OB Quiz
Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important
frequent swallowing indicates bleeding
gestational hypertension
high blood pressure (140/90 mm Hg) during pregnancy bp returns to normal after birth
ectopic pregnancy
implantation of the fertilized egg outside the uterus
placenta previa
implantation of the placenta over the cervical opening or in the lower region of the uterus
preterm labor
labor before 37 weeks
ectopic pregnancy s/s
lower abdominal pain, delayed menses, abnormal vaginal bleeding, risk for hypovolemic shock/hemorrhage if ruptures, referred shoulder pain after rupture
medication administered in an ectopic pregnancy
methotrexate
placenta abruption complications
mother: shock, failure of organs due to blood loss baby: oxygen deficiency, premature birth, still birth
two major clinical signs of ventricular septal defect
murmur heard over left lower sternal border failure to thrive
HELLP syndrome
- hemolysis (rupture of rbcs) leads to anemia - elevated liver enzymes lead to epigastric pain - low platelets leads to abnormal bleeding/clotting
preeclampsia
- increased bp and proteinuria
gestational hypertension
- ineffective tissue perfusion related to vasoconstriction of blood vessels - deficient fluid volume related to fluid loss - risk of fetal injury related to reduced placental perfusion secondary to vasospasm
cystic fibrosis
- inherited disease of the secretory glands - thick mucous secretions (in pancreas/lungs) - electrolyte abnormalities in sweat gland secretions
Which clinical manifestation of acute nasopharyngitis is more of a concern for the infant than the older child?
nasal congestion The infant has smaller airways, making it more difficult to breathe when nasal congestion occurs
cesarian section (c-section)
often as a prophylactic measure to alleviate problems
considerations when administering digoxin
- serum digoxin level therapeutic range is 0.8 to 2 ng/mL - dose would be withheld if the apical pulse is less than 60 in an adolescent and less than 90 in an infant. - avoid giving with meals as altered absorption may occur
HELLP syndrome therapy
- transfusion of fresh frozen plasma or platelets to improve platelet count - IV glucose infusion if hypoglycemia is present
Disseminated Intravascular Coagulation (DIC) treatment
- treat underlying condition - administering heparin to halt clotting cascade
The nurse is teaching a 6-year-old about peak flow testing. During this diagnostic test, what instruction should the nurse provide?
I need you to blow out through the meter as hard and fast as you can.
cullen sign
bruising around umbilicus indicates blood within peritoneum
breech presentation
buttocks or feet are the first body parts that contact cervix
Magnesium Sulfate
central nervous system depressant that acts to block nueromuscular transmission of acetylcholine to halt convulsions - to prevent seizures due to worsening preeclampsia - to slow/stop preterm labor - prevent injuries to a preterm baby's brain
What is the most common debilitating disease of childhood among those of European descent
cystic fibrosis
what does a positive sweat test indicate
cystic fibrosis
Late decelerations
- a dip in heart rate from baseline - decreased oxygen, hypoxia, due to placental insufficiency
Disseminated Intravascular Coagulation (DIC)
- abnormal blood clotting in small vessels throughout the body that cuts off the supply of oxygen to distal tissues, resulting in damage to body organs
preeclampsia with severe features symptoms
- bp 160/110 mm Hg - proteinuria 3+ to 4+ - oliguria (small amounts of urine) - elevated serum creatinine - cerebral/visual disturbances (headache, blurred vision) - pulmonary or cardiac involvement - extensive peripheral edema - hepatic dysfunction - thrombocytopenia - epigastric pain
preeclampsia without severe features symptoms
- bp is 140/90 mm Hg - proteinuria of 1+ to 2+ - weight gain over 2lb/week in 2nd trimester and 1lb/week in 3rd trimester - mild edema in upper extremities/face
gestational diabetes
- condition of abnormal glucose metabolism that arises during pregnancy - risk for type II diabetes later in life
dystocia
difficult labor form four components - power/uterine contractions - passenger/the fetus - passageway/birth canal - psyche/birthing parents & familys perception of event
The nurse routinely assesses all pregnant patients for signs of hypertension while interviewing them at the prenatal clinic and then documents the findings in the electronic health record. Which statement by B.M. would the nurse document as possible evidence that she might be developing gestational hypertension?
I can live with my puffy feet, but now it's also my hands and wrists
placenta previa interventions
do not give vaginal exam, may cause tearing of placenta
normal respiratory rate for an infant
30-60 breaths per minute
criteria used to define childhood hypertension
A systolic reading above the 95th percentile for thechild's age
The child (age 2) has a barking cough, sore throat, and fever. The nurse wants to see whether the throat looks sore and swollen. What is the safest and most accurate way of performing this assessment?
Ask the child to open their mouth and then visually inspect the throat. Because initiating gagging may cause further airway closure, the nurse should never elicit a gag reflex on children with a high fever, barky cough, and sore throat. Instead, the nurse should assess the throat with simple inspection.
A.G. is prescribed an insulin pump to administer insulin for her gestational diabetes. What patient education would the nurse want to provide to explain why nighttime is a particularly hazardous time for her fetus during pump therapy?
Continuous insulin administration with no food intake can lead to hypoglycemia.
what is an indication of a rupture in ectopic pregnancy
Cullen sign
The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?
Digoxin
Multiple studies reported the effectiveness of hand hygiene in the reduction of infection. As a result, the WHO and the CDC have endorsed the importance of hand hygiene to reduce infection (WHO, 2016a). Based on this study, the nurse determines which action is most effective to ensure that the 17-year-old consistently performs handwashing before meals?
Discuss with the parent about the importance of modeling good hand hygiene practices.
What is the priority nursing diagnosis in the plan of care for a child with a congenital heart disorder?
Ineffective Tissue Perfusion related to inadequate cardiac output
The nurse gives a report to an OR nurse prior to a cesarean birth and describes actions they took to reduce the size of the patient's bladder and to keep it away from the surgical field during the procedure. Which action should the nurse describe to their colleague?
Inserting a Foley catheter to drain the bladder and decrease its size
When planning the care for a child with Kawasaki disease, which of the following would be most important?
Observing the child for symptoms of bowel obstruction Extreme enlargement of lymph nodes canoccur with Kawasaki disease. If abdominal nodes increase in size, they can compress intestines, leading to bowel obstruction
The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?
Place the child in a knee-to-chest position
B.M.'s spouse drove her to the emergency room because she was having symptoms of preterm labor. The admitting nurse in the emergency department identifies which action as the priority?
Position her in a side-lying position and assess FHR and contractions
An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?
Raise the caloric density of the feeding beyond 20 calories per ounce Increasing the caloric density of the feeding allows the infant to ingest more calories without increased volume and in a shorter period of time. This conserves energy. Calories per ounce can be increased by adding supplements to pumped breast milk.
first sign of respiratory illness in infants and children
Tachypnea, or increased respiratory rate
When assessing a child for cyanosis, which is important for the nurse to remember?
The degree of cyanosis is not an accurate indicatorof the degree of hypoxia
The nurse caring for the child with asthma weighs the child daily. What is the most important reason for doing a daily weight on this child?
To determine fluid losses During an acute asthma attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting.
During which time frame would it be best to plan for chest physiotherapy completion?
When planning care, it is best to complete chest physiotherapy (CPT) one hour before a meal or an hour after a meal
what sounds is produced If the obstruction is at the base of the tongue or in the larynx upper airway obstruction
a harsher, strident sound on inspiration (stridor) occurs
Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot
altered cardiopulmonary tissue perfusion risk Nursing priority following cardiac surgery will focus on assessing for ineffective cardiopulmonary tissue perfusion
what sounds is produced If an obstruction is in the lower trachea or bronchioles
an expiratory whistle sound (wheezing) occurs
A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do beforeapplying the cannula?
assess patency of nares
most common symptom of placenta previa
painless vaginal bleeding
placenta abruption
placenta separates prematurely from the uterine wall
cystic fibrosis in newborns
suspected in newborns who fails to regain normal birth weight within 7-10 days of birth
Which of the following is the most frequent reason for postpartum hemorrhage?
uterine atony
