Barbiturates create a sedative effect. When the client stops taking barbiturates, he will experience tachycardia, diarrhea, and tachypnea. When given in IV anesthetics, barbiturates will produce a reduction in blood pressure and an increase in heart rate. Respiratory depression and apnea may occur. Given the potential for severe adverse events including death, a pharmacist should verify the dosing, and perform a thorough medication reconciliation to ensure there are no drug interactions, in particular, additive CNS depression effects.

Option A: Ehough depression and suicidal ideation go along with barbiturate use; it is not the priority. Barbiturates cause postsynaptic enhancement of GABA, interacting with alpha and beta subunits of the GABA-A receptor. Barbiturates increase chloride ion flux which results in GABA-induced postsynaptic inhibition. Phenobarbital and pentobarbital affect the GABA-A receptors with a dose-dependent response.
Option C: Muscle cramps and abdominal pain are vague symptoms that could be associated with other problems. Barbiturate classification is according to the duration of their action, IV formulations of thiopental and methohexital are in the ultra short-acting class. The short and intermediate-acting have an effect lasting 2 to 6 hours. This classification includes sleeping medications pentobarbital, secobarbital, amobarbital, and butabarbital. Long-acting barbiturates have an effect of longer than 6 hours and include barbital and phenobarbital.
Option D: Tachycardia is associated with stopping barbiturates, but euphoria is not. At higher micromolar concentrations associated with anesthetic levels, these drugs directly activate chloride channels. Both barbiturates and benzodiazepines interact with GABA-A receptors, but barbiturates are unique in that they potentiate GABA-A receptors while increasing chloride ion influx even with very low concentrations of the GABA neurotransmitter.

If the fetal heart tones are heard in the right upper abdomen, the infant is in a breech presentation. A breech position is not ideal for delivery. Though the majority of breech babies are born healthy, they may have a higher risk of birth defects or trauma during delivery. This position can also be problematic because it increases the risk of forming a loop in the umbilical cord that could cause injury to the baby if they’re delivered vaginally.

Option B: If the infant is positioned in the right occiput anterior presentation, the FHTs will be located in the right lower quadrant, so answer B is incorrect. The baby is head down, with their face facing the mother’s back. The baby’s chin is tucked into their chest and their head is ready to enter the pelvis. The baby is able to flex their head and neck, and tuck their chin into their chest. This is usually referred to as occipito-anterior, or the cephalic presentation.
Option C: If the fetus is in the sacral position, the FHTs will be located in the center of the abdomen, so answer C is incorrect. Left Sacrum Anterior (LSA) means the fetal sacrum is closest to the mother’s symphysis and rotated slightly to the mother’s left (clockwise from direct SA).
Option D: If the FHTs are heard in the left lower abdomen, the infant is most likely in the left occiput transverse position, making answer D incorrect. This LOT (Left, Occiput, Transverse) position and its’ mirror image, ROT, are common in early labor. As labor progresses and the fetal head descends, the occiput usually rotates anteriorly, converting this LOT to an LOA or OA as the head delivers.

Asthma is the presence of bronchial spasms. This spasm can be brought on by allergies or anxiety. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production.

Option A: The primary physiological alteration is not inflammation. Airway obstruction occurs due to the combination of inflammatory cell infiltration; mucus hypersecretion with mucus plug formation; and smooth muscle contraction.
Option B: There is the production of abnormally viscous mucus, not a primary alteration. If not corrected rapidly, asthma may become more difficult to treat, as the mucus production prevents the inhaled medication from reaching the mucosa. The inflammation also becomes more edematous. This process is resolved (in theory complete resolution is required in asthma, but in practice, this is not checked or tested) with beta-2 agonists (e.g., salbutamol, salmeterol, albuterol) and can be aided by muscarinic receptor antagonists (e.g., ipratropium bromide), which act to reduce the inflammation and relax the bronchial musculature, as well as reducing mucus production
Option C: The infection is not primary to asthma. These irreversible changes may become irreversible over time due to basement membrane thickening, collagen deposition, and epithelial desquamation, and airway remodeling occurs in chronic disease with smooth muscle hypertrophy and hyperplasia.

The client with mania is seldom sitting long enough to eat and burns many calories for energy. Finger foods or things a client can eat while moving around are the best options to improve nutrition. Decreasing environmental stimulation may assist the client to relax; the nurse must provide a quiet environment without noise, television, and other distractions.

Option B: The client should be treated the same as other clients. Frequently remind the client to eat (e.g.,Rob, finish your pancake”, “Sandra, drink this apple juice.”). The manic client is unaware of bodily needs and is easily distracted. Needs supervision to eat.
Option C: Small meals are not the correct option for this client. Encourage frequent high-calorie protein drinks and finger foods (e.g., sandwiches, fruit, milkshakes). Constant fluid and calorie replacement are needed. The client might be too active to sit at meals. Finger foods allow “eating on the run”.
Option D: Allowing her into the kitchen gives her privileges that other clients do not have and should not be allowed. Monitor intake, output, and vital signs. Ensures adequate fluid and caloric intake; minimizes dehydration and cardiac collapse.

Bryant’s traction is used for fractured femurs and dislocated hips. The hips should be elevated 15° off the bed. Bryant’s traction is used for developmental dislocated hip(s) (DDH). In Bryant’s traction, the child’s body and the weights are used as tension to keep the end of the femur (the large bone that goes from the knee to the hip) in the hip socket. Traction will help position the top of the femur into the hip socket correctly

Option A: The hips should not be resting on the bed. Let the weights hang freely. They should not touch the bed. Keep all blankets and sheets away from the traction ropes. In order to have effective traction, make sure to position the patient properly with a correct body alignment in the center of the bed to have a good maintenance of the pull. Ropes and weights should be observed and checked regularly to make sure it is moving freely on the pulley.
Option C: The hips should not be above the level of the body. The rope knots should be maintained in a right position in order to prevent it from touching the pulley. And the comfort of the patient should be maintained, and making sure he/she is comfortable in his/her position to avoid any further complications.
Option D: The hips and legs should not be flat on the bed. With Bryant’s traction, the legs are wrapped with strips of adhesive tape (moleskin) attached to a gauze adhesive elastic bandage (Elastoplast), then more moleskin and Elastoplast, then connected to ropes and weights. The bandage and weights do not hurt the child.