A pregnant client has a history of opioid dependence. Which of the following are appropriate nursing interventions for managing her care? Select all that apply.
Advise the client that occasional drug use is safe during pregnancy
offer nonjudgmental counseling and referrals to support services
Encourage abrupt discontinuation of all opioids
Monitor the newborn for signs of neonatal abstinence syndrome (NAS)
Provide methadone therapy as prescribed
Correct Answer : B,D,E
A. This is incorrect. There is no safe level of illicit opioid use during pregnancy. Encouraging or implying safety could put both the mother and fetus at serious risk, including preterm labor, low birth weight, and neonatal abstinence syndrome (NAS).
B. Providing a supportive, nonjudgmental approach encourages the client to engage in care, disclose substance use, and access rehabilitation, counseling, and social services, which improves maternal and fetal outcomes.
C. Abrupt cessation of opioids in a dependent pregnant client can lead to maternal withdrawal, fetal distress, preterm labor, or miscarriage. Safe management involves medically supervised opioid replacement therapy, not sudden discontinuation.
D. Infants exposed to opioids in utero are at risk for NAS, which includes tremors, irritability, feeding difficulties, respiratory problems, and seizures. Early identification and intervention are essential.
E. Methadone or buprenorphine therapy is the standard of care for managing opioid dependence during pregnancy. These therapies stabilize maternal opioid levels, reduce illicit drug use, and improve pregnancy outcomes. Therapy should be medically supervised.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. EMLA cream is a pharmacologic intervention because it contains local anesthetics (lidocaine and prilocaine) that numb the skin. It must be applied 30–60 minutes before the procedure under an occlusive dressing to achieve effective analgesia. Applying it immediately before a heel stick would not provide pain relief and does not qualify as nonpharmacologic.
B. Intramuscular opioids are systemic pharmacologic agents used for moderate to severe pain. They carry risks such as respiratory depression, sedation, and hypotension in neonates, so they are rarely used for minor procedures like heel sticks.
C. Distraction with toys or verbal explanations is ineffective for neonates because infants at 2 days old cannot process or respond to visual or verbal cues. Cognitive engagement strategies work only in older infants and children.
D. Oral sucrose combined with nonnutritive sucking (e.g., using a pacifier) is a safe and evidence-based nonpharmacologic method for reducing procedural pain in neonates. Sucrose triggers the release of endogenous opioids in the central nervous system, which decreases the perception of pain. Nonnutritive sucking provides comfort and a calming effect, further reducing physiological stress responses such as increased heart rate, blood pressure, and crying. Studies show that this intervention effectively lowers behavioral and physiological indicators of pain during minor procedures such as heel sticks, venipuncture, or immunizations. This method is preferred for routine procedures in neonates because it is simple, safe, and effective without the risks associated with pharmacologic agents.
Correct Answer is ["0.96"]
Explanation
Ordered dose = 400 mg
Available = 500 mg in 1.2 mL
Step 1: Use the formula
Volume to administer = (Ordered dose ÷ Available dose) × Volume available
Step 2: Substitute the values
Volume = (400 ÷ 500) × 1.2
Step 3: Calculate
Volume = 0.8 × 1.2 = 0.96 mL
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