OB/PEdi test 4

Early postpartum hemorrhage is defined as a blood loss greater than a.500 mL in the first 24 hours after vaginal delivery b.750 mL in the first 24 hours after vaginal delivery c.1000 mL in the first 48 hours after cesarean delivery d.1500 mL in the first 48 hours after cesarean delivery

a.500 mL in the first 24 hours after vaginal delivery The average amount of bleeding after a vaginal birth is 500 mL. Early postpartum hemorrhage occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL. Early postpartum hemorrhage is within the first 24 hours. Late postpartum hemorrhage is 48 hours and later.

What is true about the genetic transmission of sickle cell disease? a.Both parents must carry the sickle cell trait. b.Both parents must have sickle cell disease. c.One parent must have the sickle cell trait. d.Sickle cell disease has no known pattern of inheritance.

a.Both parents must carry the sickle cell trait. The sickle cell trait, not the disease itself, must be present in the parents for the child to have the disease. An autosomal recessive pattern of inheritance means that both parents must be carriers of the sickle cell trait.

Approximately 12% to 26% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? a.Chromosomal abnormalities b.Infections c.Endocrine imbalance d.Immunologic factors.

a.Chromosomal abnormalities At least 60% of pregnancy losses result from chromosomal abnormalities that are incompatible with life.

Which data should alert the nurse that the neonate is postmature? a.Cracked, peeling skin b.Short, chubby arms and legs c.Presence of vernix caseosa d.Presence of lanugo

a.Cracked, peeling skin Loss of vernix caseosa, which protects the fetal skin in utero, may leave the skin macerated. Postmature infants usually have long, thin arms and legs. Vernix caseosa decreases in the postmature infant. Absence of lanugo is common in postmature infants.

Nurses can prevent evaporative heat loss in the newborn by a.Drying the baby after birth and wrapping the baby in a dry blanket b.Keeping the baby out of drafts and away from air conditioners c.Placing the baby away from the outside wall and the windows d.Warming the stethoscope and nurse's hands before touching the baby

a.Drying the baby after birth and wrapping the baby in a dry blanket Because the infant is a wet with amniotic fluid and blood, heat loss by evaporation occurs quickly. Heat loss by convection occurs when drafts come from open doors and air currents created by people moving around. If the heat loss is caused by placing the baby near cold surfaces or equipment, it is termed a radiation heat loss. Conduction heat loss occurs when the baby comes in contact with cold objects or surfaces.

An infant with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which highly technical method of treatment may be necessary for an infant who does not respond to conventional treatment? a.Extracorporeal membrane oxygenation b.Respiratory support with ventilator c.Insertion of laryngoscope and suctioning of the trachea d.Insertion of an endotracheal tube

a.Extracorporeal membrane oxygenation Extracorporeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, allowing the infant's lungs to rest and recover. The infant is likely to have been first connected to a ventilator. Laryngoscope insertion and tracheal suctioning are performed after birth before the infant takes the first breath. An endotracheal tube will be in place to facilitate deep tracheal suctioning and ventilation.

Rh incompatibility can occur if the woman is Rh negative and her a.Fetus is Rh positive b.Husband is Rh positive c.Fetus is Rh negative d.Husband and fetus are both Rh negative

a.Fetus is Rh positive For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive.

While caring for the postterm infant, the nurse recognizes that the fetus may have passed meconium prior to birth as a result of a.Hypoxia in utero b.NEC c.Placental insufficiency d.Rapid use of glycogen stores

a.Hypoxia in utero When labor begins, poor oxygen reserves may cause fetal compromise. The fetus may passed meconium as a result of hypoxia before or during labor increasing the risk of meconium aspiration. Necrotizing enterocolitis (NEC) is a serious inflammatory condition of the intestinal tract that may lead to death of areas of the mucosa of the intestines. SGA infants are at increased risk for NEC. If placental insufficiency is present, decreased amniotic fluid volume and umbilical cord compression is likely to occur. This resulted in both hypoxia and malnourishment of the fetus. Postterm infants should be assessed for hypoglycemia because of the rapid use of glycogen stores.

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a.Immobilization and elevation of the affected joint b.Administration of acetaminophen for pain relief c.Assessment of the child's response to hospitalization d.Assessment of the impact of hospitalization on the family system

a.Immobilization and elevation of the affected joint Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Assessment of a child's response to hospitalization is relevant to all hospitalized children; however, in this situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all hospitalized children, but it is not the priority in this situation.

In conjunction with phototherapy, which intervention is most effective in reducing the indirect bilirubin in an affected newborn? a.Increase the frequency of feedings. b.Increase oral intake of water between feedings. c.Offer an exchange transfusion. d.Wrap the infant in triple blankets to prevent cold stress.

a.Increase the frequency of feedings. Frequent feedings prevent hypoglycemia, provide protein to maintain albumin levels in the blood and promote gastrointestinal motility and removal of bilirubin in the stools. More frequent breastfeeding should be encouraged. Avoid offering water between feedings, because the infant may decrease their milk intake. Breast milk or formula is more effective at removing bilirubin from the intestines. Exchange transfusions are seldom necessary; but, may be performed when phototherapy cannot reduce high bilirubin levels quickly enough. Wrapping the infant in blankets will prevent the phototherapy from getting to the skin and being effective. The infant should be uncovered and unclothed.

Which infant is most likely to have Rh incompatibility? a.Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor b.Infant who is Rh negative and whose mother is Rh negative c.Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor d.Infant who is Rh positive and whose mother is Rh positive

a.Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, all the offspring will be Rh positive. Only Rh-positive offspring of an Rh-negative mother are at risk for Rh incompatibility.

Nursing care of the neonate undergoing jaundice phototherapy includes a.Keeping the infant's eyes covered under the light b.Keeping the infant supine at all times c.Restricting parenteral and oral fluids d.Keeping the infant dressed in only a T-shirt and diaper

a.Keeping the infant's eyes covered under the light Retinal damage from phototherapy should be prevented by using eye shields on the infant under the light. To ensure total skin exposure, the infant's position is changed frequently. Special attention to increasing fluid intake ensures that the infant is well hydrated. To ensure total skin exposure, the infant is not dressed.

An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is a.Lethargic, pale, and irritable b.Thin, energetic, and sleeps little c.Anorexic, vomiting, and has watery stools d.Flushed, fussy, and tired

a.Lethargic, pale, and irritable Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. Infants with iron deficiency anemia are not typically thin and energetic but do tend to sleep a lot. A child with a hemoglobin level of 6.5 mg/dL has anemia. Gastrointestinal symptoms are not clinical manifestations associated with iron deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. Although the infant with iron deficiency anemia may be tired and fussy, pallor, rather than a flushed appearance, is characteristic of a low hemoglobin level.

The nurse is caring for a child with iron-deficiency anemia. What should the nurse expect to find when reviewing the results of the complete blood count (CBC)? Select all that apply. a.Low hemoglobin levels b.Elevated red blood cell (RBC) levels c.Elevated mean cell volume (MCV) levels d.Low reticulocyte count e.Decreased MCV levels

a.Low hemoglobin levels d.Low reticulocyte count e.Decreased MCV levels The results of the complete blood count in a child with iron-deficiency anemia will show low hemoglobin levels (6 to 11 g/dL) and microcytic, hypochromic RBCs; this manifests as decreased MCV and decreased mean cell hemoglobin. The reticulocyte count is usually slightly elevated or normal.

The nurse should expect medical intervention for subinvolution to include a.Oral methylergonovine maleate (Methergine) for 48 hours b.Oxytocin intravenous infusion for 8 hours c.Oral fluids to 3000 mL/day d.Intravenous fluid and blood replacement

a.Oral methylergonovine maleate (Methergine) for 48 hours Methergine provides long-sustained contraction of the uterus. Oxytocin provides intermittent contractions. There is no correlation between dehydration and subinvolution. There is no indication that excessive blood loss has occurred.

Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (select all that apply) a.Pelvic pain b.Abdominal pain c.Unanticipated heavy bleeding d.Vaginal spotting or light bleeding e.Missed period

a.Pelvic pain b.Abdominal pain d.Vaginal spotting or light bleeding e.Missed period A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a.Perinatal transmission b.Sexual abuse c.Blood transfusions d.Poor handwashing

a.Perinatal transmission Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor handwashing is not an etiology of HIV infection.

The nurse must continually assess the infant who has meconium aspiration syndrome (MAS) for the complication of a.Persistent pulmonary hypertension b.Bronchopulmonary dysplasia c.Transitory tachypnea of the newborn d.Left-to-right shunting of blood through the foramen ovale

a.Persistent pulmonary hypertension Persistent pulmonary hypertension can result from the aspiration of meconium.

Nursing care of the infant with neonatal abstinence syndrome should include a.Positioning the infant's crib in a quiet corner of the nursery b.Feeding the infant on a 2-hour schedule c.Placing stuffed animals and mobiles in the crib to provide visual stimulation d.Spending extra time holding and rocking the infant

a.Positioning the infant's crib in a quiet corner of the nursery Placing the crib in a quiet corner helps avoid excessive stimulation of the infant. These infants have an increase calorie needs, but poor suck and swallow coordination. Feeding should occur to meet these needs. Stimulation should be kept to a minimum. The neonate needs to have reduced handling and disturbances.

According to Beck's studies, what risk factor for postpartum depression (PPD) is likely to have the greatest effect on the woman's condition? a.Prenatal depression b.Single-mother status c.Low socioeconomic status d.Unplanned or unwanted pregnancy

a.Prenatal depression Depressive symptoms during pregnancy or previous ppd are strong predictors for subsequent episodes of PPD. Single-mother status is a small-relation predictor for PPD. Low socioeconomic status is a small-relation predictor for PPD. An unwanted pregnancy may contribute to the risk for PPD; however, it does not pose as great an effect as prenatal depression.

In teaching family members about their child's von Willebrand disease, what is the priority outcome for the child that the nurse should discuss? a.Prevention of injury b.Maintaining adequate hydration c.Compliance with chronic transfusion therapy d.Prevention of respiratory infections

a.Prevention of injury Hemorrhage as a result of injury is the child's greatest threat to life. Fluid volume status becomes a concern when hemorrhage has occurred. The treatment of von Willebrand disease is desmopressin acetate (DDAVP), which is administered intranasally or intravenously. Respiratory infections do not constitute a major threat to the child with von Willebrand disease.

nfants born between 34 0/7 and 36 6/7 weeks of gestation are called late preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early preterm infants, they may receive care that is much like that of a full-term baby. The mother-baby or nursery nurse knows that these babies are at increased risk for (select all that apply) a.Problems with thermoregulation b.Cardiac distress c.Hyperbilirubinemia d.Sepsis e.Hyperglycemia

a.Problems with thermoregulation c.Hyperbilirubinemia d.Sepsis All of these conditions are related to immaturity and warrant close observation. After discharge the infant is at risk for rehospitalization related to these problems. AWHONN has recently launched the Near-Term Infant Initiative to study the problem and ways to ensure that these infants receive adequate care. The nurse should ensure that this infant is feeding adequately before discharge and that parents are taught the signs and symptoms of these complications.

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by a.Subinvolution of the uterus b.Defective vascularity of the decidua c.Cervical lacerations d.Coagulation disorders

a.Subinvolution of the uterus Late PPH may be the result of subinvolution of the uterus. Recognized causes of subinvolution included retained placental fragments and pelvic infection. Although defective vascularity of the decidua may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. Although cervical lacerations may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. Although coagulation disorders may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.

Which statement is true regarding how infants acquire immunity? a.The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b.The infant acquires maternal antibodies that ensure immunity up to 12 months age. c.Active immunity is acquired from the mother and lasts 6 to 7 months. d.Passive immunity develops in response to immunizations.

a.The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. Passive immunity is acquired from the mother. Active immunity develops in response to immunizations.

Spontaneous termination of a pregnancy is considered to be an abortion if a.The pregnancy is less than 20 weeks. b.The fetus weighs less than 1000 g. c.The products of conception are passed intact. d.No evidence exists of intrauterine infection.

a.The pregnancy is less than 20 weeks. An abortion is the termination of pregnancy before the age of viability (20 weeks).

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is a.Uterine atony b.Uterine inversion c.Vaginal hematoma d.Vaginal laceration

a.Uterine atony Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of this patient's bleeding. Furthermore, if the woman was experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage; however, it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

Which clinical finding is an overt sign of retinoblastoma in children? a.Whitish reflex in the eye b.Lymphadenopathy c.Bone pain d.Change in gait

a.Whitish reflex in the eye A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children.

The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a."If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b."The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c."If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d."Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

b."The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." This is an accurate statement. Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an IUD is acceptable.

Parents of a newborn with phenylketonuria are anxious to learn about the appropriate treatment for their infant. The nurse should explain that treatment of PKU involves _____ diet. a.Sodium restrictions in the b.A phenylalanine-free c.A phenylalanine-enriched d.A protein-rich

b.A phenylalanine-free Sodium restriction is not an issue in phenylketonuria. Phenylketonuria is treated with a special diet that restricts phenylalanine intake. Phenylalanine is eliminated from the diet to prevent CNS damage. A specially prepared milk substitute is used to control the amount of protein in the infant's diet, thereby decreasing the amount of phenylalanine.

Which woman is at greatest risk for early postpartum hemorrhage? a.A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress b.A woman with severe preeclampsia on magnesium sulfate whose labor is being induced c.A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor d.A primigravida in spontaneous labor with preterm twins

b.A woman with severe preeclampsia on magnesium sulfate whose labor is being induced Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH.

The difference between physiologic and nonphysiologic jaundice is that nonphysiologic jaundice a.Usually results in kernicterus b.Appears during the first 24 hours of life c.Results from breakdown of excessive erythrocytes not needed after birth d.Begins on the head and progresses down the body

b.Appears during the first 24 hours of life Nonphysiologic jaundice appears during the first 24 hours of life, whereas physiologic jaundice appears after the first 24 hours of life. Both jaundices are the result of the breakdown of erythrocytes. Pathologic jaundice is due to a pathologic condition, such as Rh incompatibility. Jaundice proceeds from the head down.

A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? a.Call for help. b.Assess the fundus for firmness. c.Take her blood pressure. d.Check the perineum for lacerations.

b.Assess the fundus for firmness. The first action should be to assess the fundus. Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated. Assessing blood pressure is an important assessment with a bleeding patient, but the top priority is to control the bleeding. This is done by first assessing the fundus for firmness. If bleeding continues in the presence of a firm fundus, lacerations may be the cause.

The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which actions of chemotherapeutic agents? a.Gastrointestinal upset b.Bone marrow suppression c.Decreased creatinine level d.Alopecia

b.Bone marrow suppression Although gastrointestinal upset may be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No special precautions are instituted for gastrointestinal upset. Chemotherapy agents cause bone marrow suppression, which creates the need to institute precautions related to reduced white blood cell, red blood cell, and platelet counts. These precautions focus on preventing infection and bleeding. A decreased creatinine level is consistent with renal pathologic conditions, not chemotherapy. Not all chemotherapeutic agents cause alopecia. No precautions are taken to prevent alopecia.

Newborns whose mothers are substance abusers frequently have what behavior? a.Circumoral cyanosis, hyperactive Babinski reflex, and constipation b.Decreased amounts of sleep, hyperactive Moro (startle) reflex, and difficulty feeding c.Hypothermia, decreased muscle tone, and weak sucking reflex d.Excessive sleep, weak cry, and diminished grasp reflex

b.Decreased amounts of sleep, hyperactive Moro (startle) reflex, and difficulty feeding The infant exposed to drugs in utero often has poor sleeping patterns, hyperactive reflexes, and uncoordinated sucking and swallowing behavior. They will have an uncoordinated sucking and swallowing reflex and decreased muscle tone. They will have poor sleeping patterns, increased reflexes, and a high-pitched cry.

The most common cause of pathologic hyperbilirubinemia is a.Hepatic disease b.Hemolytic disorders in the newborn c.Postmaturity d.Congenital heart defect

b.Hemolytic disorders in the newborn Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause. Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Prematurity is a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause. Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.

What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis? a.Administration of antibiotics and nebulizer treatments b.Hydration and pain management c.Blood transfusions and an increased calorie diet d.School work and diversion

b.Hydration and pain management Hydration and pain management decrease the cells' oxygen demands and prevent sickling.

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests a.Uterine atony b.Lacerations of the genital tract c.Perineal hematoma d.Infection of the uterus

b.Lacerations of the genital tract The fundus is not firm with uterine atony. Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. A hematoma would be internal. Swelling and discoloration would be noticed, but bright bleeding would not be. With an infection of the uterus there would be an odor to the lochia and systemic symptoms such as fever and malaise.

An abortion in which the fetus dies but is retained in the uterus is called _____ abortion. a.Inevitable b.Missed c.Incomplete d.Threatened

b.Missed An inevitable abortion means that the cervix is dilating with the contractions. Missed abortion refers to a dead fetus being retained in the uterus. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

If the nurse suspects a uterine infection in the postpartum patient, she should assess the a.Pulse and blood pressure b.Odor of the lochia c.Episiotomy site d.Abdomen for distention

b.Odor of the lochia The pulse may be altered with an infection, but the odor of the lochia will be an earlier sign and more specific. An abnormal odor of the lochia indicates infection in the uterus. The infection may move to the episiotomy site if proper hygiene is not followed. The abdomen becomes distended usually because of a decrease of peristalsis, such as after cesarean section.

The goal of treatment of the infant with phenylketonuria (PKU) is to a.Cure mental retardation. b.Prevent central nervous system (CNS) damage, which leads to mental retardation. c.Prevent gastrointestinal symptoms. d.Cure the urinary tract infection.

b.Prevent central nervous system (CNS) damage, which leads to mental retardation. No known cure exists for mental retardation. CNS damage can occur as a result of toxic levels of phenylalanine. Digestive problems are a clinical manifestation of PKU. PKU does not involve any urinary problems.

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? a.Necrotizing enterocolitis (NEC) b.Retinopathy of prematurity (ROP) c.Bronchopulmonary dysplasia (BPD) d.Intraventricular hemorrhage (IVH)

b.Retinopathy of prematurity (ROP) NEC is due to the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. ROP is thought to occur as a result of high levels of oxygen in the blood. BPD is caused by the use of positive pressure ventilation against the immature lung tissue. IVH is due to rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.

The nurse is caring for a child with aplastic anemia. What nursing diagnoses are appropriate? Select all that apply. a.Acute Pain related to vaso-occlusion b.Risk for Infection related to inadequate secondary defenses or immunosuppression c.Ineffective Protection related to thrombocytopenia d.Ineffective Tissue Perfusion related to anemia e.Ineffective Protection related to abnormal clotting

b.Risk for Infection related to inadequate secondary defenses or immunosuppression c.Ineffective Protection related to thrombocytopenia d.Ineffective Tissue Perfusion related to anemia These are appropriate nursing diagnosis for the nurse planning care for a child with aplastic anemia. Aplastic anemia is a condition in which the bone marrow ceases production of the cells it normally manufactures, resulting in pancytopenia. The child will have varying degrees of the disease depending on how low the values are for absolute neutrophil count (affecting the body's response to infection), platelet count (putting the child at risk for bleeding), and absolute reticulocyte count (causing the child to have anemia).

The Center for Disease Control (CDC, 2009) recommendation for immunizing infants who are HIV positive is a.Follow the routine immunization schedule. b.Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c.Do not give immunizations because of the infant's altered immune status. d.Eliminate the pertussis vaccination because of the risk of convulsions.

b.Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. Immunizations are given to infants who are HIV positive. The pertussis vaccination is not eliminated for an infant who is HIV positive.

An important nursing factor during the care of the infant in the NICU is assessment for signs of adequate parental attachment. The nurse must observe for signs that bonding is not occurring as expected. These include (select all that apply) a.Using positive terms to describe the infant b.Showing interest in other infants equal to that of their own c.Naming the infant d.Decreasing the number and length of visits e.Refusing offers to hold and care for the infant

b.Showing interest in other infants equal to that of their own d.Decreasing the number and length of visits e.Refusing offers to hold and care for the infant These are all indications that parental attachment may be delayed. The parent may also show a decrease in or lack of eye contact and spend last time talking to or smiling at their infant.

Which maternal condition always necessitates delivery by cesarean section? a.Partial abruptio placentae b.Total placenta previa c.Ectopic pregnancy d.Eclampsia

b.Total placenta previa In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred.

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a.Anxiety due to hospitalization b.Worsening disease and impending convulsion c.Effects of magnesium sulfate d.Gastrointestinal upset

b.Worsening disease and impending convulsion Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent.

Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of a.Gonorrhea b.Herpes simplex virus infection c. Congenital syphilis d.HIV

c. Congenital syphilis This rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.

A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" The nurse responds a."It is an eye ointment to help your baby see you better." b."It is to protect your baby from contracting herpes from your vaginal tract." c."Erythromycin is given prophylactically to prevent a gonorrheal infection." d."This medicine will protect your baby's eyes from drying out over the next few days."

c."Erythromycin is given prophylactically to prevent a gonorrheal infection."

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a.Blood pressure increase to 138/86 mm Hg b.Weight gain of 0.5 kg during the past 2 weeks c.A dipstick value of 3+ for protein in her urine d.Pitting pedal edema at the end of the day

c.A dipstick value of 3+ for protein in her urine Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a.Vigorously stimulate the woman. b.Instruct her to take deep breaths. c.Administer calcium gluconate. d.Increase her IV fluids.

c.Administer calcium gluconate. Calcium gluconate reverses the effects of magnesium sulfate.

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a.Complete blood cell count (CBC) b.Lumbar puncture c.Bone marrow biopsy d.Computed tomography (CT) scan

c.Bone marrow biopsy A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

Transitory tachypnea of the newborn (TTN) is thought to occur as a result of a.A lack of surfactant b.Hypoinflation of the lungs c.Delayed absorption of fetal lung fluid d.A slow vaginal delivery associated with meconium-stained fluid

c.Delayed absorption of fetal lung fluid Lack of surfactant causes respiratory distress syndrome. TTN is caused by delayed absorption of fetal lung fluid. Delayed absorption of fetal lung fluid is thought to be the reason for TTN. A slow vaginal delivery will help prevent TTN.

What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a.Complaint of frequent mild nausea b.Blood pressure of 120/80 mm Hg c.Fundal height measurement of 18 cm d.History of bright red spotting for 1 day, weeks ago

c.Fundal height measurement of 18 cm Nausea increases in a molar pregnancy because of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. The history of bleeding is normally described as being brownish.

Children receiving long-term systemic corticosteroid therapy are most at risk for a.Hypotension b.Dilation of blood vessels in the cheeks c.Growth delays d.Decreased appetite and weight loss

c.Growth delays Hypertension is a clinical manifestation of long-term systemic steroid administration. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. Growth delay is associated with long-term steroid use. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

Of all the signs seen in infants with respiratory distress syndrome, which sign is especially indicative of the syndrome? a.Pulse more than 160 beats/min b.Circumoral cyanosis c.Grunting d.Substernal retractions

c.Grunting

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician, because the lab results are indicative of a.Eclampsia b.Disseminated intravascular coagulation c.HELLP syndrome d.Rh incompatibility

c.HELLP syndrome Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

What condition indicates concealed hemorrhage in an abruptio placentae? a.Decrease in abdominal pain b.Bradycardia c.Hard, boardlike abdomen d.Decrease in fundal height

c.Hard, boardlike abdomen Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. The fundal height will increase as bleeding occurs.

When a woman is diagnosed with postpartum psychosis, one of the main concerns is that she may a.Have outbursts of anger b.Neglect her hygiene c.Harm her infant d.Lose interest in her husband

c.Harm her infant Although outbursts of anger is a symptom is attributable to PPD, the major concern would be the potential of harm to herself or to her infant. Neglect of personal hygiene is symptom is attributable to PPD; however, the major concern would be the potential of harm to herself or to her infant. Thoughts of harm to one's self or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. Although this patient is likely to lose interest in her spouse, the major concern is the potential of harm to herself or to her infant.

What describes the pathologic changes of sickle cell anemia? a.Sickle-shaped cells carry excess oxygen. b.Sickle-shaped cells decrease blood viscosity. c.Increased red blood cell destruction occurs. d.Decreased red blood cell destruction occurs.

c.Increased red blood cell destruction occurs. The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) a.Is the "baby blues" plus the woman has a visit with a counselor or psychologist b.Is more common among older, Caucasian women because they have higher expectations c.Is distinguished by pervasive sadness that lasts at least 2 weeks d.Will disappear on its own without outside help

c.Is distinguished by pervasive sadness that lasts at least 2 weeks PPD is more serious and persistent than postpartum baby blues. PPD is more common among younger mothers and African-American mothers. PPD is characterized by a persistent depressed state. The woman is unable to feel pleasure or love although she is able to care for her infant. She often experiences generalized fatigue, irritability, little interest in food and sleep disorders. Most women need professional help to get through PPD, including pharmacologic intervention.

Decreased surfactant production in the preterm lung is a problem because surfactant a.Causes increased permeability of the alveoli b.Provides transportation for oxygen to enter the blood supply c.Keeps the alveoli open during expiration d.Dilates the bronchioles, decreasing airway resistance

c.Keeps the alveoli open during expiration Surfactant prevents the alveoli from collapsing each time the infant exhales, thus reducing the work of breathing.

The mother-baby nurse must be able to recognize what sign of thrombophlebitis? a.Visible varicose veins b.Positive Homans' sign c.Local tenderness, heat, and swelling d.Pedal edema in the affected leg

c.Local tenderness, heat, and swelling Varicose veins may predispose the woman to thrombophlebitis, but are not a sign. A positive Homans' sign may be caused by a strained muscle or contusion. Tenderness, heat, and swelling are classic signs of thrombophlebitis that appear at the site of the inflammation. Edema may be more involved than pedal.

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is a.Pharmacologic treatment b.Reduction of environmental stimuli c.Neonatal abstinence syndrome scoring d.Adequate nutrition and maintenance of fluid and electrolyte balance

c.Neonatal abstinence syndrome scoring Neonatal abstinence syndrome (NAS) is the term used to describe the cohort of symptoms associated with drug withdrawal in the neonate. The Neonatal Abstinence Scoring System evaluates CNS, metabolic, vasomotor, respiratory, and gastrointestinal disturbances. This evaluation tool enables the care team to develop an appropriate plan of care. The infant is scored throughout the length of stay and the treatment plan is adjusted accordingly.

The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a.Vaginal bleeding b.Rupture of membranes c.Presence of abdominal pain d.Changes in maternal vital signs

c.Presence of abdominal pain Both may have vaginal bleeding. Rupture of membranes may occur with both conditions. Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding. Maternal vital signs may change with both if bleeding is pronounced.

A plan of care for an infant experiencing symptoms of drug withdrawal should include a.Administering chloral hydrate for sedation b.Feeding every 4 to 6 hours to allow extra rest c.Swaddling the infant snugly and holding the baby tightly d.Playing soft music during feeding

c.Swaddling the infant snugly and holding the baby tightly Phenobarbital or diazepam may be administered to decrease CNS irritability. The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydration. The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions. The infant should not be stimulated (such as with music), because this will increase activity and potentially increase CNS irritability.

Overstimulation may cause increased oxygen use in a preterm infant. Which nursing intervention helps to avoid this problem? a.Group all care activities together to provide long periods of rest. b.While giving your report to the next nurse, stand in front of the incubator and talk softly about how the infant responds to stimulation. c.Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers. d.Keep charts on top of the incubator so the nurses can write on them there.

c.Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? a.Physiologic jaundice occurs during the first 24 hours of life. b.Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types. c.The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. d.This condition is also known as "breast milk jaundice."

c.The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. Pathologic jaundice occurs during the first 24 hours of life. Pathologic jaundice is caused by blood incompatibilities, causing excessive destruction of erythrocytes, and must be investigated. Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater, which occurs when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

What will the nurse note when assessing an SGA infant with asymmetric intrauterine growth restriction? a.One side of the body appears slightly smaller than the other. b.All body parts appear proportionate. c.The head seems large compared with the rest of the body. d.The extremities are disproportionate to the trunk.

c.The head seems large compared with the rest of the body. In asymmetric intrauterine growth restriction, the head is normal in size but appears large because the infant's body is long and thin due to lack of subcutaneous fat.

The nurse should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on the knowledge that a.Leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b.Research to find a cure for childhood cancers is very active. c.The majority of children go into remission and remain symptom free when treatment is completed. d.It usually takes several months of chemotherapy to achieve a remission.

c.The majority of children go into remission and remain symptom free when treatment is completed. Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%.

A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that a.The infant is protected from infection by immunoglobulins in the breast milk. b.The infant is not susceptible to the organisms that cause mastitis. c.The organisms that cause mastitis are not passed to the milk. d.The organisms will be inactivated by gastric acid.

c.The organisms that cause mastitis are not passed to the milk. The mother is just producing the immunoglobulin from this infection, so it is not available for the infant. Because of an immature immune system, infants are susceptible to many infections. However, this infection is in the breast tissue and is not excreted in the breast milk. The organisms are localized in the breast tissue and are not excreted in the breast milk. The organism will not get into the infant's gastrointestinal system.

Which statement is true about large for gestational age (LGA) infants? a.They weigh more than 3500 g. b.They are above the 80th percentile on gestational growth charts. c.They are prone to hypoglycemia, polycythemia, and birth injuries. d.Postmaturity syndrome and fractured clavicles are the most common complications.

c.They are prone to hypoglycemia, polycythemia, and birth injuries. LGA infants are determined by their weight compared to their age. They are above the 90th percentile on the gestational growth charts. All three of these complications are common in LGA infants. Birth injuries are a problem, but postmaturity syndrome is not an expected complication with LGA infants.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a.Complete hydatidiform mole b.Missed abortion c.Unruptured ectopic pregnancy d.Abruptio placentae

c.Unruptured ectopic pregnancy Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole. Methotrexate is not indicated or recommended as a treatment option for missed abortions. Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter.

What is descriptive of most cases of hemophilia? a.Autosomal dominant disorder causing deficiency is a factor involved in the blood-clotting reaction b.X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c.X-linked recessive inherited disorder in which a blood-clotting factor is deficient d.Y-linked recessive inherited disorder in which the red blood cells become moon shaped

c.X-linked recessive inherited disorder in which a blood-clotting factor is deficient The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factor IX deficiency, hemophilia B or Christmas disease.

The antidote administered to reverse magnesium toxicity is ______________.

calcium gluconate Calcium gluconate is the antidote necessary to reverse magnesium toxicity. The nurse caring for this patient should keep calcium gluconate in the room along with secured, syringes and needles.

Which statement by a postpartum woman indicates that further teaching is not needed regarding thrombus formation? a. "I'll stay in bed for the first 3 days after my baby is born." b. "I'll keep my legs elevated with pillows." c. "I'll sit in my rocking chair most of the time." d. "I'll put my support stockings on every morning before rising."

d. "I'll put my support stockings on every morning before rising." Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning.

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease? a."Your son's blood pressure must be taken daily while he is on chemotherapy." b."Limit your son's fluid intake just in case he has central nervous system involvement." c."Your son must receive all of his immunizations in a timely manner." d."Your son's temperature should be taken frequently."

d."Your son's temperature should be taken frequently." The child's temperature must be taken daily because of the risk for infection, but it is not necessary to take a blood pressure daily. Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, this intervention might be more appropriate. Children who are immunosuppressed should not receive any live virus vaccines. An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer? a.ALL b.Non-Hodgkin lymphoma c.Wilms' tumor d.Acute myeloblastic leukemia (AML)

d.Acute myeloblastic leukemia (AML) Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. The treatment for Wilms' tumor consists of surgery and chemotherapy alone or in combination with radiation therapy. HSCT is often used interchangeably with bone marrow transplantation and is currently standard treatment for children in their first remission with AML.

The infant of a mother with diabetes is hypoglycemic. What type of feeding should be instituted first? a.Glucose water in a bottle b.D5W intravenously c.Formula via nasogastric tube d.Breast milk

d.Breast milk High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin. Oral feedings are tried first; intravenous lines should be a later choice if the hypoglycemia continues. Formula does provide longer normal glucose levels but would be administered via bottle, not by tube feeding. Breast milk is metabolized more slowly and provides longer normal glucose levels.

Which combination of expressing pain could be demonstrated in a neonate? a.Low-pitched crying, tachycardia, eyelids open wide b.Cry face, flaccid limbs, closed mouth c.High-pitched, shrill cry, withdrawal, change in heart rate d.Cry face, eye squeeze, increase in blood pressure

d.Cry face, eye squeeze, increase in blood pressure Cry and an increased heart rate are manifestations of neonatal pain. Typically, infants will close their eyes tightly when in pain, not open them wide. Infants may cry in response to pain. Additionally, they may display a rigid posture with the mouth open. A high-pitched, shrill cry is associated with genetic/neurologic anomalies. The infant may cry, withdraw limbs, and become tachycardic with pain. These manifestations are indicative of pain in the neonate.

If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition? a.Hysterectomy b.Laparoscopy c.Laparotomy d.D&C

d.D&C Hysterectomy is not indicated for this condition. A hysterectomy is the removal of the uterus. Laparoscopy is not indicated for this condition. A laparoscopy is the insertion of an endoscope through the abdominal wall to examine the peritoneal cavity. Laparotomy is not indicated for this condition. A laparotomy is a surgical incision into the peritoneal cavity to explore the peritoneal cavity. D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots.

An accurate description of anemia is a.Increased blood viscosity b.Depressed hematopoietic system c.Presence of abnormal hemoglobin d.Decreased oxygen-carrying capacity of blood

d.Decreased oxygen-carrying capacity of blood Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the deceased oxygen-carrying capacity of the blood. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition is dependent on the decreased oxygen-carrying capacity of the blood. Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood.

When caring for a postpartum woman experiencing hypovolemic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is a.Absence of cyanosis in the buccal mucosa b.Cool, dry skin c.Diminished restlessness d.Decreased urinary output

d.Decreased urinary output The assessment of the buccal mucosa for cyanosis can be subjective in nature. The presence of cool, pale, clammy skin is an indicative finding associated with hypovolemic shock. Hypovolemic shock is associated with lethargy, not restlessness. Hemorrhage may result in hypovolemic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion.

What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)? a.Teaching the parents to report excessive fatigue to the physician b.Monitoring the child's hemoglobin level every 2 weeks c.Providing a diet that contains iron-rich foods d.Establishing a safe, age-appropriate home environment

d.Establishing a safe, age-appropriate home environment Excessive fatigue is not a significant problem for the child with ITP. ITP is associated with low platelet levels. Increasing the child's intake of iron in the diet will not correct ITP. Prevention of injury is a priority concern for a child with ITP.

Which clinical sign is not included in the classic symptoms of preeclampsia? a.Hypertension b.Edema c.Proteinuria d.Glycosuria

d.Glycosuria The first indication of preeclampsia is usually an increase in the maternal blood pressure. The first sign noted by the pregnant woman is a rapid weight gain and edema of the hands and face. Proteinuria usually develops later than the edema and hypertension. Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia.

Compared to the term infant, the preterm infant has a.Few blood vessels visible though the skin b.More subcutaneous fat c.Well-developed flexor muscles d.Greater surface area in proportion to weight

d.Greater surface area in proportion to weight Preterm infants have greater surface area in proportion to their weight.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a.Bed rest and analgesics are the recommended treatment. b.She will be unable to conceive in the future. c.A D&C will be performed to remove the products of conception. d.Hemorrhage is the major concern.

d.Hemorrhage is the major concern. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. Severe bleeding occurs if the fallopian tube ruptures.

A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of a.Erythroblastopenia b.von Willebrand disease c.Hemophilia d.Immune thrombocytopenic purpura (ITP)

d.Immune thrombocytopenic purpura (ITP) Excessive bruising and petechiae, especially involving the mucous membranes and gums in a child who is otherwise healthy, are the clinical manifestations of ITP, resulting from decreased platelets. The etiology of ITP is unknown, but it is considered to be an autoimmune process.

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of a.Ewing sarcoma b.Wilms' tumor c.Neuroblastoma d.Leukemia

d.Leukemia These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia.

A placenta previa in which the placental edge just reaches the internal os is called a.Total b.Partial c.Complete d.Marginal

d.Marginal With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os, but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os. A placenta previa that does not cover any part of the cervix is termed marginal.

A macrosomic infant is born after a difficult, forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse's most appropriate action is to a.Leave the infant in the room with the mother. b.Take the infant immediately to the nursery. c.Perform a gestational age assessment to determine whether the infant is large for gestational age. d.Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

d.Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia. This infant is macrosomic (over 4000 g) and is at high risk for hypoglycemia. Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a.Circulatory collapse b.Cardiomegaly, systolic murmurs c.Hepatomegaly, intrahepatic cholestasis d.Painful swelling of hands and feet; painful joints

d.Painful swelling of hands and feet; painful joints A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur.

Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? a.Postpartum depression b.Postpartum psychosis c.Postpartum bipolar disorder d.Postpartum blues

d.Postpartum blues Postpartum depression is not the normal worries (blues) that many new mothers experience. Many caregivers believe that postpartum depression is underdiagnosed and underreported. Postpartum psychosis is a rare condition that usually surfaces within 3 weeks of delivery. Hospitalization of the woman is usually necessary for treatment of this disorder. Bipolar disorder is one of the two categories of postpartum psychosis, characterized by both manic and depressive episodes. Postpartum blues or "baby blues" is a transient self-limiting disease that is believed to be related to hormonal fluctuations after childbirth.

One of the first symptoms of puerperal infection to assess for in the postpartum woman is a.Fatigue continuing for longer than 1 week b.Pain with voiding c.Profuse vaginal bleeding with ambulation d.Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth

d.Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth Fatigue is a late finding associated with infection. Pain with voiding may indicate a UTI, but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection. Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth.

Four hours after delivery of a healthy neonate of an insulin-dependent diabetic woman, the baby appears jittery, irritable, and has a high-pitched cry. Which nursing action has top priority? a.Start an intravenous line with D5W. b.Notify the clinician stat. c.Document the event in the nurses' notes. d.Test for blood glucose level.

d.Test for blood glucose level. It is not common practice to give intravenous glucose to a newborn. Feeding the infant is preferable because the formula or breast milk will last longer. Test blood glucose level according to agency policy, treat symptoms with standing orders protocol, and notify the physician with the results. Documentation can wait until the infant has been tested and treated if a problem is present. These symptoms are signs of hypoglycemia in the newborn. Permanent damage can occur if glucose is not constantly available to the brain, but it is not common practice to give intravenous glucose to a newborn. Feeding the infant is preferable because the formula or breast milk will last longer.

A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago via cesarean section is found to have moist lung sounds. What is the best interpretation of these data? a.The nurse should notify the pediatrician stat for this emergency situation. b.The neonate must have aspirated surfactant. c.If this baby was born vaginally, it could indicate a pneumothorax. d.The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

d.The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth. The condition will resolve itself within a few hours. For this common condition of newborns, surfactant acts to keep the expanded alveoli partially open between respirations. In vaginal births, absorption of remaining lung fluid is accelerated by the process of labor and delivery. Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and lymphatic systems.

Which is true about newborns classified as small for gestational age (SGA)? a.They weigh less than 2500 g. b.They are born before 38 weeks of gestation. c.Placental malfunction is the only recognized cause of this condition. d.They are below the 10th percentile on gestational growth charts.

d.They are below the 10th percentile on gestational growth charts. SGA infants are defined as below the 10th percentile in growth when compared to other infants of the same gestational age. SGA is not defined by weight. Infants born before 38 weeks are defined as preterm. There are many causes of SGA babies.

Recurrent spontaneous abortion refers to a condition in which a woman experiences three or more consecutive abortions or miscarriages. This is also known as ________ abortion.

habitual Primary causes are believed to be genetic or chromosomal abnormalities of the fetus. For the mother who repeatedly aborts, the cause is often an anomaly of the reproductive tract such as bicornate uterus or incompetent cervix. Systemic illnesses such as lupus erythematosus and diabetes mellitus have been implicated in this condition as well. Treatment depends entirely on the cause and therefore varies between medical and surgical approaches.

Approximately 30% of preterm infants weighing less than 1500 g develop bleeding around and into the ventricles of the brain. This condition is known as _______________.

intraventricular hemorrhage Rupture of the fragile blood vessels in the germinal matrix, located around the ventricles of the brain results in germinal matrix bleeding or intraventricular hemorrhage. It is associated with increased or decreased blood pressure, asphyxia, mechanical ventilation, and increased or fluctuating cerebral blood flow.

The NICU nurse begins her shift by assessing one of the preterm infants assigned to her care. The infant's color is pale, his O2 saturation has decreased, and he is grimacing. This infant is displaying common signs of ________.

pain These are all nonverbal cues to newborn pain. Other signs include moaning, whimpering, tense rigid muscles, increased or decreased heart rate, apnea, increased blood pressure, sleep-wake pattern changes, or display of a "cry face." The nurse should discuss the infant's response to pain with his provider to ensure that appropriate medications are available. Ordered medications should always be given before any painful procedure.

The condition in which the placenta is implanted in the lower uterine segment near or over the internal cervical os is _____________.

placenta previa In placenta previa, the placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces.