Which of the following maneuvers is most commonly used first to relieve shoulder dystocia during childbirth?

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

While clients with Cushing's syndrome may experience fatigue due to elevated cortisol levels affecting sleep patterns and muscle catabolism, clustering activities only in the morning may not adequately address the fluctuating energy levels or provide sufficient rest periods throughout the day. A more balanced approach involving rest periods and activity modification throughout the day is generally more beneficial.

Choice B rationale

Clients with Cushing's syndrome often experience fluid retention and edema due to the mineralocorticoid effects of excess cortisol. Therefore, increasing fluid intake would exacerbate fluid overload rather than alleviate symptoms. Fluid restriction and diuretic therapy may be necessary to manage fluid balance and prevent complications like hypertension and heart failure.

Choice C rationale

Cushing's syndrome is characterized by endogenous overproduction of cortisol, meaning the body already produces too much. Requesting a medical prescription for cortisol would further elevate cortisol levels, worsening the client's symptoms and potentially leading to adrenal crisis if exogenous cortisol is administered in addition to already elevated endogenous levels. Management focuses on reducing cortisol.

Choice D rationale

Assessing daily weights is crucial for clients with Cushing's syndrome due to the propensity for fluid retention and weight gain caused by increased mineralocorticoid activity of cortisol. Daily weights provide an objective measure of fluid balance and can indicate exacerbation or improvement of edema, helping guide interventions and monitor treatment effectiveness. Normal weight fluctuation should be within 1-2 kg in 24 hours.