A 32-week pregnant patient is receiving nifedipine for preterm labor.
Which of the following statements made by the patient indicates a need for additional teaching?

Choice A rationale

Bradycardia, or a slow heart rate, is not a typical immediate side effect of an epidural block. The primary cardiovascular risk is vasodilation below the level of the block, which can cause a sudden decrease in systemic vascular resistance and a drop in blood pressure. Bradycardia is more commonly associated with other conditions, not as a direct primary effect of epidural administration.

Choice B rationale

Fetal tachycardia is not an expected or most important immediate adverse effect of an epidural block. While maternal fever and subsequent fetal tachycardia can occur later with epidural use, the most critical immediate maternal side effect that requires vigilant monitoring is hypotension, which can lead to decreased placental perfusion and subsequent fetal distress.

Choice C rationale

The most important nursing intervention following an epidural block is to monitor the patient's blood pressure for hypotension. The epidural causes vasodilation of the blood vessels below the level of the block, leading to a decrease in systemic vascular resistance and venous return. This can cause a sudden and significant drop in blood pressure, which can decrease placental perfusion and compromise fetal oxygenation.

Choice D rationale

Limiting parenteral fluids is not an appropriate intervention; in fact, the opposite is true. A bolus of intravenous fluids is often administered before the epidural to expand the maternal blood volume and help mitigate the risk of hypotension. Limiting fluids would exacerbate the risk of hypotension and its associated complications for both the mother and fetus. *.

Choice A rationale

Naloxone is a potent, competitive opioid receptor antagonist. Administering it to an opioid-dependent individual can precipitate an acute and severe withdrawal syndrome. This occurs because naloxone rapidly displaces all opioids from their receptors, leading to an immediate reversal of both the analgesic and depressant effects, as well as the physiological dependence that has developed.

Choice B rationale

This statement is incorrect because the risk of precipitating acute withdrawal in opioid-dependent patients is a well-established and significant clinical consideration. Naloxone is indicated for opioid overdose, but its use in dependent patients requires careful management to avoid severe adverse effects.

Choice C rationale

The effect of naloxone is not a matter of "maybe.”. The pharmacological response is predictable and directly related to the patient's opioid dependency status. The certainty of precipitating withdrawal in a dependent individual is the primary reason for caution.

Choice D rationale

The patient's age is a factor in determining the dosage and potential side effects of naloxone, but it does not change the fundamental pharmacological interaction with opioid receptors in a dependent individual. The core issue is the presence of physical dependence on opioids, regardless of age.