The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.

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.

Choice A rationale:

Restriction of movement is not a necessary requirement following IV opioid administration during labor. While some healthcare providers may encourage laboring individuals to rest after receiving pain medication, it is not mandatory to remain in bed.

In fact, remaining upright and mobile can often be beneficial during labor. Movement can help encourage fetal descent, improve circulation, and potentially even shorten labor duration.

It's essential to educate clients about the benefits of staying active during labor, even after receiving pain medication. This can empower them to make informed choices about their comfort and positioning during the birthing process.

Choice B rationale:

This statement is accurate. IV opioids can cross the placenta and potentially affect the fetal heart rate.

It's crucial for clients to be aware of this potential effect so that they can understand the importance of fetal monitoring during labor. Healthcare providers will closely monitor the baby's heart rate to ensure it remains within a normal range.

Choice C rationale:

This statement is also accurate. If a baby is born too soon after the mother receives IV opioids, there is a risk of respiratory depression.

This is because the opioids can cross the placenta and affect the baby's breathing. Healthcare providers are trained to manage this risk and will take appropriate measures to ensure the baby's well-being, such as providing respiratory support if needed.

Choice D rationale:

This statement is correct. IV opioids are primarily used to relieve pain during labor, not to decrease the frequency of contractions.

While they may have some mild effects on contraction strength or duration, their primary purpose is to provide pain relief. It's important for clients to understand this distinction so that they have realistic expectations about the medication's effects.