A laboring primigravida client at 8 cm of dilation is administered a prescribed pain medication.
The nurse prepares to monitor the newborn for respiratory depression when which medication is administered?
Promethazine.
Oxytocin.
Morphine sulfate.
Misoprostol.
The Correct Answer is C
Choice A rationale
Promethazine is an antihistamine and antiemetic often used as an adjunct to opioids to potentiate the analgesic effects and reduce nausea, but it is not an opioid analgesic. While it can cause some central nervous system (CNS) depression and sedation, it does not directly depress the neonatal respiratory drive by binding to the mu-opioid receptors in the brainstem, which is the mechanism of true opioid-induced respiratory depression.
Choice B rationale
Oxytocin is a synthetic form of the naturally occurring posterior pituitary hormone used to induce or augment labor by stimulating uterine contractions via G-protein coupled receptors on myometrial cells. It does not cross the placenta in amounts sufficient to cause neonatal respiratory depression, as its primary effect is on the uterus, not the fetal central nervous system.
Choice C rationale
Morphine sulfate is an opioid agonist that readily crosses the placenta and enters the fetal circulation. Opioids act on mu-receptors in the fetal respiratory center of the brainstem, leading to a decreased responsiveness to carbon dioxide and resultant respiratory depression in the newborn, especially when administered close to the time of delivery; this is the principal scientific concern.
Choice D rationale
Misoprostol is a prostaglandin E1 analog used for cervical ripening and labor induction by causing potent uterine contractions. Although it can cause uterine hyperstimulation, which may lead to fetal distress from decreased placental perfusion, it does not act on the fetal central nervous system's respiratory centers and does not directly cause opioid-like respiratory depression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Syphilis, caused by the bacterium Treponema pallidum, typically presents as a painless, firm, single ulcer called a chancre at the site of inoculation, appearing 10 to 90 days post-exposure (average 21 days). The patient's description of painful, clustered lesions preceded by a "cold" (prodrome) and fever, appearing 7 days post-intercourse, is inconsistent with the primary stage of syphilis.
Choice B rationale
Chlamydia, caused by the bacterium Chlamydia trachomatis, is often asymptomatic, or can cause symptoms like mucopurulent cervicitis or urethritis with dysuria and discharge. It does not cause painful, blister-like genital lesions. The incubation period is typically 1 to 3 weeks or longer, contrasting with the patient's 7-day onset of painful, vesicular lesions.
Choice C rationale
Genital herpes, caused by Herpes Simplex Virus (HSV-1 or HSV-2), is characterized by the sudden onset of multiple, painful, vesicular lesions (blisters) that rupture and crust over, often preceded by a prodrome of tingling, itching, or flu-like symptoms (fever, malaise) 2 to 12 days after exposure, which aligns well with the patient's presentation and timeline.
Choice D rationale
Human papillomavirus (HPV) causes genital warts (condyloma acuminata), which are typically painless, fleshy, cauliflower-like growths. HPV infection does not present as a primary outbreak of painful, blister-like lesions or a systemic prodrome of fever. The incubation period for HPV is highly variable, ranging from weeks to years.
Correct Answer is A
Explanation
Choice A rationale
The third stage of labor is the time from the birth of the baby until the placenta is expelled. Following placental expulsion, the uterus must contract firmly (like a grapefruit or softball) to clamp down on the open blood vessels at the site where the placenta was attached. This firm contraction is crucial to prevent excessive postpartum hemorrhage.
Choice B rationale
Fetal heart rate variability (fluctuations in the FHR baseline) is an indicator of a healthy fetal nervous system and oxygenation and is a focus of the first and second stages of labor. After the baby is born (end of the third stage), fetal monitoring is no longer relevant; the maternal state and uterine involution are the priorities.
Choice C rationale
While comfort is important throughout labor and post-delivery, the desired physiological outcome at the end of the third stage is focused on preventing hemorrhage. Some discomfort is expected due to uterine contractions ("afterpains") and is an indicator of the desired uterine contraction necessary for hemostasis.
Choice D rationale
A maternal respiratory rate within the expected range (12 to 20 breaths per minute) is a general goal throughout labor. However, the most critical and unique outcome specific to the end of the third stage is the firm uterine contraction to achieve hemostasis and prevent the life-threatening complication of postpartum hemorrhage.
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