NM 704 TEST PAPER 2026 COMPLETE
QUESTIONS AND VERIFIED ANSWERS
◉ Demerol (timing of administration and side effx). Answer:
Demerol generally is not recommended for peripartum analgesia
because its active metabolite, normeperidine, has a prolonged half-
life in adults and a half-life of up to 72 hours in the neonate; the
normeperidine effect cannot be antagonized by naloxone
◉ Morphine (timing of administration and side effx). Answer:
Crosses the placenta and may have adverse effects for the fetus or
newborn. This may be reflected in loss of variability in the fetal heart
rate (FHR), reduction in the FHR baseline, neonatal respiratory
depression, or neurobehavioral changes. Drug elimination takes
longer in newborns than in adults, so effects may be prolonged,
particularly if administered near the time of delivery.
◉ Nubain (timing of administration and side effx). Answer:
Nalbuphine and butorphanol are mixed agonist-antagonists and,
therefore, are associated with less respiratory depression for an
equianalgesic dose. May trigger withdrawal symptoms or reduce
analgesic effects in those receiving opioid agonist therapy.
◉ Stadol (timing of administration and side effx). Answer: Maternal
ceiling effect on respiratory depression and analgesia. Fetal
,transient pseudo-sinusoidal FHR. May precipitate acute withdrawal
syndrome in opiate-dependent mother and baby.
◉ Fentanyl (timing of administration and side effx). Answer: Short
acting; less effective than morphine or Demerol, but very few side
effects noted. With higher doses or prolonged infusions, becomes
longer lasting. Transient decreased FHR variability or pseudo-
sinusoidal pattern.
◉ Remifentanil (timing of administration and side effx). Answer:
Remifentanil is an ultra-short-acting opioid without active
metabolites. Its pharmacokinetics allow for easy titration during
labor and for less risk of respiratory depression in the newborn.
Administered by PCA, better relief than other opioids
◉ What components should be monitored to evaluate the well-being
of mother and baby during 2nd stage of labor?. Answer: Vital signs,
FHR, nutrition and hydration, bladder distention, pain/comfort,
coping, level of fatigue
◉ How often should mom's vital signs be assessed in second stage
labor?. Answer: BP: q15 min (check between contractions)
Temp, pulse, RR: q60 min
, ◉ How often should fetal heart rate be assessed in second stage
labor?. Answer: q5-15 min, increase frequency as presenting part
descends
◉ What is the difference between alternative and traditional
definitions of second stage labor?. Answer: Traditional- begins with
complete dilation and ends with birth of the baby
Alternative (aka Physiologic)- begins with the onset of involuntary
expulsive efforts (urge to push) and ends with the birth of the baby
◉ What is the physiologic basis for the urge to push?. Answer: It is
called the Ferguson reflex- stimulation of the nerve plexus occurs as
the presenting part descends and applies pressure on the pelvic
floor- usually around +1 station. Creates an urge to push
◉ Is there evidence that pushing prior to complete dilation causes
complications?. Answer: No, there is no evidence that supports this
contention.
◉ Does delaying pushing until the woman has an urge (even if she is
complete) affect outcomes?. Answer: It slightly improves outcomes
such as: slight increase in spontaneous vaginal births, increase rate
of unassisted vaginal births, decreased perineal trauma, decreased
FHR decels, higher 1 min APGAR, less maternal exhaustion. No
QUESTIONS AND VERIFIED ANSWERS
◉ Demerol (timing of administration and side effx). Answer:
Demerol generally is not recommended for peripartum analgesia
because its active metabolite, normeperidine, has a prolonged half-
life in adults and a half-life of up to 72 hours in the neonate; the
normeperidine effect cannot be antagonized by naloxone
◉ Morphine (timing of administration and side effx). Answer:
Crosses the placenta and may have adverse effects for the fetus or
newborn. This may be reflected in loss of variability in the fetal heart
rate (FHR), reduction in the FHR baseline, neonatal respiratory
depression, or neurobehavioral changes. Drug elimination takes
longer in newborns than in adults, so effects may be prolonged,
particularly if administered near the time of delivery.
◉ Nubain (timing of administration and side effx). Answer:
Nalbuphine and butorphanol are mixed agonist-antagonists and,
therefore, are associated with less respiratory depression for an
equianalgesic dose. May trigger withdrawal symptoms or reduce
analgesic effects in those receiving opioid agonist therapy.
◉ Stadol (timing of administration and side effx). Answer: Maternal
ceiling effect on respiratory depression and analgesia. Fetal
,transient pseudo-sinusoidal FHR. May precipitate acute withdrawal
syndrome in opiate-dependent mother and baby.
◉ Fentanyl (timing of administration and side effx). Answer: Short
acting; less effective than morphine or Demerol, but very few side
effects noted. With higher doses or prolonged infusions, becomes
longer lasting. Transient decreased FHR variability or pseudo-
sinusoidal pattern.
◉ Remifentanil (timing of administration and side effx). Answer:
Remifentanil is an ultra-short-acting opioid without active
metabolites. Its pharmacokinetics allow for easy titration during
labor and for less risk of respiratory depression in the newborn.
Administered by PCA, better relief than other opioids
◉ What components should be monitored to evaluate the well-being
of mother and baby during 2nd stage of labor?. Answer: Vital signs,
FHR, nutrition and hydration, bladder distention, pain/comfort,
coping, level of fatigue
◉ How often should mom's vital signs be assessed in second stage
labor?. Answer: BP: q15 min (check between contractions)
Temp, pulse, RR: q60 min
, ◉ How often should fetal heart rate be assessed in second stage
labor?. Answer: q5-15 min, increase frequency as presenting part
descends
◉ What is the difference between alternative and traditional
definitions of second stage labor?. Answer: Traditional- begins with
complete dilation and ends with birth of the baby
Alternative (aka Physiologic)- begins with the onset of involuntary
expulsive efforts (urge to push) and ends with the birth of the baby
◉ What is the physiologic basis for the urge to push?. Answer: It is
called the Ferguson reflex- stimulation of the nerve plexus occurs as
the presenting part descends and applies pressure on the pelvic
floor- usually around +1 station. Creates an urge to push
◉ Is there evidence that pushing prior to complete dilation causes
complications?. Answer: No, there is no evidence that supports this
contention.
◉ Does delaying pushing until the woman has an urge (even if she is
complete) affect outcomes?. Answer: It slightly improves outcomes
such as: slight increase in spontaneous vaginal births, increase rate
of unassisted vaginal births, decreased perineal trauma, decreased
FHR decels, higher 1 min APGAR, less maternal exhaustion. No
