the patient is in the second stage of labour.
4. Why do anxiety and fear make the pain of labour worse?
   • Anxiety increases the strength of uterine contractions.
   • Anxiety increases the duration of uterine contractions.
   • Anxiety increases the frequency of uterine contractions.
   • Anxiety lowers a patient’s pain threshold.
5. Pain relief during labour:
   • Should only be provided by powerful analgesics which are known to be effective
   • Starts with the preparation for labour during the antenatal period
   • Is only needed if the patient receives an oxytocin infusion
   • Is only needed if the patient does not have her partner or another family member with her
6. Which of the following statements about rubbing a patient’s back during labour is correct?
   • Rubbing a patient’s back is an ‘old wives’ tale’ and is of no value.
   • It should not be done as physical contact with the patient should be avoided.
   • The pain impulses from the uterus and cervix are experienced as less painful if the patient’s lower back is rubbed.
   • There is no physiological reason why rubbing the patient’s back should relieve labour pains.
7. Which of the following statements about pain relief in labour is correct?
   • The relief of pain often speeds up the progress of labour.
   • The relief of pain often slows the progress of labour.
   • Patients must accept pain as part of normal labour.
   • Pain relief in labour should only be given to patients who obviously are suffering severe pain.
8. When should a patient be given pain relief in labour?
   • When a patient’s cervix is 4 to 6 cm dilated
   • When a patient is having 3 strong contractions in 10 minutes
   • When a patient reaches the active phase of the first stage of labour
   • When a patient asks for pain relief
9. Promethazine (Phenergan) or hydroxyzine (Aterax) should always be given together with pethidine for the relief of pain during labour because:
   • They have a sedative effect
   • They decrease nausea and vomiting which are common side effects of pethidine
   • They increase the analgesic effect of pethidine
   • All of the above
10. Pethidine causes analgesia by:
    • Acting on the central nervous system
    • Acting on the uterine muscle
    • Acting on the peripheral nerves
    • Making the patient sleepy so that she is not aware of the pain
11. What is a dangerous complication of an overdose of pethidine?
    • Suppression of uterine contractions
    • Respiratory depression in the patient
    • Convulsions
    • Excessive drowsiness
12. Pethidine and promethazine (Phenergan) or hydroxyzine (Aterax) should only be given if:
    • The cervical dilatation is 4 cm or less in a multigravida patient
    • The patient is unlikely to deliver in the next 4 to 6 hours
    • The intramuscular route is used
    • It is the most appropriate method of analgesia; the degree of cervical dilatation and the expected time of delivery are of little importance
13. Pethidine may cause respiratory depression in the newborn infant if:
    • The drug is given when the patient’s cervix is more than 4 cm dilated
    • The drug is given less than 6 hours before delivery
    • More than 50 mg pethidine is given
    • Promethazine or hydroxyzine is not given together with the pethidine
14. The duration of action when pethidine is given by intramuscular injection is usually:
    • 1 hour
    • 2 hours
    • 4 hours
    • 8 hours
15. What is the correct management of a newborn infant who does not breathe well if the mother has been given pethidine during labour?
    • The infant should be ventilated until the effect of the pethidine wears off.
    • The infant should be given an intravenous infusion of 10% dextrose.
    • The infant should be given mask oxygen while being stimulated by gently flicking the soles of the feet.
    • The infant must be ventilated and given naloxone until the effect of the pethidine is reversed.
16. What is the correct management of a teenager who has not received antenatal care and is unco-operative and frightened during labour?
    • She should be given a sedative such as diazepam (Valium).
    • It is best to let her suffer as this will ensure that she does not fall pregnant again in a hurry.
    • The staff should attempt to communicate with her while the tranquillising effect of promethazine or hydroxyzine and the analgesic effect of pethidine should also help.
    • The patient should be delivered by Caesarean section to avoid a very difficult vaginal delivery.
17. Which of the following statements about the nitrous oxide and oxygen mixture (Entonox) is correct?
    • It is completely safe.
    • It always provides excellent pain relief.
    • It may cause respiratory depression in the newborn infant.
    • Excessive use may cause respiratory depression in the mother.
18. Which of the following is a complication of an overdose of local anaesthetic?
    • Respiratory depression in the mother
    • Respiratory depression in the newborn infant
    • Convulsions
    • Nausea and vomiting
19. What is the maximum dose of 1% lignocaine that can safely be infiltrated locally in a patient of average weight?
    • 50 ml
    • 40 ml
    • 30 ml
    • 20 ml
20. Why is metoclopramide (Maxalon) given intravenously 15 minutes before a general anaesthetic?
    • It has a sedative effect on the patient.
    • Stomach emptying is increased.
    • It neutralises stomach acid.
    • It reduces intra-abdominal pressure.