Pediatrics HESI PN Review, HESI PN Obstetrics/Maternity Practice Exam, Pediatrics HESI PN Review, Hesi Peds, PN HESI Peds, Peds & Maternity HESI, HESI Maternity/Pediatric Remediation

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"Bring the child to the clinic today for an examination related to the cough."

There is a question that has to be put in order

*isolate the baby, move mom to private room, collect u/a, start iv*

What is the reason to do an ultrasound on a mother at 20 weeks gestation -

- ultrasound for gestation and fetal growth

The mother of a 6-month-old asks the practical nurse (PN) when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control and Prevention, which response is accurate?

12 to 15 months

A child who weighs 25 kg is receiving IV ampicillin 300mg/kg/24 hours in equally divided doses every 4 hours. How many mg should the nurse administer to the child for each dose?

1875 mg

The health care provider prescribes amoxicillin 60 mg PO three times a day for a child who weighs 13 pounds. The pediatric dosage range is 20 to 40 mg/kg/day in three equal doses. What is the maximum dosage in 24 hours that should be given? (Fill in the blank.)

236 mg Rationale:First, convert the pounds to kg because the conversion is for kg.1 kg = 2.2 lb13 lb/(2.2 lb/kg) = 5.9 kgSecond, determine the maximum dose the child can have in 24 hours: 40 mg × 5.9 kg = 236 mg. The maximum dose the child can have is 236 mg.

In which week of gestation would the nurse anticipate administering Rho(D) immune globulin to an Rh-negative client? A. 12 weeks B. 28 weeks C. 36 weeks D. 40 weeks

28 weeks Rho(D) immune globulin (RhoGAM) administered during the 28th week of gestation reduces an active antibody response in an Rh-negative individual exposed to Rh-positive blood. It is difficult to determine whether Rh sensitization has occurred at 12 weeks in pregnancy. RhoGAM is given earlier than 36 weeks in the pregnancy; it is a preventive measure, not a treatment for a woman who is already sensitized. Forty weeks is around the time of birth; if the client has not been sensitized, she will receive RhoGAM within 72 hours of birth.

The nurse plans to administer 10 mcg/kg of digoxin elixir as a loading dose to a child who weighs 55 pounds. Digoxin is available as elixer of 50 mcg/ml. How many ml of the digoxin elixer should the nurse administer to this child?

5 ml

A child with poison ivy weighs 25 kg and receives a prescription for diphenhydramine PO 5 mg/kg. The medication is available as a 125 mg/5 mL solution. How many milliliters should the practical nurse administer? (Fill in the blank.)

5 ml Rationale:First determine how much of the drug the child should get.The order is 5 mg/kg. Multiply 5 mg by the child's weight. 5 mg × 25 kg = 125 mg.The child would get 125 mg.Next, determine how many milliliters to administer using the following formula:Desired dose/available dose × mL/dose of available drug = mL to administer125/125 × 5 mL = 5 mL

A child with poison ivy weighs 25 kg and receives a prescription for Benadryl PO 5 mg/kg. Benadryl is available as a 125 mg/5 mL solution. How many milliliters should the practical nurse administer? (Fill in the blank.)

5ml

Which client should the practical nurse (PN) closely monitor for severe after pains?

A multigravida who is breastfeeding.

A primiparous client asks the practical nurse (PN) how much her newborn baby should sleep every day. What information should the PN provide?

A newborn sleeps most of the day and gradually will have increasing periods of wakefulness.

A 7 year old child is admitted to the hospital with acute glomerulonephritis (AGN). When obtaining the nursing history which finding should the nurse expect to obtain?

A recent strep throat infection

A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever.

Which physiological cause(s) for constipation during pregnancy should the practical nurse (PN) explain to a client in the first trimester? (Select all that apply.)

A. Displacement of the colon. E. Decrease in peristalsis.

A client is 5 weeks pregnant call the clinic to report that her home pregnancy test is positive. She asks what she should be concerned about during the weeks before her first visit. Which signs and symptoms should the practical nurse (PN) tell the client to report immediately to the healthcare provider? (select all that apply)

A. Vaginal bleeding D. Membrane rupture E. Severe headaches

A 6 year old with asthma is demonstrating a prolonged expiratory phase and wheezing and has a 35% of personal best peak expiratory flow rate (PEFR) based on these findings, what action should the nurse take first?

Administer a prescribed bronchodilator

A 2 year old child with HF is admitted for replacement of a graft for coarcion of the aorta. Prior to administering the next dose of digoxin (Lanoxin) the nurse obtains and apical heart rate at 128 bpm. What action should the nurse implement?

Administer the scheduled dose

Which adverse effect would the nurse assess for after administering oxytocin to a client to stimulate labor? Select all that apply. One, some, or all responses may be correct. A. Edema B. Headache C. Confusion D. Blurred vision E. Uterine rupture

All of the above Adverse effects of oxytocin include edema, headache, confusion, blurred vision, and uterine rupture.

A child with leukemia is admited to chemotherapy and the nursing diagnosis "alered nutrition, less than boy requirements related to anorexia, nausea, and vomiting" is identified. Which intervention the nurse included in this childs plan of care?

Allow the child to eat any food desired and tolerated

The mother of a male newborn calls the clinic to inquire about the formation of a yellow crust over her son's circumcision area. What information should the practical nurse (PN) provide? a) do not remove the yellow crust from the site b) stop using petroleum around the head of the penis c) bring him into the clinic d) tightly fasten the diaper

Answer: A Rationale: Crust formation is part of the healing process and should be removed (A). (C) is not indicated at this time. The diaper should be fastened loosely, not tightly (D) which can place pressure on the incision site. (B) assists in the healing process and should not be discontinued.

When reviewing the dietary guidelines for a child with nephrotic syndrome, which diet should the practical nurse reinforce with the parents? a) low sodium b) high protein c) low fat d) high carbohydrate

Answer: A Anasarca, generalized edema associated with nephrotic syndrome, indicates that fluid retention should be managed with a diet that is low in sodium (A). (B, C, and D) are not dietary recommendations in the management of nephrosis.

The mother of a 9 month old girl provides the PN information about her daughter's diet. Which statement by the mother may indicate why the infant has been diagnosed with iron deficiency anemia? a) she doesn't like to eat peaches or pears b) she has been on whole milk for 7 months c) she almost never drinks sugar water d) she likes to chew on bread as a snack

Answer: B Rationale: Since cow's milk lacks iron, zinc, & vitamin E, which are necessary for a 9 month old infant's growth & development (B) indicates a possible etiology for the anemia. (A, C, and D) are not r/t the etiology of iron deficiency anemia.

A mother asks the practical nurse (PN), "When will I know if my daughter has entered puberty?" Which finding should the PN tell the mother to observe for with the onset of puberty? a) mood swings b) growth of pubic hair c) heterosexual interest d) menarche

Answer: B Rationale: The onset of puberty in girls is observed with the development of secondary sex characteristics, such as breast development and the growth of pubic hair (B). (A,C, and D) are not consistently found with pubescence.

What action should the practical nurse (PN) implement when caring for a dying child and the family? a) Provide adequate oral intake on a regular schedule b) Organize care to minimize contact that interrupts rests c) Allow family to give basic care when the child is alert d) Tell family to continue talking to the child until time of death

Answer: D Rationale: Families should be encouraged to talk to the child because the sense of hearing is acute until death (D), and verbal communication and physical touch provide comfort for both the family and child. When a child is dying, comfort is based on measures that respond to the child's requests beyond a regular schedule for fluids (A). Nursing care should minimize disruptions but not contact (B). family involvement in the basic care of the child should continue throughout the child's dying process, not only when the child is alert (C).

A 5-year-old tells the practical nurse (PN) that she "needs a Band-Aid" when she has an injection. Which action is best for the PN to take?

Apply a Band-Aid over the injection site.

Which action should the practical nurse (PN) implement first when obtaining the tympanic temperature of a 2-year-old child?

Apply the probe cover to the electronic thermometer.

A pediatric client with a past history of chicken pox reports a fever and headache. Which medication would the nurse avoid giving to the client? A. Aspirin B. Tetracycline C. Nalidixic acid D. CHloramphenicol

Aspirin Clients with a past history of chicken pox should not be administered aspirin because of the risk of the client developing Reye syndrome. Tetracycline generally causes discoloration of the teeth. Nalidixic acid sometimes causes cartilage erosion. Chloramphenicol is associated with Gray syndrome in children.

A multiparous client's membranes rupture after 8 hours of labor. which action should the practical nurse implement at this time?

Assess the fetal heart rate (FHR) and pattern.

A child with acute appendicitis who is scheduled for surgery in 3 hours is complaining of abdominal pain. Which intervention should the practical nurse implement?

Assist the child into a position of comfort.

The nurse understands which antihypertensive medication is contraindicated in lactating women? A. Atenolol B. Labetalol C. Metoprolol D. Propranolol

Atenolol Atenolol is contraindicated in lactating woman because it enters the breast milk and may cause adverse effects to the neonate. Labetalol and propranolol are safe to administer during lactation. Metoprolol is considered a safe medication to be taken during lactation.

The HR for a 3 year old with CHF has steadily decreased over the last few hours, now is 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider?

BP 70/40

The health care provider prescribes carbamazepine (Tegretol) for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. What complication is assessed through frequent laboratory testing that the nurse should explain to this mother?

Bone marrow suppression

A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. When performing a nursing assessment, which symptoms that are commonly manifested by this condition should the practical nurse (PN) observe in the child?

Bone pain, pallor

A primigravida client asks the practical nurse (PN). "How will i know that I will be going into labor soon?" Which sign should the PN provide that is a common sign?

Burst of energy.

A client in active labor becomes very uncomfortable and asks the nurse for pain medication. Nalbuphine is prescribed. The nurse understands that this medication relieves pain by which mechanism? A. By producing amnesia B. By acting as a preliminary anesthetic C. By inducing sleep until the time of birth D. By acting on opioid receptors to reduce pain

By acting on opioid receptors to reduce pain Nalbuphine is classified as an opioid analgesic and is effective in relieving pain; it induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep. 82

Which medication is derived from a natural source and may be prescribed for the treatment of osteoporosis? A. Calcitonin B. Raloxifene C. Clomiphene D. Bisphosphonates

Calcitonin Calcitonin is derived from natural sources such as fish; this medication may be prescribed to prevent osteoporosis. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this medication is not derived from natural sources.

A pregnant client with severe preeclampsia is receiving intravenous magnesium sulfate. Which item would the nurse keep at the bedside in case of magnesium sulfate toxicity? A. Oxygen B. Naloxone C. Calcium gluconate D. Suction equipment

Calcium gluconate The antagonist of magnesium sulfate is calcium gluconate. Oxygen is ineffective if the action of magnesium is not reversed. Naloxone is unnecessary; it is an opioid antagonist. Suction equipment may be necessary if the client has excessive secretions after a seizure. The priority intervention is to try to prevent a seizure.

Choking, coughing, and cyanosis

Which education would the nurse provide the parents of a preschool-aged child with leukemia who is undergoing chemotherapy and is susceptible to rectal ulcerations? A. Encourage lying on the abdomen when in bed B. Have the child wear cotton underpants at night C. Apply rectal ointment liberally 4 times a day D. Clean the child's perianal area after each bowel movement

Clean the child's perianal area after each bowel movement Meticulous toilet hygiene, including cleaning the child's perianal area after each bowel movement, is essential to prevent infection and promote comfort. Changing positions in bed is preferable to only lying on the abdomen. Underpants keep the area moist and promote bacterial growth; it is preferable to leave the area exposed to air, even if it remains under bed linens. Ointments tend to occlude and trap organisms, thus promoting infection.

The practical nurse (PN) is discussing aspects of newborn hygiene with the new parents as they prepare for discharge. Which information should the PN provide?

Create a draft-free environment when bathing the baby.

Which intervention should the practical nurse implement when a child cannot swallow prescribed tablets?

Crush tablets to a fine powder and mix with a small amount of soft food.

The practical nurse (PN) is caring for a child who had a cleft lip repair. What is the most important reason to minimize this child's crying during the postoperative recovery period?

Crying stresses the suture line.

An 11-year-old boy is admitted after being hit in the head with a baseball during a Little League game. Which subject is most important for the practical nurse to explore during history taking? A. Inspection of wound for lacerations and bleeding. B. Description of the character and quality of pain. C. Independent observer's account of the event. D. The level of consciousness exhibited after the injury.

D. The level of consciousness exhibited after the injury. Rationale:The priority concern when taking the history involving a head injury is to determine the level of consciousness following the injury.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine) IM STAT. What is the primary purpose for administering this drug to the child at this time?

Decrease the oral secretions.

A primigravida client who is at 39-weeks gestation arrives at the clinic and tells the practical nurse (PN) she is having contractions every 5 minutes. The healthcare provider determines she is dilated 3 cm and in early labor. What action should the practical nurse (PN) implement when the client groans with each contraction?

Demonstrate simple relaxation measures.

the nurse suspects that an adolescent have anorexia nervosa. Which characteristics may have been observed in the adolescent? A. Denying illness B. Dismissing food C. Seeking intimacy D. Being extroverted E. Maintaining rigid body control

Denying illness, dismissing food, maintaining rigid body control Bulimia Nervosa: seeking intimacy and being extroverted

A toddler is admitted to the pediatric unit with a temperature of 103.5°F (39.7°C), a runny nose, and a productive cough. Respiratory secretion specimens are sent for culture and sensitivity tests. Standard precautions are followed until the results are known. Which other precautions would the nurse include? A. Droplet B. Contact C. Airborne D. Neutropenic E. Restriction of parental visitation

Droplet, contact, and airborne Because the cause of the child's diagnosis has not been determined, airborne precautions should be instituted. Droplet precautions would be instituted for pertussis. This child does have a fever, which may be indicative of pertussis. Contact precautions are also necessary until a diagnosis is made. Neutropenic precautions protect an immunosuppressed child from exposure to microorganisms from others. Restricting parental visitation could lead to separation anxiety and stress on the child. The parents may visit after being taught about the special precautions to be taken.

The practical nurse (PN) is caring for a toddler who is admitted for cleft palate repair. Which type of restraint should the PN prepare to apply in the postoperative period?

Elbow

To minimize separation anxiety in a hospitalized 2-year-old, which nursing intervention is best for the practical nurse to implement

Encourage parents to room-in.

Which education would the nurse provide the parent's of a 4-year-old child with a new colostomy? A. Restricting fluid intake B. Instituting dietary restrictions C. Encouraging physical activity D. Inspecting the stoma once a day

Encouraging physical activity Contact games may be restricted, but other physical activities should be encouraged. The stoma should be inspected more often than once daily to ensure adequate circulation. Increased fluid intake is needed to compensate for fecal fluid loss. The diet should not be restricted at the time of discharge. Both the parents and the child will learn which foods are poorly tolerated, and they will adjust the diet accordingly.

Which medication is prescribed for the prevention of ophthalmia neonatorum?

Erythromycin (iilotycin)

The practical nurse (PN) is assessing a client 2 hours after a vaginal delivery of a 7-pound 3-ounce newborn and determines the client's bladder is distended. Which additional finding should the PN report to the charge nurse?

Excessive bleeding on the perineal pad.

Exhibits a sudden and unexplained weight gain

The practical nurse (PN) is caring for a child with a diagnosis of acquired aplastic anemia. What should the PN expect in the child's health history that is a common cause of this type of anemia?

Exposure to certain drugs

First, convert the pounds to kg because the conversion is for kg. 1 kg = 2.2 lb 13 lb/(2.2 lb/kg) = 5.9 kg Second, determine the maximum dose the child can have in 24 hours: 40 mg × 5.9 kg = 236 mg. The maximum dose the child can have is 236 mg.

An 18-month-old toddler who has received the appropriate immunizations on time is visiting the pediatric clinic for the next scheduled immunization. Which vaccine(s) would the nurse administer? A. second hepatitis B vaccine B. Fifth inactive polio vaccine C. first pneumococcal vaccine and Influenza vaccine D. Fourth diphtheria toxoid, tetanus toxoid, and Acellular pertussis vaccine

Fourth diphtheria toxoid, tetanus toxoid, and Acellular pertussis vaccine The recommended age for the fourth dose of DTaP is 15 to 18 months. The recommended age for the second dose of Hep B is 4 weeks after the first dose, which is given immediately after birth. Four, not five, doses of IPV are recommended. The initial doses of PCV and Hib are given at 2 months.

During a well baby visit the parents explain that the soft bulge appears in the groin of their 4 month old son when he cries or strains with stool. The infant is scheduled for surgical repair of the inguinal hernia in 2 weeks. The parent should be instructed to take which measure if the hernia becomes incarceraed prior to surgery?

Gently manipulate the hernia for reducion

The nurse plans to screen only the highest risk children for scoliosis. Which group of children should the nurse screen first?

Girls between ages 10 & 14

The nurse observes a mother giving her 11 month old ferrous sulfate, followed by two ounces of orange juice. What should the nurse do next?

Give positive feedback about the way she administered the sulfate

The nurse finds a 6 month old infant unresponsive and calls for help. After opening the airway and finding the XXXX the infant is still not breathing. Which action should the nurse take?

Give two breaths that makes the chest rise

The nurse is developing the plan of care for a hospitalized child with von Willebrand disease. Waht priority nursing intervention should be included in this childs plan of care?

Guard against bleeding injuries

Which assessment technique would the nurse use to appreciate Korotkoff sounds while measuring the BP of a preschooler? A. Use an ultrasonic stethoscope to measure BP B. Measure bP by choosing a cuff labelled as a child cuff C. Hear Korotkoff sounds with the help of a pediatric stethoscope bell D. Place the stethoscope firmly on the antecubital for good ascultation

Hear Korotkoff sounds with the help of a pediatric stethoscope Korotkoff sounds are difficult to hear in preschoolers because of their low frequency and amplitude. The nurse would use a pediatric stethoscope bell to hear these sounds. An ultrasonic stethoscope is used to measure BP when auscultation is not possible because of weakened arterial pulses. It need not be used for all preschoolers. The cuff should not be chosen based on its name. For instance, an "infant" cuff may not fit an infant. Placing the stethoscope too firmly over the brachial artery on the antecubital fossa causes errors in auscultation.

A 16 year old female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Provenfil) metre-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky and her heart feels like it is "beating a mile per minute" Which information is most important for the nurse to obtain?

How often the MDI is used daily

Which statement by a school aged client going o summer camp indicates the best understanding of the mode of transmission of Lyme disease?

I have to wear long sleeves and pants when we're hiking around the pond

Which strategy should the practical nurse (PN) implement to prevent a puerperal infection for a client during the first postpartum week?

Implement strict medical and aseptic technique.

Which symptoms would the nurse expect in a 3-year-old with mild iron-deficiency anemia and fatigue? A. Cold, clammy skin B. Increased pulse rate C. Increased BP D. Cyanosis of the nail beds

Increased pulse rate Increased pulse rate (tachycardia) occurs as the body tries to compensate for the hypoxia resulting from mild iron-deficiency anemia. Severe anemia, however, can manifest as pale, cool, and clammy skin. Increased blood pressure is not a response associated with anemia. Cyanosis of the nail beds is a sign of carbon monoxide poisoning.

The nurse on a pediatric unit observes a distraught mother in the hallway scolding her 3 year old son for wetting his pants. What initial action should the nurse take?

Inform the mother that toilet training is slower for boys

While auscultating the lung sounds of a 5 year old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. What action is best for the nurse to take?

Inquire about the use of alternative methods of treatment

The practical nurse (PN) is assessing a child with asthma for retractions during respirations. When should the PN recognize the absence or presence of intercostal retractions?

Inspiration

Which cognitive development milestone is characteristic of a 4-year-old? A. Inductive reasoning B. Concrete operational thoughts C. Intuitive thought D. Conservation

Intuitive thought Preschool: preoperational stage of cognitive development, substage of intuitive thought at age 4 (asking a lot of questions) School aged children: Operational stage (Inductive logic, concrete operational thoughts and conservation)

The practical nurse (PN) is examining a child with an exacerbation of juvenile rheumatoid arthritis (JRA) and notes that the child's mobility is greatly reduced. What factor should the PN observe that affects the child's mobility?

Joint inflammation

The nurse is evaluating the effects of thyroid therapy used to treat a 5 month old with hypothyroidism. Which behavior indicates hat the treatment has been effective?

Laughs readily, turns from back to side

A young adult female comes to the health clinic to confirm a positive home pregnancy test. After determining the client's last menstrual period (LMP) as August 5, what expected date of birth (EDB) should the practical nurse (PN) calculate?

May 12

A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determines that the increased respiratory rate is a compensatory mechanism for which acid base alteration?

Metabolic Acidoses

The nurse is caring for an infant scheduled for reduction of intussusceptions. The day before the scheduled procedures the infant passes a soft-formed brown stool. Which intervention should the nurse implement?

Notify the healthcare provider of the passage of brown stool

During a well-baby check, the nurse hides a block under the baby's blanket, and the baby looks for the block. Which normal growth and development milestone is the baby developing?

Object Permanence

The practical nurse (PN) is caring for an infant with pyloric stenosis. What nursing intervention should be included in the preoperative period?

Observe for projectile vomiting.

Observe for skin and circulation compromise from the cast.

The teacher reports that a 7-year-old child frequently daydreams in school, experiences abrupt interruptions in conversations, and stares into space. Which action should the practical nurse take?

Observe the child's behavior in the classroom.

A primigravida at 33-weeks gestation is admitted after being involved in a motor vehicle collision (MVC). The client has no complaints of abdominal pain and no evidence of vaginal bleeding. Which action should the practical nurse (PN) anticipate implementing for the client?

Obtain a biophysical profile.

The nurse instills an antibiotic ophthalmic ointment into a newborn's eyes. The nurse would explain to the mother that the medication prevents which condition? A. Ophthalmia neonatorum B. Herpetic ophthalmia C. Retinopathy of prematurity D. Hemorrhagic conjunctivitis

Ophthalmia neonatorum Ophthalmia neonatorum is caused by gonorrheal and/or chlamydial infections present in the vaginal tract. It is preventable with the prophylactic use of an antibiotic ophthalmic ointment applied to the neonate's eyes. Herpes affects the neonate systemically. Retinopathy of prematurity (formerly retrolental fibroplasia) occurs as a result of prolonged exposure to a too-high oxygen concentration. Hemorrhagic conjunctivitis is usually caused by rapid expulsion of the fetus's head from the vagina.

Which medications would the nurse identify as being used to induce labor in pregnant clients? Select all that apply. One, some, or all responses may be correct. A. Oxytocin B. Ergonovine C. Carboprost D. Misoprostol E. Dinoprostol

Oxytocin, Misoprostol, Dinoprostone Oxytocin is an oxytocic that triggers or augments uterine contractions; it is used for labor induction. Misoprostol is a prostaglandin used for cervical ripening and labor induction. Dinoprostone is used for cervical ripening to induce labor. Ergonovine is an oxytocic used for postpartum or postabortion hemorrhage. Carboprost is a prostaglandin used to treat postpartum hemorrhage.

The nurse is measuring he frontal occipital circumference (FOC) of a 3 month old infant, and notes that the FOC has increased 5 inches since birth and the child's head appears large in relation to body size. Which action is most important for the nurse to take next?

Palpate the anterior fontanel for tension and bulging

Which medication for depression would be safe to use with a breast-feeding mother who wishes to continue breast-feeding the newborn? A. Fluoxetine B. Paroxetine C. Valproic acid D. Methotrexate

Paroxetine Paroxetine can be safely given during breast-feeding. Fluoxetine can easily enter breast milk; therefore this medication would be used only when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic medication that can be given safely to breast-feeding women. Methotrexate is an anticancer medication that cannot be given during breast-feeding because it enters the breast milk and can cause adverse effects in the baby.

The nurse identifies which antimicrobial medications as safe during breast-feeding? A. Penicillins B. Macrolides C. Tetracycline D. Cephlasporins E. Chloramphenicol

Penicillins, Macrolides, Cephlasporin Penicillins, macrolides, and cephalosporins are considered safe medications during breast-feeding as they are least likely to affect the infant. Tetracycline and chloramphenicol should be avoided during breast-feeding.

A child with cystic fibrosis is receiving ticarcillin disodium (Ticar) for Pseudomonas pneumonia. What adverse effect should the nurse assess for and report promptly to the health care provider?

Petechiae

The nurse observes unilateral breast enlargement in a 14-year-old male client. The client states he has had this condition for 18 months. Which treatment would the primary health care provider administer? A. Testosterone B. Plastic surgery C. Calcium channel blockers D. Testing for Klinefelter syndrome

Plastic surgery Gynecomastia is a condition in which the adolescent has some degree of unilateral or bilateral breast enlargement. If gynecomastia persists or is extensive enough to cause embarrassment, plastic surgery is indicated for cosmetic and psychological reasons. Administering testosterone and calcium channel blockers may aggravate the condition. When gynecomastia has a prepubertal onset, the adolescent should be evaluated for Klinefelter syndrome.

The nurse is preparing a 10 year old with a lacerated forehead for suturing. Both parents and 12 years old sibling are at the child's bedside. Which instruction best supports family?

Please decide who will stay when the healthcare provider begins suturing

The practical nurse (PN) is caring for a child with Wilms' tumor. Which preoperative intervention should the PN implement?

Put a sign above the bed reading, "Do not palpate abdomen."

Which assessment findings would the nurse recognize as possibly indicating a diet that is deficient in vitamin C in a preschool-aged client? A. headaches B. rashes C. Bleeding gums D. Muscle weakness E. Scaling of the skin

Rashes and bleeding gums headaches and scaling of the skin: Vitamin A deficiency Muscle weakness: Vitamin D

a client who took iron supplements during pregnancy delivers and infant by cesarean section. On the second postpartum day, the client reports having a constipated stool that is greenish-black in color. Which action should the practical nurse (PN) implement?

Record color and consistency of the stool.

A newborn receiving medication therapy for an infection has developed jaundice. The newborn has poor sucking and extreme sleepiness. Which medication would the nurse suspect as responsible for the newborn's condition? A. Tetracycline B. Sulfonamide C. Phenothiazine D. Chloramphenicol

Sulfonamide Jaundice, poor sucking, and extreme sleepiness are the clinical manifestations of kernicterus. Kernicterus is a condition seen in newborns due to deposition of bilirubin in the brain and is caused by sulfonamides. Tetracycline can cause staining of developing teeth in pediatric clients. Phenothiazine may cause sudden infant death syndrome. Chloramphenicol may cause Gray syndrome in pediatric clients.

The nurse is assessing an infant with diarrhea and lethargy. Which finding should the nurse identify that is consistent with early dehydration?

Tachycardia

The practical nurse (PN) observes the unlicensed assistive personnel (UAP) placing a tongue blade at the bedside of a child diagnosed with a seizure disorder. Which intervention should the PN implement?

Tell the UAP that tongue blades should not be inserted during a seizure.

A medication is administered to a client in her third trimester of pregnancy. Which statement regarding the medication administration is correct? A. The dose of medication should be increased for pregnant clients B. No medication should be administered to the pregnant client C. Medication dosages should not be altered for a pregnant client D. Medication dosage may need to be decreased for pregnant clients

The dose of medication should be increased for pregnant clients During pregnancy, a client's hepatic metabolism and glomerular filtration are increased. As a result, the excretion rate is faster. The dose of a medication should be increased for the medication action to be optimal. It is true that some medications should not be given to the pregnant client, because of potential teratogenic effects on the fetus. The client should see her health care provider if in doubt. The dose of a medication should be altered for a pregnant client depending on the trimester she is in. How a medication affects the fetus depends on the stage of development of the fetus and the dosage and strength of the medication administered. During the first 3 to 8 weeks after fertilization, the major organs are developing, and the dose of a medication should be decreased or withdrawn for pregnant clients.

An adolescent sustains a sports-related fracture of the femur, and open reduction and internal fixation with a rod insertion is performed. After the surgery, the nurse notes that the adolescent is very upset. Which correlates to the client's developmental level and is likely an explanation for this distress? A. The need to navigate in a wheelchair B. The perception that the rod is a body intrusion C. Inability to participate in sports for several years D. The necessity of medication for pain relief until the bone heals

The perception that the rod is a body intrusion Adolescents are concerned about body image and fitting in with a peer group; the stabilizing rod may be viewed as an insult to the intactness of the body. The nurse would obtain additional information to confirm this assumption. Weight-bearing can be prevented with crutches, which provide greater mobility than a wheelchair. Adolescents who undergo open reduction and internal fixation with a rod insertion generally return to normal activities after several months. Although pain may be a concern, an adolescent is old enough to understand that analgesics are available; this probably is not the reason that the adolescent is upset.

While teaching a parenting class to new parents the nurse describes the needs of infants and toddlers regarding discipline and limit setting. What is the most important reason for implementing such parenting behaviors?

They provide the child with a sense of security

The nurse is planning for a 5 month old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?

Thicken formula with cereal for each feeding

The parents of a 3 year old boy who has Duschenne muscular dystrophy ask "how can our son have this disease? We are wondering if we should have any more children" What information should the nurse provide these parents?

This is an inherited X-linked recessive disorder, which primarily affects male children in the family

A child with nephrotic syndrome is receiving prednisone (Deltasone). The practical nurse (PN) reviews breakfast foods at a fast food restaurant with the child's mother. Which selections indicate that the mother understands the dietary guidelines necessary for her child?

Toasted oat cereal and low-fat milk

After repeating the vital signs for a newborn who is 4 hours old, the practical nurse (PN) obtains an axillary temperature of 97.2 F and places the newborn under a radiant heat warmer. Which additional finding should the PN observe in the newborn?

Tremors of the hands during crying.

Which skin care education would the nurse provide the parents of an infant who has undergone surgical repair of a myelomeningocele? A. Will require long-term multidisciplinary follow-up care B. should take prophylactic antibiotic therapy indefinitely C. Must be kept dry by applying powder after each diaper change D. Does not need anything more than routine cleansing and diaper changes

Will require long-term multidisciplinary follow-up care These infants need follow-up care with a variety of health care providers (e.g., neurologist, physical therapist) to manage the child's condition during growth and development. Taking prophylactic antibiotic therapy indefinitely is unnecessary. Powder should be avoided; it will create a pastelike substance when mixed with urine, and when aerosolized it is a respiratory irritant. These children require more frequent perineal care than just routine cleansing and diaper changes.

Which finding for a 2-week-old infant should the practical nurse (PN) report to the healthcare provider?

Yellowish tinge around the eyes.

Wilms tumor

a rare type of malignant tumor of the kidney that occurs in young children

Which techniques would the nurse use when assessing a preschool-aged child? a. Asking questions directly to the child B. Asking the child to sit on the examination table C. Having the child undress, leaving on the undergarments D. Having the parent of the child leave the room for the duration of the assessment E. Asking the child whether he or she would like to have the respiratory or abdominal assessment done first

a. Asking questions directly to the child B. Asking the child to sit on the examination table C. Having the child undress, leaving on the undergarments E. Asking the child whether he or she would like to have the respiratory or abdominal assessment done first Developmentally appropriate assessment techniques for a preschool-aged child include asking questions directly to the child, asking the child to sit on the examination table, having the child undress but leave on undergarments, and giving the child a choice about the order of assessment. The child's parent is not asked to leave the room for the duration of the assessment for the preschool-aged client.

a. Bone pain, pallor Rationale:Bone pain and pallor are the most common presenting symptoms of leukemia. Leukemic cells invade the bone marrow, gradually causing a weakening of the bone and a tendency toward pathological fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor.

A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying uncontrollably because her mother went to the cafeteria for lunch. Which action should the practical nurse implement? a. Distract the child with a favorite toy. b. Tell the child that her mother will return. c. Take the child to the cafeteria. d. Calm the child with a dietary treat.

a. Distract the child with a favorite toy. Rationale:The best action is to refocus the child's attention by distracting with a favorite toy.

The practical nurse (PN) is assessing a child with asthma for retractions during respirations. When should the PN recognize the absence or presence of intercostal retractions? a. Inspiration b. Coughing c. Apneic episodes d. Expiration

a. Inspiration Rationale:Intercostal retractions result during the respiratory effort to draw air into restricted airways.

A child with acute appendicitis who is scheduled for surgery in 3 hours is complaining of abdominal pain. Which intervention should the practical nurse implement? a.Assist the child into a position of comfort b.Withhold administration of a narcotic analgesic. c.Place a warm compress over the tender area. d.Offer to provide the child with warm tea or broth.

a.Assist the child into a position of comfort Rationale:Placing the child in a position of comfort best minimizes abdominal pain related to intra-abdominal inflammation of the appendix.

When assessing the breath sounds of an 18 month old child who is crying, what action should the nurse take?

allow the child to initially play with stethescope, and distract during auscultation

Question about cytotec

answer is you are at an increased risk for abortion

Jewish lady

answer something to do with tay sachs

Pregnant woman has an increased costal angle and diaphragm is elevated , how does the nurse document this

as a normal finding

Baby has peri-oral cyanosis

assess the oral mucosa

Postpartum after c-section, pt is nauseated and abdominal distention, what to do first

auscultate for bowel sounds

A 15-year-old male with mild mental retardation who is hospitalized for minor surgery tells a female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to make? a. "Do you really think so?" b. "That language is not permitted." c. "You should nt speak to me like that, such language offends me." d. "Ill notify your parents if you continue to talk that way."

b. "That language is not permitted." Rationale:Limit setting is necessary for inappropriate behavior or suggestive interaction. Sets limits without threatening or degrading the client.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? a. Dorsal gluteal b. Vastus lateralis c. Ventral gluteal d. Deltoid

b. Vastus lateralis Rationale:The preferred intramuscular site for children younger than 2 years of age is the vastus lateralis.

b.12 to 15 months Rationale:The first measles, mumps, and rubella (MMR) vaccine should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age. Because of the presence of maternal antibodies, the MMR vaccine is not recommended sooner.

The practical nurse (PN) is taking the temperature of a 5-year-old child with otitis media. During the previous 24 hours, the child's temperature readings have ranged from 101.2° F oral to 102° F tympanic. Which statement accurately evaluates these findings and should be considered when planning care for the remainder of the shift? a.The PN should confer with the nursing staff about the temperature method to use. b.A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever. c.A rectal temperature should be taken q4h to evaluate effectively the clinical course of the fever. d.The pediatrician should be notified of the variances in the oral and tympanic readings.

b.A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever. Rationale:Tympanic readings obtained using proper technique correlated moderately to strongly with oral temperatures in recent research studies. A tympanic membrane sensor approximates core temperatures because the same circulation perfuses the hypothalamus and eardrum. The sensor is unaffected by cerumen or the presence of suppurative or unsuppurative otitis media.

To minimize separation anxiety in a hospitalized 2-year-old, which nursing intervention is best for the practical nurse to implement? a.Provide for privacy. b.Encourage parents to room-in. c.Explain procedures and routines. d.Encourage contact with children of the same age.

b.Encourage parents to room-in. Rationale:Separation anxiety is especially threatening for toddlers, so encouraging parents to room-in helps the toddler cope with this threat.

The practical nurse (PN) is reviewing signs and symptoms of congestive heart failure with the parents of a 2-year-old child with a congenital heart defect. Which behavior is most important for the parents to report to the health care provider? a.Sits or squats frequently when playing outdoors. b.Exhibits a sudden and unexplained weight gain c.Is not completely toilet trained and has some "accidents." d.Demonstrates irritation and fatigue 1 hour before bedtime.

b.Exhibits a sudden and unexplained weight gain Rationale:Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive heart failure.

The practical nurse (PN) is preparing a child with an intussusception for a prescribed barium enema. The PN should explain to the parent that the purpose for conducting this procedure before surgical intervention is to achieve what objective? a.Evacuate the bowel of impacted feces. b.Reduce the invaginated bowel segment. c.Locate the presence of diverticula. d.Identify the area of esophageal atresia.

b.Reduce the invaginated bowel segment. Rationale:Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception, thereby negating the need for surgical intervention.

What medication to give mom to prevent RDS in fetus

betamethasone

Mom wakes up in a pool of blood and comes to emergency room. What to check first

blood pressure

Which action should the practical nurse (PN) implement first when obtaining the tympanic temperature of a 2-year-old child? a. Point the thermometer probe tip anteriorly. b. Remove drainage from the external auditory meatus. c. Apply the probe cover to the electronic thermometer. d. Ask the mother to help stabilize the child's head.

c. Apply the probe cover to the electronic thermometer. Rationale:Before a tympanic temperature is obtained, the equipment should be prepared for use without manipulating the electronic thermometer in front of the child, so a clean probe cover should be applied first.

The practical nurse (PN) is caring for a toddler who is admitted for cleft palate repair. Which type of restraint should the PN prepare to apply in the postoperative period? a. Wrist b. Mummy c. Elbow d. Jacket

c. Elbow Rationale:Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site.

The practical nurse (PN) is caring for a child with an acute respiratory condition. When the PN is monitoring for impending respiratory distress, what sign is the child likely to exhibit first? a. Cyanosis b. Sternal retraction c. Restlessness d. Crowing respiration

c. Restlessness Rationale:Restlessness is an early sign of hypoxemia.

What is the most important information for the practical nurse (PN) to review with a 12-year-old who is receiving long-term and rescue medications for routine management of asthma? a. Drink a large amount of cold fluids after exercising to restore hydration. b. Avoid swimming, which increases the need for oxygen while underwater. c. Use albuterol for prevention of exercise-induced bronchospasm. d. Keep a prescription for a premeasured dose of epinephrine available.

c. Use albuterol for prevention of exercise-induced bronchospasm. Rationale:When used before exercise, the beta-adrenergic agonist albuterol can prevent an asthma attack.

The practical nurse (PN) in the clinic receives a phone call from the mother of a 6-year-old child with a newly applied cast for a fracture of the femur. The mother reports that the child is in pain and is crying and that the child's foot appears swollen and blue. Which nursing diagnosis supports the PN's initial intervention? a.Impaired skin integrity b.Altered comfort (acute pain) c.Altered peripheral tissue perfusion d.Ineffective individual coping

c.Altered peripheral tissue perfusion Rationale:Because the child is exhibiting indications of impaired circulation (pain and cyanosis), altered peripheral tissue perfusion is the highest priority. The PN should instruct the mother to elevate the child's foot and bring the child into the clinic or emergency room immediately for evaluation.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. What complication is assessed through frequent laboratory testing that the nurse should explain to this mother? a.Renal toxicity b.Inner ear toxicity c.Bone marrow suppression d.Liver damage

c.Bone marrow suppression Rationale:Myelosuppression (bone marrow toxicity) is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing.

The practical nurse (PN) is evaluating the play behaviors of a 2-year-old child. Which behavior should the PN expect the toddler to exhibit? a.Builds a house with blocks. b.Rides a small tricycle 6 feet. c.Displays possessiveness with toys. d.Looks at a picture book for 15 minutes.

c.Displays possessiveness with toys. Rationale:Two-year-old children are egocentric and unable to share with other children.

Which nursing intervention is most important to assist in detecting hypopituitarism and hyperpituitarism in children?

carefully recording the height and weight of children to detect inappropriate growth

Last trimester UTI

cause preterm labor

Baby starts showing signs of respiratory difficulty (nasal flaring, expiratory grunt, cyanosis)

check O2 saturation levels

Baby is showing signs of mottling

check temperature

Moms Hgb and Hct is low, what food to tell her to eat that contains the most iron?

chicken (other sources: liver, meats, whole grains, enriched bread, cereal, dried fruits)

Patient is having labor back pain

counter pressure on lower back (sacrum)

A high-school graduate with attention deficit hyperactivity disorder (ADHD) presents to the family health care provider for a precollege physical and tells the practical nurse (PN), "I don't want to take my amphetamine-dextroamphetamine in college." How should the PN respond? a. "There are other medications you can use for ADHD." b. "Your ADHD probably won't be a problem in college." c. "What will happen if you stop your Adderall?" d. "What are your concerns about continuing Adderall?"

d. "What are your concerns about continuing Adderall?" Rationale:It is important to understand the client's concerns about taking amphetamine-dextroamphetamine before making a judgment about his future use of the drug.

A mother phones the clinic because her 6-year-old child has been taking prescribed antibiotics for 7 of the previous 10 days and continues to cough. She also reports that the cough is worsening and is nonproductive. What information should the practical nurse (PN) provide to this mother? a. Watch the child a few more days and see if the cough begins to produce sputum. b. Complete the full 10-day course of antibiotics and reevaluate the cough then. c. Give the child plenty of fluids and an over-the-counter cough suppressant. d. Bring the child to the clinic today for an examination related to the cough.

d. Bring the child to the clinic today for an examination related to the cough. Rationale:The child should be evaluated as soon as possible for pneumonia. Antibiotics usually improve symptoms during the first few days of treatment but should be continued for the full prescribed course. A continued cough after 7 days of antibiotic treatment may indicate an infectious process in the lower lungs, which could cause a nonproductive cough. Children with pneumonia can deteriorate unexpectedly and rapidly and can become seriously ill with no sputum production.

The practical nurse (PN) is assessing an 8-month-old who has a medical diagnosis of tetralogy of Fallot. The child demonstrates cyanosis with crying and exertion. Which other symptom is this infant most likely to exhibit? a. Bradycardia b. Squatting posture c. Weak pedal pulses d. Clubbed fingers

d. Clubbed fingers Rationale:Tetralogy of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes resulting from tissue hypoxia.

A 5-year-old tells the practical nurse (PN) that she "needs a Band-Aid" when she has an injection. Which action is best for the PN to take? a. Show her that the bleeding has already stopped. b. Explain why a Band-Aid is not needed. c. Ask her why she wants a Band-Aid. d. Apply a Band-Aid over the injection site.

d. Crowing respiration Rationale:Preschool children sometimes think that any hole (e.g., an injection or incision) made in their bodies allows their "insides to leak out," so applying a Band-Aid over the hole prevents this from occurring.

Which intervention should the practical nurse implement when a child cannot swallow prescribed tablets? a. Give the tablets with a very cold beverage of the child's choice. b. Put intact tablets in 1 tablespoon of corn syrup. c. Place the crushed tablet in a gelatin capsule and give with food. d. Crush tablets to a fine powder and mix with a small amount of soft food.

d. Crush tablets to a fine powder and mix with a small amount of soft food. Rationale:For children who have difficulty swallowing tablets, crushing the prescribed dose of tablets (except sustained-released capsules and enteric-coated medications) into a fine powder and mixing in a small amount of applesauce, yogurt, or pudding helps the child swallow the medication.

The practical nurse (PN) observes the unlicensed assistive personnel (UAP) placing a tongue blade at the bedside of a child admitted with a seizure disorder. Which intervention should the PN implement? a. Determine if the tongue blade is the correct size based on the child's height and weight. b. Advise the UAP that a nurse should assume this responsibility. c. Assist the UAP to tape padding securely around the tongue blade. d. Tell the UAP that tongue blades should not be inserted during a seizure.

d. Tell the UAP that tongue blades should not be inserted during a seizure. Rationale:Tongue blades can cause damage or force the tongue to obstruct the airway and should not be inserted during seizure activity. Nothing should be placed in the child's mouth. During a seizure, the airway can be opened with jaw thrust technique, and the child can be turned to the side to prevent pooling of secretions.

A child with nephrotic syndrome is receiving prednisone. The practical nurse (PN) reviews breakfast foods at a fast food restaurant with the child's mother. Which selections indicate that the mother understands the dietary guidelines necessary for her child? a. French toast sticks and orange juice b. Sausage-egg muffin and grape juice c. Canadian bacon slices and hot chocolate d. Toasted oat cereal and low-fat milk

d. Toasted oat cereal and low-fat milk Rationale:A child receiving a corticosteroid for nephrotic syndrome should follow a low-sodium, low-fat, and low-sugar diet. Based on these guidelines, the best breakfast choice is toasted oat cereal and low-fat milk.

The practical nurse (PN) is caring for a child who had a cleft lip repair. What is the most important reason to minimize this child's crying during the postoperative recovery period? a.Tear formation increases salivation. b.This behavior increases respirations. c.Lack of comforting can enhance pain. d.Crying stresses the suture line.

d.Crying stresses the suture line. Rationale:Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair.

The parents of a 1-year-old child, who was recently diagnosed with hypospadias, state that they plan to delay the corrective surgery to see if the child will outgrow the problem. What information is best for the practical nurse (PN) to provide to these parents? a.The prognosis will worsen if surgery is delayed. b.Some children do outgrow this type of problem and waiting may be beneficial. c.Regardless of the decision, the staff is available to assist with the process. d.Discuss the child's diagnosis with the health care provider for additional information and clarity.

d.Discuss the child's diagnosis with the health care provider for additional information and clarity. Rationale:The PN should first ensure that the parents have adequate and correct information. Hypospadias is a congenital anomaly resulting in an abnormally located urethral meatus. Surgical correction is usually done early in childhood, which is considered the best time for the child to face surgery with the fewest fears.

The practical nurse (PN) is caring for a child with a diagnosis of acquired aplastic anemia. What should the PN expect in the child's health history that is a common cause of this type of anemia? a.Bacterial infections b.A diet deficient in iron c.Congenital heart defects d.Exposure to certain drugs

d.Exposure to certain drugs Rationale:Aplastic anemia often follows exposure to certain drugs such as chloramphenicol, sulfonamides, phenylbutazone, insecticides such as DDT, and chemicals, in particular benzene.

d.Joint inflammation Rationale:Joint inflammation and pain are the typical manifestations of an exacerbation of JRA.

The practical nurse (PN) is caring for an infant with pyloric stenosis. What nursing intervention should be included in the preoperative period? a.Monitor for signs of metabolic acidosis. b.Estimate the quantity of diarrhea stools. c.Place in a supine position after feeding. d.Observe for projectile vomiting.

d.Observe for projectile vomiting. Rationale:Projectile vomiting, the classic sign of pyloric stenosis, contributes to metabolic alkalosis.

The nurse is assessing a 6 month old infant. Which response requires further evaluation by the nurse?

demonstrate startle reflux

Patient has been breastfeeding for 15 months and 6 weeks pregnant now, what is major assessment

nutritional intake

A 16 year old male who has been treated in the past for a seizure disorder is admitted to the hospital. Immediately after admission he begins to have a Grand Mal seizure. Which action should the nurse take?

observe him carefully

Mom comes to labor and delivery unit screaming "the baby is coming", what to do first

observe the perineum

Patients uterus is above the umbilicus and to the right during postpartum, what do you do first

palpate the bladder for distention

Mom has mitral stenosis, what symptom is common with this diagnosis

persistent cough

Postpartum with bathroom privileges, what possible condition would the nurse place the patient on temporary bed rest for

possible thrombus in the leg if positive Homan's sign is present

+1 Station

presenting part is 1 cm below the ischial spines

0 station

presenting part is entering the pelvic inlet

+3/+4 Station

presenting part is visible at the vaginal opening

Woman in labor and they look at vagina and see cord

put woman in Trendelenburg position

In assessing a 10 year old newly diagnosed with osteomyelitis, which information is most for the nurse to obtain?

recent recurrence of infection

The nurse working on the pediatric unit takes two 8 year old girls to the playroom Which activity is best for the nurse to plan for these girls?

selecting a board game

Diaper change

use water

Mom has been on mag sulfate and is now postpartum, what is she at increased risk for

uterine atony (hemorrhage)

Mom is having third baby at home, her two previous babies were rH negative, does she have to come get a direct coombs test dine on baby

yes

"Call the health care provider immediately if the nail beds appear 'blue' or 'empty.'"

The parents of a 1-year-old child, who was recently diagnosed with hypospadias, state that they plan to delay corrective surgery to see if the child will outgrow the problem. What response is best for the practical nurse (PN) to provide to these parents?

"Discuss your decision with your healthcare provider for additional information of what you understand about your child's diagnosis."

The parents of a 7-month-old male infant with spastic cerebral palsy bring him to the pediatric clinic. Which statement by the parents warrants immediate intervention by the practical nurse (PN)?

"My son often chokes while I am feeding him."

Which education would the nurse provide the parents of preschool-aged children regarding injury prevention? A. "Preschool-aged children are more prone to falls than are toddlers." B. "Preschool-aged children are at risk for injury because of their poor gross motor skills." C. "Preschool-aged children are less likely to follow rules, which increases the risk for injury." D. "Preschool-aged children are at risk for head injuries from riding a tricycle or balance bike."

"Preschool-aged children are at risk for head injuries from riding a tricycle or balance bike." Preschool-aged children are at risk for head injuries from falls while riding a tricycle or balance bike; helmets are critical anticipatory guidance. The preschool-aged child is at a decreased risk for falls when compared with the toddler. Preschool-aged children have better gross motor skills; therefore this decreases their risk of injury. The preschool-aged child is more, not less, likely to follow the rules, which also decreases the risk of injury.

A male high-school graduate with attention deficit hyperactivity disorder (ADHD) presents to the family healthcare provider for his precollege physical. He tells the practical nurse (PN), "I don't want to take my Adderall (amphetamine-dextroamphetamine) in college." How should the PN respond?

"What are your concerns about continuing Adderall?"

Kawasaki disease

(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. mucocutaneous lymph node syndrome, is the most common cause of acquired heart disease in children in developed countries

The nurse is evaluating diet teaching for a client who has nontropical sprue (celiac disease). Choosing which food indicates that the teaching has been effective?

*Creamed corn*

Before surgery mom is given an anticholinergic/atropine with anesthesia. What is the therapeutic response of the anticholinergic?

*increased pulse & decrease oral secretions/dry oral membranes*

Nurse anticipates that the prenatal lab will be performed at 28 weeks

- 1 hr glucose (140 between 24-28 weeks)

Patient is diagnosed with eclampsia, what do you do

- keep airway at bedside (immediate goal of care when during convulsion is to maintain a patent airway. When seizures do occur, turn woman on her side to prevent aspiration)

Altered peripheral tissue perfusion

A child who is admitted with acute abdominal pain and possible appendicitis. Which action should the practical nurse (PN) implement for the child's abdominal discomfort? a) assist the child to any position of comfort. b) give a saline enema to cleanse the bowel c) lay a heating pad on the abdomen d) place the bed in trendelenburg

Answer: A Rationale: Abdominal pain is a common childhood complaint, but this child should be assisted to any position of comfort (A) that relieves the pain. (B and D) are contraindicated with possible appendicitis and increase the risk of ruptured appendix. If the appendix should rupture, (C) increases the spread of the infection.

Which of Freud's psychosexual development stages occurs during a toddler's growth and development? a) anal b) oral c) genital d) phallic

Answer: A Rationale: According to Freud's theory, the anal stage (A_, 1-3 years of age, focuses on toilet training and learning to delay immediate gratification. Oral gratification(B) occurs from birth to one year of age. (C) The stage of genital awareness & exploration. (D) The stage of sexual identity and expression in adolescence.

The practical nurse (PN) is monitoring a child who is manifesting signs of shock after a motor vehicle collision. Which finding is most important for the PN to report to the charge nurse? a) narrowing pulse pressure b) irritability c) apprehension d) thirst

Answer: A Rationale: As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs of decompensated shock become pronounced, such as tachycardia and narrowing pulse pressure (A) (the difference between systolic and diastolic blood pressure), which should be reported immediately. (B,C, and D) are not as significant as (A).

Answer: A Rationale: As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs of decompensated shock become pronounced, such as tachycardia and narrowing pulse pressure (A). (The difference between systolic and diastolic blood pressure), which should be reported immediately. (B,C, and D) are not as significant as (A).

The PN is checking the musculoskeletal system of a one month old infant during a well child visit. Which finding should the PN report to the healthcare provider? a) one leg is shorter than the other. b) 2 skin folds on the back of each thigh c) broadening & flattening of the buttocks d) hypotonicity of the leg muscles

Answer: A Rationale: Developmental hip dysplasia, subluxation or discoloration, either partial or complete, is a common orthopedic deformity where the head of the femur is partly or completely displaced as a result of a shallow hip socket (acetabulum). Hip dysplasia causes the leg on the affected side to appear shorter (A) than the leg on the unaffected side. (D) is a sign of a neurologic problem, not hip dysplasia. The skin folds of the thigh are deeper and often asymmetrical, not (B), and the best indicator of hip dysplasia is femur shortening. (C) is not a sign of hip dysplasia.

A child is admitted for observation following a closed head injury. Which assessment is most essential for the practical nues (PN) to monitor for an early sign of a worsening condition? a) level of consciousness b) posturing c) focal neurologic signs d) vital signs

Answer: A Rationale: Following a head injury, determining a change in the child's LOC (A) provides the first indication that a progression of the injury is possible. (C) is a symptom of advanced neurologic insult. Alterations in consciousness appear earlier than alterations of (B and D).

A toddler with a chronic illness that requires frequent hospitalization is likely to experience which psychosocial developmental problem? a) interference with the development of autonomy b) distortion of differentiation of self from parent c) delayed language, fine motor, and self care skill d) fixation with the feelings of inadequacy

Answer: A Rationale: Frequent hospitalization for a toddler with a chronic illness may experience interference with the development of autonomy (A), which is a major psychosocial task of the age group 1-3 years of age. Achieving other psychosocial development tasks can be impeded during the stages of school age (B), infancy (C), and preschool age children (D).

A 2 year old child who is hospitalized has become withdrawn and quiet on the fourth day after admission. The parent expresses concern about this change in behavior. Which explanation should the practical nurse (PN) provide? The child is a) Experiencing the despair stage of separation b) Detaching emotionally from the family c) Protesting the separation from the parents d) Adjusting to hospitalization

Answer: A Rationale: In the despair stage of separation (A), the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. Toddlers do not readily "adjust" to hospitalization (D) and separation from caregivers. During the detachment stage (B) which occurs after prolonged separation, the child becomes interested in the environment and begins to play. In the protest stage (C), the child is likely to cry and resist care by others, and is inconsolable.

The practical nurse (PN) identifies an increased frequency of otitis media (OM) is children who are coming to the clinic. Based on this finding, which age group should the PN monitor a child for signs and symptoms of OM? a) toddler b) preschooler c) school ager d) adolescent

Answer: A Rationale: Infants and toddlers (A) are most prone to otitis media due to the anatomical structure of the eustachian tube that allows fluid and microbial entry into the middle ear. (B, C, and D) are most susceptible to acute infectious diseases acquired through environmental transmission from daycare or school settings.

Which nonfood item is the most common cause of respiratory arrest in young children? a) latex balloons b) broken rattles c) buttons d) pacifiers

Answer: A Rationale: Nonfood items cause the majority of choking deaths in young children. Latex balloons (A), whether partially inflated, uninflated, or popped, are the leading cause of pediatric choking that leads to aspiration of small objects (A,B, and D) because they experience the environment by placing objects in the mouth, but (A) is the leading cause of death causing respiratory obstruction and arrest.

A 3 year old male child who has been toilet trained has had several urinary "accidents" since hospital admission. What action should the practical nuse (PN) implement? a) provide the child with frequent opportunities to urinate b) inform the parent that the child will need to be retrained c) determine how the long the child has been toilet trained d) place a bedpan on the bedside table for the child to use

Answer: A Rationale: Offering choices and allowing the child to make a decision increases the child's sense of control. Asking the child frequently if he has to go to the bathroom (A) helps reduce the incidents of accidental urinations. Regression to previous behaviors is common during hospitalization, even when the child has been practicing the skill successfully (B). A 3 year old child is not developmentally able to use a bedpan independently (D). Relearning a skill such as toilet training, contributes to the child's stress and should not be attempted during hospitalization.

Which physiological difference is present in a 3 month old infant that affects oral drug absorption rates? a) variable pancreatic enzyme activity b) more acidic gastric secretions c) more rapid peristaltic activity d) an accelerated gastric emptying rate

Answer: A Rationale: Pancreatic enzyme activity (A) is variable in infants for the first 3 months of life as the Gi system matures. The gastric secretions of infants are less acidic than those of older children or adults, not (B). Intestinal motility and gastric emptying rate tend to be slower in infants, not (C and D).

Which finding should the practical nurse confirm with the parents of an infant who is admitted with possible intussusception? a) red currant jelly stools b) clay colored stools c) constant abdominal pain d) projectile vomiting after meals

Answer: A Rationale: Red currant jelly stools (A) is a sign of intussusception, which causes a mixture of stool, mucous, and blood as the intestines telescopes inside itself. (D) is associated with pyloric stenosis. (B) is consistent with biliary obstruction. Infants with intussusception usually have periods of severe pain followed by intervals in which they appear comfortable, not (C).

A child is prescribed radiographs of the hand and wrist. The child's parent asks the practical nurse (PN) the purpose of this procedure. What finding should the PN explain is provided by the diagnostic study? a) skeletal age b) linear growth c) external proportions d) neurologic maturation

Answer: A Rationale: Skeletal age (A) can be determined with radiologic examinations that analysis carpal bones maturity and degree of ossification, which is most useful for determining skeletal age before 6 years of age. (B, C, and D) do not describe the correct rationale for this procedure.

A 6 year old who had a tonsillectomy 12 hours ago is complaining of thirst. What should the practical nurse (PN) offer? a) popsicle b) lemonade c) orange juice d) chocolate milk

Answer: A Rationale: Small amounts of clear liquids without red dyes should be offered to the child. Popsicles (A) are cold and help soothe a dry throat. Citrus drinks (B and C) are acidic and irritate the operative site in the posterior oropharynx. Milk (D) thickens oral mucus which makes swallowing more difficult and causes coughing.

What age appropriate play activity should the PN suggest to the parents of a 7 month old infant to encourage visual stimulation? a) play peek a boo b) show how to clasp hands c) play pat a cake d) imitate animal sounds

Answer: A Infant stimulation is as important for psychological growth as food is for physical growth. By 6 months-1 year, play is a very important part of an infant's day and involves sensorimotor skills. Infants are very personable and enjoy playing games such as peek a boo, an activity for visual stimulation (A). (B) is an appropriate activity at 7 months for kinetic stimulation. (C) is more appropriate for auditory stimulation for infants 9-12 months old. (D) is an age appropriate activity at 7 months for auditory stimulation.

The practical nurse (PN) is caring a 6 year old who is hospitalized with asthma. Which developmentally correct activity should the PN provide the child? a) an audio cassette and player b) crayons and a coloring book c) a ball to throw into a basket d) a 1000 piece jigsaw puzzle

Answer: B Painting, drawing, playing computer games, and modeling allow children to practice and improve newly refined skills, so crayons and a coloring book (B) are an age appropriate activity for a 6 year old child who is hospitalized with asthma. A 1000 piece puzzle (D) requires conceptualization of a bigger picture, which a 6 year old may not be able to conceptualize. Throwing a soft foam ball (C) around the room stresses the oxygen demand for the child with acute asthma and poses a safety issue with equipment in a hospital room if unsupervised. An audio cassette play (A) may not provide the best diversion for a 6 year old.

The practical nurse is caring for a 6 year old girl who had surgery 12 hours ago. The child tells the PN that she does not have pain but a few minutes later, tells her parents that she does. What child development concept is relevant to this situation? a) inconsistency in pain reporting suggests that pain not present b) a child may have pain yet deny its presence to the nurse c) truthful reporting of pain should occur by this age d) children use pain experiences to manipulate their parents

Answer: B Rationale: A child may fear receiving an injection for pain or may believe that pain is a deserved punishment for some misdeed, so the pain is denied (D) when the nurse asks the child, who then readily admits having pain to a parent. This behavior should not be interpreted as (C) but as a valid indication of pain. (A and C) are incorrect interpretations of this behavior.

A male adolescent who is newly diagnosed with a seizure disorder receives a prescription for an anticonvulsant. Which statement indicates the client is at risk for non-compliance with life-long medication management? a) i will take the pills at home so others will not see me b) my friends will think i am a freak if i take these pills c) i don't want my parents monitoring my medications d) i hope i will be able to drive while taking these pills

Answer: B Rationale: Adolescents are concerned with being normal, so the statement indicating his fear that his peer group will not accept him places the adolescence at risk for noncompliance (B). The ability to drive an automobile (D), maintaining independence (C), and privacy (A) are common tasks of adolescence, which should not hinder compliance.

The practical nurse (PN) is observing a group of children at a day care center to determine whether children are achieving developmental milestones. Which activity should the PN identify as typical for a 2 year old child's cognitive development? a) has a vocabulary of about 1000 words b) uses short sentences to express self c) initiates play with other children d) recognizes right and wrong

Answer: B Rationale: Although children develop at different rates, a 2 year old typically uses short sentences to express independence and control (B) and has a vocabulary of up to 300 words, not (A). At the age of 2 years, a toddler is developing negativism without understanding the concepts of right and wrong (D). A 2 year old engages in solitary play and parallel play but does not initiate or cooperative with other children (C) in play, which begins with socialization of the preschool child.

During a well child visit, the mother of an infant states, "I will probably not have my baby immunized because I am concerned about the risk of a severe reaction." Which response should the PN provide? a) have you talked with other parents about this decision b) no immunization poses a greater risk for your child c) you are making a mistake d) it' is your decision

Answer: B Rationale: Although immunizations have caused reported adverse reactions in a small number of cases, an infant who is not immunized is at greater risk of developing complications from childhood diseases than from the vaccines (B). (A,C, and D) ignore the PN's responsibility to inform parents about the risks to children who are not immunized.

The practical nurse (PN) is talking with a group of elementary students about bicycle safety. Which information should the PN provide? a) wearing protective gear on a bicycle is a voluntary measure b) children should wear a bicycle helmet when riding a bicycle c) bicycle injuries involve a collision with an automobile d) riding double is allowed if the bicycle has an extra large seat

Answer: B Rationale: Bicycle accidents that result in head injuries are a common, accidental cause of morbidity and mortality, so bicycle safety and some state laws mandate that children should wear a protective helmet (B). (A, C, and D) do not provide accurate information.

The practical nurse (PN) arrives at the playgrounds and sees a school-aged boy who has eaten something he is allergic to and is demonstrating a stridor. Which action should the PN implement first? a) ask if the child is alone b) call for an ambulance c) mov the child to a different environment d) determine what the child has eaten

Answer: B Rationale: Food allergy hypersensitivity can cause an anaphylactic reaction that can occur shortly after ingestion (5-30 minutes) or exposure to an allergen, and manifest with hives, rash, flushing, asthmatic episode, or airway compromise, such as stridor. The first action is to call for an ambulance (B) immediately, since the condition may progress and become life-threatening. (A,C, and D) do not have the same priority of (B).

The mother of a 9 month old male infant is concerned because he cries whenever she leaves him with a sitter. What is the best response for the practical nurse (PN) to provide? a) "Have you noticed whether your baby is teething?" b) "Crying when you leave him in a healthy sign of attachment." c) "Consider taking the baby to the doctor because he may be ill." d) "You could consider leaving the infant more often so he can adjust."

Answer: B Rationale: Healthy attachment is manifested by stranger anxiety in late infancy (B). Pain from teething expressed by the infant's cries does not occur only when the mother leaves the infant with another person (A). The PN should evaluate the infant's developmental needs (C) before suggesting the infant may be ill. An infant who manifests stranger anxiety is best supported by the mother if the infant is left for shorter periods of time, not (D).

When reviewing the adverse effects of the DTap (diphtheria, tetanus, and acellular pertussis) vaccine with parents whose child is being immunized, what side effect should the practical nurse convey as most common? a) persistent crying and hyperpyrexia b) local erythema and edema at injection site c) vomiting and dehydration d) seizures and hypo-responsive episodes

Answer: B Rationale: Mild side effects of the DTaP vaccine that resolve in 24-48 hours after administration include mild fever, redness and swelling at the injection site (B), fussiness, & a slight decrease in appetite. Serious side effects (A and D) usually occur after 48 hours of administration and manifest signs of encephalopathy, which include persistent, inconsolable crying, fever of 104.8F, seizures, & hypotonic hypo-responsive episodes. (C) is not an expected reaction.

The practical nurse (PN) is caring for a school aged male child who is having problems adjusting to a new school. Which action should the PN recommend to the parents that may foster their child's developmental task of industry. a) identify failures immediately for feedback from the child and his peers b) structure the tasks in the home environment and recreational settings c) decrease their expectations of home tasks and school success d) ask the child what the child wants to achieve in his new school

Answer: B Rationale: Structuring the environment (B) provides opportunities to solve increasingly more complex problems, which enhances self-confidence and promotes a sense of mastery. (C) is not as important as structuring the environment so that the child is successful. (D) Does not promote a sense of achievement or mastery. Sharing failures with the child's peers (A) for feedback reinforces the child's feelings of failure.

Using Freud's theory, the practical nurse should expect a 2 year old boy to demonstrate the behaviors of which stage? a) phallic b) anal c) latency d) oral

Answer: B Rationale: The anal phase (B) defines the behaviors of a toddler, ages 1-3 years, who begins to develop sphincter control and the ability to control the release of feces. Success in this stage results in a sense of autonomy. The oral phase (D), ages birth to 1 year, is the stage of learning to relate to others without excessive jealously, dependency, and the development of trust and sense of self-reliance. Phallic phase (A), ages 3-7 years, is an age r/t formation of an identity focuses on sexuality or the genitalia. Success in this stage results in mastery over internal processes and impulses. Latency, ages 7 years to puberty, is a stage of development where one's attention is turned toward learning and successful achieving the ability to delay gratification.

Which statement by a mother indicates that her 5 month old infant girl is ready for solid food? a) i find that my baby really has to be encouraged to eat. b) my baby has started to sit up without any support c) when i give my baby solid foods she has difficulty getting it to the back of her throat to swallow d) i am surprised that my baby only weights 11 pounds. I expected her to have gained more weight.

Answer: B Rationale: Voluntary skeletal muscular activities, such as sitting (B) and involuntary activities such as absence of the protrusion reflex, are indicators of neuromuscular development. (A and C) indicate that the infant is not interested in starting solid foods. The ability to manipulate foods to the back of the throat is a sign that the infant is ready to manage solid foods, not (D).

The practical nurse (PN) is caring for a 6 year old girl who had surgery 12 hours ago. The child tells the PN that she does not have pain but a few minutes later, tells her parents that she does. What child development concept is relevant to this situation? a) inconsistency in pain reporting suggests that pain is not present b) truthful reporting of pain should occur by this age c) a child may have pain yet deny its presence to the nurse d) children use pain experiences to manipulate their parents

Answer: C Rationale: A child may fear receiving an injection for pain or may believe that pain is a deserved punishment for some misdeed, so the pain is denied (C) when the nurse asks the child, who then readily admits having pain to a parent. This behavior should not be interpreted as (D) but as a valid indication of pain. (A and B) are incorrect interpretations of this behavior.

Which preoperative action is most important for the practical nurse (PN) to implement for a newborn with meningomyelocele? a) document vital signs b) prevent skin breakdown c) minimize the risk for infection d) monitor neurologic functioning

Answer: C Rationale: A meningomyelocele provides a direct entry for bacteria into the central nervous system, leading to meningitis. Measures that protect the integrity of the meningomyelocele sac and infection control measures should be implemented to minimize the risk of infection (C). (A,B, and D) should be implemented but do not have the priority of (C).

The mother of a child with croup is having barking, coughing episodes calls the clinic for assistance. What action should the practical nurse (PN) recommend that the mother implement first? a) take the child outside in the cool air b) bring the child directly to the emergency room c) sit with the child in bathroom with a hot shower running d) have the child drink plenty of fluids

Answer: C Rationale: Croup (laryngotracheobronchitis) is a viral infection that causes a "barking" cough and varying degrees of inspiratory stridor, which often responds to a high humidity environment. Most children can be managed at home using the stream from a hot shower in a closed bathroom (C) which often stops laryngeal spasm. Increasing the child's fluid intake is important (D), but not a priority at this time.Although exposure to cold air (A) also relieves stridor, parents should be encouraged to use mist humidifier in the child's room. (B) is not necessary unless the child is having increasingly difficulty breathing that may lead to a compromised airway.

The practical nurse (PN) is interviewing a 10 year old girl about school and her extracurricular activities. She responds, "I like school. I play the flute in the school band, and I take tennis lessons." Based on Erikson's psychosocial theory, the PN identifies that this child is in what stage of development? a) identity b) intimacy c) industry d) initiative

Answer: C Rationale: Erikson's stage of industry (C) for a school aged child is demonstrated by successful participation in new skills and peer activities, such as sports and band. (A, B, and D) are achieved in other age groups.

Which first aid action should the practical nurse implement for a child who has sustained a second degree thermal burn? a) apply petroleum jelly to the burned skin b) apply ice to the burned area c) immerse the burned area in cold water d) break any blisters that are present

Answer: C Rationale: First aid treatment of a second degree thermal burn is immersion of the burned area in cold water (C) to halt the burning process. (A, B, and D) are not indicated due tot he risk of increased skin damage or infection.

Which information is most important for the PN to reinforce with an adolescent who has hepatitis A about preventing the spread of hepatitis in the home? a) wash the adolescent's dishes separately b) ensure that all family members wash their hands before eating c) prevent the adolescent from preparing food d) encourage the adolescent to wear a mask over the nose and mouth

Answer: C Rationale: Hepatitis A is spread through fecal oral contamination, so the chance of contaminating others is best reduced when the client does not participate in any food prep (C). Although (B) is always recommended, the adolescent is an infectious reservoir and should refrain from family meal prep during the period of communicability. (A and D) are not necessary.

The mother of a young child with Type 1 diabetes mellitus (DM) who needs insulin injections at home tells the practical nurse (PN) that she is afraid she does not know what to do properly. Which action is most important for the PN implement to decrease the mother's apprehension? a) have the mother verbalize the importance of follow up care b) help the mother devise a schedule for rotating the injections c) observe the mother while she administers an insulin injection d) review the side effects of insulin with the mother

Answer: C Rationale: Observing the mother's ability to give the insulin injection (C) provides an opportunity to reinforce information & provide validation to increase the mother's confidence and relieve apprehension about caring for her child with DM. (A, B, and D) are of less priority than (C).

After reinforcing information to treat a sprained ankle, what statement by the adolescent indicates tot he PN that further instruction is needed? a) keep the leg elevated when sitting b) put an ice pack on the ankle, alternating 30 minutes on & 30 minutes off c) apply warm compresses to the ankle for the first 24 hours d) wrap the ankle in an elastic bandage for support

Answer: C Rationale: The "RICE" treatment (rest, ice, compression, & elevation) should be implemented for a sprain. Warm compresses (C) reflects the need for further instruction because heat causes vasodilation which can increase fluid accumulation in the injured area and increase swelling. (A, B, and D) reflect correct understanding of the treatment protocol.

Which play activity should the practical nurse (PN) provide a hospitalized 6 month old infant? a) push and pull toys b) ball rolling and hide and seek game c) supervised water play d) pat a cake and peek a boo

Answer: D Rationale: 6 month old enjoy playing pat a cake and peek a boo (D). 12 month old infants enjoy (A). 4 months old infants enjoy (C). 9 month olds enjoy (B).

A 3 year old boy with cerebral palsy (CP) has difficulty swallowing, cannot hold a utensil, and is slightly underweight for his height. Which action should the practical nurse implement when feeding this child? a) put the child in a well-supported semi-reclining position b) offer a specialized formula per tube feeding c) place the child in a sitting position with the neck hyperextended d) stabilize the child's jaw with the caregiver's hand

Answer: D Rationale: A child with CP should be fed in an upright, eating position, and manual stability of the oral mechanisms during swallowing should be provided to minimize the risk of aspiration. Hold the child's jaw (D) from the side or front of the face assists with head control, correction of the neck and trunk hyperextension, and jaw stabilization. (A, B, and C) are not indicated.

What information should the practical nurse (PN) reinforce with the parents of a 3 month old infant about liquid medication administration? a) pour the medication into a small cup and allow the infant to drink it b) place the medication in a nipple and have infant suck the nipple c) administer the medication with a dropper to the back of the infant's tongue d) use an oral syringe to place the medication in the side of the infant's mouth

Answer: D Rationale: An oral syringe is a useful device for measuring small quantities of medications for infants. The syringe is placed in the side of the mouth. (B) increases the amount of air the infant swallows, which cause excessive gas. (B and D) increase the risk for aspiration.

An adolescent female who comes to the school clinic is reluctant to confide her concerns to the practical nurse (PN). The PN tells the teen that confidentiality and privacy are maintained unless a life-threatening situation arises. Which principal supports the PN's response? a) disclosures from the adolescent should be kept confidential b) minor adolescents should not be encouraged to disclose private concerns c) the adolescent should be encouraged to seek help outside of the school clinic d) honest information ensures establishing a trusting relationship

Answer: D Rationale: Critical elements in establishing trusting relationships include active listening, responding to the adolescent's emotions, and ensuring confidentiality and privacy, but situations that pose a life-threatening situation for the adolescent must be reported. Minor-aged adolescents have the right to confidential communication with providers unless the client is being abused or a life-threatening situation is evident. Honesty (D) is vital in the development of trust between an adolescent and a health professional. (A,B, and C) do not provide immediate intervention for the adolescent's concerns about self integrity and safety.

The practical nurse (PN) collects information about infant growth and development milestones for infants who come to the clinic for a well child visit. Which findings should the PN document as normal infant growth and development? a) maternal iron stores persist during the first 12 months of life b) anterior fontanel closes by 6 to 10 months of age c) binocularity is well established by 8 months of age d) birth weight double by age 5 months and triples by 1 year

Answer: D Rationale: Infants gain approximately 1.5 pounds/month until age 5 to 6 months, when the birth weight doubles, and by 1 year of age, the birth weight usually triples (D). The anterior fontanel closes by 12 to 18 months of age, with the average being 14 months, not (B). Binocularity begins to develop by 6 weeks of age and should be well established by age 4 months, not (C). Maternally derived iron stores ares present for the first 5 to 6 months and gradually diminish, which results in an expected lowered hemoglobin levels toward the end of the first 6 months (A).

A 3 year old boy cries, kicks, and clings to his father when the parents try to leave the hospital room. The parents express their concern to the practical nurse (PN). What response should the PN provide? a) "It is not helpful for parents to stay with children during hospitalization." b) "Your child's behavior indicates a need for a psychological consultation." c) "You can avoid this if you wait to leave after your child falls asleep." d) "Your child is showing a normal response to the stress of hospitalization."

Answer: D Rationale: The child is exhibiting a healthy attachment to the father (D). Leaving while your child is asleep creates mistrust in the child (C). To minimize the child's stress hospital policy often require someone to stay with their child during hospitalization, not (A). The child's behavior represents the protest stage of separation and does not represent maladaptive behavior (B).

A 4 year old girl is brought to the emergent care center with a frog like croaking sound on inspiration. She is having difficulty breathing and has her chin trust forward with her mouth open. She is drooling, agitated, and insists on sitting upright. What action should the PN take? a) Auscultate the lungs and make preparations for placing the child in a mist tent. b) Examine the oral pharynx and report to the HCP c) make the child lie down on the stretcher & rest quietly c) notify the HCP & prep for immediate intubation of tracheotomy

Answer: D Rationale: The child is exhibiting signs of acute epiglottis, a serious obstructive, inflammatory process that can rapidly progress to severe respiratory distress, which requires immediate intubation or tracheotomy (D) by the HCP to secure the airway. (A, B, and C) are contraindicated.

The practical nurse (PN) is preparing to administer an intramuscular immunization to a 6 month old infant. What site should the PN select? a) dorsogluteal b) ventrogluteal c) deltoid d) vastus lateralis

Answer: D Rationale: The vastus lateralis (D) has minimal nerves or blood vessels and is the best site for intramuscular (IM) injections in children younger than 3 years of age. The deltoid muscle (C) is a small muscle mass that accommodates small volumes, less than 0.5 mL, and is not recommended for IM use in young children. The gluteal muscles (A and B) are used as an injection site in children whose musculature develops after walking.

Which response should the PN provide a school age child who asks to talk with a dying sister? a) touch provides tactile presence of others if she does not responds to words b) talk loudly to ensure the dying client hears & recognizes others voices c) sitting close offers the dying person the sensation of others presence d) although the dying client may not response, she cna still hear what is said

Answer: D Rationale: There is evidence that hearing acuity remains during the dying process, so talking to a dying client is important both for the client the family (D). (A) os unnecessary. Although, (B and C) provide additional actions, hearing (D) remains an intact sensory perceptions through unconsciousness and the dying process.

Which action is best for the practical nurse (PN) to implement to help a 7 year old child cope with a lengthy course of IV antibiotics therapy? a) give the child stickers for cooperative behavior b) arrange for the child to go to the playroom daily c) ask the child to draw a picture about himself d) allow the child to participate in injection play

Answer: D Supervised injection play (D) is an effective coping strategy for a school aged child who is receiving extended IV therapy, or any other therapy involving syringes and needles. Rewards, such as stickers (A) may enhance cooperative behavior but do not address coping with painful treatments. The hospitalized child should have opportunities for play each day, if his condition warrants, but free play (B) does not have any specific therapeutic purpose in preparing for painful experiences. (C) may not elicit the child's feeling about IV treatment.

The practical nurse (PN) palpates the anterior fontanel of a 14 month old toddler and finds that it is closed. What action should thePN implement? a) refer the toddler for a developmental evaluation b) perform a focused neurological examination c) report premature cranial suture closure to the healthcare provider d) document the normal finding for the 14 month old toddler

Answer: D The anterior fontanel normally closes between 12 and 18 months of age, so this finding should be documented as a normal finding for the 14 month old toddler (D). (A, B, and C) are unnecessary.

A mother who is preparing for discharge begins asking the practical nurse (PN) questions about bottle feeding her infant. What information should the PN reinforce?

Burp the newborn periodically during the feeding.

A young adolescent reports abdominal bloating, pelvic fullness, menstrual cramps, and breast tenderness. Which is the primary responsibility of the nurse? A. Client education B. Preparation for surgery C. Medication administration D. Administration of IV fluids

Client education female adolescents often experience premenstrual syndrome in their lifetime.

Which medication may cause photophobia as an adverse effect? A. Nifedipine B. Alendronate C. Clomiphene D. Indomethacin

Clomiphene Clomiphene is a fertility medication that may cause photophobia. Nifedipine may cause maternal fetal problems. Alendronate may cause dysphagia. Indomethacin may cause birth defects.

Which medication used to promote fertility would the nurse identify as a potential cause of esophageal burns? A. Estrogen B. Clomiphene C. Nifedipine D. Indomethacin

Clomiphene Clomiphene is a serum selective receptor modulator that may cause esophageal burns. Estrogen may cause a thromboembolism. Nifedipine may cause maternal-fetal problems. Indomethacin may cause birth defects.

Clubbed fingers

Which long-term effect is associated with untreated congenital hypothyroidism? A. Myxedema B. Thyrotoxicosis C. Spastic paralysis D. Cognitive impairment

Cognitive impairment Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland because of an embryonic defect. A decreased level of thyroid hormone affects the fetus before birth during cerebral development, so it is likely that there will be some cognitive impairments at birth. Treatment before 3 months of age will prevent further damage. Congenital hypothyroidism does not become myxedema. Thyrotoxicosis is another term for hyperthyroidism. Although it is not expected, it may occur with an overdose of exogenous thyroid hormone, but it is too soon to discuss this possibility with the parents. Spastic paralysis occurs only if the infant has cerebral palsy.

Collect a specimen of the otorrhea for culture.

A client is taking fertility medications for the first time. Which adverse effect of the medication would the nurse inform the client about? A. Vaginitis B. Constipation C. Joint swelling D. Deep vein thrombosis

Constipation Constipation is seen in the clients who are treated with fertility medications for the first time. Fertility medications do not cause vaginitis or swelling of joints. Deep vein thrombosis is an adverse effect of prolonged use of fertility medications.

The practical nurse (PN) palpates fundal height at the umbilicus of a multiparous client who has just given birth to an 8-pound boy when dark red blood comes from the client's vagina. What action is most important for the PN to implement?

Continue to massage the fundus until firm.

2 year old is admitted to the hospital with possible encehalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this child concerning the procedure?

Describe he side-lying, knees to chest position that must be assumed during the proceudure

Develops a sore throat

The nurse understands which medication taken by a pregnant woman may show a delayed teratogenic effect in the offspring? A. Aspirin B. Heparin C. Ethyl alcohol D. Diethylstilbestrol

Diethylstilbestrol Diethylstilbestrol may cause vaginal cancer in a female child 18 or more years after birth. Aspirin suppresses contractions during labor and may cause bleeding in the mother. Heparin does not cause fetal harm but may cause osteoporosis in the mother. Ethyl alcohol causes drug dependence or alcohol withdrawal syndrome in neonates.

Which medication is indicated for evacuation in case of a miscarriage? A. Clomiphene B. Dinoprostone C. Methylergonovine D. Magnesium sulfate

Dinoprostone Dinoprostone is a prostaglandin E2 abortifacient and cervical ripening medication, which is indicated for uterine evacuation in cases of miscarriage. Clomiphene is indicated for female infertility in some clients. Methylergonovine is used to treat postpartum uterine atony and hemorrhage. Magnesium sulfate is used to treat pregnancy-induced hypertension.

When screening a 5 year old for strabism, what action should the nurse take?

Direct the child through the 6 cardinal position of glaze

The practical nurse (PN) is evaluating the play behaviors of a 2-year-old child. Which behavior should the PN expect the toddler to exhibit?

Displays possessiveness with toys

Distract the child with a favorite toy.

The mother of a 9 month old who was diagnosed with respiratory syncytial virus yesterday calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friends child the following day. What response should the nurse provide this mother?

Do not expose other children to RSV, it is very contagious even without direct contact

The nurse observes that a 3-year-old child combines words in short phrases and understands the concepts of hot and cold and big and little. Which intervention should the PN implement?

Document that the child's expressive speech is age-appropriate.

A 14-week gestational client, who weighed 125 pounds before pregnancy, comes into the health clinic for a prenatal appointment. The client's weight today is 129 pounds. What action should the practical nurse (PN) implement?

Document the finding in the medical record.

The practical nurse (PN) quickly moves the crib of a male newborn and notices that his legs flex. arms fan out, and then return toward his midline. What action should the PN implement?

Document the newborn demonstrates a Moro reflex.

A 3-day-old newborn who weighed 7 pounds, 8 ounces at birth is breast feeding and now weighs 6 pound and 15 ounces. Which action should the practical nurse take?

Document the weight loss

The nurse recognizes which statement as true regarding transdermal estradiol? A. Estradiol reduces estrogen levels. B. Estradiol is slowly absorbed from the skin. C. Estradiol patches are applied monthly. D. Estradiol should be used along with sunscreen products.

Estradiol is slowly absorbed from the skin. Estradiol is slowly absorbed from the skin for up to 8 hours after application. Estradiol is administered to increase the levels of estrogen in postmenopausal women to ease hot flashes. Estradiol is available as an emulsion that is typically applied to the thighs or calves. Estradiol transdermal films are changed once or twice a week, whereas gel is applied daily. Sunscreen products should not be applied with estradiol because sunscreen may reduce the absorption of estradiol.

A month old girl is brought to the clinic by her mother because she has had a cold for 2 to 3 days and woke up this morning with a hacking cough and difficulty breathing. Which additional assessment finding should alert the nurse that the child is in acute respiratory distress?

Flaring of the nares

While counseling the parents of an adolescent with anemia related to an inadequate diet, the nurse explains that several different nutrients, including protein, iron, and vitamin B12, are involved. Which other nutrient would the nurse include in the teaching? A. Calcium B. Thiamine C. Folic acid D. Riboflavin

Folic acid Folic acid acts as a necessary coenzyme in the formation of heme, the iron-containing protein in hemoglobin. Calcium is not involved in the production of red blood cells. Thiamine is a coenzyme in carbohydrate metabolism. Riboflavin is a control agent for energy production and tissue formation.

Which care plan would the nurse implement for an infant with nonorganic failure to thrive? A. Maintaining silence while feeding the infant B. Following a structured routine throughout the day C. Periodically changing the seating arrangement during meals D. Distracting the infant with playful activities during feedings

Following a structured routine throughout the day A structured routine is important for infants with nonorganic failure to thrive. Disruptions in other areas of the infant's activities of daily living can affect feeding behaviors. The nurse should talk to the infant during feeding time; this indicates that the nurse cares and demonstrates the social aspects of eating. The infant should be fed in the same manner at each meal. Infants may be held while being fed, and older children may be fed in a high chair or at a table. Sensory stimulation and play activities are important, but these should be incorporated at times other than when the infant is feeding.

What is the most important action by the practical nurse (PN) in preventing neonatal infection?

Hand washing.

Which education would the nurse provide the parents of a preschooler who stutters? A. Avoid looking at the child when there is difficulty articulating words. B. Ignore the stuttering, and try to prevent situations that increase stuttering. C. Help by supplying the correct word when the child is experiencing a block. D. Stop the conversation by telling the child to speak slowly and to think before starting again.

Ignore the stuttering, and try to prevent situations that increase stuttering Ignoring the stuttering and preventing situations that induce stuttering will avoid undue emphasis on the speech pattern, thus preventing inadvertent reinforcement of the pattern. Avoiding looking at the child is demeaning; it may decrease the child's self-esteem and worsen the stuttering. Stuttering is common in preschoolers because they are learning new vocabulary and are attempting to find the right words to express themselves; hesitancy and dysfluency are typical speech characteristics of preschoolers. Stopping the conversation and telling the child to slow down is counterproductive; it may decrease the child's self-esteem and worsen the stuttering.

Which pathophysiological process would the nurse expect to account for growth failure in a 4-year-old child with newly diagnosed cystic fibrosis? A. Impaired digestion and absorption because of the lack of pancreatic enzymes B. Dyspnea and shortness of breath, which cause anorexia and disinterest in food C. Increased bowel motility and diarrhea, which lead to inadequate absorption of nutrients D. Pulmonary obstruction, which causes an oxygen deficit and inadequate tissue nourishment

Impaired digestion and absorption because of the lack of pancreatic enzymes Obstruction of the pancreatic duct and the absence of enzymes (e.g., trypsin, amylase, and lipase) to aid fat digestion and absorption lead to wasting of tissues and failure to thrive. Currently it is recommended that children with cystic fibrosis consume 150% to 200% of the calories recommended for their body weight. Despite dyspnea and shortness of breath, these children have voracious appetites when feeling well; the difficulty involves poor digestion and malabsorption of fats and fat-soluble vitamins. Increased bowel motility and diarrhea are not associated with cystic fibrosis. The pulmonary disease process leads to localized respiratory dysfunction, not to retarded physical growth.

The nurse is caring for a 3-year-old child with acute laryngotracheobronchitis. The child has severe dyspnea, a temperature of 104.0°F (40.0°C), and is receiving cool mist by way of a face mask. The mother asks why her child is not receiving warm mist. Which statement explains the purpose of cool mist? A. It helps dry mucosal secretions faster. B. It facilitates reduction of mucosal edema. C. It provides a more comfortable environment. D. It assists in absorption of fluid by the mucosa.

It facilitates reduction of mucosal edema. Cool mist helps reduce edema; it may also help reduce the fever. Edema in the airway is a priority of care. The mucosal secretions should be kept moist, not dry. Heat not only dries secretions but can also increase inflammation. Cool mist is less comfortable because the environment becomes cold and damp. Absorption by way of the mucosa is insignificant.

An Rh-negative client has a spontaneous abortion at the end of the second trimester and is prescribed Rho(D) immune globulin. The client asks the nurse, "Why do I need this medication?" Which information would the nurse consider before answering the client's question? A. It will expand the woman's antibody pool. B. It will prevent the woman from producing antibodies. C. The woman's production of immune bodies will be accelerated. D. The activity of the mother's Rh-negative antibodies will be suppressed.

It will prevent the woman from producing antibodies Rho(D) immune globulin attacks fetal red cells that have gained access to the maternal bloodstream at the time of birth; it prevents antibody formation. Antibody formation is undesirable; it sensitizes the woman and contributes to fetal red cell destruction in future pregnancies. There is no production of immune bodies. Rho(D) immune globulin prevents the woman's immune system from responding to the fetal Rh-positive blood.

Which drink choice on a hot day indicates to the nurse that a teenager with sickle cell anemia understands dietary considerations related to the disease?

Lemonade

The mother asks the practical nurse (PN) what her infant may need if the phenylketonuria(PKU) test is positive. What type of treatment should the PN tell the mother will be required?

Lifelong dietary management.

Which type of medication would the nurse identify as readily crossing the placenta? A. Polar medications B. Ionized medications C. Lipid-soluble medications D. Protein-bound medications

Lipid-soluble medications Medications that are lipid soluble penetrate the placenta in higher concentrations. Polar medications are not transferred in higher concentrations through the placenta. Nonionized medications are more likely to be transferred through the placenta than ionized medications. Protein-bound medications remain in the maternal plasma because the molecules are too large to cross the placenta.

The parent of an adolescent who is going to be a foreign exchange student asks the nurse why the child must have a tetanus toxoid immunization. The nurse provides which information? A. lifelong passive immunity B. Longer-lasting active immunity C. Temporary active natural immunity D. Temporary passive natural immunity

Long-lasting active immunity Toxoids are modified toxins that stimulate the body the body to form antibodies that can last up to 10 years against the specific disease; because the adolescent will be in a foreign country, the toxoid is given prophylactically. The tetanus toxoid provides active, not passive, immunity; all passive immunity is short acting. Only by having the disease can someone gain natural immunity. Toxoids confer active, not temporary passive, immunity.

Which antihistamine is considered safe for a woman who plans to breast-feed? A. Sertraline B. Loratadine C. Clemastine D. Bromocriptine

Loratadine Loratadine does not get excreted in the breast milk. It is a safe medication for a lactating mother to take. Sertraline is an antidepressant that is safe for lactating women. Clemastine and bromocriptine are contraindicated in lactating women.

The nurse is assessing an infant with pyloric stenosis. Which pathophysiological mechanism is the most likely consequence of this infant's clinical picture?

Metabolic Alkalosis

Which medication would the nurse identify as being used to induce abortion? A. Oxytocin B. Mifepristone C. Dinoprostone D. Indomethacin

Mifepristone Mifepristone is used to induce abortion. Oxytocin is used to induce labor at full-term gestation. Oxytocin also enhances labor when uterine contractions are weak and ineffective, which is inappropriate for abortion. Dinoprostone is a uterine stimulant that produces labor by softening the cervix and enhancing uterine muscle tone. Indomethacin is a tocolytic medication.

The nurse understands which is the medication of choice for a client who wants to abort her pregnancy at 3 months of gestation? A. Nifedipine B. Terbutaline C. Mifepristone D. Methylergonovine

Mifepristone Mifepristone is a progesterone antagonist that stimulates uterine contractions; it is used to selectively terminate a pregnancy. Nifedipine is a calcium channel blocker that is used to maintain pregnancy in cases of preterm labor. Terbutaline is a medication previously used to inhibit labor and maintain pregnancy, but in 2011 the FDA issued a warning that it should not be used for prevention or prolonged treatment of preterm labor; it is approved to prevent and treat bronchospasm. Methylergonovine is used to reduce postpartum uterine hemorrhage; this medication is not used for abortion.

An infant who weight 4550 grams is delivered using forceps-assisted vaginal delivery. What action is most important for the practical nurse (PN) to implement?

Monitor for signs of hypoglycemia.

Which combination of maternal and infant blood type would be an indication for administration of Rho (D) immune globulin (RhoGAM) to the postpartum client? A. Mother A positive and infant O positive B. Mother O negative and infant O positive C. Mother AB negative and infant B negative D. Mother B positive and infant B negative

Mother O negative and infant O positive Mom: negative Baby: positive = RhoGAM

Which eduction would the nurse provide the parents of an infant with a cleft lip and palate about the infant's predisposition to infection? A. Waste products accumulate along the defect B. Circulation to the defective area is insufficient C. inefficient feeding behaviors result in inadequate nutrition D. Mouth breathing dries the oropharyngeal mucous membranes

Mouth breathing dries the oropharyngeal mucous membranes Infants with cleft lip and palate breathe through their mouths, bypassing the natural humidification and filtration provided by the nose; as a result, the mucous membranes become dry and cracked and are at risk for infection. Although some waste products may accumulate along the defect, it is not difficult to keep the area clean by cleansing it with water after a feeding. Circulation to the area is unimpaired. Feeding can be adequate with the use of special equipment and a slow approach.

Which medication is used to prevent preterm labor? A. Oxytocin B. Nifedipine C. Raloxifene D. Clomiphene

Nifedipine Nifedipine is used to prevent preterm labor because it inhibits myometrial activity by blocking the influx of calcium. Oxytocin may be used to induce labor. Raloxifene is used to prevent postmenopausal osteoporosis. Clomiphene is used to cause ovulation.

The practical nurse (PN) is reviewing the informational packets with a client who is at risk for preeclampsia. Which information is most important for the PN reinforce with the client?

Notify the clinic if any vision changes are experienced.

A child with acute lymphocytic leukemia (ALL) who is receiving chemotherapy via a subclavian IV infusion, has an oral temperature of 103 degrees. In assessing the IV site, the nurse determines that there are no signs of infection at the site. Which intervention is the most important for the nurse to implement?

Obtain specimen for blood cultures

A client's body mass index (BMI) is 31. This client has a history of hyperinsulinemia caused by an intracranial tumor. Which treatment strategies would be beneficial? A. Leptin B. Orlistat C. Octreotide D. Metformin E. Sibutramine

Octreotide, Metformin A client with a body mass index (BMI) greater than 30 is considered obese. Specifically, octreotide is recommended for clients with hypothalamic obesity, which is caused by intracranial tumors. Metformin is prescribed for obese clients with insulin resistance and hyperinsulinemia, and it may be useful. Leptin is used to treat congenital leptin deficiency. Orlistat is a lipase inhibitor that has been approved for clients who are 12 years and older. Sibutramine is an appetite suppressant used to treat obesity.

The father of a 4-year-old often observes his daughter at day care via a video camera hookup to his computer. The father tells the practical nurse (PN) at the day care center that he frequently observes his daughter eating with her fingers rather than with utensils. How should the PN respond?

Offer reassurance that this behavior is normal but that he can begin teaching his child how to use utensils.

Which care plan would the nurse implement for an infant admitted to the pediatric unit with the diagnosis of heart failure? A. Increase the infants fluid intake B. Position the infant flat on the back C. Offer the infant small, frequent feedings D. Measure the infant's head circumference

Offer the infant small, frequent feedings Because infants with heart failure become extremely fatigued while suckling, small, frequent feedings with adequate rest periods between can improve their total intake. Infants with heart failure usually have fluids restricted to reduce the cardiac workload. Lying flat restricts lung expansion and should be avoided; positioning with the upper body elevated facilitates respirations. Infants with heart failure are not prone to hydrocephalus and do not need to have head circumference measured again if the initial newborn assessment findings are within expected limits.

Which intervention should the practical nurse (PN) provide a neonate during hospitalization?

Offer the neonate a pacifier between feedings.

A health care provider prescribes teriparatide for a client with osteoporosis. Which statement about this medication would the nurse recognize as accurate? A. It requires increased intake of vitamin A. B. It prevents existing bone from being destroyed. C. Sunscreen should be used to prevent vitamin D absorption. D. Osteoblastic activity is stimulated more than osteoclastic activity.

Osteoblastic activity is stimulated more than osteoclastic activity. Teriparatide is a 34-amino acid polypeptide that represents the biologically active part of human parathyroid hormone; it enhances bone microarchitecture and increases bone mass and strength by stimulating activity by osteoblasts. Supplemental intake of vitamin A should not exceed recommended daily requirements; too much vitamin A has been associated with bone loss and an increased incidence of fractures. Alendronate sodium, a regulator of bone metabolism, not teriparatide, inhibits osteoclast-mediated bone resorption, minimizing bone destruction and loss of bone density. Sunscreen should be avoided to promote exposure to the sun so that vitamin D can be converted in the skin; vitamin D helps the body absorb calcium. Sunscreen should be used after 5 to 20 minutes of exposure to prevent the negative effects of prolonged exposure to ultraviolet rays.

A father expresses concern that his 3-day-old infant looks "yellow." Which information should the practical nurse (PN) provide?

Physiologic jaundice occurs from a normal reduction in red blood cells.

An infant with tetralogy of fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first?

Place the infant in a knee-chest position

Which nursing intervention would the nurse implement for an infant with a myelomeningocele awaiting surgical correction of the defect? A. Using disposable diapers B. Placing the infant in the prone position C. Performing neurologic checks above the site of the lesion D. Washing the area below the defect with nontoxic antiseptic

Placing the infant in the prone position The prone position is the best position for preventing pressure on the sac. Diapers should not be applied because they may irritate or contaminate the sac. Assessment of the area below the defect is essential in determining motor and sensory function. There is no indication for the use of an antiseptic.

The nurse is assessing a child for neurological soft signs, which finding is most likely demonstrated in the child's behavior?

Poor coordinatin and sense of position

The mother of a one month old calls the clinic to report that the back of her infants head is flat. How should the nurse respond?

Position the infant on the stomach occasionally when awake and active

A child is brought to the clinic complaining of fever and joint pain, and is DX with rheumatic fever. When planning care for this child what is the goal of nursing care?

Prevent cardiac damage

Prevent the return of oxygenated blood to the lungs.

The nurse identifies which medication as impairing fertility when administered along with fertility medications? A. Clomiphene B. Menotropins C. Promethazine D. Choriogonadotropin

Promethazine When taken with fertility medications, promethazine increases prolactin concentration, which may impair fertility. Clomiphene and menotropins are ovulation stimulants given to induce ovulation in infertile women. Choriogonadotropin alfa is a recombinant form of human gonadotropin hormone; this medication is an ovulation stimulant.

Which information should the practical nurse (PN) provide the parents about the purpose of instilling erythromycin (llotycin) ophthalmic ointment in the newborn's eyes.

Prophylactic treatment for gonorrheal and chlamydia infection.

Red blotchy macular rash on the face and neck

Reduce the invaginated bowel segment.

Which provider prescription would the nurse question for a young child with a tentative diagnosis of Wilms tumor? A. Renal biopsy B. Abdominal ultrasound C. Computed tomography scan (CT) D. Magnetic resonance imaging (MRI)

Renal biopsy A renal biopsy is an invasive procedure. In the early stages, Wilms tumor is encapsulated. Any disruption of the tumor capsule may precipitate metastasis. Magnetic resonance imaging, computed tomography, and abdominal ultrasound are all helpful in making the diagnosis.

The parents of a newborn infant with hypospadia are concerned about when the surgical correction should occur. What information should the nurse provide?

Repairs typically should be done before the child is potty trained

Minocycline (Minocin) 50 mg PO every 8 hours is prescribed for a 18-year old adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.)

Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception if sexually active.

The practical nurse (PN) should take the vital signs of a 4-month-old child in which sequence to collect the most accurate results?

Respiratory rate, heart rate, then axillary temperature

The practical nurse (PN) is caring for a child with an acute respiratory condition. When the PN is monitoring for impending respiratory distress, what sign is the child likely to exhibit first?

Restlessness

A 3 year old with HIV infection is staying with a foster family who is caring for 3 other foster children in their home. When one of the children acquires pertussis, the foster mother calls the clinic and asks then nurse what she should do. Which action should the nurse take first?

Review the immunizaiton documentation of the child who has HIV

The nurse is caring for a 3 year old child who is 2 hours postop from a cardiac catheritization via the right femoral artery. Which assessment finding is an indication of arterial obstruction?

Right foot is cool to the touch and appears pale and blanched

The nurse in the pediatric clinic receives a call from the mother of a 12-month-old infant who has had a fever, runny nose, cough, and white spots in the mouth for 3 days. A rash started on the face and has now spread to the entire body. Which communicable infection would the nurse be concerned about? A. Rubella B. Rubeola C. Pertussis D. Varicella

Rubeola White spots (Koplik spots) and the rash with a fever, cough, and runny nose are clinical indicators of rubeola (measles). Rubella (German measles), pertussis (whooping cough), and varicella (chickenpox) do not cause Koplik spots.

A 7 year old is admitted to the hospital with persistent vomiting, and a nasogastric tube attached to low intermittent suction is applied. Which finding is most important for the nurse to report to the healthcare provider?

Serum potassium of 3.0 mg/dL

Following a motor vehicle collision, a 3 year old girl has a spica cast applied. Which toy is best for the nurse for this 3 year old child?

Set of cloth and hand puppets

Which medication treatment in the client during her gestation may cause a single-lobed brain and neural tube defects? A. Simvastatin B. Isotretinoin C. Carbamazepine D. Cyclophosphamide

Simvastatin Neural tube defects and single-lobed brains are teratogenic effects in a newborn associated with simvastatin, an HMG-CoA reductase inhibitor. Isotretinoin may cause central nervous system (CNS) defects. Carbamazepine exposure may cause neural tube defects. Cyclophosphamide may cause CNS malformation as a teratogenic effect.

Which toy would the nurse select for a 1-year-old child in the hospital playroom? A. Rocking horse B. Stuffed animal C. Four-piece puzzle D. Squeaky plastic duck

Squeaky plastic duck A plastic toy that squeaks is appropriate for a 1-year-old child because it provides auditory, tactile, and visual stimulation. The potential for injury is too great for a 1-year-old child to be placed on a rocking horse. A stuffed animal should not be kept in a playroom because it cannot be washed between uses by different children. A 1-year-old is too young for a puzzle.

A 12-year-old with type 1 diabetes mellitus complains of abdominal pain and has experienced increased thirst during the previous 24 hours. What action should the practical nurse implement first?

Test urine for ketones and glucose.

Which medication treatment may have been given during gestation to a mother whose baby was born with shortened limbs? A. Phenytoin B. Topiramate C. Thalidomide D. Carbamazepine

Thalidomide Thalidomide is an anticancer medication that may cause shortening of the limbs as a teratogenic effect. Phenytoin, topiramate, and carbamazepine are antiseizure medications that may cause growth delays and neural tube defects.

A 15-year-old male with mild mental retardation who is hospitalized for minor surgery tells a female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to make?

That language is not permitted."

Which client is a candidate for the administration of human immune globulin (RhoGam) after delivery?

The Rh-negative mother who delivers a Rh-positive baby.

Prior to discharge, the parents of a child with cystic fibrosis are demonstrating chest physiotherapy (CPT) that they will perform for their child at home. Which action requires intervention by the nurse?

The child is placed in a supine position to begin percussion

An 11-year-old boy is admitted after being hit in the head with a baseball during a Little League game. Which subject is most important for the practical nurse to explore during history taking?

The level of consciousness exhibited after the injury

Which parental statement would the nurse recognize as a concern? A. My baby like several different types of pacifiers B. The mouth guard for the pacifier was too big do I had to alter the size C. I allow my baby to fall asleep with the pacifier during day naps and at night D. I have clipped the pacifier to my baby's clothing so that it does not fall on the floor

The mouth guard for the pacifier was too big do I had to alter the size Altering the size of a pacifier poses a safety risk. There is no problem with an infant using different types of pacifiers as long as they are appropriate for the infant's age. The use of a pacifier is associated with a reduced risk of sudden infant death syndrome (SIDS). There are clips available that are safe to use to secure a pacifier.

The practical nurse (PN) places a newborn who is 4 hours old with an axillary temperature of 97.2 F under the radiant heat warmer. Which rationale supports the PN's action?

The newborn's thin layer of subcutaneous fat provides poor insulation.

The parents of a gifted child note that their child has been showing signs of rebellion and acting out. Which is one important thing to teach the parents about gifted children? A. They need boundaries like any other child B. Intense emotions require an outlet C. All discipline models approve physical aggression D. Gifted children should be allowed to freely express themselves

They need boundaries like any other child Gifted children need discipline like any other child to feel loved and safe. Punishment is appropriate for behavior that is unsafe or falls outside set boundaries. Discipline appropriately applied does not lead to physical aggression. Free expression does not mean overstepping the boundaries of appropriate behavior.

Which medication is responsible for neonatal hypoglycemia? A. Warfarin B. Simvastatin C. Tolutamide D. Methimazole

Tolutamide Tolbutamide is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have effects such as neonatal hypoglycemia. Warfarin, a common blood thinner, may cause teratogenic effects such as skeletal and central nervous system defects. Simvastatin, an HMG-CoA reductase inhibitor used for the treatment of high cholesterol, may cause teratogenic effects such as facial malformations and severe central nervous system anomalies. Methimazole, an antithyroid medication administered for the treatment of maternal hyperthyroidism, may cause teratogenic effects such as neonatal goiter, cretinism, and hypothyroidism.

An adolescent reports genital warts. Which suggestions would the nurse provide to reduce the discomfort? A. Try out cryotherapy if needed B. Wear loose-fitted cotton clothes C. Take a bath with oatmeal solution D. Use less water for cleaning the genitals E. Anticipate a prescription of imiquimod

Try out cryotherapy if needed, wear loose-fitted cotton clothes, take a bath with oatmeal solution To reduce the irritation and discomfort of genital warts, bathing with oatmeal solution can be helpful. Wearing loose-fitted cotton clothes helps in reducing the irritation and friction. Depending on the severity of the warts, cryotherapy can be an option to treat the warts. Proper cleaning and hygiene of the genital area is necessary to reduce the growth of the warts. Medications such as imiquimod should not be used during pregnancy.

The mother of a 4 month old asks the nurse to advice in preventing diaper rash. What suggestion should the nurse provide?

Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change

What is the most important information for the practical nurse (PN) to review with a 12-year-old who is receiving long-term and rescue medications for routine management of asthma?

Use albuterol (Proventil) for prevention of exercise-induced bronchospasm.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization?

Vastus lateralis

A 3 year old boy in a daycare facility scratches his head frequently and the nurse confirms the presence of head lice. The nurse washes the child's hair with permethrin (Nix) shampoo and call his parents. What instructions should the nurse provide to the parents about treatment of head lice?

Wash the child's bed linens and clothing in hot soapy water

Which nursing intervention is most important to include in the plan of care for a child with acute glomerulonephritis?

Weigh the child daily

A short arm cast is applied to a child with a fractured right ulna. The practical nurse (PN) is preparing the parents with home instructions and should reinforce that the parents follow which discharge instruction? a. Call the health care provider immediately if the nail beds appear "blue" or "empty." b. Check the child's ability to move his fingers without pain hourly for the first 48 hours. c. Elevate the arm above the heart for the first 24 hours. d. Monitor temperature every 4 hours for the next 2 days and call if an elevation is noted.

a. Call the health care provider immediately if the nail beds appear "blue" or "empty." Rationale:Cyanosis indicates impaired circulation to the fingers and should be reported immediately.

The parents of a 7-month-old infant with spastic cerebral palsy bring him to the pediatric clinic. Which symptom reported by the parents warrants immediate intervention by the practical nurse (PN)? a. Choking while being fed. b. The child's legs continually cross each other. c. Child gets stiff when shifting to a sitting position. d. Older sibling is jealous of the younger sibling.

a. Choking while being fed. Rationale:Aspiration is a priority when caring for an infant with cerebral palsy and dysphagia.

A full-term infant is admitted to the newborn nursery. During the initial PO feeding, the practical nurse (PN) observes the infant for possible tracheal esophageal atresia. Which symptoms are likely to be exhibited during the feeding if this condition is present? a. Choking, coughing, and cyanosis b. Projectile vomiting and cyanosis c. Apneic spells and grunting d. Scaphoid abdomen and anorexia

a. Choking, coughing, and cyanosis Rationale:Choking, coughing, and cyanosis are the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea.

A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes (TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the child has a purulent discharge from the right ear, and the mother explains that the toddler has had a cold for 3 days. What action should the PN plan to implement? a. Collect a specimen of the otorrhea for culture. b. Refer the child for audiologic screening tests. c. Administer prescribed antibiotics. d. Perform an otoscopic exam for TM tube placement.

a. Collect a specimen of the otorrhea for culture. Rationale:The presence of the purulent drainage indicates that the middle ear is draining a new infectious process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes are surgically placed to manage otitis media with effusion (OME) to provide mechanical drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM and ossicle function, necessitating hearing screening. The immediate problem, however, is infection.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate IM STAT. What is the primary purpose for administering this drug to the child at this time? a.Decrease the oral secretions. b.Reduce the child's anxiety. c.Potentiate the opioid effects. d.Prevent possible peritonitis.

a.Decrease the oral secretions. Rationale:Atropine sulfate (Atropine), an anticholinergic agent, is given to decrease oral secretions during a surgical procedure.

The nurse observes that a 3-year-old child combines words in short phrases and understands the concepts of hot and cold and big and little. Which intervention should the PN implement? a.Document that the child's expressive speech is age appropriate. b.Request immediate referrals for speech and hearing evaluations. c.Review the child's history for prior evaluations of developmental lags. d.Ask the parent to leave the room so that findings can be reevaluated.

a.Document that the child's expressive speech is age appropriate. Rationale:A 3-year-old should be able to distinguish between common opposites and speak in short phrases, so the child's age-appropriate speech pattern should be documented.

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. What adverse effect should the nurse assess for and report promptly to the health care provider? a.Petechiae b.Tinnitus c.Oliguria d.Hypertension

a.Petechiae Rationale:Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae.

Minocycline 50 mg PO every 8 hours is prescribed for a 18-year-old adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) a.Report vaginal itching or discharge. b.Take the medication at 0800, 1500, and 2200 hours. c.Protect skin from natural and artificial ultraviolet light. d.Avoid driving until response to medication is known. e.Take with an antacid tablet to prevent nausea. f.Use a nonhormonal method of contraception if sexually active.

a.Report vaginal itching or discharge. c.Protect skin from natural and artificial ultraviolet light. d.Avoid driving until response to medication is known. f.Use a nonhormonal method of contraception if sexually active. Rationale:Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge, protect the skin from ultraviolet light, and use a nonhormonal method of contraception while on the medication. Minocycline (Minocin) is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving should be avoided.

The practical nurse (PN) should take the vital signs of a 4-month-old child in which sequence to collect the most accurate results? a.Respiratory rate, heart rate, then axillary temperature b.Heart rate, axillary temperature, then respiratory rate c.Axillary temperature, heart rate, then respiratory rate d.Axillary temperature, respiratory rate, then heart rate

a.Respiratory rate, heart rate, then axillary temperature Rationale:The respiratory rate should be taken first in infants, because touching them or performing unpleasant procedures usually makes them cry, which elevates the heart rate and makes respirations difficult to count.

A newborn who has mild transitional (positional) clubfeet is placed in bilateral casts in an overcorrected valgus (outward) position. What is the primary issue the practical nurse should review with the parents during discharge teaching? a.Prevent cast soiling and maintain the cast's edge by petaling. b.Observe for skin and circulation compromise from the cast. c.Manipulate the cast surfaces with the palms of the hands. d.Support and elevate both legs on pillows continuously.

b.Observe for skin and circulation compromise from the cast. Rationale:Reinforcing information with parents about their role in care and about vigilant observation for potential problems of the infant at home such as skin and circulation compromise is the most important nursing intervention.

The teacher reports that a 7-year-old child frequently daydreams in school, experiences abrupt interruptions in conversations, and stares into space. Which action should the practical nurse take? a.Reassure the teacher that this is normal behavior. b.Observe the child's behavior in the classroom. c.Notify the child's parents about this behavior. d.Refer the child for further evaluation.

b.Observe the child's behavior in the classroom. Rationale:Absence (petit mal) seizures are often manifested as daydreaming behaviors. The child should be observed to confirm what the teacher is describing because this child might be experiencing petit mal seizures.

The health care provider prescribes the anticonvulsant carbamazepine (Tegretol) for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? a.Experiences dry mouth b.Experiences dizziness c.Develops a sore throat d.Develops gingival hyperplasia

c.Develops a sore throat Rationale:Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.

An infant is born with a ventricular septal defect (VSD), and surgery is planned to correct the defect. The practical nurse (PN) should understand that the surgical correction is designed to achieve which hemodynamic outcome? a.Stop the flow of unoxygenated blood into systemic circulation. b.Increase the flow of unoxygenated blood to the lungs. c.Prevent the return of oxygenated blood to the lungs. d.Reduce peripheral tissue hypoxia and nail bed clubbing.

c.Prevent the return of oxygenated blood to the lungs. Rationale:Closure of the VSD will stop shunting of oxygenated blood from the left ventricle (higher pressure) to the right ventricle.

A 12-year-old with type 1 diabetes mellitus complains of abdominal pain and has experienced increased thirst during the previous 24 hours. What action should the practical nurse implement first? a.Obtain blood for a complete blood count (CBC) test. b.Initiate D10W at 50 mL/hour IV. c.Test urine for ketones and glucose. d.Assess temperature and blood pressure.

c.Test urine for ketones and glucose. Rationale:This child is exhibiting signs of impending diabetic ketoacidosis (DKA), so the child's urine should be tested for ketones and glucose to assess for DKA.

Baby shows signs of jitteriness and other signs of hypoglycemia. What to do first

capillary glucose level

The parent of a 4-year-old often observes his child at day care via a video camera hookup to his computer. The parent tells the practical nurse (PN) at the day care center that the child frequently eats with her fingers rather than with utensils. How should the PN respond? a.Explain that the day care center employs certified child care specialists with knowledge of growth and development. b.Advise the parent that an in-service program will be provided to staff regarding mealtime behavior to be expected of preschoolers. c.Schedule the child for an Ages and Stages Questionnaire to evaluate the child's developmental skill level. d.Offer reassurance that this behavior is normal but that the child can now be taught how to use utensils.

d.Offer reassurance that this behavior is normal but that the child can now be taught how to use utensils. Rationale:Preschoolers should learn to use utensils but often prefer to use their fingers.

The practical nurse (PN) is caring for a child with Wilms' tumor. Which preoperative intervention should the PN implement? a.Gently percuss the abdomen for evidence of trapped air. b.Observe the abdomen for any noticeable discolorations. c.Apply cold compresses to the abdomen to reduce edema. d.Put a sign above the bed reading, "Do not palpate abdomen."

d.Put a sign above the bed reading, "Do not palpate abdomen." Rationale:Prevention of abdominal palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis.

While examining a 6-year-old visiting the clinic for fever and a rash, the practical nurse (PN) notices several elevated 1- to 3-mm white spots on the buccal mucosa. What other signs should the PN expect this child to exhibit? a.Pruritic vesicular skin eruptions on trunk b.Honey-colored crusted exudate from ruptured skin vesicles c.Irregular red macular rash in the perianal area d.Red blotchy macular rash on the face and neck

d.Red blotchy macular rash on the face and neck Rationale:Elevated white spots on the oral mucosa of a child are likely Koplik's spots and are indicative of rubeola. They are accompanied by a red blotchy rash that starts on the face and spreads to the neck, the trunk, and the rest of the body.

Patient is taking mag sulfate and urine output is 25 mL/hr, respirations 14/min, pulse is 116/min, what should the nurse do first

discontinue mag sulfate (signs of mag tox)

Mom feels the urge to defecate during labor

do a vagina exam

Baby has total bilirubin level of 12 after 24 hrs

encourage mom to breastfeed

Functions of placenta in early pregnancy

estrogen and progesterone production

In a gestational diabetic mom, what is the most important aspect for a healthy pregnancy

euglycemia

Assessment of a normal breast after delivery

expels colostrum (3-4 days)

Signs of fetal alcohol syndrome

flat nose bridge

How do you measure the frequency of contractions

from the beginning of one to the beginning of the next

What does nurse do prior to administering RhoGAM injection

get second nurse to confirm med and patient

Mom is prescribed hemabate

give antiemetic before hemabate due to s/e (also cause diarrhea so give antidiarrheal)

Mothers Hemoglobin A1C

give her a consultation to a nutritionist

Baby progressing in extrauterine life would show what signs

good vigorous cry with stimulation

Baby shows cyanosis in hands and feet and has elevated respirations

gradually warm the baby

Cyanotic 3 hour old infant temperature 96.5, 40 breaths/min, 165 beats/minute. Intervention best to implement?

gradually warm under heat source

What is the best method to get hemoglobin and hematocrit on baby

heel stick

Myelomeningocele

hernia of the spinal cord and meninges (SPINA BIFIDA)

Mom is complaining that baby isn't getting enough to eat, what do you tell her

if baby's urine is straw colored, baby is ok

Baby is given surfactant to help RDS, what assessment lets you know that the baby is Improving

increased urinary output

Mom is at 20 week gestation and has gained 20 lbs, what is of most concern out of the data of mom

increased weight gain

Mom comes out of room screaming that her baby is missing. What do you do

initiate a lockdown

Mom asks why her baby is being screened for T4 and TSH levels

it is state protocol to monitor for metabolic abnormalities

IDDM insulin needs

less insulin needed in the first trimester

A 2 year old boy begins to cry when the mother starts to leave. What is the nurse's best response to the situation?

let me read this book to you

Woman had cleft lip, dads uncle had cleft lip

send them for genetic testing

Mom has post partial hemorrhage. What is most likely the cause

she is a multigravida

Pregnant woman has a diaphragm

she needs to have it refitted for another diaphragm

Pt is administered with anesthesia, what is the highest priority -

side rails up and call bell in reach

Which education would the nurse provide the parent of a child diagnosed with sleep terrors? A. Sleep terrors are followed by full waking. B. Sleep terrors usually occur 1-4 hours after falling asleep C. It takes place during REM sleep D. The child rapidly returns to sleep after an episode of sleep terrors E. The child is aware of and reassured by another's presence after an episode of sleep terrors

sleep terrors usually occur 1 to 4 hours after falling asleep, the child rapidly returns to sleep after an episode of sleep terrors Sleep terrors usually occur 1 to 4 hours after falling asleep, when non-REM sleep is deepest. After an episode, the child rapidly returns to sleep; it is often difficult to keep the child awake after this. Nightmares are followed by full waking; sleep terrors are followed by partial arousal. Nightmares take place during REM sleep; sleep terrors take place during stage IV, non-REM sleep. After a nightmare, the child is aware of and reassured by another's presence. After an episode of sleep terrors, however, the child is not very aware of another's presence, is not comforted, and may push the person away and scream and thrash more if held or restrained.

Mom says baby is trying to walk, what do you say

stepping reflex is normal reflex for babies

Pt is induced for labor contractions begin occurring 1 ½ to 2 min apart with no resting in between contractions, what to do first

stop Pitocin infusion

Patient is showing signs of mag toxicity (nausea, feeling of warmth, flushing)

stop infusion

Patient is noted to have positive homan sign, what do you do

tell the patient to stay in the bed and notify the dr

During fundal massage, place one hand at the fundus, what is the second hand used for

to anchor fundus

How should then nurse instruct the parents of a 4 month old with seborrheic dermatitis (cradle cap) to shampoo the childs hair?

Pediatrics HESI PN Review, HESI PN Obstetrics/Maternity Practice Exam, Pediatrics HESI PN Review, Hesi Peds, PN HESI Peds, Peds & Maternity HESI, HESI Maternity/Pediatric Remediation

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