What must the nurse do when administering promethazine?

Correct Answer: C

Rationale: C: Dilute before IV administration is the correct answer because promethazine is a vesicant, meaning it can cause tissue damage if it leaks out of the vein during IV administration. Diluting the medication before IV administration helps reduce the risk of tissue injury. It is important for the nurse to follow the proper dilution guidelines provided by the medication manufacturer or hospital policy to ensure safe administration. A: Administer subcutaneously is incorrect because promethazine should not be given subcutaneously. Subcutaneous administration can cause tissue irritation and damage due to the medication's pH and osmolality. It is important to administer promethazine through the correct route to prevent harm to the patient. B: Never administer with an opioid is incorrect because promethazine can be safely administered with opioids in some situations. However, the combination of promethazine with opioids can increase the risk of respiratory depression and other side effects. It is essential for the nurse to monitor the patient closely when administering these medications together. D: Never administer in first stage labor is incorrect because promethazine can be used in the management of nausea and vomiting during labor. However, the nurse should be cautious when administering promethazine in labor as it can cross the placenta and affect the fetus. It is important to assess the risks and benefits of using promethazine in labor on a case-by-case basis.

Correct Answer: B

Rationale: General anesthesia is a medical procedure that allows patients to be unconscious and unaware during surgery. It is essential to consider various factors before administering general anesthesia to ensure the safety and well-being of the patient. Choice A, hyperactive newborns, does not limit the use of general anesthesia. In fact, hyperactivity in newborns is not a contraindication for general anesthesia. It is essential to monitor and manage hyperactivity during the procedure, but it does not necessarily restrict the use of general anesthesia. Choice C, an increase in uterine contractions, is also not a limiting factor for general anesthesia. While it is crucial to consider the effects of anesthesia on uterine contractions during childbirth, it does not necessarily prevent the use of general anesthesia altogether. Choice D, a decrease in cervical dilation, is not a direct limitation of general anesthesia. Cervical dilation is a physiological process that may impact the delivery of a baby but does not specifically restrict the use of general anesthesia. The correct answer is B, newborn respiratory depression. Respiratory depression, or the slowing down of breathing, is a significant concern when administering general anesthesia, especially in newborns. Newborns have underdeveloped respiratory systems, making them more susceptible to respiratory depression under anesthesia. Monitoring and managing respiratory function are crucial during anesthesia to prevent complications such as hypoxia or respiratory failure. Therefore, the potential for newborn respiratory depression limits the use of general anesthesia in this population.

Correct Answer: D

Rationale: In obstetric triage, it is essential to gather information that can help in assessing the immediate needs and risks of pregnant patients. A 24-hour diet recall is a crucial component of obstetric triage because it provides valuable information about the patient's nutritional status, which can impact maternal and fetal health. By understanding what the patient has consumed over the past day, healthcare providers can assess if the patient is meeting their nutritional needs and address any deficiencies or concerns. History and physical assessment (Choice A) is also important in obstetric triage as it allows healthcare providers to gather information about the patient's medical history, current symptoms, and physical well-being. This information helps in determining the appropriate course of action for the patient's care. Fetal monitoring (Choice B) is typically not a component of obstetric triage as it is more focused on assessing the well-being of the fetus during labor and delivery. While fetal monitoring is crucial in certain situations, such as during labor, it is not typically done during triage assessments. Estimated Due Date (EDD) (Choice C) is important information to have during pregnancy, but it is not a component of obstetric triage. EDD is used to track the progress of pregnancy and plan for labor and delivery but does not provide immediate information that is necessary during a triage assessment. Overall, a 24-hour diet recall is the most essential component of obstetric triage as it provides valuable information about the patient's nutritional status, which can impact maternal and fetal health.

Correct Answer: C

Rationale: C is the correct answer because when a person is receiving oxytocin, it is crucial to closely monitor the fetal heart rate due to the potential risk of uterine hyperstimulation, which can lead to fetal distress. Assessing the fetal heart rate every 5 minutes allows the nurse to promptly identify any changes in the heart rate pattern and take appropriate action to prevent harm to the fetus. A (every 30 minutes) is incorrect because this interval is too long when oxytocin is being administered. Waiting 30 minutes between assessments may result in delayed recognition of fetal distress and could lead to adverse outcomes. B (every 15 minutes) is also incorrect as this interval is still too long for close monitoring of fetal well-being in the presence of oxytocin. Waiting 15 minutes between assessments may not provide timely information to intervene if needed. D (every 1 hour) is the furthest from the correct answer. Waiting an hour between assessments is far too infrequent when oxytocin is being used, as uterine hyperstimulation and fetal distress can occur rapidly. This interval does not allow for timely detection and intervention in case of complications. In conclusion, assessing the fetal heart rate every 5 minutes when a person is receiving oxytocin is essential for ensuring the safety and well-being of both the mother and the fetus. This frequent monitoring allows for early detection of any issues and timely intervention to prevent adverse outcomes.

Correct Answer: A

Rationale: Delayed cord clamping refers to waiting a certain amount of time before clamping and cutting the umbilical cord after the baby is born. This practice has been shown to have various benefits for the newborn, such as increased iron levels and better cardiovascular stability. The optimal time for delayed cord clamping is typically between 30-60 seconds after birth. Choice A (30-60 seconds) is the correct answer because it falls within the recommended timeframe for delayed cord clamping. Waiting this amount of time allows for the transfer of additional blood from the placenta to the baby, which can be beneficial for their overall health and development. Choice B (15-30 seconds) is incorrect because it is a bit too short of a timeframe for optimal delayed cord clamping. While it is better than immediate clamping, waiting a bit longer can provide more benefits for the baby. Choice C (30 seconds) is also incorrect because it is on the lower end of the recommended timeframe. Waiting just 30 seconds may not allow for as much blood transfer from the placenta to the baby compared to waiting a bit longer. Choice D (Delayed cord clamping is not recommended) is incorrect because delayed cord clamping is actually recommended by many healthcare providers and organizations due to its potential benefits for the newborn. It is important to follow evidence-based practices and recommendations regarding delayed cord clamping to optimize outcomes for the baby.