OB/PEDS Final

Client gave birth vaginally 12 hr ago and palpates her uterus to the right above umbillicus. Intervention?

Assist the client to empty her bladder

School aged child dx w/ asthma, reports chest pain. First nx action:

Auscultate breath sounds (1st action of nursing process)

A nurse in the emergency department is caring for a 2-year-old child who was found by his parents crying and holding a container of toilet bowl cleaner. The child's lips are edematous and inflamed, and he is drooling. Which of the following is the priority action by the nurse?

Check the child's respiratory status

A nurse is providing teaching to the parents of a 4-year-old child about fine motor development. Which of the following tasks should the nurse include in the teaching as an expected finding for this age group?

Copies a circle

A nurse is caring for an 18-month-old toddler who has been admitted following surgical repair of a cleft palate. Postoperatively, the child complains of thirst. The nurse should provide fluids using which of the following?

Cup

4yo assessment. expect developmental milestone?

Cuts a shape using scissors (should be able to use scissors to cute out a shape)

Hypovolemic shock, what should nurse do next?

massage client's fundus

A nurse is assessing a newborn who was born at 26 weeks of gestation using the New Ballard Score. Which of the following findings should the nurse expect?

minimal arm recoil (at 26 weeks decreased muscular tone)

nonpharmalogical measure for breastfeeding client experiencing engorgement

"You should use cold compresses after each feeding."

34 weeks of gestation asks the nurse how she will know when she is in labor and should go to the hospital. Which of the following responses should the nurse make?

"You will notice blood-tinged discharge from your vagina."

Rh immune globulin. Which statements indicates understanding of teaching?

"need this medication if I have an amniocentesis" (potential fetal RBC enters maternal circulation following an amniocentesis) (administered 28 weeks of gestation, for Rh-neg mother potentially having Rh-positive baby)

First step of Leopold maneuvers

(both hands on top of fundus)

One day postpartum. Vaginal birth w/ fourth-degree perineal laceration. Nurse should contact provider regarding which prescriptions?

Bisacodyl rectal suppository daily as needed for constipation (no rectal suppository or enema to 4th degree perineal laceration, may cause separation of suture line)

A nurse is caring for a 2-year-old child who has cystic fibrosis. The nurse is planning to take the child to the playroom. Which of the following activities would be appropriate for the child?

Building towers of blocks

A nurse is caring for a child diagnosed with nephrotic syndrome who is receiving Predisone (Deltasone). Which of the following should the nurse recognize as a therapeutic response of the medication?

Weight drops 500 g

A nurse is caring for a 2 month old infant with a ventricular septal defect. Which of the following observations should indicate to the nurse that the child's condition is worsening?

Weight gain of 275 g

A nurse is teaching a parent of a 12-month old child about development during the toddler years. Which of the following statements should the nurse include?

Your child should be able to scribble spontaneously using a crayon at the age of 15 months

38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring?

perform Leopold maneuvers (assess position of fetus to determine optimal placement for external fetal monitoring transducer)

Parvovirus B19 (fifth disease) Which action should nurse take?

schedule an ultrasound examination (fetal hydrops)

Amniotomy, which assessment is priority?

temperature (greatest risk of amniotomy is infection)

36 weeks of gestation prescription for amniocentesis. Which of the following reasons should the nurse prepare the client for an ultrasound?

to locate a pocket of fluid

Appendicitis, possible perforation. manifestations of peritonitis

Abdominal distention

A nurse in an emergency department is caring for an 8-year old who is up-to-date with current immunization recommendations and has a deep puncture injury. Which of the following should the nurse anticipate administering?

Adult tetanus booster

A nurse is caring for a 6 year old child who is newly diagnosed with diabetes mellitus. The nurse is educating the child on how to do finger sticks for blood glucose checks. The nurse knows the most effective method to teach this skill will be to do which of the following?

Allow the child to practice the skill on themselves or others.

Managing nausea and vomiting. Which to include in teaching?

eat high-carbohydrate foods (ie. toast, potatoes, and rice; avoid spicy, fatty, fried foods (drink fluids between meals, cool temp food, brushing teeth triggers gag reflex)

Client states that she is, "happy one minute and crying the next." The nurse should interpret the client's statement as an indication of?

emotional lability

Oxytocin. Indication for the administration of the medication?

flaccid uterus, excess vaginal bleeding

26 weeks gestation. Which finding should nurse report to provider?

fundal height measurement (of 30 cm) (should be +/- 2 cm of weeks gestation) (130-140 mg/dL 1-hr glucose tolerance test is abnormal, hematocrit level should be greater than 33% to be normal)

35 weeks of gestation clinical manifestations of potential pregnancy complications to report to the provider.

headache that is unrelieved by analgesia (could indicate preeclampsia)

Physical assessment of newborn. Which of the following clinical findings should the nurse expect?

heart rate 154/min, respiratory rate 58/min, weight 2.6 kg (5 lb 12 oz) (HR 110-160, R 30-60, T 97.7-100, 45-55 cm (17.7-21.7 in), 2.5-4 kg (5.5-8.8 lb))

End of first trimester. Place Doppler ultrasound stethoscope at...

just above the symphysis pubis

Caring for crying newborn who is bottle feeding. Positive parenting behavior?

lays the newborn across her lap and gently sways (correct technique for quieting a newborn)

A nurse is caring for a child with a Milwaukee brace for scoliosis. After educating the adolescent, the nurse evaluates the client understands the proper application and use of the brace. Which of the following statements should indicate to the nurse that the adolescent understands the use of the brace?

"I can take my brace off for about an hour to shower daily."

10 weeks of gestation, nutrition. Which statement indicates understanding of teaching?

"I should take 600 micrograms of folic acid each day." (71 g protein intake, 3L of water, inc caloric intake 340 cal during 2nd trimester and 452 cal during 3rd)

Terbutaline

"I will have blood tests because my potassium might decrease." (hypokalemia, hypotension, hyperglycemia)

A nurse is caring for a 4 month old infant with otitis media. The nurse is educating the child's parent on how to prevent reoccurrences. Which of the following statements by the parent should the nurse recognize as an understanding of the teaching?

"I will make sure my baby is sitting upright when drinking a bottle."

Respiratory syncytial virus (RSV) in child. Nursing implementation for infection control

Have a designated stethoscope in the room

School aged w/ poorly controlled seizure disorder. plan of care

Have oxygen available (may requires supplemental oxygen follwing a sezuire)

A nurse at a pediatric clinic is assessing a 5-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider?

Head lags when pulled form a lying to a sitting position

A nurse is assessing a 12-month-old male infant's vital signs during a well-child visit. The infant is in the 90th percentile of height. Which of the following findings should the nurse report to the provider?

Heart rate 175/min

A nurse is caring for an adolescent with diabetes mellitus who has been admitted twice this year to the hospital with diabetic ketoacidosis. Which of the following tests should the nurse recognize as the best information to evaluate the client's compliance?

Hemoglobin A1C

A nurse is caring for a newborn with a myelomeningocele. In planning care for the newborn, the nurse should be aware that postoperatively, the child is most prone to developing which of the following?

Hydrocephalus

Nephrotic syndrome manifestation:

Hyperalbuminuria (manifestation of nephrotic syndrome)

A nurse is providing education to the parent of a toddler who is about to receive her first dose of the MMR (measles, mumps and rubella) immunization. Which of the following statements by the parent indicates an understanding of the teaching?

I can give my child acetaminophen for discomfort associated with the immunization

A nurse is teaching the parent of a toddler about home safety. Which of the following statements by the parent indicates an understanding of the teaching?

I lock my medications in the medicine cabinet

Adolescent managing tinea pedis. understands teaching

I should wear sandals as much as possible. (Allow air circulation, promoting healing of fungal infection)

A nurse is assessing a 9-month-old infant during a well-child visit. Which of the following findings indicates that the infant has a developmental delay?

Inability to vocalize vowel sounds

A nurse is caring for a child diagnosed with sickle cell anemia. The nurse should make which of the following recommendations to the client regarding sickle cell anemia?

Increase fluid intake.

A nurse is caring for a child with cystic fibrosis. In planning nutritional care for this child, the nurse should include which of the following actions?

Increased protein intake.

12 hr newborn. Which should nurse report to provider?

Jaundice (occurring w/n first 24 hr of birth associated w/ ABO incompatibility, hemolysis, Rh-isoimmunization)

A nurse is caring for a 2-year-old child who has not received any immunizations. During assessment, the child is noted to have maculopapular rash and fever. The child's parent tells the nurse that the child has been exposed to rubeola. Which of the following assessment findings should the nurse expect?

Koplik spot

A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings indicates the need for further assessment?

Legs remain crossed and extended when supine

Treated streptococcal throat infection but admitted w/ dx acute rheumatic fever. appropriate RN intervention

Maintain bed rest

A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and is planning to attend college. The nurse should inform the client that he should receive which of the following immunizations prior to moving into a campus dormitory?

Meningococcal polysaccharide

A nurse in a pediatric clinic is assessing a toddler at a well-child visit. Which of the following actions should the nurse take?

Minimize physical contact with the child initially

Infant postop pyloric stenosis repair. RN action:

Monitor infant following feedings for vomiting (Evaluates success of surgery)

A nurse is caring for a child with a ventricular septal defect. Which of the following should the nurse expect to assess in this child?

Murmur best heard at the lower left sternal border

A nurse is teaching the parent of a 12-month-old infant about nutrition. Which of the following statements by the parent indicates a need for further teaching?

My infant drinks at least 2 quarts of skim milk each day

A nurse is observing a mother who is playing peek-a-boo with her 8-month-old child. The mother asks if this game has any developmental significance. The nurse should inform the mother that peek-a-boo helps develop which of the following concepts in the child?

Object permanence

Nephrotic syndrome. RN assessment to confirm peripheral edema

Palpating dorsum of feet

A nurse is caring for an adolescent with a fiberglass cast. When providing education for the adolescent, which of the following should the nurse explain?

Place plastic over the cast while bathing.

A nurse on a pediatric unit is admitting a 4-year-old child. Which of the following toys should the nurse plan to provide for the child to engage in independent play?

Plastic stethoscope

Postpartum and has preeclampsia. Which should nurse report to the provider?

Platelets 50,000/mm3 (less than 100,000/mm3, report)

A nurse is caring for a 2 year old child with vomiting and dehydration. Which of the following assessments should prompt the nurse to contact the primary care provider?

Potassium 2.5 mEq/L

Postop care 13mo post cleft palate repair. RN intervention

Prevent the client from using a pacifier

Impetigo. teaching

Remove crust after soaking with 1:20 Burow's solution

3yo well visit. Report to Provider:

Respirations 30/min

Child has Glomerulonephritis & is edematous. plan of care

Restrict sodium intake

Naegele's rule. November 27th menstrual cycle. Expected date of birth?

September 3rd (subtract 3 months and add 7 days)

A nurse is caring for a 6 week old infant who is admitted to the pediatric acute care unit following pyloromyotomy. The nurse should anticipate the feeding schedule 8 hr postoperative will be which of the following?

Small, frequent bottle feedings

A nurse is assessing a 7-year-old child's psychosocial development. Which of the following findings should the nurse recognize as requiring further evaluation?

The child complains daily about going to school

Cerebral palsy, trouble w/ verbal communication:

Use pictures and objects when talking to the child; encourage the child to move his lips and tongue when eating; allow the child time to articulate at his own pace

A nurse is assessing a 3-year-old child who is 1 day postoperative following a tonsillectomy. Which of the following methods should the nurse use to determine if the child is experiencing pain?

Use the FACES scale

Discharge teaching car seat 6mo. Mother needs more teaching

Using a blanket as padding underneath the infant while traveling

A nurse is teaching a 12-year-old child how to use an steroid inhaler. The nurse should recognize that the teaching has been effective when the child makes which of the following statements?

"I will use this medication every day even if I don't have any manifestations."

A nurse is caring for a child with dehydration. Which of the following should the nurse recognize as an appropriate assessment to determine the child's response to parenteral fluids?

Weighing the child at the same time every day

A nurse is caring for a child with acute glomerulonephritis and an ASO titer is ordered. The child's parent asks the nurse, "Why does the child need this titer?" Which of the following would be an appropriate response by the nurse?

"It will tell us if the child had a recent strep infection."

8 weeks gestation exercise teaching

"You should exercise for 30 minutes each day."

Postpartum client taking insulin for gestational DM. Which instructions should nurse include in teaching?

"You should get a 2-hour oral glucose tolerance test in 6 to 12 weeks." (every 3 yr to screen for type 2 DM)

A nurse is teaching the parent of an infant about home safety. Which of the following information should the nurse include?

-Position the car seat so it is rear-facing -Secure a safety gate at the top and bottom of the stairs -Maintain the water heater temperature at 49 C (120 F)

A nurse is caring for a preschool-age child who is dying. Which of the following findings is an age-appropriate reaction to death by the child?

-The child views death as similar to sleep -The child believes his thoughts can cause death -The child thinks death is a punishment

Washing newborn steps

1. Wipe the newborn's eyes from inner canthus outwards 2. Wash the newborn's neck by lifting the newborn's chin 3. Cleanse the skin around newborn's umbilical cord stump 4. Wash the newborn's legs and feet 5. Clean the newborn's diaper area (clean to dirty; head to toe)

A nurse is caring for a child with a history of diarrhea for 24 hr. The primary care provider orders a urine specific gravity. Which of the following values should the nurse expect to see?

1.030

Urine dipstick test w/ nephrotic syndrome. Expected results:

4+protein (glomerular membrane to become permeable to protein)

A nurse in a prenatal clinic is assessing a group of clients. Which of the following clients should the nurse request the provider see first?

A client who is at 11 weeks of gestation and reports abdominal cramping (could indicate an ectopic pregnancy or spontaneous abortion)

Client has hyperemesis gravidarum and recieves IV fluid replacment. Which should nurse report to the provider?

BUN 25 mg/dL (elevated, indicates dehydration)

A nurse is performing a physical assessment on a 6-month-old infant. Which of the following reflexes should the nurse expect to find?

Babinski

A nurse is assessing a 30-month-old toddler during a well-child visit. Which of the following findings requires further assessment by the nurse?

Birth weight is tripled

Early manifestation of pertussis

Dry, hacking cough

A nurse is caring for an 8-year-old child who has acute glomerulonephritis. Which of the following should the nurse expect to find with this client?

Elevated red blood cells

18 weeks of gestation, normal finding?

FHR 152/min (FHR is higher earlier in gestation w/ avg of 160/min at 20 weeks gestation) (18-32 weeks height of fundus equal to number of weeks gestation +/- 2 cm)

A nurse is caring for a child who has had a tonsillectomy. Which of the following findings should the nurse give the most attention to 8 hr after surgery?

Frequent swallowing

A nurse is preparing to administer a liquid medication to an infant. Which of the following actions should the nurse take?

Give the medication at the side of the infant's mouth

A nurse is caring for a 4 month old infant who is admitted with a ventricular septal defect (VSD) and undergoing a cardiac catheterization. Post catheterization, which of the following manifestations should alert the nurse to a potential complication?

Groin dressing with small amount of blood noted

A nurse is preparing to administer recommended immunizations to a 2-month-old infant. Which of the following immunizations should the nurse plan to administer?

Haemophilus influenzae type B (Hib) and inactivated polio virus (IPV)

Following a cesarean birth. Which of the following assessments is the nurse's priority?

amount of lochia (greatest risk to client is bleeding and postpartum hemorrhage)

Discharge for client 3 days postpartum. Nonpharamacological intervention for lactation suppression?

apply cabbage leaves to the breasts

36 weeks gestation and has positive contraction stress test. Diagnostic test?

biophysical profile

Amniocentesis at 18 weeks gestation. Which should nurse report to provider as complication?

leakage of fluid from the vagina (could indicate premature leakage of amniotic fluid) (Complications: dec fetal movement)

Indication that newborn is experiencing pain?

chin quivering (behavioral responses to pain include facial expressions; all inc HR, dilated pupils, rapid and shallow respiration)