question

the infant fears _____ most when hospitalized

answer

separation from loved object

question

the toddler fears _________ most when hospitalized

answer

separation from family

question

the preschooler fears separation as well as ________ when hospitalized

answer

mutilation- remember preschoolers have vivid imaginations... fantasy

question

the toddler and preschooler will think that illness is caused by ______________

answer

something they did wrong

question

the school aged hospitalized child is afraid of separation from ______

answer

age group

question

the school aged child perceives the cause of illness to be external or internal?

answer

external- she knows that illness is not a result of bad behavior

question

the adolescent who is hospitalized fears separation from ___ and loss of _______

answer

peers, loss of independence

question

preschoolers may require physical restraint during painful procedures (t/f)

answer

true

question

which age group engages in stalling tactics before painful procedures most?

answer

school-aged

question

which age groups are most likely to physically resist the nurse during procedures?

answer

school aged, adolescents

question

toddlers may require physical restraint for painful procedures (t/f)

answer

true

question

"The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, ""I don't understand how this could happen to us. We have been so careful to make sure our child is healthy."" Which response by the nurse is most appropriate? "A. ""This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"" B. ""Why do you say that? Do you think that you could have prevented this?"" C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" D. ""Many children are diagnosed with cancer. It is not always life-threatening."""

answer

"Correct Answer: A Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

question

"A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care? "a. Administer tube feedings. b. Offer small, frequent meals. c. Offer fluids only between meals. d. Allow the child to choose what to eat for meals."

answer

"Correct answer: D While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks."

question

A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease? 1 . Elevated vanillylmandelic acid urinary level. 2. The presence of blast cells in the bone marrow 3. The presence of Epsetin-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes

answer

Correct Answer 4 . Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma.

question

"Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting? "A. Fluid and Electrolyte Imbalance B. Alterations in Nutrition C. Alterations in Skin Integrity D. Body Image Disturbances"

answer

"Correct Answer: A While all of the nursing diagnoses listed here are important, dehydration and fluid and electrolyte loss secondary to vomiting is the priority for this client."

question

"A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? "A. Hemorrage B. Anemia C. Infection D. Pain"

answer

"Correct answer: A Hemorrhage The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage."

question

"Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? "1. Measure abdominal girth 2. Claculate BMI 3. Ask the client about his/her height and weight 4. Weigh and measure the client on the day of medication administration"

answer

"Answer: 4 To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration. Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed."

question

"Which diagnostic test should be performed annually after age 50 to screen for colon cancer? "a. Abdominal computed tomography (CT) b. Abdominal X-ray c. Colonoscopy d. Fecal occult blood test"

answer

Answer d: Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of stools, so a fecal occult blood test and CT scan can help establish tumor size and metastasis. A colonoscopy can help to locate a tumor as well as polyps, but is only recommended every 10 years.

question

"David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain? "a. Decreased appetite b. Increased heart rate c. Decreased urine output d. Increased interest in play"

answer

"Correct: D Answer D. One of the most valuable clues to pain is a behavior change: A child who's pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration."

question

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. " "1. Monitor closely for signs of infection. 2. Temp every four hours. 3. Isolation precautions 4. Use a small toothbrush for mouth care"

answer

4. **Correct... Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.

question

"The parent of a child undergoing chemotherapy asks the nurse why the child must wear a mask in public places. Which of the following responses by the nurse would be most appropriate? "A) ""Chemotherapy causes dry mouth, and the mask will help contain moisture."" B) ""Chemotherapy decreases immune system function, increasing the risk of acquiring an infection."" C) ""Chemotherapy makes the oral mucous membranes deteriorate and makes them susceptible to infection."" D) ""Chemotherapy kills cancer cells, and your child might spread those cells to others."""

answer

"Correct: B Chemotherapeutic agents decrease the immunity of the child. Proper use of the mask will decrease the chance of acquiring an infection. Cancer is not spread; a mask cannot contain moisture; and unsightly mouth sores are not a medical reason to wear a mask."

question

A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents? "1. Do not put pressure on the abdomen. 2. Frequent visits from friends and family will improve morale. 3. Appropriate protective equipment should be worn for contact sports. 4. Encourage the child to remain active."

answer

Correct answer: 1. Do not put pressure on the abdomen. Palpation of Wilms' tumor can cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be exposed to more infections, and activity and sports are discouraged because of the risk of rupture of the encapsulated tumor.

question

"A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: "a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass"

answer

"CORRECT: D The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor."

question

The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother? "a.) Appropriate use of sunscreen decreases the risk of skin cancer. b.) Repeated exposure to the sun causes premature aging of the skin. c.) A child's skin is delicate, and burns easily. d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer."

answer

"Correct: A. While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer (a) is the best response."

question

"A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? (Choices were deleted)

answer

Correct: 2. Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.

question

A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child? "A. provide a diet low in protein and high in carboydrates B. avoid fresh vegetables that are not cooked or peeled C. notify the doctor if the child's temp exceeds 101 degrees F D. increase the use of humidifiers throughout the house"

answer

Answer B - fresh vegetables harbor microorganisms, which can cause infections in immune-compromised children, fruit or vegetables should be either peeled or cooked. The physician should be notified of a temp above 100 degrees F. A diet low in protein is not indicated. Humidifiers harbor fungi in the water containers.

question

"The pediatric nurse understands that the most common cancer found in children is: "1. Non-hodgkin's lymphoma 2. Acute lymphocytic leukemia 3. Chronic lymphocytic leukemia 4. Ewing's sarcoma"

answer

"Correct: 2. 1. No - this is not a common cancer in children 2. YES! this is the most common form of cancer found in children is acute lymphocytic leukemia. 3. No - this is not a common cancer in children 4. No - this is not a common cancer in children"

question

"When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most important to avoid which of the following? "A. Measuring the child's chest circumference B. Palpating the child's abdomen C. Placing the child in an upright position D. Measuring the child's occipitofrontal circumference"

answer

"Answer: B. The abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. Children with Wilm's tumor should always be handled gently and carefully. Other answers. The child's head and chest measuring will not affect Wilm's tumor. Repositioning a child in the upright position may cause more pain to the child, but priority this is not worse than disseminating tumor cells."

question

A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to the colo-rectal cancer is necessary if the client identifies which of the following as an associated risk factor? "1. Age younger than 50 years 2. History of coloractal polyps 3. Family history of colorectal cancer 4. Chronic inflammatory bowel disease"

answer

"Correct: 1. Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease."

question

What are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia? "(A) to a private room so she will not infect other patients and health care workers (B) to a private room so she will not be infected by other patients and health care workers (C) to a semiprivate room so she will have stimulation during her hospitalization (D to a semiprivate room so she will have the opportunity to express her feelings about her illness "

answer

"Correct: B. a-— poses little or no threat B(CORRECT:)- protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection c-— should be placed in a room alone d-ensure that patient is provided with opportunities to express feelings about illness"

question

"The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? "a. colorless drainage is to be expected b. analgesics are contraindicated because of altered consciousness c. positioning is on the operative side in the Trendelenberg position d. carefully monitor fluids due to cerebral edema"

answer

"D CORRECT: Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. A. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. B. Analgesics can be used for postoperative pain. C. Child should not be positioned in Trendelenburg position postoperatively."

question

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? "A. Malaise B. Seizures C. Neuropathy D. Lymphadenopathy"

answer

"Answer A is Correct Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers."

question

A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During the course of the nursing assessment, which findings would be expected? Select all that apply. "a) fever. b) painless cervical nodes. c) painful cervical nodes. d) poor appetite. e) complaints of night sweats"

answer

"Answers: b and d (complaints of night sweats, painless cervical nodes.) Painless cervical nodes are a hallmark sign of HD. In addition to this, night sweats also are characteristic. Fever, poor appetite, and painful cervical nodes are more characteristic of infection."

question

"A nurse is performing an assessment on a 10-year old child suspected having Hodgkin's disease. The nurse understands that which of the following assessment findings is characteristic of this disease? "a) fever and malaise b) anorexia and weight loss c) painful, enlarged inguinal lymph nodes d) painless, firm, and movable adenopathy in the cervical area"

answer

"D. painless, firm, and movable adenopathy in the cervical area - Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders."

question

"The nurse is admitting a patient who is jaundiced due to pancreatic cancer. The nurse should give the highest priority to which of the following needs? "1. Nutrition 2. Self-image 3. Skin integrity 4. Urinary elimination"

answer

"Correct: 1. 1. profound weight loss and anorexia occur with pancreatic cancer. Correct. 2. jaundiced patients are concerned about how they look, but physiological needs take priority 3. jaundice causes dry skin and pruritis, scratching can lead to skin breakdown 4. urine is dark due to obstructive process, kidney function is not affected"

question

"The mother of a 4 year old child brings the child to the clinic and tells the pediatric nurse specialist that the child's abdomen seems to be swollen. During further assessment of the subjective data, the mother tells the nurse that the child has been eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of a Wilm's tumor, would avoid which of the following during the physical assessment? "1. Palpating the abdomen for a mass. 2. Assessing the urine for hematuria 3. Monitoring the temperature for presence of fever 4. Monitoring the blood pressure for presence of hypertension"

answer

"Answer: 1 Rationale: Wilm's tumor is the most common intra-abdominal and kidney tumor of childhood. If Wilm's tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause the seeding of the tumor and spread of cancerous cells. Fever, hematuria, and hypertension are all clinical manifestations of Wilm's tumor."

question

"A 9-year old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is: "1. There is no need to be concerned. 2. Bring the child into the clinic for a vaccine. 3. Keep the child out of school for 2 week period. 4. Monitor the child for an elevated temperature, and call the clinic if this happens."

answer

"Correct anwser: 2. Rationale: immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the chances of developing the disease."

question

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? "1.Infection. 2.Anemia. 3.Nutrition. 4.Grieving."

answer

"Correct: 4. Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration."

question

A client is admitted to the hospital for a colon resection and in preparation for surgery the physician orders neomycin. The nurse understands the main reason why this antibiotic is especially useful before colon surgery is because it: "A. Will not affect the kidneys B. Acts systemically without delay C.Has limited absorption from the GI tract. D.Is effective against many different organisms "

answer

"ANSWER:C Because neomycin is limited absorption form the GI tract, it exerts it antibiotic effect on the intestinal mucosa. In preparation of GI surgery, the level of microbial organisms will be reduced."

question

"A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to: "a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"

answer

"CORRECT: Answer A. The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn't act in the manner described in the other options."

question

"After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia?" "A) ""The disease is an infection resulting in increased white blood cell production."" B) ""The disease is a type of cancer characterized by an increase in immature white blood cells."" C) ""The disease is an inflammation associated with enlargement of the lymph nodes."" D) ""The disease is an allergic disorder involving increased circulating antibodies in the blood."""

answer

"CORRECT: B. Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells."

question

"A 10 year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer an: "A. injection of factor X B. intravenous infusion of iron C. intravenous infusion of factor VIII D. intramuscular injection of iron using the Z track method"

answer

"CORRECT: C Hemophila refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. the primary meds used are to replace missing clotting factor. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the bleeding,"

question

When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? "a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea"

answer

Answer D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.

question

The nurse understands a primary step toward achievement of a long range goal associated with the rehabilitation of a client with a new colostomy is: "A. Mastery of techniques of colostomy care B. Readiness to accept an altered body function C. Awareness of available community resources D.Knowledge of the neccessary dietary modifications.

answer

"ANSWER: B The client must be ready to accept changes in body image and function; this acceptance will facilitate mastery of the techniques of colosotomy care and optimal use of community resources."

question

"Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? "a) Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. b) Infiltration will not occur unless superficial veins are used for the intravenous infusion. c) Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. d) Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary."

answer

"CORRECT c. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. a. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. b. Infiltration and extravasations are always a risk, especially with peripheral veins. d. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward."

question

A nurse is discussing childhood cancer with the parents of a child in an oncology unit. Which statement by the nurse would be the most accurate? "A. ""The most common site for children's cancer is the bone marrow."" B. ""All childhood cancers have a high mortality rate."" C. ""Children with leukemia have a higher survival rate if they are older than 11 when diagnosed."" D. ""The prognosis for children with cancer isn't affected by treatment strategies."""

answer

"Correct: A. Childhood cancers occur most commonly in rapidly growing tissue, especially in the bone marrow. Mortality depends on the time of diagnosis, the type of cancer, and the age at which the child was diagnosed. Children who are diagnosed between the ages of 2 and 9 consistently demonstrate a better prognosis. Treatment strategies are tailored to produce the most favarable prognosis. (NCLEX-RN Questions & Answers, made Incredibly Easy)"

question

What assessment finding would the nurse expect to find specifically for a client admitted with Hodgkin's disease? "1. Fatigue 2. weakness. 3. Weight gain 4. Enlarged lymph nodes."

answer

Correct: 4. Enlarged lymph nodes with progression to extralymphatic sites. This is a characteristic specifically to lymphoma, where as fatigue and weakness can occur with other diseases. Weight loss is more likely than weight gain.

question

"What is a characteristic manifestation of Hodgkin's Disease? "1.) petechiae 2.) erythematous rash 3.) enlarged lymph nodes 4.) pallor"

answer

Correct: #3 "Knowledge of the usual pattern of spread of this lymphoma, with its orderly progression through lymph node groups and its typical forms of extranodal involvement, facilitates timely diagnosis, staging, and treatment planning".

question

"A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is essential to: "A. Request a low-salt diet B. Restrict fluids C. Educate the family regarding renal transplants D. Prevent urinary tract infections"

answer

Answer D is correct. Because the child has only one remaining kidney, it is important to prevent urinary tract infections. Answers A, B, and C are not necessary, so they are incorrect.

question

"The goals of cancer treatment are based on the principle that "a. surgery is the single most effective treatment for cancer. b. initial treatment is always directed toward cure of the cancer. c. a combination of treatment modalities is effective for controlling many cancers. d. although cancer cure is rare, quality of life can be increased with treatment modalities. "

answer

"Correct answer: C Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy)."

question

"After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following? "a. Advise the client to rest and avoid exertion b. Prevent client exposure to infections c. Monitor the blood pressure frequently d. Observe for increased bruising"

answer

"Correct Answer: B. Prevent client exposure to infections Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding."

question

A preschool-aged child is to undergo several painful procedures. Which of the following techniques is most-appropriate for the nurse to use in preparing the child? "A. Allow the child to practice injections on a favorite doll. B. Explain the procedure in simple terms. C. Allow a family member to explain the procedure to the child. D. Allow the child to watch an educational video."

answer

"Answer: B Preschoolers have the cognitive ability to understand simple terms. Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might perceive the doll is experiencing pain."

question

Which condition assessed by the nurse would be an early warning sign of childhood cancer? 1. difficulty swallowing 2. nagging cough or hoarseness 3. slight changes in bowel and bladder function 4. swelling, lumps, masses on body

answer

"Correct: 4. Swelling or lumps or masses anywhere on the body are early warning signs whereas difficulty swallowing or cough or hoarseness are signs of cancer in adults. there may be a marked sign in changes to bowel or bladder function, not a slight change"

question

A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? "a. ""The cells in your tumor do not look very different from normal bowel cells."" b. ""The tumor cells have DNA that is different from your normal bowel cells."" c. ""Your tumor cells look more like immature fetal cells than normal bowel cells."" d. ""The cells in your tumor have mutated from the normal bowel cells."""

answer

"Correct Answer: C Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue."

question

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? "1. child's WBC count goes up. 2. child's WBC count goes down. 3. child's temperature remains within normal range. 4. parents demonstrate good hand washing technique."

answer

CORRECT is #3 - RATIONALE: in leukemia, the WBCs that are present are immature and incapable of fighting infection. increases or decreases in the number of WBCs can be related to the disease process and treatment, and not related to infection. the only value that indicates the child is infection-free is the temperature. the use of proper handwashing technique is a measure or intervention used to meet a goal. but is not a goal itself. STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client who is immunosuppressed from leukemia. recall that temperature and WBC counts are frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so choose the option related to temperature.

question

A pediatric nurse specialist provides a teaching session to the nursing staff regarding osteogenic sarcoma. Which statement by a member of the nursing staff indicates a need for clarification of the information presented? "1.) ""The femur is the most common site of this sarcoma."" 2.) ""The child does not experience pain at the primary tumor site."" 3.) ""Limping, if a weight-bearing limb is affected, is a clinical manifestation."" 4.) ""The symptoms of the disease in the early stage are almost always attributed to normal growing pains."""

answer

"2.) ""The child does not experience pain at the primary tumor site."" (CORRECT ANSWER--Need for further clarification). Osteogenic sarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur (omit #1). Osteogenic sarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site (correct answer: #2). By the time these children receive medical attention, they may be in considerable pain from the tumor. All options: 1, 3, 4 are accurate regarding osteogenic sarcoma. "

question

"A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? "A) The tumor is less than 3 cm. in size and requires no chemotherapy. B) The tumor did not extend beyond the kidney and was completely resected. C) The tumor extended beyond the kidney but was completely resected. D) The tumor has spread into the abdominal cavity and cannot be resected."

answer

"1. Answer: C The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis."

question

"The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? "a. Petechiae, fever, fatigue b. Headache, papilledema, irritability c. Muscle wasting, weight loss, fatigue d. Decreased intracranial pressure, psychosis, confusion"

answer

"Correct answer: A Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia. The other options are not signs of bone marrow involvement."

question

A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which of the following findings is most specifically related to this type of tumor? "1. Elevated vanillylmandelic acid (VMA) urinary levels 2. Presence of blast cells in the bone marrow 3. Projectile vomiting, usually in the morning 4. Postive Babinski's sign"

answer

ANSWER: 1 Rationale: Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.

question

"The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? "1. Survival for Hodgkin's disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is ﬁne for primary Hodgkin's, but secondary cancers occur within a year."

answer

"1. Up to 90% of clients respond well to standard treatment with chemotherapy and radiation therapy, and those who relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis (correct). 2. Investigational therapy regimens would not be recommended for clients initially diagnosed with Hodgkin's disease because of the expected prognosis with standard therapy 3. Clients usually achieve a signiﬁcantlylonger survival rate than six (6) months.Many clients survive to develop long-termsecondary complications. 4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin'sdisease has occurred."

question

An adolescent with a history of surgical repair for undescended testes comes to the clinic for a sport physical. Anticipatory guidance for the parents and adolescent would focus on which of the following as most important? "a) the adolescent sterility b) the adolescent future plans c) technique for monthly testicular self-examinations d) need for a lot of psychosocial support"

answer

"Answer C Because the incidence of testicular cancer is increased in adulthood among children who have undescended testes. It is extremely important to teach the adolescent how to perform the testicular self-examination monthly."

question

The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy? a. Painless vaginal bleeding b. Abdominal cramping c. Throbbing pain in the upper quadrant d. Sudden, stabbing pain in the lower quadrant

answer

Answer D is correct. The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Painless vaginal bleeding is a sign of placenta previa, abdominal cramping is a sign of labor, and throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy, making answers A, B, and C incorrect.

question

A client telephones the emergency room stating that she thinks that she is in labor. The nurse should tell the client that labor has probably begun when: a. Her contractions are 2 minutes apart. b. She has back pain and a bloody discharge. c. She experiences abdominal pain and frequent urination. d. Her contractions are 5 minutes apart.

answer

Answer D is correct. The client should be advised to come to the labor and delivery unit when the contractions are every 5 minutes and consistent. She should also be told to report to the hospital if she experiences rupture of membranes or extreme bleeding. She should not wait until the contractions are every 2 minutes or until she has bloody discharge, so answers A and B are incorrect. Answer C is a vague answer and can be related to a urinary tract infection

question

Which of the following instructions should be included in the nurse's teaching regarding oral contraceptives? a. Weight gain should be reported to the physician. b. An alternate method of birth control is needed when taking antibiotics. c. If the client misses one or more pills, two pills should be taken per day for 1 week. d. Changes in the menstrual flow should be reported to the physician.

answer

Answer B is correct. When the client is taking oral contraceptives and begins antibiotics, another method of birth control should be used. Antibiotics decrease the effectiveness of oral contraceptives. Approximately 5-10 pounds of weight gain is not unusual, so answer A is incorrect. If the client misses a birth control pill, she should be instructed to take the pill as soon as she remembers the pill. Answer C is incorrect. If she misses two, she should take two; if she misses more than two, she should take the missed pills but use another method of birth control for the remainder of the cycle. Answer D is incorrect because changes in menstrual flow are expected in clients using oral contraceptives. Often these clients have lighter menses.

question

A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that: a. FSH and LH are released from the anterior pituitary gland. b. FSH and LH are secreted by the corpus luteum of the ovary c. FSH and LH are secreted by the adrenal glands d. FSH and LH stimulate the formation of milk during pregnancy.

answer

a. FSH and LH are released from the anterior pituitary gland. FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.

question

A woman who's 36 weeks pregnant comes into the labor & delivery unit with mild contracts. Which of the following complications should the nurse watch out for when the client informs her that she has placenta prevue? a. sudden rupture of membranes b. vaginal bleeding c. emesis d. fever

answer

b. vaginal bleeding contractions may disrupt the microvascular network in the placenta of a client with placenta prevue and result in bleeding. If the separation of the placenta occurs at the margin of the placenta, the blood will escape vaginally. Sudden rupture of the membranes isn't related to placenta prevue. Fever would indicate an infectious process, and emesis isn't related to placenta previa

question

A 21y.o. client has been diagnosed with hydatidiform mole. Which of the following factors is considered a risk factor for developing hydatidiform mole? 1. age in 20s or 30s 2. high in SES 3. Primigravida 4. prior molar gestation

answer

4. previous molar gestation increases risk for developing subsequent molar gestation by 4-5 times. Adolescents and women ages 40+ are at increased risk for molar pregs. MULTIGRAVIDAS, esp women with prior preg loss, and women with LOWER SES are at increased risk for this problem.

question

A 21 y.o. has arrives to the ER with c/o cramping abdominal pain and mild vaginal bleeding. Pelvic exam shows a left adnexal mass that's tender when palpated. Culdocentesis shows blood in the culdesac. This client probably has which of the following conditions? 1. Abruptio placentae 2. Ecoptic pregnancy 3. Hydatidiform mole 4. Pelvic Inflammatory Disease

answer

2. Ecoptic pregnancy most ecoptic pregnancies dont appear as obvious life threatening med emergencies. THey must be considered in any sexually active woman of childbearing age who c/o menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding. PID, abruptio placentae and hydatidiform moles wont show blood in the cul de sac

question

A client, 34 weeks pregnant, arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client denies vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decels. The client most likely has which of the following?

answer

1. Abruptio placentae a client w/ severe abruptio placentae will often have SEVERE abdominal pain. The uterus will have increased tone w/ little to no return to resting tone btw/ contractions. The fetus will start to show signs of distress, with decels in the HR or even fetal death w/ large placental separation. Placenta previa usually involves PAINLESS vaginal bleeding w/out UCs. A molar preg. generally would be detected before 34 weeks gestation. An ecoptic preg. which usually occurs in the FALLOPIAN TUBES, would rupture well before 34 weeks gestation

question

Before the placenta functions, the corpus luteum is the primary source for synthesis of which of the following hormones? 1. cortisol and thyroxine 2. estrogen and progesterone 3. LH and FSH 4. T4 and T3

answer

2. estrogen and progesterone The CL produces progesterone and estrogen for the 1st 8-10 weeks of pregnancy until the placenta takes over this function. The high levels of estrogen and progesterone cause suppression of LH and FSH. T4 and T3 are produced in the adrenal gland

question

Which of the following changes in resp functioning during pregnancy is considered normal? 1. increased tidal volume 2. increases expiratory volume 3. decreased inspiratory capacity 4. decreased oxygen consumption.

answer

1. increased tidal volume a pregnant client breathes deeper, which increases the tidal volume of gas moved in and out of the respiratory tract w/ each breath. The expiratory volume and residual volume DECREASE as the preg. progresses. The inspiratory capacity INCREASES during preg. The increases oxygen consumption in the preg client is 15-20% greater than in the nonpreg state

question

Which of the following conditions is common in pregnant clients in the 2nd trimester of preg? 1. mastitis 2. metabolic alkalosis 3. physiologic anemia 4. respiratory acidosis

answer

3. physiologic anemia Hgb and Hct values DECREASE during preg as the INCREASE in plasma volume exceeds the increase in RBC production. Alterations in acid-base balance during pregnancy result in a state of resp. alkalosis, compensated by mild metabolic acidosis. Mastitis is an infection in the breast characterized by a swollen tender breast and flu like Sx. this condition is most freq. seen in breast feeding clients.

question

a 21 y.o. client, 6 weeks pregnant, is diagnosed with hyperemesis gravidum. This excessive vomiting during pregnancy will often result in which of the following? 1. bowel perforation 2. electrolyte imbalance 3. miscarriage 4. PIH

answer

2. ELECTROLYTE IMBALANCE Excessive vomiting in clients with hyperemesis grav often causes weight loss / fluid and electrolyte, acid base imbalance. PIH and bowel perforation arent r/t hyper grav the effects of hyper grav on the fetus depend on the severity of the disorder. clients w/ severe hyper grav may have low birth weight infant, but the disorder isnt life threatening to the fetus.

question

a client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum. WHich of the following factors predisposes a client to the development of this? 1. trophoblastic disease 2. maternal age > 35 y.o. 3. malnourished or underweight clients 4. low levels of HCG

answer

1. Trophoblastic disease is associated w/ hyperemesis grav obesity and maternal age younger than 20 y.o. are risk factors too. High levels of estrogen HCG have also been associated with the development.

question

Clients with gestational diabetes are usually managed by which of the following therapies? 1. diet 2. long acting insulin 3. oral hypoglycemic drugs 4. oral hypoglycemic drugs/insulin

answer

1. diet oral hypoglycemics are contraindicated in preg. long acting insulin usually inst needed for blood glucose control in the client with GDM

question

Rh isoimmunization in a pregnant client develops during which conditions? 1. Rh positive maternal blood crosses into fetal blood, stimulating fetal antibodies. 2. Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies. 3. Rh Negative fetal blood crosses into maternal blood, stimulating maternal antibodies. 4. Rh negative maternal blood crosses into fetal blood, stimulating fetal antibodies.

answer

2. Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh isoimmunization occurs when Rh positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies w/ Rh positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy fetal blood cells.

question

Which of the following doses of Rh immune globulin RhoGAM is appropriate for a pregnant client at 28 weeks gestation? 1. 50 mcg in a sensitized client 2. 50 mcg in an unsensitized client 3. 300 mcg in a sensitized client 4. 300 mcg in a unsensitized client

answer

4. 300 mcg in a unsensitized client An Rh negative unsensitized woman should be given 300 mcg of RhoGAM at 28 weeks after an indirect Coombs test is done to verify that sensitization hasn't occurred. For a 1st trimester abortion or ectopic pregnancy, 50 mcg of RhoGAM is given.

question

A client hospitalized for premature labor tells the nurse she's having occasional contractions. Which of the following nursing interventions would be the most appropriate? 1. Teach the client the possible complications of premature birth. 2. Tell the clients to walk to see if she can get rid of the contractions. 3. Encourage her to empty her bladder and drink plenty of fluids, IV fluids 4. Notify anesthesia for immediate epidural placement to relieve the pain associated with contractions.

answer

3. Encourage her to empty her bladder and drink plenty of fluids, IV fluids An empty bladder and adequate hydration may help decrease or stop labor contractions. Walking may encourage contractions to become stronger. Teaching the potential complications is likely to increase the clients anxiety rather than relax her It would be inappropriate to call anesthesia

question

The phrase gravida 4, para 2 indicated which of the following prenatal histories? 1. a client has been pregnant 4 times and had 2 miscarriages. 2. a client has been pregnant 4 times and had 2 live born children 3. a client has been pregnant 4 times and had 2 c-sections 4. a client has been pregnant 4 times and 2 spontaneous abortions.

answer

2. a client has been pregnant 4 times and had 2 live born children Gravida refers to the number of times a client has been pregnant. Para refers to the # of viable children born. Therefore, the client who's gravida 4, para2 has been pregnant 4x and had 2 live born children.

question

Which of the following factors would contribute to a high risk pregnancy? 1. Blood type O positive 2. first pregnancy at age 33y.o. 3. Hx of allergy to honey bee pollen 4. Hx of insulin dependent DM

answer

4. a woman w/ a hx of diabetes has an increased risk for perinatal complications, including HTN, preeclampsia, and neonatal hypoglycemia. The age of 33 years w/out other risk factors doesn't increase risk, nor does type O positive blood or environmental allergens.

question

Which of the following complications can be potentially life threatening and can occur in a client receiving a tocolytic agent? 1. diabetic ketoacidosis 2. hyperemesis gravidarum 3. pulmonary edema 4. sickle cell anemia

answer

3. pulmonary edema Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Clients who dont have diabetes dont need to be observed for diabetic ketoacidosis. Hyperemesis gravidium doesnt result from tocolytic use. Sickle cell anemia is an inherited genetic condition and doesnt develop spontaneously

question

Which of the following hormones would be administered for the stimulation of uterine contractions? 1. Estrogen 2. Fetal cortisol 3. Oxytocin 4. Progesterone

answer

Oxytocin is the hormone responsible for stimulating UCs. Pitocin, the synthetic form, may be given to clients who are past their due date. Progesterone has a relaxation effect on the uterus Fetal cortisol is believed to slow the production of progesterone by the placenta although estrogen has a role in UC, it isnt given in a synthetic form to help UC

question

Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged? 1. conception 2. 9 weeks gestation when the fetal heart is well developed 3. 32-34 weeks gestation 3rd Trimester 4. maternal and fetal blood are never exchanged

answer

4. maternal and fetal blood are never exchanged only nutrients and waste products are transferred across the placenta. blood exchange never occurs complications and some medical procedures can cause an exchange to occur accidentally

question

Which of the following rationales best explains why a pregnant client should lie on her left side when resting or sleeping in the later stages of pregnancy? 1. to facilitate digestion 2. to facilitate bladder emptying 3. to prevent compression of vena cava 4. to avoid fetal anomalies

answer

3. to prevent compression of vena cava the weight of the preg uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, possibily decreasing oxygen to the fetus. The side lying position hasnt been shown to prevent fetal anolmaies nor bladder emptying and or digestion

question

Because uteroplacental circulation is compromised in clients with preeclampsia, a NST is performed to detect which conditions? 1. Anemia 2. Fetal well being 3. IUGR 4. oligohydarminos

answer

An NST is based on the theory that a healthy fetus will have transient fetal heart rate accelerations with fetal movement. A fetus with compromised uteroplacental circulation usually wont have these accelerations, which indicate a nonreactive NST. Serial US wil detect IUGR and oligohydramnios in a fetus. An NST cant detect anemia in a fetus

question

A client is 33 weeks pregnant and has had diabetes since she was 21. When checking her fasting blood sugar level, which values indicate the clients disease was controlled. 1. 45 mg/dl 2. 85 mg/dl 3. 120 mg/dl 4. 136 mg/dl

answer

2. 85 mg/dl recommended fasting blood sugar levels in pregnant clients w/ dm are 60-90 mg/dl a fasting blood sugar level of 45mg/dl is low and may result in hypoglyecemia a bs level below 120mg/dl is recommeded for 1hour postprandial values a bs level above 136 mg/dl in a pregnant client indicates hyperglycemia

question

Which of the following is best to monitor a fetus of a client with diabetes in her 3rd trimester 1. US exam weekly 2. NST 2x/week 3. Daily contraction stress test at 32 weeks 4. monitoring fetal activity by client weekly

answer

2. NST 2X/week NST is the preferred antepartum HR screening test for pregnant clients with diabetes. NSTs should be done at least 2x per week staring at 32 weeks gestation, as fetal deaths in clients w/ diabetes have been noted within 1 week of a reactive NST. US should be done ever 4-6 weeks to monitor fetal growth. CST wouldnt be initiated at 32 weeks Maternal fetal activity monitoring should be done daily

question

A client diagnosed with preterm labor at 28 weeks gestation. Later, she comes to the emergency dept saying "I think im in labor" The nurse would expect her physical exam to show which condition? 1. painful contractions with no cervical dilation 2. regular uterine contractions with cervical dilation 3. irregular uterine contractions with no cervical dilation 4. irregular uterine contractions with cervical effacement

answer

2. regular uterine contractions (every 10 min or more) along with cervical dilation change before 36 weeks = PTL no cervical change with UC isnt' PTL

question

Which drug would the nurse choose to utilize as an antagonist for magnesium sulfate? 1. Oxytocin 2. Terbutaline 3. Calcium gluconate 4. Narcan

answer

3. Calcium gluconate should be kept at the bedside while a client is recieivng mag sulfate infusion. If magnesium toxicity occurs, calcium gluconate is admined as an antidote oxytocin is the synthetic form of the naturally occurring pituitary hormone used to initiate or augment UCs Terbutaline is a beta2 adrenergic agonist that may be used to relax smooth muscle of the uterus, esp for PTL and uterine hyperstimulation Naloxone is an opiate antagonist admin to reverse resp distress

question

The nurse receives an order to start an infusion for a client whos hemorrhaging due to a placenta previa. What supplies will be needed? 1. Y tubing, normal saline solution, and 20G cathether 2. Ytubing, lactated Ringers solution and 18G cath 3. Y tubing, normal saline, 18G cath 4. Y tubing, lactated RIngers, 20G cath

answer

3. Y tubing, normal saline, 18G cath blood transfusions require Y tubing Normal Saline solution to mix with the blood product and an 18G cath to avoid lysing breaking the RBCs. A 20G cath lumen isnt large enough for a blood transfusion. Lactated RIngers solutions isnt the IV solution of choice for blood transfusions

question

During the last 6 weeks of gestation, which of the following tests isnt used to determine FWB? 1. BPP 2. NST 3. Maternal blood count 4. FM count

answer

3. Maternal Blood count - evaluates maternal, not fetal well being BPP - uses US to eval fetal body movements, breathing movements, muscle tone, reactive fetal cardiac rate, amniotic fluid volume NST - evals the FHR for accels during FM FM - counts are used during the last trimester to obtain a rough index of fetal health - the number of FM are counted at diff times throughout the day and then charted to detect any change in overall activity over a number of days

question

Which of the following conditions isnt dx by abdominal US during the prenatal period? 1. fetal presentation 2. fetal heart activity 3. maternal diabetes 4. amniotic fluid volume

answer

3. maternal diabetes abdominal US evals fetal presentation, fetal heart activity, amniotic fluid volume although it may show increased amnitoic flud, thus helping to diagnose maternal diabetes, it isnt used for that purpose.

question

When teaching an antepartal client about the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Place these events in the proper sequence in which they occur: 1. Flexion 2. External rotation 3. Descent 4. Expulsion 5. Internal Rotation 6. Extension

answer

1. Descent 2. Flexion 3. Internal rotation 4. Extension 5. External rotation 6. Expulsion DFI EEE

question

A client who is 32 weeks pregnant is being monitored in the antepartum unit for PIH. She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing internventions should be included in the care of this client? Check all that apply 1. Evaluate VS 2. Prepare for vaginal delivery 3. Reassure client that she'll be able to continue pregnancy 4. Evaluate FHT 5. Monitor amt of vaginal bleed 6. Monitor I&O

answer

1. Evaluate VS 4. Evaluate FHT 5. Monitor amt of vaginal bleed 6. Monitor I&O The clients Sx indicate that she's experiencing abruptio placenta. The nurse must immed eval the moms well being by eval VS, FWB, by auscultation of heart tones, monitoring amt of blood loss and eval the vol status by measuring I&O. After the severity of the abruption has been determined and blood and fluid have been replaced, prompt C-SECTION delivery of the fetus (not vaginal) is indicated if the fetus is in distress

question

A woman with a term, uncomplicated pregnancy comes into L&D in early labor saying that she thinks her water broke. Which action should the nurse take? 1. prep the woman for delivery 2. note color, amt and odor of fluid 3. immed contact doctor 4. collect sample of fluid for microbial analysis

answer

2. Noting color, amount and odor of the fluid as well as the time of the rupture, will help guide the nurse in her next action. There's no need to call the doctor immed or prep the client for delivery if the fluid is clear and delivery isnt imminent. ROM isnt unusual in early stages of labor. Fluid collection for microbe analysis isnt routine and theres no concern for infection/maternal fever.

question

A woman who's 36 week preg comes into L&D with mild contractions. Which of the following complications should the nurse watch for when the client informs her that she has placenta previa? 1. sudden ROM 2. Vaginal bleeding 3. emesis 4. fever

answer

2. Vaginal bleeding contractions may disrupt the microvascular network in the placenta of the client with placenta previa and result in bleeding. if the separation of the placenta occurs at the margin of the placenta, the blood will escape vaginally. sudden ROM isnt r/t placenta previa fever would indicate an infections process, and emesis isnt r/t placenta previa

question

A clients labor doesnt progress. After ruling out CPD, the doctor orders IV admin of 1,000 ml normal saline w/ Pitocin 10 units to run at 2 miliunits / min. 2 miliunits/min is equivalent to how many ml/unit 1. 0.002 2. 0.02 3. 0.2 4. 2.0

answer

3 = 0.2 each unit of oxytocin contains 1,000 miliunits. Therefore, 1,000 ml of IV fluid contains 10,000 miliunits (10 units) of Pitocin

question

A client at 42 weeks gest is 3cm dilated, 30% effaced, with membranes intact and the fetus at +2 station. FHR is at 140-150 bpm. After 2 hours, the nurse notes on the EFM that, for the past 10 min, the FHR ranged from 160-190bpm. The client states that her baby has been extremely active. UCs are strong, occurring every 3-4 min. and lasting 40-60 sec. Which of the following findings would indicate fetal hypoxia? 1. Abnormally long UCs 2. Abnormally strong uterine intensity 3. Excessively frequent contractions with rapid fetal movement 4. Excessive fetal activity and fetal tachycardia

answer

4. Excessive fetal activity and fetal tachycardia Fetal tachycardia and excessive fetal activity are the FIRST SIGNS OF FETAL HYPOXIA The duration of UCs is w/in normal limits. Uterine intensity can be mild-strong and still be w/in normal limit. The frequency of contractions is w/in normal limits for the active phase of labor.

question

A client at 33 weeks gestation and leaking amniotic fluid is place on an EFM. The monitor indicates uterine irritability and contractions occuring every 4-6 min. The doctor orders terbutaline. Which of the following teaching statements is approp for this client? 1. This medicine will make you breathe better 2. You may feel fluttering or tight sensation in your chest 3. This will dry your moth and make you thirsty 4. You'll need to replace potassium lost by this drug

answer

2. You may feel fluttering or tight sensation in your chest A fluttering or tight sensation in the chest is a common adverse reaction to terbutaline It relives bronchospasm but the client is getting it to reduce uterine motility. Mouth dryness and thirst occur w/ the inhaled form but are unlikely with subcut form Hypokalemia is a potential adverse reaction following large doses of terbutaline but not at doses of 0.25 mg

question

A 17 y.o. primpigravida with severe PIH has been receiving mag sulfate IV for 3 hours. The latest assessment reveals DTR of +1, BP 150/100 mmgHg, pulse 92 bpm, respiratory rate 10bpm and urine output 20ml/hr. Which of the following actions would be most approp? 1. Continue monitoring per standards of care 2. Stop the mag sulfate infusion 3. Increase infusion by 5gtt/min 4. Decrease infusion by 5gtt/min

answer

2. Stop the mag sulfate infusion Mag sulfate should be withheld if the clients resp rate or urine output falls or if reflexes are diminished / absent. The client also shows other signs of impending toxicity such as flushing / feeling warm. Inaction wont resolve the clients suppressed DTRs and low RR / urine output. The client is already showing CNS depression bc of excessive magsulfte so increasing the infusion is wrong. Impending toxicity indicates that the infusion should be stopped rather than just slowed down.

question

During a vaginal exam of a client in labor, the nurse palpates the fetus' larger, diamond shaped fontanelle toward the anterior portion of the clients pelvis. Which of the following statements best describes this situation? 1. The client can expect a brief and intense labor, which potential for lacerations. 2. The client is at risk for uterine rupture and needs constant monitoring 3. The client may need interventions to ease back pain and change fetal position 4. The fetus will be delivered using forceps or vacuum extractor

answer

3. The client may need interventions to ease back pain and change fetal position The fetal position is occiput posterior, a position that commonly produces intense back pain during labor. Most of the time, the fetus rotates during labor to occiput anterior position. Positioning the client on her side can facilitate this rotation. An occiput posterior position would most likely result in prolonged labor POSTERIOR - PROLONGED. occiput posterior alone doesnt create a risk of uterine rupture. The fetus wont be delivered with forceps / vacuum only if its presenting part DOESNT rotate and descend spontaneously

question

The cervix of a 26 year old primigravida in labor is 5cm dilated and 75% effaced, and the fetus is at 0 station. The doctor prescribes an epidural regional block. Into which of the following positions should the nurse place the client when the epidural is admin? 1. Lithotomy 2. Supine 3. Prone 4. Lateral

answer

THe client should be placed on her left side or sitting up right, with her shoulders parallel and legs slightly flexed. Her back shouldnt be flexed bc this position increases increases the possibility that the dura may be punctured and the anesthetic will accidentally be given as spinal, not epidural, anesthesia.

question

Which of the following terms is used to describe the thinning and shortening of the cervix that occurs just before and during labor? 1. Ballottement 2. Dilation 3. Effacement 4. Muliparous

answer

3. Effacement effacement is cervical shortening and thinning while dilation is widening of the cervix both facilitate opening the cervix in prep for delivery. Ballottement is the ability of another individual to move the fetus by externally manipulating the maternal abdomen. A ballotable fetus hasn't yet engaged in the maternal pelvis. Multiparous refers to a woman who has had previous live births.

question

Which of the following fetal positions is most favorable for birth? 1. Vertex 2. Transverse lie 3. Frank breech presentation 4. Posterior position of the head

answer

1. Vertex presentation flexion of the fetal head is the optimal presentation for passage thru the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires c-section frank breech presentation, in which the buttocks presents first, can be difficult vaginal delivery. posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis.

question

Which of the following nursing actions is required before a client in labor receives an epidural? 1. Give a fluid bolus of 500 ml 2. check for maternal pupil dilation 3. assess maternal reflexes 4. assess maternal gait

answer

1. Give a fluid bolus of 500 ml one of the major adverse effects of epidural admin is hypotension therefore, a 500ml fluid bolus is usually admin to help prevent hypotension in the client who wishes to receive an epidural for pain relief. assessments of meternal reflexes, pupil response and gait arent necessary

question

Which of the following complications is possible with an episiotomy? 1. blood loss 2. uterine disfigurement 3. prolonged dyspareunia 4. hormonal flucuation postpartum

answer

3. prolonged dyspareunia - painful intercourse may result when complications such as infection interefere with wound healing. minimal blood loss occurs when an episitomy is done the uterus isnt affected bc its the perineum that's cut to accomodate the fetus hormonal fluctuations that occur during the postpartum period arent the result of an episiotomy

question

A client in early labor states that she has a thick yellow discharge from both of her breasts. Which of the following actions by the nurse would be correct? 1. tell her that her milk is starting to come in bc she's in labor 2. complete a thorough breast exam and document the results in the chart. 3. perform a culture on the discharge and inform the client that she might have mastitis 4. inform the client that the discharge is colostrum, normally present after the 4th month of preg.

answer

4. after the 4th month, colostrum may be expressed. the breasts normally produce colostrum for the first few days after delivery. milk production begins 1-3 days PP A clinical breast exam isnt indicated in intrapartum although a culture may be indicated, it requires advanced assessment as well as a medical order

question

Which statement best describes lochia rubra? 1. it contains a mixture of mucus, tissue debris and blood 2. it contains placental fragments, and blood 3. it contains mucus, placental fragments and blood. 4. it contains tissue debris and blood

answer

1. lochia rubra contains a mixture of mucus tissue debris blood normal lochia rubra contains NO PLACENTAL FRAGMENTS

question

On the 2nd PP day, a client complains that shes urinating more than when she was pregnant. Which is the primary cause of increased urinary output post delivery? 1. postpartum diuresis

answer

occurs as the body starts to reduce the extracellular fluid volume that increased during preg renal plasma flow and GFR also increase slightly until approx 1 week PP Renal malfunctioning is more likely to decrease urinary output, not increase it increase PP fluid intake and breast feeding arent major causes of PP diuresis

question

Lochia alba follows lochia serosa and usually lasts from the 1st to 3rd week PP. Which of the following statements best describes lochia alba? 1. creamy white-brown, stale odor 2. creamy white to brown, contains decidual cells, may have stale odor 3. brown to red, tissue fragments, odor 4. brown to red contains decidual cells and leukocytes

answer

2. creamy white to brown, contains decidual cells, may have stale odor also contais leukocytes but it shouldnt contain tissue fragments or have a foul odor

question

Pulmonary embolus signs

answer

sudden dyspnea diaphoresis confusion tachycardia stationary blood clot from a varicose vein becomes an embolus (moving clot) that lodges in the pulmonary circulation chills and fever = infection

question

Breastfeeding preterm neonates

answer

studies have proven that breast milk provides preterm neonates w/ better protection from infection such as NEC bc of the antibodies contained in breast milk Commercial formula doesn't provide any better nutrition than breast milk breast milk feedings can be started as soon as the neonate is stable and the neonate is more likely to develop infections when fed formula rather than breast milk

question

Main role of surfactant in the neonate

answer

helps the lungs remain expanded after the initiation of breathing works by reducing surface tension in the lung allows the lung to remain slightly expanded decreases amount of work required for inspiration

question

how long should normal acrocyanosis last max.

answer

max 24 hours post birth

question

A positive Babinski's signs is present in infants until approx. what age?

answer

1 year of age this is normal in neonates but abnormal in adults

question

At what gestational age is a conceptus considered viable (able to live outside the womb)? 1. 9 weeks 2. 14 weeks 3. 24 weeks 4. 30 weeks

answer

3. 23 / 24 weeks the lungs are developed enough to sometimes maintain extrauterine life. the lungs are the most immature system during the gestational period. medical care for premature labor begins much earlier (aggressively at 21 weeks0

question

Role of vitamin k in a neonate

answer

vitamin K, deficient in the neonate, is needed to activate clotting factors II,IV,IX and X In the event of trauma, the neonate would be at risk for EXCESSIVE BLEEDING vitamin k doesnt assist the gut to mature but the gut PRODUCES vitamin K once maturity is achieved

question

Neonates born to women infected with hepatitis B should undergo which Tx regimen 1. Hep B vaccine at birth and 1 month 2. Hep B immune globulin at birth, no hepatitis B vaccine 3. Hepatits B immune globulin within 48 hours of birth and Hep B vaccine at 1 month 4. Hep B immune globulin within 12 hours of birth and Hep B vaccine at birth, 1 month, 6 months

answer

4. Hep B immune globulin within 12 hours of birth and Hep B vaccine at birth, 1 month, 6 months Hep B immune globulin should be given as soon as possible after birth but within 12 hours neonates should also receive hep B vaccine at regularly scheduled intervals this sequence of care has been determined as superior to the others

question

Two days after circumcision, the nurse notes a yellow - white exudate around the head of the neonates penis. What would be the most appropriate nursing intervention? 1. Leave the area alone as this is a normal finding 2. report findings to physician and document it 3. Take the neonate's temperature bc an infection is suspected 4. Try to remove the exudate with a warm washcloth

answer

1. the yellow white exudate is part of the granulation process and a normal finding for a healing penis after circumcision therefore, notifying the doctor isnt necessary theres no indication of an infection that would necessitate taking the neonates temp the exudate shouldnt be removed

question

A client has just given birth at 42 weeks gestation. When assessing the neontate, which phsycial finding is expected? 1. a sleepy, lethargic baby 2. lanugo covering body 3. desquamation of the epidermis 4. vernix caseosa covering the body

answer

3. desquamation of the epidermis postdate fetuses lose the vernix caseosa and the epidermis may become desquamated these neonates are usually VERY alert lanugo is missing in the postdate neonate

question

The SGA neonate is at increased risk during the transitional period for which complication? 1. anemia probably due to chronic fetal hypoxia 2. hyperthermia due to decreased glycogen stores 3. hyperglycemia due to decreased glycogen stores 4. polycythemia probably due to chronic fetal hypoxia

answer

4. polycythemia probably due to chronic fetal hypoxia the SGA baby is at risk for developing polycythemia during the transitional period in an attempt to decrease hypoxia the neonates are also at increased risk for developing hypoglycemia due to decreased glycogen stores

question

WHich finding might be seem in a neonate suspected of having an infection? 1. flushed cheeks 2. increased temp 3. decreased temp 4. increased activity level

answer

3. decreased temp temp instability esp when it resutls in low temp in the neonate, may be a sign of infection. the neonate's color often changes with an infection process but generally becomes ashen or mottled the neonate w/ an infection will usually show a decrease in activity level or lethargy

question

Which Sx would indicate the neonate was adapting approp to extrauterine life w/out difficulty? 1. nasal flare 2. light audible grunting 3. resp rate 40-60 breaths/min 4. resp rate 60-80 breaths/min

answer

4. resp rate of 40-60 breaths/min is normal for a neonate during the transitional period nasal flaring, resp rate > 60 and audible grunting = SIGNS OF RESP DISTRESS!

question

After reviewing the client's maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? 1. hypoglycemia 2. jitteriness 3. resp depression 4. tachycardia

answer

3. resp depression mag sulfate crosses the placenta and adverse neonatal effects are: resp depression hypotonia bradycardia the serum blood sugar isnt affected by mag sulfate the neonate wold be floppy, not jittery

question

Convection heat loss

answer

the flow of heat from the body surface to COOLER AIR

question

Evaporation Heat Loss

answer

the loss of heat that occurs when a liquid is converted to a vapor

question

Conduction heat loss

answer

is the loss of heat from the BODY SURFACE to COOLER SURFACES in direct contact

question

RADIATION HEAT LOSS

answer

is the loss of heat from the body surface to COOLER SOLID SURFACES NOT in direct contact but in relative proximity

question

A neonate has been diagnosed with caput succedaneum. which statement is true? 1. usually resolves in 3-6 weeks 2. collection of blood btw/ skill and periosteum 3. doesnt cross the cranial suture line 4. it involves swelling of the tissue over the presenting part of the head

answer

4. it involves swelling of the tissue over the presenting part of the head due to sustained pressure this boggy edematous swelling is present at birth, CROSSES the suture line occurs in occipital area a cephalohematoma is a collection of blood btw/ the skill and periosteum that DOESNT cross the suture lines and resolves in 3-6 weeks caput seccedaneum resolves within 3-4 DAYS

question

MENCONIUM

answer

collects in the GI tract during gestation and is initially STERILE greenish black bc of occult blood and is viscous stools of breast fed neonates - are loose golden yellow after the transition to extrauterine life stools of formula fed babies are - typically soft and pale yellow after feeding's well established

question

3 day old neonate needs phototherapy for hyperbilirubinemia. nursery care of a neonate getting phototherapy would include which nursing intervention? 1. tube feedings 2. feeding the neonate under phototheraphy lights 3. mask over the eyes to prevent retinal damage 4. temp monitored every 6 hours during phototherapy

answer

3. mask the neonate's eyes must be covered with eye patches to prevent damage the mouth of the neonate doesnt need to be covered the neonate can be removed from the lights and held for feeding the neonates temp should be monitored at least every 2-4 hours due to risk of hyperthermia w/ phototherpahy

question

Which assessment finding would be the most unlikely risk factor for RDS 1. second born of twins 2. neonate born at 34 weeks 3. neonate of diabetic mom 4. chronic maternal HTN

answer

4. CHRONIC MATERNAL HTN unlikely factor bc chronic fetal stress tends to INCREASE LUNG MATURITY premature neonates < 35 weeks are associated with RDS Even with a mature lecithin to sphingomyelin ration, neonates of moms with diabetes still develop RDS 2nd born of twins may be prone to greater risk of asphyxia

question

A male neonate has just been circumcised. Which nursing intervention is part of the initial care of a circumcised neonate? 1. apply alcohol to the site 2. Change the diaper as needed 3. keep the neonate in supine position 4. apply petroleum gauze to the site for 24 hours

answer

4. Petroleum gauze is applied to the site for the 1st 24 hours to prevent the skin edges from sticking to the diaper neonates are initially kept in the prone position diapers are changed more freq to insepct the site alcohola is CONTRAINDICATED

question

When performing an assessment on a neonate, which assessment finding is MOST SUGGESTIVE of hypothermia? 1. bradycardia 2. hyperglycemia 3. metabolic alkalosis 4. shivering

answer

1. bradycardia hypothermic neonates become bradycardic proportional to the degree of core temp HYPOGLYCEMIA is seen in HYPOTHERMIC NEONATES Shivering is rarely observed in neonates metabolic ACIDOSIS, not alkalosis is seen due to slowed resp

question

Which nursing ntervention helps prevent evaporative heat loss in the neonate immed after birth? 1. admin warm oxygen 2. controlling drafts in the room 3. immed drying the neonate 4. placing neonate on a warm, dry towel

answer

3. immed drying the neonate decreases evaoporative heat loss from moist body from birth placing the neonate on a warm, dry towel decreases CONDUCTIVE losses. controlling draft in the room and admin warm oxygen helps reduce CONVECTIVE LOSS

question

Infant (Birth-12 months) stage

answer

Trust v. Mistrust

question

Infant (Birth-12 months) major task

answer

learn to trust the environment and caregivers depending on the response to crying, nurturing, feeding

question

Toddler (1-3 years) stage

answer

Autonomy v. Shame and Doubt

question

Toddler (1-3 years) major task

answer

reassurance and self-respect are obtained through learning, exploring, and independence

question

Preschool (3-6 years) stage

answer

Initiative v. Guilt

question

Preschool (3-6 years) major task

answer

performance of activities to gain approval

question

School-Age (6-12 years) stage

answer

Industry v. Inferiority

question

School-Age (6-12 years) major task

answer

working through competition to completion and tangible results

question

Adolescent (12-18 years) stage

answer

Identity v. Role Confusion

question

Adolescent (12-18 years) major task

answer

establish independence with ideals and goals, understand and enact adulthood

question

Young Adult (18-35 years) stage

answer

Intimacy v. Isolation

question

Young Adult (18-35 years) major task

answer

seek close, personal relationships to develop productivity and contentment

question

Middle Adult (36-65 years) stage

answer

Generativity v. Stagnation

question

Middle Adult (36-65 years) major task

answer

pursues self-fulfillment for sense of accomplishment

question

Older Adult (>65 years) stage

answer

Ego Integrity v. Despair

question

Older Adult (>65 years) major task

answer

adjust to aging with self-worth; reflect on life with satisfaction

question

Infant age range

answer

0-12 months

question

Toddler age range

answer

1 year - 3 years

question

Preschool age range

answer

3 years - 6 years

question

School-Age age range

answer

6 years - 12 years

question

Preadolescent age range

answer

10 - 12 years

question

Adolescent age range

answer

12 years - 18 years

question

Young Adult age range

answer

18 years - 35 years

question

Middle Adult age range

answer

36 years - 65 years

question

Older Adult age range

answer

greater than 65 years

question

0-3 months

answer

1. posterior fontanelle closes 2. makes noise when spoken to 3. holds head up when prone

question

3-6 months

answer

1. birth weight doubles, teeth emerge 2. sits up, rolls over, makes sounds 3. puts objects in mouth

question

6-9 months

answer

1. fears separation from mother 2. combines syllables 3. transfers objects, crawls

question

9-12 months

answer

1. birth weight triples; anterior fontanelle closes by 18 mo. 2. words emerge 3. stands alone; begins to walk

question

1-3 years

answer

1. importance of rituals, training, and instruction 2. temper tantrums, parallel play 3. partial to total toilet training

question

3-6 years

answer

1. conscience develops; learns the rules 2. transitions from fantasy to reality; has feelings; fears intrusions into body 3. teeth completely emerge; leg and foot growth rapid; tie shoes at 6 years

question

6-12 years

answer

1. begin to discard parental standards; competence and perseverance; able to classify; seek sense of accomplishment 2. lose baby teeth; develop speed and strength

question

10-12 years

answer

1. variability in growth and maturation 2. strong desire to conform

question

12-18 years

answer

1. rational sense of self; actualizes abilities; moral judgment 2. confused; indecisive; antisocial 3. rapid growth; bone growth completed; secondary sexual features develop

question

18-35 years

answer

1. leave home; commit to personal relationships and career 2. develop a lifestyle; increase responsibility 3. physical growth complete; chronic disease is uncommon

question

36-65 years

answer

1. desire to accomplish unfulfilled goals 2. examine the past; assess current life; plan for future, and realize mortality 3. chronic disease emerges; life subtly changes

question

65+ years

answer

1. desire to find satisfaction with life 2. assure housing and relationships 3. adjust to losses; manage illness; prepare for death

question

Five P's

answer

Passenger, Passageway, Powers, Position of laboring woman, Pyschological response

question

Lie

answer

Relationship of maternal spine and fetal spine (transverse makes a cross and will not accomodate vaginal birth, Parallel is linear, but vaginal birth depends on presentation)

question

Attitude

answer

Relationship of body parts to one another. Fetal flexion-chin flexed to chest, extremities into torso Fetal extension- chin extended, extremities extended

question

Presentation

answer

Part of fetus entering pelvic inlet first. Head (occiput) Chin (mentum), shoulder (scapula), breech (sacrum)

question

Fetopelic position

answer

Relationship between presenting part and direction relating to maternal quadrants. 1st: R or L maternal pelvis 2nd: presenting part of fetus (O,S,M, Sc) 3rd: References anterior (A), posterior (P), Transverse (T) of maternal pelvis

question

Station

answer

measurement of fetal descent

question

Passageway

answer

Birth canal

question

External Electronic Monitoring (tocotransducer)

answer

Toco, on maternal stomach

question

Intrauterine Pressure catheter

answer

IUPC, Measures pressure

question

Signs preceding labor

answer

Lightening (fetal head drops into pelvis), backache, Contractions, Bloody show (cervical mucus plug discharged), wt loss, energy, rupture of membranes.

question

Amniotic fluid assessment

answer

pale to straw yellow, no odor, watery and clear, between 500-1,200ml, Nitrazine paper will turn BLUE!

question

Mechanism of labor

answer

Engagement, Descent (fetal head drops through pelvis), Flexion (head flexes toward chin), Internal rotation (fetal head rotates to lateral anterior position CORKSCREW), Extension (passes through symphysis pubis and head deflects anteriorly chin extends away), External rotation, Expulsion.

question

States of labor

answer

First stage (latent, active, transition), Second stage, Third stage, fourth

question

First stage

answer

Latent- Cervix 0-3 some dilation and effacement Active- Cervix 4-7 strong contractions rapid dilation and effacement Transition 8-complete dilation of cervix, feeling to push

question

Second stage

answer

full dilation of cervix to birth, maternal pushing

question

Third stage

answer

Birth to delivery of placenta

question

Fourth stage

answer

Delivery of placenta to maternal stabilization

question

Order of attaining vital signs

answer

1. Respirations 2. heart rate (apical) 3. Blood pressure 4. temp

question

Who should not be getting a rectal temp?

answer

children over 3 months

question

When to start oral temp?

answer

age 5-6

question

What happens to the growth rate between 6-12 years of age?

answer

decreases

question

How much earlier to girls experience the onset of adolescence?

answer

1-2 years

question

Lab values that are important in determining nutritional status

answer

h/h albumin creatinine nitrogen

question

Pain assessment CRIES scale

answer

C=crying (0-2) R=Requires increased oxygen (0-2) I=increased vital signs (0-2) E=Expressions (0-2) S=sleepless (0-2)

question

Pain assessment: FLACC

answer

Face, Legs, Activity, Crying, Consolability 0-10 scale, each worth 2 points

question

Wong-Baker rating scale AKA

answer

faces

question

How old for Wong-Baker scale?

answer

any age, but usually 3 and older Make sure the child has cognitive development and is not delayed. Scale is 0-5

question

When is the numerical pain scale used in children?

answer

age 5 and older

question

Laryngotrachiobronchitis

answer

-Most common type of croup experienced by children admitted to the hospital and primarily affects children under 5

question

Causes of Laryngotrachiobronchitis (Croup)

answer

Virus -Parainfluenza adenovirus RSV

question

S/S of Laryngotrachiobronchitis

answer

slight to severe diarrhea barking or brassy cough increased temp

question

Epiglottitis

answer

Serious obstructive disease caused by H. ifluenza

question

S/S of Epiglottitis

answer

absence of cough drooling agitation with rapid progression to severe resp. distress **Children with epiglottitis usually look worse than they sound, and the id with LTB sounds worse then they look***

question

Treatment for epiglottitis

answer

This is an emergency -may require intubation or a trach -IV antibiotics and corticosteroids

question

Tonsilitis S/S

answer

Difficulty swallowing and breathing so child is a mouth breather and they have bad breath impaired taste and smell, voice has a nasal.muffled quality persistent cough swollen tonsils can block drainage of the ear canal and cause otitis media

question

Treatment for tonsilitis

answer

tonsilectomy

question

What would indicate that hemorrhage is occuring post tonsilectomy?

answer

frequent swallowing

question

How many post op days is the child at risk for hemorrhage after a tonsilectomy?

answer

up to 10 days

question

Complaints/normal occurrences after tonsilectomy

answer

sore throat and slight ear pain low grade temp bad breath

question

what does tympanic membrane look like with otitis?

answer

bulging and bright red

question

Treatment of otitis media

answer

-heating pads help (alternate with ice) -avoid chewing (soft foods) -lie on the affected side -may not hear you -avoid smoke -May require PE (pressure equalizing) tubes to keep the middle ear drained. The ear tube (grommet) stays in about 6 months and then falls out

question

RSV Respiratory Syncytial Virus

answer

An acute viral infection that affects the bronchioles and includes RSV bronchiolitis or RSV pna Leading cause of lower resp tract illness in children less than 2 years

question

Risk factors for RSV

answer

prematurity congenital disorders smoke focus is on prevention (high risk will get RSV vaccine)

question

S/S of RSV

answer

URI nasal discharge mild fever dyspnea nonproductive cough tachypnea with flaring nares retraction and wheezing disease becomes worse on days 2-3

question

What is the transmission of RSV?

answer

Contact precautions teach good handwashing techniques

question

Treatment for mild vs. severe RSV

answer

mild: treat symptoms severe: hospitalization, may use antivirals like Ribavirin

question

Causes of pna

answer

1. Viral (RSV, adenovirus or parainfluenza) 2. Bacterial (culprit is strep pneumonia) children <4 years 3. Mycotic (walking pna) primarily in adolescents Mycoplasma pna 4. Aspiration pna (something other than air gets into the lungs)

question

S/S of pna

answer

fine crackles or rhonchi with a cough that is productive or nonproductive abdominal distention back pain fever that is usually high chest pain from coughing

question

Treatment for pna

answer

oxygen fluids antibiotics antipyretics nebulizer cough suppressant

question

What type of infections are Down Syndrome children prone to developing?

answer

Respiratory because they have a poor immune system

question

The most common type of defect associated with Down's is

answer

heart defects

question

Causes of cystic fibrosis

answer

inherited trait, and must get from both parents

question

S/S of cystic fibrosis

answer

**thick, sticky secretions everywhere (resp and GI) -characterized by exocrine gland dysfunction. These secrete mucus -Thick, sticky secretions found in the resp and GI tracts

question

Dx of Cystic Fibrosis

answer

-positive sweat chloride test -At risk for hyponatremia because they are losing sodium through the skin -The earliest sign in the newborn is the meconium ileus (does not pass meconium) -They will have steatorrhea stools (fatty and frothy)

question

Treatment for cystic fibrosis

answer

-Enzymes that help improve digestion are the pancreatic enzymes -Take 30 minutes prior to eating, do not crush or chew -Need a well balanced, low fat, high calorie, high protein diet -Require 150% of the recommended daily allowance -They need to take water soluable forms of vitamin A, D, E, and K because they are not able to have the fat soluable regular forms

question

What is the hallmark sign of heart failure in babies?

answer

lips turn blue when feeding

question

Digoxin for infants

answer

-rarely get more than 1 cc -give 1 hour before and 2 hours after eating -do NOT mix with medicine, food, or fluid -Always check the dose with another nurse -check the apical pulse for 60 seconds

question

Ace Inhibitors for infants (prils, Vasotec, Capoten)

answer

-decrease blood pressure -can cause kidney problems -dry cough

question

What other drug might be given to pediatric patient with HF?

answer

lasix

question

Nutrition for infants with HF (when to give meals?)

answer

small frequent feedings every 3 hours, no longer than 30 minutes

question

Rheumatic Fever

answer

inflammatory disease that occurs after an infection with group A beta hemolytic strep

question

What is the major cardiac clinical manifestation of Rheumatic Fever?

answer

carditis

question

What is the medication to treat Rheumatic Fever?

answer

penicillin G (or erythromycin if they are allergic)

question

Kawasaki Disease

answer

characterized by wide-spread inflammation of the small and medium sized blood vessels. Coronary arteries are most susceptible.

question

Treatment of Kawasaki Disease

answer

-High dose of IV immune-globulin -aspirin therapy -quiet environment

question

How should you feed an infant with a cleft lip/palate?

answer

-elongated nipple on the side of the mouth

question

After cleft repair surgery, how should the nurse position the client?

answer

Cleft lip repair: back or side lying to protect the suture Cleft Palate: prone to promote drainage

question

Feedings for patients with GER/GERD

answer

small, frequent feedings with thickened formula Breast feeding continues with more frequent feeding or expressing the milk for thickening with rice cereal

question

Medications for GERD

answer

H2 blockers, proton pump inhibitors

question

Esophageal Atresia/T-E fistula

answer

The saliva can't make it to the stomach because the esophagus ends in a blind pouch (closed off at the bottom, not connected to the stomach)

question

Why do babies with esophageal atresia not have meconium?

answer

They never swallowed amniotic fluid

question

What are symptoms of T-E fistula?

answer

Coughing Cyanotic Choking (esp while drinking)

question

What should the first feeding be because of T-E fistula?

answer

sterile and observed

question

S/S of pyloric stenosis

answer

projectile vomiting very hungry olive shaped mass in epigastric region peristalsis is obvioius

question

Intussusception

answer

when a piece of bowel goes backwards inside itself forming an obstruction

question

What are S/S of intussusception?

answer

sudden onset cramping and abdominal pain inconsolability drawing up knees CURRANT JELLY stools

question

Dx/Tx of intussuscpetion

answer

Definitive Dx is through barium enema and that can sometimes fix the problem Teach what to watch for with reoccurence

question

Hirschsprung's Disease

answer

A congenital anomaly also known as aganglionic megacolon that results in a mechanical obstruction along the bowel (esp. sigmoid)

question

S/S of Hirschsprung's Disease

answer

-presenting symptom is constipation -abdominal distention -ribbon-like stools that have a very foul odor

question

Imperforate Anus

answer

There is no rectal opening, therefore, the baby will not pass meconium...have to do surgery

question

Celiac Disease

answer

Think Sam -a genetic malabsorption disorder where there is a permanent intestinal intolerance to gluten

question

Celiac's can't have BROW

answer

Barley Rye Oats Wheat

question

Celiac's can have RCS

answer

Rice Corn Soy

question

Symptoms of UTIs vary with young children vs. babies

answer

-newborns and children under 2: the s/s may be non-specific, might even seem to be a GI problem -Classic symptoms in children >2 (same as adults)

question

Testicular torsion

answer

Surgical emergency -Painful condition caused by the sudden twisting of the spermatic cord which results in the loss of blood flow to the testicle. Occurs in 1/40,000 males with a peak onset of 13 years -Most common cause of testicular loss in adolescent males -If not diagnosed in a timely manner, they can lose the affected testicle -Unilateral pain to the affected testicle

question

Sickel Cell Disease

answer

This is a hereditary disorder in which the hemoglobin is partly or completely replaced with sickle-shaped hemoglobin

question

Treatment for Sickle Cell disease

answer

bed rest, hydration, analgesics, antibiotics, blood transfusions, and oxygen

question

Leukemia

answer

Cancer of the blood forming tissue and proliferation of immature white cells -Always remember immunosuppresion, thrombocytopenia, and anemia -ALL and AML

question

S/S of Leukemia

answer

-fever -pallor -anorexia -petechiae -vague abdominal discomfort -easily acquired infections

question

Cancer: Wilm's tumor or nephroblastoma are found?

answer

kidney -Swelling or non-tender mass on the side of the abdomen -DONT PALPATE

question

Hydrocephalus

answer

A disturbance of the ventricular circulation of the cerebral spinal fluid in the brain -bulging in the anterior fontanel -dillated scalp veins -depressed eyes -irritability and changes in LOC -high-pitched cry -Tx is insertion of VP shunt

question

Parial Seizure

answer

limited to a particular location of the brain

question

Simple Partial seizure

answer

without the loss of consciousness with various sensations: numbness, tingling, prickling, pain

question

Complex Partial:

answer

impaired consciousness and may be confused or unable to respond

question

Generalized seizure

answer

LOC Tonic-Clonic (grand mal) Myoclonic (sudden, brief contractions of a muscle or group of muscles; may look like a startle reflex) Absence (petit mal, brief loss of consciousness)

question

3 O's treatment for scoliosis

answer

Observation Orthosis (supports and braces) Operation (usually spinal fusion with rod)

question

How are pin worms diagnosed?

answer

tape test in the morning before defacation

question

Medication treatment for pinworms

answer

Mebendazole (Vermox)

question

Home remedies that alleviate itching from chicken pox

answer

oatmeal baths baking soda paste

question

Is acyclovir ever prescribed for chicken pox?

answer

if they have an increased risk for severe varicella

question

What is the virus that causes infectious mononucleosis?

answer

epstein barr

question

Why should Mono patients be involved in contact sports

answer

enlarged spleen

question

First trimester reasons for bleeding

answer

Spontaneous abortion, ectopic pregnancy

question

Spontaneous abortion

answer

vaginal bleeding, cramping, expulsion of products. Types include: threatened, inevitable, incomplete, complete, missed.

question

Ectopic Pregnancy

answer

Abnormal implantation of ovum outisde of uterus. S/S: US with empty uterus, WBC 15,000, unilateral stabbing pain, REFERRED RIGHT SHOULDER PAIN.

question

Threatened abortion

answer

May have cramps, spotting to moderate bleeding, no tissue passed, cervix closed.

question

Inevitable abortion

answer

Moderate cramping, mild to severe bleeding, no tissue passed, dilated cervix with membranes or tissue bulging,

question

Incomplete abortion

answer

Severe cramps, continuous bleeding, partial tissue passed, dilated cervix.

question

Complete abortion

answer

No cramps, minimal bleeding, complete expulsion, closed cervix.

question

Missed abortion

answer

No cramps, brown discharge, No tissue passed, Closed cervix

question

Septic Abortion

answer

Malodorous discharge usually with cervix dilated.

question

Second trimester bleeding

answer

Gestational trophoblastic disease,incompetent cervix

question

Gestational Trophoblastic disease

answer

Uterine size increases abnormally fast, abnormally high levels of hCG, N/V hyperemesis, no fetus present, dark brown or red vaginal bleeding

question

Incompetent cervix

answer

a condition in which the cervix dilates silently during the second trimester; without intervention, the membranes bulge through the cervix and rupture, and the fetus drops out, resulting in a premature preterm delivery or abortion.

question

Third trimester bleeding

answer

Placenta Previa, abruptio placenta, preterm labor

question

Placenta Previa

answer

placenta abnormally implants in lower segment of utuerus over the cervix. Results in bleeding in third trimester at cervix begins to dilate and efface. Complete (entire cervical os covered) vs Incomplete (partially covered) Marginal (does not touch os, but is close) S/S: BRIGHT red blood as cervix dilates, relaxed uterus with normal tone, palpable placenta, fundal height great than gestational age norm. Assess: bleeding with counting pads, NOTHING inserted vaginally (NO CHECKS), corticosteriods to mature fetal lungs for C-section.

question

Abruptio Placenta

answer

Premature separation of placenta (partial or complete detachment) Leading cause of maternal death. DIC is associated with abruption. Ultrasound for placental and fetal well-being, hgb/hct, BPP. S/S: sudden onset of intense uterine pain, vaginal bleeding that is bright red or dark, BOARD LIKE ABDOMEN (blood pooling) that is tender, uterine hypertonicity, hypovolemic shock. Assess: uterus, bleeding, FHR, VS, RR, cardiac sounds, LOC, cap refill, U/O. Interventions: bedrise, no vaginal exams, admin blood products, corticosteriods, delivery.

question

Hyperemesis Gravidarum

answer

Excessive N/V (high hCG levels). Causes dehydration, wt loss, electrolyte imbalance, ketosis and acetonuria. Risk for IUGR for fetus. Assess for ketones (muscle breakdown for nutrients). Interventions: NPO, IV LR, vitamins as tolerated, Promethazine, metoclopramide. May need TPN if severe.

question

HTN in pregnancy

answer

Gestational Hypertension, Mild preeclampsia, severe preeclampsia, eclampsia, HELLP

question

Gestational Hypertension

answer

HTN that begins after 20 week with a BP of 140/90 mm Hg or greater, but without edema or proteinurea.

question

Mild Preeclampsia

answer

characterized by hypertension of >140/90 after 20wks gestation and protienuria of 1-2+(by dipstick)

question

Severe Preeclampsia

answer

BP >160/110, proteinuria >2g in 24h urine, oliguria, ALOC, HA, blurry vision, epigastric pain, ^ LFT's, thrombocytopenia, fetal growth restrictions. Mngmnt: ^ prot, decrease Na, adequate fluids, BR, antiHTN (Hydralizine or labetalol target diastolic=95-100) Risk: new partner, young 1st pregnancy, delivery is the cure.

question

Eclampsia

answer

is severe preeclampsia with seizure or coma.

question

HELLP

answer

This stands for H = Hemolysis, EL = Elevated Liver Enzymes, LP = Low platelets (<100,000) PREECLAMPSIA WITH LIVER DAMAGE!

question

D&C

answer

Dilation and curettage- dilate cervix and scrape uterine walls

question

D&E

answer

Dilation and evacuation after 16 weeks gestation

question

Magnesium Sulfate

answer

Anticonvulsant, lowers BP and depresses CNS. Signs of toxicity: absense of patellar DTRs, <30ml urine, RR <12, <LOC. Calcium gluconate is antidote. Client will feel flushed, hot, sedated with magnesium sulfate.

question

Gestational Diabetes

answer

Tests: 1 hour glucose screen, 50g sugar load then 1 hour test (24-28 weeks) 3 hour glucose test, overnight fast, fasting glucose obtained, 100g load is given and levels are determined at 1,2,3 hours.

question

Toxoplasmosis

answer

Comes from eating raw meat or cleaning cat litter. Affects pregnant women and immunosuppressed patients. S/S: Cervical lymphadenopathy, HA, fever, malaise, sore throat, can cause still birth or severe congenital anomalies in fetus of pregnant women. Tx: Spiramycine, sulfadine, pyramethamine (potentially harmful but must kill parasite)

question

Rubella

answer

Contact with children with rashes or other mothers who had rubella during pregnancy. S/S: rash, aches, joint pain, miscarriage, congenital anomalies, death. Tx: Immunize before pregnancy, avoid crowds. Vaccination not an option.

question

Cytomegalovirus

answer

Transmission by droplet. semen, vaginal secretions, breask milk, placenta, milk, urine, feces, blood. S/S: asymptomatic or mononeucleosis-like. Tx: No treatment

question

Herpes Simplex Virus

answer

Direct contact with oral or genital lesion. S/S: lesions. Tx: C-section delivery recommended for mothers with active lesions.

question

Fear of surgery for toddler

answer

separation

question

Fear of surgery for preschooler

answer

mutilation

question

Fear of surgery for school-ager

answer

loss of control

question

Fear of surgery for adolescent

answer

loss of independence, being different from peers, alterations in body image

question

teach parents to expect regression in toilet training & difficult separations

answer

toddler

question

allow child to play with models of equipment; encourage expression of feelings

answer

preschooler

question

explain procedures in simple terms; allow choices when possible

answer

school-ager

question

involve them in procedures & therapies; expect resistance; express understanding of concerns; point out strengths

answer

adolescent

question

teaching for toddler

answer

simple directions

question

teaching for preschool & school aged

answer

allow to play with equipment

question

expect resistance with this age group

answer

adolescent

question

typical fears for newborn

answer

loud noises; sudden movements

question

typical fears for 6-12 months

answer

strangers; heights

question

typical fears for 3-5 years

answer

separation from parents; ghosts; scary people

question

typical fears for 12-36 months

answer

separation from parents; animals;strangers; change in environments

question

typical fears for 5+ years

answer

dark;injury;being alone;death

question

typical fears for adolescent

answer

social incompetence;war; accidents;death

question

age appropriate preparation for health care procedures for newborn

answer

include parents; mummy restraint

question

age appropriate preparation for health care procedures for 6-12 months

answer

model desired behavior

question

age appropriate preparation for health care procedures for toddler

answer

simple explanations; use distractions; allow choices

question

age appropriate preparation for health care procedures for preschooler

answer

encourage understanding by playing with puppets or dolls, demonstrate equipment; talk at child's eye level

question

age appropriate preparation for health care procedures for school age child

answer

allow questions; explain why; allow to handle equipment

question

age appropriate preparation for health care procedures for adolescent

answer

explain long term benefit; accept regression; provide privacy

question

Eliminate all dietary supplements at least ___ to ____ weeks before surgery.

answer

2 to 3

question

side effects of general anesthesia via inhalation (halothane)

answer

respiratory depression; circulatory depression; delirium during induction & recovery; nausea & vomiting; aspiration during induction; myocardial depression; hepatic toxicity

question

side effects of nitrous oxide

answer

hypotension; postop nausea; vomiting

question

side effects of IV thiopental sodium (pentothal)

answer

respiratory depression; low BP; laryngospasm; poor muscle relaxation; hypotension; irritating to skin & subcutaneous tissue

question

side effects of spinal anesthesia

answer

hypotension; headache

question

side effects of conduction blocks

answer

hypotension; respiratory depression

question

side effects of local anesthesia (xylocaine)

answer

excitability; toxic reactions such as respiratory difficulties; vasoconstriction if substance contains epinephrine

question

side effects of moderate (conscious) sedation (Versed, Valium)

answer

respiratory depression; apnea; hypotension; bradycardia

question

situations where pt turns & deep breathe but does not cough vigorusly

answer

ICP; intrabdominal pressure; eye surgeries; brain surgeries

question

13 potential complications of surgery

answer

hemorrhage; shock; atelectasis; pneumonia; embolism; deep vein thrombosis; paralytic ileus; infection of wound; dehiscence; evisceration; urinary retention; urinary infection; psychosis

question

nursing considerations for hemorrhage

answer

replace blood volume; monitor vital signs

question

nursing considerations for shock

answer

treat cause; oxygen; IV fluids

question

nursing considerations for atelectasis & pneumonia

answer

experienced second day postop; suctioning; postural drainage; antibiotics; cough & turn

question

nursing considerations for embolism

answer

experienced second day post op; oxygen; anticoagulants; IV fluids

question

nursing considerations for deep vein thrombosis

answer

experienced 6-14 days up to 1 year later; anticoagulant therapy

question

nursing considerations for paralytic ileus

answer

nasogastric suction; IV fluids; decompression tubes

question

nursing considerations for infection of wound

answer

experienced 3-5 days post op; antibiotics; aseptic technique; good nutrition

question

nursing considerations for dehiscence

answer

experienced 5-6 days postop; low fowlers position; no coughing; NPO; notify MD

question

nursing considerations for evisceration

answer

experienced 5-6 days postop; low fowlers position; no coughing; NPO; cover viscera with sterile saline; notify MD

question

nursing considerations for urinary retention

answer

experienced 8-12 hours postop; catheterize as needed

question

nursing considerations for urinary infection

answer

experienced 5-8 days postop; antibiotics; force fluids

question

nursing considerations for psychosis

answer

therapeutic communication; medications

question

assessment for hemorrhage

answer

decreased BP; increased pulse; cold & clammy skin

question

assessment for shock

answer

decreased BP; increased pulse; cold & clammy skin

question

assessment for atelectasis & pneumonia

answer

dyspnea; cyanosis; cough; tachycardia; elevated temperature; pain on affected side

question

assessment for embolism

answer

dyspnea; pain; hemoptysis; restlessness; ABG- low oxygen & high carbon dioxide

question

assessment for DVT

answer

positive homan's sign

question

assessment for paralytic ileus

answer

absent bowel sounds; no flatus or stool

question

assessment for infection of wound

answer

elevated WBC & temperature; positive cultures

question

assessment for dehiscence

answer

disruption of surgical incision or wound

question

assessment for evisceration

answer

protrusion of wound contents

question

assessment for urinary retention

answer

unable to void after surgery; bladder distention

question

assessment for urinary infection

answer

foul smelling urine; elevated WBC

question

assessment for psychosis

answer

inappropriate affect

question

A mother expresses fear about changing the infant's diaper after circumcision. Which information should the nurse include in the teaching plan?

answer

Place petroleum ointment around the glans with each diaper change and cleansing.

question

The nurse is counseling a client who wants to become pregnant. She tells the nurse that she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. When will the client's next fertile period occur?

answer

January 29 to 30

question

This client can expect her next period to begin ------- days from the first day of her last menstrual period

answer

36

question

Six hours after an oxytocin induction was begun and 2 hours after spontaneous rupture of the membranes, the nurse notes several sudden decreases in the fetal heart rate with quick return to baseline, with and without contractions. Based on this fetal heart rate pattern, which intervention is best for the nurse to implement?

answer

Place the client in a slight Trendelenburg position

question

A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective in preventing nipple soreness?

answer

Ensure that the baby is positioned correctly for latch-on.

question

The most common cause of nipple soreness is ___________.

answer

incorrect positioning

question

The nurse observes an antepartum client, on bedrest for preterm labor, eating ice rather than the food on her breakfast tray. The client states that she has been craving ice and then feels too full to eat anything else. What is the best response by the nurse?

answer

Notify the healthcare provider * The healthcare provider should be notified when a client practices pica (craving for and consumption of nonfood substances)

question

A client at 32 weeks of gestation is hospitalized with severe pregnancy-induced hypertension (PIH), and magnesium sulfate is prescribed to control the symptoms. Which assessment finding indicates that therapeutic drug levels have been achieved?

answer

Respiratory rate decreases from 24 to 16 *Magnesium sulfate, a CNS depressant, helps prevent seizures. A decreased respiratory rate indicates that the drug is effective. However, a respiratory rate below 12 indicates toxic effects.

question

Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 90/60. What action should the nurse take immediately?

answer

Place the client in a lateral position * The nurse should immediately turn the client to a lateral position or place a pillow or wedge under one hip to deflect the uterus. Other immediate interventions include increasing the rate of the main line IV infusion and administering oxygen by face mask at 10 to 12 L/min.

question

A client at 28 weeks of gestation calls the antepartal clinic and states that she just experienced a small amount of vaginal bleeding, which she describes as bright red. The bleeding has subsided. She further states that she is not experiencing any uterine contractions or abdominal pain. What instruction should the nurse provide?

answer

"Come to the clinic today for an ultrasound." * Third trimester painless bleeding is characteristic of a placenta previa. Bright red bleeding may be intermittent, occur in gushes, or be continuous. Rarely is the first incidence life threatening, nor cause for hypovolemic shock. Diagnosis is confirmed by transabdominal ultrasound (A). Bleeding that has a sudden onset and is accompanied by intense uterine pain indicates abruptio placenta, which is life threatening to the mother and fetus.

question

An off-duty nurse finds a woman in a supermarket parking lot delivering an infant while her husband is screaming for someone to help his wife. Which intervention has the highest priority?

answer

Put the newborn to breast * Putting the newborn to breast will help contract the uterus and prevent a postpartum hemorrhage

question

Client teaching is an important part of the perinatal nurse's role. Which factor has the greatest influence on successful teaching of the pregnant client?

answer

The client's investment in what is being taught * When teaching any client, readiness to learn is related to how much the client has invested in what is being taught, or how important the material is to their particular life. For example, the client with severe morning sickness in the first trimester may not be "ready to learn" about labor and delivery, but is probably very "ready to learn" about ways to relieve morning sickness

question

The nurse is counseling a couple who has sought information about conceiving. The couple asks the nurse to explain when ovulation usually occurs. Which statement by the nurse is correct?

answer

Two weeks before menstruation * Ovulation occurs 14 days before the first day of the menstrual period

question

Ovulation occurs _____ days before the first day of the menstrual period.

answer

14

question

A mother expresses fear about changing the infant's diaper after circumcision. Which information should the nurse include in the teaching plan?

answer

Place petroleum ointment around the glans with each diaper change and cleansing. * With each diaper change, the glans penis should be washed with warm water to remove any urine or feces and petroleum ointment should be applied to prevent the diaper from sticking to the healing surface. Prepackaged wipes often contain other products that may irritate the site. The yellow exudate, which covers the glans penis as the area heals and epithelializes, is not an infective process and should not be removed

question

On admission to the prenatal clinic, a client tells the nurse that her last menstrual period began on February 15 and that previously her periods were regular (28-day cycle). Her pregnancy test is positive. What is this client's expected date of birth (EDB)?

answer

22-Nov * (A) correctly applies Nägele's rule for estimating the due date by counting back 3 months from the first day of the last menstrual period (January, December, November) and adding 7 days (15 + 7 = 22).

question

A 25-year-old client has a positive pregnancy test. One year ago she had a spontaneous abortion at 3 months of gestation. What is the correct description of this client that should be documented in the medical record?

answer

Gravida 2, para 0 *

question

A client who is 3 days postpartum and breastfeeding asks the nurse how to reduce breast engorgement. Which instruction should the nurse provide?

answer

Breastfeed the infant every 2 hours * The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding

question

One hour following a normal vaginal delivery, a newborn infant boy's axillary temperature is 96° F, his lower lip is shaking, and when the nurse assesses for a Moro reflex, his hands shake. What intervention should the nurse implement first ?

answer

Obtain a serum glucose level * This infant is demonstrating signs of hypoglycemia, possibly secondary to a low body temperature

question

A client at 30 weeks of gestation is on bedrest at home because of increased blood pressure. The home health nurse has taught her how to take her own blood pressure and given her parameters to judge a significant increase in blood pressure. When the client calls the clinic complaining of indigestion, which instruction should the nurse provide?

answer

"Take your blood pressure now, and if it is seriously elevated, go to the hospital." * Checking the blood pressure for an elevation is the best instruction to give at this time. A blood pressure exceeding 140/90 or increased by 15 mm Hg diastolic and/or 30 mm Hg systolic is indicative of preeclampsia. Epigastric pain can be a sign of an impending seizure (eclampsia), a life-threatening complication of PIH.

question

A blood pressure exceeding _____ or increased by 15 mm Hg diastolic and/or ___ mm Hg systolic is indicative of preeclampsia.

answer

140/90 30

question

An expectant father tells the nurse he fears that his wife "is losing her mind." He states she is constantly rubbing her abdomen and talking to the baby, and that she actually reprimands the baby when it moves too much. What recommendation should the nurse make to this expectant father?

answer

Reassure him that normal maternal/fetal bonding is occurring *

question

between Birth to 2 Months

answer

Hep B #1

question

between 1-4 Months

answer

Hep b #2

question

exactly at 2 Months

answer

Dtap 1, Hib 1, IPV 1, PCV1

question

exactly 4 months

answer

Dtap 2, Hib 2, IPV 2, CV2

question

exactly 6 months

answer

Dtap 3, Hib3, PCV 3

question

between 6-18 Months (6 months- 1.5 year)

answer

Hep B 3, IPV 3

question

between 12-15 Months (1 year- 1y 3 Months)

answer

Hib 4, MMR 1, PCV 4

question

12-18 Month (1 yr-1.5)

answer

Varicella (Chicken pox)

question

15-18 months (1y 3m- 1.5 y)

answer

Dtap 4

question

4-6 year

answer

Dtap 5, IPV 4, MMR 2

question

School Aged Erickson Stage

answer

6-12yr Task= Industry vs. Inferiority Positive- sense of confidence Negative-self-doubt, inadequate Acheivement and acomplishment are very important as they take on tasks and carry them through, they become parts of teams and groups and it is important for them to be encouraged during these endevors. If they can not accomplish this, they have feelings of inadequacy or infferiority

question

Adolescence Erickson Stage

answer

12-20yr Task= Identity vs. role confusion Positive- coherent sense of self; plans for education/work future Negative-lack of personal or vocational identity Very emotional and physical time...fitting in is very important, roles are changing and they want to fit in with their peers..what their peers think becomes much more important than what parents think and by the end they should be thinking about their careers and what they are going to do...very braud stage

question

Young Adulthood Erikson Stage

answer

20-45yr Task=Generativity vs Stagnation Positive- Creative and productive Negative- Self Centered They now have personal attatchments with a job, career, and family...Now start to think about what they can leave the generations behind them and have interest in what they can give back to the community...Those that do not reach this may be self centered and almost adolescent

question

Late Adulthood Erikson Stage

answer

65+ Task= Integrity vs. despair Positive-sees life as meaningful Negative-Fear of death; life lacks meaning Individuals are progressing towards the end of life....if they have a positive outcome...they will feel they have made a contribution to life and if negative, they may become distainful or bitter

question

School Age Growth and Development: 6 years

answer

-Self centered, show off, rude -Sensitive to criticism (might cheat on things and dont like to lose) -Begins loosing temparary teeth

question

School Age Growth and Development: 7 years

answer

-Team games/sports -Developes concept of time -Prefers playing with same sex child

question

School Age Growth and Development: 8 years

answer

-Seeks out friends (much more social) -Writing replaces printing

question

School Age Growth and Development: 9 years

answer

-Conflicts between adult authority and peer group -Conflicts between independence and dependence

question

School Age Growth and Development: 10 years

answer

-Remainder of teeth (except Wisdom) erupt -Uses telephone; loves conversation -Increasingly responsible/social -More selective when choosing friends -Begins to develop interest in the opposite sex -Might be able to left alone for a little while at this age -Might Enjoy reading now more than before

question

Toys & Activities for School Age

answer

-Construction Toys -Tools, household and sewing tools -Table games, sports -Bicycle with helmet (be sure to stress helmet to parents) -May be getting into hobbies -They like to have a goal and meet it (industry vs. inferiority)

question

Potential Problems for School Age

answer

-Enuresis- Bed Wetting (beyond the age of voluntary bladder control) (child is easily embarrassed, they dont like to be critcized so they may be mortified about bed wetting) -Encopresis- Incontinent of stool -Safety: Injuries & Head lice (lice normally at school when kids are in close proximities with others) -Need to be taught to wear seat belts to avoid injuries

question

Interventions for Enuresis

answer

-void at bed time -may need to be wakened to void if they are a heavy sleeper -some medications to help a child stay dry through the night are available -need to explore if this is a new thing :if they were once able to stay dry and now a routine physical exam may be needed to role out other potential problems like UTI, Neuro deficits, and Diabetes

question

Adolescent Growth and Development

answer

Physical Development: Puberty (physical growth and sexual maturation; can begin as early as 8 in girls) -Girls develop more rapidly than boys -Rapid alterations in height and weight: May cause easy fatigue -Development of secondary sexual characteristics -Preoccupation with physical appearance (body image is everything for this child)

question

Accomplishments by the End of Adolescent Growth and Development

answer

-By the End of this stage: They should have -Complete development of secondary sexual characteristics -Improved motor coordination and wisdom teeth appear

question

Adolescent Growth and Development: Male Changes

answer

-Increase in genital size -Pubic, facial, axillary, and chest hair -Deepening voice -Producation of fuctional sperm -Nocturnal emissions "Wet Dreams" (important for them to understand that this is normal) -They can also develop gynecomastia and even some milk leaking from the breasts due to hormonal flucuations and can become HIGHLY destressed by this (make sure that they understand that this may happen and should subside as they continue to grow (It is considered pubertal delay if boys have had not testes enlargment by age 13 or 14)

question

Adolescent Growth and Development: Female Changes

answer

-Breast Development -Axillary and pubic hair -Menarche (1st menstral period) Can occur between age 9-13 -Puberty for girls usually starts with breast buds, followed by pubic hair, then menstral period (average age for menarch is 12.8years...as young as 10 1/2 and as old as 15 -Pubertal delay is considered if breasts have not formed by age 13 or if menarch has not occured within 4 years of breast development

question

Adolescent Psychosexual Development

answer

-Masturbation -Sexual Fantasies -Experimental sexual intercourse

question

Adolescent Psychosocial Development

answer

-Conforms to peer pressure (want to be liked and do what peers are doing -Moody (this is the age of raging hormones) -Increased independence -It is important that we teach...what they are feeling is normal and safety tip for sexual intercourse (regarding unplanned pregnancies and STD's

question

Potential Problems for Adolescence

answer

-Adolesent pregnancy -Poort self-image -Safety (automobile accidents, diving accidents) -Drug and alcohol abuse -AIDS -High school dropout -Violence (need teaching regarding preventing pregancy whats a myth and whats a fact...need teaching for sexual protection..need counselling to delay any impulsive action that could have long term consequences...need help identifying coping mechanisms...help identify who their friends are and who their peer support group is

question

Adult Growth and Development: 20-33yr

answer

-Increased reality -Independence from parents -Marriage, partnership -Peak Intelligence, memory -Maximum problem solving (having a family, and balancing a career, and their health...SO Health Promotion is a huge part of this age group...Smoking, Smoking cessation, maintaing weight at an optimal level, proticipating in regular exercise, and being aware of ETOH and drug abuse) How are they dealing with stress??

question

Adult Growth and Development: 33-40yr

answer

-Increased sense of urgency -Life more serious -Major goals to accomplish -Plateaus at work and marriage -Sense of satisfaction (Very important to acheive balance..of work, family and taking care of self, bodies are also changing and they may need to understand what normal changes are)

question

Adult Growth and Development: 35-45yr

answer

-Self questioning (am I doing what I should be?) -Fear of middle age and aging (more worried about wrinkles) -Potential changes of work, marriage -Dicards unrealistic goals -"Sandwhich" generation (between young adulthood, going into middle adult hood) -Increased awarness of mortality

question

Potential Problems with Adulthood

answer

-Difficulty with relationships -Stress (normally about balance of life as a whole and are how they are taking care of their physical bodies)

question

Older Adult Growth and Development: 65-80yr & 80+

answer

-Physical decline -Loss of significant others -Appearance of chronic diseases -Change in social roles

question

Problems of Older Adult

answer

-Self care deficit (are they still able to care for themselves) -Isolation (they may have lost a spouse, children, or friends) -Altered relationships -Decreased independence (Consider that children in middle adulthood may be the caregivers now, so care giver strain, elder abuse, and increased falls and injuries)

question

Mental Retardation

answer

Based on IQ Mild: IQ 55-70 Moderate: IQ 40-55 Severe: IQ 25-40 Profound: IQ <25 Level of Retardation Affects -Preschool Growth and Development -School training and education -Adult social and vocational level

question

Mental Retardaiton Causes

answer

-Hereditary -Infection -Fetal anoxia -Cranial or chromosomal abnormalites -Things that occured at birth -Things that noone had any control over (be sure to evaluate family adjustment and explore resources for the individual to help them perform at their optimal level)

question

Fetal Alcohol Syndrome

answer

Assessment: -Mental deficiencies, motor deficiencies -Physical: thin upper lip/ epicanthal folds, maxillary hypoplasia Implementation: -Prevention: Avoid ETOH 3 months before conception (remember there is not a safe level of ETOH consumption during pregnancy) -Monitor weight gain, promote nutrition

question

Downs Syndrome

answer

Assessment: -Mental deficiencies: IQ 20-70 -Hypotonia -Altered physical development (epicanthal folds, low set ears, protruding tounge, low nasal bridge) Implementation: -Provide stimulation: OT/PT/Special Ed -Assess for physical problems (often have other problems like heart defects, respiratory infections...be sure to monitor and screen for these) -Parental education -Be sure to provide resources to allow child to reach optimal function

question

Learning Disabilities

answer

ADD (decreased attention span) /ADHD (hyperkinesis)/Dyslexia (Perceptual deficits) -main thing to know is that these children normally have a high IQ so detection of these things and diagnosis can be difficult so be sure that resources for parents are available -Commorbidities such as depression are not uncommon becuase child may feel inferior or that they are constanly in trouble and not doing things right so it it important to figure out what is going on with resources for child and parent Implementation: -Special education interventions -Medications -Support groups I

question

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

answer

"I'm giving my baby iron-fortified formula and a flouride supplement because our water isn't flouridated."

question

A nurse is teaching new parents about normal development. Voluntary grasp is usually present at what age?

answer

5 months

question

A parent whose family drinks low-fat milk asks if her child can begin to drink low fat milk. The AAP recommends that children can begin to drink low fat milk at what age?

answer

2 years

question

A nurse is doing discharge teaching. She explains that the anterior fontanel normally closes between ages:

answer

12-18 months

question

Toddlers are at high risk for injuries because of their increasing curiosity, advancement in cognition, and improved motor skills. All these hazards are a concern for this age-group except: 1. burns 2. poisoning 3. sports injury 4. falls

answer

sports injury- a toddler clearly would not be involved in team sports. :)

question

In a clinic, the mother of an 8-month old asks the nurse what to feed her infant because she wants to stop breast feeding. The nurse recommends :

answer

formula

question

Directional trends in growth and development are easily seen in the neonate. Which term describes development in the head-to-tail direction?

answer

Cephalocaudal trend

question

3yo is hospitalized for femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy?

answer

Allow the child to administer her own Keflex (cehphalexin) via oral syringe.

question

A 16yo male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this pt. what action can you take that will most enhance his psychosocial development?

answer

Encourage the teen's friends to visit him in the hospital.

question

A 6-month old male is at his well-child visit. The nurse weighs him, and his mom ask if his weight is normal for his age. The nurse's best response is?

answer

"At 6 months his weight should be approximately twice his birth weight."

question

The nurse caring for a 4yo female in the ER is about to start an IV. The nurse's best method for explaining the procedure to the child is to:

answer

Show the child the IV placement equipment, and demonstrate the procedure on the doll.

question

A 17yo male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should:

answer

Gather info. during a casual conversation

question

How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized?

answer

The nurse should encourage the parents to hold their child as much as possible.

question

A 3yo female is hospitalized for an ASD repair. Her parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is:

answer

"Your mommy and daddy will be back after your nap."

question

An ER nurse is assessing a 12-month old female. Which statement accurately describes the best method for assessing this child?

answer

The nurse should assess the child while she is in her mother's lap.

question

An 11yo male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment?

answer

The nurse should explain to the child what the nurse will be doing in basic understandable terms.

question

Presumptive signs of Pregnancy

answer

amenorrhea, nausea & vomiting, tired, urinary frequency, breast tenderness, quickening, constipation

question

Probable signs of pregnancy

answer

(examiners objective findings) Positive pregnancy test, enlarge abdomen uterus, Gooddells signs, chadwick, hegars signs, ballottement, braxtons hicks contractions

question

Hegar's Sign

answer

A softening of the lower uterine segment found upon palpation in the second or third month of pregnancy.

question

Chadwick's Sign

answer

A purplish-blue color of the cervix and vagina caused by the increased vascularity are both noted at about 8 wks.

question

Goodell's Sign

answer

softening of the cervix

question

Ballottement

answer

the rebounding of the fetus against the examiner's finger on palpation. when the cervix is tapped, the fetus floats upward in the amniotic fluid. a rebound is felt by the examiner when the fetus falls back

question

Nagele's Rule

answer

A method of determining the estimated date of birth (EDB): after obtaining the first day of the last menstrual period, subtract 3 months and add 7 days.

question

Gravidity

answer

Number of pregnancies

question

Parity

answer

Number of pregnancies which fetus(es) reach viability (20-24 weeks) regardless of if fetus is born live or not.

question

GTPAL

answer

# pregnancys, term preg, preterm pregnancy, abortions/miscarriages, living children

question

Physiological Changes in Pregnancy

answer

Reproductive- uterus increases in size/shape and position. Cardiovascular- C/O and blood volume increase. HR increases Respiratory-Oxygen needs increase M/S-weight increase, pelvic joints relax GI- N/V r.t hormone, organs displaced due to uterine enlargement Renal-Filtration rate increases (urinary frequency) Endocrine- HCG, Progesterone, estrogen, lactogen and prostaglandins increase.

question

Home Pregnancy Tests

answer

Measure HCG levels (26 days after conception in urine, 6-11 days in serum) Urine samples should be first void morning specimens

question

Chloasma

answer

mask of pregnancy; pigmentation disorder that occurs during pregnancy characterized by brown spots on the face

question

Linea Nigra

answer

a dark line appearing on the abdomen and extending from the pubis toward the umbilicus

question

Striae gravidarum

answer

Stretch marks

question

Intussusception Definition

answer

• Telescoping of one portion of the bowel into another portion. This condition results in obstruction to the passage of intestinal contents. Causes edema, vascular compromise, then partial or total bowel obstruction.

question

Intussusception S/S

answer

-Sudden onset of severe, intermittent abdominal pain -screaming and drawing up legs with periods of calm in between episodes -pain relieved once abdomen relaxes -currant jelly stools (blood and mucus) -sausage shaped mass in RUQ

question

Intussusception Tx & Dx

answer

Barium enema for reduction surgical reduction if BE not effective Bowel resection if all fails DX also based on findings during physical exam (distended abdomen, sausage mass, BS)

question

Intussception Nursing care

answer

-If tx is managed thru reduction, nurse observes for passage of stool and barium-->must monitor and record # stool -if tx is sx, chld is NPO, NG inserted and IV fluids given -monitor for perforation (acute pain, rigid abdomen, tachy, fever chills), peritonitis, increased pain

question

Pyloric Stenosis Definition

answer

Hypertrophy of pyloric sphincter (between stomach and intestine) causing obstruction Can run in families, more common in males. Develps in first few weeks of life

question

Pyloric Stenosis S/S

answer

-olive size mass in RUQ (moveable/firm) -peristaltic waves during and after feedings -projectile vomiting!** -hungry and irritable after vomiting -dehydration & metabolic acidosis

question

Pyloric Stenosis Tx

answer

laprascopic pyloromyotomy-->incision and suture of pyloric sphincter

question

Pyloric stenosis Nursing Pre op

answer

If dehydration present (depressed fontanel, skin turgor, low UO), surgery is done after correction with fluids/electrolytes -NPO -IV Fluids -NG tube

question

Pyloric Stenosis Nursing Post op

answer

-Maintain fluid balance -vomiting for 24-36 hrs after sx is NORMAL -small clear liquid feedings @ 4-6 hrs post op -breastfeeding in 24 hrs if clear liquid diet is tolerated -weigh wet diapers to measure ouput

question

Pyloric stenosis teaching

answer

save and weight wet diapers breastfeeding in 24 hrs if clear diet is tolerated watch infants response to feeding bc vomiting can still occur **if vomiting after 48 hrs--call Dr! monitor for infection

question

Exstrophy of bladder Care

answer

-Prevent infection!** -keep area as clean as possible bc urine on skin will cause irritation and ulceration -change diaper frequently, keep it loose fitting -wash with mild soap and water -cover exposed bladder with vaseline gauze

question

Nephrotic syndrome assessment

answer

proteinuria hypoproteinemia hyperlipidemia pallor, lethar hepatomegaly weight gain HTN preorbital facial edema in moring asicite scrotal/ankle edema

question

Nephrotic syndrome teaching

answer

-Bed rest. quiet games, things that conserve energy -long term use of corticosteroids ( impaired wound healing, hyperglycema, osteoporosis, moon facies) -prevent infection-->keep kids away from sick kids -urine testing (in the morning) -need for long term follow up -high protein and low sodium diet during edema phase -antbiotics for bacterial infections & diuretics

question

Vesicoureteral Reflux definition

answer

urine backflows from bladder to ureters and back to kidney, occuring at vesicoureteral junction (normally creates a one-way valve from urine to enter the bladder without reflux back into urterers). Primary is d/t congenital defect, secondary d/t obstruction

question

Vesicoureteral reflux predisposis child to:

answer

- UTI from urine stasis -pyelonehprosis from chronic UTI -hydronephrosis from increased pressure on renal pelvis

question

Vesicourereteral reflux S/S

answer

-Recurring UTI most common -flank pain -abdominal pain -enuresis

question

Vesicour reflux Tx

answer

-Grades 1 & 2 may resolve on its own, more severe may need surgery -management is preventing and treating UTI. -pts will take long term prophylatic antibiotics and ditropan to relieve bladder pressure

question

Vesicour reflux nursing

answer

** monitor I & O and pain control** -monitor drains- check output from drains Q 1 hr -ureters should be draining the most -if anything stops draining, call HCP -look at color and make sure there are no breaks that could cause infection -observe drainage from abdominal dressing

question

Vesicour reflux nursing infants (book)

answer

-nurse must observe for urinary discomfort during: -voiding or straining to void -dribbling of urine -starting and stopping of stream -monitor for fever and irritability as a sign of uti-->obtain clean catch

question

TEF S/S

answer

-3 C's: couching and choking with feedings & intermittent cyanosis -distended abdomen from inhaled are -aspiration pneunomnia from reflux into trachea

question

TEF nursing Pre OP

answer

Priority: maintain patent airway/prevent aspiration -NPO -IV fluids -position semi-fowlers to protect trachea from secretions -turn head to side to prevent aspiration -regular suctioning -antibiotics started bc aspiration pneumonia is inevitable!

question

TEF nursing Post OP

answer

-baby will return with chest tube and still intubated (will go home with this) -minimal suctioning to avoid disruption of surgical repair -TPN initially followed by oral feedigs -infant will lead normal life after sx

question

cleft lip post op

answer

-position on BACK or SIDE opposite of repair -avoid strain on suture -use elbow restraints -keep suture line clean -maintain patent airway!

question

Cleft palate post op

answer

-position PRONE or side -emergency suction at bedside -prevent injury to suture line -give water after feeding to clean suture line -no brushing teeth, hard foods, or putting things in mouth, sucking -hold and cuddle!

question

Cleft lip/palate feeding

answer

-feed in upright position to decrease aspiration and swalloing of air -burp frequently -tube feedings as neccesary -can still breastfeed until sx -bottle feed with special nipple that is longer to help prevent aspiration -haberman nipple

question

Meningitis S/S

answer

nuchal rigidity bulging fontanel fever/chills/headache poor feeding or anorexia seizures photophobia petechial/purpura rash positive kernig sign (pain behind knee during leg extension) positive brudzinski (flexion of hip and knee with passive flexion of nexk)

question

Meningitis care

answer

-Respiratory ISOLATION for 24 hrs after antibiotics -monitor I7O- decreased UO may be a sign of SIADH (also fluid retention, cerebral edema, dilutional hyponatremia) -steroids to reduce cerbral edema and prevent hearing loss, hydrocephalus, learning disorders -monitor for increased ICP- high BP, low pulse, high pitched cry, irritably, bulging fontanel -keep room quiet, dim -seizure precaution -NPO until N/V subsides

question

when does the anterior fontanel close?

answer

18 to 24 months

question

infant's birth weight should ___ in six months

answer

double

question

infant's birth weight should ____in a year

answer

triple

question

infant's respiratory rate is ____ to _____ breaths per min

answer

30-60

question

infant's heart rate is _____ to _______ per minute

answer

110-160

question

which are the first teeth to erupt

answer

lower central incisors

question

when does infant's teeth first erupt

answer

4-6 months

question

what age can infant follow an object with its head?

answer

2 months

question

what age are children first afraid of strangers

answer

6-7 months

question

when does an infant walk alone?

answer

14-15 months

question

what age does an infant have a pincer grasp

answer

12-13 months

question

when can an infant roll over

answer

4-5 months

question

when can an infant sit up unassisted?

answer

6-8 months

question

what age does an infant stand alone?

answer

12-13 months

question

what age does an infant crawl?

answer

8-9 months

question

what age does an infant walk holding onto furniture?

answer

10-11 months

question

Birth - 1 year = infancy stage

answer

trust vs. mistrust

question

What is a positive outcome for infancy?

answer

trust self and others (need to meet infants basic needs)

question

What is a negative outcome for infancy?

answer

an inability to trust; withdrawal, isolation

question

1 yr -3 yr = Toddler stage

answer

autonomy vs. shame and doubt (if no contact)

question

What is a positive outcome for a toddler?

answer

exercises self-control and directly influences the environment, they want to do things themselves

question

What is a negative outcome for a toddler?

answer

demonstrates defiance and negativism

question

3-6 = preschool stage

answer

initiative vs. guilt

question

What is a positive outcome for a preschooler?

answer

begins to evaluate own behavior; learns limits on influence in the environment

question

What is a negative outcome for a preschooler?

answer

Demonstrates fearful pessimistic behaviors; lacks self confidence

question

6-12 = school age stage

answer

industry vs. inferiority

question

What is a positive outcome for a school age child?

answer

develops a sense of confidence thro achievement & accomplishments; uses creative energies to influence the environment

question

What is a negative outcome for a school age child?

answer

demonstrates feelings of inadequacy, mediocrity, and self-doubt

question

12-20 yr = adolescent stage

answer

identity vs. role diffusion aka prob if a kid is DM w/diet compliance b/c want to do what peers are doing

question

What is a positive outcome for adolescence?

answer

develops a coherent sense of self; plans for a future of work/education

question

What is a negative outcome for adolescence?

answer

demonstrates inability to develop personal and vocational identity

question

20-35 = young adulthood stage

answer

intimacy vs. isolation

question

What is a positive outcome for young adulthood?

answer

develops connections to work and intimate relationships

question

What is a negative outcome for young adulthood?

answer

demonstrates an avoidance of intimacy and vocational career commitments

question

35-64 = middle adulthood stage

answer

generativity vs stagnation (want to leave a legacy)

question

What is a positive outcome for middle adulthood?

answer

involved w/est family; expands personal creativity and productivity

question

What is a negative outcome for middle adulthood?

answer

demonstrates lack of interests, commitments; preoccupation w/self-centered concerns

question

> 65 = late adulthood stage

answer

integrity vs. despair

question

What is a positive outcome for late adulthood?

answer

identification of life as meaningful

question

What is a negative outcome for late adulthood?

answer

demonstrates fear of death' life lacks meaning

question

height increases by 3/4 inch per month

answer

infant

question

weight is doubled at 5-6 months & tripled at 12 months

answer

infant

question

at birth, head circumference is _____cm or _____inches, approximatley____cm more than chest circumference

answer

33-35 cm; 13.2-14 inches; 2-3 cm

question

by 2-3 years of age, head circumference are?

answer

equal

question

anterior fontanelle in a normal infant

answer

soft and flat

question

anterior fontanelle closes ?

answer

by 12-18 months

question

posterior fontanelle closes?

answer

by end of second month

question

posterior fontanelle in normal infant?

answer

soft and flat

question

infant has 10 upper and 10 lower decidous teeth by what age?

answer

2.5 years

question

Lower central incisors are present?

answer

by 6-8 months

question

by what age do most infants develop a nocturnal pattern of sleep that lasts 9-11 hours.

answer

3-4 months

question

between ages 1 and 2 years the head circumference increases by?

answer

1 inch

question

after 2 years until 5 years, the head circumference increases by

answer

1/2 inch

question

anterior fontanelle closes by?

answer

12-18 months (1-1.5 year)

question

average weight at age 2 years?

answer

22-27 pounds

question

average toddler height at 2 years?

answer

34 inches

question

lordosis is noted in what age?

answer

toddler

question

When should a toddler see a dentist?

answer

soon after the first teeth erupt

question

why should a toddler never fall to sleep with a bottle of milk, juice, soda, or sweetened water ?

answer

dental caries

question

when is a daytime nap discontinued in a toddler?

answer

3 years

question

What can help the toddler prepare for sleep?

answer

having a ritual

question

average height of preschooler at 3?

answer

37 inches

question

average height of preschooler at 4?

answer

40.5 inches

question

average height of preschooler at 5?

answer

43 inches

question

average weight at age 5?

answer

35-40 pounds

question

how many hours of sleep does a preschooler require?

answer

12 hours

question

When is the eruption of the primary teeth complete?

answer

at the beginning of the preschool periord

question

girls grow faster than boys in what period?

answer

school age

question

sleep requirements for school age?

answer

10-12 hours

question

Health Screening for Newborn

answer

PKU Hypothyroidism Galactosemia Sickle-Cell disease HIV

question

Galactosemia

answer

error of carbohydrate metabolism

question

Health Screening for Infant/Child

answer

developmental screening(DENVER II) Cystic fibrosis screening Cholesterol screening for children with family history of sudden death, MI Lead poisoning Neuroblasta

question

Lead Poisoning Risk Factors

answer

children 6-72 months at highest risk live in deteriorated housing sibling or close peer with lead poisoning household member with hobbies( stained glass) or lead related occupations

question

School-Age Screening

answer

hearing/vision test at 4 yr and yearly dental exams medical assessments

question

When should Pelvic Exam start?

answer

annually after sexual active or after 18years of age

question

When to begin breast self exam?

answer

18-20 monthly

question

Mammogram should start when?

answer

35-39 once as baseline 40 year old + annually

question

Testicular self-exam

answer

18-20 monthly

question

Inaccurately high BP?

answer

cuff is too short or too narrow or the brachial artery is below the heart

question

High diastolic BP?

answer

auscultatory gap

question

Inaccurately low BP?

answer

cuff is too long or wide brachial artery is above the heart

question

low systolic BP

answer

unrecognized auscultatory gap

question

What is the difference between active immunity and passive immunity?

answer

active is permament and in active immunity, the individual already has their own antiobody for the antigens passive antibodies are formed from being introduced from other sources ie breastfeeding

question

Contradictions for Immunization

answer

severe febrile illness live viruses should not be given to anyone with an altered immune system ie going through chemo or imunocompromised previous allergic response to a vaccine blood transfusion

question

Interrupted schedule or uncertain immunity status

answer

not necessary to repeat immunization when the schedule is interrupted just continue from where left off if no record of immunization and the child is younger than 7 give DTAP,IPV, and 4-6 weeks later give MMR 1 month later give DTAP and IPV this is repeated in another month and then again in 10-16 months

question

DTAP Immunization schedule

answer

two doses 4-8 weeks apart third dose 6-12 months booster 10 years intervals for life

question

Influenza indications?

answer

ages 19-49 years for persons each fall dont give if allergic to eggs

question

Measles and Mumps indications

answer

adults born after 1957 without proof on or after first birthday HIV patients without severe immunosuppression travelers to foreign countries persons entering college

question

Measles and Mumps Schedule

answer

one dose two doese if in college, in health care profession, or traveling to foreign countries with second dose more than a month after the first

question

Measles and Mumps Vaccine Contraindications

answer

avoid immunization 30 days after shot

question

Small Pox Vaccination Indications

answer

first responders one dose needed

question

Contraindications of Small Pox Vaccination

answer

history of eczema or orther skin condition, pregnancy, or breast feeding or women who want to concieve in the next month

question

Small Pox Vaccination Care

answer

disease can be passed from unhealed vaccination site to other people with close contact wash hands with soapy watery immediately after changing bandage and seal in plastic bag wear long sleeve clothing

question

TB Test

answer

can be given to 4-6 year olds and 11-16 years if in high prevalence areas elevated 48-72 hours

question

IPV in the US

answer

no longer recommended

question

Rubella Indications?

answer

persons especially women without proof of vacacine on or after first birthday health care personnel at risk of exposure to rubella and who have contact with pregnancy client

question

Rubella Schedule

answer

one dose

question

Rubella Contraidications

answer

allergy to neomycin pregnancy-avoid pregnancy 3 months after vaccination receipt of blood transfusion

question

Hepatitis B Vaccine Indications

answer

household contacts of ppl with HBV at risk to exposure of bloody products Gay men heterosexual with multiple sex partners Inmates of long term correctional facilities unvaccinated adolescents

question

HBV Vaccine Schedule

answer

three doses second dose 1-2 months after 1st third dose 4-6 months after 1st

question

Varicella Immunization

answer

person who didnt have disease or havent had a vaccination

question

Varicella immunization

answer

two doses 4-8 wks apart

question

Contraindications of varicella immunization

answer

immunosuppresive therapy or HIV pregnancy- avoid pregnancy for 1 month

question

Hepatitis A Vaccine Indications

answer

travelers to countries with high incidence gay men drug addicts clotting factor disorders food handlers

question

Hep A Vaccine Schedule

answer

two doses 6-12 months apart

question

HEP A Vaccine considerations

answer

welling and redness at injection site is normal

question

HPV Vaccine Indications

answer

all females 11/12 to 25

question

HPV Vaccine Schedule

answer

three doses second dose 2 months after first third dose 6 months after 2nd

question

Allergic Prodromal Assessment

answer

c/o weakness, apprehension, impending frrom dry/scratchy throat, N/V

question

Allergic Cutaneous Assessment

answer

generalized intense pruritis and uritcaria(hives) angioedema(swelling) of lips and eyelips

question

Allergic Bronchial Assessment

answer

increasing resp distress with audible wheezing, rales, diminished breath sounds and heard on auscultation

question

diminished breath sounds and heard on auscultation Circulatory Assessment

answer

hypotension and a rapid, weak, irregular pulse, dysrhythmias, shock, cardiac arrest can occur within minutes

question

Histamine

answer

evidence of allergic response

question

Plan for Allergic Reaction

answer

establish ABC adminsiter epi in arm opposite to side of injection and can be repeated in 15-20 minutes PRN (3 times with children)

question

Latex Allergy Risk Factors

answer

allergies to bananas, avocado, chestnut, papaya, peaches health care workers,hairdressers,cleaning staff H/O of multiple surgeries clients with spinal cord injuries clients with urgogenital abnormalities children with neural tube defects

question

Avoid Latex products

answer

gloves catheters and syringes brown ace bandages band-aid dressing elastic pressure stocking balloons condoms feminine hygiene pad

question

Physical Assessment: Tips

answer

empty bladder beforehand

question

Resonance

answer

moderate to loud, low-pitched clear(clear,hollow) sound of moderate duration; found with air-filled tissue(normal lung)

question

Hyperresonance

answer

loud, booming, low-pitched sound of longer duration found with overinflated air-filled tissue (pulmonary emphysema) normal in child due to thin chest wall

question

Tympany

answer

loud, drumlike high pitched or musical sound of moderately long duration found with enclosed, air-filled structures(bowel)

question

Liver sounds

answer

dull-soft, muffled, moderate to high pitched sound of short duration, found with dense, fluid-filled tissue

question

Sounds over bone

answer

flat-very soft; high pitched sound of short durationl found with very dense tissue

question

Normal Resp Rate for new born

answer

30-60 min

question

Normal Resp Rate 1-4 years

answer

20-40 min

question

Normal Resp Rate 5-12 years

answer

15-25

question

Normal Resp Rate adult

answer

12-20 min

question

Normal Pulse Rate new born

answer

120-160, or 180 bpm when crying

question

Normal Pulse Rate 1-4 years

answer

80-140 bpm

question

Normal Pulse Rate 5-12 years

answer

70-115 bpm

question

Normal Pulse Rate adult

answer

60-100 bpm

question

Normal Blood Pressure newborn

answer

65/41

question

Normal Blood Pressure 1-4 years

answer

90-99/60-65

question

Normal Blood Pressure 5-12 years

answer

100-110/56-60

question

Normal Blood Pressure adult

answer

<120/80

question

Normal Temp

answer

Rectal: 99.6 Oral: 98.6 Axillary: 97.6

question

PERRLA

answer

size, shape, equality, reactivity to light and accommodation

question

Cranial Nerve I

answer

olfactory-smell

question

Cranial Nerve II

answer

optic-sense of vision

question

Cranial Nerve III

answer

Oculomotor-pupil contriction raising eyelids to assess have patient look up & down, inaward and observe for symmetry

question

Cranial Nerve IV

answer

trochlear- downward and inward movement of eyes

question

Cranial Nerve V

answer

trigeminal-motor jaw movement sensory-senation on the face and neck

question

Cranial Nerve VI

answer

abducens lateral movement of the eyes

question

Cranial Nerve VII

answer

facial muscle movement sensory taste of sweet and salt

question

Cranial Nerve VIII

answer

acoustic-sense of hearing and balance

question

Cranial Nerve IX

answer

Glossopharyngeal- ability to swallow taste of sour and bitter

question

Cranial Nerve X

answer

vagus swallowing and speaking(smooth)

question

Cranial Nerve XI

answer

spinal accessory flexion/rotation of head shrugging/shoulders

question

Cranial Nerve XII

answer

motor tongue movements

question

S1lubb

answer

closure of tricuspid and mitral valves

question

S2 dubb

answer

closure of aortic and pulmonic valves

question

Apical Pulse

answer

left at 5th intercostal space at midclavicular line

question

incubation of chicken pox (varicella)

answer

13- 17 days

question

incubation of diphtheria

answer

2-5 days

question

incubation of pertussis (whooping cough)

answer

5-21 days

question

incubation of rubella (german measles)

answer

14-21 days

question

incubation of rubeola

answer

10-20 days

question

incubation of scarlet fever

answer

2-4 days

question

incubation of mononucleosis

answer

4-6 weeks

question

incubation of mumps

answer

14-21 days

question

prodromal definition

answer

early symptom indicating onset of an attack

question

prodromal: slight fever, malaise, anorexia

answer

chicken pox (Varicella)

question

rash is pruritic, begins as a macule, then papule, & then vesicle with successive crops of all three stages present at any one time; lymphadenopathy; elevated temperature

answer

chicken pox (varicella)

question

transmission of chicken pox (varicella)

answer

spread by direct contact, airborne, contaminated object

question

prodromal: resembles common cold

answer

diphtheria

question

low grade fever, hoarseness, malaise, pharyngeal, lymphadenitis, white/gray pharyngeal membrane

answer

diphtheria

question

transmission of diptheria

answer

direct contact with a carrier, infected client contaminated articles

question

prodromal: upper respiratory infection for 1-2 weeks

answer

pertussis

question

severe cough with high pitched whooping sound, especially at night, lasts 4-6 weeks, vomiting

answer

pertussis

question

transmission of pertussis

answer

direct contact, droplet, contaminated articles

question

prodromal: none in children, low fever, & sore throat in adolescent

answer

rubella (german measles)

question

maculopapular rash appears first on face &then on rest of the body, symptoms subside first day after rash

answer

rubella (german measles)

question

transmission of rubella

answer

droplet spread & contaminated articles

question

prodromal: fever & malaise followed by cough & Koplk's spots on buccal mucosa

answer

rubeloa

question

erythematous maculopapular rash with face first affected; turns brown after 3 days when symptoms subside

answer

rubeloa

question

transmission of rubeloa

answer

direct contact with droplets

question

prodromal: high fever with vomiting, chills, malaise, followed by enlarged tonsils covered with exudate, strawberry tongue

answer

scarlet fever

question

rash: red tiny lesions that become generalized & then desquamate; rash appears within 24 hours

answer

scarlet fever

question

transmission of scarlet fever

answer

droplet spread or contaminated articles

question

malaise, fever, enlarged lymph nodes, sore throat, flulike aches, low grade temperature

answer

mononucleosis

question

transmission of mononucleosis

answer

direct contact with oral secretions

question

fever, white exudate on tonsils, positive group A strep

answer

tonsillitis

question

malaise, headache, fever, parotid gland swelling

answer

mumps

question

transmission of mumps

answer

direct contact with saliva, droplet

question

Chicken pox: Avoid use of _____ due to association with Reye's syndrome.

answer

aspirin

question

precaution for chicken pox

answer

airborne & contact precautions

question

diptheria: contact & droplet precautions until two successive ______& ____ are obtained.

answer

negative nose & throat cultures

question

complications for pertussis

answer

pneumonia, weight loss, dehydration, hemorrhage, hernia, airway obstruction

question

rare complications of rubella (german measles)

answer

arthritis & encephalitis

question

rubeola: isolate until ___; maintain bedrest durng first _____days.

answer

5th day; 3 to 4 days

question

mono: advise family members to avoid contact with saliva for about ____

answer

3 months.

question

complications of mono

answer

encephalitis & spleen rupture

question

serious complications of tonsillitis

answer

rheumatic fever & glomerulonephritis

question

complications of mumps

answer

deafness, meningitis, encephalitis, sterility

question

A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted? 1.The client begins to expel clear vaginal fluid 2.The contractions are regular 3.The membranes have ruptured 4.The cervix is dilated completely

answer

4. The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate.

question

A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to: 1.Place the mother in the supine position 2.Document the findings and continue to monitor the fetal patterns 3.Administer oxygen via face mask 4.Increase the rate of pitocin IV infusion

answer

3. Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned to her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous

question

A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician? 1.Fetal heart rate of 180 beats per minute 2.White blood cell count of 12,000 3.Maternal pulse rate of 85 beats per minute 4.Hemoglobin of 11.0 g/dL

answer

1. A normal fetal heart rate is 120-160 beats per minute. A count of 180 beats per minute could indicate fetal distress and would warrant physician notification. By full term, a normal maternal hemoglobin range is 11-13 g/dL as a result of the hemodilution caused by an increase in plasma volume during pregnancy.

question

A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The client is transferred to the delivery room table, and the nurse places the client in the: 1.Trendelenburg's position with the legs in stirrups 2.Semi-Fowler position with a pillow under the knees 3.Prone position with the legs separated and elevated 4.Supine position with a wedge under the right hip

answer

4. Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and the fetus. The best position to prevent this would be side-lying with the uterus displaced off of abdominal vessels. Positioning for abdominal surgery necessitates a supine position; however, a wedge placed under the right hip provides displacement of the uterus.

question

A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse most accurately determines that the fetal heart sounds are heard by: 1.Noting if the heart rate is greater than 140 BPM 2.Placing the diaphragm of the Doppler on the mother abdomen 3.Performing Leopold's maneuvers first to determine the location of the fetal heart 4.Palpating the maternal radial pulse while listening to the fetal heart rate

answer

4. The nurse simultaneously should palpate the maternal radial or carotid pulse and auscultate the fetal heart rate to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the fetal heart rate. Leopold's maneuvers may help the examiner locate the position of the fetus but will not ensure a distinction between the two rates.

question

A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? 1.Three contractions occurring within a 10-minute period 2.A fetal heart rate of 90 beats per minute 3.Adequate resting tone of the uterus palpated between contractions 4.Increased urinary output

answer

2. A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue to pitocin. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period.

question

A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of Pitocin. The nurse ensures that which of the following is implemented before initiating the infusion? 1.Placing the client on complete bed rest 2.Continuous electronic fetal monitoring 3.An IV infusion of antibiotics 4.Placing a code cart at the client's bedside

answer

2. Continuous electronic fetal monitoring should be implemented during an IV infusion of Pitocin.

question

A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate? 1.Encourage the client's coach to continue to encourage breathing exercises 2.Encourage the client to continue pushing with each contraction 3.Continue monitoring the fetal heart rate 4.Notify the physician or nurse mid-wife

answer

4. A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the physician or nurse mid-wife needs to be notified.

question

A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate? 1.Document the findings and tell the mother that the monitor indicates fetal well-being 2.Take the mothers vital signs and tell the mother that bed rest is required to conserve oxygen. 3.Notify the physician or nurse mid-wife of the findings. 4.Reposition the mother and check the monitor for changes in the fetal tracing

answer

1. Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve.

question

A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the monitor, the initial nursing assessment is which of the following? 1.Identifying the types of accelerations 2.Assessing the baseline fetal heart rate 3.Determining the frequency of the contractions 4.Determining the intensity of the contractions

answer

2. Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur. Options 1 and 3 are important to assess, but not as the first priority.

question

A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at -1 station. The nurse determines that the fetal presenting part is: 1.1 cm above the ischial spine 2.1 fingerbreadth below the symphysis pubis 3.1 inch below the coccyx 4.1 inch below the iliac crest

answer

1. Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines.

question

A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following? 1.A loud mouth 2.Low self-esteem 3.Hemorrhage 4.Postpartum infections

answer

4. Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage. Having a loud mouth is only related to the person typing up this test.

question

A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of: 1.Hematoma 2.Placenta previa 3.Uterine atony 4.Placental separation

answer

4. As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears.

question

A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most likely have: 1.Less pressure on her cervix 2.Increased efficiency of contractions 3.Decreased number of contractions 4.The need for increased maternal blood pressure monitoring

answer

2. Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions.

question

A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction? 1.Early decelerations 2.Variable decelerations 3.Late decelerations 4.Short-term variability

answer

2. Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because it suggests uteroplacental insufficiency during a contraction. Short-term variability refers to the beat-to-beat range in the fetal heart rate.

question

A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is: 1.A form of biofeedback to enhance bearing down efforts during delivery 2.Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus 3.The application of pressure to the sacrum to relieve a backache 4.Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest

answer

2. Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen and is used before transition to promote relaxation and relieve mild to moderate pain. Effleurage provides tactile stimulation to the fetus.

question

A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as: 1.Exhaustion 2.Fear of losing control 3.Involuntary grunting 4.Valsalva's maneuver

answer

2. Pains, helplessness, panicking, and fear of losing control are possible behaviors in the 2nd stage of labor.

question

A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes. 1.Stop of Pitocin infusion 2.Perform a vaginal examination 3.Reposition the client 4.Check the client's blood pressure and heart rate 5.Administer oxygen by face mask at 8 to 10 L/min

answer

1, 4, 2. 5, 3. If uterine hypertonicity occurs, the nurse immediately would intervene to reduce uterine activity and increase fetal oxygenation. The nurse would stop the Pitocin infusion and increase the rate of the nonadditive solution, check maternal BP for hyper or hypotension, position the woman in a side-lying position, and administer oxygen by snug face mask at 8-10 L/min. The nurse then would attempt to determine the cause of the uterine hypertonicity and perform a vaginal exam to check for prolapsed cord.

question

A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition? 1.Medication that will provide sedation 2.Increased hydration 3.Oxytocin (Pitocin) infusion 4.Administration of a tocolytic medication

answer

3. Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows.

question

A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to: 1.Monitor the Pitocin infusion closely 2.Provide pain relief measures 3.Prepare the client for an amniotomy 4.Promote ambulation every 30 minutes

answer

2. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern.

question

A nurse is developing a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects which of the following nursing interventions as the highest priority? 1.Keeping the significant other informed of the progress of the labor 2.Providing comfort measures 3.Monitoring fetal heart rate 4.Changing the client's position frequently

answer

3. The priority is to monitor the fetal heart rate.

question

A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins. The nurse monitors the fetal heart rates by placing the external fetal monitor: 1.Over the fetus that is most anterior to the mothers abdomen 2.Over the fetus that is most posterior to the mothers abdomen 3.So that each fetal heart rate is monitored separately 4.So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal monitoring period for the second fetus

answer

3. In a client with a multi-fetal pregnancy, each fetal heart rate is monitored separately.

question

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? 1.Disseminated intravascular coagulation 2.Chronic hypertension 3.Infection 4.Hemorrhage

answer

4. Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.

question

A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery? 1.The umbilical cord shortens in length and changes in color 2.A soft and boggy uterus 3.Maternal complaints of severe uterine cramping 4.Changes in the shape of the uterus

answer

4. Signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark blood from the introitus (vagina), a firmly contracted uterus, and the uterus changing from a discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness, but not severe uterine cramping.

question

A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action? 1.Place the client in Trendelenburg's position 2.Call the delivery room to notify the staff that the client will be transported immediately 3.Gently push the cord into the vagina 4.Find the closest telephone and stat page the physician

answer

1. When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the physician and notify the delivery room. No attempt should be made to replace the cord. The examiner, however, may place a gloved hand into the vagina and hold the presenting part off of the umbilical cord. Oxygen at 8 to 10 L/min by face mask is delivered to the mother to increase fetal oxygenation.

question

A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation? 1.Swelling of the calf in one leg 2.Prolonged clotting times 3.Decreased platelet count 4.Petechiae, oozing from injection sites, and hematuria

answer

1. DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophebitis.

question

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? 1.Absence of abdominal pain 2.A soft abdomen 3.Uterine tenderness/pain 4.Painless, bright red vaginal bleeding

answer

3. In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to constrict blood vessels and control bleeding.

question

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order? 1.Prepare the client for an ultrasound 2.Obtain equipment for external electronic fetal heart monitoring 3.Obtain equipment for a manual pelvic examination 4.Prepare to draw a Hgb and Hct blood sample

answer

3. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.

question

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for: 1.Complete bed rest for the remainder of the pregnancy 2.Delivery of the fetus 3.Strict monitoring of intake and output 4.The need for weekly monitoring of coagulation studies until the time of delivery

answer

2. The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.

question

A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred? 1.Hypotonic contractions 2.Forceps delivery 3.Schultz delivery 4.Weak bearing down efforts

answer

2. Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall.

question

A client is admitted to the birthing suite in early active labor. The priority nursing intervention on admission of this client would be: 1.Auscultating the fetal heart 2.Taking an obstetric history 3.Asking the client when she last ate 4.Ascertaining whether the membranes were ruptured

answer

1. Determining the fetal well-being supersedes all other measures. If the FHR is absent or persistently decelerating, immediate intervention is required.

question

A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus' head is: 1.Not yet engaged 2.Entering the pelvic inlet 3.Below the ischial spines 4.Visible at the vaginal opening

answer

3. A station of +1 indicates that the fetal head is 1 cm below the ischial spines.

question

After doing Leopold's maneuvers, the nurse determines that the fetus is in the ROP position. To best auscultate the fetal heart tones, the Doppler is placed: 1.Above the umbilicus at the midline 2.Above the umbilicus on the left side 3.Below the umbilicus on the right side 4.Below the umbilicus near the left groin

answer

3. Fetal heart tones are best auscultated through the fetal back; because the position is ROP (right occiput presenting), the back would be below the umbilicus and on the right side.

question

The physician asks the nurse the frequency of a laboring client's contractions. The nurse assesses the client's contractions by timing from the beginning of one contraction: 1.Until the time it is completely over 2.To the end of a second contraction 3.To the beginning of the next contraction 4.Until the time that the uterus becomes very firm

answer

3. This is the way to determine the frequency of the contractions

question

The nurse observes the client's amniotic fluid and decides that it appears normal, because it is: 1.Clear and dark amber in color 2.Milky, greenish yellow, containing shreds of mucus 3.Clear, almost colorless, and containing little white specks 4.Cloudy, greenish-yellow, and containing little white specks

answer

3. by 36 weeks' gestation, normal amniotic fluid is colorless with small particles of vernix caseosa present.

question

At 38 weeks' gestation, a client is having late decelerations. The fetal pulse oximeter shows 75% to 85%. The nurse should: 1.Discontinue the catheter, if the reading is not above 80% 2.Discontinue the catheter, if the reading does not go below 30% 3.Advance the catheter until the reading is above 90% and continue monitoring 4.Reposition the catheter, recheck the reading, and if it is 55%, keep monitoring

answer

4. Adjusting the catheter would be indicated. Normal fetal pulse oximetry should be between 30% and 70%. 75% to 85% would indicate maternal readings.

question

When examining the fetal monitor strip after rupture of the membranes in a laboring client, the nurse notes variable decelerations in the fetal heart rate. The nurse should: 1.Stop the oxytocin infusion 2.Change the client's position 3.Prepare for immediate delivery 4.Take the client's blood pressure

answer

2. Variable decelerations usually are seen as a result of cord compression; a change of position will relieve pressure on the cord.

question

When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as: 1.An acceleration 2.An early elevation 3.A sonographic motion 4.A tachycardic heart rate

answer

1. An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate. A tachycardic FHR is above 160 beats per minute.

question

A laboring client complains of low back pain. The nurse replies that this pain occurs most when the position of the fetus is: 1.Breech 2.Transverse 3.Occiput anterior 4.Occiput posterior

answer

4. A persistent occiput-posterior position causes intense back pain because of fetal compression of the sacral nerves. Occiput anterior is the most common fetal position and does not cause back pain.

question

The breathing technique that the mother should be instructed to use as the fetus' head is crowning is: 1.Blowing 2.Slow chest 3.Shallow 4.Accelerated-decelerated

answer

1. Blowing forcefully through the mouth controls the strong urge to push and allows for a more controlled birth of the head.

question

During the period of induction of labor, a client should be observed carefully for signs of: 1.Severe pain 2.Uterine tetany 3.Hypoglycemia 4.Umbilical cord prolapse

answer

2. Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise.

question

A client arrives at the hospital in the second stage of labor. The fetus' head is crowning, the client is bearing down, and the birth appears imminent. The nurse should: 1.Transfer her immediately by stretcher to the birthing unit 2.Tell her to breathe through her mouth and not to bear down 3.Instruct the client to pant during contractions and to breathe through her mouth 4.Support the perineum with the hand to prevent tearing and tell the client to pant

answer

4. Gentle pressure is applied to the baby's head as it emerges so it is not born too rapidly. The head is never held back, and it should be supported as it emerges so there will be no vaginal lacerations. It is impossible to push and pant at the same time.

question

A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working she: 1.Will not feel the episiotomy 2.May lose bladder sensation 3.May lose the ability to push 4.Will no longer feel contractions

answer

1. A pudendal block provides anesthesia to the perineum.

question

Which of the following observations indicates fetal distress? 1.Fetal scalp pH of 7.14 2.Fetal heart rate of 144 beats/minute 3.Acceleration of fetal heart rate with contractions 4.Presence of long term variability

answer

1. A fetal scalp pH below 7.25 indicates acidosis and fetal hypoxia.

question

Which of the following fetal positions is most favorable for birth? 1.Vertex presentation 2.Transverse lie 3.Frank breech presentation 4.Posterior position of the fetal head

answer

1. Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires a C-section. Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery. Posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis.

question

A laboring client has external electronic fetal monitoring in place. Which of the following assessment data can be determined by examining the fetal heart rate strip produced by the external electronic fetal monitor? 1.Gender of the fetus 2.Fetal position 3.Labor progress 4.Oxygenation

answer

4. Oxygenation of the fetus may be indirectly assessed through fetal monitoring by closely examining the fetal heart rate strip. Accelerations in the fetal heart rate strip indicate good oxygenation, while decelerations in the fetal heart rate sometimes indicate poor fetal oxygenation.

question

A laboring client is in the first stage of labor and has progressed from 4 to 7 cm in cervical dilation. In which of the following phases of the first stage does cervical dilation occur most rapidly? 1.Preparatory phase 2.Latent phase 3.Active phase 4.Transition phase

answer

3. Cervical dilation occurs more rapidly during the active phase than any of the previous phases. The active phase is characterized by cervical dilation that progresses from 4 to 7 cm. The preparatory, or latent, phase begins with the onset of regular uterine contractions and ends when rapid cervical dilation begins. Transition is defined as cervical dilation beginning at 8 cm and lasting until 10 cm or complete dilation.

question

A multiparous client who has been in labor for 2 hours states that she feels the urge to move her bowels. How should the nurse respond? 1.Let the client get up to use the potty 2.Allow the client to use a bedpan 3.Perform a pelvic examination 4.Check the fetal heart rate

answer

3. A complaint of rectal pressure usually indicates a low presenting fetal part, signaling imminent delivery. The nurse should perform a pelvic examination to assess the dilation of the cervix and station of the presenting fetal part. Don't let the client use the potty or bedpan before she is examined because she could birth that there baby right there in that darn potty.

question

Labor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which are the other four factors? 1.Contractions, passageway, placental position and function, pattern of care 2.Contractions, maternal response, placental position, psychological response 3.Passageway, contractions, placental position and function, psychological response 4.Passageway, placental position and function, paternal response, psychological response

answer

3. The five essential factors (5 P's) are passenger (fetus), passageway (pelvis), powers (contractions), placental position and function, and psyche (psychological response of the mother).

question

Fetal presentation refers to which of the following descriptions? 1.Fetal body part that enters the maternal pelvis first 2.Relationship of the presenting part to the maternal pelvis 3.Relationship of the long axis of the fetus to the long axis of the mother 4.A classification according to the fetal part

answer

1. Presentation is the fetal body part that enters the pelvis first; it's classified by the presenting part; the three main presentations are cephalic/occipital, breech, and shoulder. The relationship of the presenting fetal part to the maternal pelvis refers to fetal position. The relationship of the long axis to the fetus to the long axis of the mother refers to fetal lie; the three possible lies are longitudinal, transverse, and oblique.

question

A client is admitted to the L & D suite at 36 weeks' gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates titanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms? 1.Hysteria compounded by the flu 2.Placental abruption 3.Uterine rupture 4.Dysfunctional labor

answer

3. Uterine rupture is a medical emergency that may occur before or during labor. Signs and symptoms typically include abdominal pain that may ease after uterine rupture, vomiting, vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client typically complains of vaginal bleeding and constant abdominal pain.

question

Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. Which of the following is a correct interpretation of the data? 1.Fetal presenting part is 1 cm above the ischial spines 2.Effacement is 4 cm from completion 3.Dilation is 50% completed 4.Fetus has achieved passage through the ischial spines

answer

1. Station of - 1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. A station of zero would indicate that the presenting part has passed through the inlet and is at the level of the ischial spines or is engaged. Passage through the ischial spines with internal rotation would be indicated by a plus station, such as + 1. Progress of effacement is referred to by percentages with 100% indicating full effacement and dilation by centimeters (cm) with 10 cm indicating full dilation.

question

Which of the following findings meets the criteria of a reassuring FHR pattern? 1.FHR does not change as a result of fetal activity 2.Average baseline rate ranges between 100 - 140 BPM 3.Mild late deceleration patterns occur with some contractions 4.Variability averages between 6 - 10 BPM

answer

4. Variability indicates a well oxygenated fetus with a functioning autonomic nervous system. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats per minute. Late deceleration patterns are never reassuring, though early and mild variable decelerations are expected, reassuring findings.

question

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1 1/2 to 2 minutes. The nurse's immediate action would be to: 1.Change the woman's position 2.Stop the Pitocin 3.Elevate the woman's legs 4.Administer oxygen via a tight mask at 8 to 10 liters/minute

answer

2. Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic which stimulates the uterus to contract. The woman is already in an appropriate position for uteroplacental perfusion. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

question

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia would be: 1.Severe postpartum headache 2.Limited perception of bladder fullness 3.Increase in respiratory rate 4.Hypotension

answer

4. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure. Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic as it would be with a low spinal (saddle block) anesthetic; 2 is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication.

question

Abnormal transmission of which neurotransmitter is throught to play a part in tic disorders

answer

Dopamine

question

What is selective mutism

answer

persistant failure to speak in social situations where speaking is expected

question

Sterotypic movement disorders include

answer

Waving, rocking, twirling objects, biting fingernails, handing the head, biting or hitting ones self, picking at the skin or body orfices

question

Echolia

answer

Repeating the last heard sound, word, or phrase

question

in which grade are reading and written expression disorders usually identified?

answer

First Grade

question

Limit setting

answer

Most appropriate intervention for an adolescent who is manipulative and exhibiting agressve behaviors

question

What are the three steps of limit setting

answer

Infroming the client of the rule or limit Explaining the consequences if the client exceeds the limit Stating the expected behavior

question

What perentage range of children with conduct disorder fo on to be diagnosed with antisocial personality as adults?

answer

30-50 %

question

What is the most effective drug for ADHD

answer

Ritalin

question

What must a child diagnosed with conduct disorder do?

answer

He or she must accept responsibitlity for his or her own actions

question

What are the IQ levels of the vairous levels of Retardation

answer

Profound Retadation -- less than 20 Severe retardation -- between 20 and 35 Moderate retardation -- between 35 and 50 Mild Retardation -- betwween 50 and 70

question

Which of the following is a drug choice for Tourett's disorder?

answer

Haloperidol (Haldol)

question

Which medication has been found to be effective as treatment for autism?

answer

(Haloperidol (Haldol)

question

What is Coprolalia

answer

The use of socially unacceptable words, which are frequently obscene

question

What is palilia

answer

Repeating of ones own words or sounds

question

What percentage of children with pervasive developmental disorders have mental retardation?

answer

aproximately 75%

question

Which side effects should be monitored with a child taking Methylphenidate (ritalin) for treatment of ADHD

answer

Monitor appetite supression *** Growth delays

question

Which of the following is an antidepressant used to treat ADHD?

answer

Atomextine (Strattera)

question

What are some inattentive behavior seen in ADHD?

answer

Missing details Avoiding tasks that require mental effort Making careless mistakes Being forgetful in daily activities

question

What are some hyperactive/impulsive behaviors seen in ADHD?

answer

fidgiting, interrupting, talking excessively Inability to play quietly

question

What is Rett's disorder

answer

Loss of motor skill and begin showing stereotyed movements instead

question

What is stuttering

answer

a disturbance of te normal fluency and time patterning of speech

question

What is phonlogic disorder

answer

Involves problems with articulation

question

What is Mixed receptive-expressive language disorder

answer

includes problems of expressive language disorder aling with difficulty understanding and determining the meaning of words and sentences

question

Expressive language disorder

answer

involves an impaired abilit to communicate through verbal and sign language

question

Conduct disorder

answer

persistant antisocial behavior in choldren and adolecants that significantly imairs their ability to function in social, academic, or occupational areas.

question

Rumination disorder

answer

the repeated regurgitation and rechewing of food

question

ADHD

answer

Inattentiveness, overactivity, and impulsiveness

question

Which of the following cerebral lobes has decreased metabolism in brain images of people with ADHD

answer

FRONTAL - responsible for attention, impulse control, organization, sustained goal-directed activity

question

What is the most common disorder of childhood

answer

ADHD

question

Which of the following meds is used in the treatment of tic disorders?

answer

Tic disorders are usually treated with ANTIPSYCHOTICS, like risperidone (Risperdal) or olanzapine (Zyprexa)

question

The nurse should advise the clinet diagnosed with ADHD who is taking dextroamphetamine to take his or her last dose at what time?

answer

Early in the afternoon to prevent the insomnia effect of stimulants

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