NCLEX RN Practice Question # 411

naloxone hydrochloride (Narcan)

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  • Used to relieve moderate to severe pain associated with labor
  • Administered by intramuscular or intravenous route
  • Regular use of opioids during pregnancy may produce withdrawal symptoms in the newborn (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, and seizures).

Antidotes for opioids

  • Naloxone (Narcan) is usually the treatment of choice because it rapidly reverses opioid toxicity; the dose may need to be repeated every few hours until opioid concentrations have decreased to nontoxic levels.
  • Nalmefene (Revex) is a long-acting opioid antagonist that does not require repeat doses.
  • These medications can cause withdrawal in opioid-dependent clients.

Meperidine hydrochloride (Demerol) and hydromorphone hydrochloride (Dilaudid)

  • Can cause dizziness, nausea, vomiting, sedation, decreased blood pressure, decreased respirations, diaphoresis, flushed face, urinary retention
  • May be prescribed to be administered with an antiemetic such as promethazine (Phenergan) to prevent nausea
  • High dosages may result in respiratory depression, skeletal muscle flaccidity, cold clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor, and coma.
  • Used cautiously in clients delivering preterm infants
  • Not administered in early labor because it may slow the labor process
  • Not administered in advanced labor (within 1 hour of expected delivery); if the medication is not adequately removed from the fetal circulation, respiratory depression can occur. Fentanyl (Sublimaze) and sufentanil (Sufenta): Can cause respiratory depression, dizziness, drowsiness, hypotension, urinary retention, fetal narcosis and distress

 Butorphanol tartrate (Stadol) and nalbuphine(Nubain)

  • Can cause confusion, sedation, sweating, nausea, vomiting, hypotension, sinusoidal-like fetal heart rhythm
  • Use with caution in a client with preexisting opioid dependency because these medications can precipitate withdrawal symptoms in the client and the newborn.


  • signs, particularly respiratory status; if respirations are 12 breaths/min or less, withhold the medication and contact the health care provider.
  • Monitor the fetal heart rate and characteristics of uterine contractions.
  • Monitor for blood pressure changes (hypotension); maintain the client in a recumbent position (elevate the hip with a wedge pillow or other device).
  • Record the client’s response and level of pain relief.
  • Monitor the bladder for distention and retention.
  • Have the antidote naloxone (Narcan) available, especially if delivery is expected to occur during peak drug absorption time.

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