A nurse is reinforcing teaching with the mother of a newborn about the proper use of a bulb syringe for suctioning.
Which of the following instructions should the nurse include in the teaching?

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.

Choice A rationale:

At approximately 20 weeks of gestation, the fundus is typically located at the level of the umbilicus. By 32 weeks, the uterus has grown significantly beyond this point. Therefore, a fundal height at the umbilicus would be inconsistent with 32 weeks gestation and may suggest intrauterine growth restriction or incorrect dating if observed.

Choice B rationale:

At 32 weeks of gestation, the fundus is expected to be located about halfway between the umbilicus and the xiphoid process. Fundal height in centimeters generally correlates with gestational age between 20 and 36 weeks. Thus, a measurement of approximately 32 cm from the symphysis pubis to the top of the fundus is expected, placing it midway between these anatomical landmarks.

Choice C rationale:

The fundus typically reaches the xiphoid process around 36 to 40 weeks of gestation. At 32 weeks, it has not yet ascended to this level. A fundal height at the xiphoid process at 32 weeks may suggest polyhydramnios, macrosomia, or multiple gestation, and would require further evaluation.

Choice D rationale:

At 16 weeks of gestation, the fundus is generally located halfway between the symphysis pubis and the umbilicus. By 32 weeks, the uterus has expanded well beyond this point. A fundal height at this level would be abnormally low for 32 weeks and could indicate fetal growth restriction or oligohydramnios.