A nurse is caring for a patient in the latent phase of labor who is requesting an epidural for minor labor pains.
The nurse encourages the patient to delay the epidural because she knows that walking and frequent position changes in labor can help to do which of the following? Select all that apply.

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.

Choice A rationale

Vacuum extraction involves applying a suction cup to the fetal scalp to assist with delivery. The pressure from the vacuum can cause a collection of blood between the periosteum and the skull, known as a cephalohematoma. This condition is confined to one cranial bone and does not cross suture lines. It typically resolves on its own over weeks to months.

Choice B rationale

A depressed fontanelle is a sign of dehydration or sunken sutures. In a vacuum-assisted delivery, the opposite often occurs, with the suction creating a "chignon" or caput succedaneum (scalp swelling) that can make the fontanelles appear full or even bulging, but not depressed. A depressed fontanelle is not a complication of this procedure.

Choice C rationale

A ruptured uterus is a rare but severe complication of labor. While it can be associated with oxytocin use or a history of previous uterine surgery, it is not a direct complication of vacuum extraction itself. The risk factors for uterine rupture are different and not directly related to the application of the vacuum cup to the fetal head.

Choice D rationale

Down syndrome is a chromosomal disorder (trisomy 21) that occurs at conception. It is not caused by labor or delivery methods, including vacuum extraction. This is a congenital condition resulting from an extra copy of chromosome 21. A vacuum delivery has no impact on the genetic makeup of the fetus.