A laboring client received nalbuphine (Nubain) IV 90 minutes before she gave birth.
Which of the following medications should be available to reduce the postnatal effects of nalbuphine (Nubain) on the neonate?
Naloxone (Narcan)
Ephedrine
Promethazine (Phenergan)
Fentanyl (Sublimaze)
Fentanyl (Sublimaze)
The Correct Answer is A
Choice A rationale:
Naloxone is an opioid antagonist. It works by binding to opioid receptors in the brain and body, reversing the effects of opioids. This includes respiratory depression, which is a major concern in neonates exposed to opioids during labor.
Nalbuphine is an opioid agonist-antagonist. This means that it has both agonist and antagonist effects at opioid receptors. At low doses, it acts primarily as an agonist, providing pain relief. However, at higher doses, it can also act as an antagonist, blocking the effects of other opioids.
Naloxone can effectively reverse the respiratory depression caused by nalbuphine in neonates. It is a safe and effective medication that is commonly used for this purpose.
Naloxone should be readily available whenever opioids are administered to a laboring woman. This is to ensure that it can be administered promptly if the neonate experiences respiratory depression.
Choice B rationale:
Ephedrine is a sympathomimetic drug. It works by stimulating the sympathetic nervous system. This can cause a number of effects, including increased heart rate, blood pressure, and respiratory rate.
Ephedrine is not effective in reversing the respiratory depression caused by opioids. It may even worsen the situation by increasing the neonate's oxygen demand.
Ephedrine is not a safe or effective medication for use in neonates. It can cause serious side effects, such as tachycardia, hypertension, and arrhythmias.
Choice C rationale:
Promethazine is a phenothiazine antiemetic. It is commonly used to treat nausea and vomiting.
Promethazine does not have any effects on opioid receptors. It is not effective in reversing the respiratory depression caused by opioids.
Promethazine can cause sedation and respiratory depression in neonates. It should be used with caution in this population.
Choice D rationale:
Fentanyl is a potent opioid analgesic. It is similar to nalbuphine in that it is an opioid agonist.
Fentanyl would not be effective in reversing the respiratory depression caused by nalbuphine. In fact, it would likely worsen the situation by further depressing the neonate's respiratory system.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
This statement suggests that the patient has some awareness of infertility treatments, but it does not necessarily indicate a full understanding of infertility itself.
It's important to consider that a few months of trying to conceive may not be indicative of infertility, as it can take up to a year for healthy couples to achieve pregnancy.
Jumping to fertility treatments without a proper evaluation could lead to unnecessary interventions and potential financial and emotional burdens.
Choice B rationale:
This statement is incorrect. Male factor infertility is a common cause of difficulty conceiving, accounting for about 40% of infertility cases.
It's essential to evaluate both partners when assessing fertility issues.
Choice C rationale:
This statement demonstrates the patient's understanding of the relationship between age and fertility.
Female fertility gradually declines with age, especially after the age of 35, due to a decrease in the number and quality of eggs.
This awareness indicates that the patient is realistic about her chances of conceiving and is prepared to seek appropriate help if needed.
Choice D rationale:
While family history can play a role in infertility, it's not a guarantee that someone will experience the same issues as their relatives.
Each case is unique, and multiple factors can contribute to infertility, including genetics, lifestyle, medical conditions, and environmental factors.
It's important to undergo a thorough evaluation to determine the specific causes of infertility in each individual.
Correct Answer is A
Explanation
Choice A rationale:
Misoprostol (Cytotec) is a medication used to induce labor.
It is placed in the posterior vaginal fornix.
However, it should not be used if the woman’s water has broken.
If the amniotic sac has ruptured, using Misoprostol can increase the risk of infection for both the mother and the baby.
Therefore, the statement “I can receive the Cytotec as long as my water hasn’t broken yet” indicates a need for further education.
Choice B rationale:
Walking can indeed help to speed up labor by using gravity to help the baby descend.
However, once Misoprostol has been administered, the woman is usually asked to lie on her side for about 30 to 40 minutes to allow the medication to be absorbed.
After that, if the healthcare provider agrees, she may be able to walk around.
Choice C rationale:
Monitoring the baby’s heart rate and the woman’s contraction pattern is a standard procedure during labor and delivery.
This allows the healthcare team to ensure the safety of both the mother and the baby.
It is especially important when medications like Misoprostol are used, as they can cause changes in the frequency and strength of contractions.
Choice D rationale:
Nausea and vomiting are potential side effects of Misoprostol.
However, not all women experience these side effects, and if they do occur, they are usually temporary.
The healthcare provider can offer solutions to manage these side effects if they become bothersome.
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