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NEW QUESTION 46
The nurse needs to be aware that the most common early complication of a myocardial infarction is:

  • A. Diabetes mellitus
  • B. Cardiac dysrhythmia
  • C. Cardiac hypertrophy
  • D. Anaphylactic shock

Answer: B

Explanation:
(A) Diabetes mellitus is not a common complication of myocardial infarction. (B) Anaphylactic shock is an allergic reaction. (C) Cardiac hypertrophy is a late potential complication. It is a common complication of congestive heart failure. (D) Myocardial infarction causes tissue damage, which may interrupt electrical impulses. Myocardial irritability results from lack of oxygenated tissue.

 

NEW QUESTION 47
A client has been in labor for 10 hours. Her contractions have become hypoactive and slowed in duration.
The fetus is at 0 station, cervix is dilated 8 cm and effaced 90%. The physician orders an oxytocin (Pitocin) infusion to be started at once. The RN begins the oxytocin infusion. It is important that the RN discontinue the infusion if which one of the following occur?

  • A. Duration of the contractions are 60 seconds.
  • B. The client’s contractions are <2 minutes apart.
  • C. The client complains that she is tired.
  • D. The uterus relaxes between contractions.

Answer: B

Explanation:
Explanation/Reference:
Explanation:
(A) It is very important that there is a resting phase or relaxation period between the contractions. During this period, the uterus, placenta, and umbilical vessels re-establish blood flow. No resting phase between contractions can lead to fetal bradycardia, fetal hypoxia, and acidosis. It can also result in a tetanic contraction, which can cause uterine rupture. (B) The goal of the oxytocin infusion is to help establish a contraction pattern lasting 45-60 seconds occurring every 2 minutes and a uterine tonus of 60-70 mm Hg.
(C) This choice is correct. The uterus has time to recover from the contraction. (D) The client’s tiring is no indication to stop the infusion. She will be tired even without the infusion.

 

NEW QUESTION 48
A client in active labor asks the nurse for coaching with her breathing during contractions. The client has attended Lamaze birth preparation classes. Which of the following is the best response by the nurse?

  • A. “Find a comfortable position before you start a contraction. Once the contraction has started, take slow breaths using your abdominal muscles.”
  • B. “Make sure you take a deep cleansing breath as the contractions start, focus on an object, and breathe about 16-20 times a minute with shallow chest breaths.”
  • C. “If a woman in labor listens to her body and takes rapid, deep breaths, she will be able to deal with her contractions quite well.”
  • D. “Keep breathing with your abdominal muscles as long as you can.”

Answer: B

Explanation:
(A) Lamaze childbirth preparation teaches the use of chest, not abdominal, breathing. (B) In Lamaze preparation, every patterned breath is preceded by a cleansing breath; as labor progresses, shallow, paced breathing is found to be effective. (C) It is important to assume a comfortable position in labor, but the Lamazeprepared laboring woman is taught to breathe with her chest, not abdominal, muscles. (D) When deep chest breathing patterns are used in Lamaze preparation, they are slowly paced at a rate of 6-9 breaths/min.

 

NEW QUESTION 49
Often children are monitored with pulse oximeter. The pulse oximeter measures the:

  • A. O2 content of the blood
  • B. PO2
  • C. Oxygen saturation of arterial blood
  • D. Affinity of hemoglobin for O2

Answer: C

Explanation:
(A) The O2 content of whole blood is determined by the partial pressure of oxygen (PO2) and the oxygen saturation. The pulse oximeter does not measure the PO2. (B) The pulse oximeter is a noninvasive method of measuring the arterial oxygen saturation. (C) The PO2 is the amount of O2 dissolved in plasma, which the pulse oximeter does not measure. (D) The affinity of hemoglobin for O2 is the relationship between oxygen saturation and PO2 and is not measured by the pulse oximeter.

 

NEW QUESTION 50
……

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