OB HESI/FINAL

The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instructions?`

B. "I need to lie flat on my back to perform the kick count"

The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and expects which finding?`

B. 30 cm

Which growth and development characteristic should the nurse consider when monitoring the effects of a topical medication for an infant?`

B. A thin stratum corneum that increases topical absorption.

What intervention is required for a teenager experiencing acute glomerulonephritis with a BP of 170/88 (previously 210/110)?`

B. Administer PRN nifedipine (Procardia) sublingually

Which interventions should the nurse include in the teaching plan for the mother of a 6-year-old who is experiencing encopresis secondary to a fecal impaction? (Select all that apply.)`

B. Administer mineral oil daily. D. Eliminate dairy products. E. Initiate consistent toileting routine.

A 6-month-old boy and his mother are at the health clinic for a well-baby checkup and routine immunization. The HP recommends an influenza vaccine. What medications should the RN plan to administer?`

B. All the immunizations with the influenza being administered in a different site

The nurse caring for a laboring client encourages her to void at least q2h, and records each time the client empties her bladder. What is the primary reason for implementing this nursing intervention?`

B. An over-distended bladder could be traumatized during labor, as well as prolong the progress of labor

A child with sickle cell anemia who is in vaso-occlusive crisis is admitted to the hospital. Which health care provider prescription would assist in reversing the vaso-occlusive crisis?`

B. Begin intravenous fluids

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention?`

B. Cover the bladder with a nonadhering plastic wrap.

A child is admitted to the pediatric unit with a diagnosis of acute stage Kawasaki disease. In performing an assessment on the child, which findings are characteristic of this disorder? Select all that apply.`

B. Cracking lips C. Conjunctival hyperemia D. Desquamation of the skin

A 3-year-old boy is brought to the emergency room after swallowing an entire bottle of multi-vitamins. Which intervention should RN implement first?`

B. Determine the child's pulse and respirations

The mother of a preschool-aged child asks the nurse if it is all right to administer Pepto Bismol to her son when he "has a tummy ache." After reminding the mother to check the label of all over-the-counter drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question?`

B. Do not give if the child has chickenpox, flu, or any other viral illnesses

The nurse is teaching the parents of a 2-year-old child with a congenital heart defect about signs and symptoms of congestive heart failure. Which information about the child is most important for the parents to report to the health care provider?`

B. Exhibits a sudden and unexplained weight gain

A client in active labor is admitted with preeclampsia. Which assessment finding is most significant in planning this client's care?`

B. Extend the leg and dorsiflex the foot

During discharge teaching of a child with juvenile rheumatoid arthritis, the nurse should stress to the parents the importance of obtaining which diagnostic testing?`

B. Eye exams

The nurse in the gynecology clinic is reviewing the record of a pregnant client after the first prenatal visit. The nurse notes that the health care provider has documented that the woman has a platypelloid pelvis. On the basis of this documentation, the nurse plans care, knowing that this type of pelvis has which characteristic?`

B. Has a flat

Which maternal behavior is the nurse most likely to see when a new mother receives her infant for the first time?`

B. Her arms and hands receive the infant and she then traces the infant's profile with her fingertips

A primigravida, when returning for the results of her multiple marker screening (triple screen), asks the nurse how problems with her baby can be detected by the test. What information will the nurse give to the client to describe best how the test is interpreted?`

B. If MSAFP and estriol levels are low and the hCG level is high, results are positive for a possible chromosomal defect.

When inserting a nasogastric tube into the stomach of a 3-month-old infant, which nursing intervention is most important to implement?`

B. Monitor the infant's heart rate.

An infant is receiving digoxin for congestive heart failure. The apical heart rate is assessed at 80 beats/min. What intervention should the nurse implement?`

B. Obtain a therapeutic drug level.

A nurse performs a vaginal assessment on a pregnant client in labor. On assessment, the nurse notes the presence of the umbilical cord protruding from the vagina. Which is the initial nursing action?`

B. Place the client in Trendelenburg's position.

The health care provider prescribes patching for a child with strabismus of the right eye, and the nurse instructs the mother regarding this procedure. What should the nurse include in the instructions?`

B. Place the patch on the left eye.

A six month old returns from surgery with elbow restraints. What nursing care should be included when caring for a child in restraints?`

B. Remove restraints one at a time and provide ROM exercises

The nurse should explain to a 30-year-old gravid client that alpha fetoprotein testing is recommended for which purpose?`

B. Screen for neural tube defects

A 3-year-old client with sickle cell anemia is admitted to the Emergency Department with abdominal pain. The nurse palpates an enlarged liver, an x-ray reveals an enlarged spleen, and a CBC reveals anemia. These findings indicate which type of crisis?`

B. Sequestration.

An 18-month-old child returns to the unit following a cardiac catheterization with a cannulated femoral artery site. Which intervention should the nurse implement?`

B. Show the parents how to hold the child with the extremity extended.

A nurse receives a shift change report for a newborn who is 12 hours post-vaginal delivery. In developing a plan of care, the nurse should give the highest priority to which finding?`

B. Skin color that is slightly jaundiced

The vital signs of 4 yr old child w/ polyuria are: BP 80/40, pulse, 118, and Resp. 24. The child's pedal pulses are present w/ a volume of +1, and no edema is observed. What action should the nurse implement first?`

B. Start an IV infusion of normal saline

Which class of antiinfective drugs is contraindicated for use in children under 8 yrs of age?`

B. Teteracyclines

Which action by the nurse is most helpful in communicating with a preschool-aged child?`

B. Use a doll to play and communicate

The nurse has provided instructions about measures to clean the penis to a mother of a male newborn who is not circumcised. Which statement, if made by the mother, indicates an understanding of how to clean the newborn's penis?`

C. "I need to avoid pulling back the foreskin to clean the penis because this may cause adhesions."

Several children have contracted rubeola (measles) in a local school, and the school nurse conducts a teaching session for the parents of the schoolchildren. Which statement made by a parent indicates a need for further teaching regarding this communicable disease?`

C. "The disease can be spread to others 10 days before any sign of the disease appears to 15 days after the rash appears."

A pregnant client at 10 weeks' gestation calls the prenatal clinic to report a recent exposure to a child with rubella. The nurse reviews the client's chart. What is the nurse's best response to the client? `

C. "You were wise to call. Your rubella titer indicates that you are immune and your baby is not at risk."

The nurse is collecting data from a client during the first prenatal visit. The client is anxious to know the gender of the fetus and asks the nurse when she will be able to know. The nurse should respond to the client knowing that the gender of the fetus is determined by which weeks?`

C. 13 to 16

The nurse is using the Silverman-Anderson index to assess an infant with respiratory distress and determines that the infant is demonstrating marked nasal flaring, an audible expiratory grunt, and just visible intercostal and xiphoid retractions. Using this scale, which score should the nurse assign?`

C. 5

A 3-month-old infant weighing 10 lb 15 oz has an axillary temperature of 98.9° F. What caloric amount does this child need?`

C. 600 calories/day

A client at 32-weeks gestation is hospitalized with severe pregnancy-induced hypertension (PIH), and magnesium sulfate is prescribed to control the symptoms. Which assessment finding indicates the therapeutic drug level has been achieved?`

C. A decrease in RR from 24 to 16

A client with severe preeclampsia is admitted to the maternity department. Which room assignment would be most appropriate for this client?`

C. A private room two doors away from the nurses' station

Surgery is being delayed for an infant with undescended testes. In collaboration with the healthcare provider and the family, which prescription should the nurse anticipate.`

C. A trial of chorionic gonadotrophic hormone

A 16-year old boy is brought to the E.D. with a crushed leg after falling off a horse. His last tetanus toxoid booster was received at 8-years old. Which action should the nurse take?`

C. Administer tetanus toxoid booster

The nurse should teach the parents of a child with a cyanotic heart defect to perform which action when a hypercyanotic spell occurs?`

C. Allow the child to assume a knee-chest position, with the head and chest slightly elevated.

Prior to discharge, what instructions should the nurse give to parents regarding the newborn's umbilical cord care at home?`

C. Allow the cord to air-dry as much as possible.

An adolescent with diabetes receives 30 units of Humulin N insulin at 7:00 am. In accordance with the peak insulin action time, the nurse would monitor for a hypoglycemic episode at what time?`

C. Before supper

The parents of a child with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond?`

C. Cleft-lip repair is usually performed during the first weeks of life.

A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior?`

C. Concerns for body integrity

The nurse in the newborn nursery is preparing to complete an initial assessment on a newborn infant who was just admitted to the nursery. The nurse should place a warm blanket on the examining table to prevent heat loss in the infant caused by which method?`

C. Conduction

The nurse observes a 4-year-old boy in a day care setting. Which behavior should the nurse consider normal for this child?`

C. Demonstrates aggressiveness by boasting when telling a story

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action?`

C. Encourage the child to drink liquids.

A new mother is having trouble breastfeeding her newborn. The child is making frantic rooting motions and will not grasp the nipple. Which intervention should the nurse implement?`

C. Encourage the mother to stop feeding for a few minutes and comfort the infant.

A 12-month-old is admitted with a respiratory infection and possible pneumonia. He is placed in a mist tent with oxygen. Which nursing intervention has the greatest priority?`

C. Have a bulb syringe readily available to remove secretions

The nurse is assessing a 2-year-old. Which behavior indicates that the child's language development is within normal limits.`

C. Is capable of making a three word sentence

The nurse is counseling a woman who wants to become pregnant. The woman tells the nurse that she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. The nurse correctly calculates that the woman's next fertile period is`

C. January 30-31

When caring for a child with congenital heart disease and polycythemia, which nursing intervention has the highest priority?`

C. Maintaining adequate hydration

A client who delivered an infant an hour ago tells the nurse the she feels wet underneath her buttock. The nurse notes that the perineal pad is saturated and the client is lying in a 6-inch diameter pool of blood. Which action should the nurse implement first?`

C. Palpate the firmness of the fundus

The nurse is reviewing the health care provider's (HCP's) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question?`

C. Perform a vaginal examination every shift.

Six hours after an oxytocin (Pitocin) induction was begun and 2 hours after spontaneous rupture of the membranes, the nurse notes several sudden decreases in the fetal heart rate with quick return to baseline, with and without contractions. Based on this fetal heart rate pattern, which intervention is best for the nurse to implement?`

C. Place the client in a slight Trendelenburg position.

In developing a teaching plan for a 5-year-old child with diabetes, which component of diabetic management should the nurse plan for the child to manage first.`

C. Process of glucose testing

The nurse is developing a plan of care for a preterm newborn infant. The nurse develops measures to provide skin care, knowing that the preterm newborn infant's skin appears in what way?`

C. Reddened, translucent, and gelatinous, with decreased amounts of subcutaneous fat

A client at 30 weeks of gestation is on bed rest at home because of increased blood pressure. The home health nurse has taught her how to take her own blood pressure and gave her parameters to judge a significant increase in blood pressure. When the client calls the clinic complaining of indigestion, which instruction should the nurse provide?`

C. Take your blood pressure now, and if it is seriously elevated, go to the hospital.

Prophylactic antibiotics are prescribed for a child who has mitral valve damage. The nurse should advise the parents to give the antibiotics prior to which occurrence?`

C. Urinary catheterization

A 14-year-old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide?`

C. Wash the hair and skin frequently with soap and hot water

A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first?`

C. Wash the wound gently with mild soap and water

The nurse must prevent a 2-year old with severe eczema on the face, neck and scalp from scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the pruritis? `

C. place elbow restraints on the child's arms

The nurse should encourage the laboring patient to begin pushing when`

C. the cervix is completely dilated

A mother is concerned because she has counted only 8 kicks from her baby in two, 2-hour intervals; what intervention is necessary?

CALL THE HCP

A child is scheduled for a tonsillectomy in a day surgical unit. On the day after surgery, the mother calls the surgical unit and expresses concern because the child has a bad mouth odor. Which response is most appropriate?`

D. "Bad mouth odor is normal and may be relieved by drinking more liquids."

The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicate that further teaching is necessary?`

D. "I'll let him decide when to return to his play activities."

A new mother is afraid to touch her baby's head for fear of hurting the "large soft spot." Which explanation should the nurse give to this anxious client?`

D. "There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb their hair"

A nulliparous woman asks the nurse when she will begin to feel fetal movements. The nurse responds by telling the woman that the first recognition of fetal movement will occur at approximately how many weeks of gestation?`

D. 18 weeks

A child is seen in the health care clinic for complaints of fever. On data collection, the nurse notes that the child is pale, tachycardic, and has petechiae. Aplastic anemia is suspected. The nurse understands that which diagnostic test will confirm the diagnosis of aplastic anemia?`

D. Bone marrow Biopsy

A mother calls the clinic because her 6-year-old son, who has been taking prescribed antibiotics for 7 of the previous 10 days, continues to have a cough that she reports is worsening. Further questioning by the nurse reveals that the cough is nonproductive. What advice should the nurse provide to this mother?`

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

One hour after giving birth to an 8-pound infant, a client's lochia rubra has increased from small to large and her fundus is boggy despite massage. HR is 84 bpm, BP 156/96. The M.D. prescribe Methergine 0.2 mg IM x 1. Which action should the nurse take immediately?`

D. Call the HP to question the prescription

A 2-year-old with gastroesophageal reflux disease has developed a fear of eating. What instruction should the RN include in the parent's teaching plan?`

D. Consistently follow a set meal-time routine

In making the initial assessment of a 2-hour-old infant, which finding should lead the nurse to suspect a congenital heart defect?`

D. Diminished femoral pulses

An infant is born to a mother with hepatitis B. Which prophylactic measure would be indicated for the infant?`

D. Hepatitis B immune globulin (HBIG) and hepatitis B vaccine given within 12 hours after birth

A 41-week multigravida is receiving oxytocin (Pitocin) to augment labor. Contractions are firm and occurring every 5 minutes, with a 30- to 40-second duration. The fetal heart rate increases with each contraction and returns to baseline after the contraction. Which action should the nurse implement?`

D. Increase the rate of the oxytocin (Pitocin) infusion.

An expectant father tells the nurse he fears that his wife "is losing her mind." He states she is constantly rubbing her abdomen and talking to the baby, and that she actually reprimands the baby when it moves too much. What recommendation should the nurse make to this expectant father?`

D. Let him know that these are normal maternal/fetal bonding behaviors which occur once the mother feels fetal movement

What preoperative nursing intervention should be included in the plan of care for an infant w/ pyloric stenosis?`

D. Observe for projectile vomiting

One hour following a normal vaginal delivery, a newborn infant boy's axillary temperature is 96° F, his lower lip is shaking, and when the nurse assesses for a Moro reflex, the boy's hands shake. Which intervention should the nurse implement first?`

D. Obtain a serum glucose level.

The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?`

D. Perform Leopold's maneuvers

The nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of which condition?`

D. Placental separation

An off-duty nurse finds a woman in a supermarket parking lot delivering an infant while her husband is screaming for someone to help his wife. Which intervention has the highest priority?`

D. Put the newborn to breast

The nurse caring for a client with a diagnosis of subinvolution should understand that which is a primary cause of this diagnosis?`

D. Retained placental fragments from delivery

What bowel habits are seen in children with Hirschsprung's disease?`

D. Ribbon-like and brown

A child with cystic fibrosis is having stools that float and are foul smelling. Which descriptive term should the nurse use to document the finding?`

D. Steatorrhea

A father of a 5-year-old boy calls the nurse to report that his son, who has had an upper respiratory infection, is complaining of a headache, and his temperature has increased to 103° F, taken rectally. Which intervention has the highest priority?`

D. Tell the parent to take the child to the emergency department.

In developing a teaching plan for expectant parents, the nurse decides to include information about when the parents can expect the infant's fontanels to close. Which statement is accurate regarding the timing of closure of an infant's fontanels that should be included in this teaching plan?`

D. The anterior fontanel closes at 12 to 18 months and the posterior fontanel by the end of the second month.

A couple has been trying to conceive for nine months without success. Which information obtained from the clients is most likely to have an impact on the couple's ability to conceive a child?`

D. They use lubricants with each sexual encounter to decrease friction

A mother discovers a bug has flown into her child's ear and can hear the buzzing; what intervention is priority?`

D. Use a flashlight to coax the insect out of the ear.

The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction?`

D. Variable decelerations

What does a brace do for scoliosis?

Halts the progression of most curvatures. DOES NOT FIX CURVATURE.

When discussing discipline with the mother of a 4 year-old, the nurse should include which guideline?`

A. Parental control should be constant

Which behavior would the nurse expect a 2-year-old to exhibit?`

C. Display possessiveness of toys

What is the therapeutic level of theophylline?

10-20 mcg/dL

A woman who thinks she could be pregnant calls her neighbor, who is a nurse, to ask when she should use a home pregnancy test. Which response is appropriate?`

A. "A home pregnancy test can be used right after your first missed period."

Which statement made by the client indicates that the mother understands the limitations of breastfeeding her newborn?`

A. "Breastfeeding my infant consistently every 3 to 4 hours stops ovulation and my period."

As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider?`

A. A 6-month old with failure to thrive that has a closed anterior fontanel

A nurse is caring for a client in the active stage of labor. The nurse notes that the fetal pattern shows a late deceleration on the monitor strip. Based on this finding the nurse should prepare for which appropriate nursing action?`

A. Administering oxygen via face mask

The nurse is conducting an initial admission assessment of a 12-month-old child in celiac crisis. Which intervention is most important for the nurse to implement?`

A. Assess the child's mucous membranes and skin turgor.

A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. During the initial nursing assessment, which symptoms will this child most likely exhibit?`

A. Bone pain, pallor

A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is prescribed. Which instruction should the nurse provide to this client?`

A. Breastfeed the infant, ensuring that both breasts are completely emptied.

A full-term infant is admitted to the newborn nursery and, after careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited?`

A. Choking, coughing, and cyanosis

A client at 28-weeks gestation calls the antepartal clinic and states that she is experiencing a small amount of vaginal bleeding which she describes as bright red. She further states that she is not experiencing any uterine contractions or abdominal pain. Which instruction should the nurse provide?`

A. Come to the clinic today for an ultrasound

A 2-year-old child with Downs Syndrome is brought to the clinic for his regular physical exam. The nurse knows which problem is frequently associated with DS`

A. Congenital heart disease

Which findings are of most concern to the nurse when caring for a woman in the first trimester of pregnancy? (Select all that apply.)`

A. Cramping with bright red spotting C. Lack of tenderness of the breast E. Increased right-side flank pain

A woman with Type 2 diabetes mellitus becomes pregnant, and her oral hypoglycemic agents are discontinued. Which intervention is most important for the nurse to implement?`

A. Describe diet changes that can improve the management of her diabetes

A 6-year-old is admitted to the pediatric unit after falling off of a bicycle. Which intervention should the RN implement to help the child adjust to the unit.`

A. Explain hospital schedules, including mealtime

Which action should the nurse implement when preparing to measure the fundal height of a pregnant client?`

A. Have the client empty the bladder

A nurse is monitoring a client who is in the active phase of labor. The client has been experiencing contractions that are short, irregular, and weak. Which type of labor dystocia should the nurse document that the client is experiencing?`

A. Hypotonic

Which findings are most critical for the nurse to report to the primary health care provider when caring for the client during the last trimester of her pregnancy? (Select all that apply.)`

A. Increased heartburn that is not relieved with doses of antacids E. Chronic headache that has been lingering for a week behind the client's eyes

When assessing a child with asthma, the nurse should expect intercostal retractions during`

A. Inspiration

Which finding in a 19 yr old female client should trigger further assessment by the nurse?`

A. Menstruation has not occurred

A 3-week-old newborn is brought to a clinic for follow-up after a home birth. The child bottle feeds for 5 minutes only then falls asleep. A loud murmur characteristic of ventricular septal defect (VSD), and finds the newborn acyanotic with a RR of 64 bpm. What instruction should be provided to ensure the newborn gets adequate fluid intake? (Select all that apply).

A. Monitor the infant's weight and number of wet diapers per day B. Increase the infant's intake per feeding by 1-2 ounces per week D. Allow the infant to rest and refeed on demand or every 2 hours E. Use a softer nipple or increase the size of the nipple opening

When explaining "postpartum blues" to a client who is 1 day postpartum, which symptoms should the nurse include in the teaching plan? (Select all that apply)`

A. Mood swings C. Tearfulness

A 3-month-old develops oral thrush. Which pharmacological agent should the RN administer?`

A. Nystatin

Which menu selection by a child w/ celiac disease indicates to the nurse that the child understands necessary dietary considerations?`

A. Oven-baked potato chips and cola

A child diagnosed with scarlet fever is being cared for at home. The home health nurse performs an assessment on the child and checks for which clinical manifestations of this disease? Select all that apply.`

A. Pastia's sign C. White strawberry tongue D. Edematous and beefy-red pharynx E. Petechial red, pinpoint spots on the soft palate

A 3-month-old infant returns from surgery with elbow restraints and a Logan bow over a cleft lip suture line. Which intervention should the nurse implement to maintain suture line integrity during the initial postoperative period?`

A. Place the infant upright in an infant seat position.

The nurse is teaching a 12-year-old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse S/S are commonly associated with this therapy?`

A. Polyuria and polydipsia

The nurse reviews the laboratory results for a child with rheumatic fever and would expect to note which findings? Select all that apply.`

A. Presence of Aschoff's bodies C. Elevated antistreptolysin O titer E. Elevated erythrocyte sedimentation rate

A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine evaluation. Which assessment finding suggests the presence of a common complication often experienced by those with Down syndrome?`

A. Presence of a systolic murmur

Which interventions should the nurse include when preparing a care plan for a child with hepatitis? Select all that apply`

A. Providing a low-fat, well-balanced diet. B. Teaching the child effective hand-washing techniques. E. Instructing the parents to avoid administering medications unless prescribed.

When evaluating the effectiveness of interventions to improve the nutritional status of an infant with gastroesophageal reflux disease, which intervention is most important for the nurse to implement?`

A. Record weight daily

A child comes to the school nurse complaining of itching. Further assessment reveals that the child has impetigo. What action should the nurse take?`

A. Send the child home with the parents to see the health care provider before returning to school.

Which assessment findings should the nurse expect when caring for a child with cystic fibrosis? (Select all that apply.)`

A. Steatorrhea C. Foul-smelling stools D. Delayed growth E. Pulmonary congestion

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data if noted on the client's record would alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy?`

A. The client's last baby weighed 10 pounds at birth.

A new mother who has just had her first baby says to the nurse, "I saw the baby in the recovery room. She sure has a funny looking head." Which response by the nurse is best?`

A. This is not an unusual shaped head. espec

The nurse is giving a liquid iron preparation to a 3-year-old, which technique should the RN implement to encourage active engagement?`

A. Use a colorful straw

To assess the effectiveness of an analgesic administered to a 4-yr old, what intervention is best for the nurse to implement?`

A. Use a happy-face/sad-face pain scale

Twenty-four hours after admission to the newborn nursery, a full-term male infant develops localized edema on the right side of his head. The nurse knows that, in the newborn, an accumulation of blood between the periosteum and skull which does not cross the suture line is a newborn variation known as`

A. a cephalhematoma, caused by forceps trauma and may last up to 8 weeks