maternity/peds review quiz

A 9-year-old child with chronic kidney disease is undergoing peritoneal dialysis. For which associated complication should the nurse monitor the child? 1 Petechiae 2 Abdominal bruit 3 Cloudy return dialysate 4 Increased blood glucose level

3

An ultrasound scan of a 7-month-pregnant woman indicates fetal death. Which drug should be given to the client to evacuate the contents of the uterus? 1 Terbutaline 2 Mifepristone 3 Dinoprostone 4 Methylergonovine

3

A client with mild preeclampsia is being treated on an outpatient basis. Three days of bed rest is prescribed. What position should the nurse encourage the client to maintain while in bed? 1 Supine 2 Side-lying 3 Semi-Fowler 4 Slight Trendelenburg

Side-lying-The side-lying position improves venous return to the heart and increases stroke volume and cardiac output.

The nurse is caring for a school-aged child with cystic fibrosis. Which pathophysiologic factor has the greatest impact on the child's health status and is of priority in the care plan? 1 Extremely thick mucus causes obstructed airways. 2 There is acute inflammation of the lung parenchyma. 3 Endocrine glands secrete increased levels of hormones. 4 Increased irritability of the airways results in obstruction.

1

Which teratogen causes masculinization of the female fetus? 1 Danazol 2 Vitamin A 3 Topiramate

1

A client is admitted with a diagnosis of preeclampsia. Which significant clinical finding does the nurse expect when reviewing the client's history? 1 Proteinuria 2 Tachycardia 3 Increased serum glucose 4 Tonic-clonic movements

Proteinuria A characteristic of preeclampsia is vasospasms that cause renal injury, resulting in loss of protein in the urine. The maternal heart rate is not affected by preeclampsia. An increased serum glucose level is associated with uncontrolled diabetes, not preeclampsia. There are no data to indicate that the client had or is having a seizure. The admitting diagnosis is preeclampsia, not eclampsia.

During testing of the neurologic reflexes of an infant, which reflex should the nurse expect to appear at 3 months and persist until 24 to 36 months of age? 1 Neck righting 2 Body righting 3 Otolith righting 4 Labyrinth righting

1 While the infant is supine, if the head is turned to one side, the shoulder, trunk, and finally pelvis will turn toward that side. This reflex appears at 3 months, and persists until 24 to 36 months of age. Body righting is a modification of the neck-righting reflex in which turning hips and shoulders to one side causes all other body parts to follow; it appears at 6 months, and persists until 24 to 36 months of age. When the body of an erect infant is tilted, the head is returned to an upright, erect position; this is known as otolith righting, which appears at 7 to 12 months of age, and persists indefinitely. When an infant in prone or supine position is able to raise head, it is known as labyrinth righting. It appears at 2 months, and is strongest at 10 months of ag

The nurse is teaching the mother of a 3-year-old child about techniques to promote medicine adherence. What instructions should the nurse include in the teaching? Select all that apply. 1 Choose the proper dosage form. 2 Compensate for spilled or spit-out medicine by overdosing. 3 Complete the prescribed dose. 4 Use calibrated spoons for measuring liquid formulations. 5 Improve palatability of the drug by mixing it with food or juice.

1,3,4

A pregnant client who is Rh negative visits the prenatal clinic during the first trimester of pregnancy. She is informed by the primary healthcare provider that Rh sensitization is suspected and that Rho(D) immune globulin eventually will be given. At what week of gestation should the nurse explain that the medication will be administered? 1 12 weeks 2 28 weeks 3 36 weeks 4 40 weeks

2

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? 1 Insulin needs will increase during the second trimester. 2 Insulin needs will decrease during the second trimester. 3 Insulin needs will not change during the second trimester. 4 Insulin will be switched to an oral antidiabetic medication during the second trimester

1 At the end of the second trimester and the beginning of the third trimester, insulin needs increase because of an increase in maternal resistance to insulin. During the earlier part of pregnancy, fetal demands for maternal glucose may cause a tendency toward hypoglycemia. During the last weeks of pregnancy, maternal resistance to insulin decreases and insulin needs decrease accordingly.

A mother complains that her child's teeth have become yellow in color. With prolonged use, which medication may be responsible for the child's condition? 1 Tetracycline 2 Promethazine 3 Chloramphenicol 4 Fluoroquinolones

1

A nurse is caring for a 6-year-old child who has undergone craniotomy. The parents ask what effect mannitol has. The nurse responds that this medication is given to achieve what goal? 1 Relieve cerebral pressure 2 Increase the bladder's filtration rate 3 Reduce glucose excretion in the urine 4 Decrease the peripheral retention of fluid

1

A client is admitted to the birthing unit with uterine tenderness and minimal dark-red vaginal bleeding. She has a marginal abruptio placentae. The priority assessment includes fetal status, vital signs, skin color, and urine output. What additional assessment is essential? 1 Fundal height 2 Obstetric history 3 Time of the last meal 4 Family history of bleeding disorders

1 It is vital that a baseline measurement be obtained because increasing fundal height is a sign of concealed hemorrhage.

Which points should be included when the mother of an epileptic child is being counseled? Select all that apply. 1 The child should wear a medical alert bracelet. 2 The child should be given valproic acid with milk to reduce gastric irritation. 3 The parent should keep a journal of signs and symptoms before, during, and after seizures. 4 The child should discontinue the drug immediately and the parent should notify the primary healthcare provider if a rash develops. 5 The parent should understand that chewable forms of antiepileptic drugs are recommended for once-a-day administration.

1,3,4

An expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies that this pain occurs most often when the fetus is in what position? 1 Breech 2 Transverse 3 Occiput anterior 4 Occiput posterior

4

When does a nurse caring for a client with eclampsia determine that the risk for another seizure has decreased? 1 After birth occurs 2 After labor begins 3 48 hours postpartum 4 24 hours postpartum

48 hours postpartum Rationale: The danger of a seizure in a woman with eclampsia subsides when postpartum diuresis has occurred, usually 48 hours after birth; however, the risk for seizures may remain for as long as 2 weeks after delivery. After birth occurs, after labor starts, and 24 hours after delivery are all too soon.

Calcium disodium edetate chelation therapy injections for lead poisoning can cause local discomfort. What is the most appropriate nursing intervention to lessen the discomfort? 1 Administering the injection with a local anesthetic 2 Giving the child a cool tub bath after each injection 3 Massaging the affected injection site with an alcohol swab 4 Helping the child to ambulate immediately after each injection

Administering the injection with a local anesthetic Rationale: A local anesthetic can lessen the pain that occurs with this deep intramuscular injection. A cool bath will prolong the discomfort by inducing vasoconstriction, which will slow the rate of absorption. Massaging the site will cause more discomfort because the area is tender. Movement will probably be difficult and will cause more discomfort.

What is the optimal method for the nurse to use to assess blood loss in a client with placenta previa? 1 Count or weigh perineal pads 2 Monitor pulse and blood pressure 3 Check hemoglobin and hematocrit values 4 Measure or estimate the height of the fundus

Count or weigh perineal pads. Rationale: An accurate measurement of the amount of blood loss may be obtained by counting or weighing pads. The vital signs will reflect the effects of the blood loss rather than the amount. Laboratory results demonstrate the effects of the blood loss rather than the amount. The fundus may be higher than expected because the low-lying placenta prevents the descent of the fetus into the pelvis, but the height cannot be used to estimate blood loss.

Which clinical finding should the nurse evaluate before continuing the administration of intravenous (IV) magnesium sulfate therapy? 1 Temperature and respirations 2 Patellar reflexes and urinary output 3 Urinary glucose and specific gravity 4 Level of consciousness and funduscopic appearance

Patellar reflexes and urinary output-Adequate urinary output, an indicator of effective renal function, is necessary to prevent toxicity because magnesium sulfate is excreted by the kidneys

Phenytoin 75 mg twice daily is prescribed for a school-aged child with a seizure disorder. What instruction will the nurse include when teaching the parents about activities to limit the consequences of long-term phenytoin therapy? 1 Administer the medication between meals. 2 Watch for a reddish-brown discoloration of urine. 3 Supplement the diet with high-calorie foods and encourage fluids. 4 Provide oral hygiene, including gum massage and flossing of the teeth.

Provide oral hygiene, including gum massage and flossing of the teeth These procedures reduce the risk for gingival hyperplasia, a side effect of phenytoin. This drug is strongly alkaline and should be administered with meals to help prevent gastric irritation. Discoloration of the urine may occur during drug excretion; it does not cause physiologic problems. Avoiding overeating and overhydration may result in better seizure control.

A woman at 39 weeks' gestation whose membranes have ruptured at home arrives at the clinic to be evaluated. Assessment reveals mild irregular contractions 10 to 15 minutes apart, and a fetal heart rate (FHR) of 186 beats/min is auscultated between contractions. In light of this assessment, what does the nurse conclude? 1 The fetus is not at risk. 2 A precipitous birth is imminent. 3 This is a response to an infection. 4 A further assessment is necessary

A further assessment is necessary The fetal heart rate should be 110 to 160 beats/min; an FHR of 186 is tachycardic and further evaluation is necessary because the fetus may be at risk.

During labor a client begins to experience dizziness and tingling of her hands. What should the nurse instruct the client to do? 1 Breathe into her cupped hands 2 Pant during the next three contractions 3 Hold her breath with the next contraction 4 Use a fast, deep, or shallow breathing pattern

1

The nurse is preparing to conduct a scheduled health maintenance visit for a 15-month-old toddler-age client. Which information should the nurse include in the teaching session with the toddler's parents related to socialization and cognition? 1 Engages in parallel play 2 Imitation of parental activities 3 An elevated fear of strangers 4 Tolerates long periods of parental separation

2

While auscultating the lungs of a client admitted with severe preeclampsia, the nurse identifies crackles. What inference does the nurse make when considering the presence of crackles in the lungs? 1 Seizure activity is imminent. 2 Pulmonary edema has developed. 3 Bronchial constriction was precipitated by the stress of pregnancy. 4 Impaired diaphragmatic function was caused by the enlarged uterus

2

A pregnant woman who is in the third trimester arrives in the emergency department with vaginal bleeding. She states that she snorted cocaine approximately 2 hours ago. Which complication does the nurse suspect as the cause of the bleeding? 1 Placenta previa 2 Tubal pregnancy 3 Abruptio placentae 4 Spontaneous abortion

3 Abruptio placentae Abruptio placentae is associated with cocaine use; it occurs in the third trimester. Placenta previa is seen in the third trimester but is not associated with cocaine use. A tubal pregnancy is identified in the first trimester. Spontaneous abortion occurs in the first two trimesters.

A nurse is preparing a 5-year-old girl who has undergone a myringotomy for discharge. What should the parents be taught about their child's care at home? 1 Insert earplugs whenever a bath is given. 2 Keep cotton in the ears until drainage subsides. 3 Keep the child out of kindergarten until the ears are healed. 4 Clean the child's ears with cotton-tipped swabs after each bath

4 Water in the ears after myringotomy supports the growth of pathogens and should be avoided. The ears should be kept open to the air and allowed to drain naturally. There is no reason to keep the child isolated. Cleaning the ears with cotton swabs is contraindicated because it may result in trauma.

At which stage of Kohlberg's theory is the child afraid of punishment? 1 Stage 1 2 Stage 2 3 Stage 3 4 Stage 4

A. Stage 1 (According to Kohlberg's theory of moral development, at stage 1 a child is afraid of punishment. At stage 2, the child recognizes that there is more than one correct viewpoint. At stage 3, an individual seeks the approval of and maintains the expectations of one's immediate group. At stage 4, an individual expands focus from a relationship with others to societal concerns.)

A client who has been prescribed tetracycline continues the course of treatment during the first trimester of pregnancy. Which teratogenic effect may occur in the fetus? 1 Bone anomalies 2 Central nervous system malformations 3 Facial malformations 4 Internal organ defects

1

A parent is worried about the infant's excessive dependence on nonnutritive sucking. Which intervention will help decrease this dependence? 1 Prolonging the feeding time 2 Using infant formulas frequently 3 Using a pacifier as soon as the crying begins 4 Wrapping the infant snugly most of the time

1

What is true about the instrumental relativist orientation stage? 1 An individual recognizes that there is more than one correct point of view. 2 An individual finds a balance between societal rules and basic human rights and obligations. 3 An individual response to a moral dilemma is in terms of absolute obedience to authority and rules. 4 An individual sees moral reasoning based on own personal internalization of societal and other's expectations.

1 During the instrumental relativist orientation stage, an individual finds that there is more than one correct point of view. During the postconventional reasoning stage, a person finds a balance between societal rules and basic human rights and obligations. During the punishment and obedience orientation stage, a child's response to a moral dilemma is in terms of absolute obedience to authority and rules. During the conventional reasoning stage, the person sees moral reasoning based on his or her own personal internalization of societal and other's expectations.

In which age range would the nurse expect a client to understand the concept of conservation related to liquids and numbers when conducting a developmental assessment? 1 5 to 7 years 2 6 to 7 years 3 9 to 10 years 4 9 to 12 years

1 Mastering the concept of conservation related to liquids and numbers occurs at 5 to 7 years of age. Conservation related to length is expected at 6 to 7 years of age. Conservation related to weight and area occurs at 9 to 10 years of age. Conservation related to volume occurs at 9 to 12 years of age.

Which statement regarding anesthetic drugs in pediatric clients requires correction? 1 During general anesthesia, the upper air obstruction risk is less in pediatrics. 2 Pediatric clients are more affected by anesthesia than adults. 3 Cardiac abnormalities are more common in pediatric clients receiving anesthesia. 4 The central nervous system of pediatric clients is more sensitive to the effects of anesthetics.

1 Neonates have a respiratory structure that is small in diameter, and they have a high metabolic rate. Because of this, the chance of upper air obstruction during general anesthesia is quite high. In pediatric clients, drug accumulation and toxicity also increases because the child's liver and kidney functions are immature. Thus children are more affected by anesthesia than adults. A child's cardiac system is not fully developed, which causes problems with the excretion and metabolism of anesthetics and leads to cardiac abnormalities. Because the blood brain barrier is underdeveloped in pediatric clients, the central nervous system becomes more affected by anesthetics.

A client wants to abort her pregnancy after 4 months of gestation. Which oral medication would be given to the client? 1 Oxytocin 2 Misoprostol 3 Indomethacin 4 Dinoprostone

2 Misoprostol is an oral drug used to induce an abortion. Oxytocin is available as an injection; it is used to induce labor at or near full-term gestation. Indomethacin is used to maintain a pregnancy during preterm labor. Dinoprostone is used to induce an abortion; it is available only for vaginal use.Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

Which pregnant client does the nurse suspect is most likely to have placenta previa? 1 19 years old, gravida 1, para 0 2 30 years old, gravida 6, para 5 3 25 years old, gravida 2, para 1 4 40 years old, gravida 3, para 2

2 Multiple past pregnancies can scar the endometrial lining, rendering it vulnerable to an abnormal implantation. Primigravidas are the least prone to placenta previa; the endometrium is receptive to implantation. Two pregnancies have not compromised the endometrium to the extent that an abnormal implantation is likely to occur. Age is not known to be a significant factor; also, three pregnancies should not have compromised the endometrium.

What would the student nurse claim is an acceptable respiratory rate range in a toddler of 2 years of age? 1 20 to 30 breaths/minute 2 25 to 32 breaths/minute 3 30 to 50 breaths/minute 4 35 to 40 breaths/minute

2 The acceptable respiratory rate range in a toddler is 25-32 breaths/minute. The acceptable range in a child is 20-30 breaths/minute. The respiratory rate in a 6-month-old infant is 30-50 breaths/minute; in newborns, it is 35-40 breaths/minute.

An 8-year-old child who is experiencing a sickle cell pain episode is admitted to the child health unit. What is the most appropriate nursing care during this acute period? 1 Limiting fluids until the crisis ends 2 Administering prescribed analgesics 3 Applying cold compresses to painful joints 4 Performing range-of-motion exercises of affected joints

2 The priority is pain management; severe pain requires analgesics. Increased hydration is necessary to promote hemodilution, improve circulation, and prevent more sickling. Cold will constrict blood vessels, further depleting oxygenation to affected parts; warmth is preferable. There is too much swelling and pain in the joints during a crisis for the implementation of range-of-motion exercises.

The nurse is admitting a pregnant client who has mitral valve stenosis to the high-risk unit. Which prophylactic medication does the nurse anticipate administering during the intrapartum period? 1 Diuretic 2 Antibiotic 3 Cardiotonic 4 Anticoagulant

2! Clients who have mitral valve stenosis are administered prophylactic antibiotic therapy to minimize the development of streptococcal infections that may cause endocarditis. A diuretic will probably be used if heart failure develops. A cardiotonic will probably be used if heart failure develops. An anticoagulant will probably be used if thrombophlebitis or atrial fibrillation develops.

Which statements regarding the adverse effects of immunization are true? Select all that apply. 1 Only diphtheria vaccines cause acute encephalopathy. 2 The oral poliovirus vaccine causes paralytic poliomyelitis. 3 The hepatitis B vaccine is the safest vaccine because it does not cause any adverse side effects. 4 Swelling of glands in the cheeks and neck is an adverse effect of the measles vaccine. 5 Fever and erythema at the injection site are common adverse effects of all vaccines.

2,4,5 Paralytic poliomyelitis is caused only by the poliovirus vaccine; it occurs when the live vaccine undergoes mutation in the intestine and enters the central nervous system. The swelling of glands in the cheeks and neck is a mild adverse effect of the measles vaccine. Almost all vaccines cause fever and erythema at the injection site; these effects are the result of activation of the body's defense mechanism. Acute encephalopathy is a serious side effect of not only the diphtheria vaccine but also the tetanus toxoid and acellular pertussis vaccine. Hepatitis B, with only mild side effects, is one of the safest vaccines.

A pregnant woman was exposed to a teratogenic drug during her first trimester. Which nursing interventions would be beneficial to the client? Select all that apply. 1 Ultrasound scanning should be avoided. 2 The woman should be referred for evaluation. 3 The woman's pregnancy should be terminated even if minor malformations are found. 4 The woman should be educated about the risks of drug-induced malformations. 5 The woman should be assured that the risk is minimal if the malformation is minor.

2,4,5 if a pregnant woman is exposed to a teratogenic drug, further evaluation is needed to determine the type of malformation that can be expected. The woman should be educated about the effects of drugs on the fetus so she can avoid being exposed to drugs with teratogenic effects. If the malformations are minor, the woman should be assured the risk is minimal and can be corrected by surgery. Ultrasound scanning should be done to assess the extent of the injury. The pregnancy should be terminated only if the malformation is severe.

The nurse is caring for a woman who just had a positive contraction stress test (CST). Which complication of pregnancy is of most concern when there is a positive CST? 1 Preeclampsia 2 Placenta previa 3 Imminent preterm birth 4 Uteroplacental insufficiency

4

Which nursing assessment is important to recognize to determine the causative factors in a client with a history of spontaneous abortions? 1 Use of sex hormones 2 Use of contraceptive pills 3 Presence of heart problems 4 History of alcohol consumption

4

A woman reports night sweats, sleep disturbances, and weight gain. Upon diagnosis, the woman has low levels of estrogen and is given hormonal therapy. Which nursing interventions would be beneficial to the client? Select all that apply. 1 Encourage physical activity 2 Recommend the long-term use of estradiol 3 Advise the client to take oral forms of estradiol with food 4 Provide the client with instructions on self-administration 5 Instruct the client to administer oral forms of estradiol at any time during the day

Answer: 1, 3, 4 The nurse should encourage the client to perform physical activities to reduce her weight. Taking oral forms of estradiol with food helps to minimize gastrointestinal upset. The nurse should provide instructions on self-administration of the drug for safety purposes. The nurse should not recommend long-term use of estradiol because of the potential toxic effects. The client should take estradiol at the same time every day so that effective hormone serum levels are maintained.

What are the major reasons that the pediatric population is more sensitive to drugs when compared to adults? Select all that apply. 1 Age 2 Protein binding 3 Blood-brain barrier 4 Renal drug excretion 5 Hepatic drug metabolism

Answer: 2, 3, 4, 5 Rationale: In the pediatric population, drugs do not readily bind to protein. This increases the blood concentration of the drug, which potentiates the drug action. Because the blood-brain barrier is not fully developed in infants, these clients would be more sensitive to drugs than adults. The metabolizing capacity of the liver and the excretion capacity of the kidney are very low in children; these factors lead to increased drug sensitivity in the pediatric population. A child's age does not affect the pediatric sensitivity.

When assessing a neonate and mother after a vaginal delivery, the nurse finds that the neonate's blood group is B positive and mother's is AB negative. The nurse also finds that the mother has a negative Coombs test. What is the appropriate intervention in this situation? 1 Administering Rho(D) immune globulin intravenously to the mother within 1 week of delivery 2 Administering Rho(D) immune globulin intramuscularly to the mother within 72 hours of delivery 3 Administering Rho(D) immune globulin intramuscularly to the neonate within 1 week of delivery 4 Administering Rho(D) immune globulin intravenously to the neonate within 72 hours of delivery

B

A child is diagnosed with classic hemophilia. A nurse teaches the child's parents how to administer the plasma component factor VIII through a venous port. It is to be given three times a week. When should the parents administer this therapy? 1 Whenever a bleed is suspected 2 In the morning on scheduled days 3 At bedtime while the child is lying quietly in bed 4 On a regular schedule at the parents' convenience

Factor VIII has a short half-life; therefore prophylactic treatment involves administering the factor on the scheduled days in the morning so the child will get the most benefit during the day, while he is most active. Prophylactic treatment is administered on a scheduled basis to prevent bleeds from occurring. Administering the drug at bedtime will limit its effectiveness because bleeds are more common when the child is active. Administering the medicine on a regular schedule at the parents' convenience does not take into consideration the properties of the drug.f

Which assessment finding should the nurse consider to be of concern in a client at 35 weeks' gestation? 1 Frequent painless urination 2 Painful intermittent contractions 3 Increased fetal movement after eating 4 Lower back pain that results in insomnia

Painful intermittent contractions Painful contractions at this time may indicate preterm labor or the presence of preparatory contractions (also known as Braxton Hicks contractions). The client's painful intermittent contractions must be assessed further to distinguish between the two types. Frequent urination is common during the last trimester because of the pressure of the enlarging fetus; painful urination may indicate a urinary tract infection. Fetal movement usually increases after the mother eats. Difficulty sleeping and lower back pain are both common adaptations during the third trimester.

After surgery for a myelomeningocele, an infant is being fed by means of gavage. When checking placement of the feeding tube, the nurse is unable to hear the air injected because of noisy breath sounds. What should the nurse do next? 1 Notify the provider. 2 Advance the tube 1 cm. 3 Insert 1 mL of formula slowly. 4 Try aspirating stomach contents.

Try aspirating stomach contents.Gastric returns indicate correct placement of the feeding tube. Further assessment is necessary before the provider is notified. Advancing the tube even 1 cm may cause undue trauma, regardless of where the tube is located. Inserting even a small amount of formula is unsafe until correct placement is verified; formula may enter the lungs if the tube is not in the stomach.