HESI Maternity/Pediatric Remediation

Which adverse effect would the nurse assess for after administering oxytocin to a client to stimulate labor? Select all that apply. One, some, or all responses may be correct. A. Edema B. Headache C. Confusion D. Blurred vision E. Uterine rupture

All of the above Adverse effects of oxytocin include edema, headache, confusion, blurred vision, and uterine rupture.

+1 Station

presenting part is 1 cm below the ischial spines

+3/+4 Station

presenting part is visible at the vaginal opening

The nurse identifies which antimicrobial medications as safe during breast-feeding? A. Penicillins B. Macrolides C. Tetracycline D. Cephlasporins E. Chloramphenicol

Penicillins, Macrolides, Cephlasporin Penicillins, macrolides, and cephalosporins are considered safe medications during breast-feeding as they are least likely to affect the infant. Tetracycline and chloramphenicol should be avoided during breast-feeding.

The parent of an adolescent who is going to be a foreign exchange student asks the nurse why the child must have a tetanus toxoid immunization. The nurse provides which information? A. lifelong passive immunity B. Longer-lasting active immunity C. Temporary active natural immunity D. Temporary passive natural immunity

Long-lasting active immunity Toxoids are modified toxins that stimulate the body the body to form antibodies that can last up to 10 years against the specific disease; because the adolescent will be in a foreign country, the toxoid is given prophylactically. The tetanus toxoid provides active, not passive, immunity; all passive immunity is short acting. Only by having the disease can someone gain natural immunity. Toxoids confer active, not temporary passive, immunity.

Which medication may cause photophobia as an adverse effect? A. Nifedipine B. Alendronate C. Clomiphene D. Indomethacin

Clomiphene Clomiphene is a fertility medication that may cause photophobia. Nifedipine may cause maternal fetal problems. Alendronate may cause dysphagia. Indomethacin may cause birth defects.

A client is taking fertility medications for the first time. Which adverse effect of the medication would the nurse inform the client about? A. Vaginitis B. Constipation C. Joint swelling D. Deep vein thrombosis

Constipation Constipation is seen in the clients who are treated with fertility medications for the first time. Fertility medications do not cause vaginitis or swelling of joints. Deep vein thrombosis is an adverse effect of prolonged use of fertility medications.

Which long-term effect is associated with untreated congenital hypothyroidism? A. Myxedema B. Thyrotoxicosis C. Spastic paralysis D. Cognitive impairment

Cognitive impairment Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland because of an embryonic defect. A decreased level of thyroid hormone affects the fetus before birth during cerebral development, so it is likely that there will be some cognitive impairments at birth. Treatment before 3 months of age will prevent further damage. Congenital hypothyroidism does not become myxedema. Thyrotoxicosis is another term for hyperthyroidism. Although it is not expected, it may occur with an overdose of exogenous thyroid hormone, but it is too soon to discuss this possibility with the parents. Spastic paralysis occurs only if the infant has cerebral palsy.

Which medication is used to prevent preterm labor? A. Oxytocin B. Nifedipine C. Raloxifene D. Clomiphene

Nifedipine Nifedipine is used to prevent preterm labor because it inhibits myometrial activity by blocking the influx of calcium. Oxytocin may be used to induce labor. Raloxifene is used to prevent postmenopausal osteoporosis. Clomiphene is used to cause ovulation.

In which week of gestation would the nurse anticipate administering Rho(D) immune globulin to an Rh-negative client? A. 12 weeks B. 28 weeks C. 36 weeks D. 40 weeks

28 weeks Rho(D) immune globulin (RhoGAM) administered during the 28th week of gestation reduces an active antibody response in an Rh-negative individual exposed to Rh-positive blood. It is difficult to determine whether Rh sensitization has occurred at 12 weeks in pregnancy. RhoGAM is given earlier than 36 weeks in the pregnancy; it is a preventive measure, not a treatment for a woman who is already sensitized. Forty weeks is around the time of birth; if the client has not been sensitized, she will receive RhoGAM within 72 hours of birth.

The nurse understands which antihypertensive medication is contraindicated in lactating women? A. Atenolol B. Labetalol C. Metoprolol D. Propranolol

Atenolol Atenolol is contraindicated in lactating woman because it enters the breast milk and may cause adverse effects to the neonate. Labetalol and propranolol are safe to administer during lactation. Metoprolol is considered a safe medication to be taken during lactation.

A young adolescent reports abdominal bloating, pelvic fullness, menstrual cramps, and breast tenderness. Which is the primary responsibility of the nurse? A. Client education B. Preparation for surgery C. Medication administration D. Administration of IV fluids

Client education female adolescents often experience premenstrual syndrome in their lifetime.

The nurse observes unilateral breast enlargement in a 14-year-old male client. The client states he has had this condition for 18 months. Which treatment would the primary health care provider administer? A. Testosterone B. Plastic surgery C. Calcium channel blockers D. Testing for Klinefelter syndrome

Plastic surgery Gynecomastia is a condition in which the adolescent has some degree of unilateral or bilateral breast enlargement. If gynecomastia persists or is extensive enough to cause embarrassment, plastic surgery is indicated for cosmetic and psychological reasons. Administering testosterone and calcium channel blockers may aggravate the condition. When gynecomastia has a prepubertal onset, the adolescent should be evaluated for Klinefelter syndrome.

Which medication used to promote fertility would the nurse identify as a potential cause of esophageal burns? A. Estrogen B. Clomiphene C. Nifedipine D. Indomethacin

Clomiphene Clomiphene is a serum selective receptor modulator that may cause esophageal burns. Estrogen may cause a thromboembolism. Nifedipine may cause maternal-fetal problems. Indomethacin may cause birth defects.

0 station

presenting part is entering the pelvic inlet

Which combination of maternal and infant blood type would be an indication for administration of Rho (D) immune globulin (RhoGAM) to the postpartum client? A. Mother A positive and infant O positive B. Mother O negative and infant O positive C. Mother AB negative and infant B negative D. Mother B positive and infant B negative

Mother O negative and infant O positive Mom: negative Baby: positive = RhoGAM

A pregnant client with severe preeclampsia is receiving intravenous magnesium sulfate. Which item would the nurse keep at the bedside in case of magnesium sulfate toxicity? A. Oxygen B. Naloxone C. Calcium gluconate D. Suction equipment

Calcium gluconate The antagonist of magnesium sulfate is calcium gluconate. Oxygen is ineffective if the action of magnesium is not reversed. Naloxone is unnecessary; it is an opioid antagonist. Suction equipment may be necessary if the client has excessive secretions after a seizure. The priority intervention is to try to prevent a seizure.

The nurse is caring for a 3-year-old child with acute laryngotracheobronchitis. The child has severe dyspnea, a temperature of 104.0°F (40.0°C), and is receiving cool mist by way of a face mask. The mother asks why her child is not receiving warm mist. Which statement explains the purpose of cool mist? A. It helps dry mucosal secretions faster. B. It facilitates reduction of mucosal edema. C. It provides a more comfortable environment. D. It assists in absorption of fluid by the mucosa.

It facilitates reduction of mucosal edema. Cool mist helps reduce edema; it may also help reduce the fever. Edema in the airway is a priority of care. The mucosal secretions should be kept moist, not dry. Heat not only dries secretions but can also increase inflammation. Cool mist is less comfortable because the environment becomes cold and damp. Absorption by way of the mucosa is insignificant.

A client's body mass index (BMI) is 31. This client has a history of hyperinsulinemia caused by an intracranial tumor. Which treatment strategies would be beneficial? A. Leptin B. Orlistat C. Octreotide D. Metformin E. Sibutramine

Octreotide, Metformin A client with a body mass index (BMI) greater than 30 is considered obese. Specifically, octreotide is recommended for clients with hypothalamic obesity, which is caused by intracranial tumors. Metformin is prescribed for obese clients with insulin resistance and hyperinsulinemia, and it may be useful. Leptin is used to treat congenital leptin deficiency. Orlistat is a lipase inhibitor that has been approved for clients who are 12 years and older. Sibutramine is an appetite suppressant used to treat obesity.

Which nursing intervention would the nurse implement for an infant with a myelomeningocele awaiting surgical correction of the defect? A. Using disposable diapers B. Placing the infant in the prone position C. Performing neurologic checks above the site of the lesion D. Washing the area below the defect with nontoxic antiseptic

Placing the infant in the prone position The prone position is the best position for preventing pressure on the sac. Diapers should not be applied because they may irritate or contaminate the sac. Assessment of the area below the defect is essential in determining motor and sensory function. There is no indication for the use of an antiseptic.

A newborn receiving medication therapy for an infection has developed jaundice. The newborn has poor sucking and extreme sleepiness. Which medication would the nurse suspect as responsible for the newborn's condition? A. Tetracycline B. Sulfonamide C. Phenothiazine D. Chloramphenicol

Sulfonamide Jaundice, poor sucking, and extreme sleepiness are the clinical manifestations of kernicterus. Kernicterus is a condition seen in newborns due to deposition of bilirubin in the brain and is caused by sulfonamides. Tetracycline can cause staining of developing teeth in pediatric clients. Phenothiazine may cause sudden infant death syndrome. Chloramphenicol may cause Gray syndrome in pediatric clients.

The nurse instills an antibiotic ophthalmic ointment into a newborn's eyes. The nurse would explain to the mother that the medication prevents which condition? A. Ophthalmia neonatorum B. Herpetic ophthalmia C. Retinopathy of prematurity D. Hemorrhagic conjunctivitis

Ophthalmia neonatorum Ophthalmia neonatorum is caused by gonorrheal and/or chlamydial infections present in the vaginal tract. It is preventable with the prophylactic use of an antibiotic ophthalmic ointment applied to the neonate's eyes. Herpes affects the neonate systemically. Retinopathy of prematurity (formerly retrolental fibroplasia) occurs as a result of prolonged exposure to a too-high oxygen concentration. Hemorrhagic conjunctivitis is usually caused by rapid expulsion of the fetus's head from the vagina.

A pediatric client with a past history of chicken pox reports a fever and headache. Which medication would the nurse avoid giving to the client? A. Aspirin B. Tetracycline C. Nalidixic acid D. CHloramphenicol

Aspirin Clients with a past history of chicken pox should not be administered aspirin because of the risk of the client developing Reye syndrome. Tetracycline generally causes discoloration of the teeth. Nalidixic acid sometimes causes cartilage erosion. Chloramphenicol is associated with Gray syndrome in children.

A client in active labor becomes very uncomfortable and asks the nurse for pain medication. Nalbuphine is prescribed. The nurse understands that this medication relieves pain by which mechanism? A. By producing amnesia B. By acting as a preliminary anesthetic C. By inducing sleep until the time of birth D. By acting on opioid receptors to reduce pain

By acting on opioid receptors to reduce pain Nalbuphine is classified as an opioid analgesic and is effective in relieving pain; it induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep. 82

While counseling the parents of an adolescent with anemia related to an inadequate diet, the nurse explains that several different nutrients, including protein, iron, and vitamin B12, are involved. Which other nutrient would the nurse include in the teaching? A. Calcium B. Thiamine C. Folic acid D. Riboflavin

Folic acid Folic acid acts as a necessary coenzyme in the formation of heme, the iron-containing protein in hemoglobin. Calcium is not involved in the production of red blood cells. Thiamine is a coenzyme in carbohydrate metabolism. Riboflavin is a control agent for energy production and tissue formation.

Which medications would the nurse identify as being used to induce labor in pregnant clients? Select all that apply. One, some, or all responses may be correct. A. Oxytocin B. Ergonovine C. Carboprost D. Misoprostol E. Dinoprostol

Oxytocin, Misoprostol, Dinoprostone Oxytocin is an oxytocic that triggers or augments uterine contractions; it is used for labor induction. Misoprostol is a prostaglandin used for cervical ripening and labor induction. Dinoprostone is used for cervical ripening to induce labor. Ergonovine is an oxytocic used for postpartum or postabortion hemorrhage. Carboprost is a prostaglandin used to treat postpartum hemorrhage.

Which medication for depression would be safe to use with a breast-feeding mother who wishes to continue breast-feeding the newborn? A. Fluoxetine B. Paroxetine C. Valproic acid D. Methotrexate

Paroxetine Paroxetine can be safely given during breast-feeding. Fluoxetine can easily enter breast milk; therefore this medication would be used only when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic medication that can be given safely to breast-feeding women. Methotrexate is an anticancer medication that cannot be given during breast-feeding because it enters the breast milk and can cause adverse effects in the baby.

The nurse identifies which medication as impairing fertility when administered along with fertility medications? A. Clomiphene B. Menotropins C. Promethazine D. Choriogonadotropin

Promethazine When taken with fertility medications, promethazine increases prolactin concentration, which may impair fertility. Clomiphene and menotropins are ovulation stimulants given to induce ovulation in infertile women. Choriogonadotropin alfa is a recombinant form of human gonadotropin hormone; this medication is an ovulation stimulant.

Which medication treatment in the client during her gestation may cause a single-lobed brain and neural tube defects? A. Simvastatin B. Isotretinoin C. Carbamazepine D. Cyclophosphamide

Simvastatin Neural tube defects and single-lobed brains are teratogenic effects in a newborn associated with simvastatin, an HMG-CoA reductase inhibitor. Isotretinoin may cause central nervous system (CNS) defects. Carbamazepine exposure may cause neural tube defects. Cyclophosphamide may cause CNS malformation as a teratogenic effect.

Which assessment findings would the nurse recognize as possibly indicating a diet that is deficient in vitamin C in a preschool-aged client? A. headaches B. rashes C. Bleeding gums D. Muscle weakness E. Scaling of the skin

Rashes and bleeding gums headaches and scaling of the skin: Vitamin A deficiency Muscle weakness: Vitamin D

Which provider prescription would the nurse question for a young child with a tentative diagnosis of Wilms tumor? A. Renal biopsy B. Abdominal ultrasound C. Computed tomography scan (CT) D. Magnetic resonance imaging (MRI)

Renal biopsy A renal biopsy is an invasive procedure. In the early stages, Wilms tumor is encapsulated. Any disruption of the tumor capsule may precipitate metastasis. Magnetic resonance imaging, computed tomography, and abdominal ultrasound are all helpful in making the diagnosis.

The parents of a gifted child note that their child has been showing signs of rebellion and acting out. Which is one important thing to teach the parents about gifted children? A. They need boundaries like any other child B. Intense emotions require an outlet C. All discipline models approve physical aggression D. Gifted children should be allowed to freely express themselves

They need boundaries like any other child Gifted children need discipline like any other child to feel loved and safe. Punishment is appropriate for behavior that is unsafe or falls outside set boundaries. Discipline appropriately applied does not lead to physical aggression. Free expression does not mean overstepping the boundaries of appropriate behavior.

Myelomeningocele

hernia of the spinal cord and meninges (SPINA BIFIDA)

The nurse understands which medication taken by a pregnant woman may show a delayed teratogenic effect in the offspring? A. Aspirin B. Heparin C. Ethyl alcohol D. Diethylstilbestrol

Diethylstilbestrol Diethylstilbestrol may cause vaginal cancer in a female child 18 or more years after birth. Aspirin suppresses contractions during labor and may cause bleeding in the mother. Heparin does not cause fetal harm but may cause osteoporosis in the mother. Ethyl alcohol causes drug dependence or alcohol withdrawal syndrome in neonates.

Which medication is derived from a natural source and may be prescribed for the treatment of osteoporosis? A. Calcitonin B. Raloxifene C. Clomiphene D. Bisphosphonates

Calcitonin Calcitonin is derived from natural sources such as fish; this medication may be prescribed to prevent osteoporosis. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this medication is not derived from natural sources.

the nurse suspects that an adolescent have anorexia nervosa. Which characteristics may have been observed in the adolescent? A. Denying illness B. Dismissing food C. Seeking intimacy D. Being extroverted E. Maintaining rigid body control

Denying illness, dismissing food, maintaining rigid body control Bulimia Nervosa: seeking intimacy and being extroverted

Which care plan would the nurse implement for an infant with nonorganic failure to thrive? A. Maintaining silence while feeding the infant B. Following a structured routine throughout the day C. Periodically changing the seating arrangement during meals D. Distracting the infant with playful activities during feedings

Following a structured routine throughout the day A structured routine is important for infants with nonorganic failure to thrive. Disruptions in other areas of the infant's activities of daily living can affect feeding behaviors. The nurse should talk to the infant during feeding time; this indicates that the nurse cares and demonstrates the social aspects of eating. The infant should be fed in the same manner at each meal. Infants may be held while being fed, and older children may be fed in a high chair or at a table. Sensory stimulation and play activities are important, but these should be incorporated at times other than when the infant is feeding.

Which symptoms would the nurse expect in a 3-year-old with mild iron-deficiency anemia and fatigue? A. Cold, clammy skin B. Increased pulse rate C. Increased BP D. Cyanosis of the nail beds

Increased pulse rate Increased pulse rate (tachycardia) occurs as the body tries to compensate for the hypoxia resulting from mild iron-deficiency anemia. Severe anemia, however, can manifest as pale, cool, and clammy skin. Increased blood pressure is not a response associated with anemia. Cyanosis of the nail beds is a sign of carbon monoxide poisoning.

Which antihistamine is considered safe for a woman who plans to breast-feed? A. Sertraline B. Loratadine C. Clemastine D. Bromocriptine

Loratadine Loratadine does not get excreted in the breast milk. It is a safe medication for a lactating mother to take. Sertraline is an antidepressant that is safe for lactating women. Clemastine and bromocriptine are contraindicated in lactating women.

Which medication would the nurse identify as being used to induce abortion? A. Oxytocin B. Mifepristone C. Dinoprostone D. Indomethacin

Mifepristone Mifepristone is used to induce abortion. Oxytocin is used to induce labor at full-term gestation. Oxytocin also enhances labor when uterine contractions are weak and ineffective, which is inappropriate for abortion. Dinoprostone is a uterine stimulant that produces labor by softening the cervix and enhancing uterine muscle tone. Indomethacin is a tocolytic medication.

The nurse understands which is the medication of choice for a client who wants to abort her pregnancy at 3 months of gestation? A. Nifedipine B. Terbutaline C. Mifepristone D. Methylergonovine

Mifepristone Mifepristone is a progesterone antagonist that stimulates uterine contractions; it is used to selectively terminate a pregnancy. Nifedipine is a calcium channel blocker that is used to maintain pregnancy in cases of preterm labor. Terbutaline is a medication previously used to inhibit labor and maintain pregnancy, but in 2011 the FDA issued a warning that it should not be used for prevention or prolonged treatment of preterm labor; it is approved to prevent and treat bronchospasm. Methylergonovine is used to reduce postpartum uterine hemorrhage; this medication is not used for abortion.

Which pathophysiological process would the nurse expect to account for growth failure in a 4-year-old child with newly diagnosed cystic fibrosis? A. Impaired digestion and absorption because of the lack of pancreatic enzymes B. Dyspnea and shortness of breath, which cause anorexia and disinterest in food C. Increased bowel motility and diarrhea, which lead to inadequate absorption of nutrients D. Pulmonary obstruction, which causes an oxygen deficit and inadequate tissue nourishment

Impaired digestion and absorption because of the lack of pancreatic enzymes Obstruction of the pancreatic duct and the absence of enzymes (e.g., trypsin, amylase, and lipase) to aid fat digestion and absorption lead to wasting of tissues and failure to thrive. Currently it is recommended that children with cystic fibrosis consume 150% to 200% of the calories recommended for their body weight. Despite dyspnea and shortness of breath, these children have voracious appetites when feeling well; the difficulty involves poor digestion and malabsorption of fats and fat-soluble vitamins. Increased bowel motility and diarrhea are not associated with cystic fibrosis. The pulmonary disease process leads to localized respiratory dysfunction, not to retarded physical growth.

An Rh-negative client has a spontaneous abortion at the end of the second trimester and is prescribed Rho(D) immune globulin. The client asks the nurse, "Why do I need this medication?" Which information would the nurse consider before answering the client's question? A. It will expand the woman's antibody pool. B. It will prevent the woman from producing antibodies. C. The woman's production of immune bodies will be accelerated. D. The activity of the mother's Rh-negative antibodies will be suppressed.

It will prevent the woman from producing antibodies Rho(D) immune globulin attacks fetal red cells that have gained access to the maternal bloodstream at the time of birth; it prevents antibody formation. Antibody formation is undesirable; it sensitizes the woman and contributes to fetal red cell destruction in future pregnancies. There is no production of immune bodies. Rho(D) immune globulin prevents the woman's immune system from responding to the fetal Rh-positive blood.

Which medication is indicated for evacuation in case of a miscarriage? A. Clomiphene B. Dinoprostone C. Methylergonovine D. Magnesium sulfate

Dinoprostone Dinoprostone is a prostaglandin E2 abortifacient and cervical ripening medication, which is indicated for uterine evacuation in cases of miscarriage. Clomiphene is indicated for female infertility in some clients. Methylergonovine is used to treat postpartum uterine atony and hemorrhage. Magnesium sulfate is used to treat pregnancy-induced hypertension.

Wilms tumor

a rare type of malignant tumor of the kidney that occurs in young children

Kawasaki disease

(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. mucocutaneous lymph node syndrome, is the most common cause of acquired heart disease in children in developed countries

Which education would the nurse provide the parent's of a 4-year-old child with a new colostomy? A. Restricting fluid intake B. Instituting dietary restrictions C. Encouraging physical activity D. Inspecting the stoma once a day

Encouraging physical activity Contact games may be restricted, but other physical activities should be encouraged. The stoma should be inspected more often than once daily to ensure adequate circulation. Increased fluid intake is needed to compensate for fecal fluid loss. The diet should not be restricted at the time of discharge. Both the parents and the child will learn which foods are poorly tolerated, and they will adjust the diet accordingly.

An 18-month-old toddler who has received the appropriate immunizations on time is visiting the pediatric clinic for the next scheduled immunization. Which vaccine(s) would the nurse administer? A. second hepatitis B vaccine B. Fifth inactive polio vaccine C. first pneumococcal vaccine and Influenza vaccine D. Fourth diphtheria toxoid, tetanus toxoid, and Acellular pertussis vaccine

Fourth diphtheria toxoid, tetanus toxoid, and Acellular pertussis vaccine The recommended age for the fourth dose of DTaP is 15 to 18 months. The recommended age for the second dose of Hep B is 4 weeks after the first dose, which is given immediately after birth. Four, not five, doses of IPV are recommended. The initial doses of PCV and Hib are given at 2 months.

Which education would the nurse provide the parents of preschool-aged children regarding injury prevention? A. "Preschool-aged children are more prone to falls than are toddlers." B. "Preschool-aged children are at risk for injury because of their poor gross motor skills." C. "Preschool-aged children are less likely to follow rules, which increases the risk for injury." D. "Preschool-aged children are at risk for head injuries from riding a tricycle or balance bike."

"Preschool-aged children are at risk for head injuries from riding a tricycle or balance bike." Preschool-aged children are at risk for head injuries from falls while riding a tricycle or balance bike; helmets are critical anticipatory guidance. The preschool-aged child is at a decreased risk for falls when compared with the toddler. Preschool-aged children have better gross motor skills; therefore this decreases their risk of injury. The preschool-aged child is more, not less, likely to follow the rules, which also decreases the risk of injury.

A toddler is admitted to the pediatric unit with a temperature of 103.5°F (39.7°C), a runny nose, and a productive cough. Respiratory secretion specimens are sent for culture and sensitivity tests. Standard precautions are followed until the results are known. Which other precautions would the nurse include? A. Droplet B. Contact C. Airborne D. Neutropenic E. Restriction of parental visitation

Droplet, contact, and airborne Because the cause of the child's diagnosis has not been determined, airborne precautions should be instituted. Droplet precautions would be instituted for pertussis. This child does have a fever, which may be indicative of pertussis. Contact precautions are also necessary until a diagnosis is made. Neutropenic precautions protect an immunosuppressed child from exposure to microorganisms from others. Restricting parental visitation could lead to separation anxiety and stress on the child. The parents may visit after being taught about the special precautions to be taken.

Which assessment technique would the nurse use to appreciate Korotkoff sounds while measuring the BP of a preschooler? A. Use an ultrasonic stethoscope to measure BP B. Measure bP by choosing a cuff labelled as a child cuff C. Hear Korotkoff sounds with the help of a pediatric stethoscope bell D. Place the stethoscope firmly on the antecubital for good ascultation

Hear Korotkoff sounds with the help of a pediatric stethoscope Korotkoff sounds are difficult to hear in preschoolers because of their low frequency and amplitude. The nurse would use a pediatric stethoscope bell to hear these sounds. An ultrasonic stethoscope is used to measure BP when auscultation is not possible because of weakened arterial pulses. It need not be used for all preschoolers. The cuff should not be chosen based on its name. For instance, an "infant" cuff may not fit an infant. Placing the stethoscope too firmly over the brachial artery on the antecubital fossa causes errors in auscultation.

Which cognitive development milestone is characteristic of a 4-year-old? A. Inductive reasoning B. Concrete operational thoughts C. Intuitive thought D. Conservation

Intuitive thought Preschool: preoperational stage of cognitive development, substage of intuitive thought at age 4 (asking a lot of questions) School aged children: Operational stage (Inductive logic, concrete operational thoughts and conservation)

Which type of medication would the nurse identify as readily crossing the placenta? A. Polar medications B. Ionized medications C. Lipid-soluble medications D. Protein-bound medications

Lipid-soluble medications Medications that are lipid soluble penetrate the placenta in higher concentrations. Polar medications are not transferred in higher concentrations through the placenta. Nonionized medications are more likely to be transferred through the placenta than ionized medications. Protein-bound medications remain in the maternal plasma because the molecules are too large to cross the placenta.

Which care plan would the nurse implement for an infant admitted to the pediatric unit with the diagnosis of heart failure? A. Increase the infants fluid intake B. Position the infant flat on the back C. Offer the infant small, frequent feedings D. Measure the infant's head circumference

Offer the infant small, frequent feedings Because infants with heart failure become extremely fatigued while suckling, small, frequent feedings with adequate rest periods between can improve their total intake. Infants with heart failure usually have fluids restricted to reduce the cardiac workload. Lying flat restricts lung expansion and should be avoided; positioning with the upper body elevated facilitates respirations. Infants with heart failure are not prone to hydrocephalus and do not need to have head circumference measured again if the initial newborn assessment findings are within expected limits.

Which toy would the nurse select for a 1-year-old child in the hospital playroom? A. Rocking horse B. Stuffed animal C. Four-piece puzzle D. Squeaky plastic duck

Squeaky plastic duck A plastic toy that squeaks is appropriate for a 1-year-old child because it provides auditory, tactile, and visual stimulation. The potential for injury is too great for a 1-year-old child to be placed on a rocking horse. A stuffed animal should not be kept in a playroom because it cannot be washed between uses by different children. A 1-year-old is too young for a puzzle.

The nurse in the pediatric clinic receives a call from the mother of a 12-month-old infant who has had a fever, runny nose, cough, and white spots in the mouth for 3 days. A rash started on the face and has now spread to the entire body. Which communicable infection would the nurse be concerned about? A. Rubella B. Rubeola C. Pertussis D. Varicella

Rubeola White spots (Koplik spots) and the rash with a fever, cough, and runny nose are clinical indicators of rubeola (measles). Rubella (German measles), pertussis (whooping cough), and varicella (chickenpox) do not cause Koplik spots.

Which medication treatment may have been given during gestation to a mother whose baby was born with shortened limbs? A. Phenytoin B. Topiramate C. Thalidomide D. Carbamazepine

Thalidomide Thalidomide is an anticancer medication that may cause shortening of the limbs as a teratogenic effect. Phenytoin, topiramate, and carbamazepine are antiseizure medications that may cause growth delays and neural tube defects.

A medication is administered to a client in her third trimester of pregnancy. Which statement regarding the medication administration is correct? A. The dose of medication should be increased for pregnant clients B. No medication should be administered to the pregnant client C. Medication dosages should not be altered for a pregnant client D. Medication dosage may need to be decreased for pregnant clients

The dose of medication should be increased for pregnant clients During pregnancy, a client's hepatic metabolism and glomerular filtration are increased. As a result, the excretion rate is faster. The dose of a medication should be increased for the medication action to be optimal. It is true that some medications should not be given to the pregnant client, because of potential teratogenic effects on the fetus. The client should see her health care provider if in doubt. The dose of a medication should be altered for a pregnant client depending on the trimester she is in. How a medication affects the fetus depends on the stage of development of the fetus and the dosage and strength of the medication administered. During the first 3 to 8 weeks after fertilization, the major organs are developing, and the dose of a medication should be decreased or withdrawn for pregnant clients.

Which parental statement would the nurse recognize as a concern? A. My baby like several different types of pacifiers B. The mouth guard for the pacifier was too big do I had to alter the size C. I allow my baby to fall asleep with the pacifier during day naps and at night D. I have clipped the pacifier to my baby's clothing so that it does not fall on the floor

The mouth guard for the pacifier was too big do I had to alter the size Altering the size of a pacifier poses a safety risk. There is no problem with an infant using different types of pacifiers as long as they are appropriate for the infant's age. The use of a pacifier is associated with a reduced risk of sudden infant death syndrome (SIDS). There are clips available that are safe to use to secure a pacifier.

An adolescent reports genital warts. Which suggestions would the nurse provide to reduce the discomfort? A. Try out cryotherapy if needed B. Wear loose-fitted cotton clothes C. Take a bath with oatmeal solution D. Use less water for cleaning the genitals E. Anticipate a prescription of imiquimod

Try out cryotherapy if needed, wear loose-fitted cotton clothes, take a bath with oatmeal solution To reduce the irritation and discomfort of genital warts, bathing with oatmeal solution can be helpful. Wearing loose-fitted cotton clothes helps in reducing the irritation and friction. Depending on the severity of the warts, cryotherapy can be an option to treat the warts. Proper cleaning and hygiene of the genital area is necessary to reduce the growth of the warts. Medications such as imiquimod should not be used during pregnancy.

Which education would the nurse provide the parents of a preschool-aged child with leukemia who is undergoing chemotherapy and is susceptible to rectal ulcerations? A. Encourage lying on the abdomen when in bed B. Have the child wear cotton underpants at night C. Apply rectal ointment liberally 4 times a day D. Clean the child's perianal area after each bowel movement

Clean the child's perianal area after each bowel movement Meticulous toilet hygiene, including cleaning the child's perianal area after each bowel movement, is essential to prevent infection and promote comfort. Changing positions in bed is preferable to only lying on the abdomen. Underpants keep the area moist and promote bacterial growth; it is preferable to leave the area exposed to air, even if it remains under bed linens. Ointments tend to occlude and trap organisms, thus promoting infection.

Which medication is responsible for neonatal hypoglycemia? A. Warfarin B. Simvastatin C. Tolutamide D. Methimazole

Tolutamide Tolbutamide is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have effects such as neonatal hypoglycemia. Warfarin, a common blood thinner, may cause teratogenic effects such as skeletal and central nervous system defects. Simvastatin, an HMG-CoA reductase inhibitor used for the treatment of high cholesterol, may cause teratogenic effects such as facial malformations and severe central nervous system anomalies. Methimazole, an antithyroid medication administered for the treatment of maternal hyperthyroidism, may cause teratogenic effects such as neonatal goiter, cretinism, and hypothyroidism.

Which skin care education would the nurse provide the parents of an infant who has undergone surgical repair of a myelomeningocele? A. Will require long-term multidisciplinary follow-up care B. should take prophylactic antibiotic therapy indefinitely C. Must be kept dry by applying powder after each diaper change D. Does not need anything more than routine cleansing and diaper changes

Will require long-term multidisciplinary follow-up care These infants need follow-up care with a variety of health care providers (e.g., neurologist, physical therapist) to manage the child's condition during growth and development. Taking prophylactic antibiotic therapy indefinitely is unnecessary. Powder should be avoided; it will create a pastelike substance when mixed with urine, and when aerosolized it is a respiratory irritant. These children require more frequent perineal care than just routine cleansing and diaper changes.

Which techniques would the nurse use when assessing a preschool-aged child? a. Asking questions directly to the child B. Asking the child to sit on the examination table C. Having the child undress, leaving on the undergarments D. Having the parent of the child leave the room for the duration of the assessment E. Asking the child whether he or she would like to have the respiratory or abdominal assessment done first

a. Asking questions directly to the child B. Asking the child to sit on the examination table C. Having the child undress, leaving on the undergarments E. Asking the child whether he or she would like to have the respiratory or abdominal assessment done first Developmentally appropriate assessment techniques for a preschool-aged child include asking questions directly to the child, asking the child to sit on the examination table, having the child undress but leave on undergarments, and giving the child a choice about the order of assessment. The child's parent is not asked to leave the room for the duration of the assessment for the preschool-aged client.

The nurse recognizes which statement as true regarding transdermal estradiol? A. Estradiol reduces estrogen levels. B. Estradiol is slowly absorbed from the skin. C. Estradiol patches are applied monthly. D. Estradiol should be used along with sunscreen products.

Estradiol is slowly absorbed from the skin. Estradiol is slowly absorbed from the skin for up to 8 hours after application. Estradiol is administered to increase the levels of estrogen in postmenopausal women to ease hot flashes. Estradiol is available as an emulsion that is typically applied to the thighs or calves. Estradiol transdermal films are changed once or twice a week, whereas gel is applied daily. Sunscreen products should not be applied with estradiol because sunscreen may reduce the absorption of estradiol.

Which education would the nurse provide the parents of a preschooler who stutters? A. Avoid looking at the child when there is difficulty articulating words. B. Ignore the stuttering, and try to prevent situations that increase stuttering. C. Help by supplying the correct word when the child is experiencing a block. D. Stop the conversation by telling the child to speak slowly and to think before starting again.

Ignore the stuttering, and try to prevent situations that increase stuttering Ignoring the stuttering and preventing situations that induce stuttering will avoid undue emphasis on the speech pattern, thus preventing inadvertent reinforcement of the pattern. Avoiding looking at the child is demeaning; it may decrease the child's self-esteem and worsen the stuttering. Stuttering is common in preschoolers because they are learning new vocabulary and are attempting to find the right words to express themselves; hesitancy and dysfluency are typical speech characteristics of preschoolers. Stopping the conversation and telling the child to slow down is counterproductive; it may decrease the child's self-esteem and worsen the stuttering.

Which eduction would the nurse provide the parents of an infant with a cleft lip and palate about the infant's predisposition to infection? A. Waste products accumulate along the defect B. Circulation to the defective area is insufficient C. inefficient feeding behaviors result in inadequate nutrition D. Mouth breathing dries the oropharyngeal mucous membranes

Mouth breathing dries the oropharyngeal mucous membranes Infants with cleft lip and palate breathe through their mouths, bypassing the natural humidification and filtration provided by the nose; as a result, the mucous membranes become dry and cracked and are at risk for infection. Although some waste products may accumulate along the defect, it is not difficult to keep the area clean by cleansing it with water after a feeding. Circulation to the area is unimpaired. Feeding can be adequate with the use of special equipment and a slow approach.

A health care provider prescribes teriparatide for a client with osteoporosis. Which statement about this medication would the nurse recognize as accurate? A. It requires increased intake of vitamin A. B. It prevents existing bone from being destroyed. C. Sunscreen should be used to prevent vitamin D absorption. D. Osteoblastic activity is stimulated more than osteoclastic activity.

Osteoblastic activity is stimulated more than osteoclastic activity. Teriparatide is a 34-amino acid polypeptide that represents the biologically active part of human parathyroid hormone; it enhances bone microarchitecture and increases bone mass and strength by stimulating activity by osteoblasts. Supplemental intake of vitamin A should not exceed recommended daily requirements; too much vitamin A has been associated with bone loss and an increased incidence of fractures. Alendronate sodium, a regulator of bone metabolism, not teriparatide, inhibits osteoclast-mediated bone resorption, minimizing bone destruction and loss of bone density. Sunscreen should be avoided to promote exposure to the sun so that vitamin D can be converted in the skin; vitamin D helps the body absorb calcium. Sunscreen should be used after 5 to 20 minutes of exposure to prevent the negative effects of prolonged exposure to ultraviolet rays.

An adolescent sustains a sports-related fracture of the femur, and open reduction and internal fixation with a rod insertion is performed. After the surgery, the nurse notes that the adolescent is very upset. Which correlates to the client's developmental level and is likely an explanation for this distress? A. The need to navigate in a wheelchair B. The perception that the rod is a body intrusion C. Inability to participate in sports for several years D. The necessity of medication for pain relief until the bone heals

The perception that the rod is a body intrusion Adolescents are concerned about body image and fitting in with a peer group; the stabilizing rod may be viewed as an insult to the intactness of the body. The nurse would obtain additional information to confirm this assumption. Weight-bearing can be prevented with crutches, which provide greater mobility than a wheelchair. Adolescents who undergo open reduction and internal fixation with a rod insertion generally return to normal activities after several months. Although pain may be a concern, an adolescent is old enough to understand that analgesics are available; this probably is not the reason that the adolescent is upset.

Which education would the nurse provide the parent of a child diagnosed with sleep terrors? A. Sleep terrors are followed by full waking. B. Sleep terrors usually occur 1-4 hours after falling asleep C. It takes place during REM sleep D. The child rapidly returns to sleep after an episode of sleep terrors E. The child is aware of and reassured by another's presence after an episode of sleep terrors

sleep terrors usually occur 1 to 4 hours after falling asleep, the child rapidly returns to sleep after an episode of sleep terrors Sleep terrors usually occur 1 to 4 hours after falling asleep, when non-REM sleep is deepest. After an episode, the child rapidly returns to sleep; it is often difficult to keep the child awake after this. Nightmares are followed by full waking; sleep terrors are followed by partial arousal. Nightmares take place during REM sleep; sleep terrors take place during stage IV, non-REM sleep. After a nightmare, the child is aware of and reassured by another's presence. After an episode of sleep terrors, however, the child is not very aware of another's presence, is not comforted, and may push the person away and scream and thrash more if held or restrained.