Pedi OB Final Prep - Prep U

Discharge planning is being finalized for a neonate who was born at 32 weeks' gestation and was diagnosed with retinopathy of prematurity. What should the nurse tell the parents?

"An ophthalmologist will examine the baby before discharge."

A pregnant client at 36 weeks gestation tells the nurse she has been to see her physician, but doesn't feel that the physician is taking her symptoms of lower extremity edema seriously. Which of the following is the most appropriate response from the nurse?

"Tell me more about your experience with your physician."

A nurse is teaching a new mother about intussusception. Which signs and symptoms should the nurse include?

Abdominal distension and vomiting

Which physiologic change during labor makes it necessary for the nurse to assess blood pressure frequently?

Alterations in cardiovascular function affect the fetus.

Which behavior should cause the nurse to suspect that a client's labor is moving quickly and that the physician should be notified?

An increased sense of rectal pressure

The nurse caring for a multigravida in active labor observes a variable fetal heart rate deceleration pattern. The nurse should first:

Change the client's position.

A client brings her 6-month-old infant in for a well-baby visit. During the exam, the nurse is unable to elicit the Moro reflex. Which of the following is the appropriate action by the nurse?

Explaining to the client that this reflex disappears around 3-4 months

A nurse is caring for four clients who gave birth 12 hours ago. Which client is at greatest risk for complications?

Gravida 2 para 2002, cesarean birth, incision site intact, hemoglobin level 9.8 g/dl

When teaching the mother of a toddler diagnosed with lead poisoning, what should the nurse include as the most serious complication if the condition goes untreated?

neurologic deficits

A 25-year-old primiparous client who gave birth 2 hours ago has decided to breastfeed her neonate. Which instruction should the nurse address as the highest priority in the teaching plan about preventing nipple soreness?

placing as much of the areola as possible into the baby's mouth.

A 36-year-old multipara client is 20 weeks gestation and comes to the prenatal clinic in distress. She has been experiencing edema of her lower extremities and headaches two to three times a week. She is worried about her pregnancy and her own health. What is an appropriate response from the nurse?

"I am glad you came in. We need to do more assessments."

A primiparous client who is bottle-feeding her neonate asks, "When should I start giving the baby solid foods?" The nurse instructs the client to introduce solid foods no sooner than at which age?

6 months

A nurse notices that a large number of clients who receive oxytocin to induce labor vomit as the infusion is started. The nurse assesses the situation further and discovers that these clients received no instruction before arriving on the unit and haven't fasted for 8 hours before induction. How should the nurse intervene?

Initiate a unit policy involving staff nurses, certified nurse-midwives, and physicians in teaching clients before labor induction.

A multigravid client at 34 weeks' gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client's contractions are 20 minutes apart, lasting 20 to 30 seconds. Her cervix is dilated to 2 cm. The nurse reviews prescriptions (see chart). Which prescription should the nurse initiate first?

Initiate fetal and contraction monitoring.

Which goal is a priority after surgical repair of a cleft lip?

Prevent infection.

An adolescent primiparous client 24 hours postpartum asks the nurse how often she can hold her baby without "spoiling" him. Which response would be most appropriate?

"Hold him as much as you want to hold him."

A client is exclusively breastfeeding her 1-week-old infant and is concerned about her baby taking enough milk per day. The client tells the nurse that the infant has six wet diapers per day. Which of the following responses by the nurse is most appropriate?

"That many wet diapers indicates your infant is adequately hydrated."

A multiparous client 48 hours postpartum who is breast-feeding tells the nurse, "I am having a lot of cramping. This did not 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."

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

"We'll go to the physician if our child pulls on the ears or won't lie down."

A 16-year-old client at 10 weeks' gestation has been diagnosed with mild iron deficiency anemia. The client tells the nurse that she doesn't like to eat much meat. Which of the following foods should the nurse suggest to provide the client with the greatest amount of iron in her diet?

1 cup of sunflower seeds.

A nurse is caring for a pediatric client wearing diapers. The nurse must calculate the urine output for the client. The dry diaper weighs 35 g. The wet diaper weighs 250 g. How much urine output has the client had? Record your answer using a whole number.

215 g

At 32 weeks' gestation, a client is admitted to the facility with a diagnosis of gestational hypertension. Based on this diagnosis, the nurse expects the assessment to reveal:

3+ edema in the lower extremities.

While assessing a 2-hour-old neonate, a nurse observes that the neonate has acrocyanosis. Which nursing action should the nurse perform at this time?

Do nothing — acrocyanosis is normal in the neonate.

Initial client assessment information includes: blood pressure 160/110 mm Hg, pulse 88 beats/minute, respiratory rate 22 breaths/minute, reflexes +3/+4 with 2 beat clonus. Urine specimen reveals +3 protein, negative sugar and ketones. Based on these findings, a nurse should expect the client to have which complaints?

Headache, blurred vision, and facial and extremity swelling

A mother brings her 6-week-old infant to the well-baby clinic for a checkup. The nurse plans to begin the examination by assessing the baby's fontanels. In which of the following positions should the nurse place the baby?

Hold the baby in a sitting position and palpate the occipital and frontal areas of the head

A nurse is caring for an infant who is in critical condition. The nurse notes that the child weighs 11 lb (5 kg) and has had a blood loss of 100 mL. Assessment reveals a decreased urine output, mild tachycardia, and restlessness. Which of the following should be the priority action for the nurse to take?

IV administration of lactated Ringer's

The nurse determines that a multigravid client in active labor is about to give birth. The nurse has no attending clinician immediately available. After calling for assistance, which of the following should the nurse do first?

Prepare a clean area on which to receive the neonate.

A nurse is developing a care plan for a client in her 34th week of gestation who's experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor?

Promoting adequate hydration

A client received magnesuim sulfate during labor. Which condition should the nurse anticipate as a potenial problem in the neonate?

Respiratory depression

A client with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is admitted to the labor and delivery unit. The client's condition rapidly deteriorates and despite efforts by the staff, the client dies. After the client's death, the nursing staff displays many emotions. With whom should the nurse-manager consult to help the staff cope with this unexpected death?

The chaplain, because his educational background includes strategies for handling grief

An Iranian mother and father admitted their 13-month-old son to the pediatric unit for treatment of a Wilms' tumor. When the female pediatric oncologist, who is not Muslim, introduced herself, they became uncooperative and refused treatment. The nurse should be aware that this change of behavior is probably related to:

The gender of the physician.

A primiparous client is on a regular diet 24 hours postpartum. She is from Guatemala and speaks only Spanish. The client's mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds, based on the understanding about which principle?

The mother can bring the daughter any foods that she desires.

When administering an oral medication to an infant, the nurse should take which action to decrease the risk of aspiration?

Use an oral syringe to place the medication beside the tongue, and administer the medication slowly.

During the immediate postpartum period, the nurse is caring for a primipara who gave birth to a post-term neonate after oxytocin induction. When developing the client's plan of care, which of the following should the nurse expect to assess for frequently?

Uterine atony.

A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should:

assess the fetal heart rate.

A multigravid client at 38 weeks' gestation is scheduled to undergo a contraction stress test. What should the nurse include in the explanation as the purpose of this test?

assessment of fetal ability to tolerate labor

Which measure would the nurse expect to include in the teaching plan for a multiparous client who gave birth 24 hours ago and is receiving intravenous antibiotic therapy for cystitis?

emptying the bladder every 2 to 4 hours while awake

(see full question) The primary health care provider (HCP) prescribes whole blood replacement for a multigravid client with abruptio placentae. Before administering the intravenous blood product, the nurse should first:

validate client information and the blood product with another nurse.

When developing a teaching plan for the parents of a neonate who is to receive phototherapy, the nurse should tell the parents about which of the following? Select all that apply.

• The vital signs will need to be monitored frequently. • Their baby's eyes will be covered. • They will be able to visit and care for their baby.

For which of the following should the nurse assess in a preterm neonate suffering from cold stress?

Hyperactivity and twitching.

A postpartum primiparous client is having difficulty breastfeeding her infant. The infant latches on to the breast, but the mother's nipples are extremely sore during and after each feeding. The client needs further instruction about breastfeeding when she states:

"As long as some of my nipple is in the baby's mouth, the baby will receive enough milk."

The mother of a 6-month-old reports starting her infant on 2% milk. The nurse should first ask the mother:

"Can you tell me more about the reason you switched your baby to 2% milk?"

A mother is concerned that she might be spoiling her 2-month-old daughter by picking her up each time she cries. Which suggestion should the nurse offer?

"Continue to pick her up when she cries because young infants need cuddling and holding to meet their needs."

A client tells the nurse during a postpartum parenting class that she has switched her 6-month infant from formula to cow's milk to save money on the cost of formula. Which one of the following statements made by the nurse would be the best?

"Cow's milk can be safely given to an infant older than one year of age."

During a postpartum examination, the mother of a 2-week-old infant tearfully tells the nurse she feels very tired and thinks she is not a good mother to her baby. Which statement by the nurse would be best?

"I am concerned about what you are experiencing. Tell me more about what you are thinking and feeling."

After instruction of a primigravid client at 8 weeks' gestation about measures to overcome early morning nausea and vomiting, which client statement indicates the need for additional teaching?

"I will eat two large meals daily with frequent protein snacks."

A bottle-fed infant, age 3 months, is brought to the pediatrician's office for a well-child visit. During the previous visit, the nurse taught the mother about infant nutritional needs. Which statement by the mother during the current visit indicates effective teaching?

"I'm giving the baby iron-fortified formula and a fluoride supplement because our water isn't fluoridated."

Parents of a 3-week-old healthy newborn ask the nurse why their daughter is intermittenly cross-eyed. The nurse's best response is:

"It is normal to have eye crossing in the newborn period."

After teaching the parents of a 15-month-old child who has undergone cleft palate repair how to use elbow restraints, which statement by the parents indicates effective teaching?

"We will remove the restraints temporarily at least three times a day to check his skin, then put them right back on."

The nurse is providing prenatal education regarding microorganisms to be avoided during pregnancy. Which of the following statements during the counseling session would indicate to the nurse that the client understands the teaching?

"Women should avoid unpasteurized milk and cheese and undercooked meat."

The nurse is caring for a client in labor who has tested positive for gonorrhea. Which of the following will the nurse include in the client's plan of care?

Administer erythromycin eye drops to the infant after birth

A 16-year-old primigravida at 36 weeks' gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What should the nurse do upon the client's arrival?

Admit the client to a quiet, darkened room

A neonate born to a primipara at 36 weeks' gestation in a small, rural hospital is to be transferred by ambulance to a level III nursery. To prepare the parents for the transfer, What should the nurse include in the plan of care?

Allow the parents to touch the neonate before transfer

Which item in the care plan for a toddler with a seizure disorder should a nurse revise?

Arm restraints while asleep

Assessment of a nulligravid client in active labor reveals the following: moderate discomfort; cervix dilated 3 cm, 0 station and completely effaced; and fetal heart rate of 136 bpm. Which should the nurse plan to do next?

Assist the client with comfort measures and breathing techniques.

The nurse is preparing to administer a rubella vaccine to a postpartum client before discharge. Which of the following should the nurse caution the client to avoid?

Becoming pregnant for at least 1 month.

Which complication is common in neonates who receive prolonged mechanical ventilation at birth?

Bronchopulmonary dysplasia

A postpartum client has a nursing diagnosis of risk for impaired urinary elimination related to loss of bladder sensation after childbirth. Which of the following priorities outcome criteria should the client achieve?

Client voids more than 30 mL/hour without urinary retention beginning 1 hour after birth.

During the nurse's assessment, the newborn wakes and is in a quiet-alert state. The nurse counts the apical pulse to be 157 beats per minute. Which of the following is the most appropriate nursing action?

Document this finding as on the high end of the normal range and plan to reassess.

A 2-month-old infant has been diagnosed with pyloric stenosis. The infant will undergo a pyloromyotomy to remedy the condition. Prior to the surgery, which of the following conditions represents the most danger to the infant?

Electrolyte imbalance

A nurse is caring for a woman receiving a lumbar epidural anesthetic block to control labor pain. What should the nurse do to prevent hypotension?

Ensure adequate hydration before the anesthetic is administered.

A client's membranes have just ruptured, and the amniotic fluid is clear. Her medical history includes testing positive for human immunodeficiency virus (HIV). The client inquires about having the fetal scalp electrode placed because she's worried about her baby. Which response by a nurse is best?

Explain to the client that fetal scalp electrode application increases the risk of maternal-fetal HIV transmission.

Which of the following information obtained during a health history should the nurse correlate as consistent with the diagnosis of failure to thrive in an infant?

Fussiness during feedings.

A multigravida client has given birth to a large-for-gestational age infant with Apgar scores of 8 and 9. The priority nursing assessment for this infant is for:

Hypoglycemia

A primigravid client in active labor has just received an epidural block for pain. After administration of the epidural block, the nurse should assess the client for:

Hypotension.

After administering bethanechol to a client with urine retention, the nurse monitors the client for adverse effects. Which effect is most likely to occur?

Nausea and vomiting

The administration of medications during infancy is often necessary. The nurse needs to be concerned about the metabolism of these drugs. What concern regarding metabolism should the nurse consider when administering medications to an infant?

Inefficient liver function

The nurse is caring for a laboring client fluent in English, but the client defers to her mother-in-law when asked to sign the hospital consent forms. Which of the following factors contributes to the challenges the nurse faces in obtaining consent?

Influence of the extended family

A client at 27 weeks gestation experiences uterine cramping and also secretes a small amount of bright red bleeding and mucus. The client calls her prenatal clinic nurse. Which of the following recommendations is most appropriate from the nurse?

Instruct the client to go to an emergency room for an urgent assessment.

After a lengthy labor, a primigravid client gives birth to a healthy newborn boy with a moderate amount of skull molding. What information would the nurse include when explaining to the parents about this condition?

It usually lasts a day or two before resolving.

A pregnant client's last menstrual period began on October 12. Using Nägele's rule the nurse calculates the estimated date of delivery (EDD) as:

July 19.

The mother of a toddler asks the nurse what she should do with her toddler when he has a temper tantrum. Which suggestion would be most appropriate?

Leave the toddler alone during the tantrum as long as he is safe.

A client with eclampsia begins to experience a seizure. Which of the following should the nurse do immediately?

Maintain a patent airway.

An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child?

Maintaining a consistent, structured environment

When performing an initial assessment of a postterm male neonate weighing 4,000 g (8 lb, 13 oz) who was admitted to the observation nursery after a vaginal birth with low forceps, the nurse detects Ortolani's sign. Which action should the nurse take next?

Notify the health care provider (HCP) immediately.

Which of the following actions would be appropriate after assessing a neonate's cry as infrequent, weak, and very high-pitched?

Notify the primary care provider because this may indicate a neurologic problem.

A nurse who works in a community-based clinic is implementing primary prevention with the clients who use the clinic. What should the nurse include in primary prevention activities?

Obtaining a rubella titer on a woman who is planning to start a family

A nurse has been providing care to a client in labor for the past 9 hours. The father remains at the bedside while the laboring client is sleeping with the epidural block in situ. Which of the following is the most appropriate nursing action?

Offer to remain with the client while the father takes a short break.

An infant requires tracheal suctioning after the nurse assesses airway congestion. Which of the following is the priority initial action when performing the procedure?

Oxygenation prior to the procedure

A client with a history of drug abuse gives birth to a low-birth-weight neonate who is experiencing drug withdrawal. Which intervention is helpful for this neonate?

Place the isolette in a quiet area of the nursery.

While assessing the fundus of a multiparous client on the first postpartum day, the nurse performs handwashing and dons clean gloves. What should the nurse do next?

Place the nondominant hand above the symphysis pubis and the dominant hand at the umbilicus.

A nurse is caring for a client in the fourth stage of labor. Based on the nurse's note, which postpartum complication has the client developed?

Postpartum hemorrhage.

An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which nursing intervention is most appropriate at this time?

Recommend a pregnancy test after acknowledging the client's distress.

A multigravida in active labor is 7 cm dilated. The fetal heart rate baseline is 130 bpm with moderate variability. The client begins to have variable decelerations to 100 to 110 bpm. What should the nurse do next?

Reposition the client and continue to evaluate the tracing.

A client is 41 weeks gestation and is admitted to the hospital in true labor. She has an external fetal monitor in place. Which of the following does the nurse recognize as a reassuring fetal heart rate (FHR) pattern?

Spontaneous accelerations; FHR increases by 15 beats per minute (bpm) lasting at least 15 seconds

A client who's 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping the client cope with these cramps?

Teaching her to dorsiflex her foot during the cramp

A primigravid client gave birth vaginally 2 hours ago with no complications. As the nurse plans care for this postpartum client, which postpartum goal would have the highest priority?

The client will demonstrate self-care and infant care by the end of the shift.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate?

The fetus isn't in distress at this time.

Which of the following would the nurse expect to find during the physical examination of a preterm male neonate born at 28 weeks' gestation?

Thin, wasted appearance.

While caring for a neonate born at 32 weeks' gestation, which finding would most suggest the infant is developing necrotizing enterocolitis (NEC)?

abdominal distention

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate?

absence of any seizure activity during the first 48 hours

For an infant who's about to undergo a lumbar puncture, the nurse should place the infant in:

an arched, side-lying position, avoiding flexion of the neck onto the chest.

The parents of a healthy infant request information about advance directives. The nurse's best response is to:

ask open-ended questions to understand the parents' concerns.

The nurse is evaluating an infant for auditory ability. What is the expected response in an infant with normal hearing?

blinking and stopping body movements when sound is introduced

A client is in the last trimester of pregnancy. The nurse should instruct her to notify her primary health care provider immediately if she notices:

blurred vision.

Normal lochial findings in the first 24 hours after birth include:

bright red blood.

While caring for a multiparous client 4 hours after vaginal birth of a term neonate, the nurse notes that the mother's temperature is 99.8°F (37.2°C), the pulse is 66 bpm, and the respirations are 18 breaths/min. Her fundus is firm, midline, and at the level of the umbilicus. The nurse should:

continue to monitor the client's vital signs.

The primigravid client is at +1 station and 9 cm dilated. Based on these data, the nurse should first:

encourage the client to breathe through the urge to push.

When preparing for the discharge of a newborn after surgery to correct tracheoesophageal fistula (TEF), the nurse teaches the parents about the need for long-term health care because their child has a high probability of developing which complication?

esophageal stricture

When developing the plan of care for a toddler who has taken an acetaminophen overdose, which intervention should the nurse expect to include as part of the initial treatment?

gastric lavage

Which activity by the mother offers the most support to the child during the first few days after surgery to repair a cleft lip?

holding and cuddling the child

A 3-year-old child with Down syndrome is admitted to the pediatric unit with asthma. The child doesn't enunciate words well and holds onto furniture when he walks. The nurse should ask the mother:

how the child's condition today differs from his normal condition.

A neonate born by cesarean at 42 weeks' gestation, weighing 4.1 kg (9 lb), with Apgar scores of 8 at 1 minute and 9 at 5 minutes after birth, develops an increased respiratory rate and tremors of the hands and feet 2 hours postpartum. What is the priority problem for this neonate?

hypoglycemia

A 31-year-old multigravid client at 39 weeks' gestation admitted to the hospital in active labor is receiving intravenous lactated Ringer's solution and a continuous epidural anesthetic. During the first hour after administration of the anesthetic, the nurse should monitor the client for:

hypotension.

When teaching a group of pregnant adolescents about reproduction and conception, the nurse is correct when stating that fertilization occurs:

in the first third of the fallopian tube.

A 3-year-old is recovering from a concussion. The persistence of which finding would the nurse consider as being a normal finding for a 3-year old?

inability to hop

A registered nurse on the neonatal unit appropriately uses the chain of command when she:

notifies the unit manager of unresolved issues between the nursing unit and housekeeping personnel

The nurse is caring for a newborn of a primiparous woman with insulin-dependent diabetes. When the mother visits the neonate at 1 hour after birth, the nurse explains to the mother that the neonate is being closely monitored for symptoms of hypoglycemia because of which reason?

interrupted supply of maternal glucose and continued high neonatal insulin production

A nurse is reviewing a client's maternal prenatal record and notes that the mother used narcotics during her pregnancy. A primary nursing intervention when caring for a drug-exposed neonate is to:

minimize environmental stimuli.

A 25-year-old primiparous client who gave birth 2 hours ago has decided to breastfeed her neonate. Which instruction should the nurse address as the highest priority in the teaching plan about preventing nipple soreness?

placing as much of the areola as possible into the baby's mouth

The nurse is caring for a client on her second postpartum day. The nurse should expect the client's lochia to be:

red and moderate.

When caring for a client with preeclampsia during labor, the nurse should:

restrict the amount of fluid administered.

A client is concerned that her 2-day-old, breast-feeding neonate isn't getting enough to eat. The nurse should teach the client that breast-feeding is effective if:

the neonate latches onto the areola and swallows audibly.

Prophylactic heparin therapy is prescribed to treat thrombophlebitis in a multiparous client who gave birth 24 hours ago. After instructing the client about the medication, the nurse determines that the client understands the instructions when she states which as the purpose of the drug?

to prevent further blood clot formation

A nurse is providing care for a pregnant client. The client asks the nurse how she can best deal with her fatigue. The nurse should instruct her to:

try to get more rest by going to bed earlier.

A primigravid client has just completed a difficult, forceps-assisted birth of a 9-lb (4.08-Kg) neonate. Her labor was unusually long and required oxytocin augmentation. The nurse who's caring for her should stay alert for:

uterine atony.