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The physician determines that the fetus of a multiparous client in active labor is in distress, necessitating a cesarean delivery with general anesthesia. Before the cesarean delivery, the anesthesiologist orders cimetidine (Tagamet) 300 mg PO. After administering the drug, the nurse should assess the client for reduction in which of the following?
- A. Incidence of bronchospasm.
- B. Oral and respiratory secretions.
- C. Acid level of the stomach contents.
- D. Incidence of postoperative gastric ulcer.
Correct Answer: C
Rationale: Cimetidine, an H2-receptor blocker, is given before general anesthesia to reduce gastric acid levels, minimizing the risk of aspiration pneumonitis. It does not affect bronchospasm, secretions, or postoperative ulcers directly.
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Which of the following forms the basis for the teaching plan about avoiding medication use unless prescribed for a primiparous client who is breast-feeding?
- A. Breast milk quality and richness are decreased.
- B. The mother's motivation to breast-feed is diminished.
- C. Medications may be excreted in breast milk to the nursing neonate.
- D. Medications interfere with the mother's letdown reflex.
Correct Answer: C
Rationale: Medications can pass into breast milk, potentially affecting the neonate, making this the primary concern.
A 39-year-old multigravid client at 39 weeks' gestation admitted to the hospital in active labor has been diagnosed with class II heart disease. To ensure cardiac emptying and adequate oxygenation during labor, the nurse plans to encourage the client to do which of the following?
- A. Breathe slowly after each contraction.
- B. Avoid the use of analgesics for the labor pain.
- C. Remain in a side-lying position with the head elevated.
- D. Request local anesthesia for vaginal delivery.
Correct Answer: C
Rationale: For class II heart disease, a side-lying position with head elevation reduces cardiac strain by optimizing venous return and oxygenation. Slow breathing is helpful but less specific, avoiding analgesics may increase stress, and local anesthesia is unrelated to cardiac emptying.
Which of the following should the nurse include in the teaching plan for a primiparous client who asks about weaning her neonate?
- A. Wait until you have breast-fed for at least 4 months.
- B. Eliminate the baby's favorite feeding times first.
- C. Plan to omit the daytime feedings last.
- D. Gradually eliminate one feeding at a time.
Correct Answer: D
Rationale: Gradual weaning by eliminating one feeding at a time minimizes discomfort and distress for both mother and baby.
Which of the following actions should the nurse take when performing external cardiac massage on a neonate born at 28 weeks' gestation?
- A. Alternate cardiac massage with ventilation.
- B. Compress the sternum with the palm of the hand.
- C. Compress the chest 70 to 80 times per minute.
- D. Displace the chest 70 to 80 times per minute.
Correct Answer: A
Rationale: Alternating cardiac massage with ventilation follows neonatal resuscitation guidelines to restore circulation and oxygenation.
Following a cesarean delivery for abruptio placentae, a multigravid client tells the nurse, "I feel like such a failure. None of my other deliveries were like this." The nurse's response to the client is based on the understanding of which of the following?
- A. The client will most likely have postpartum blues.
- B. Maternal-infant bonding is likely to be difficult.
- C. The client's feeling of grief is a normal reaction.
- D. This type of delivery was necessary to save the client's life.
Correct Answer: C
Rationale: Grief is a normal reaction to a complicated delivery.