OB/Peds Final Exam 2020

A 30-minute-old newborn starts crying in a high-pitched manner and cannot be consoled by the mother. Which action should the nurse prioritize if jitteriness is also noted and the infant is unable to breastfeed?

Check blood glucose

The nurse is preparing discharge instructions for the parents of a male newborn who is to be circumcised before discharge. Which instruction should the nurse prioritize?

Cover the glans generously with petroleum jelly.

What is bonding?

Developing an attachment and becoming acquainted

An 8-month-old child is diagnosed with a second ear infection and the father is concerned the infections are being caused by something he is doing or by something in the child's development. Which question should the nurse prioritize to collect more information to answer this father's questions?

Does the baby go to bed with a bottle of formula each night?

Slow progression of labor resulting in a cesarean section is due to?

Dystocia

The parents of an infant diagnosed with phenylketonuria are not sure they agree with the diagnosis and proposed treatment. The nurse should point out that this condition can result in which additional condition if left untreated?

Intellectual disability

What process results in the return of nonpregnant size and function of the uterus?

Involution

What is the function of surfactant?

Keeps alveoli from collapsing with breaths

The African American parents are spending time with their newborn after the nurse brings the baby back form the transition nursery. The parents are horrified to note that their infant's buttocks appears bruised and demand to know what happened. The nurse should explain this is related to which factor?

Mongolian spots

The nurse is monitoring a new mother as she breast-feeds her 1-day-old infant. The nurse determines more instruction is necessary when the infant uses which action to latch on?

Nipple tip only

The new mother is determined to breast-feed her baby exclusively for 6 months but will need to return to work before then. The nurse should encourage the mother to wait until the baby is what age before using expressed milk?

6 weeks

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.

Which is a reassuring fetal heart rate?

Acceleration of at least 15 bpm for 15 seconds

The nurse is assisting the new mother who has chosen to feed her newborn formula. The nurse should encourage the mother to burp her baby at which time?

After every half-ounce

The nurse is assisting a new couple with breast-feeding. The nurse points out which common position will place the mother and baby "tummy-to-tummy"?

Cradle hold

The nurse is preparing discharge instructions for a new mother who has been learning to breast-feed. Which response should the nurse prioritize when the mother questions her ability to produce enough milk for her infant?

Drink a lot of fluids

The nurse is escorting the newborn to the transition nursery for the initial assessment and care. The nurse is prepared to carefully monitor the infant during the transition period which occurs at which time interval?

First 6 to 12 hours

The nurse is helping a mother prepare to breast-feed her newborn for the first time. Which position should the nurse point out will be most appropriate with her cesarean incision site?

Football hold

If a Maternal Serum Alpha Fetal Protein (MSAFP) level was elevated what should the nurse prioritize?

Further testing

What is the GTPAL? Previous pregnancy ended at 18 weeks, twins at 31 weeks, and a 5 year old at 39 weeks.

G4, T1, P2, A1, L3

The young mother has been breast-feeding her newborn, however, the nurse is concerned the infant is not thriving and may need to be switched to a formula. When questioned by the mother, the nurse should point out which condition that would be a contraindication for the infant to continue breast-feeding?

Galactosemia

What is the priority when preparing for an epidural?

IV fluid bolus

During which stage does a woman's cardiac output increase 80% above pre-labor levels?

Immediately after birth

What would you monitor if a client has an epidural?

Inability to push

A mother with gestational diabetes is at increased risk of long-term complications such as?

Increased risk of developing type 2 diabetes

The nurse caring for a newborn notes a distended abdomen approximately 24 hours after birth. Which action should the nurse prioritize after review for the medical record reveals an apparent healthy newborn at birth but no documentation of a bowel movement?

Inform the RN and/or primary care provider immediately

The nurse is caring for a newborn after the parents have spent time bonding. As the nurse performs the assessment and evidence-based care, which eye care will the nurse prioritize?

Instill 0.5% opthalmic erythromycin

In understanding fluid and electrolyte balance, it is important for the nurse to recognize that fluid contained within the body cells is known as:

Intracellular

The nurse is preparing to teach the young parents of a newborn who is diagnosed with spinal bifida occulta how to care for their newborn. Which information should the nurse prioritize when explaining this defect?

There is a bony defect that occurs without soft-tissue involvement.

The nurse is administering an intramuscular injection of an antibiotic to a 3-month-old child. Which would be the best site for the nurse to give this medication

Thigh

What are late decelerations?

Uteroplacental insufficiency

Prostaglandin Ex is delivered via what route?

Vaginal

What mode of heat loss occurs with a fan blowing on the infant?

Convection

The nursing instructor is conducting a session with a group of nursing students, exploring potential difficulties of newborns involving respiratory concerns. The instructor determines the session is successful after the students correctly choose which contributing factor for transient tachypnea of the newborn?

Often seen with cesarean births

A nursing student tells the staff nurse on the pediatric orthopedic unit that she has heard of a musculoskeletal disorder in which there is an infection of the bone. Which disorder does this statement describe?

Osteomyelitis

The nurse is evaluating the neonate for gestational age. Which assessment finding will the nurse note when determining the infant is post-term?

Ear cartilage is thick and the pinna is stiff

What is the best action to treat heartburn at night during pregnancy?

Elevate the head of the bed.

The nurse is caring for a pregnant woman who is struggling with controlling her gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus?

Grow to an unusually large size

The parents are bonding with their newborn when the nurse notes the infant's axillary temperature is 97.2 F (36.2C) an hour after birth. Which intervention should the nurse prioritize for this family?

Help the mother provide kangaroo care.

The nurse is interviewing the mother of a child who is at the local clinic. When asked why she brought her toddler in today, she replies that he has been running a fever and coughing a lot since last weekend. This information would be noted in the chart as what data?

Chief complaint

The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which clinical manifestations would the nurse most likely note in this child?

Drowziness and fruity odor to breath

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?

During this procedure, small tubes are inserted into the tympanic membrane.

Where will the fundus be located 1 day postpartum?

1 cm below the umbilicus

The nurse is assessing the breast-feeding sessions of a newborn by looking at a log of the duration of breast feeding sessions. The nurse determines the mother is successfully learning the process after noting which time frame for nursing?

10 to 20 minutes each side

The young mother is nervous about discharge wit her first child. The nurse encourages the mother by pointing out various instructions, including to call her health care provider if the newborn does not void within which time period?

12 hours

The nurse is accepting a new mother and her term infant into the unit after delivery and notes the newborn is documented as low birth weight. How much does the nurse expect the newborn to weigh?

2000 grams

Blood volume in pregnancy can increase by?

40%-45%

Which blood sugar in an infant would the nurse prioritize?

40mg/dl

The new mother has decided to formula-feed her infant and is unsure when to introduce soft foods. Which age should the nurse point out will be appropriate to introduce her infant to mashed fruit and vegetables?

6 to 8 months

Which physical assessment data would the nurse find concerning and would warrant reporting to the physician?

A blood pressure of 128/80 in a pre-school aged child

Which procedure should the nurse administer RhoGam if the woman is Rh negative?

Amniocentesis

A first-time mother has been breast-feeding her baby for 3 days and is concerned she is not making enough milk. Which signs can the nurse teach the mother to look for that indicate the infant is getting enough milk?

Appears drowsy or asleep after feeding

The nurse is answering questions from the parents of a newborn diagnosed with congenital talipes equinovarus. When asked by the parents which treatment will be used, what would the nurse predict?

Application of a cast

In working with infants diagnosed with atopic dermatitis the nurse anticipates that when these children are older they will likely have a tendency to have which disorder?

Asthma

What would the woman experience if the fetus was in a occiput posterior position?

Back pain

The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers?

Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality.

What test is the best indicator for a successful induction?

Bishop score of 7

Dizziness, shortness of breath while lying supine is caused by what in pregnancy?

Blood trapped in the vena cava in a supine position

What color is the nitrazine paper if the membranes are ruptured?

Blue

In understanding the cardiovascular and hematologic systems of the body it is important to know that the blood is made up of plasma, red blood cells, white blood cells, and platelets. These blood cells are formed in the:

Bone marrow

What should the nurse do if the client is having variable decelerations?

Change positions

Infection of amniotic fluid is called?

Chorioamnionitis

Which test can be done at 10 weeks to check for risk of a genetic defect?

Chorionic villus sampling

The nurse is caring for a child in the emergency department who is on a cardiac monitor. Which nursing action should the nurse prioritize?

Confirm the alarms are set with maximum and minimum settings.

The nurse is assessing a group of infants and notes one of the infants has chronic constipation and an enlarged abdomen. The nurse would determine this infant is showing indications of which condition?

Congenital hypothyroidism

Difference between true and false labor?

Contraction increase even if relaxing

The nursing student is preparing a presentation which will illustrate the various stages of growth and development starting with a newborn. Which example should the student point out will best illustrate cephalocaudal growth pattern?

Controlling the head and neck before being able to control the arms and legs

A caregiver calls the pediatrician's office and reports to the nurse that her 4-year old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6 F (39.2 C). The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which condition?

Epiglottitis

The 11-year old arrives in the emergency department presenting with the following: nosebleed with no apparent trauma, disoriented, confused, difficulty walking, nausea, and coughing. The nurse should question the child concerning which potential activity?

Experimenting with an inhalant

The nurse is monitoring a newborn who exhibited a large head at birth and is exhibiting an increasing head growth on continued assessment. Which additional findings on assessment should lead the nurse to suspec hydrocephalus in this infant?

Eyes appear to be pushed downward

The nurse is preparing a presentation for a health fair which will illustrate various factors which can contribute to preterm births. Which contributing factor should the nurse prioritize?

Fertility treatments which are resulting in multiple births.

Positive sign of pregnancy

Fetal movement felt by examiner

What is the nurse referring to when she says the fetus is ROA?

Fetal position

The nurse is caring for a 22-hour-old neonate male and notes on assessment at the beginning of shift: Apgar score of 9, nursing without difficulty and appeared healthy. As the nurse's shift goes on, subsequent assessment reveals his sclera and skin have begun to take on a yellow hue. The nurse would report this as a possible indication of what condition?

Hemolytic disease

The nurse is assessing a 4-year-old on a routine well-child visit. When assessing the gross motor skills of this preschooler, which activity will the nurse predict the child to be able to successfully accomplish?

Hop on one foot

The nurse is assisting a primigravida woman make decisions and prepare for her baby. The nurse should point out that breast-feeding is not an option for this client based on which assessment finding?

Human immunodificiency virus infection

The nurse is admitting to the nursery a newborn of a mother who continued to drink alcohol during her pregnancy. Which finding does the nurse predict to encounter on the newborn's assessment?

Hyperactive and irritable

A male nurse is meeting with a group of high school boys to discuss various health topics. After the session on testicular self-exam, the nurse determines the session is successful when one of the students responds with which comment?

I am almost 15 now, so that means I could possibly get this disease.

When is a pudendal block given?

Just before birth

A caregiver brings a 13-year-old male for a pre high school checkup and reports he has spent lots of time in the principal's office or serving detention during junior high and questions if he is too immature to be in high school. The nurse's assessment reveals evident breasts, little underarm or chest hair, and a high-pitched voice. Which condition should the nurse suspect and discuss with the primary care provider?

Klenefelter syndrome

The nurse is assessing the newborn male of a teen mother who was afraid to seek appropriate prenatal care. Which assessment finding should lead the nurse to question if this infant is preterm?

Lanugo on the back and shoulders

What kind of deceleration would be noted on the monitor if the woman has a uterine rupture?

Late deceleration

The nurse is assessing a newborn and suspects developmental dysplasia of the hip. Which sign is the nurse prioritizing for in this potential diagnosis?

Limited abduction of the affected hip

The nurse is preparing to assess an infant who is diagnosed with a ventricular septal defect. Which assessment finding should the nurse be prepared to document?

Loud, harsh murmur

What is the priority for shoulder dystocia?

McRoberts Maneuver

What is green amniotic fluid?

Meconium

Which cervical ripening agent can be given orally?

Misoprostol

The nurse is caring for an adolescent just transferred from PACU to the inpatient unit. As the nurse helps the child settle into the unit, which nursing intervention should the nurse prioritize?

Monitor for change in vital signs

A young child has been admitted with a diagnosis of enterobiasis (pinworm infection). This child will most likely have a history of:

Perianal itching

What action is taken for a prolapsed cord?

Place in knee chest position

Probable sign of pregnancy

Positive home pregnancy test

If a woman reports not eating, neglecting infant, and is disheveled. What would you be concerned with?

Postpartum psychosis

A woman is unable to maintain adequate blood sugar control during pregnancy. What is the top priority?

Prepare for assessment of fetal lung maturity

A fetus is in transverse lie at 40 weeks. What should the nurse assist the doctor with?

Prepare to assist with an external version

The nurse is conducting a prenatal class explaining the various activities which will occur within the first 4 hours after birth. The nurse determines the session is successful when the couple correctly choose which reason for the use of an antibiotic ointment?

Prevent infection of the eyes from vaginal bacteria

What hormone is necessary after birth for newborn growth?

Prolactin

What initiates labor?

Prostoglandins may be the causing factor

The nurse is explaining to the new parents the various substances which will be administered to their newborn within a few hours of birth. Which explanation should the nurse prioritize as the best rationale for administering vitamin K?

Provides blood clotting factors

Which is the best pain option if a woman won't push because it hurts too much?

Pudendal block

Which phase of the contraction is most important to make sure the fetus has adequate oxygenation?

Relaxation

What do you monitor with magnesium sulfate?

Respiratory depression, hypotension

An infant with a low temperature is at risk for?

Respiratory distress

The pediatric nurse is presenting basic safety tips at a local health fair for families. The nurse should point out the majority of hospital visits for toddlers can be prevented by exercising which precaution?

Safely store all chemical substances

The nurse is assessing a newborn to establish a gestational age. Which factors will the nurse prioritize when assessing the newborn's neuromuscular maturity?

Scarf sign, heel to ear, posture, arm recoil

Uterine contraction postpartum are essential for?

Sealing off blood vessels at the placenta site

When the fetus crowns and the client is pushing what stage of labor is this?

Second

Which fetal presentation is least likely to occur?

Shoulder

What would be the reason for an episiotomy?

Shoulder dystocia

Which action would the nurse prioritize for an emergent cesarean delivery?

Sign informed consent

The nurse has completed an assessment on a newborn and documents a score of 17 for the physical maturity in the records. Which elements has the nurse prioritized for this assessment?

Skin, plantar creases, breast buds, lanugo

How does anxiety affect labor?

Slows down labor and decreases oxygen to the fetus

The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructors determine the class is successful after the students correctly choose which milestone as the beginning of adolescence?

The beginning of puberty

A caregiver brings her 7-year old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting?

The child has been sexually abused, maybe on the fishing trip.

A nurse is caring for a newborn who is determined to be small for gestational age with intrauterine growth restriction. Which finding would lead the nurse to also question if this infant has asymmetric growth restriction?

The head is large in comparison with the body

The nurse is monitoring a breast-feeding session and determines the infant is nursing well. Which assessment finding is the nurse using to make this determination?

The mother is experiencing uterine contractions.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?

The spinal meninges protrude through the bony defect and form a cystic sac.

The nurse is preparing new parents and their infant for discharge by answering questions and presenting basic discharge instruction. Which explanation should the nurse provide when questioned about the infant's yellow hue?

The tint is due to jaundice.

What are decelerations?

Uteroplacental insufficiency

The nurse is preparing to teach the parents of an infant scheduled for surgical repair of hydrocephalus with a shunt from the brain to the heart about the postoperative care involved. Which type of shunting should the nurse prioritize in the teaching?

Ventriculoatrial

A white cheesy substance on newborn is called?

Vernix

The nurse is completing the growth chart of a 2-month-old infant at the well-child visit. When asked by the mother what purpose this chart serves, which response would be most appropriate by the nurse?

We are comparing the child's current measurements with the child's previous measurements.

The nurse is caring for a child admitted with asthma. Which clinical manifestations would likely have been noted in the child with this diagnosis?

Wheezing

Most urinary tract infections seen in children are caused by:

intestinal bacteria

The nurse is collecting data from the caregiver of an 8 year old child who recently started soiling his underwear each day rather than using the toilet to defecate. This behavior indicates a symptom of:

encopresis