A laboring client received nalbuphine (Nubain) IV 90 minutes before she gave birth.
Which of the following medications should be available to reduce the postnatal effects of nalbuphine (Nubain) on the neonate?
Naloxone (Narcan)
Ephedrine
Promethazine (Phenergan)
Fentanyl (Sublimaze)
Fentanyl (Sublimaze)
The Correct Answer is A
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Joining a support group can be beneficial. I can provide some recommendations.
Support groups offer a safe and supportive environment where couples can share their experiences, feelings, and coping strategies with others who understand what they are going through. This can be incredibly helpful in reducing isolation, normalizing their emotions, and promoting a sense of hope. Support groups can also provide valuable information and resources about infertility, treatment options, and coping strategies. Additionally, they can help couples develop a sense of community and belonging, which can be especially important during a challenging time.
I can provide some recommendations for support groups in your area. This demonstrates the nurse's willingness to help the couple find the resources they need and underscores the value of support groups in managing infertility.
Choice B rationale:
Share your situation with friends and family so they can provide support.
While sharing with friends and family can be helpful for some couples, it's important to recognize that not everyone may be able to provide the kind of support that is needed. Some friends and family members may not understand the challenges of infertility or may offer unsolicited advice, which can be hurtful. Additionally, couples may not feel comfortable sharing such personal information with their loved ones. It's important to respect the couple's privacy and preferences in this regard.
Choice C rationale:
Start adoption proceedings immediately as it can be challenging to adopt an infant.
This response is not appropriate as it does not address the couple's immediate concern, which is how to maintain their emotional balance while dealing with infertility. It also assumes that the couple is interested in adoption, which may not be the case. While adoption can be a wonderful option for some families, it's a major decision that requires careful consideration and should not be rushed into.
Choice D rationale:
Speak only with other friends who are dealing with infertility as they can provide the most help.
While connecting with others who are experiencing infertility can be helpful, it's important not to isolate oneself from other sources of support. Friends and family who are not dealing with infertility can still offer valuable support, understanding, and companionship. It's important to have a variety of supportive relationships in one's life.
Correct Answer is A
Explanation
Choice A rationale:
Trisomy 21, also known as Down syndrome, is a genetic condition caused by the presence of an extra copy of chromosome 21.
The nuchal translucency test (NT) is a non-invasive ultrasound screening test that measures the thickness of the fluid-filled space at the back of a developing baby's neck.
Evidence suggests that fetuses with Down syndrome tend to have increased fluid accumulation in this area, resulting in a larger-than-average nuchal translucency measurement.
Therefore, an increased NT measurement can be a marker for an increased risk of Down syndrome.
It's important to emphasize that the NT test is a screening tool, not a diagnostic test.
This means it can only indicate an increased risk of Down syndrome; it cannot definitively diagnose the condition.
To confirm a diagnosis, further testing, such as chorionic villus sampling (CVS) or amniocentesis, is required.
Choice B rationale:
Neural tube defects (NTDs) are birth defects that affect the brain, spine, or spinal cord.
The most common NTDs are spina bifida and anencephaly.
The NT test is not a diagnostic test for NTDs, although it might detect some cases of open spina bifida.
However, it's not specifically designed for this purpose, and other tests, such as alpha-fetoprotein (AFP) screening or detailed ultrasound, are more reliable for diagnosing NTDs.
Choice C rationale:
The NT test is typically performed in the first trimester of pregnancy, between 11 and 14 weeks gestation.
It's not available in the second trimester because the nuchal translucency measurement becomes less reliable after this point in pregnancy.
Choice D rationale:
A nuchal translucency measurement of 3mm or less is generally considered normal.
Measurements greater than 3mm are associated with an increased risk of Down syndrome and other chromosomal abnormalities.
The higher the measurement, the greater the risk.
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