The obstetrician opts to use a vacuum extraction device for a delivery. The nurse understands that:
1. There is little risk with vacuum devices.
2. There should be further fetal descent with the first two pulls.
3. Traction is applied between contractions.
4. The woman often feels increased discomfort during the procedure.
2
Rationale:
1. There is increased risk of complications with the use of a vacuum device.
2. There should be further descent with the first two pulls on the vacuum device, which will indi-cate there is nothing holding the fetus back.
3. Traction should be applied with contractions to maximize the effort.
4. The woman often feels only slight pressure during a vacuum extraction if she has adequate re-gional anesthesia.
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The procedure for palpation of the axillary lymph nodes is to first stand at the patient's right side, facing the patient, and next
a. ask her to flex her head to enhance relaxation of the shoulders and arms. b. abduct her left arm, using your left hand to relax the axillary muscles. c. adduct her right arm, using your left hand so that it is close to the chest wall. d. support her flexed left arm on your left forearm.
As you are attending to your patient's hypotension waiting for the anaesthetist to arrive, you note that her heart rate has fallen to 46 bpm. What should you do now? Provide rationales for you answer
Mrs Lucia Caruso is a 31-year-old woman who has been admitted into the postanaesthesia care unit (PACU) following a dilation and curette after having had an incomplete missed abortion (miscarriage). On arrival, Mrs Caruso has a size 3 laryngeal mask airway (LMA) in situ, and is unconscious and in a supine position. A disposable t-piece and oxygen, 6 litres per minute, are connected to the LMA and monitoring is connected. You accept a full handover from the anaesthetist, who reports a fit and healthy patient and an uneventful procedure. An IV line is in situ in the back of the patient's left hand with a litre of Hartmann's solution running at an 8-hourly rate. You make your initial assessment and document the patient's vital signs as follows: airway clear, oxygen saturation 99%, respiratory rate 18 per minute, BP 130/90 mmHg (preoperative 120/80 mmHg) and heart rate regular at 74 bpm. Five minutes after arrival, Mrs Caruso stirs and opens her eyes and you remove the LMA and place her on 6 litres of O2 via a Hudson mask. Now that the patient is conscious, you continue your observations, taking and recording her core temperature (using a tympanic ear thermometer) at 36.2°C and assessing the per vaginal (PV) loss, which is slight and bright. You sit Mrs Caruso slightly head up to facilitate optimal ventilation. Mrs Caruso is understandably upset and so you comfort her. Her vital signs remain stable and so after 15 minutes you remove her oxygen and trial her on room air. Mrs Caruso appears stable: SaO2 97% on room air, BP 115/85 mmHg, respirations 20 per minute and heart rate 70 bpm. No further PV loss is present and so you conclude that your patient is ready to be transported to the ward. You decide to record the next set of observations (due in 2 minutes) on the ward observation chart and then you will call the ward nurse to collect Mrs Caruso. What will be an ideal response?
Which information should the nurse include in the education for a client with peptic ulcer disease prescribed omeprazole (Prilosec)?
A. Omeprazole (Prilosec) should not be crushed or chewed. B. Omeprazole (Prilosec) is best taken with yogurt. C. Omeprazole (Prilosec) is recommended for long-term treatment of peptic ulcer disease. D. Omeprazole (Prilosec) should be administered before meals. E. Omeprazole (Prilosec) should be administered after meals.
An 18-month-old child who attends day care has head lice and has been treated with permethrin 1% (Nix). The parent brings the child to the clinic 1 week later, and the primary care NP notes live bugs on the child's scalp. The NP should order:
a. lindane. b. malathion. c. ivermectin. d. permethrin 5%.