A nurse is collecting data from a client who is at 34 weeks of gestation and has hyperglycemia.
Which of the following manifestations should the nurse expect?

Choice A rationale

Nalbuphine hydrochloride is an opioid agonist-antagonist analgesic that primarily acts on kappa opioid receptors, producing analgesia, and partially on mu opioid receptors, which can lead to adverse effects like sedation. Sedation is a common central nervous system depressant effect of opioid medications due to their action on specific brainstem and cortical regions, altering neurotransmission and decreasing overall neuronal excitability. The degree of sedation can vary depending on the dosage and individual patient sensitivity.

Choice B rationale

Fever is an elevated body temperature and is not a direct adverse effect typically associated with nalbuphine hydrochloride. Fever is more commonly indicative of an infectious process, inflammatory response, or certain drug reactions (e.g., drug fever), but it is not a direct pharmacological action or common side effect of opioid analgesics like nalbuphine. Opioids generally do not affect thermoregulation in a way that causes a fever.

Choice C rationale

Diarrhea is characterized by loose, watery stools and is not a common adverse effect of nalbuphine hydrochloride. Opioids, in general, are more known for causing constipation due to their effects on decreasing gastrointestinal motility and increasing fluid absorption in the intestines, by acting on opioid receptors in the enteric nervous system. Therefore, diarrhea would be an atypical and unexpected response to nalbuphine.

Choice D rationale

Diuresis refers to increased urine production and is not a typical adverse effect of nalbuphine hydrochloride. Opioids can sometimes affect antidiuretic hormone (ADH) secretion, potentially leading to fluid retention or oliguria rather than diuresis. Diuresis is usually associated with diuretic medications or certain physiological conditions that promote increased urine output, which is contrary to the expected effects of opioids on renal function.

? Rationales for Each Condition

1️⃣ Neonatal abstinence syndrome (NAS)

Definition: NAS is a withdrawal syndrome in newborns caused by in utero exposure to opioids or other substances. It typically presents within 24–72 hours after birth.

Findings and Scientific Explanation:

• Cry characteristics: A high-pitched, inconsolable cry is a hallmark of NAS due to autonomic nervous system dysregulation.
• Nasal findings: Sneezing and nasal stuffiness are common due to increased autonomic activity and are not typically seen in hypoglycemia.
• Tremor: Tremors, especially when undisturbed, are due to central nervous system irritability from opioid withdrawal.
• Maternal urine drug screen: A positive result for opioids confirms in utero exposure, supporting a diagnosis of NAS.
• Respiratory rate: Tachypnea (e.g., 65/min on Day 3) is common in NAS due to increased metabolic demand and autonomic instability. Normal neonatal respiratory rate is 30–60/min.

2️⃣ Hypoglycemia

Definition: Neonatal hypoglycemia is defined as a plasma glucose concentration less than 40–45 mg/dL in the first 24 hours of life.

Findings and Scientific Explanation:

• Cry characteristics: Hypoglycemia may cause irritability or weak cry due to neuroglycopenia.
• Tremor: Tremors or jitteriness can result from adrenergic stimulation in response to low glucose levels.
• Respiratory rate: Tachypnea may occur as a compensatory response to metabolic acidosis secondary to hypoglycemia. The newborn had a glucose of 35 mg/dL on Day 1, which is below the normal range (>40–45 mg/dL).