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

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Pulmonary hypertension is not a primary complication of rheumatic fever. While pulmonary vascular changes can occur secondary to left-sided heart dysfunction, this is not the main concern in acute rheumatic fever.

B. Rheumatic fever is an autoimmune response to Group A Streptococcus. It can involve the heart (carditis), joints (polyarthritis), skin (erythema marginatum), and central nervous system (Sydenham chorea). Cardiac involvement is the most serious complication. Pancarditis may affect the endocardium, myocardium, and pericardium, but valvular damage, especially to the mitral valve, can persist long-term, potentially leading to rheumatic heart disease. Monitoring for heart murmurs, arrhythmias, and signs of heart failure is critical.

C. While post-streptococcal glomerulonephritis can follow strep infection, rheumatic fever does not primarily affect the kidneys, and bladder insufficiency is unrelated.

D. Coronary artery aneurysms are associated with Kawasaki disease, not rheumatic fever. Hypertension is not a direct feature of rheumatic fever, and coronary involvement is not typical.

A. Pancreatic enzyme replacement is only required when children develop diabetes, a common complication of CF B. Digestive enzymes are needed to break down fat, which children with CF can digest more efficiently than carbohydrates C. Children with CF have an overproduction of digestive enzymes, leading to malabsorption D. CF causes thickened mucus that obstructs the pancreas, preventing the release of digestive enzymes

Correct Answer is D

Explanation

A. Pancreatic enzyme replacement therapy (PERT) is not tied to the development of diabetes. While CF-related diabetes can occur due to progressive pancreatic damage, enzyme therapy is required much earlier to address malabsorption caused by blocked pancreatic ducts. Waiting for diabetes to develop would allow continued nutrient deficiencies, poor weight gain, and fat-soluble vitamin deficiencies (A, D, E, K).

B. Children with CF do not digest fats more efficiently than carbohydrates. In fact, fat digestion is particularly impaired because pancreatic lipase is insufficient due to duct obstruction. Proteins and carbohydrates are also affected to a lesser extent. PERT provides a mix of lipase, amylase, and protease to compensate for this deficiency and ensure adequate nutrient absorption.

C. CF does not cause an overproduction of digestive enzymes. On the contrary, thick mucus blocks pancreatic ducts, preventing enzymes from reaching the intestines. This blockage leads to enzyme deficiency in the gastrointestinal tract, resulting in malabsorption, steatorrhea (fatty stools), abdominal bloating, and poor growth.

D. In CF, mutations in the CFTR gene lead to thick, sticky mucus production in multiple organs, including the pancreas. This mucus obstructs the pancreatic ducts, preventing digestive enzymes such as lipase, amylase, and protease from reaching the small intestine. Without these enzymes, fats, proteins, and carbohydrates are incompletely digested, causing nutrient malabsorption, fatty stools, and poor weight gain. PERT replaces the missing enzymes, allowing proper digestion and absorption of nutrients, improving growth, and reducing gastrointestinal symptoms. Regular dosing with meals and snacks is essential to optimize nutrient absorption and support normal growth and development in children with CF.

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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.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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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.

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