Which of the following medications should the nurse plan to administer and document in the client's medical record for a client who is experiencing severe pain during active labor?
Fentanyl citrate
Naloxone hydrochloride
Naproxen
Hydrocodone
The Correct Answer is A
Choice A reason: Fentanyl citrate is appropriate for severe labor pain, as it provides rapid-onset analgesia via IV administration, crossing the blood-brain barrier to block pain signals. Its short half-life minimizes fetal respiratory depression, making it safe for labor. Fentanyl targets opioid receptors, offering effective pain relief, per obstetric analgesia protocols.
Choice B reason: Naloxone hydrochloride is an opioid antagonist used to reverse opioid overdose, not to manage labor pain. It blocks opioid receptors, reversing analgesia, which would exacerbate pain. In labor, naloxone is reserved for neonatal respiratory depression from maternal opioids, not maternal pain relief, per pharmacological principles.
Choice C reason: Naproxen, a nonsteroidal anti-inflammatory drug, is unsuitable for labor pain, as it primarily reduces inflammation and mild pain via prostaglandin inhibition. Labor pain requires rapid, potent analgesia like fentanyl. Naproxen’s slow onset and limited efficacy for visceral pain make it inappropriate for active labor, per pain management guidelines.
Choice D reason: Hydrocodone, an oral opioid, is not used in active labor due to its slow onset and prolonged duration, risking fetal respiratory depression. IV fentanyl provides faster, controlled analgesia suitable for labor’s acute pain. Hydrocodone’s pharmacokinetics are better suited for postpartum or chronic pain, not intrapartum use.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
Choice A reason: A newborn weight of 2.948 kg is normal and not a risk factor for postpartum hemorrhage. Large-for-gestational-age infants (>4 kg) increase uterine overdistension, impairing contraction and causing bleeding. This weight does not strain uterine muscle tone, maintaining normal postpartum hemostasis, per obstetric physiology.
Choice B reason: Uterine atony, failure of the uterus to contract post-delivery, is a major cause of postpartum hemorrhage. Ineffective contractions prevent hemostasis at placental separation sites, leading to excessive bleeding. Myometrial fatigue or previous atony increases risk, as poor uterine tone disrupts clotting cascades, necessitating vigilant monitoring and oxytocic intervention.
Choice C reason: Vacuum-assisted delivery increases postpartum hemorrhage risk due to potential uterine or cervical trauma. Instrumentation can cause lacerations or hematomas, disrupting hemostasis. Tissue trauma triggers local bleeding, and prolonged labor may weaken uterine contractions, impairing clot formation at the placental site, per obstetric complication studies.
Choice D reason: History of human papillomavirus (HPV) does not increase postpartum hemorrhage risk, as it affects cervical epithelium, not uterine contractility or hemostasis. HPV is linked to cervical cancer, not obstetric complications. Postpartum bleeding stems from uterine or traumatic factors, making HPV irrelevant to hemorrhage pathophysiology in the postpartum period.
Choice E reason: Labor induction with oxytocin increases postpartum hemorrhage risk, as prolonged exposure may desensitize myometrial receptors, leading to uterine atony. Ineffective contractions post-delivery impair hemostasis at the placental site, causing bleeding. Oxytocin’s effect on uterine muscle tone requires careful monitoring to prevent excessive blood loss, per obstetric pharmacology.
Correct Answer is D
Explanation
Choice A reason: Mitral valve stenosis at 28 weeks increases cardiac workload, risking heart failure or arrhythmias due to increased blood volume in pregnancy. However, it does not directly cause seizures. Seizure risk is linked to neurological or hypertensive conditions, not cardiac valvular issues, which primarily affect hemodynamic stability and not seizure thresholds.
Choice B reason: A positive Kleihauer-Betke test at 32 weeks indicates fetal-maternal hemorrhage, requiring Rho(D) immune globulin to prevent isoimmunization. It does not increase seizure risk, as it affects blood compatibility, not neurological stability. Seizures are unrelated to this hematological issue, which primarily impacts future pregnancies rather than maternal neurological function.
Choice C reason: Cystic fibrosis at 30 weeks affects respiratory and pancreatic function, leading to infections or malabsorption, but not seizures. Seizure risk requires neurological or hypertensive triggers, not pulmonary or metabolic issues. The condition’s impact on maternal oxygenation does not directly alter seizure thresholds or neurological excitability in pregnancy.
Choice D reason: Severe chronic hypertension at 36 weeks increases seizure risk due to preeclampsia or eclampsia, where elevated blood pressure disrupts cerebral autoregulation, causing neuronal irritability. Seizure precautions are critical, as hypertension-induced endothelial damage and cerebral edema can trigger convulsions, threatening maternal and fetal safety, necessitating magnesium sulfate prophylaxis.
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