A charge nurse is discussing the guidelines for narcotic medications with a newly licensed nurse. Which of the following information should the charge nurse include?

Rationale for correct choices

• oxytocin: The client is term, contracting regularly, and already 3 cm dilated, indicating early active labor progression. Oxytocin may be anticipated to augment labor when contractions are present but not yet efficient. The presence of infection risk (fever, malodorous discharge) also increases the need to progress labor toward delivery.

• nalbuphine: The client reports pain that increases to 8 during contractions, indicating a need for pharmacologic analgesia. Nalbuphine is an opioid analgesic used in labor for moderate to severe pain and is appropriate for intrapartum pain management. It can be anticipated when the client requests stronger pain relief before progression to active labor.

Rationale for incorrect choices

• magnesium sulphate: This medication is used for seizure prophylaxis in preeclampsia or for neuroprotection in preterm labor. The client’s blood pressure is within normal range, and gestation is 38 weeks, so there is no indication for magnesium sulfate.

• misoprostol: Cervical ripening is not required because the cervix is already 3 cm dilated with active contractions. Misoprostol would not be indicated when labor is already progressing, especially in the presence of suspected infection, where accelerating delivery is preferred.

• hydralazine: Hydralazine is an antihypertensive used for severe hypertension in pregnancy. The client’s blood pressure is 128/82 mm Hg, which does not indicate hypertensive management.

A. "I should place a rolled blanket along each side of my baby's head in the car seat.": Adding blankets around the newborn’s head can interfere with proper harness fit and may increase the risk of suffocation or injury during a crash. Blankets should be placed over the harness, not underneath or beside the infant.

B."I should place my baby's car seat rear-facing until 2 yearsof age.":The American Academy of Pediatrics (AAP) and the National Highway Traffic Safety Administration (NHTSA) recommend that all infants and toddlers should ride in a rear-facing car seat until they are at least 2 years of age or until they reach the highest weight or height allowed by their car seat manufacturer. This position provides the best support for the child's head, neck, and spine in the event of a crash, which is critical since a newborn's neck muscles are not yet strong enough to support their relatively large head during sudden deceleration.

C. "I should put the car seat retainer clip at the level of my baby's belly button": The harness retainer clip should be positioned at the level of the infant’s armpits (chest level), not at the belly button, to keep the straps properly positioned over the shoulders.

D. "I should position my baby's car seat at a 90-degree angle in the car.": Newborn car seats should be reclined at about a 45-degree angle to prevent the head from falling forward and obstructing the airway, rather than upright at 90 degrees.