A client who is in the transition phase reports the narcotic pain medication they last received 3 hours ago has worn off.
The client asks if they can have another dose of the narcotic. How should the nurse respond to the request?
"It is too early as the medication should be given only every 4 hours.”.
"I will get permission from your health care provider.”.
"Since it has been over 3 hours, you should be able to have more of the medication.”.
"Your phase of labor makes giving another dose unsafe for the fetus.”
The Correct Answer is D
Choice A rationale
While it is true that many narcotic pain medications are administered every four hours, this response is insufficient and potentially misleading. The duration of action of a narcotic is not the only factor to consider in the context of labor. The client's phase of labor and the potential fetal effects are also critical, particularly in the advanced stages of labor when the fetus is more susceptible to medication-induced respiratory depression.
Choice B rationale
While the nurse may need to consult the healthcare provider, this response is not the most direct or professional answer. The nurse has independent knowledge regarding the safety of medication administration based on the client's stage of labor. In the transition phase, the fetus is at a high risk for respiratory depression if narcotics are administered, and the nurse should explain this rationale directly to the client.
Choice C rationale
This response is incorrect and could be harmful. The time since the last dose is only one factor in medication administration. The transition phase of labor is characterized by rapid cervical dilation and is typically a sign that delivery is imminent. Administering a narcotic at this stage increases the risk of neonatal respiratory depression at birth, as the medication crosses the placenta and affects the fetal central nervous system.
Choice D rationale
The transition phase of labor, typically occurring when the cervix is dilated 8 to 10 cm, is a period of high risk for fetal compromise. Administering a narcotic during this phase is contraindicated because the medication can cross the placental barrier and cause neonatal respiratory depression at the time of delivery. The nurse's response should prioritize fetal safety by explaining this physiological risk, which is the most appropriate and scientific response. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Insomnia is a common symptom of postpartum depression, often characterized by difficulty falling or staying asleep, or waking up early. This sleep disturbance, when coupled with other symptoms such as persistent sadness, loss of interest in activities, and fatigue, is a key diagnostic criterion for the condition.
Choice B rationale
Intermittent crying in the first week postpartum, now resolved, is a common symptom of the "baby blues.”. The baby blues are a transient condition, typically resolving within the first two weeks. Postpartum depression, in contrast, involves more severe and persistent symptoms lasting longer than two weeks.
Choice C rationale
Delusions are a symptom of postpartum psychosis, a rare and severe mental health condition that is distinct from postpartum depression. Postpartum psychosis involves a break from reality and is a psychiatric emergency. Delusions are not characteristic of postpartum depression.
Choice D rationale
Induced vomiting is a symptom associated with eating disorders, such as bulimia nervosa. While eating disorders can coexist with postpartum depression, induced vomiting is not a defining symptom of postpartum depression itself. It is a separate clinical finding.
Correct Answer is A
Explanation
A macrosomic infant, weighing over 4000 grams (8 lbs 13 oz), significantly stretches the uterine muscles, leading to a diminished ability to contract effectively after birth. This uterine atony is the primary cause of postpartum hemorrhage. The uterus fails to clamp down on the blood vessels at the placental site, resulting in continuous bleeding. The client’s G6 status further increases this risk due to repeated uterine stretching.
Choice B rationale
Thrombosis is a risk in the postpartum period due to hypercoagulability and venous stasis, but it is not the primary complication associated with a macrosomic infant and high parity. The most immediate and significant risk following this type of delivery is the uterus's inability to contract properly, leading to uncontrolled bleeding. While thrombosis is a concern, it is a secondary risk compared to hemorrhage.
Choice C rationale
Postpartum seizures, also known as eclampsia, are typically associated with preeclampsia and hypertension, not specifically with macrosomic infants or high parity. While a client may have other risk factors for seizures, a large infant and multiparity do not directly cause them. The primary and most immediate physiological risk is the inability of the uterus to involute and stop bleeding.
Choice D rationale
While infection is a risk following any delivery, especially if there are lacerations or a prolonged rupture of membranes, it is not the immediate or most significant complication related to a macrosomic infant. The overwhelming primary concern in this specific scenario is the uterine atony caused by the large infant and multiple pregnancies, which predisposes the client to hemorrhage.
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