Family Final Study Set

Risks to the mom when they have gestational dm (6)

a. C-sections b. Hypoglycemia c. DKA d. Preeclampsia e. DM following delivery f. Polyhydramnios

HELLP syndrome risk to mother

a. Liver Hematoma b. Maternal Death c. Renal Failure d. Placenta Abruption

Risks to the fetus due to gestational dm

a. Macrosomia b. Birth injury c. RDS (increase level of insulin delays surfactant production causing delayed lung maturity)

A nurse is caring for a client who follows a vegan diet. What is the most concerning to the nurse? a. lacking B12 b. lacking magnesium c. Lacking calcium d. lacking folic acid

a. lacking B12

A client is experiencing category 3 FHT and is having persistent late decelerations. First intervention

provide intrauterine resuscitation

false labor

Discomfort localized in abdomen; no lower back pain; contractions decrease in intensity or frequency with ambulation

Piaget's Stages of Cognitive Development

1. Sensorimotor: birth-2years old 2. Preoperational: 2-7 years old 3. Concrete Operational: 7-11 years old 4. Formal Operational: 11years old +

Your patient who has sickle cell anemia is admitted for severe pain and is 15 years old. Which med is appropriate?

5-325 mg oxycodone

Autism Behavior Interventions

- modification programs - positive reenforcement - set small realistic goals

Digoxin Level (Therapeutic)

0.5-2.0 ng/mL (held for apical pulse <60, >120)

Safe Sleep

1. Firm mattress and fitted sheet 2. No blankets, pillows, bumpers 3. No soft objects, toys, loose bedding 4. Do not smoke or let anyone smoke around baby 5. Always place on back for sleep 6. Dress baby in light sleep clothing 7. Do not allow baby to sleep in adult bed, couch, or chair alone or with you or anyone else

Kohlberg Stages of Moral Development

1. Preconventional: 2-7 years old 2. Conventional: 7-12 years old 3. Postconventional: 12 years old +

Erikson's Stages of Psychosocial Development

1. Trust: birth-1 years old 2. Autonomy: 1-3years old 3. Initiative: 3-6 years old 4. Industry: 6-12 years old 5. Identity: 12-18 years old 6. Intimacy: 18-35 years old 7. Generativity: 35-60 years old 8. Integrity: 60 years old +

You perform an SVE (Sterile vaginal examination) or cervical exam. You note that she is 2/40/-2. You interpret this as:

2 centimeters dilated, 40 percent effaced, and 2 cm above the ischial spines

Late PPH

24 hours to 6 weeks

When some one is in tractions what do you want to asses?

5 P's Pain Pallor Pulses Paresthesia Paralysis

Athetoid Cerebral Palsy

A type of cerebral palsy in which movements are contorted, abnormal, and purposeless. - involuntary movements - hypo or hyper tonic - worm like movements

Reactive NST

Acceleration > 15 bpm for 15 seconds in 20 minutes

What does a BPP measure? (BATMaN)

B = Breathing movement of the fetus A = Amniotic fluid volume T = Tone of the fetus (muscle tone) M = Movement of the fetus N = Nonstress Test (NST)

What structure provides cushioning and warmth to the fetus? A. The placenta B. Embryonic membranes C. Amniotic fluid D. The umbilical cord

C. Amniotic fluid

epiglottis symptoms

CHILD REFUSES TO SWALLOW AND STRUGGLES TO BREATH, CHEST HAS STRIDOR SOUND

REEDA

Redness Edema Ecchymosis Discharge Approximation

What adverse prenatal outcomes is NOT associated with HELLP syndrome? a. abrupto placenta b. placentae previa c. renal failure d. maternal/fetal demise

b. placentae previa the others are all outcomes that can occur from HELLP syndrome

Strongest indication of true labor?

cervical dilation

avascular necrosis

death of bone tissue due to lack of blood supply

a client had a reactive NST. what is the appropriate action for the nurse?

discharge patient home

Epiglottitis: what should you never do if it is suspected?

do not inspect child's mouth!

What type of deceleration would not be concerning to a nurse?

early

Early PPH

first 24 hours

Homecare instructions for a child in a brace

- Place padding underneath it -Avoid lotions and powders under it (skin breakdown)

Causes of secondary amenorrhea

- Polycystic ovarian syndrome (POS) - pregnancy - endocrine disorders

therapeutic management for DMD?

- ROM

Nursing Assessments for Pitocin

- Strength of contractions - duration on contractions - resting fundal tone, -FHR

Steps to take to prevent cold strss

- apply hat - wrap in blanket - keep newborn away from vents - remove wet clothing immediately

What systems are affected most by Duchenne Muscular Dystrophy

- cardiac - respiratory

intrauterine resuscitation interventions

- change position to side-lying - IV fluids - admin O2

Breastfeeding assesment

- done with every feeding (LATCH SCORE) - ensure nipples are everted

Administering pancreatic enzymes for CF patients

- swallow whole - sprinkled on a small amount of food - always give before meals

best way to remove a tick?

- using tweezers/forceps - pull with steady pressure

fracture of epiphyseal plate

- younger children heal quicker than older children - bone marrow is not lost through the fraction - there is no disruption of blood supply to the bone

What is chorioamnionitis?

infection of the amniotic sac

Congenital Hip Dysplasia

malformation of the acetabulum causing displacement of the femoral head

Ewing sarcoma

malignant tumor that develops from bone marrow, usually in long bones or the pelvis

Number one problem nurses should worry about when caring for a sickle cell patient?

managing pain

Group Beta Streptococcus (GBS) Interventions

- If mom is positive, prophylactic antibiotic therapy will be done during labor to protect the fetus - This is normal bacteria that grows naturally, some women just have more of it - If the mom is positive, its not harmful to her, but we need to try to prevent infection of the baby!

Gross motor skills of 18 month old

- Jumps in place with both feet - Throws ball overhand without falling - Push and pulls

Non-stress Test (NST)

- Looks at FHR patterns and accelerations - Common antepartum surveillance for high-risk populations - Monitored via external FHR monitor - Depending on the situation with mother NST could be done every week or every-other-week

Risk factors for PPH

- Macrosomia - prior PPH - use of Pitocin - obesity

Risk factors for prolapsed cord

- Malpresentation of the fetus - unengaged presenting part - AROM - polyhydramnios

A nurse is working in urgent care and a patient presents with a bat bite. Which of the following is not considered an appropriate intervention? (1) IM injection of human rabies immunoglobulin into proximal wound area (2) TDaP vaccine should be given first (3) wound can be left open to air for healing (4) antibiotic ointment can be used

(2) TDaP vaccine should be given first

The nurse is administering a blood transfusion and notices the following: dyspnea, distended neck veins, and a slight cough. She notes that these are some of the symptoms of? (1) febrile transfusion reaction (2) circulatory overload (3) hemolytic transfusion reaction (4) allergic reaction

(2) circulatory overload

A child presents to the ER and their are leaning forward and thrusting their chin out. The nurse suspects? (1) pharyngitis (2) epiglottis (3) asthma exacerabtion (4) bronchopulmonary dysplasia

(2) epiglottis

risk factors for Reye's syndrome

- Most commonly follows influenza, chicken pox, upper respiratory infection - taking aspirin during illness can cause

Which of the following are components of the Biophysical Profile (BPP)? SATA (1) location of the placenta (2) fetal tone (3) fetal movement (4) amniotic fluid volume (5) fetal breathing movements (6) fetal heart rate

(2) fetal tone (3) fetal movement (4) amniotic fluid volume (5) fetal breathing movements (6) fetal heart rate

A nurse is caring for a child after he had his tonsils removed. Which of the following is not an appropriate intervention? (1) monitor for frequent swallowing- notify physician if occuring (2) child should be prone until fully awake (3) encourage coughing to clear secretions (4) provide child ice chips and popsicles once awake

(3) encourage coughing to clear secretions

Which if the following is not considered a function of amniotic fluid? (1) cushions the developing fetus (2) allows movement of the fetus (3) provides O2 and nutrients to fetus (4) maintains consistent temperature (5) allows for symmetrical development of the limbs

(3) provides O2 and nutrients to fetus

can cephalopelvic disproportion be accurately predicted?

No

A nurse is caring for a patient who has pitocin running for induction of labor. What item should not be included in the nurses assessment? (1) fetal heart tones (2) strength of contractions (3) frequency of contractions (4) cervical length (5) fundal resting tone

(4) cervical length

Which of the following is not a risk factor for a prolapsed umbilical cord? (1) polyhydramnios (2) artificial rupture of membranes (3) malpresentation of the fetus (4) fetal presenting part at 0 station (5) unengaged presenting part

(4) fetal presenting part at 0 station

A child who has a blood disorder is prescribed steroids. Which of the following is not true regarding steroids? (1) steroids can cause fluid retention and weight gain (2) steroids should be given with food (3) sodium intake should be limited (4) steroids can cause fluid and weight loss

(4) steroids can cause fluid and weight loss

Presumptive signs of pregnancy (7)

** Objective = changes that might make a woman think she is pregnant. ** -such as: - amenorrhea - fatigue - nausea - vomiting - polyuria - breast changes(darkened areolae, enlarged Montgomery glands) - quickening( slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).

Pre-conception counseling in patients with DM (2)

- Educate that diet and insulin needs may change throughout pregnancy - Congenital abnormalities in the fetus

s/s of Duchenne Muscular Dystrophy (DMD)

- Gowler sign - delayed motor skills - lordosis - waddling gait - difficulty walking

Select the factors that put a pregnancy in the high risk category! SATA (1) 18 or younger (2) advanced maternal age (3) obesity (4) pregnancy-induced hypertension (5) gestational diabetes (6) multiples (7) history of delviering at 38 weeks

(1) 18 or younger (2) advanced maternal age (3) obesity (4) pregnancy-induced hypertension (5) gestational diabetes (6) multiples

A nurse performs a cervical exam and documents it as 3/50/-2. How do you interpret this assessment? (1) 3 cm dilated, 50 percent effaced, presenting part is 2 cm above the ischial spines (2) 3 cm dilate, 50 percent effaced, presenting part is 2 cm below the ischial spines (3) 5 cm dilated, 30 percent effaced, presenting part is 2 cm above the ischial spines (4) 5 cm dilated, 30 percent effaced, presenting part is 2 cm below the ischial spines.

(1) 3 cm dilated, 50 percent effaced, presenting part is 2 cm above the ischial spines

What are the 5 components of a FHR tracing that must be assessed regularly? SATA (1) baseline rate (2) baseline variability (3) fetal movement (4) accelerations (5) contraction frequency (6) decelerations (7) changes or trends over time

(1) baseline rate (2) baseline variability (4) accelerations (6) decelerations (7) changes or trends over time

The mother has several risk factors for developing GDM. They are listed below. SATA (1) previous birth of a large infant (2) obesity (3) previous birth of a small infant (4) family history of fetal macrosomia

(1) previous birth of a large infant (2) obesity (4) family history of fetal macrosomia

Probable signs of pregnancy (10)

**objective signs to the medical professional** - Chadwick's sign: Bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks - Goodell's sign: Softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks - Hegar's sign: Softening of the lower uterine segment; palpated at 6 weeks - Uterine growth and abdominal growth - Skin hyperpigmentation - Melasma (chloasma), also referred to as the mask of pregnancy: Brownish pigmentation over the forehead, temples, cheek, and/or upper lip - Linea nigra: Dark line that runs from the umbilicus to the pubis - Ballottement: A light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position; occurs at 16 to 18 weeks - Positive pregnancy test results (The tests are extremely accurate but not 100%. There can be both false-positive and false-negative results. Because of this, a positive pregnancy test is considered a probable rather than a positive sign of pregnancy) - Laboratory tests are based on detection of the presence of hCG in maternal urine or blood. (The tests are extremely accurate but not 100%. There can be both false-positive and false-negative results. Because of this, a positive pregnancy test is considered a probable rather than a positive sign of pregnancy.)

Positive signs of pregnancy

*signs only attributed to fetus* - Auscultation of the fetal heart, by 10 to 12 weeks' gestation with a Doppler - Observation and palpation of fetal movement by the examiner after about 20 weeks' gestation - Sonographic visualization of the fetus: Cardiac movement noted at 4 to 8 weeks.

When is Rhogam given?

- 28 weeks - 72 hours of delivery if Mother is (-) and infant is (+)

Important considerations for home care of a chronically ill child, what needs to be done to determine if home care is appropriate?

- Age-appropriate - Necessary equipment at home - Proper training for parents/patient (teach about disease, s/s of infection, how to use equipment, how to give medications, when to seek HCP care, when to seek emergency care)

Fetal Heart Rate Tracing Nomenclature (3)

- Category 1 - Category 2 - Category 3

HELLP syndrome risk to fetus (2)

- Death - Preterm Birth

Pregestational DM

- Educate on the importance of glycemic control prior to conceiving

Treatment for Congenital Hip Dysplasia

- Pavlik Harness - early interventions

Vitamin missing in some vegetarians/vegans

B12

What is Cephalopelvic disproportion (CPD)

Baby does not fit out birth canal

HELLP syndrome

H = hemolysis EL = elevated liver enzymes LP = low platelets

Moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement.

what is the time frame for physiologic jaundice?

after first 24 hours and before first week of life

You are caring for a patient who was dx with bacterial meningitis. what is the patient at risk for developing

seizures

Five essential components of Bishop Score

Position Consistency Effacement Dilation Baby station

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched

Cephalopelvic disproportion risk

Shoulder distortion and Low blood sugar

Most common cause of late PPH

Subinvolution of the uterus

What is the most common cause of LATE PPH?

Subinvolution of the uterus due to retained placental fragments

Contraindication for epidural?

Thrombocytopenia (Low Platelet count)

Physical signs of Scoliosis

Unleveled shoulders and hips Uneven gait

RhoGAM

Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type

VEAL CHOP MINE

V = Variable decelerations E = Early decelerations A = Acceleration L = Late decelerations C = Cord Compression H = Head Compression O = OK! P = Placenta Insufficiency M = Move position I = Initiate secondary measures N = Nothing! E = Emergency Delivery

appropriate actions in regard to interpreters

- introduce to family - use same interpreter if possible - ask one question at a time - speak and look at the patient/patients family

Definition of preterm labor

- labor before 37 completed weeks of gestation - plus regular contractions and cervical dilation

Digoxin toxicity

- nausea - vomiting - diarrhea - blurry yellow vision - arrhythmias - AV block - Can lead to hyperkalemia

Medications for PPH

- pitocin - methergine - hemabate - cytotec

Risk factors for chorioamnionitis?

- prolonged rupture of membranes

which induction medication stimulate contractions and is not used for ripening the cervix?

Pitocin (oxytocin)

Risks for epidural

- reduced movement - maternal hypotension - increase in maternal temp

Lab test for juvenile idiopathic arthritis (JIA)

- rheumatoid factor - c-reactive protein - anti-nuclear antibody testing - CBC w/Diff

Bacterial Meningitis nursing interventions

- seizure precautions

types of cerebral palsy

- spastic - athetoid - ataxic - mixed

treatment for avascular necrosis

- surgery - traction

A client who's blood type is A negative. You are explaining the purpose of RhoGAM. What is the best explanation by the nurse? (1) it inhibits the mother's active immune response (2) changes the maternal blood type to RH positive (3) it determine if fetal blood has entered the maternal bloodstream (4) destroys antibodies

(1) it inhibits the mother's active immune response

Ewings sarcoma and osteosarcoma have similar presentations. The nurse can expect to find? (1) thigh pain and lump over the distal femur (2) necrosis to the hip joint (3) compound fractures below the knee (4) limited ROM to the shoulders

(1) thigh pain and lump over the distal femur

A child comes into the walk in clinic after they had stepped on a rusty nail. Which action is appropriate for the nurse to take first? (1) check immunization record to see when the last TDaP vaccine was given (2) call the physician immediately (3) tell parents that this could be treated at home (4) ask about the length of the nail Clear selection

(1) check immunization record to see when the last TDaP vaccine was given

A patient has delievered via c-section and the nurse suspects a PE? What are the s/s?

- hypotension - tachypnea - decreasing O2 stats

A nurse is teaching parents about their son's circumcision. What would the nurse want to include in the teaching? SATA (1) wash with warm water (2) notify the provider if the entire penis is red and swollen (3) apply petroleum jelly/gauze with every diaper change (4) contact the provider if the infant hasn't voided in 8 hours

(1) wash with warm water (2) notify the provider if the entire penis is red and swollen (3) apply petroleum jelly/gauze with every diaper change

Your client is currently pregnant. She has had a delivery at 38 weeks, a delivery at 41 weeks and a twin delivery at 35 weeks. All children are living. What is her GTPAL? (1) 4-2-2-0-3 (2) 4-2-1-0-4 (3)5-2-1-0-4 (4)5-2-1-0-3

(2) 4-2-1-0-4

Vegetarians and vegans do not not eat meat. What vitamin is the nurse most concerned about? (1) calcium (2) B12 (3) folic acid (5) Fe

(2) B12

Indications of true labor (3)

- contractions are closer - patient is reporting stronger contractions - cervical change has occurred

what is the time frame for pathologic jaundice?

- first 24 hours - after 7 days

you are caring for a patient who is diagnosed with a club foot. What are the appropriate actions for tx?

- follow-up care will be required until the child is full grown - treatment should start ASAP - infant should come in weekly for recasting

peak flow meter (PFM)

-a hand-held device that measures expiratory flow. - record the highest score of three attempts

Which of the following would not be an expected intervention post cardiac catheterization? A. assess color and temp of affected extremity B. remove pressure dressing after 4 hours C. keep affected extremity immobile for 4 to 6 hours D. Have a patent IV in patient until they are discharged home

B. remove pressure dressing after 4 hours

Mixed Cerebral Palsy

Combination of spastic, athetoid or ataxic

Who's at risk for gestational diabetes? A. Obese pregnant women B. History of fetal macrosomia C. Family history of diabetes D. All of the above

D. All of the above

what should be the first intervention by the nurse when they notice the "turtle sign"?

McRoberts maneuvers

Non-reactive NST

NO fetal heart rate accelerations of accelerations less than 15 beats/min or lasting less than 15 seconds throughout any fetal movement during the 40 minute testing period

Description of pediculosis capitus

White sacs attached to hair shafts in occipital region

What is Duchenne Muscular Dystrophy (DMD)?

X-linked recessive disorder resulting from a deficiency of dystrophin, a cytoskeletal protein

rooting reflex

a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple

Ataxic Cerebral Palsy

a form of cerebral palsy marked by a lack of whole balance in the coordination of muscles - lack of balance - Lake of coordination

Spastic Cerebral Palsy

characterized by uncontrolled tightening or pulling of muscles - scissor like gait - leg stiffness

Patient presents to the ER with deed rapid respirations. Priority action by the nurse?

check blood glucose level

Naegele's Rule

count back 3 months from first day of last menstrual period and add 7 days

Amniotic fluid

cushions fetus from sudden movements, prevents developing human from sticking to amniotic membranes, allows freedom of movement, provides consistent thermal environment

plantar reflex

elicited touching the soles of the feet. toes curl downward. (birth to 8 months)

(T/F) a women is not at risk for infection after her water breaks?

false

GTPAL

gravida term births preterm births abortions living children

a patient calls the triage nurse and reports tingling and weakness that started in their legs but seems to be moving up their body quickly. what dx does the nurse suspect?

guillain-barre syndrome

leading cause of death in females

heart disease

After the epidural procedure is complete you lay the patient back down in bed and adjust her electronic fetal monitors. She is now reporting pain at a 3/10 and her legs feel heavier. Her BP is 84/53. You see late decelerations and minimal variability for FHR. You know this is category 2. What could be the cause of the category 2 FHR?

maternal hypotension

A nurse suspects guillain-barre syndrome when speaking with a patient. She tells them to immediately come to the ER, Why?

patient may need medical intervention to help with breathing

What can a patient who has PKU not correctly metabolize?

phenylalanine

Reye's syndrome

potentially serious or deadly disorder in children that is characterized by vomiting and confusion

Disadvantages of the epidural procedure are explained to the woman. She is already aware that she will not be able to get out of bed and move on her own which is worrisome to her. What other concern would you share with her?

she may have a higher body temperature

palmar reflex

the grasping reflex that a newborn infant exhibits when an object is placed in his or her hand

osteo sarcoma

the most common type of bone cancer - malignant tumor arising from bone

Patient who are GBS positive receive antibiotics why?

to protect the baby from getting sick

IM injection site for infants

vastus lateralis (outer thigh)

5 P's of labor

•Powers (contractions) •Passage (pelvis and birth canal) •Passenger (fetus) •Psyche (response of woman) •Position (maternal postures, physical positions)

What is a biophysical profile (BPP)?

•Ultrasounds of fetus is done •Highest score possible is a 10 •Lowest score possible is a 0 (very bad thing)