OB/Peds questions Lippincott Course Point NCLEX

A mother brings her 2-year-old adopted child from an Asian background to the clinic for an initial checkup. The child has been living with the adopted family for several weeks. The nurse notes an irregular area of deep blue pigment on the child's buttocks extending into the sacral area. What should the nurse do?

Do nothing concerning this finding. This lesion is a Mongolian spot, which is common in children of Asian or African heritage.The key word in the description is pigment. A bruise results from bleeding into subcutaneous or muscle tissue; it is not a pigment change in the skin.Notifying social services is inappropriate as this is a normal finding.Asking about the family's discipline style suggests the nurse has interpreted this normal finding as a bruise and not as pigment variation.

The nurse reviews the plan of care for the child with leukemia who is at risk for bleeding. Which intervention would the nurse question?

IM injections For a child with leukemia who is at risk for bleeding, all treatments should be performed gently. However, all injections should be limited or avoided as much as possible to reduce the risk of tissue injury and subsequent bleeding and bruising.Stool softeners are used to facilitate bowel elimination by preventing the passage of hard stool that may damage the rectal mucosa and subsequently lead to bleeding.Frequent position changes in bed help maintain skin integrity and minimize the risk of trauma to the skin, thereby reducing the possibility of bleeding and bruising secondary to this trauma.Visits with friends and siblings are important for adequate growth and development of the child. Visitation would be curtailed if the child were at risk for possible infection secondary to a decreased neutrophil count.

While a 31-year-old multigravida at 39 weeks' gestation in active labor is being admitted, her amniotic membranes rupture spontaneously. The client's cervix is 5 cm dilated, the presenting part is at 0 station, and the electronic fetal heart rate pattern is reassuring. What should the nurse do first?

Note the color, amount, and odor of the amniotic fluid.

A nurse and an LPN are working in the labor and birth unit. Of the activities that must be done immediately, which should the nurse assign to the LPN?

Perform a straight catheterization for protein analysis. The straight catheterization is within the scope of practice of a licensed practical nurse. An initial or continuing assessment is the responsibility of the registered nurse. Assessment must be complete before increasing the IV rate of oxytocin. The assessment and the increase in oxytocin rate are responsibilities for the nurse.

A nurse cares for a woman who gave birth to a term neonate at 0600. At 1600, the woman has a distended bladder and is reporting pain of 5 on a scale of 1 to 10. The nurse reviews the client's output record. What should the nurse do first?

Use an in-and-out catheter to empty the bladder. The client is not emptying her bladder after repeated attempts. The nurse should now use an in-and-out catheter to empty the bladder. While the other comfort measures may be helpful, this client has not completely emptied her bladder since birth and will be at risk for a urinary tract infection and postpartum hemorrhage.

A young child who has been sexually abused has difficulty putting feelings into words. Which approach should the nurse employ with the child?

engaging in play therapy The dolls and toys in a play therapy room are useful props to help the child remember situations and reexperience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but does not help the child express feelings.

A child underwent a tonsillectomy 4 hours ago. Which assessment finding should make the nurse suspect postoperative hemorrhage?

frequent swallowing Frequent swallowing — an attempt to clear the throat of trickling blood — suggests postoperative hemorrhage. Emesis may be brown or blood-tinged after a tonsillectomy; only bright red emesis signals hemorrhage. The child may refuse fluids because of painful swallowing, not bleeding. Hemorrhage is associated with an increased, not decreased, heart rate.

A client is admitted to the facility with nephrotic syndrome. The nurse carefully monitors the client's fluid intake and output and checks urine specimens regularly with a reagent strip. Which finding is the nurse most likely to see?

proteinuria In nephrotic syndrome, the glomerular membrane of the kidneys becomes permeable to proteins, resulting in massive proteinuria. Nephrotic syndrome typically doesn't cause glycosuria or ketonuria. Because the syndrome causes fluids to shift from plasma to interstitial spaces, it's more likely to decrease urine output than to cause polyuria (excessive urine output).

A nurse is assessing a school-age child with diabetes who is experiencing hyperglycemia. Which symptoms indicate that the hyperglycemia requires immediate intervention? Select all that apply.

weakness thirst dizziness Weakness, thirst, and dizziness are symptoms related to dehydration caused by excretion of large amounts of glucose and water in the urine. The nurse should notify the health care provider (HCP). Shakiness, hunger, headache, and irritability are related to hypoglycemia and result from the brain and other cells being starved for nutrients.

A child, age 2, with a history of recurrent ear infections is brought to the clinic with a fever and irritability. To elicit the most pertinent information about the child's ear problems, the nurse should ask the parent:

"Does your child tug at either ear?" A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety.The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge.Tightness in the chest occurs as a result of bronchial spasms.

A nurse is teaching the parents of an infant with heart failure about the administration of furosemide. The parents will be administering the medication to the infant at home. What is the most important information for the nurse to teach the parents about the drug administration?

"It's important to call the clinic if there is no urine output in 8 hours." Furosemide is nephrotoxic, so parents should be taught to notify the healthcare provider if there is no urine output in 8 hours.

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease?

limiting interaction with extended family and friends Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating that the family is dealing with the situation. Participating in social media may serve as a form of support and can be a healthy coping mechanism.

The nurse is caring for an adolescent who has been admitted several times with uncontrolled type 1 diabetes. The child is now stabilized and is preparing for discharge. What should be the priority focus for the nurse when conducting discharge teaching?

management of the therapeutic regimen The priority immediately after recovery is therapy management, including reviewing that the interruption of insulin administration may result in diabetic ketoacidosis. The multiple admissions suggest that the adolescent either does not understand the consequences of the disease or is making choices that are not consistent with the health teaching. This is an opportunity to review those choices.

A multiparous client 48 hours postpartum who is breastfeeding tells the nurse, "I'm having a lot of cramping. This didn't happen when I nursed my first baby." Which would be the nurse's best response?

"The cramping is normal and is caused by your baby's sucking, which stimulates the release of oxytocin." The cramping is caused by the baby's sucking and subsequent stimulation for the release of oxytocin. This cramping is normal. With each subsequent pregnancy, the uterus becomes "stretched" and the release of oxytocin causes the uterus to contract, resulting in the feeling of cramping that can become more severe with each birth. Continued moderate to large amounts of lochia rubra are indicative of retained placental fragments. Cramping indicates that the uterus is contracting and most likely firm. A boggy uterus, continued moderate to heavy lochia, mild vasoconstriction, and restlessness and anxiety suggest delayed postpartum hemorrhage due to subinvolution of the placental site, retained placental tissue, or infection. Most clients receive a standard dose of oxytocin after birth. Oxytocin has a duration of action of 60 minutes. Therefore, the effects of the drug would have worn off by 24 hours postpartum.

At the beginning of a shift, the nurse is assigned to care for four school-age children admitted that day due to an acute asthma exacerbation. Which children should the nurse assess first?

child with oxygen saturation of 93% and no wheezing on auscultation No wheezing on auscultation is an indication that the child is not moving air in and out and is in respiratory distress when the oxygen saturation is 93%. A respiratory rate of 24 breaths/minute in an 8-year-old child is normal. An oxygen saturation of 95% and wheezing noted on auscultation is somewhat of a concern, possibly indicating that the child needs oxygen or needs to clear the airways. However, this finding is a lower priority than no wheezing on auscultation and an oxygen saturation of 93%. The child sometimes forgetting to take medication is a concern but an oxygen saturation level of 93% is a more immediate concern.

A client at a follow-up appointment after having a miscarriage 2 weeks previously yells at the nurse, "How could God do this to me? I've never done anything wrong." Which response by the nurse would be most appropriate at this time?

"I know you're angry. It's so hard to lose your baby." Acknowledging the anger and its source encourages communication about the client's feelings. Although anger at God is common after a loss, the client is displacing the anger that she needs to deal with more directly. Telling the client that the miscarriage was an accident or that she is a strong person and will get through this ignores the client's feelings of anger and loss, thereby cutting off communication.

During a scheduled cesarean birth for a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean birth tend to have an increased incidence of which problem?

respiratory distress syndrome Respiratory distress syndrome is more common in neonates born by cesarean section than in those born vaginally. During a vaginal birth, pressure is exerted on the fetal chest, which aids in the fetal inhalation and exhalation of air and lung expansion. This pressure is not exerted on the fetus with a cesarean birth. Congenital anomalies are not more common with cesarean birth. Pulmonary hypertension occurs more commonly in infants with meconium aspiration syndrome, congenital diaphragmatic hernia, respiratory distress syndrome, or neonatal sepsis, not with cesarean birth. Meconium aspiration syndrome occurs more commonly with vaginal birth, postterm neonate, and prolonged labor, not with cesarean birth.

The nurse is providing teaching to an expectant mother about breastfeeding. What statement made by the mother would require immediate follow-up by the nurse?

"I have been HIV positive for 4 years." A mother who has HIV is strongly discouraged from breastfeeding because of the risk of transmitting the infection to the neonate. Newborns born to HIV-positive mothers are generally treated with the antiviral medication zidovudine for the first 6 weeks after birth. A mother with a history of endometriosis may breastfeed and should not have symptoms of the condition until menses resume. Having a heart murmur may be a benign condition in childhood and is not a contraindication for breastfeeding. A past history of gonorrhea is not a contraindication to breastfeeding.

A 15-month-old client is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the caregivers indicates effective discharge teaching?

"We'll go to the physician if our child pulls on the ears or won't lie down." The caregivers indicate full understanding of discharge teaching by repeating the specific, common signs of otitis media in toddlers, such as pulling on the ears and refusing to lie down, and by verbalizing the need for immediate follow-up care if these signs arise. Expressing that they should have gone to the physician sooner doesn't indicate effective teaching because it implies a sense of guilt - a feeling not promoted through teaching. Stating that they'll take the client to the physician's office every week addresses only weekly follow-up care and expressing that they're happy the problem is behind them is unrealistic because the client's condition may recur.

After giving birth to a viable neonate 12 hours ago, the client's fundus is firm at midline, and her breasts are soft. She has scant lochia and she is voiding sufficiently. The client reports pain in her lower back. What should the nurse do next?

Administer a prescribed mild analgesic. After giving birth, it is not unusual for postpartum clients to have backache, which results from stretching of the muscles during the labor and birth process. The nurse can provide the client with a mild analgesic to help alleviate the backache.The client is not demonstrating any evidence of a urinary tract infection at this time, so calling the primary care provider to obtain a prescription for a urinalysis is not necessary.Although asking the client how long she was in labor may encourage her to discuss her labor and birth experience and provide the nurse with additional information, it will not alleviate the client's backache.On the day of childbirth, it is too soon for the client to begin abdominal exercises.

The nurse is late by over an hour when administering an antibiotic to a child being treated for a urinary tract infection. The antibiotic is prescribed to be given every 4 hours. What action should the nurse take after documenting the medication on the medication administration record?

fill out a medication error/occurrence report Failure to adhere to scheduled administration of a medication such as an antibiotic is a medication error. The nurse should complete a medication error/occurrence report. The nurse should also notify the charge nurse of the error but does not need to do this prior to initiating the proper paperwork. The nurse should adjust the time of the next dose to get the schedule back on track but does not need to involve the pharmacy to do this. The monitoring of the child's response would be done regardless of the time the medication was administered, so it is not relevant to this scenario.

After teaching the parents about the cause of ringworm of the scalp (tinea capitis), which statement by a parent indicates successful teaching?

"It's a fungal infection of the scalp." Ringworm of the scalp is caused by a fungus of the dermatophyte group of the species. Overexposure to the sun would result in sunburn. Mites, such as chiggers or ticks, produce bites on the skin, resulting in inflammation. An allergic reaction commonly is manifested by hives, rash, or anaphylaxis.

A 4-year-old child is admitted for an appendectomy. What is the most appropriate way for the nurse to prepare the child for surgery?

Permit the child to play with the blood pressure cuff, electrocardiogram (ECG) pads, and a face mask. The best way to teach a child about surgery is through play. The nurse can let the child handle the items that will be used for monitoring, such as the blood pressure cuff and the ECG pads. The child will become more familiar with the face masks he sees the surgical team wearing in the operating room after playing with one and wearing it before surgery. A child of this age-group does not understand detailed explanations of how to use equipment, such as a PCA, a VAS, or even a video. The pain scale that should be used for children is the FACES scale.

A child is admitted with a 5-day history of severe vomiting and diarrhea. Which intervention is the priority for the nurse?

administering IV fluids Severe vomiting and diarrhea cause fluid and electrolyte imbalances. Water loss can be greater than sodium loss, causing dangerously high serum sodium levels. Other electrolyte imbalances can occur that may require replacement. Potassium should not be administered until urine output is determined. Monitoring strict intake and output is important, but it assesses dehydration status rather than correcting it. Oral rehydration is started only after fluid and electrolyte corrections have been made. The BRAT diet is no longer recommended for children.

A toddler hospitalized with nephrotic syndrome has marked dependent edema and hypoalbuminemia. His urine is frothy. When assessing the child's vital signs, the nurse should report which finding to the health care provider?

body temperature of 102.8° F (39.3° C) Temperature of 102.8° F (39.3° C) is elevated, suggesting an infection. The nurse should notify the health care provider.The child is displaying signs and symptoms of nephrotic syndrome. With this disorder, blood pressure is characteristically normal or slightly low. The other vital signs are likely to be normal unless edema causes respiratory distress and respirations increase and become labored. The blood pressure reading, heart rate, and respiratory rate here are within the normal range for a toddler.A pulse rate of 85 bpm is normal for a toddler. In nephrotic syndrome, the pulse rate would be normal unless other problems arise.A respiratory rate of 28 is normal for a toddler. In nephrotic syndrome, the respiratory rate would be normal unless edema causes respiratory distress and the respirations increase and become labored.

An adolescent girl is prescribed amoxicillin for an ear infection. The nurse should teach the adolescent about the risks associated with her concurrent use of:

oral contraceptive When a person is taking amoxicillin as well as an oral contraceptive, it renders the contraceptive less effective. Because pregnancy can occur in such a situation, the nurse should advise the client to use additional means of birth control during the time she is taking the antibiotic. There are no risks associated with the concurrent use of amoxicillin and over-the-counter antihistamines, vitamins, or ibuprofen.

The nurse is assessing the development of a 7-month-old. The child should be able to perform which skill?

Sit without support. The majority of infants (90%) can sit without support by 7 months of age. Approximately 75% of infants at 10 months of age are able to play pat-a-cake. The ability to say two words occurs in 90% of children by age 16 months. A child typically can wave bye-bye at about 14 months of age.