NPQ - OB/PEDS practice questions

**Which of the following infections can cause visual impairment to a fetus exposed in utero? Select all that apply. A. syphilis B. rubella C. toxoplasmosis D. chlamydia E. herpes

A, B, C, D, E

**A nurse is educating a pregnant client on the risks of smoking during pregnancy. Which of the following should be included in the teaching? Select all that apply. A. stunted growth after birth B. large growth C. addiction D. poor lung development E. small growth in utero

C, D, E (Fetus can be born addicted to nicotine & experience withdrawals; causes poor lung development & poor pulmonary function of the fetus; Smoking causes vasoconstriction, causing blood flow through the placenta to be decreased, which means the fetus gets insufficient nutrients leading to stunted growth while in utero; Growth after birth is not affected)

A 3-month-old is awaiting surgery to repair a truncus arteriosus. The nurse educating the parents on managing symptoms at home includes which of the following in the teaching? Select all that apply. A. "limit feeding to 30 mins to avoid over-tiring" B. "weigh your child daily on the same scale" C. "administer prophylactic abx" D. "provide chest PT twice a day" E. "restrict feedings to only 3/day to avoid fluid overload"

A, B

**A pregnant client presents to the emergency department at 32 weeks' gestation. She is Rh-negative and has suffered a motor vehicle trauma but is minimally injured. What test(s) does the nurse anticipate will be ordered to assess the pregnancy? Select all that apply. A. non-stress test B. Kleinhauer-Betke test C. CBC D. C-reactive protein E. liver function tests

A, B (After maternal trauma in an Rh-negative mother, a non-stress test can evaluate the health of the fetus; After maternal trauma in an Rh-negative mother, a Kleinhauer-Betke test for the presence of fetal cells in maternal serum. This test should be done after every case of maternal trauma, and Rhogam is given to the mother if positive.)

**The nurse is providing care for a two-month-old who has just been diagnosed with gastroesophageal reflux. While educating the parents about this diagnosis the nurse includes which of the following? Select all that apply. A. "most children outgrow this by the time they are 12 mos old" B. "you will need to monitor your child's weight closely" C. "you should have your child sleep in the prone position" D. "your child will need to start taking medication immediately" E. "a problem that is associated with reflux is constipation"

A, B (Gastroesophageal reflux (GER) is often outgrown by 12-24 months of age; An infant with GER should have their weight monitored closely. If the child is losing weight, then further treatment may be prescribed by the provider; reflux and constipation are not related, however, they may present with some of the same symptoms)

**A nurse is caring for a postpartum client that had a blood loss of 1,200 mL after vaginal delivery. Which of the following are priorities to include in her plan of care? Select all that apply. A. frequent fundal assessments B. CBC in 6 hrs C. encourage bottle feeding D. hysterectomy E. aspirin for pain

A, B (The fundus should be examined frequently to ensure it stays firm and no more bleeding occurs. This may initially be done every hour, then spread out to every 2-4 hours depending on the progression; A CBC should be checked in no more than 6 hours to see what the H&H are after the hemorrhage. It takes time for the lab work to catch up with the blood loss, so there is no need to check one right away as it will likely not show the extent of the blood loss.)

The parents of a 20-month-old child are asking the nurse about what tasks they can do to stimulate their child's development. Which of the following tasks would be most appropriate for this age group? Select all that apply. A. start toilet training B. use puppets and toys while reading a story C. recognizing separation anxiety D. drawing letters with sidewalk chalk E. practicing using a jump rope

A, B, C (A 20-month-old child is at a stage of rapid development that changes quickly in a short period of time. Parents of a child this age can be taught about the appropriate developmental tasks the child should be able to perform. A 20-month-old may, however, be able to start toilet training; playing with puppets & toys & recognizing separation anxiety are also appropriate actions)

The nurse is caring for a 13-year-old girl who has revealed to the nurse that she was sexually abused. The nurse must be sure to communicate which of the following to the child? Select all that apply. A. the abuse is not her fault and she is not to blame B. the nurse is required by law to report the abuse C. she has done the right thing by telling the nurse D. she will need to re-tell her account of the abuse to all the doctors on staff E. the girl's parents will have to be notified immediately

A, B, C (Telling her it was not her fault helps her feel safe & supported; The nurse is considered to be a mandatory reporter. Therefore, any form of abuse, either suspected or confirmed, must be reported; The child is very likely feeling anxious about speaking with someone. They should be given positive reinforcement for speaking up; The parents would not be notified immediately because it is possible that one of the parents may be the abuser, we do not have this information yet.)

A child is brought into the emergency department after a traumatic accident. The providers have been unable to secure an IV for the client and the physician has ordered the medication to be given IO. Which of the following is an example of a contraindication to obtaining intraosseous access? Select all that apply. A. previous attempts at the same site B. osteogenesis imperfecta C. cellulitis in the skin overlying the bone D. diabetes diagnosis E. septicemia

A, B, C (When it is not possible to place an IV for fluids and medications in a child, a nurse may be able to start an intraosseous catheter by cannulating one of the child's bones for infusion of fluids and medications. This may more likely be done in an emergent situation before there is time for a central line or cutdown for placement of a venous device. Intraosseous cannulation contraindications include cellulitis or burn over the affected area, a previous attempt at IO placement at the same site, osteogenesis imperfecta and the inability to locate landmarks, among others.)

**A nurse is educating clients on the symptoms of ectopic pregnancy. Which of the following symptoms should be included in the education? Select all that apply. A. fatigue B. spotting C. positive pregnancy test D. amenorrhea E. quickening

A, B, C, D

**A pregnant client is admitted to receive prostaglandins for induction. What should be included in the plan of care? Select all that apply. A. obtain maternal vital signs B. have the client void prior to administration C. have the client stay in bed for an hour afterwards D. assess cervical dilation E. start oxytocin

A, B, C, D (The client's vitals should be obtained before and after the procedure; The client should empty her bladder, as she will remain in the bed post procedure; The client will need to remain in the bed post procedure for 30-60 minutes so it stays in place; Dilation needs to be assessed because if the cervix is already dilated then cervidil won't be placed; Oxytocin won't be started until the following day or several hours after cervidil has been placed.)

**The nurse caring for a client with Marfan syndrome is educating him/her on potential cardiac complications. The nurse knows that which of the following symptoms are associated with aortic dissection? Select all that apply. A. shortness of breath B. paralysis on one side of the body C. sudden, severe chest pain D. loss of vision E. sudden, severe abdominal pain

A, B, C, D, E (Sudden, severe chest pain, loss of vision, sudden and severe abdominal pain, shortness of breath, and paralysis on one side of the body are all symptoms of an aortic dissection.)

**The nurse is caring for a client whose contractions are two minutes apart and the fetus is having late decelerations. Which of the following is an appropriate action for the nurse to take? Select all that apply. A. notify the provider B. turn the client to the left side C. give the client oxygen D. turn off oxytocin E. check the cervical dilation

A, B, C, D, E (provider should be notified b/c the fetus is in distress & HCP should be aware; turning to the left side allows more blood flow to the placenta, & therefore the fetus; supplemental O2 should be given so that excess goes to the fetus to help prevent hypoxia observed with decreased FHR & late decels; oxytocin should be turned off b/c we need to stop fetal distress that is occurring with contractions that are occurring too quickly or too close together; when fetal distress develops, it can sometimes mean that there has been a rapid change in dilation, so this should be checked as well)

**The nurse is caring for a pregnant client who is hepatitis B positive and is about to deliver. The nurse knows that which of the following should be part of this newborn's care? Select all that apply. A. immediate bath B. Hep B immunoglobulin C. eye prophylaxis D. phytonadione prior to bath E. hep B vaccine

A, B, C, E (This baby needs to be bathed prior to any needle sticks and to remove maternal blood from the skin; This infant should receive the hepatitis B vaccine after the bath and not wait so that protection is offered sooner)

**When educating parents on appropriate cooling measures to use when their child has a temperature, the nurse should include which of the following? Select all that apply. A. have your child wear minimal amounts of clothing B. increase air circulation in the room C. apply moist compresses to the skin D. let your child take a cool bath E. keep the room cool

A, B, C, E (cool baths or ice baths are not shown to be effective for fevering children; cool baths are however, indicated for those withy hyperthermia)

**The nurse is caring for an eight-year-old with severe burns and is preparing to perform a dressing change. The nurse knows to do which of the following to reduce stress and anxiety for the child? Select all that apply. A. have all materials ready before beginning the procedure B. allow the child to select which dressing to change first C. avoid telling the child about the dressing ahead of time to avoid excess anxiety D. allow the child to help with removing the dressings if desired E. always avoid using sedatives so the child can be involved in the process

A, B, D (Being prepared will make the dressing change more efficient, decreasing the amount of time the child may be stressed; Involving the school-age child in their care and giving them the opportunity to make decisions will decrease their anxiety; The school age children are capable of processing time and benefit from having time to prepare for a difficult procedure. Toddlers and preschoolers should not be told about the dressing change well in advance due to their poor concept of time.)

You are developing a care plan for evaluating and managing developmental issues for an adolescent. Which issues are important? Select all that apply. A. stable routines for work and rest B. peer relationships C. speech D. sexual development E. ambulation

A, B, D (In an adolescent, a care plan should include evaluations of peer relationships, sexual development, and stable routines for work and rest, as well as substance use, immunizations, nutrition, and safety.)

A nurse is educating a pregnant client on signs of preterm labor. What should be included in this education? Select all that apply. A. increase in vaginal discharge B. contractions C. headache D. leg pain E. lower back pain

A, B, E (if increase in vaginal discharge, the woman could possibly be losing her mucus plug)

**A nurse is caring for a postpartum client with an episiotomy. Which of the following orders should the nurse anticipate? Select all that apply. A. sitz baths B. NSAIDS C. urinary catheter D. witch hazel pads E. ice packs to the perineum

A, B, E (witch hazel is used for hemorrhoids, not for an episiotomy)

The nurse is educating a new graduate nurse about blood pressure readings in pediatric clients. Which of the following statements would be most appropriate to include? Select all that apply. A. "Comparing blood pressures in the upper and lower extremities helps us to detect abnormalities like coarctation of the aorta" B. "Appropriate cuff size is the most important factor in accurately measuring a blood pressure" C. "if the pressure cuff is too large, you will probably get a false high reading" D. "It's okay to just choose a blood pressure cuff based on the name on the cuff. If it says infant it is appropriate" E. "Hypotension is an ominous sign in pediatric clients"

A, B, E (Cuffs that are too small cause false high readings, & cuffs that are too large cause false low readings; BP's also do not tend to drop in children until they are extremely ill)

A crying infant is having the lungs checked. From this observation alone, what can the nurse deduce? Select all that apply. A. the vocal cords are intact B. the infant needs emergency management C. the infant may be distressed D. the airway of the infant is patent E. the infant is suffering from respiratory distress

A, C, D (A crying infant has a patent airway, intact vocal cords, and may be under some kind of distress. Respiratory distress and an emergency situation cannot be deduced from listening to a crying child.)

Which of the following is an example of a non-pharmacological comfort measure that may be developmentally appropriate for a preschool-age child? Select all that apply. A. watching a movie B. guided imagery C. art therapy D. blowing bubbles E. humor

A, C, D (A preschool-age child is at a different developmental age when compared to an infant or a school-age child. A child who is in preschool does not understand some of the concepts of medical care and would benefit from non-pharmacological interventions for comfort. The most appropriate activities for this age group include hands-on or distracting tasks such as art therapy, watching a movie, or blowing bubbles; a preschool age child would not likely be able to focus in order to perform guided imagery; preschool age children see the world in very literal terms, so humor is not effective)

The mother of a five-year-old boy is feeling anxious about him attending school next year. She asks the nurse for advice on how to prepare him for this, specifically how to prevent sexual abuse from happening. Which of the following pieces of advice are appropriate? Select all that apply. A. "urge the child to tell about anyone who makes them uncomfortable for any reason" B. "he is too young to learn about sexual abuse, so you must work to make sure you trust the people around him" C. "encourage communication by taking seriously what they have to say" D. "support your child's right to say 'no'" E. "provide age appropriate examples of sexual assault"

A, C, D, E (encourage the child to communicate and be confident in their efforts of self-protection; establish healthy and open communication between child & parent; saying 'NO' is an important practice in setting boundaries, & teaches the child that they have control over their bodies; be specific & direct about what kinds of touch are appropriate & what kinds of touch are inappropriate)

A nurse is helping a family with two small children who lost their home because of recent flooding. The family is staying at a shelter designated for victims in the area. The mother asks the nurse, "How am I supposed to handle this in front of my children?" Which actions should the nurse recommend to this parent when caring for children during a disaster? Select all that apply. A. try to maintain as regular of a routine as possible B. contact the State Department of Children and Families to report the situation C. bring any medications or important caregiving items along if there is a need to evacuate D. stay calm around the children E. take breaks and get plenty of rest

A, C, D, E (Children need routine and predictability. Advising the parent to provide this for her children is an appropriate nursing action; Along with maintaining current treatment regimens that may be necessary, having items on hand will enable the parent to care for the children in as normal of a way as possible; Parents of small children may feel helpless when a disaster strikes. Many parents have difficulties caring for their children in the face of stressful events. The nurse can help a family with small children during a disaster by educating them about what to do to keep their children calm and to maintain as much of a routine as possible; Parents of small children may feel helpless when a disaster strikes. Many parents have difficulties caring for their children in the face of stressful events. Precautions against caregiver role strain must be taken in order to provide optimal care for children given the difficult circumstances.)

A charge nurse is making assignments for a labor & delivery unit. When planning resources, the charge nurse knows that which of the following clients would be at the highest risk for postpartum hemorrhage? Select all that apply. A. a precipitous delivery B. small for gestational age fetus C. client carrying twins D. placenta attached in the fundus E. client with preeclampsia

A, C, E (A precipitous delivery puts the client at risk because the uterus may be fatigued from the strong, fast delivery. This would cause it to struggle to contract/clamp down after delivery; Multiples would overstretch the uterus, causing it to struggle to contract/clamp down after delivery, and therefore could put the client at risk for PPH; Preeclampsia is a risk factor for PPH. This client should be monitored closely in the postpartum period.)

A new nurse on the pediatric unit is discussing what age appropriate education topics to cover with a family who has a three-year-old. Which of the following statements indicate that the nurse has an accurate understanding of common childhood health problems. Select all that apply. A. water safety and car safety are appropriate topics to discuss with this family B. preschoolers often engage in risky behaviors C. injuries and accidents are the most common cause of death and disability in children D. client education mainly happens in the outpatient setting so I don't need to talk to them about much E. injuries are often closely associated with the childs developmental stage

A, C, E (It is important to tailor nursing education to fit the child's age. Knowledge of developmental capabilities will help the nurse identify appropriate preventive measures.)

**A student nurse is educating other students on the diet for a client with Phenylketonuria (PKU). The student nurse would be correct in explaining that which of the following foods should be avoided? Select all that apply. A. macaroni & cheese B. peas C. grilled cheese D. asparagus E. hot dogs

A, C, E (Phenylketonurea (PKU) is an autosomal recessive disorder resulting in impaired metabolism of essential amino acid phenylalanine. Foods that are high in protein and artificial sweeteners can be toxic to patients. Meats and cheeses are high in protein and should be avoided.)

An infant in the pediatrics unit has been diagnosed with respiratory syncytial virus (RSV). The nurse should include which of the following precautions in caring for this infant? Select all that apply. A. keep the client in a private room B. have staff wear an N95 respirator when caring for the client C. wear a surgical mask for close contact with this client D. ensure the clients room has negative pressure ventilation E. wear goggles if there is a potential for splashing of body fluids

A, C, E (Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact or if the client is coughing or sneezing.)

**A nurse suspects a pregnant client may have chorioamnionitis. Which assessment findings would specifically confirm this diagnosis? Select all that apply. A. fetal tachycardia B. maternal temp of 100 C. leukocytosis D. abdominal pain E. maternal tachycardia

A, C, E (both heart rates increase d/t infection; elevated WBC's are indicative of infection; abdominal pain is not an indication of chorioamnionitis; temp cut off for chorioamnionitis is 100.4)

A nurse is talking with the parent of a 15 month old child about safety in the home. Based on this child's age and developmental status, which factors would the nurse include that would describe the child's greatest risk of injuries? Select all that apply. A. the child is more likely to put items in the mouth B. the child is likely to be approached by a stranger C. the child is more likely to have mood swings D. the child has limited physical coordination and is more likely to fall E. the child needs to wear safety gear with play

A, D

An 8-year-old child is in the hospital for a respiratory illness. The nurse recognizes that which of the following developmental tasks are associated with a child of this age? Select all that apply. A. increased confidence in the ability to perform tasks B. increased mobility and risk of injuries C. fear of the unknown and practicing animism D. the ability to separate from parents for a time E. learning to master skills

A, D, E (An 8-year-old child has unique developmental tasks when compared to a child who is older or younger. This child would most likely be learning how to competently perform more complex tasks and is fine with spending more time away from parents, such as during school or at camp.)

**Which of the following are signs that an infant might be suffering from drug withdrawal? Select all that apply. A. loose stools B. loud cry C. soothed with pacifier D. tremors E. sneezing

A, D, E (loose stools are a sign that the GI system shows of withdrawal; tremors & frequent sneezing are also withdrawal signs)

**An infant is born to a mother who contracted chorioamnionitis. What immediate interventions should the nurse anticipate when caring for the newborn? Select all that apply. A. blood cultures B. nasal swab C. fluid bolus D. antibiotics E. temperature monitoring

A, E (A blood culture will ensure the infection has not been transferred to the newborn. Only after this results would any further interventions be ordered; we would not want to give abx right away because we want to avoid development of resistance - only give if a diagnosis is confirmed)

The nurse is caring for an eight-year-old boy that has presented to the emergency department with edema, high blood pressure and hematuria. The nurse asks the mother to describe his health up until now. Which of the following statements from the mother would the nurse identify as being most significant, in light of his current symptoms? A. "he has strep throat two weeks ago and took abx for it" B. "he broke his arm last year" C. "he had his sports physical a month ago and everything was fine" D. "he had a stomach bug last week and missed a few days of school"

A. "he had strep throat two weeks ago and took abx for it" (These three symptoms are common in the diagnosis of Acute Streptococcal Glomerulonephritis which may occur following an infection caused by Group A beta-hemolytic streptococcus (GABHS).)

On the first newborn assessment the nurse hears a loud "whooshing" noise when auscultating heart sounds. The mother asks what this means. What is the most appropriate response by the nurse? A. "this can be normal, it is likely a duct that is still closing" B. "this is simply a congenital anomaly that will go away within a few hours of life" C. "your baby may have a cardiac defect" D. "your baby may have fluid in her lungs, we will run some tests"

A. "this can be normal, it is likely a duct that is still closing" (Murmurs make a loud whooshing noise as the ducts close because the hole is smaller and blood is quickly trying to get through. This is normal in the first 24 hours.)

**A pregnant client in labor receives a dose of IV push butorphanol tartrate and suddenly feels rectal pressure. What is your priority? A. alert the NICU team B. administer Naloxone stat C. assist the client to the bathroom D. stop the butorphanol tartrate

A. alert the NICU team (Rectal pressure is a sign that the client is close to delivery. Because the dose of butorphanol tartrate (opioid analgesic) was given so close to delivery, the NICU team should be present because of the high risk for newborn respiratory depression.)

A nurse is providing discharge teaching to a client who is going home after having a tonsillectomy. Which of the following signs and symptoms are concerning enough for the client to call the provider? A. bleeding or persistent earache B. slight ear pain despite analgesic use C. mouth odor & xerostomia D. temp of 100.2

A. bleeding or persistent earache (Following a tonsillectomy, a client should be educated to notify the provider for any bleeding, fever, or persistent earache, as this could indicate a post-operative complication. The client should not use any sharp objects such as forks or straws to minimize the risk of bleeding. Coughing should be kept to a minimum, and antiemetics should be taken to prevent vomiting.)

A nurse is caring for a baby who was born 72 hours ago. The nurse notes that the child has not had a bowel movement or has passed meconium stool on her shift. The nurse checks the records and notes that the child has not had any bowel movements documented since birth. Which action should the nurse perform next? A. contact the provider to report the situation B. check the infants HR, BP, and skin temp C. continue to monitor and note when the baby has a BM D. insert a rectal thermometer to stimulate the infant to have stool

A. contact the provider to report the situation (A newborn infant should pass the first stool of meconium within approximately 24 hours of birth. An initial assessment of a newborn typically looks for signs of a patent anal opening, but an internal condition affecting the colon could cause difficulties with stooling. Hirschsprung disease is a condition characterized by severe constipation and mechanical obstruction of the bowel; the nurse can assess for Hirschsprung disease in the newborn by noting the time and number of stools of the infant.)

A nurse is caring for a 6-year-old child who has severe vitamin C deficiency. The nurse notes that the child's skin has areas of purpura. This condition of most likely described as which of the following? A. dark red, flat, scattered macules B. clusters of blood vessels around bony orifices C. dilated blood vessels under the skin D. yellow or brow, flat, irregularly-shaped lesions

A. dark red, flat, scattered macules (Purpura is a condition that develops when the capillaries leak blood under the skin. It causes dark red or purple flat macules on the skin and it may be associated with low platelet levels in the bloodstream. Purpura can develop from a number of conditions including vitamin C deficiency (scurvy), cytomegalovirus, rubella, and some blood clotting disorders.)

**A nurse is helping a client who just had an intrauterine device (IUD) inserted as a form of contraception. The nurse is teaching the client about side effects of the IUD. Which of the following information should the nurse give? A. if the client becomes pregnant while the IUD is in place, she has a greater risk of having an ectopic pregnancy B. the sharp cramping that occurred with insertion should resolve within 4 weeks C. the client may not experience menstrual period for 3 months following insertion D. a string check shows that the end of the IUD string outside of the vagina means the IUD is in proper place

A. if the client becomes pregnant while the IUD is in place, she has a greater risk of having an ectopic pregnancy (An intrauterine device is a long-term method of contraception that involves placing the device in a woman's cervix. It is 98 percent effective in preventing pregnancy but it does not prevent sexually transmitted infections. A woman who becomes pregnant while using an IUD may have an increased chance of ectopic pregnancy. The IUD also increases the chance of pelvic infections and abnormal menstrual bleeding.)

A client who is 16 weeks pregnant is at the healthcare provider's office for a routine prenatal exam. The nurse is educating the client about pregnancy-related body changes that may occur in the next several months. Which best describes a condition that affects the musculoskeletal system occurring during pregnancy? A. increased lumbrosacral curve B. joint swelling C. whole body stiffness D. a sensation of burning in the muscles

A. increased lumbrosacral curve (Pregnancy causes physical changes that can impact various body systems, including the musculoskeletal system. As the fetus grows, the pregnant client may experience a greater curve in the lower back, accompanied by low back pain. She may also experience leg cramps, which often develop during the 2nd and 3rd trimesters and appear in the calves in the lower legs. Other musculoskeletal symptoms that the client may experience include carpal tunnel syndrome, aching, numbness and difficulty walking, and an increased risk for falls.)

A nurse has attended the birth of an infant; after the baby is born, the provider hands the infant to the nurse to begin the assessment. The baby is pale and is not crying; he takes an occasional breath by gasping and his heart rate is 58 bpm after 60 seconds. Which action should the nurse perform next? A. initiate positive pressure ventilation B. listen to the infant's lung sounds when he takes a breath C. begin lactated ringer's @ 18 mL/hr D. assess a brachial pulse under the arm

A. initiate positive pressure ventilation (According to the principles of the newborn resuscitation program (NRP), if a nurse assesses an infant who is not breathing and who has a heartbeat less than 60 bpm, the nurse should provide ventilatory support, then begin chest compressions. A normal newborn's heart rate is between 120 and 160 beats per minute. A low heart rate indicates hypoxia, and the newborn needs further intervention through positive-pressure ventilation, followed by chest compressions.)

**A nurse is teaching a student nurse about fertilization and implantation. Teaching has been understood if which of the following is identified as the role of the Corpus Luteum? A. it releases progesterone B. it is the site of implantation C. it releases luetinizing hormone D. it releases the ovum

A. it releases progesterone (the corpus luteum is created when fertilization occurs to secrete progesterone which will cause the uterus to thicken and be ready for implantation and maintain the pregnancy.)

A pregnant client presents with bright red painless vaginal bleeding at 30 weeks. What should the nurse plan to assess for? A. placenta previa B. cervical tears C. placental abruption D. cervical dilation

A. placenta previa (symptoms include painless bright red vaginal bleeding; assess by reviewing medical hx & obtaining a U/S)

An interdisciplinary team is working in a postpartum unit and discussing a case of a mother who is placing her baby for adoption. Which best describes the role of the nurse in this situation? A. providing care and treatment for the biological mother and the baby as needed B. drawing up paperwork to facilitate adoption C. helping the adoptive parents bond with the baby when they visit D. arranging for the adoptive parents to meet the baby

A. providing care and treatment for the biological mother and the baby as needed (A nurse may work with some clients who choose to place their child for adoption after delivery. When this occurs, the nurse typically allows the social worker to make arrangements for the adoption plans. It is the nurse's job to continue to care for the mother and the infant.)

The nurse is caring for a six-year-old who is very tired and experiencing frequent episodes of vomiting. The nurse knows that which of the following positions will reduce the risk of aspirating? A. side-lying B. supine C. sims positiong D. reverse trendelenberg

A. side-lying

A pregnant client with a Bishop's score of 8 means which? A. sponteneous labor is likely B. the use of cervidil is necessary C. preterm labor is likely D. the client should be admitted

A. spontaneous labor is likely (The Bishop's Score measures cervical dilation, effacement, firmness, and position, as well as fetal position in order to determine likelihood of spontaneous labor and necessity of induction. Spontaneous labor is likely with a score over 7.)

The nurse is assessing the growth and development of a 12-month-old. Which of the following is considered appropriate for the weight of this baby? A. triple the birth weight B. two and a half times the birth weight C. double the birth weight D. quadruple the birth weight

A. triple the birth weight

**A nurse is caring for a client who had an episiotomy during her vaginal delivery. Which intervention would be most appropriate when caring for a client with this condition? A. use clean technique for perineal care B. help the client to sit on a donut pillow C. administer an enema to prevent constipation D. apply a heating pad to the perineum for comfort

A. use clean technique for perineal care (An episiotomy is an incision made to enlarge the vaginal canal for the baby to pass through. Use of episiotomy procedures is not as common as in the past, but the nurse may still encounter this situation with a client. It is very painful for a postpartum client. Nursing interventions for the post-episiotomy client center on pain relief, keeping the area clean, and monitoring for infection. Ice, sitz baths after the first 24 hours, pain medications, clean technique with perineal care, showers instead of baths and applying the perineal pad without touching the inside of the pad are all measures the nurse can take to assist the client.)

A nurse is caring for a laboring client. Contractions are 6-7 minutes apart and the client is 4 cm dilated with intact membranes. This is unchanged from the last exam several hours ago. What is the expected management for this patient? Select all that apply. A. hydrotherapy B. AROM C. oxytocin D. cervidil E. oxygen

B, C (Artificially rupturing the membranes can help stimulate contractions and make them stronger. This will help change the cervix because the fetal head drops low in the pelvis and onto the cervix which assists in dilation; Hypotonic labor occurs when contractions aren't strong or regular and cervical change does not occur or labor is prolonged. Oxytocin (pitocin) will help increase intensity and occurrence of contractions.)

**The nurse is administering indomethacin to a newborn. To be certain that the newborn has been identified correctly, which of the following actions are appropriate for the nurse? Select all that apply. A. compare the number on the crib with the number on the client's ID band B. verify the DOB from the medical record with the DOB on the infant's ID band C. check the newborn's ID band against the medical record number in the chart D. ask another nurse to confirm that this is the appropriate newborn E. ask the parents to confirm that it is their child

B, C (the numbers on the crib are not reliable sources of information)

A nurse is working in a pediatric clinic and is caring for a 5-year-old, 45 pound child. The child's mother tells the nurse that she needs a new car seat, as they no longer have their former car seat. Which information would the nurse give to this family about a car seat for a child this age and weight? Select all that apply. A. the child can be in the front seat or the back seat of the car B. the child should sit in a booster seat with a lap and shoulder belt C. the child should have the belt across the upper thighs D. the child should face forward E. the child would need a 5 point restraint harness in a car seat

B, C, D (In a booster seat, the lap belt should be positioned snugly across the upper thighs, and the shoulder belt in front of the body, not placed behind the child's shoulders; A 5-year-old, 45 pound child requires a booster seat in the back seat of a car. This is less restrictive than a standard car seat but provides a boost before the child is big enough to use a lap and shoulder belt alone. A booster seat is used facing forward with a lap and shoulder belt.)

A nurse is teaching a class on labor to pregnant clients. The nurse is explaining the role(s) the mother plays in the process of labor. Which of the following should be included? Select all that apply. A. presentation B. psyche C. powers D. passageway E. Lie

B, C, D (Psyche refers to the mother's mental state during labor; Powers includes the force of contraction and pushing; Passageway refers to the pelvic girdle and vaginal canal, as well as dilation and effacement of the cervix to make room for the fetus.)

**A nurse is drawing labs for newborn screening. Which of the following tests would be included in this screening? Select all that apply. A. jaundice B. maple syrup urine disease C. phenylketonuria D. inborn errors of metabolism E. cleft palate

B, C, D (maple syrup urine disease is a metabolic disorder that is tested on the newborn screening tests. It is an autosomal recessive metabolic disorder which causes inability to process certain amino acids and has a distinct sweet smell to the urine; Phenylketonuria is a metabolic disorder known as PKU that is tested on the newborn screening. This disorder affects the newborn's inability to process proteins and artificial sweeteners.)

A nurse is caring for a 4 year old child with pediculosis capitis. The mother has asked the nurse how to care for the child. Which statements by the nurse would be appropriate? Select all that apply. A. "wash the hair in bug spray, then with conditioner" B. "place all toys in a plastic bag and seal it shut for 2 weeks" C. "use a fine toothed comb to brush the hair" D. "change linens everyday" E. "soak all hair care devices in boiling water for 10 mins"

B, C, D, E

**A school nurse is educating parents on what to look for when inspecting the hair of their children. The nurse accurately tells parents which of the following facts about lice? Select all that apply. A. the eggs may be confused with dandruff B. lice are small grey or tan bugs with no wings that are visible to the naked eye C. gloves should be worn when inspecting the scalp D. nits are tiny whitish oval specks that adhere to the hair shaft E. bite marks or red areas may be visible on the scalp

B, C, D, E (should not be confused with dandruff because dandruff flakes and falls off, whereas lice are attached to the hair shaft)

A 12-year-old with autism spectrum disorder has just been admitted with possible appendicitis. Which of the following nursing interventions would be most appropriate for helping the child cope with the stress associated with hospitalization? Select all that apply. A. keeping family members out of the room B. clustering nursing care C. ensuring the child is placed in a private room D. providing frequent reassuring touches E. providing clear and concrete explanations

B, C, E

The nurse is assessing a mother's understanding of SIDS prevention and knows that teaching has been successful when which of the following statements are made? Select all that apply. A. "we have soft bumpers to keep his legs from getting stuck" B. "i'm bummed that I have to take out all the stuffed animals from his crib" C. "there won't be anyone who smokes around our peanut" D. "we need to place pillows around him to keep him lying on his back at night" E. "this little guy is going to love his crib at night"

B, C, E

**A nurse is caring for a postpartum mother who has chosen to bottle feed her infant. The client is concerned about how to properly care for her breasts even though she is not breastfeeding. What self-care suggestions should the nurse include in the teaching? Select all that apply. A. apply lanolin to the nipples B. take ibuprofen to relieve engorgement pain C. wear a supportive bra D. hand express some drops if you feel engorged E. keep warm water on your back when you shower

B, C, E (When warm water hits the breast it causes the milk ducts to open and milk to drop in. Therefore, the client should be encouraged to turn her back to the warm water if she is not breastfeeding; Motrin can help relieve the discomfort of engorgement and is safe to take in the postpartum period; Lanolin is used for a breastfeeding mother who has nipple damage and wouldn't be necessary for a non-breastfeeding mother.)

A 15-year-old client is in the hospital for hernia surgery. The client does not want to talk to the nurse and turns away every time the nurse enters the room. Which of the following are age-appropriate interventions that the nurse would utilize in this situation? Select all that apply. A. utilize play therapy B. allow some control over self care C. provide medication to help the client sleep D. encourage visits from friends E. use simple explanations when speaking

B, D (An adolescent client may have difficulty accepting a health problem and may not want to talk about it with adults. The nurse can help this client by encouraging visits from friends and allowing the client to have some control over the client's own care.)

**A nurse is planning care for a postpartum client with the goal of preventing the development of a DVT. Which of the following should be included? Select all that apply. A. hourly calf measurements B. ambulate frequently C. clear liquids D. cross the client's E. compression hose

B, E (ambulation prevents venous stasis in the legs; compression hose keep blood moving, especially if client had a c-section and isn't moving much)

**The nurse providing care for a 3-year-old diagnosed with epiglottitis expects orders for which of the following medications? Select all that apply. A. nebulized epinephrine B. IV antibiotics C. nebulized bronchodilators D. IV diuretics E. IV corticosteroids

B, E (Research shows that bronchodilators and nebulized epinephrine are not effective in treating epiglottitis.)

The nurse is caring for a pregnant client who has a blood type of A- and needs education for what to expect in her pregnancy. Which of the following should be included in the education? A. Rhogam after delivery B. Rhogam at 28 weeks C. frequent bilirubin levels after delivery of the newborn D. chorionic villi sampling to identify fetal blood type

B. Rhogam at 28 weeks

A seven-year-old child must take an oral medication that is provided in the form of a tablet. The child is crying and says that she does not want to take the medicine. Which of the following actions from the nurse is most appropriate to help the child take the medicine? A. offer to give her the med through IV instead B. ask the child if she wants to eat either applesauce or pudding after taking it C. crush the med & stir it into a glass of juice D. tell the child that she must take the med or she will get sick

B. ask the child if she wants to eat either applesauce or pudding after taking it (There are multiple reasons a child may refuse to take medication from a nurse. A few common reasons include a lack of feeling in control of the situation, fear, lack of familiarity with the nurse and a dislike of the medicine. The nurse can help the child feel more in control by giving choices. While the child cannot choose to refuse the medicine, she could choose whether she wants to eat applesauce or pudding after taking the medicine.)

A nurse is caring for a pediatric client who needs to have surgery right away. The nurse has several other clients to care for as well, but the surgical team arrives to take the client to the operating room. The nurse has not yet finished her charting on the client. Which of the following actions is most appropriate in this situation? A. chart some information & leave the rest for report to the receiving peri-op nurse B. chart as much pertinent information as possible before the client leaves and then finish with a late entry C. tell the surgical team to wait while the nurse finishes documentation D. keep the chart and take it to the surgical area when documentation is complete

B. chart as much pertinent info as possible before the client leaves & then finish with a late entry (In this situation, the nurse should chart as much about the client as possible before the client leaves for surgery without requiring the surgical team to wait for the chart. Because the client needs surgery right away, it is unlikely that the team can wait for the nurse to finish charting. The nurse should chart the most important information first and then finish the charting as soon as possible after the client returns from surgery, noting the time and adding late entry.)

The nurse caring for a child experiencing heart failure knows that which of the following medications has a narrow therapeutic window? A. furosemide B. digoxin C. enalapril D. carvedilol

B. digoxin (Digoxin has a very narrow therapeutic window. Nurses must monitor closely for signs of toxicity and carefully check doses prior to administration.)

A nurse is teaching a student nurse about fertilization of an ovum. The nursing student demonstrates proper understanding if he/she lists the site of fertilization as what? A. uterus B. fallopian tubes C. cervix D. ovary

B. fallopian tubes (This is the site where the egg and sperm meet after ovulation and is where fertilization occurs.)

**The nurse caring for a client diagnosed with cystic fibrosis knows that which of the following is a clinical manifestation of long term respiratory problems? Select all that apply. A. epistaxis B. nasal polyps C. retractions D. clubbing of fingers & toes E. barrel-shaped chest

B. nasal polyps, D. clubbing of fingers & toes, E. barrel-shaped chest (nasal polyps are caused by chronic inflammation that occurs in those with CF; clubbing is a physical deformity that is caused by chronic hypoxia; chronic overinflation of the lungs causes barrel-shaped chest)

Which of the following pediatric client is in need of emergent intervention? A. 10 yo w/ obvious deformity of the arm B. protruding tongue and drooling 5 yo C. fussy 5 month old D. nausea, vomiting, & diarrhea of a 13 yo

B. protruding tongue an drooling 5 yo (This child is demonstrating signs of epiglottitis. This is an emergency because the airway is becoming occluded. The cardinal signs include drooling and a protruding tongue.)

A nurse is caring for a client diagnosed with cerebral palsy that has increased tone in only the left arm. The nurse knows that which of the following accurately describes this? A. spastic hemiplegia B. spastic monoplegia C. ataxic hemiplegia D. ataxic monoplegia

B. spastic monoplegia

**A nurse is scheduling a client for her first OB appointment at about 8 weeks pregnant, when the client expresses concern about what to expect. What is the most appropriate response by the nurse? A. "you will need to drink a full glass of water to fill your bladder, so we can hear the heart beat with a doppler" B. "you have nothing to worry about. it won't hurt. we're just looking at the baby" C. "a lubricated ultrasound wand will be inserted in the vagina to visualize the fetus. for your comfort, you can insert it yourself if you like" D. " I will put warm gel on your abdomen and place the ultrasound wand on that to visualize the fetus from the outside"

C (too early in the pregnancy to perform an external u/s; cannot visualize the fetus)

**The nurse is caring for a client that is 26 weeks pregnant who has been put on bedrest for preterm labor. Which of the following should be included in her care? Select all that apply. A. clear liquid diet B. passive ROM C. compression stockings D. bedside commode E. maintain a left lateral position

C, D (The client should do active ROM, not passive)

The nurse is caring for a newborn with an umbilical hernia. Prior to discharging the client, the nurse educates the parents on when to seek medical treatment. Which of the following does the nurse include? Select all that apply. A. your baby isn't sleeping through the night B. the hernia can be pushed back in C. the skin over the hernia becomes red and inflamed D. your babies stomach gets bigger E. your baby is throwing up a lot

C, D, E

While caring for a postpartum client who delivered a baby 12 hours ago, the nurse notes excessive vaginal bleeding exceeding 750 mL. Which of the following are causes of early hemorrhage in a postpartum client? Select all that apply. A. mastitis B. puerperal infection C. retained placental fragments D. lacerations E. uterine atony

C, D, E (Early hemorrhage in the postpartum client occurs within the first 24 hours after delivery. It is most often the result of complications that occurred during labor and delivery, such as with perineal lacerations, retained placental fragments, or uterine atony.)

**The nurse educating a group of parents on sudden infant death syndrome knows that which of the following are considered to be protective factors? Select all that apply. A. place the baby on their stomach to sleep B. dressing the baby warmly C. breastfeeding D. using a crib bumper pad E. placing the baby on it's back to sleep

C, E (not B because overheating during sleep has been associated with SIDS; When infants sleep on their stomach they are at increased risk for suffocating and rebreathing carbon dioxide during their sleep, thus increasing their risk for SIDS.)

A five-year-old child has been admitted to the hospital with appendicitis. Which statement made by the nurse would be appropriate to include when explaining the procedure to someone of this age? A. "I need to give you a shot before you go see the doctor about the pain in your tummy" B. "after surgery you will have a small incision in your tummy" C. "the doctor is going to make a special opening in your tummy to help you feel better" D. "when you come back from surgery I'm going to have to check your blood pressure a bunch of times"

C. "the doctor is going to make a special opening in your tummy to help you feel better" (avoid threatening or confusing words)

**A nurse is caring for an infant born 5 hours ago who hasn't eaten yet. On assessment, the nurse notes respirations of 98/minute. What is the best nursing action? A. syringe feed formula B. feed the infant 15 mL of formula C. check the blood glucose D. start TPN

C. check the blood glucose (98 breaths/min is considered tachypnea for a newborn; a baby that is breathing this fast should not be fed d/t the risk of aspiration; Blood sugar should be assessed. If it is stable the baby can continue to be monitored. If it is low then intervention will be needed with glucose gel or IV fluids.)

A nurse is caring for a 5-year-old child who has been diagnosed with bronchiectasis. Based on the nurse's understanding of this condition, the nurse knows to expect signs and symptoms of which of the following? A. absence of respiratory effort B. wheezing and barrel chest C. chronic cough that produces green sputum D. sharp chest pain with each breath

C. chronic cough that produces green sputum (Bronchiectasis is a lung condition that causes permanent dilation of the bronchi, resulting in breathing difficulties and pooling of sputum in the bronchial tree that can progressively worsen. The nurse should assess for signs and symptoms of a productive cough with thick or green sputum. Occasionally, the client may also cough up blood. As the disease progresses, sputum production tends to increase.)

A nurse who works on the postpartum unit is caring for a client who delivered a baby by cesarean section three hours ago. The mother has an epidural in place and is unable to get out of bed. Which information must be reinforced to this parent that would protect the safety of both the mother and the baby in this situation? A. avoid using pain meds while the baby is in the room B. do not change the babies diaper unless the nurse is present C. do not leave the baby in her crib when she is out of arms reach D. avoid getting OOB when the baby is not in the room

C. do not leave the baby in her crib when she is out of arms reach (A postpartum client who had an epidural for a cesarean section will most likely have little pain or feeling below the waist due to the anesthetic medication being delivered through the catheter. If the client cannot get out of bed without help, the baby should not be left in the crib out of reach of the mother because if something were to happen to the baby, the mother would not be able to get to the baby without help.)

An adolescent girl is admitted to the hospital for appendicitis. The nurse notes that the client is uncomfortable changing into a gown and does not want to remove her clothing. The nurse recognizes that an increase in reproductive hormones causes which of the following characteristics in adolescent girls? A. development of facial hair B. rapid increase in height C. growth of breast tissue D. development of longer range eyesight

C. growth of breast tissue (The growth of breasts, along with pubic hair are important secondary sex characteristics that develop in adolescent females due to an increase in reproductive hormones. The average age this stage of puberty begins is age nine or ten, with a range of initiation at approximately 7 to 13 years, depending on ethnicity.)

The nurse is caring for an infant who was born addicted to heroin. Which of the following is NOT an appropriate nursing intervention for this infant? A. initiating seizure precautions B. initiate skin precautions C. initiating bleeding precautions D. holding the baby tightly/snuggling during feedings

C. initiating bleeding precautions (not necessary)

**A nurse receives a call from a breastfeeding mother who is concerned she may have mastitis. Which of the following symptoms would be indicative of possible mastitis? Select all that apply. A. back pain B. bruising C. redness D. fever E. equal milk production

C. redness, D. fever (Mastitis is a bacterial infection, therefore would present with fever. The client may also experience flu-like symptoms and local redness and tenderness of the breast.)

A 29-year-old client has just given birth to her 4th child. She asks the nurse about whether she can undergo sterilization to prevent becoming pregnant again. Which response from the nurse provides the most accurate information? A. you should not undergo sterilization so soon after delivery B. you can, but you will first need to speak to an attorney C. you can if that is your choice. I can speak with your provider about it D. you can, but your husband will also have to sign informed consent

C. you can if that is your choice. I can speak with your provider about it. (Sterilization is an option that some women choose to prevent future pregnancies. It involves a surgical procedure that prevents fertilization and pregnancy. A woman may have a sterilization procedure shortly after delivering a baby, and she does not need to have her partner's permission before doing so.)

The nurse knows to provide which of the following wound care instructions to the parents of a 9-month-old that just had surgery for a hypospadias reconstruction? A. "allow the wound to soak in a tub bath 2x/day" B. "apply hydrocortisone cream to the wound" C. "apply powder to the wound to minimize moisture" D. "apply petroleum jelly to the wound"

D. "apply petroleum jelly to the wound" (This can increase comfort & keep the wound from sticking to the diaper)

**A nurse is caring for a newborn infant who has tested positive for congenital hypothyroidism. The nurse is explaining to the infant's mother about the baby's need for medication. The mother asks, "What will happen if I do not give her the medicine?" Which response from the nurse is accurate? A. "she will develop severe nausea & vomiting, which will impair her ability to eat" B. "she will not be able to regulate her own temperature and will be more likely to get sick" C. "she will grow at an abnormally rapid rate" D. "she would likely suffer from damage to the brain, which will affect her growth and mental development"

D. "she would likely suffer from damage to the brain, which will affect her growth & mental development" (Congenital hypothyroidism is a condition that is present at birth in about 1 in 1500 babies. The condition involves inappropriate activity of the thyroid gland. A baby born with congenital hypothyroidism will need thyroid replacement. Without this medication, the infant can suffer from brain damage, growth disturbance, and mental delays.)

The nurse is caring for a 7-year-old child with asthma. The nurse recognizes that which of the following observations would be the most concerning? A. substernal and intercostal retractions B. child's SpO2 is 98% on 2L via NC C. child flinches when you start an IV D. child is unable to speak in complete sentences

D. child is unable to speak in complete sentences (A child who is unable to speak due to their increased work of breathing is at risk of airway obstruction.)

A nurse is caring for a pregnant, hypertensive client on bed rest. What nursing intervention is priority for the care of this client? A. frequent ambulation B. antibiotics C. passive range of motion D. compression hose

D. compression hose (hypertensive clients are at increased risk of blood clots)

A nurse is assessing a 4-year-old child who is in the hospital for a tonsillectomy. The child is playing in the toy room of the pediatric unit and the nurse notes that the child interacts with other children and sometimes shares toys. This best describes which type of play as seen among children? A. solitary B. parallel C. associative D. cooperative

D. cooperative (The child in this example is demonstrating cooperative play, which typically develops between 4 and 5 years of age. During cooperative play, a child interacts and engages with other children his own age. The child is also more willing to share toys during this type of play.)

The nurse is ready to begin an exam on a 9-month-old infant sitting in the mother's lap. What should the nurse do first? A. check the Babinski reflex B. check tympanic membranes C. palpate the abdomen D. listen to heart and lung sounds

D. listen to heart and lung sounds (Parts of the assessment that involve listening should be done while the child is quiet. This includes listening to heart, lungs, and abdomen. Other areas of the nursing assessment could cause the infant to cry, making auscultation impossible.)

A nurse is providing education to a pregnant client with hypertension. What is the priority topic to include in this education? A. to take a baby aspirin daily B. it is important to increase exercise C. to lay flat for 15 mins prior to BP checks D. low fat and low sodium food options

D. low fat and low sodium food options (Diet can help manage weight and low sodium can help with decreasing fluid retention and therefore blood pressure.)

**The nurse providing care to a child with influenza knows to give top priority to which of the following interventions? A. encouraging small, frequent meals B. assessing the child's skin for s/s of breakdown C. monitor for s/s of hearing loss D. monitor for s/s of secondary infection

D. monitor for s/s of secondary infection (The most common complication of influenza is a secondary infection, like pneumonia. The priority intervention would be to monitor for signs of secondary infection; A is important, but not the top priority)

A nurse is assessing a postpartum client for possible Disseminated Intravascular Coagulation. Which symptoms would the nurse expect to find? A. headache, decreased urinary output B. boggy uterus, pain C. lung crackles, hypertension D. petechiae, purpura

D. petechiae, purpura (The increased clotting and bleeding will produce these symptoms, among others, in clients with DIC.)