A nurse is caring for a client with hypothyroidism who is starting levothyroxine.
What should the nurse understand about the initial start of levothyroxine for hypothyroidism?

Choice A rationale

A weak cough, inability to talk, and grasping the throat are classic signs of a severe airway obstruction. The Heimlich maneuver, or abdominal thrusts, is the recommended intervention for conscious adults and children experiencing a severe foreign body airway obstruction. It increases intrathoracic pressure to expel the obstruction, restoring airflow and preventing anoxic injury.

Choice B rationale

Slapping the client on the back is not the primary intervention for a conscious adult with a severe airway obstruction and may actually worsen the situation by dislodging the object further into the airway. Back blows are generally recommended for infants or as an alternative for conscious choking victims when abdominal thrusts are not feasible.

Choice C rationale

Assisting the client to the floor and initiating mouth-to-mouth resuscitation is inappropriate when the client is still conscious and has an airway obstruction. Resuscitation efforts are indicated for unresponsive individuals who are not breathing or are only gasping. The priority here is to clear the airway obstruction while the person is still conscious.

Choice D rationale

Observing the client before taking further action is dangerous and could lead to rapid deterioration and loss of consciousness. A severe airway obstruction is a medical emergency requiring immediate intervention. Delaying action significantly increases the risk of hypoxia, brain damage, and cardiac arrest, making prompt and decisive action crucial.

Choice A rationale

Episiotomy involves an incision in the perineum to enlarge the vaginal opening. While it can facilitate delivery, it does not directly address the mechanical obstruction caused by the shoulder impacting against the maternal symphysis pubis, which is the hallmark of shoulder dystocia.

Choice B rationale

The McRoberts maneuver is most commonly used first to relieve shoulder dystocia. It involves hyperflexing the maternal hips onto the abdomen, which flattens the sacrum, rotates the symphysis pubis cephalad, and often allows the impacted anterior shoulder to clear underneath the symphysis pubis, facilitating delivery.

Choice C rationale

The Zavanelli maneuver involves pushing the fetal head back into the birth canal and performing a Cesarean section. This is a highly invasive and often last-resort maneuver, employed only after less invasive methods like McRoberts and suprapubic pressure have failed due to its significant risks.

Choice D rationale

Fundal pressure involves applying downward pressure on the top of the uterus. This maneuver is contraindicated in shoulder dystocia because it can worsen the impaction of the fetal shoulder against the maternal symphysis pubis, potentially leading to more severe injury to the fetus or mother.