Family Final Exam

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

D. elevate casted arm when resting and when sitting up

Positions that help with fetal decent

Hands and knees, on hands and knees but running start position

Positions that help with fetal descent

Hands and knees, on hands and knees but running start position

Risks associated with C-section

Hemorrhage Fetal injuries Urinary tract infections Wound dehiscence

GDM- what is the fetus at greatest risk for

Hypoglycemia, also causes polyhydramnios

Likely cause for late postpartum hemorrhage

Main cause is subinvolution (retained placental tissue), response is to find underlying cause

Epidural intervention

Medication to treat maternal hypotension from epidural = ephedrine

Disadvantages of Epidural

Most common complication is hypotension Other side effects include nausea, vomiting, pruritis, respiratory depression, alterations in FHR

Rabies

Rabies prophylaxis includes passive immunization (rabies immune globulin) that is given initially into the wound and IM. It also includes active immunization (rabies vaccine) that is given as a series of five IM injections over 28 days

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman: a. Discusses her labor and birth experience excessively. b. Believes that her baby is more attractive and clever than any others. c. Has not given the baby a name. d. Has a partner or family members who react very positively about the baby.

c. has not given the baby a name

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

c. i will record the readings the same time everyday

An appropriate nursing intervention when caring for an unconscious child should be to: a. change the child's position infrequently to minimize the chance of increased ICP. b. avoid using narcotics or sedatives to provide comfort and pain relief. c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. give tepid sponge baths to reduce fever because antipyretics are contraindicated.

c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

c. preparation and training of family

A child steps on a nail and sustains a puncture wound of the foot. Which is the most appropriate method for cleansing this wound? a. Wash wound thoroughly with chlorhexidine. b. Wash wound thoroughly with povidone-iodine. c. Soak foot in warm water and soap. d. Soak foot in solution of 50% hydrogen peroxide and 50% water.

c. soak foot in warm water and soap

Which statement by the client will assist the nurse in determining whether she is in true labor as opposed to false labor? a."I passed some thick, pink mucus when I urinated this morning." b."My bag of waters just broke." c."The contractions in my uterus are getting stronger and closer together." d."My baby dropped, and I have to urinate more frequently now."

c. the contractions in my uterus are getting stronger and closer together

A nurse is completing preoperative teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching? a. You will go home the same day of surgery b. You will have minimal pain c. You will need to receive blood d. You will not be able to eat until the day after surgery

c. you will need to receive blood

A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development?

conventional

The nurse is talking to the parents of a child with pediculosis capitis. Which should the nurse include when explaining how to manage pediculosis capitis? a. "You will need to cut the hair shorter if infestation and nits are severe." b. "You can distinguish viable from nonviable nits, and remove all viable ones." c. "You can wash all nits out of hair with a regular shampoo." d. "You will need to remove nits with an extra-fine tooth comb or tweezers."

d. you will need to remove nits with an extra-fine tooth comb or tweezers.

blood transfusion reactions

1. allergic: hives, pruritis, wheezing; antihistamines (allergy to plasma protein) 2. anaphylactic: similar but more sever; seen in IgA deficient people. Dyspnea, bronchospasm, hypotension, shock 3. acute hemolytic transfusion reaction: ABO mismatch; type II hypersensitivity. chills, difficulty breathing, chest pain (tachypnea, tachycardia, hemoglobinuria/jaundice)

Nagele's Rule

1st day of last period + 7 days - 3 months

How long is pregnancy?

280 days 10 Lunar months 40 weeks

Classification of postpartum hemorrhage

500 lost for vaginal, 1000 lost for c-section 24 hrs to 6 weeks (late) Within 24 hrs (early)

A nurse is assessing a child who has Legg-Calve-Perthes Disease. Which of the following findings should the nurse expect? A. Longer affected leg B. Hip stiffness C. Intense pain D. Limited ROM E. Limp with walking

B. D. E. Hip stiffness Limited ROM Limp when walking

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which is a priority in the care for this child? a. Monitoring intake and output b. Assessing respiratory efforts c. Placing on a telemetry monitor d. Obtaining laboratory studies

B. assessing respiratory efforts

Postpartum Hemorrhage- concerning VS

Blood pressure will drop and the heart rate will raise

A nurse is caring for a client whose right leg is in Buck's traction. Which of the following interventions should the nurse implement to promote the client's mobility? A. Log rolling every 2 hours B. Isometric exercises of both legs C. Active range-of-motion exercises of the left leg D. Passive range of motion to the right leg

C. active range-of-motion exercise on the left leg

cervical exam documented

Cervical exams are done to check station, dilation and effacement. (Station 2+, 3cm, 30%)

A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child's mother asks the nurse why a Pavilk harness is not being used. Which of the following responses should the nurse make? a. The pavlik harness is used for children with scoliosis, not hip dysplasia b. The pavlik harness is used for school-age children c. The pavlik harness cannot be used for your child because her condition is too severe d. The pavlik harness is used for infants less than 6 months of age

D

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits: a. Absent ankle clonus .b. A sleepy, sedated affect. c. Deep tendon reflexes of 2. d. A respiratory rate of 10 breaths/min.

D

Which is beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin to treat fever associated with influenza

D. avoidance of aspirin to treat fever associated with influenza

The nurse is caring for a child after an accident in which the child fractured his arm. A cast has been applied to the child's right arm. Which actions should the nurse implement?

Document any signs of pain. Monitor the color of the nail beds in the right hand. Check radial pulse in the both arms.

Most likely cause for Postpartum hemorrhage immediately following birth

Early PPH is caused by uterine atony (no tone) response is to massage the uterus and empty the bladder

What are the 5 things that nurses chart on the fetal heart tracings?

FHR baseline, variability, accelerations, and decelerations. (bottom row shows contractions

Probable signs of pregnancy

FROM PROVIDER blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign

How would a nurse know that contractions are effective

Frequency, Duration, Intensity, Resting tone, Relaxation time between UCs Results in cervical change

Causes of OB lacerations

Give birth to large babies (fetal macrosomia). Experience an operative vaginal delivery, such as use of forceps or vacuum extraction. Experience a precipitous labor and birth.

Most effective way to prevent the spread of infection

Hand hygiene

Leukemia: Risk for Infections

Infection is a major cause of death in the patient with leukemia, and SEPSIS is a common complication -autocontamination -cross-contamination -drug therapy -hematopoietic stem cell transplantation

Idiopathic thrombocytopenia purpura-pathology

Low platelets/destruction of platelets

Priority intervention for postpartum hemorrhage r/t uterine atony

Massage the uterus, empty the bladder

Sickle Cell anemia- inpatient care of

Never give demerol (Meperidine) because it causes seizures

Digoxin toxicity

Normal level 0.5-2mcg s/s: vomiting, diarrhea, blurred vision For a child don't give when pulse is below 70 For an infant don't give when pulse is below 90

Medication management for postpartum hemorrhage

Oxytocin (Pitocin) Methylergonovine (Methergine) Carboprost—Tromethamine (Hemabate) Misoprostol (Cytotec)

fetal intrauterine resuscitation

Turn the mother, Run IV fluids, put oxygen on

VEAL CHOP

V- Variable C- Cord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placenta

How would the nurse best describe Gowers' sign to the parents of a child with muscular dystrophy? a) A transfer technique b) A waddling-type gait c) Muscle twitching present during a quick stretch d) The pelvis position during gait

a. a transfer technique

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

a. c. d. a. notify the surgeon if the child swallows frequently c. place the child on the abdomen until fully awake d. allow the child to have diluted juice after the procedure

An important nursing intervention when caring for a child who is experiencing a seizure would be to: a. describe and record the seizure activity observed. b. restrain the child when seizure occurs to prevent bodily harm. c. place a tongue blade between the teeth if they become clenched. d. suction the child during a seizure to prevent aspiration.

a. described and record the seizure activity observed

When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective?a.Dilation of the cervix b.Descent of the fetus to -2 station c.Rupture of the amniotic membranes d.Increase in bloody show

a. dilation of the cervix

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. Which instruction best describes these measures?a.Encouraging the woman to try various upright positions, including squatting and standing b.Telling the woman to start pushing as soon as her cervix is fully dilated c.Continuing an epidural anesthetic so pain is reduced and the woman can relax d.Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

a. encouraging the women to try various upright positions, including squatting and standing

Through which mechanism is Duchenne's muscular dystrophy acquired? a) Heredity b) Virus c) Autoimmune factors d) Environmental toxins

a. heredity

The nurse is planning a staff in-service on childhood spastic cerebral palsy. Spastic cerebral palsy is characterized by: a. hypertonicity and poor control of posture, balance, and coordinated motion. b. athetosis and dystonic movements. c. wide-based gait and poor performance of rapid, repetitive movements. d. tremors and lack of active movement.

a. hypertonicity and poor control of posture, balance and coordinated motion

The nurse must assess 10-month-old infant. The infant is sitting on the father's lap and appears to be afraid of the nurse and of what might happen next. Which initial action by the nurse would be most appropriate? a.Initiate a game of peek-a-boo. b.Ask father to place the infant on the examination table. c.Undress the infant while he is still sitting on his father's lap. d.Talk softly to the infant while taking him from his father.

a. initiate a game of peek-a-boo

The nurse is caring for a client in early labor. Membranes ruptured approximately 2 hours earlier. This client is at increased risk for which complication? a.Intrauterine infection b.Hemorrhage c.Precipitous labor d.Supine hypotension

a. intrauterine infection

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? a. Maintain a structured routine and keep stimulation to a minimum. b. Place child in a room with a roommate of the same age. c. Maintain frequent touch and eye contact with the child. d. Take the child frequently to the playroom to play with other children.

a. maintain a structured routine and keep stimulation to minimum

In recovery, if a woman is asked to either raise her legs (knees extended) off the bed or flex her knees, and then place her feet flat on the bed and raise her buttocks well off the bed, the purpose of this exercise is to assess what? a.Recovery from epidural or spinal anesthesia b.Hidden bleeding underneath her c.Flexibility d.Whether the woman is a candidate to go home after 6 hours

a. recovery from epidural or spinal anesthesia

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time? a. The family is included in the decision to shift the goals of treatment. b. The decision must be made by the health professionals involved in the child's care. c. The family needs to understand that palliative care takes place in the home. d. The decision should not be communicated to the family because it will encourage a sense of hopelessness.

a. the family is included in the decision to shift the goals of treatment

According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler's stage of moral development?

actions are determined as good or bad in terms of their consequences

avascular necrosis

an area of bone tissue death caused by insufficient blood flow

PKU (phenylketonuria)

autosomal recessive

A nurse is assessing a 2.5 year old toddler at a well-child visit. WHich of the following findings should the nurse report to the provider. a. Height increased by 7.5 CM(3in) in the past year. b. Head circumference exceeds chest circumference c. Anterior and posterior fontanels are closed d. Current weight equals four times the birth weight

b. head circumference exceeds chest circumference

the pediatric nurse practioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? a) Severe lordosis is evident in the lumbar spine. b) The boy rises from the floor by walking his hands up his legs. c) The head is held tilted with limited side-to-side motion. d) The boy has a large tan skin lesion on his torso.

b. the boy rises from the floor by walking his hands up his legs

A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

c. Frequent, serial casting is tried first. (every 2 weeks)

: A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client's expected date of birth (EDB)? a.September 17, 2015 b.November 7, 2015 c.November 21, 2015 d.December 17, 2015

c. November 21, 2015

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a. not administer pancreatic enzymes if child is receiving antibiotics. b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. administer pancreatic enzymes between meals if at all possible. d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal

A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures? a. Bone biopsy b. Genetic testing c. MRI d. Radiographs

d. radiographs

Example question: Trauma to which site can result in a growth problem for children's long bones?

epiphyseal growth plate

1st symptom of puerperal infection

fever greater than 38.0 °C (100.4 °F)

Pica

psychological disorder characterized by an appetite for substances that are largely non-nutritive, sign of iron deficiency.

true labor

women will tell you, Strong continuous contractions with change of cervix

Positive pregnancy signs

(FROM BABY) fetal parts, heart beat, fetal movement, palpating the baby (leopolds menuver), If you can see it, hear it or feel it then it's a baby

Presumptive signs of pregnancy

(FROM MOM) changes that might make a woman think she is pregnant. amenorrhea, fatigue, nausea, vomiting, polyuria, breast changes(darkened areolae, enlarged Montgomery glands), mood swings, frequent urination, a missed period, quickening

PREVENTION OF ICP

- semi fowlers position to promote venous return - avoid extreme head and neck flexion - maintain head in neutral position.

How to remove ticks

-Use tweezers to remove the tick directly from the skin. -Do not squeeze or handle the tick or pull it with bare fingers because tick feces carry disease organisms. -Use gloves or tissues if gloves are unavailable, and wash hands afterward. -If part of the tick remains in the skin, soak the skin to soften it and then remove any tick parts in the same way that a splinter would be removed.

Rheumatoid arthritis labs

-X-ray = most specific test (erosions, articular demineralization, joint space narrow) -Anti-CCP = most specific blood test (95%) -Rheumatoid factor (present in 70-80% of pts) -ANA (low titers in 20%) -ESR = elevated -CRP = elevated -Anemia

Hispanic health/medicine beliefs:

-avoid direct eye contact -use therapeutic touch -use face, hand, and body gestures -respect them wanting to use traditional therapies

Thrombocytopenia

-low platelet count -results from damage to bone marrow, chemotherapy, leukemia, or overactive spleen

Epiglottitis S/S

-sitting upward with leaning forward and mouth open - not able to breathe -drooling saliva -difficulty swallowing -cough is absent -wide-eye appearance -very anxious& restless -frog like croaking sound on inspiration -enlarged edematous epiglottis DO NOT TRY LOOKING AT THE THROAT -laryngospasm is triggered causing respiratory distress or failure

A woman's obstetric history indicates that she is pregnant for the fourth time, and all her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

4-1-2-0-4

nurse is performing a developmental screening on a 10-month-old infant. Which of the following fine motor skills should the nurse expect the infact to perform? SATA A. Grasp a rattle by the handle B. Try building a two block tower C. Use a crude pincer grasp D. Place objects into a container E. Walks with one hand held.

A and C

Which signs and symptoms should a woman immediately report to her health care provider? (Select all that apply.) a.Vaginal bleeding b.Rupture of membranes c.Heartburn accompanied by severe headache d.Decreased libido e.Urinary frequency

A, B, C Vaginal bleeding Rupture of membranes heartburn accompanied by severe headache

Emergency conditions during labor that require immediate nursing intervention can arise with startling speed. Examples of such emergencies include (choose all that apply): a. Nonreassuring or abnormal fetal heart rate (FHR) pattern b. Inadequate uterine relaxation c. Vaginal bleeding d. Infection e. Prolapse of the cord

A, B, C, E

The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.) a.Identification of fetal heartbeat b.Palpation of fetal outline c.Visualization of the fetus d.Verification of fetal movement e.Positive hCG test

A,B, C, D

When caring for the child with Reye syndrome, the priority nursing intervention should be to: a. monitor intake and output. b. prevent skin breakdown. c. observe for petechiae. d. do range-of-motion exercises.

A. monitor intake and output

A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurse'sbest response? a.Normal pregnancy is 10 lunar months. b.Pregnancy is made up of four trimesters. c.Pregnancy is considered term at 36 weeks. d.Estimated date of delivery (EDD) is 40 completed weeks.

A. normal pregnancy is 10 lunar months

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify physician. d. Chart the observations and check the extremity again in 15 minutes.

A. notify the practitioner of the changes noted

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as which of the following? a) Spastic hemiplegia b) Athetoid or dyskinetic c) Spastic diplegia d) Ataxic

A. spastic hemiplegia

The nurse is assessing a child with spastic cerebral palsy. Which of the following would the nurse expect to assess? Select all that apply. a) Poor control of balance b) Dysarthria c) Exaggerated deep tendon reflexes d) Hypertonicity e) Hemiplegia f) Drooling

ACDE poor control of balance exaggerated deep tendon reflexes hypertonicity hemiplegia

Identify critical nursing actions for a newborn after birth

APGAR, Vitamin K, Erythromycin eye ointment, Hep. b vaccine.

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a. correction of acidosis. b. adequate hydration and pain management. c. pain management and administration of heparin. d. adequate oxygenation and replacement of factor VIII.

b. adequate hydration and pain management

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent? a) Provide accommodations for both parents to room-in with their teen b) Assume responsibility for the teen's daily care while accepting input from parents and the teen c) Teach the parents how to add chest physical therapy to the care they provide d) Encourage the parents to assist their child with his activities of daily living while hospitalized

b. assume responsibility for the teen's daily care while accepting input from parents and the teen

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

b. complete obstruction

Which statement regarding the probable signs of pregnancy is most accurate? a.Determined by ultrasound b.Observed by the health care provider c.Reported by the client d.Confirmed by diagnostic tests

b. observed by the health care provider

Which is the preferred site for intramuscular injections in infants? a. Deltoid b. Dorsogluteal c. Rectus femoris d. Vastus lateralis

d. vastus lateralis

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to clinic every 1 to 2 weeks. d. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

c. Return to clinic every 1 to 2 weeks.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. Parents are better able to manage the disease

c. children are better able to manage the diabetes

Nursing care of the newborn with oral candidiasis (thrush) includes: a. avoiding use of pacifier. b. removing characteristic white patches with a soft cloth. c. continuing medication for a prescribed number of days. d. applying medication to oral mucosa, being careful that none is ingested.

c. continuing medication for prescribed number of days

The nurse should recommend medical attention if a child with a slight head injury experiences: a. sleepiness. b. vomiting, even once. c. headache, even if slight. d. confusion or abnormal behavior.

d. confusion or abnormal behavior

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

d. teaching the family the care and management of the corrective appliance

Supplements important for pregnancy/preconception counseling

folic acid and genetic testing

GTPAL

gravida, term births, preterm births, abortions, living children

HELLP

hemolysis, elevated liver enzymes, low platelets

Risks associated with rupture of membranes

infection, postpartum infection, endometritis, and death

Interventions post cardiac catheterization

lie flat maintain a patent peripheral venous catheter color and extremity affected by insertions check pulse distal from the insertion point of the catheterization

Clinical presentation of both Ewing and Osteosarcoma

lump on femur and hip pain.

Antidote to Demerol

naloxone

"P's" of pregnancy

passenger, passageway, powers, position, psychological response

Cause and Effect pregnancy issues?

uteroplacental insufficiency cause oligohydramnios Gestational diabetes causes polyhydramnios Advanced maternal age causes genetic abnormalities Chronic hypertension causes intrauterine growth restriction