OB / PEDS IRATs

Parents bring their 4-month-old son to the emergency department because "he is breathing so fast, is not eating, and he feels hot". Physical examination reveals nasal flaring, intercostal retractions and moderate, inspiratory and expiratory wheezing. The nurse suspects that the infant is exhibiting symptoms of Bronchiolitis Chronic lung disease Epiglottitis An upper respiratory infection

Bronchiolitis

What category? Strongly predictive of normal acid-base status, baseline rate 110 to 160 beats per minute with moderate variability absence of late or variable decelerations.

Category I

What category? Not predictive of abnormal acid-base status, minimal, absent or marke variability, absence of accelerations after stimulaiton, recurrent variable or late declerations, prolonged deceleration, recurrent late decelerations with moderate variability, variable decelerations with "slow return to baseline", "overshoots" or "shoulders".

Category II

What category? Predictive of abnormal acid-base status at the time of observation, Absent variability along with bradycardia, recurrent late or variable decelerations. Sinusoidal pattern.

Category III

You are seeing an 4 month old in clinic with known a VSD who has not gained weight since the last appointment. You notice on your physical exam that the child has dyspnea, hepatosplenomegaly, and periorbital edema. You know that together these signs/ symptoms are concerning for: Decreased central venous pressure Congestive heart failure Pericarditis Endocarditis

Congestive heart failure

You are the nurse caring for an 18-month-old with suspected iron deficiency anemia. Which lab results would confirm his diagnosis? Increased hemoglobin, increased hematocrit, increased reticulocyte count, microcytosis, hypochromia, increased serum iron, and increased serum ferritin Increased serum iron, increased serum ferritin, microcytosis, and hypochromia Decreased hemoglobin, decreased hematocrit, increased reticulocyte, microcytosis, hypochromia, decreased serum iron, and decreased serum ferritin Increased hemoglobin, increased hematocrit, increased reticulocyte count, decreased serum ferritin, decreased serum iron, microcytosis, and hypochromia

Decreased hemoglobin, decreased hematocrit, increased reticulocyte, microcytosis, hypochromia, decreased serum iron, and decreased serum ferritin

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? Apply a cardiac monitor to the child. Give the antibiotic as prescribed. Administer the bronchodilator via a nebulizer. Apply oxygen at 2 liters via a nasal cannula.

Give the antibiotic as prescribed. Administer the bronchodilator via a nebulizer.

A 2-year-old child is suspected of having acute epiglottitis. Which of the following signs/ symptoms would the nurse expect to see? (Select all that apply) Inspiratory stridor Tachycardia Nasal flaring Vomiting Drooling

Inspiratory stridor Tachycardia Nasal flaring Drooling

The nurse is assisting in an emergency situation at a store. The child appears pale, has small quick respirations, exhibits stridor and is sitting in a tripod position. What action will the nurse take first? Instruct the child to cough. Obtain a heart and respiratory rate. Begin abdominal thrusts. Instruct someone to call 911 for emergency assistance.

Instruct someone to call 911 for emergency assistance.

The primary reason that the respiratory infection rate increases drastically in the age range from 3 to 6 months is that the: Viral agents that are mild in older children are extremely severe in infants Infant's exposure to pathogens is greatly increased during this time Maternal antibodies have decreased and the infant's own antibody production is immature Infants do not have the ability to clear secretions from their airway

Maternal antibodies have decreased and the infant's own antibody production is immature

You are a nursery RN caring for newborns in a busy delivery center. You are doing an assessment on a full term infant delivered vaginally who is now 26 hours of age, pink, well perfused, and breastfeeding well with mom. You note loud, machinery like murmur on exam. Your next step is to: Place the infant in nursery and place her on a cardio-respiratory monitor for 24 hour observation Order a STAT ECHO to rule out a congenital heart defect Have the resident order a CBC so that you can look at the infant's hemoglobin in case the infant needs to be emergently transferred to NICU Note this normal finding as you complete the remainder of your exam

Note this normal finding as you complete the remainder of your exam

Before preparing a teaching plan for the parents of an infant with a patent ductus arteriosus, it is important that the nurse understands this condition. Which statement best describes patent ductus arteriosus? The baby has a murmur because there is a hole between the pulmonary artery and the pulmonary vein Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close The baby has a murmur because there is a hole between the pulmonary artery and the pulmonary vein

Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close

A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. The parents are better able to manage the disease when the children are given a role. Oxygen is carried to the fetus by the umbilical arteries. Pulmonary vascular resistance is high because the lungs are filled with fluid.

Pulmonary vascular resistance is high because the lungs are filled with fluid.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? Pulses weaker in upper extremities compared to lower extremities Pulses weaker in lower extremities compared to upper extremities Cyanosis with crying Cyanosis with feeding

Pulses weaker in lower extremities compared to upper extremities

A 3 year old with asthma was just prescribed Ventolin/ Albuterol via a nebulizer as a rescue medication for acute episodes. The parents should be advised that the child may exhibit which of the following common side effects of the medication? Tachycardia Lethargy Bradycardia Weight gain

Tachycardia

Which of the following children is most likely to be hospitalized for treatment of croup? The 2-year-old child whose cough worsens at night The child with inspiratory stridor during physical examination The 5-year-old child whose cough worsens during the day The 2-year-old child who has nasal flaring and is using accessory muscles to breathe

The 2-year-old child who has nasal flaring and is using accessory muscles to breathe

applying oxygen at 10L/" per re-breather mask. repositioning mom on left side. decreasing or discontinuing pitocin.

The above fetal heart rate pattern has persisted for over 1 hour. Nursing interventions would include: applying oxygen at 10L/" per re-breather mask. preparing for emergency C/section. begin maternal pushing. repositioning mom on left side. decreasing or discontinuting pitocin.

A 6 month old exhibiting no sign of CHF has been diagnosed with a small VSD. Which of the following information should the nurse explain to the baby's parents? The defect will likely close without medical intervention The baby will likely be placed on a high calorie formula with restricted volumes The defect likely developed early in the second trimester of pregnancy The baby will likely need open heart surgery by his first birthday to correct the defect

The defect will likely close without medical intervention

Match the fetal heart rate finding with the appropriate fetal condition. Heart rate finding: Variable decelerations. Moderate variability with accelerations. Early decelerations Late decelerations. Fetal condition: Cord compression. Oxygenated fetus Head compression Utero-placental insufficiency

Variable decelerations. --> Cord compression. Moderate variability with accelerations. --> Oxygenated fetus Early decelerations --> Head compression Late decelerations. --> Utero-placental insufficiency

A 7-year-old child is diagnosed with rheumatic fever. Which of the following physical findings would the nurse expect to assess? Vesicular rash over the face and chest Warm and swollen knees and elbows Yellow sclera indicating possible biliary complications Palpable mass in the upper right quadrant of the abdomen

Warm and swollen knees and elbows

Progress in the first stage of labor is indicated by interior rotation of the presenting part. descent of the fetus in the pelvis. acceleration in fetal heart rate. cervical dilation.

cervical dilation.

When providing intrauterine resuscitation for minimal variability or prolonged decelerations in the fetal heart rate, the nurse understands that actions include (select all that apply): decrease or discontinue oxytocin. reposition the mother laterally. administer oxygen at 2L/" per nasal cannula. give a bolus of IV lactated ringers. modify or temporarily stop pushing in second stage of labor.

decrease or discontinue oxytocin. reposition the mother laterally. give a bolus of IV lactated ringers. modify or temporarily stop pushing in second stage of labor.

In a child diagnosed with sickle cell disease, which clinical manifestation would the nurse most likely encounter upon assessing the child and reviewing her information? increased perfusion to tissues decreased appetite decreased urine output decreased hemoglobin levels

decreased hemoglobin levels

Progress in the second stage of labor is indicated by cervical dilation of at least 8cm. internal rotation of the presenting part. descent of the fetus in the pelvis. 60% effacement.

descent of the fetus in the pelvis.

The nurse is performing a routine assessment on a 3-year-old child. Which finding(s) prompts the nurse to perform an in-depth assessment of the child's respiratory status? Select all that apply. polyuria diaphoresis tachypnea diarrhea tachycardia restlessness

diaphoresis tachypnea tachycardia restlessness

There are five factors the affect labor, also known as the "Five P's". The "P" that stands for Passenger refers to the fetal size and position. size and shape of the maternal pelvis. frequency, strength, and duration of the contractions. woman's emotional response to labor.

fetal size and position.

The nurse enters a labor room to find that the fetal heart rate has dropped to the 90's from a baseline of the 140's for the past 90 seconds. The nurse's immediate actions do not include administering oxygen at 10L/" via rebreather mask. checking the cervix to determine labor progress. going to the desk to to call the provider. changing the position of the person in labor.

going to the desk to to call the provider.

The most common error that occurs in using oxytocin in labor is patient hypersensitivity. inappropriate use for elective purposes. failure to apply internal monitors. lack of recognition of tachysystole.

lack of recognition of tachysystole.

The nurse is preparing to assist with placement of a fetal scalp electrode and understands that it is indicated to improve the woman's comfort while being monitored. more accurately determine the extent of fetal distress. record an accurate measurement of contraction strength. decrease the amount of time the nurse needs to spend at the bedside.

more accurately determine the extent of fetal distress.

An infant is hospitalized with heart failure. The health care provider has prescribed furosemide, enalapril, and carvedilol as part of the plan of care. Based on these medications, when reviewing the infant's laboratory results, which value is most important for the nurse to consider? blood urea nitrogen (BUN) calcium potassium glucose

potassium

The advantage of an intrauterine pressure catheter is that it is the most accurate predictor of fetal distress. is more comfortable for the woman than the external monitor. records an accurate measurement of contraction strength. best determines whether a C/section will be needed.

records an accurate measurement of contraction strength.

The goal of intrauterine resuscitation during episodes of tachysystole is to promote fetal oxygenation. improve maternal blood presure. reduce uterine activity. alleviate cord compression.

reduce uterine activity.

When a laboring person is given opioid analgesics such as morphine sulfate during labor, the nurse's priority concern is: respiratory depression in the neonate. uterine atony and hemorrhage. constipation postpartum. excessive sedation and impaired bonding.

respiratory depression in the neonate.

True labor contractions are decrease in frequency with hydration are extremely painful. decrease in intensity with ambulation. start in the lower back and radiate toward the front of the abdomen

start in the lower back and radiate toward the front of the abdomen

A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as: hoarseness. stridor. barking cough. wheezing.

stridor

The nurse is assessing a 6-month-old child with suspected cystic fibrosis. What test will the nurse anticipate as most likely for the child? chest radiographs arterial blood gases incentive spirometry sweat chloride

sweat chloride

In order for an amnioinfusion to be administered, the bag of waters must be ruptured. an epidural should be in place. the cervix has to be completely dilated. oxygen must be administered.

the bag of waters must be ruptured.