Nokea
A multigravid laboring client has an extensive documented history of drug addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with contractions every 3 minutes of moderate intensity. The physician orders nalbuphine (Nubain) 15 mg slow I.V. push for pain relief followed by an epidural when the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client states she thinks she is going to have her baby now. Of the following drugs available at the time of the delivery, which should the nurse avoid using with this client in this situation?
- A. 1% lidocaine (Xylocaine).
- B. Naloxone hydrochloride (Narcan).
- C. Local anesthetic.
- D. Pudendal block.
Correct Answer: B
Rationale: In a client with recent opioid use, naloxone (Narcan) could precipitate withdrawal symptoms, which is risky during delivery. Lidocaine, local anesthetics, or pudendal blocks are safe for perineal anesthesia and do not interact with the client's history.
You may also like to solve these questions
A client asks about the risks of the contraceptive injection. Which of the following would the nurse include?
- A. Increased risk of blood clots.
- B. Decreased bone density with long-term use.
- C. Permanent weight loss.
- D. Guaranteed regular periods.
Correct Answer: B
Rationale: The contraceptive injection may decrease bone density with long-term use, which is a significant risk. It does not significantly increase blood clot risk, cause permanent weight loss, or guarantee regular periods.
A client is considering the contraceptive injection. Which of the following side effects should the nurse discuss?
- A. Permanent weight loss.
- B. Irregular menstrual bleeding.
- C. Guaranteed regular periods.
- D. Decreased bone density with long-term use.
Correct Answer: B,D
Rationale: The contraceptive injection can cause irregular menstrual bleeding and decreased bone density with long-term use, which are important side effects to discuss. It does not cause permanent weight loss or guarantee regular periods.
A multigravid client at 39 weeks' gestation diagnosed with insulin-dependent diabetes is admitted for induction of labor with oxytocin (Pitocin). Which of the following should the nurse include in the teaching plan as a possible disadvantage of this procedure?
- A. Urinary frequency.
- B. Maternal hypoglycemia.
- C. Preterm birth.
- D. Neonatal jaundice.
Correct Answer: B
Rationale: Oxytocin induction in diabetic clients increases metabolic demand, risking maternal hypoglycemia due to insulin use. Urinary frequency is unrelated, preterm birth is not a concern at 39 weeks, and neonatal jaundice is not directly linked.
A client asks about the disadvantages of the vaginal contraceptive ring. Which of the following would the nurse include?
- A. It requires daily insertion.
- B. It may cause nausea or breast tenderness.
- C. It is less effective than condoms.
- D. It causes permanent infertility.
Correct Answer: B
Rationale: The vaginal contraceptive ring may cause nausea or breast tenderness, especially initially. It is inserted once every 3 weeks, is more effective than condoms when used correctly, and does not cause permanent infertility.
A nurse is explaining basic principles of asepsis and infection control to a client who has a respiratory tract infection following delivery. The nurse determines the client understands principles of infection control to follow when the client says:
- A. I must use barrier isolation.
- B. I must wear a gown and gloves.
- C. I must use individual client care equipment.
- D. I must practice frequent hand washing.
Correct Answer: D
Rationale: Frequent hand washing is the most effective infection control measure for a respiratory tract infection.