PEDS/OB TEST #2 Probable test questions from various study guides
Assessment of a postpartum woman experiencing postpartum hemorrhage reveals mild shock. Which of the following would the nurse expect to assess? Select all that apply. A) Diaphoresis B) Tachycardia C) Oliguria D) Cool extremities E) Confusion
A) Diaphoresis D) Cool extremities S/S of mild shock include diaphoresis, increased cap refill, cool extremities and maternal anxiety. Tachycardia and oliguria suggest moderate shock. Confusion suggests severe shock.
A woman gave birth to a healthy term neonate at 1330. It is now 1430 and the nurse has completed the client's assessment. at which time would the nurse assess the client? A. 1445 B. 1500 C. 1530 D. 1830
A. 1500 The woman is in her second hour postpartum. Typically, the nurse would assess Q30. In this case it would be 1500. During the first hour, assessments are usually completed Q15. After the second hour, assessments would be made Q4 for the first 24 hours and then Q8.
A nurse is caring for a child who is receiving treatment for DKA and has a current blood glucose of 250 mg/dL. Which of the following actions should the nurse take? A. Administer 5% Dextrose in 0.9% sodium chloride by continuous IV infusion B. Give potassium as a rapid IV bolus C. Administer 3 units of ultralente insulin SC D. Obtain an HcA1C level stat
A. Administer 5% Dextrose in 0.9% sodium chloride by continuous IV infusion When the child's blood glucose level falls between 250-300 mg/dL, the nurse should begin IV infusion of 5% or 10% dextrose in 0.9% sodium chloride. The goal is to maintain blood glucose levels b/t 120-240 mg/dL. If dextrose is not added, hypoglycemia might occur.
A nurse is reviewing the medical record of a postpartum client. The nurse identifies that the woman is at risk for postpartum infection based on which information? Select all that apply. A. history of diabetes B. labor of 12 hours C. rupture of membranes for 16 hours D. hemoglobin level 10 mg/dL E. placenta requiring manual extraction
A. history of diabetes D. hemoglobin level 10 mg/dL E. placenta requiring manual extraction Risk factors for postpartum infection include history of diabetes, labor over 24 hours, hemoglobin less than 10.5 mg/dL, PROM (more than 24 hours), and manual extraction of the placenta.
A nurse is providing postpartum d/c teaching to a client who is non-lactating about breast discomfort relief measures. Which of the following pieces of information should the nurse include? A. "Wear a loose-fitting bra to alleviate breast discomfort." B. "Place fresh cabbage leaves on your breasts." C. Apply warm, moist compresses to your breasts." D. "Express small amounts of milk from your breasts frequently."
B. "Place fresh cabbage leaves on your breasts." After 3 days postpartum, the client's breasts can become swollen and distended b/c of congestion of the vascular structures of the breasts. Fresh cabbage leaves can be applied to engorged breasts to help relieve breast discomfort. The coolness of the leaves and the phytoestrogens exert a therapeutic effect on engorged breasts. Leaves should be replaced when they become wilted.
A nurse in the ED is caring for an unaccompanied infant following a MCV. During the assessment, the nurse notes that. the infant's anterior fontanel is almost closed. She has 6 teeth, is able to sit unsupported, and can drink from a cup. The child cries whenever anyone new to her enters the room, says a few words, and is asking for "mama" and "dada." The nurse should make which of the following age assessments for this child? A. 6 months old B. 12 months old C. 18 months old D. 24 months old.
B. 12 months old The nurse should know that this infant must be less than 18 months old b/c her anterior fontanel is still open. The infant is approximately 12 months old d/t the presence of 6 teeth. Her skills - sitting unsupported (8 months), drinking well from a cup (9 months), strange anxiety (8 months), and ability to say 2 words (12 months) - should also help the nurse estimate the infant's age as 12 months.
A nurse is caring for a client who had a vaginal delivery 24 hrs ago. Which of the following findings should the nurse report to the provider? A. 2,000mL urine since delivery B. 3+ deep tendon reflexes C. Fundus at umbilicus D. Soft breasts
B. 3+ deep tendon reflexes DTRs of 3+ or greater can indicate preeclampsia and should be reported to the provider.
A nurse is providing d/c instructions for a client who had a c-section 4 days ago. The client's hemoglobin is 9.2 g/dL, and the provider has prescribed an iron supplement. Which of the following foods should the nurse recommend to help increase the client's iron intake? A. spinach B. citrus fruit C. milk D. whole grain bread
B. citrus fruit Foods that have a high vitamin C content help increase the absorption of iron. These foods include citrus fruits, strawberries, melons, and tomatoes.
A nurse is monitoring a newborn for indications of septic shock. Which of the following findings should the nurse expect if the newborn develops this condition? A. slow RR B. decreased BP C. bradycardia D. flushed skin
B. decreased BP The nurse should monitor the BP of a newborn who is at risk for septic shock and should identify decreased BP as an indication of this complication. Other manifestations include tachypnea, mottled or gray-colored skin, cool extremities, and a rapid pulse.
A nurse is visiting a postpartum woman who gave birth to a healthy newborn 5 days ago. Which finding would the nurse expect? A. bright red discharge B. pinkish brown discharge C. deep red mucus-like discharge D. creamy white discharge
B. pinkish brown discharge Lochia serosa is pinkish brown and is expelled 3-10 days postpartum. Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3-4 days after birth. Lochia alba is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content and occurs from days 10-14 but can last 3-6 weeks postpartum.
The nurse is conducting a physical exam of a 9-month-old baby and finds a flat, discolored area on the skin. The nurse documents this as a: A: papule B: macule C: vesicle D. scale
B: macule A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.
A nurse suspects that a client may be developing DIC. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion? A. severe uterine pain B. board-like abdomen C. appearance of petechiae D. inversion of the uterus
C. appearance of petechiae A complication of placental abruption is DIC, which is manifested by petechiae, ecchymoses, and other signs of impaired clotted. Severe uterine pain, a board-like abdoment, and uterine inversion are not associated with DIC and placental abruption.
Hydrocephalus is suspected in a 4-month-old infant. Which would the nurse expect to assess? A. Sunken fontanels B. Diminished reflexes C. lower extremity spasticity D. skull symmetry
C. lower extremity spasticity Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk reflexes, and skull asymmetry.
A nurse is planning care for an infant with an unrepaired myelomeningocele. Which of the following actions should the nurse take? A. fasten the diaper loosely B. cleanse the meningeal sac with providone-iodine daily C. palpate the abdomen for bladder distention D. cover the sac with a dry, sterile gauze dressing
C. palpate the abdomen for bladder distention A neurogenic bladder is a common complication of a myelomeningocele. Even if the infant is having wet diapers, the nurse should assess for bladder distention d/t the possibility of incomplete emptying of the bladder.
A nurse is assessing a school-age child who reports horseback riding 3x/week and has injuries reportedly related to a fall from a horse. Which of the following finding should the nurse investigate further as an indication of child maltreatment? A. bruising of the right elbow B. dislocated left shoulder revealed by x-ray C. thin, frail extremities D. abrasions on both wrists
C. thin, frail extremities The nurse should identify that thin, frail extremities are related to malnourishment and can indicate child maltreatment. The nurse should investigate this finding further and report the results to the provider.
Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage? A. multiparity, age of mother, operative birth B. size of placenta, small baby, operative birth C. uterine atony, placenta previa, operative procedures D. prematurity, infection, length of labor
C. uterine atony, placenta previa, operative procedures Risk factors for PPH include precipitous labor less than 3 hours, uterine atony, placenta previa or abruption, labor induction or augmentation, operative procedures such as vacuum extraction, forceps, or cesarean birth, retained placental fragments, prolonged third stage of labor greater than 30 minutes, multiparity, uterine overdistention wuch as with a large infant, twins, hydramnios.
The parents of a child diagnosed with celiac disease ask the nurse what types of food they can offer their child. What recommendation would the nurse include in the teaching plan? A. Frozen yogurt B. Rye bread C. Creamed spinach D. fruit juice
D. fruit juice
A nurse is caring for a toddler who has a fever, a high-pitched cry, irritability, and vomiting. Which of the following actions should the nurse take? A. Administer 81 mg of aspirin to the toddler B. give the toddler a cold bath C. place the toddler in a supine position D. pad the rails of the toddler's bed
D. pad the rails of the toddler's bed When caring for a toddler who has manifestations of bacterial meningitis, the nurse should implement seizure precautions, which includes padding the side rails of the bed.
A nurse is caring for a school-aged child who has skeletal traction applied to repair a pelvic fracture. Which of the following actions should the nurse take? A. rest the child's traction weights on the floor for 8 hr during the night B. ensure the child's meal tray contains no high-fiber foods C. perform passive ROM exercises on the child's involved joints Q4 D. place the child on a pressure-reduction mattress
D. place the child on a pressure-reduction mattress Placing the child on a pressure-reduction mattress will alleviate the pressure on bony prominences, which decreases the risk of skin breakdown.
A nurse is providing a refresher class for a group of postpartum nurses. The nurse reviews the risk factors associated with PPH. The group demonstrates understanding of the info when they ID which risk factors associated with uterine tone? Select all that apply. A. rapid labor B. retained blood clots C. polyhydramnios D. operative birth E. fetal malposition
A. rapid labor C. polyhydramnios Risk factors associated with uterine tone include polyhydramnios, rapid or prolonged labor, oxytocin use, maternal fever, or PROM. Retained blood clots are a risk factor associated with tissue retained in the uterus. Fetal malposition and operative birth are risk factors associated with trauma of the genital tract.
When assessing the postpartum woman, the nurse uses indicators other than pulse rate and BP for PPH b/c: A. these measurements may not change until after the blood loss is large B. the body's compensatory mechanisms activate and prevent any changes C. they relate more to change in condition than to the amount of blood lost D. maternal anxiety adversely affects these V/S
A. these measurements may not change until after the blood loss is large The typical signs of hemorrhage do not appear in the postpartum woman until as much as 1,800 - 2,100 mL of blood has been lost. In addition, accurate determination of actual blood loss is difficult b/c of blood pooling inside the uterus and on perineal pads, mattresses and the flood.
A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands that after this treatment: A. PaCO2 levels decrease, causing vasoconstriction B. drainage of cerebrospinal fluid occurs C. activity is controlled via a stimulator D. hyper-excitability of the nerve is reduced
A. PaCO2 levels decrease, causing vasoconstriction Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore decreases intracranial pressure. A shunt would allow for drainage of CSf. A vagal nerve stimulator is used to provide an appropriate dose of stimulation to manage seizure activity. Anticonvulsants decrease the hyper-excitability of nerves.
A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? A. dyspnea, diaphoresis, hypotension, and chest pain B. dyspnea, bradycardia, hypertension, and confusion C. weakness, anorexia, change in LOC, and coma D. pallor, tachycardia, seizures, and jaundice
A. dyspnea, diaphoresis, hypotension, and chest pain Sudden unexplained SOB and reports of chest pain along with diaphoresis and hypotension suggest a PE, which requires immediate action. Other S/S include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a PE.
A nurse is providing instructions to the parents of a 3-month-old infant with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement(s) by the parents demonstrates understanding of the instructions? Select all that apply. A. "We need to adjust the straps so that they are snug but not too tight." B. "We should change the diaper without taking our infant out of the harness." C. "We need to check the area behind out infant's knees for redness and irritation." D. "We need to send the harness to the dry cleaners to have it cleaned." E. "We need to call the HCP if our infant is not able to actively kick the legs."
B. "We should change the diaper without taking our infant out of the harness." C. "We need to check the area behind out infant's knees for redness and irritation." E. "We need to call the HCP if our infant is not able to actively kick the legs." Instructions related to the use of a Pavlik harness include changing the child's diapers while in the harness; checking the areas behind the knees and diaper area for redness, irritation or breakdown; and calling the HCP if the child is unable to actively kick the legs. The straps are not to be adjusted without checking with the HCP first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting (no heat) is used.
The parents of a 6-week-old boy come to the clinic for evaluation b/c the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? A. sausage-shaped mass in the upper abdomen B. hard, moveable, olive-shaped mass in the RUQ C. tenderness over the McBurney point in the RLQ D. abdominal pain in the epigastric or umbilical region
B. hard, moveable, olive-shaped mass in the RUQ With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the RUQ. A sausage-shaped mass in the upper abdomen would suggest intussusception. Tenderness over the McBurney point in the RLQ would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.
A nurse is developing a program to help reduce the risk of PPH in clients in the L&D unit. Which measure would the nurse emphasize as part of this program? A. administering broad-specturm antibiotics B. inspecting the placenta after delivery for intactness C. manually removing the placenta at birth D. applying pressure to the umbilical cord to remove the placenta.
B. inspecting the placenta after delivery for intactness After the placenta is expelled, a thorough inspection is necessary to confirm its intactness b/c tears or fragments left inside may indicate an accessory lobe or placenta accreda. These can lead to profuse hemorrhage b/c the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not PPH. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.
After teaching a group of nurses during an in-service program about risk factors associated with PPH, the nurse determines that the teaching was successful when the group identifies which risk factors? Select all that apply. A. prolonged labor B. placenta previa C. null parity D. hydramnios E. labor augmentation
B. placenta previa D. hydramnios E. labor augmentation Risk factors for PPH include precipitous labor less than 3 hours, placenta previa or abruption, multiparity, uterine overdistention wuch as with a large infant, twins, hydramnios, and labor induction or augmentation. Prolonged labor over 24 hours is a risk factor for postpartum infection.
A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they state that: A. children have a proportionately greater amount of body water than do adults B. fever plays a greater role in insensible fluid losses in infants and children C. a higher metabolic rate plays a major role in increased insensible fluid losses. D. the infant's immature kidneys have a tendency to over-concentrate urine
D. the infant's immature kidneys have a tendency to over-concentrate urine The young infant's renal immaturity does not allow the kidneys to concentrate urine as well as in older children and adults, placing them at risk for dehydration or overhydration. Children do have a proportionately greater amount of body water than do adults, and fever plays a greater role in insensible fluid losses in infants and children because children become febrile more readily and their fevers are higher than those of adults. Children also experience a higher metabolic rate, which accounts for increased insensible fluid losses and an increased need for water and excretory function.
A nurse is caring for a newborn who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect and report to the provider? A. weak cry B. absent Moro relfex C. constipation D. tremors
D. tremors Newborns who have neonatal abstinence syndrome can have tremors, tachypnea, nasal flaring, apnea, retractions, incessant crying, frequent yawning and sneezing, mottling of the skin, excessive sucking, vomiting and fevers.
A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which factor would the nurse identify as being a significant contributor to this condition? A. early ambulation B. short duration of labor C. breastfeeding D. use of anesthetics
D. use of anesthetics Factors that inhibit involution include prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine muscles (such as multiple gestation, polyhydramnios, LGA), full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution include complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breastfeeding and early ambulation.
