Maternity and Peds Hesi Review Fall 2019,100% CORRECT

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Maternity and Peds Hesi Review Fall 2019 MP Hesi.1 • Mastitis: antibiotic therapy, wear a supportive bra, warm compress • Pyloric stenosis: olive size obstruction on abdomen • Anchor the low... er part of the uterus - then massaging the fundus • High bp maybe with preeclampsia: check for protein in the urine (proteinuria) • Boy child frequent visits to the school nurse headache, irritable for few weeks: ask how daily school day is • BMI 6 -year old: physical activity at the school, girls physical activity at home, and diet • Saturated 2 pads in 30 mins: massage the fundus • Tick bite: test for Lyme disease • HIV AZT is given to slow down the transmission to the fetus • Clear water to clean for diaper change • APGAR = 9, acrocyanotic only gets 1 point for color • Mom says baby not sleeping through night, nurse should assess severe skin breakdown on the baby to plan family care • Blind child with traction - bring familiar objects or stuff animals from home • Drooling, temp - epiglottitis need to notify the provider • Muscular irritability from hemorrhaging • Osteomyelitis - give milkshake as snack- high protein, high fiber • Hypoglycemic: give milk • Croup- barking sound, high pitch on breathing - bring in shower with warm mist • Transillumination throughscrotal sac to test if testes are present • Earache if meningitis • Hypothyroidism: D- TSH is high so T4 is low by thyroid gland • Tetralogy of Fallot - cyanotic limbs crying • Cephalohematoma noticed near occiptal sutures- notify Dr • Increase AFP- need to do an sonogram • • • 30 week gestation age 38 inches fundal height - do an ultrasound, bc should’ve been equal • Inguinal Hernia - palpate to get it back in • • Breastfeeding 5 day with yellow stools - this is normal • Spontaneous rupture of membranes - ask the color and consistency • 3+ pitting edema with GERD- normal during pregnancy?? • Postpartum depression - may need to be evaluated ** Know the length of PPD • Afebrile seizures - will eventually go away • MD - wobble legs at this stage • Tonsillitis-signs of bleeding - need to inspect the oral cavity • Movements caused from rh??? they temporary something a C --wasn’t this the amniocentesis- testing the rh for rhogam? Yes testing maternal blood to see if they need to administer RhoGam • Fetal heart pattern in V form - priority is change mother’s position • Braxton Hicks will go away with walking it is not true labor • Placenta Previa - check fetal HR • I’m having pain in my stitches - look at the episiotomy • Use breathing techniques after giving pain meds 30 mins ago • Female - parenteral antibiotics administration is most effective • Introducing solid foods - 1 food at a time for 4-7 days • Digoxin - missed dose can give if it’s been less than 4hrs /if more than 4 hrs wait until next dose/If miss 2 doses, call HCP • Dilantin - check the serum levels • UTI child - return for another urine sample • 3 hour newborn with irregular respirations and small/soft murmur - put pulse ox on the foot • Mag toxicity possibility: mag was 8? With hypoactive reflexes • Gonorrhea infection tell other partners to seek treatment • Adolescent gets a rubella vaccine at maternal bearing age - use another form of birth control for 28 days • Diaphragm – use same as before giving birth - get resized? Use another form of bc? • Tonic clonic seizure and heart issue - monitor calcium • Amniocentesis priority - something with to get Rh factor for rhogam *Breasts- need supportive bra, antibiotics, cold compress *infant vital signs- normal *DMD- weak muscles and gait - I remember something with DMD & serum Ca+ *preeclampsia- check urine for protein MP Hesi 2017 1. dosage : 700. 77 lb baby. 2. 20 units of oxytocin+1L LR→ 125 . 3. Gerd: sugar cookies 4. Mom is Rh-: check Rh immunoglobulin or check FHR 5. Cystic fibrosis: infertility 6. Tetanus questions: clean and antibiotic!!! 7. folic acid, doesn’t like green lefy veggies: strawberries 8. Diaper rash: zinc oxide 9. young parents, 24hrs birth: evaluate feeding 1 0. mom forcing kid to eat means and veggie(requires further. 11. sickle cell: hot and thirsty 12. pyloric stenosis: olive-shaped 13. Pyloric stenosis, hungry and irritable after feelings, first intervention→ crying or weight 14. turn to side and suction 15. fractured clavicle 16. jitteriness: check glucose 17. Normal primipara finding: 2 saturated pads for 1st hr. I put pulse 56. 18. Dad called few days post-partum - hormonal swings are normal. 19. MgSO4 priority: calcium gluconate 20. HIV: AZT 21. Assess FHR and coombs 22. check for after amniocentesis: monitor for labor 23. Post-partum mood swings vs. depression: fatigue&not making decisions? 24. eye ointment: prevent eye infection 25. intussuception: brown stool notify HCP 26. girl SATA: 27. girl who druinks: atta boy 28. ADHD: refer or help with HW?? 29. transitional phase: monitor contractions, help mantain control 30. AFP: Sonogram 31. Priority pt: ARF and hyperkalemia!!! 32. mastitis: antibiotics, bra support, warm support 33. Open heart surgery:demonstration of splintintg, deep breathing etc 34. rupture membranes 12hrs ago--: temperature 35. C-section priority: uterine atony or positive homans??? 36. AGN: Sore throat 37. hemophilia: NOT motrin(elevate and immobilize. 38. Resp distress: nasal flaring 39. Leopolds: anchoring fundus 40. Drooling, s/o epiglotitis→ emergency response!!! 41. flick the sole 42. RF: Chorea 43. after c section lacerated. trickle of blood: BP 44. +2 edema: MgSO4 45. position on stomach 46. HPV: C “immunization is amust to prevent it” 47. scoliosis: girls 10-14 48. metabolic alkalosis-vomiting or pyloric 49. MDI: spacer or cold??? 50. position on stomach 51. sesnse of security 52. IUGR: sonogrm 53. Flaring of the nare 54. Developmental delay: maximum potential 55. 8 mos expected: sitting up unassisted MP Hesi 2017 • Protruding cord - knees to chest • Child who had Slipped Capital Femoral Epiphysis (SCFE. - pin and something • 4-month old what to do to prevent diaper rash - use a barrier cream, such as zinc oxide • Mother with mastitis, what would you advise - start on the unaffected breast first • Adolescent turns 18 and mother calls for lab results - must get permission from daughter • Different acid base levels - normal acid base • A breastfeeding mother wants to avoid having another pregnancy. What do you do? use condoms and gel • Infant getting phototherapy - Cover the infant’s eyes • 6 month baby goes in for routine vaccine and flu shot - give all immunization and influenza but alternate site and injection • Medication to prevent respiratory issues in the baby - betamethasone IM • 15 mo breastfeeding & now 6 mosprego - get nutrition history • Postpartum hemorrhage even after finishing oxytocin infusion - check maternal BP • Math questions were 10 and 10 • Baby got otitis media after an acute respiratory infection, why do infants get otitis media - shorter eustachian tubes • Boy with spine injury after driving accident - maintain alignment • Obese question SATA - find out what physical activities she does& if school has PE class, 3 day diet history from mother • Iron supplement - take with meal • Preeclamptic women received Pitocin IV and is having contractions 1 to 2 minutes apart - discontinue Pitocin • Lyme disease - if rash, then test • Esophageal atresia, highest priority - body temperature • Baby regurgitation and vomiting - suction the mouth and nose • An adolescent received an above the knee amputation. Would do you tell them to do everyday - inspect the stump daily • Women says about 6 mos pregnant &smokes a pack of cigs/day, how to check for estimated gestation age:ultrasonography • 8 month old development, you would notice - sitting unassisted • Glucose was 800 mg - give IV normal saline and insulin • Rubella - give after delivery within 72 hours • Newborn has swollen, tender, testicles. Suspect hydrocele. What do you do? Use transillumination to check for fluid • Fetal heart rate dropped abruptly to a V - change mom’s position • Pregnant had a temp of 101 – chorioamnionitis • Epidural anesthesia - check maternal HR and BP • Teenagers who are pregnant, be sure to include - nutrition requirement during pregnancy • Patient who was 9 cm and 80% effacement - ? • Transitional phase - assess uterine contractions • Infertile couple - allow them to control if they want to stop or support group before another IVF cycle • 4 neonates, who to see first – Tet • 9yr old (school age. – industry • Child with pneumonia - assess lung sounds • Child is dehydrated. What to check for? Weak cry but no tears • Pyloric stenosis - metabolic alkalosis • Assess for cryptorchidism - warm the room • “He doesn’t feed himself, I make him eat vegetables and meat” • A newborn infant is crying, temperature is 96.5, has elevated bp and is cyanotic. What do you do? Warm that baby up (answer) MP Hesi 2017 • What put kid at risk for bacterial meningitis?? Earache NOT VARICELLA IT’S A VIRUS • Tree bark flies in eyes Put on patches & call ophthalmologist • Kid is 2 years old drinking with bottle drinking sweetened soda, what should Nurse discuss? Don’t drink out of a cup, soda leads to obesity, & soda lead to dental caries • Kid with type I Diabetes & Blood sugar 180 wants to play in his soccer game what does Nurse recommend? The kid can play soccer w/o eating a snack or taking insulin • Mom depressed how does she feel? Tired, sad, dec. appetite • Mag toxicity DTR +1, UO was 25, Mag was 8, Respiration 14 Closely follow up • Intussusception & now has brown poop Notify HCP • Kid sees the school nurse with stomach acheNotify HCP • Cleft Lip/Cleft Palate See genetic counselor • Hx of syphilis & chicken pox urine sample/blood sample • Salt wasting Check the Perineum • What do you report to Dr first with an epidural? Blood Pressure, • She has excessive bleeding, what do you let the dr know Report BP or Apical HR • Administering Epiduralslows the labor process • Palpate with one hand & the other hand is there to do what? Anchor the uterus • The uterus was firm midline & in place she felt like she had vag pressure check perineum • Episitomyvisualize the perineum • The person is oozing blood & has muscle irritability, what electrolyte level are you most concerned about? Calcium • Budding breasts & ?Tanner II • A 7 year old girl has a UTI & discharged what do you tell her to check?check urine odor • 4 year old girl what is a normal finding? imaginary friend • 10 year old had rheumatic fever & is on strict bed rest. What is an appropriate form of play? checkers • Rubella vaccine don’t get pregnant for 1 month • Pitocin after labor to stimulate uterine contractions • MOM has HIV & is administered AZT during birth what do you need to do with the newborn after? Administer AZT • What is most likely a sign of pregnancy Hegars • 5 month with hypothyroidism laughs & rolls to side • Immunization question Need Consent forHep B • Mom is 36 wks pregnant, nonreactive nonstress test then has contraction Stress Test with an infusion of Pitocin. What is the priority to let the doctor know? Fetal Late decelerations • When do you have to notify the HCP? When the deceleration is after the peak of the contraction. • Pt has a hard, rigid abdomen, is bleeding profusely what do you do next? Stay with Pt & call the health care provider • Administering prostaglandins. What is the finding you make the doctor aware of?Fetal HR of 50 • Woman is 3 cm dilated & she wants topee?Check her cervix • C8 injury looses bladder control doesn’t have reflex? • How do you know the baby is in distress? Nasal Flaring • Temp was 97.7 Pulse of 140, 42 breaths per minute but irregular Put in EMR • What would you do when the newborn nurse comes in the nursery put the thermal regulator in line with the abdomen • She was 30 wks& edema was +3, Ask about blurred vision • The little kid has abdominal pain, fever & is vomiting what do you ask him? Ask him the quality & location of his pain • Mother DM. What is most important about her care? Strict glucose control • Amniocentesis at 36wks Mother has 8 1/2 lb baby what do you assess in her? Fetal lung status • Muscle dystrophy X linked recessive • Teen has Pelvic inflammatory disease & finished with a 14 day antibiotics &flagyl orally. She wants to know if she can be treated at home. Why not? Monitor parental antibiotics IV • The girl has a fractured ulnar & her wrist is in splints. What do you do next Check wrist pulses • Digoxin: Can administer a first missed dose within 4 hours • A child has liver disease & the parents are aware that they are dying. • What is the priority for the nurse? Reassure the parents • 5 day old newborn yellow sticky poop that smells like sour milkThis was normal • What to do for cryptochismAsk parent if they felt it before? • Dosage Calculation: 2.5 • Dosage Calculation: 25 • Kid is drooling Notify HCP & trach kit by bedside • Lyme Disease/tetracycline Don’t take with milk or antacids • The point of an ultrasound Growth & age • What’s the intervention when the kid has puss filled vesicles Prevent transmission • The kid has a tonsillectomy & is swallowing a lot. What do you do first? Look in their throat with a flashlight • Afebrile Seizures The kid will grow out of them MP Hesi 2016 • Rubella Vaccine Teaching, wait 1 month before having sex • Esophageal atresia (check body temp) • 2 year speech • Tremors in a newborn suspect cocaine addiction • 5 months pregnant mothers which assessment info is the most vital (dribbling urine or blood. • betamethasone (30 weeks) • Tetracycline don’t take with milk/antacids • Boggy fundus 10lb baby and has 2 soaked pad in 30 mins do what next Massage her fundusCheck the perineum • Yellow sticky stool • Hypospadias post circumcision no physical sports • Nephrotic syndrome treatment evaluation the edema is reducing • Blinds 5 years fracture leg and in traction what does the nurse do next Teach the family, Familiarize pt with her surrounding • 4 month old baby with hypothyroidism how do u=you evaluate treatment The baby can pick up his head, The baby laughs and turns it self from his back to his stomach • Digoxin the HR was WNL give the treatment • Sickle cell crisis what’s the manifestation pain • Soccer player with a type 1 DM, ask child to go and play • Scoliosis demographic 10-14 y/o girls • Play (game. for 10y/o on bed rest: checkers • Croup under a Mist tent the parent brings child a stuff animal what do you do • Moro reflex in child of 6 months Moro reflex is gone by 3-4 mos • Mother is schedule for C-SECTION stated to the nurse that she drank a cup of coffee before coming in what should the nurse do Inform the pt doctor, Informed the anesthesiologist • Grandfather molesting child (call social work/report) • Coarctation or aorta Lumen obstruction • MMR is given at 12-15 months • Open heart surgery • What drug not for child under 9:Tetracycline, Aminoglycoside HESI 2015 • What is the probable sign of pregnancy?Hegar’s Sign • Taner’s Sign ans: II • Jewish Lady &genetic disorderTay-Sachs gene • Tetracyclines Do not give with Milk and antacids • Child with 95th percentile BMIExercise, eat fruits &vegetables • Young girl with UTIGirl must come back for urine test • Mom states she can’t stop crying but so happy she had babyIt is normal because Milk is coming and hormonal level change • How to encourage newborn bonding?Provide for mother’s needs and demonstrate warmth for infant • Left breast Mastitis SATA. Warm compress, Wear supportive bra, Continue breastfeeding while on antibiotics • Ear infection with exudate SATA. Remove exudate from ear before putting med in, Tylenol, q4hrs, Don’t use tongue blade, Don’t pick palpate around ear, Don’t use sterile water to ear • Patient had eclampsia Keep airway at bedside • Boggy uterus- what priority do you do?Massage uterus • Crackling in the temporal after getting hit by a swingRefer to PCP for further evaluation • Patient wanted to use oral contraceptives, what is a contradiction?Family history of stroke • Patient complaining of sore nipple, what to do?Assess breastfeeding positioning • Patient had preeclampsia Lift foot of the bed • Pregnant lady fell, what do you assess first?Dribbling urine • Infant being treated for hypothyroidism, how do you know txis working?Infant is laughing& moving from back to side • Nurse held solid food for pregnant lady while in labor-why?Can aspirate food in case general anesthesia is used • Increased levels of APF - Do sonogram to confirm • Infant has RR of 35, axillary temperature of 96.85, HR 165, what do you doGradually warm baby in heat source (radiant warmer) • Dosage calculation-8.6 • Dosage calculation-12.5 • Infant was oozing blood from incision, experiencing muscle irritability, what do you assess?Calcium • Infant boy experiencing circumcision, what do you teach parents?Apply prescribed ointment at every diaper change • Pt had ulnar fraction with splint, what do you check?wrist pulse • Four patients came in, who do you assess first?Patient having 3 minute contractions. • Herpes mom delivered child Isolate baby from others in nursery • Salt wasting: assess perineal edema • Does not cross suture lines: cephalohematoma • weight loss of baby, 7.5 yesterday and today 7lbsIt is normal • The woman had 20wks gestation and gained 20 poundsThe gestational weight gain is not normal • 6months old, abnormal findingStartle/ moro reflex • Last miscarriage and pregnant againIncrease minerals &vitamins • Woman on bedrest not to move becauseHoman’s signs • Child has shakiness, baby sitter call, what to do Give 8oz of milk • OsteomyelitisReoccurrence of recent infection • Rheumatic feverChorea is temporary, it would go away • The baby in the tentAllow the child play with the Stuffed toy • Head circumference increased by 5cmBulging fontannel • Child have fever or explosive diarrheaLarge bore IV • Child has respiratory distressNasal flaring • Child is always goes to the nurse for past three weeks What is your typical day at school • Child holding abdomen/complaining of painDescribe pain level • Pregnant, what pet not to haveCat • Two sex ambiguous Offer information on sonogram • Child suck thumbIt is normal • You have sore nippleCheck infant position • Two pad saturation within 30minuteMassage the uterus • 36 weeks pregnant and bleedingStay with pt& Call Dr • Inguinal hernia visible the child cryPersistent diarrhea • Congenital heart defect. (coartation of aorta. Lumen obstruction • Hirschsprungs syndrome Ribbon-like stools • Non-Reactive testFetal late deceleration • After the epiduralCheck FHR. Maternity & Peds 1 Drug reference states Ampicillin should be infused over 30 mins. Nurse adds antibiotic to Pt's soluset chamber that contains 25 mL of IV solution & IV tubing used delivers 60 drops/mL Nurse should set IV pump at _ mL/hour? 25ml/30 min=50 ml/1 hr 2 Nurse is caring for a child with Nephroblastoma (Wilm's tumor. should include which one of the following interventions in the child's plan of care? Wilm’s tumor- altered nutrition or Do not palpate the abdomen 3 Parents of a toddler with sickle cell ask if they will have other children with this illness. How should Nurse respond? Possible that future kids will have it, refer for genetic counseling 4 Dr. orders IV infusion of D5% 1/2 normal saline to infuse at rate of 75 mL/hr via microdrip tubing for child. Nurse hangs500mL bag at 6:00AM. At what time should a new IV bag be hung? D/H x V D: 75 mL/hr H: 500 mL Hung bag: 6:00 AM500mL/1=1hr/75Ml - 6.6 hours ≈ 6 hours and 30 min - This how long bag is hung for, so if she hung it at 6:00 AM, next time she change it is: 12:30pm -- Another person said: Left In Bag→ 1pm----So anywhere from 12:30pm to 1:00 pm 5 Which one of the following statements by the parents indicates understanding of colostomy care for their infant child? 6 Which one of the following nursing diagnoses would be appropriate for a child with nephritis Fluid Volume Excess r/t decreased plasma infiltration, Risk for Imbalanced Fluid Volume related to retention of sodium and fluid and dietary fluid restriction. ii. Risk for Activity Intolerance related to fatigue. iii. Risk for Impaired Skin Integrity r/to edema and decreased activity iv. Anxiety r/to insufficient knowledge about disease process or hospitalization 7 Which statement by mom w/ kid on oral Predisone for Nephrosis means understanding of med regime? Take with meals 8 In order to properly measure the abdominal girth of a 2 year old child which techniue should Nurse use? Measure abdominal girth above umbilicus, measure at same area each time 9 As a nurse you are required to report your suspicion of child abuse under which one of the following circumstances? Mother said child doesn’t like her 10 Dr. orders Ampicillin 200mg IV Q6 hrs to infuse over 30mins. In order for med to infuse as ordered, Nurse adds 25mL of IV solution to soluset chamber &sets the IV pump at a rate of __ mL/hr using microdrip tubing. 25ml/30 min - 50 ml/1 hr 11 A child with hemophilia has been accidentally hit on knee with a bat during recess. What action should school nurse do? Apply Ice - RICE: rest, ice, compression, elevate 12 Nurse caring for a child with sickle cell disease would expect which abnormal laboratory finding? Hemoglobin (hgb): 8.5(Low hgb: less than 9.5) 13 Indomethacin (Indocin) may sometimes be used to treat which congenital heart defects prior to any surgical correction. Closes PDA (patent ductus arteriosus) 14 A 9-year old child with a recent diagnosis of rheumatic fever is being seen in the pediatric clinic. In order to evaluate family's compliance with the plan of care Nurse should: Make sure they taking full course of antibiotics 15 An 8-year old child with a diagnosis of glomerulonephritis is complaining of a headache and a blurred view of the television in his room. What action should Nurse take next? Assess BP, Comfort, allow child to rest(seizure precaution), Give vasodilators for hypertension 16 The priority nursing action for a toddler 2-hours post cardiac catheterization is to: Assess both pedal pulses 17 Nurse is teaching family of a toddler w/ hemophilia about disease. Which statement by parents requires additional teaching? Something regarding - Blood transfusion 18 Which diagnosis would be appropriate for infant with ventricular septal defect? Impaired Gas Exchange???Other choices: Decreased cardiac output, Decreased tissue perfusion, Activity Intolerance, Delayed growth & development 19 Suspected cases of child abuse can be reported by:(SATA. Physicians, nurses, physician assistants, family members 20 Parents of a child with Sickle Cell Disease ask why child is receiving daily doses of oral folic acid. How should Nurse respond? To stimulate RBC production 21 Dr. orders Amoxicillin po 250 mg for a child weighing 25 lbs. The drug reference recommends 25-50/mg/kg. Is this dose safe? No: less than recommended dose: 25 lbs /1 = 1 kg/ 2.2 lbs - 11.36 kg 250 mg/ 11.36 kg - 22 mg/kg - NO 22 Assessing child w/ acute glomerulonephritis, Nurse would expect: ANS-Mild periorbital & lower extremityedema, cloudy urine 23 Sometimes children with Nephrosis may be placed on fluid and sodium restrictions for edema. In order to minimize thirst, Nurse can encourage parents to: ANS-Give child Lollipop for dry mouth, candy, popsicles 24 One-month-old infant is to receive 0.125mg of Digoxin. Bottle of Digoxin is labeled 0.250 mg/ml. Nurse should give ___ milliliters of Digoxin to child? D/H x V D: 0.125 mg H: 0.250 mg V: 1 mL 0.125mg /0.250mg x 1 ml - 0.5 mL 25 When assessing a child with a Tetralogy of Fallott, Nurse would expect to see: cyanosis 26 The mother of a 5-month-old with atrial septal defect tells Nurse at the cardiac clinic that her infant gets tired during feeding. Nurse should advise the mother to:small frequent feeding 27 Dr. in children's clinic orders single dose of penicillin 1,200,000 units IM for an 8yr old child. The med is available 1,200,000 units/2 mL. How should Nurse administer this medication? SATA: D/H x VD: 1,200,000. H: 1,200,000V: 2mL 1,200,000 / 1,200,000 x 2mL - 2 mL 28 To decrease risk of vaso-occlusive crises in sickle cell kids, Nurse should teach family: Treat Infection, Prevent child from events that increase O2 demand: cold, infections, heat, dehydration 29 Nurse at the pediatric clinic is instructing a mother on proper medication administration. The child is 4-years-old and is receiving oral ferrous sulfate to treat her iron deficiency anemia. What statement by the mother needs further clarification? Giving meals with calcium containing foods; Ex: Milk - Need Vitamin c for absorption 30 Nurse caring for a 5-year old child with suspected Intususception notices the child holding his abdomen and grimacing after eating half of his lunch. Which action should Nurse take next? Call Dr 31 What information should Nurse include when teaching the mother of an 8-month old infant who is receiving oral Digoxin? Notify physician if child is vomiting 32 Nurse is administering oral Digoxin to an infant with a congenital heart defect. Prior to administering the medicine Nurse assesses the apical rate to be 92 BPM. What action should Nurse take next? reassess apical pulse 33 Nurse caring for a 13yr old in sickle cell crisis complaining of pain. Which action should Nurse take first? Assess pain??? Administer fluids as ordered??? 34 Which is an example of potential child maltreatment: 6 and 9 yr old left at home alone&bringing friends over 35 Which maternity situations may be indicative of potential abuse? Isolation, low self-esteem, alcohol and drug use????? 36 Nurse caring for child with rheumatic fever should assess for most serious complication of disease: Checking heart sounds 37 Which findings is Nurse likely to observe in a newborn diagnosed with Hirschsprung's disease (aganglionic megacolon)? Failure to pass stool within 24 hours, Distended abdomen, chronic constipation altering with diarrhea, Enterocolitis in emergency event, Ribbon-like stools- older children 38 In order to minimize incidence of iron deficiency in newborns Nurse in antepartal clinic should instruct pregnant women to: Green leafy vegetables 39 The pediatrician orders a stat dose Furosemide (Lasix. 25mg of IV, for a child. The child weighs 18 lbs. The drug reference states normal dose for Lasix as 2mg/kg. Which action should Nurse take first? 18 lbs/1 = 1kg/2.2lbs - 8.18 kg2mg/kg = 8.18 kg/1 - 16.36 mg - 16.4 mg - Dose is too large–Call Dr 40 Which explanation regarding an echocardiogram is appropriate for a 5-year old child? Listen to your heart /hear heart sound A 5 year old, whose sister is terminally ill with brain tumor is most likely to believe: Something that they did or said caused Prevent Iron deficiency anemia in toddlers→ 2 boiled eggs Patient with Iron deficiency anemia requires further teaching- something about black hard stool Ventricular Septal Defect (VSD. Post op extubation on ventilator - assess lung fields Hemophilia (S/A. - soft toothbrush / padded bed rails-soft toys /MedicAlertBracele/ frequent floss Hemophilia - Normal RBC (missing clotting factors 8,9) Is Rheumatic fever contagious - bring siblings for throat culture Nephrotic syndrome - asses skin breakdown due to peri edema Bruises on face, upper extremity- continue assessment. Ask partner to step out Partner abuse - Help patient Identify options Child neglect→ torso over window When child ask about death - answer honestly Stillborn baby - allow parent private time with baby Prednisone - take with meals The nurse caring for neonates born to substance abusing mothers might expect the following findings: Placental function is affected by the vasoconstrictive properties of many illicit drugs, as well as by cigarette smoke. Which of the following behaviors indicates ineffective coping after the recent death of a child/sibling????? 1. Both lack an understanding of the concept of death 2. Infants react to loss of caregiver with behaviors such as crying, sleeping more, and eating less 3. Aware someone is missing, may exp. separation anxiety 4. Toddlers may develop fearfulness, become more attached to remaining parent, cease walking and talking As a nurse you are required to report your suspicion of child abuse under which one of the following circumstances???? How should the nurse assess for signs of shunt malfunction in an infant with a ventricular-peritoneal shunt? Position child on side that hasn't been operated on, Keep child flat to avoid pressure on shunt valve, Observe for increased ICP, Neuro assessment: pupillary dilation, blood pressure, Monitor for signs of CSF infection: elevated temp, poor feeding, vomiting, decreased responsiveness, seizures MP • Which drug is contraindicated in children under 8? TCA’s • Best indicator of pregnancy? Hegar’s sign • Highest priority for woman receiving mag sulfate? Calcium gluconate on hand • Celestone to which pt? 30 wk with regular contractions & cervical changes • Requires further assessment or 3 or 6 month old with hypothyroidism? Laughing & turning the back 6. Baby goes from 3317 to 3175? Normal 7. Mom that got rubella shot? Can't get pregnant for a month 8. 500 ml 20g at 1 g/hr? 25 ml/hr 9. 100mg on hand 200mg in 5ml? 2.5 10. TCA? Don”tgive with milk or antacids 11. Mom w/ boggy fundus & something? Massage fundus til firm 12. Mom on pitocin with contractions every minute that is stopped & given oxygen contractions every 5 mins? Restart pitocin 13. Mom w/boardlike/rigid uterus? Call Dr from bedside 14. Child with hypospadia? puzzle 15. Infant just had ventriculoperitoneal shunt placed? fontanels 16. Child with dark colored scrotum? Review ACTH level 17. Priority nursing action for baby just born & RN making sure it can breath to ensure survival? Heat loss 18. Obese child with hypertension & possible diabetes? tell them to incorporate fruits, vegetables & exercise 19. Girl who broke ulna? check pulses 20. Girl whos asking about contraceptives? Explain risk & benefits of oral contraceptives or teach about all contraceptives 21. Albumin IV child w/ nephrotic syndrome? Swelling/wt decrease 22. Yellow, sticky, sour milk stool? normal 23. Which group to assess for scoliosis (highest risk)? Girls 10-14 24. 2nd stage of labor with hx of heart failure? +1 edema, basilar rales & irregular pulse 25. Pregnant woman 39 weeks fell ;what concurrent symptoms would you see? Urine dribbling 26. Tanner sign breast bud & scant pubic hair? Level 2 27. 10yr old clutching stomach/vomiting? Quantity, pain source 28. Boy hirschsprungs? IV large bore catheter 29. Croup with mist tent with stuffed animal? Give them toy 30. 3 yr old with blind? bring toy from home/orient to sounds 31. Spitting up baby? Turn over & suction 32. (SATA. Mastitis? Continue breast feeding, warm compress, take antibiotics at regular intervals 33. GBS mother in labor? Give antibiotics 34. Mother calls hotline happy crying over baby? influx of hormones 35. 6 months gets MMR? 12-15 month 36. SGA but term? 4lbs, 31 head, smooth skin visible veins & vernix 37. 10yr old going into open heart surgery? demonstrate cough, deep breath & splinting or use incentive spirometer after surgery 38. What is appropriate for 2 y.o? 3 word sentence or understand half what the child says 39. Terbutaline assess? Breath sounds 40. Otitis media ...? 41. Coarctation of the aorta ...? 42. Mom’s prenatal visit? Baseline weight & blood pressure 43. Oral contraceptives who is not supposed to take it? Diabetes 44. Tracheoesophageal fistula? Check temperature 45. Soccer player with Diabetes 1 glucose of 180? Go play 46. 10 year old? Checkers 47. Sickle cell crisis? Pain 48. Immediate intervention? FHR is 60 something 49. C-section woman wants to go to the bathroom why shouldn’t she? Positive homans sign • 50 ml - 25 ml to be infused in 30 mins • 2 ml - 1,000,000 units/ 500,000 units x 1 mL • 325 mL - 500 ml at 10, how much in bag at 17 (25 ml/hr. • What indicates that the mom needs further teaching Digoxin &lasix? take the pulse before administering, but question said after • Kid with 92 bpm taking digoxin - reassess apical pulse for a min Cardiac Defects • VSD - bacterial endocarditis ?? or VSD w. Persistent cyanosis> Increased pulmonary resistance • CHF - poor feeding - give small frequent feedings • For left HF assessment finding = fine, moist crackles • (SATA)Bilateral rales - HOB (30-45 degrees), give Lasix BID • 47. Severe edema - skin breakdown Cardiac Catheterization • 2 hrs post Cardiac cath - check femoral pulses RF • RF what is symptom of severe complication (RHD. - apical pulse • mom w/ CF kid wants to know if siblings will get it – explaindisease • RF compliance: ask if they are taking the antibiotics • (SATA)Penicillin shot - 2 syringes & lateral thigh Sickle Cell • Vaso-occlusive crises - drink water & juice • Vaso-occlusive crisis - keep them hydrated • Kid who got hit in knee with bat, disease not specify - ice or immobilize (question getting thrown out; automatic 2 points. • Kid with SCD is jaundiced - high bilirubin Hemophilia • Parents w/hemo kid. will future kids have it - genetic counseling • (SATA. Prevention of injury for hemo - no contract sports, use electrical shaver, (passive ROM. • Hemophilia ptt> prolonged Acute Glomerulonephritis & Nephrotic Syndrome • Kid with headache & visual disturbances - asses bp or tell Dr • AGN - tea colored urine • Child peeing 80 mL/4hrs, weight 36 kg, AGN - assess for dehydration or report abnormal findings to physician • Fluid shift, glomerulonephritis - weight gain • (SATA)Prednisone - snacks in between, immunizations up to date, & something else • Priority nursing dx for Pt with GU problem - risk for injury r/t htn&pulm. congestion or fluid vol excess r/t decreased filtration • Kid thirsty & has nephrosis - give popsicle • Child Abuse /Sign of maltreatment - windows with no kid guards • (SATA)Who are reporters - nurse, doctor, police; neighbors??? • What is indicative of possible abuse?> mother says child doesn’t like her Intimate Partner Violence • Pregnant lady comes in with partner who answer for her - isolate • Pregnant lady - partner shoved her - help her explore options • (SATA. Women abused - assure her, help her get plan, help her contact domestic violence center • (SATA. options (do not know answer): watch child interact with parent, suggest foster care, role model to child Death & Grief • Mom is bargaining - if I do this, baby will get better • Child w/dying sibling - if I listen to parents, sister will get better • Ineffective coping - Pt won’t talk about loss of child • (SATA)Wilms tumor - measure abdominal circumference, listen to breath sounds • Wilms tumor - refer mom to nephrologist & no known cause • Kid getting chemo - encourage letter to mom • Prevent anemia in toddler - advise mom about diet when pregnant fresh fruits & vegetables or feed kid eggs twice a week • SATA. Give iron> with syringe, empty stomach & possibly something else • Girl with menstruation who is fatigued - advise to get iron studies • Which indicates pt needs further teaching about anemia - give meds after meal Fluid & Electrolyte • Low Plasma protein - risk for infection or fluid vol deficit • (SATA. little girl who’s peeing on herself in school - UTI & school phobia (question may get thrown out b/c select all that applies was not in the question. 15 year old asking about oral contraceptives, parents don't know? Provide pros & cons of use Cold on camping trip got Lyme disease, had to take tetracycline? Don't take with milk or antacids Infant with a variety of burns on right side of body? 16% or 22% 20-week gestation, 20 lb gain, 20 cm fundal height, most concerning assessment finding? 20 lb gain Dosage calculation questions: 20mg in 1000ml of D5...12.5. other was 2.5ml with the first dose Instillation of ophthalmic erythromycin? Instill a strip on lower conjunctival sac Mom brings her son w/ fever, vomiting & abdominal pain for past 12 hours? Ask about quantity & nature of pain or normal BMs. Infant in obvious respiratory distress (retractions, dusky appearance, grunting, RR of 67)? Somehow the answer isn't notify health provider immediately, it was get pulse ox on toe Pt with Hirschsprung Disease, explosive diarrhea? Pregnant & depressed in 1st trimester asking about herbal supplements? Not advised Working at Hotline. Pt asked about post-partum blues. Says she's so happy doesn't understand why she's crying? Milk coming in & the hormones are responsible Newborn weighing 7.5 lbs is down to 7? Part of normal findings cuz newborns can lose 10% of weight lbs? Ashkenazi Jew asking about generic counseling? Tay-Sachs disease Assessing strabismus? 6 cardinal gazes High school athlete with cbg of 180mg/dL? Let him play in game MP Hesi 2015 1. woman had variable deceleration. What is nursing action? Turn her on her side 2. parents asking nurse why heel stick is important for baby? It is routine exam to check for metabolic deficiency 3. patient was on drug; what is side effect? Rapid abdominal girth 4. drug calc: magnesium sulfate, convert from mL to units. 240 mg 5. herpes 2 baby: put baby in isolation room 6. Coke baby: mother was diagnosed with Coke. Baby is irritable, cries a lot. 3.2 What do you do? Initiate seizure precaution 7. Woman on Pitocin suddenly has problems & has variable decelerations. What do you do? Turn off Pitocin decrease Pitocin 8. Mom wants to know what substance to use when changing baby’s diaper: Clean water baby lotion, talcum powder 9. Woman’s hematocrit (values) & hemoglobin (value) levels are abnormal but she says she’s been eating green veggies. She wants to know how pregnancy effects these lab values. nurse says: plasma volume affects 10. Mom has mastitis. She is on antibiotics. Nurse advises patient to: Initially breastfeed on unaffected breast 11. New mother states her nipples are tender after breastfeeding for 2 days: assess position of infant while breastfeeding 12. Mom unsure about being a good parent: determine support from family, friends 13. Mother is breastfeeding & wants to know what contraceptive to use: condoms & diaphragm with spermicide 14. Mother has diaphragm after birth & wants to know if she should get new one? Use alternative contraceptives until she gets new one 15. Nurse discovers postpartum Pt has a boggy uterus & is on left side. Encourage patient to void 16. Mother is given Atropine. What to look out for? Increased pulse & dry oral membranes/secretions 17. Mother has DM type 1, what do you expect for fetal complications? Hypoglycemia 18. forgot question but answer is: start IV of lactated ringers at 200mL/hr 19. Pt has history of “heart damage”. She has potential to have heart failure. What is her nursing Dx? fluid volume excess. MP Hesi 2016 Highlighted = on my HESI 2016 version (it depends on which version you may have which questions you will see below) • Good source of folic acid – peanuts • Mom getting hypotensive on spine board after car wreck – roll her on her side on spine board • Mom goes to bathroom with contractions 5 min apart, you hear baby cry – hit call light for help • Iron (SATA) – dark stool normal, give at bedtime • Man calls clinic says his wife has been sad, happy, moody – tell him normal hormonal changes • Mag question – stop infusion due to mag tox • Contractions get really close & she is dilated, stop Pitocin, then contractions get 5 min apart – restart Pitocin per agency policy • Bright red trickling blood – lacerated cervix • Teach adolescent pregnant girls – proper nutritional needs • 42 wk ballard score – check blood sugar • Breast feeding woman asks about birth control – breast feed only every 2-3 hrs • Rubella vaccine – use birth control for 28 days • Baby as white curd patches in his mouth – discuss medicine with mother (candidiasis infection) • Mom has baby – she reaches out & traces profile with fingertips • HIV positive mom gives birth & is worried about passing it to baby – explain to mom AZT for baby after birth • Baby has to have COOMBS test, mom doesn’t want rhogam but will keep her from building up antibodies for future babies • HSV 2, baby born, vaginal delivery – isolate in nursery • Hormone for positive pregnancy test – human chorionic gonadotropin (HCG) • Swollen vagina is normal in female infant • Moro reflex is normal in infant • 800 ml output in an hour with mag question – just continue whatever you are doing • Woman has baby in a cab – start pitocin, massage fundus • Woman comes in with pain in her stomach – you start an IV, not type & cross blood • Put eye ointment in conjunctival sac of newborn (erythromycin) as prophylactic eye ointment for prevention of eye infections contracted from bacteria in birth canal • Had kid now complains of vaginal pain fullness – check vaginal/perineal area • Swollen vagina question is long & talks about salt wasting – normal finding explain about androgens • -1 placement of baby active labor 3 cm dilated, has to go to bathroom – check Pt’s cervix • Baby born to diabetic mother – check baby’s blood sugar • PKU baby – 25% any babies will have it too • Baby with clavicle problem – will have intracurvature • Question about a woman who drinks & has cut down – give her an “atta boy” & encourage her to reduce amount even more • Woman getting radiation iodine – hold off on test to confirm if pregnant or not • Some type of fertility drugs – you need to report sudden increase in abdominal girth • Breast feeding baby & sore nipples – start feeding on unaffected breast • Breast feeding mother has a diaphragm – use condom & foam until diaphragm can be refitted • Baby born to mother who has a positive drug screen for something – monitor baby for seizures • Baby has an apgar score of 3 – continue resuscitation • Baby is jaundice & brought back to hospital after 7 to 10 days – provide eye protection & placed under light or phototherapy • Pregnant woman with low Hct Hgb levels – this is normal because of increase in plasma levels • Woman in labor lying in supine position states she is finally comfortable – place a wedge under her right hip • Preparing a woman for triple screen or something test – you need to prepare to draw blood lab work • Woman comes in stating her water broke – test with nitrate paper & if it turns blue then prepare to admit • Woman is having an amniocentesis test – nurse should check for signs of labor once it is complete • A newborn weighs 7.5 lbs at birth & weighs 7 lbs 24 hrs later – this is normal weight loss • Something about woman 12 weeks prenatal visit. What is important to discuss at this time? It is a cultural question answer is something about – birthing plans or techniques • Baby weighs over 9 lbs – assess for fracture of clavicle • Pt with non-reassuring pattern – stop Pitocin infusion • Baby 28 weeks – hemodilution – anemia (hemodilution of pregnancy peaks at 28 weeks results in decreased Hct) • Parents in transition stage – maintain relationship with extended family • Which block deadens vagina & perineum – pudendal block • Woman comes in vomiting with low BP – give antiemetic • There are two questions on apneic baby – rub baby’s trunk & flick soles of feet • Neonate is apneic for 20 seconds – rub baby’s trunk • Teaching pregnant teens about – iron deficiency anemia • A woman is 5 hrs postpartum with fundus 3 cm above umbilicus & to left – encourage her to void/urinate • Woman is certain number of weeks, which method is best to determine fetal position - ultrasound • Baby born to mother that tested positive for cocaine – nursing priority is seizure precautions • Neonate respiratory distress – nasal flaring • Mother has a firm fundus but continues to have bright red blood trickling from vagina, what is possible indication – lacerated cervix • During fundal massage, place one hand at fundus, what is second hand used for – to anchor fundus • There is a question that has to be put in order – isolate baby, move mom to private room, collect u/a, start iv • How do you measure frequency of contractions – from beginning of one to beginning of next • Mothers Hemoglobin A1C – give consultation to a nutritionist • Baby shows cyanosis in hands & feet & has elevated respirations – gradually warm baby • Baby is showing signs of mottling – check temp • Mom is at 20 week gestation & has gained 20 lbs, what is of most concern out of data of mom – increased weight gain • Mom asks why her baby is being screened for T4 & TSH levels – it is state protocol to monitor for metabolic abnormalities • Pt having labor back pain – counter pressure on lower back • Woman had cleft lip, uncle had cleft lip – send for genetic testing • Woman in labor & they look at vagina & see cord – put woman in Trendelenburg position • Pregnant woman has a diaphragm – she needs to have it refitted for another diaphragm • Baby starts showing signs of respiratory difficulty (nasal flaring, expiratory grunt, cyanosis) – check O2 saturation levels • Baby progressing in extrauterine life would show what signs – good vigorous cry with stimulation • Baby has peri-oral cyanosis – assess oral mucosa • Before surgery mom is given an anticholinergic/atropine with anesthesia. What is therapeutic response of anticholinergic – increase pulse & decrease oral secretions • Question about cytotec – answer is increased risk for abortion • Pts uterus is above umbilicus & to right during postpartum, what do you do 1st – palpate bladder for distention • Mom feels urge to defecate during labor – do a vagina exam • What is reason to do an ultrasound on a mother at 20 weeks gestation – ultrasound for gestation & fetal growth • Pt is taking mag sulfate & urine output is 25 mL/hr, respirations 14/min, pulse is 116/min, what should Nurse do 1st – discontinue mag sulfate (signs of mag tox) • Postpartum with bathroom privileges, what possible condition would Nurse place Pt on temporary bed rest for – possible thrombus in leg if positive Homan’s sign is present • Pregnant woman has increased costal angle & diaphragm is elevated , how does Nurse document this – as a normal finding • Moms Hgb &Hct is low, what food to tell her to eat that contains most iron? – chicken (other sources: liver, meats, whole grains, enriched bread, cereal, dried fruits) • Mom wakes up in a pool of blood & comes to emergency room. What to check 1st – BP • Nurse anticipates that prenatal lab will be performed at 28 weeks – 1 hr glucose (140 between 24-28 weeks) • What med to give mom to prevent RDS in fetus – betamethasone • Pt induced for labor contractions begin occurring 1 ½ to 2 min apart with no resting in between contractions, what to do 1st – stop pitocin infusion • Mom has been on mag sulfate & is now postpartum, what is she at increased risk for – uterine atony (hemorrhage) • Mom is prescribed hemabate – give antiemetic before hemabate due to s/e (also cause diarrhea so give antidiarrheal) • Mom says baby is trying to walk, what do you say – stepping reflex is normal reflex for babies • Functions of placenta in early pregnancy – estrogen & progesterone production • What does nurse do prior to giveing RhoGAM injection – get second nurse to confirm med & patient • Mom is having third baby at home, her two previous babies were rH negative, does she have to come get a direct coombs test dine on baby – yes • Pt has been breastfeeding for 15 mos& 6 weeks pregnant now, what is major assessment – nutritional intake • Signs of fetal alcohol syndrome – flat nose bridge • Pt is showing signs of mag toxicity (nausea, feeling of warmth, flushing) – stop infusion • What is best method to get hemoglobin & hematocrit on baby – heel stick • Pt is diagnosed with eclampsia, what do you do – keep airway at bedside (immediate goal of care when during convulsion is to maintain a patent airway. When seizures do occur, turn woman on her side to prevent aspiration) • Postpartum after c-section, pt is nauseated & abdominal distention, what to do 1st – auscultate for bowel sounds • Pt is noted to have positive homan sign, what do you do – tell Pt to stay in bed & notify dr • Mom comes to labor & delivery unit screaming “the baby is coming”, what to do 1st – observe perineum • Baby is given surfactant to help RDS, what assessment lets you know that baby is Improving – increased urinary output • Mom has mitral stenosis, what symptom is common with this Dx – persistent cough • Pt is giveed with anesthesia, what is highest priority – side rails up & call bell in reach • Assessment of a normal breast after delivery – expels colostrum (3-4 days) • Mom is complaining that baby isn’t getting enough to eat, what do you tell her – if baby’s urine is straw colored, baby is ok • Baby has total bilirubin level of 12 after 24 hrs – encourage mom to breastfeed • Baby shows signs of jitteriness & other signs of hypoglycemia. What to do 1st – capillary glucose level • In a gestational diabetic mom, what is most important aspect for a healthy pregnancy – euglycemia • Mom comes out of room screaming that her baby is missing. What do you do – initiate a lockdown • Mom has post partial hemorrhage. What is most likely cause – she is a multigravida • Diaper change – use water • Last trimester UTI – cause preterm labor • IDDM insulin needs – less insulin needed in 1st trimester • Jewish lady – answer something to do with taysachs • Lady is 30 weeks gestation measuring 38 – get prescription for an ultrasound • Pregnant lady car wreck, report - positive fetal hemoglobin • Lady having baby, no meds – nurse is to help her through contractions • Mom comes to hospital with thoracic respiration, chest circumference is 5 cm with increase intercostal angle – normal sign of respiration in pregnancy • U-shape FHR, nursing intervention – change pt position • Question on after pains, what teaching would you tell pt – lying prone/a pillow on abdomen • Pt is worried about Down syndrome baby – chorionic villus sampling (CVS) test • Pt had baby at home, mom is rH -, what should Nurse do 1st – assess newborn blood typing • Pt comes in worrying about baby – rooming in • Meconium staining – meconium aspirator • Question on betamethasone (Celestone) & weeks of gestation (who gets betamethasone) - 30 weeks & cervical changes • Pt getting an epidural, side effects – assess HR & BP (maternal) • HR 120, loud cry, good muscle tone, acrocyanotic – apgar score 9 • Pt had cup of coffee & getting epidural – inform anesthesiologist • Mom is frequently voiding – collect a urine sample • Best way to check for pregnancy – vaginal ultrasound • AZT on HIV, what is it for – AZT prevents transmission • Teaching about rubella vaccine – don’t get pregnant for a mo • Pt teaching to avoid inferior vena cava syndrome – teach to roll on left or right side • Breech presentation, assessment – turtling sign • Cesarean section, biggest reason to do – herpes in perineum area • Pt on meds for vagina & rectum area – pudendal block • Turbutaline sulfate, side effects – tachycardia, restlessness or nervousness (tachycardia is main indicator) • Prior to giving immunization of Hep B to a newborn, what to do 1st – get consent from mom • Question on description of vernix – vernix (know what it is) (vernix caseosa is a white, creamy, naturally occurring biofilm covering skin of fetus during last trimester of pregnancy. It is a chees like coating & is natural in newborn) • Greatest cause of developmental delay in infant – (sapa) alcohol, marijuana, tobacco/smoking • Postpartum hemorrhage, nursing intervention – massage fundus • Question on mom with s/s of placental previa (need to know what it is) – placenta previa • baby with cephalhematoma , swelling does not cross suture line in parietal bone, what to do – notify Dr. about cephalhematoma • Perineal hematoma – check BP & HR • Baby presenting with s/s of withdrawal – check cocaine/drug use • Visual check for episiotomy • Epidural given – check BP 1st • Newborn 1st vaccine – K • Illicit drug that causes learning deficit & mental retardation – marijuana, alcohol, ETOH, tobacco • Postpartum mother, assess breast how will they be – breast filling & colostrum • G2, P1, 28 wks preterm labor, 3 doses of terbutaline sulfate (SE): tachycardia & nervousness/restlessness (tachycardia #1 effect of tocolytics) • G3, P3, Rh- delivers at home, other 2 kids RhO-. What should nurse tell mom – newborn needs to be tested for Rhogam • Anesthesia that causes loss of sensation only to vaginal & perineum area – pudendal block • 17 yo doesn’t know how to care for baby, promote parent infant attachment behaviors: encourage rooming in while in hospital • Gestational diabetes, amniocentesis what info would you find – fetal lung maturity • 32 weekfreqere has irregular contraction, what should nurse do – collect urine for urine culture • Best method to obtain blood sample on a newborn – heel stick on lateral surface of heel • 36 weeks, Rh-, abdominal trauma in MVA, what assessment is important – hemoglobin testing for fetus • 29 weeks, determine fetal position accurate (tool) – ultrasound • 35 yo, 10 weeks pregnant, concerned baby with Down syndrome, what to give – chorionic villus sample at 12 weeks • Newborn instruction on circumcision site – petroleum jelly with each diaper change • Started Pitocin 6 hrs ago, U shaped pattern on contraction. What to do 1st – change position • Important to mention after epidural is given – get up slowly (orthostatic hypotension) check BP • HIV+, receives AZT, what does drug do – decrease transmission • Breech position – turtling sign • Female taking cytotec gets pregnant – increase risk of miscarriage • Hematoma – check HR & BP 1st • Full term gestation, teach – vernix protects baby & will be in folds of skin • Nurse giving baby immunization to newborn – get consent • After pains – lying prone with pillow on abdomen • Mag tox – absent patellar reflex • Cephalahematoma – check for jaundice q 8 hr • Mom day 1 postpartum – breast will be filling • Baby has curds on inside of cheek from bottle feeding – needs medicine • Breast pain – wear a supportive bra • Uterus boggy after delivery, info Nurse provide – clots inside • Meconium stained fluid – have meconium aspirator • Pregnancy induced HTN – absent patellar reflexes • Gestational diabetes – maintain euglycemia; check for euglycemia • 39 week L&D – 101.2F temp • Test for trichomonas – saline wet smear (wbc protozoa (many) positive for trichomonas) • Seroconversion to HIV positive once HIV enters body: 6-12 wks • Babies have IgG & IgM immunoglobulins • Lecithin/sphingomyelin ratio – 2:1 when fetal lungs are mature • G – number of pregnancies (including current pregnancy) T – number of term births (>37 weeks) P – number of preterm births (<37 weeks) A – number of abortions or miscarriages (<20 weeks) L – number of living children • Hegar sign – 6 weeks gestation, softening & compressibility of lower uterine segment • Chadwick sign – 4th week blue violet color of cervix with increased vascularity • Goodell sign – softening of cervical tip 6th week – can be indication of pelvic congestion • More than normal HcG – ectopic pregnancy or Down’s syndrome • Foods rich in iron – liver, whole grain, enriched breads & cereals, green leafy vegetables, legumes, dried fruits • Vit C rich food that aids in absorption of iron – orange slices • Normal protein - +1 urine dipstick, <300 g in 24 hrs • B 12 deficiency in vegans • Iron supplements at bedtime to prevent GI upset • Increase of 30 systolic & 15 diastolic – preeclampsia hypertension HESI Meds: Danazol – endometriosis Lupron – endometriosis & uterine fibroids Nafarelin – endometriosis, menopausal symptoms, blocks estrogen, Gn RH agonist Tomoxifan – breast cancer drug, hypoestrogenism effect, GnRH agonist, menopausal symptoms ERT – menopausal therapy, increased risk of breast cancer Imiquimod, podophyllin, podofilox – treatment for HPV Clomid/serophene – infertility drugs Calcium, evista, Fosamax, Actonel, calcitonin – treatment/prevention of osteoporosis Fluconazole, metronidazole, clotrimazole – treatment of candidiasis Zidovudine – HIV prevention mother/fetus transmission Penicillin – syphilis Doxycycline, azithromycin – chlamydia 1. -1 placement of baby, mom in active labor, 3 cm dilated, mom has to go to bathroom: check her cervix 2. 42 weeks Ballard score: check blood sugar 3. baby born to diabetic mother: check babys blood sugar 4. baby born to mom w/positive drug screen: monitor baby for seizures 5. baby has apgar of 3: continue recuscitation 6. baby has white curd patches in mouth: discuss medicine with mother (candidiasis infection) 7. baby is jaundiced & brought back to hospital after 7-10 days: provide eye protection & place under light/phototherapy 8. baby with clavicle problem: it will have intracurvature. 9. breast feeding & sore nipples: start off feeding on unaffected breast 10. breast feeding mother has a diaphragm: use condom & foam until diaphragm can be refitted 11. breast feeding woman asks about birth control: breast feed only every 2-3 hrs 12. bright red trickling blood: lacerated cervix 13. contractions get close & mom is dilated, stop pitocin, then contractions get 5 min apart: restart Ptocin per agency policy 14. fertility drugs: report sudden increase in abdominal girth 15. HIV positive mom gives birth & is worried about passing it to her baby: explain to mom AZT for baby after birth 16. hormone for positive pregnancy test: human chorionic gonasotropin (HCG) 17. HSV 2, baby born via vaginal delivery: isolate in nursery 18. Iron: dark stool is normal, give at bed time 19. is swollen vagina normal in an infant: yes 20. magnesium: stop infusion due to magnesium toxicity 21. man calls clinic says his wife has been sad, happy, moody: tell him these are normal hormonal changes 22. mom getting hypotensive on spine board after MVA: roll her on her side on spine board 23. mom goes to bathroom with contractions 5 min apart - you hear her baby cry: hit call light for help 24. mom had a child but now complains of vaginal pain & fullness: check vaginal & perianal area 25. mom has baby, what is to be expected for 1st meeting: she reaches out & traces profile with fingertips 26. PKU baby: 25% any further baby will have it too 27. put eye ointment in conjunctival sac of newborn as prophylactic eye ointment for prevention of infections from birth canal 28. rubella vaccine: use birth control for 28 days 29. salt wasting & swollen vagina: normal finding - androgens 30. Source of folic acid: peanuts 31. teach adolescent pregnant girls: proper nutritional needs 32. woman comes in with ab pain: start IV, not type & cross blood 33. woman getting radiation iodine: hold off on test to confirm if pregnant or not 34. woman has a baby in a cab & arrives at hospital, what do you do: start pitocin, massage fundus 35. woman on magnesium sulfate has 800 mL output in 1 hr. what do you do: continue what you are doing 36. woman who drinks but has cut down: good job & encourage her to reduce even more 1. 4 mo old what to do to prevent diaper rash: use a barrier cream such as zinc oxide that doesnt have to be fully removed 2. 6 mo old presents for routine vaccine & flu shot: give all immunizations & influenza but alternate site & injection 3. 8 mo old development you would notice: sitting unassisted 4. 15 mo breastfeeding mom now 6 mos gestation: get nutritional history 5. adolescent received an above knee amputation what do you tell them to do every day: inspect stump daily 6. adolescent turns 18 & mother calls for lab results: must get permission from daughter 7. baby got otitis media after an acute respiratory infection - why do infants get otitis media: shorter eustacian tubes 8. baby is regurgitating & vomiting. priority: suction mouth & nose 9. boy with spine injury after MVA: maintain spine alignment 10. breastfeeding mom wants to avoid having another pregnancy - what do you tell her: use condoms & gel 11. dehydrated child finding: weak cry & no tears 12. child with a slipped capital femoral epiphysis: pin & hygiene 13. esophageal atresia what is highest priority for infant: body temp 14. fetal HR dropped abruptly in a V formation - what do you do: change mothers position 15. girl with precocious sexual development is on LHRH, tell mom: daughter will have similar sexual growth patterns as her peers 16. glucose was 800 mg: give IV NS & insulin 17. infant getting phototherapy what do you do: cover their eyes 18. infertile couple goes to a fertility doc: allow them to control if they want to stop or go to a support group before next cycle 19. iron supplements: take with meals 20. lyme disease: if a rash presents then get tested 21. med to prevent respiratory issues in baby: bethamethasone IM 22. mom with mastitis: start on unaffected breast 1st 23. newborn has swollen tender testicles, you suspect a hydrocele, what do you do: use transillumination to check for fluid 24. newborn infant is crying & has elevated bp/is cyanotic, what do you do: warm baby 25. obesity in teens: what physical activity they do does school have PE, 3 day diet history from mom 26. postpartum hemorrhage even after finishing oxytocin infusion: check maternal BP 27. preeclamptic woman received Ptocin IV & having contractions 1-2 minutes apart: discontinue ptocin 28. pregnant woman with temp 101 - can it indicate chorioamionitis 29. Protruding cord: knee to chest position 30. pyloric stenosis, what will occur: metabolic alkalosis 31. Rubella: give after delivery within 72 hrs 32. school age children - Erikson: industry vs inferiority 33. teach prego teens: nutrition requirements during pregnancy 34. to assess for cryptorchidism: warm hands/room transitional phase of labor -priority is assess uterine contractions 36. woman has epidural anesthesia – monitor maternal HR & BP 37. woman who said she thinks shes about 6 mos pregnant & smokes - how to chest for estimated gestational age: ultrasound MP Hesi 2017 V2 • Pt is admitted to labor & delivery unit with contractions that are 3-5 minutes apart, lasting 60-70 seconds. She reports that she is leaking fluid. A vaginal exam reveals that her cervix is 80 percent effaced & 4 cm dilated & a -1 station. Nurse knows that Pt is in which phase & stage of labor? b. Active Phase of 1st Stage • To assess uterine contractions Nurse would: d. Assess duration from beginning to end of each contraction frequency by measuring time between beginnings of contractions, & palpate fundus of uterus for strength. • Which basic type of pelvis includes correct description & % of occurrence in women? a. Platypelloid: flattened, wide, shallow; 3% • What position would be least effective when gravity is desired to assist in fetal descent? a. Lithotomy • The factors that affect process of labor & birth, known commonly as five Ps, include all EXCEPT: d. Pressure. 5 P's are: 1. Powers (contractions), 2. Passengers (fetus & placenta), 3. Passageway (birth canal), 4. Position (of mother), 5. Psychological Response • While evaluating an external monitor tracing of a woman in active labor, Nurse notes that fetal HR (FHR) for five sequential contractions begins to decelerate late in contraction, with nadir of decelerations occurring after peak of contraction. Nurse 1st priority is to: c. Change woman's position • During labor a fetus with average HR of 175 beats/min over a 15-min period would be considered to have: d. Tachycardia • As a perinatal Nurse you realize a HR that is tachycardic, is bradycardic, or has late decelerations with loss of variability is nonreassuring& is associated with: hypoxemia/acidemia • Nurse caring for laboring woman should understand that amnioinfusion is used to treat: c. Variable decelerations • The most common cause of decreased variability in fetal HR (FHR) that lasts 30 minutes or less is: b. Fetal sleep cycles • While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, Nurse notes that fetal HR (FHR) begins to decelerate in a slow curve at onset of several contractions & returns to baseline before each contraction ends. Nurse should: b. Document finding in Pt's record. • What 3 measures should Nurse do to provide intrauterine resuscitation? Select priority of actions to be taken: Reposition mother, increase IV fluid, & provide O2 via face mask. • When using intermittent auscultation to assess uterine activity, Nurse should be aware that: b. examiner's hand should be placed over fundus before, during, & after contractions. • Perinatal Nurse are legally responsible: Correctly interpreting fetal HR patterns, initiating appropriate nursing interventions & documenting outcomes • Nurse caring for laboring woman should understand late fetal HR decelerations are caused by: Uteroplacental insufficiency • Nurse caring for laboring woman should understand variable fetal HR decelerations caused by: Umbilical cord compression • Which is NOT reassuring component of fetal HR: Absent FHR Variability • You are evaluating fetal monitor tracing of Pt in active labor. Suddenly you see fetal HR drop from its baseline of 125 down to 80. You reposition mother, provide O2, increase intravenous (IV) fluid, & perform a vaginal examination. cervix has not changed. Five mins have passed, & fetal HR remains in 80s. What additional nursing measures should you take? Call RRT & Notify Dr. • What is an advantage of external electronic fetal monitoring? c. external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring. • Methods to assist in assessment of fetal well-being have been developed for use in conjunction with electronic fetal monitoring. These various technologies assist in supporting interventions for a non reassuring fetal HR pattern when necessary. labor & delivery nurse should be aware that one of these modalities, fetal O2saturation monitoring, includes use of: Fetal pulse oximetry. • Nurse caring for woman in labor should understand that maternal hypotension can result in: a. Uteroplacental insufficiency. • Nurse caring for laboring woman should understand accelerations with fetal movement: d. Are reassuring. • Woman in active labor gets opioid agonist. Which med relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors & may even relax cervix but should be used cautiously with cardiac disease? Meperidine (Demerol) • Laboring woman given meperidine (Demerol) by IV 90 mins before she gave birth. What med should be available to reduce postnatal effects of Demerol on neonate? Naloxone (Narcan) • Woman in labor received epidural block. Most important nursing intervention: Monitor maternal BP for possible hypotension • A woman is experiencing back labor & complains of intense pain in her lower back. An effective relief measure would be to use: a. Counterpressure against sacrum • A woman has requested an epidural for her pain. She is 5 cm dilated & 100% effaced. baby is in a vertex position & is engaged. Nurse increases woman's intravenous fluid for a pre-procedural bolus. She reviews her laboratory values & notes woman's hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, & WBCs are 12,000/mm3. Which factor would contraindicate an epidural for woman? c. She has thrombocytopenia • The role of Nurse with regard to informed consent: Act as Pt advocate & help clarify procedure & options. • With regard to systemic analgesics giveed during labor, Nurse should be aware that: b. Effects on fetus & newborn can include decreased alertness & delayed sucking. • With regard to spinal & epidural (block) anesthesia, Nurse should know: incidence of after-birth headache is higher with spinal blocks than epidurals. • SATA. Maternal hypotension is a potential side effect of regional anesthesia & analgesia. What nursing interventions could you use to raise Pt's BP? b. Place woman in a lateral position, c. Increase intravenous (IV) fluids, e. Administer ephedrine per MD order • Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of gate-control theory? a. Massaging woman's back. • Woman in active phase of 1st stage of labor is using shallow pattern of breathing that is about twice normal adult breathing rate. She starts to complain about feeling lightheaded & dizzy & states fingers are tingling. Nurse should: Help her breathe into paper bag • With regard to pregnant woman's anxiety & pain experience, Nurse should be aware: b. Severe anxiety increases tension, which increases pain, which in turn increases fear & anxiety, & so on. • Maternity nurses often have to answer questions about many, sometimes unusual ways people have tried to make birthing experience more comfortable. Nurse should be aware that: d. Electrodes attached to either side of spine to provide mild-intensity electrical impulses facilitate release of endorphins • Pt is nulliparous woman, requesting pain relief. You examine her & she is 8 cm. What is best option for pain relief? c. Epidural • A primiparous woman is in triage room being evaluated for labor. She has been having contractions for 2 days, has slept little & is feeling exhausted. On cervical exam she is 1.5 cm dilated, 50% effaced, -1 station - which is not changed from a day ago. Contractions are irregular, 30-40 secs long. Which is best option for her? a. Offer morphine IM & a sedative to help her sleep. • Which of following is NOT a reason to come to labor & birth: c. Pt is 40 weeks & has contractions that are 8-10 minutes apart, 30 seconds long & been that way for 8 hrs. • What is an expected characteristic of amniotic fluid? b. Pale, straw color with small white particles • The uterine contractions of woman early in active phase of labor are assessed by internal uterine pressure catheter. Nurse notes intrauterine pressure at peak of contraction ranges from 65-70 mm Hg & resting tone range is 6 to 10 mm Hg. uterine contractions occur every 3-4 minutes & last an average of 55 to 60 seconds. On basis of this info, LPN should: c. Document findings because they reflect expected contraction pattern for active phase of labor. • A multiparous woman has been in labor for 8 hrs & membranes just ruptured. Nurse initial response: Assess fetal HR & pattern. • Through vaginal exam Nurse determines that a woman is 4 cm dilated, & external fetal monitor shows uterine contractions every 3.5 to 4 minutes. Nurse would report this as: 1st stage, active phase • Nurse expects to give oxytocic (e.g., Pitocin, Methergine) to woman after expulsion of placenta to: Stimulate uterine contraction • Vaginal exams should be performed by Nurse under certain circumstances EXCEPT: When accelerations of fetal HR are noted • With regard to a woman's intake & output during labor, Nurse should be aware that: a. tradition of restricting laboring woman to clear liquids & ice chips is being challenged because regional anesthesia is used more often than general anesthesia & studies are not showing harm from drinking fluids in labor. • 46.For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. woman may fight labor process & react with pain or anger. Alternately she may become a passive player & emotionally absent herself from process. Nurse is in a unique position of being able to assist Pt to associate sensations of labor with process of childbirth & not past abuse. Nurse can implement a number of care measures to help her Pt view childbirth experience in a positive manner. Which intervention would be key for Nurse to use while caring? b. Limiting number of procedures that invade her body • In third stage of labor, Nurse should be aware: An active approach to managing this stage of labor reduces risk of excessive bleeding • When planning care for laboring woman whose membranes have ruptured, Nurse recognizes woman's risk for__ has increased. a. Intrauterine infection • When managing care of a woman in second stage of labor, Nurse uses various measures to enhance progress of fetal descent. These measures include: a. Encouraging woman to try various upright positions, including squatting & standing. Giving positive feedback about her efforts. • When assessing a multiparous woman who has just given birth to an 8-pound boy, Nurse notes that woman's fundus is firm & has become globular in shape. A gush of dark red blood comes from her vagina. Nurse concludes: a. placenta has separated. • LPN can help their Pts by keeping them informed about distinctive stages of labor. What description of phases of 1st stage of labor is accurate? b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hrs • Match degree of tear or episiotomy to its description: 1st degree = small nick in perineum, not involving muscle 2nd degree = a tear thru part or all of perineal muscles 3rd degree = Laceration thru part or all of anal sphincter muscle 4th degree = Laceration thru anal sphincter & rectal wall • Which of following is true about placenta previa? d. Once placenta previa is diagnosed by a 20 week ultrasound, it is very likely placenta previa will resolve in third trimester. • What assessment is least likely to be associated with a breech presentation? c. Postterm gestation • SATA. During labor, Pt at 4 cm suddenly becomes dyspneic, cyanotic, & hypotensive. Nurse must prepare immediately for: b. Cesarean delivery, c. CPR • Mother of a preschool-aged child calls school RN to report her child was bitten by a tick while on a school outing last wk. Mother tells RN she removed tick & flushed it down toilet. What action should school RN take? Schedule test for Lyme disease if rash appears. • Dr. prescribes phenytoin (Dilantin) for school-aged child diagnosed with tonic-clonic epilepsy. Which info should RN provide parents when teaching about seizure management with phenytoin? Monitor child’s serum phenytoin levels routinely while taking Dilantin. • During newborn admission assessment, RN palpates newborn’s scrotum & does not feel the testicles. Which assessment technique should RN perform next to verify absence of testes: Perform transillumination of scrotal sac to visualize shadows of testes. • The parents of a 14-month-old-child who is hospitalized due to febrile seizures tell RN that they fear their child will have lifelong seizures. What info should RN convey to these parents? Reassure the parents that febrile seizures decrease as child grows older. • In determining the one min Apgar score of a male infant, RN assesses a heart rate of 120 beats per min & 44 respirations per min. He has a loud cry with stimulation, good muscle tone, & his color is acrocyanotic. What Apgar score should RN assign? 9 • School-aged child with otitis media receives prescription for azithromycin (Zithromax) 100 mg once, then 50 mg daily for 4 days. Med available in solution containing 200 mg/5 ml. How many ml should RN give on first day? 2.5 • 39-wk-gestational multigravida is admitted to L & D with spontaneous rupture of membranes (SROM) & contractions occurring every 2-3 mins. A vaginal exam indicates that cervix is dilated 6 cm, 90% effaced, & the fetus is at a +2 station. During last 45 mins FHR has ranged between 170 & 180 beats/min. What action should RN implement? Take oral maternal temp. • During admission of newborn, RN identifies localized swelling that does not cross suture line on the posterior area of the parietal bone. What action should RN implement? Notify Dr of cephalhematoma. • Mother of 6 y/o girl concerned about child’s obesity. The child’s weight plots at 75 percentile, & height at 25 percentile. The child’s BMI is at 85 percentile for age & gender. Which interventions should RN implement? SATA: Determine child’s usual physical activity pattern, Ask if school has PE program, Get child’s 3-day diet history based on mother’s input. • Woman 36-wks & Rh negative admitted to L & D with abdominal cramping. She is placed on strict bedrest & FHR & contraction pattern are monitored with external fetal monitor. Two hrs later, RN notes large amount of bright red vaginal bleeding. Highest priority nursing action? Assess FHR & Pt’s contraction pattern. • Nutritional info RN should give mother of 6-mo-old on introducing solid foods? Introduce foods one at a time, at 4-7 day intervals. • Digoxin is prescribed to 3-month-old with congenital heart disease. RN should teach parents to do what if they miss giving a dose of this med? If less than four hrs have elapsed, give the missed dose. • A 10 y/o boy has been seen frequently by the school RN over the past three wks after school begins in the fall. He reports headaches, stomach aches, & difficulty sleeping. What intervention should RN implement? a. Ask the boy to describe a typical day at school. • Pt who had her first baby three months ago & is breastfeeding tells RN that she is currently using the same diaphragm that she used before becoming pregnant. What info should RN provide this Pt? Use other form of conception until new diaphragm obtained. • In assessing child with suspected bacterial meningitis, RN should anticipate a recent history of which problem? a. Ear ache • Following the vaginal delivery of a 10-pound infant, RN assesses a new mother’s vaginal bleeding & finds that she has saturated two pads in 30 mins & has a boggy uterus. What action should RN implement first? a. Perform fundal massage until firm. • Mother brings her 3 y/o son to ER & tells RN he has had an upper respiratory infection for past two days. Assessment of child reveals rectal temp of 102 F. He is drooling & becoming increasingly more restless. First RN acton? d. Notify Dr & obtain a tracheostomy tray. • Mother brings 3-month-old to clinic because baby does not sleep through the night. Which finding is most significant in planning care for this family? diaper area shows severe skin breakdown. • Pt 18-wks was informed this morning that she has elevated alpha-fetoprotein (AFP) level. After Dr. leaves room, Pt asks what she should do next. What info should RN provide? Explain sonogram should be scheduled for definitive results. • A 4 y/o boy was recently diagnosed with Duchenne muscular dystrophy (DMD). Which characteristic of the disease is most important for RN to focus on during the initial teaching? c. Lower legs become progressively weaker, causing a waddling, unsteady gait. • While caring for laboring Pt on continuous fetal monitoring, RN notes FHR pattern that falls & rises abruptly with “V” shaped appearance. First RN action? Change maternal position. • Woman returns to clinic for 2-wk postpartum checkup & has signs of left breast mastitis. Which instructions should RN suggest Pt follow at home? SATA: Wear bra with good breast support, Takeantibitotics at regular intervals, Apply warm compress to left breast. • A one-month old male infant is brought to clinic by his mother who states son has been vomiting forcefully after each meal for last three days. Infant is afebrile, dehydrated, & pyloric stenosis is suspected. What other findings should RN identify that are consistent with pyloric stenosis? olive-shaped mass in abdominal area • Babysitter of 7 y/o with type 1 diabetes calls clinic to report that child is very irritable, perspiring, & shaking. Which instructions should RN provide to the babysitter? Give child 8oz glass of milk. • Pt in preterm labor has had infusion of mag sulfate running for 8 hrs. Current findings: RR 14 breaths/min; urine output 25 ml/hr; DTRs 1+; serum mag level 8 mEq/L. Based on these findings, what conclusion should RN reach? c. Findings indicate potential toxicity to magnesium sulfate & close follow-up is indicated. • Teen with pelvic inflammatory disease (PID) is admitted to hospital after 14 days of taking levofloxacin (Levaquin) 500 mg orally once daily & metronidazole (Flagyl) 500 mg twice daily. She asks RN, “Why do I have to be in hospital? Why can’t I get my Tx at home?” Which purpose should RN provide that supports effective outcome? Administration of a supervised parenteral antibiotic protocol. • A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) & high levels of thyroid stimulating hormone (TSH). Best explanation for this finding? TSH is high because of the low production of T4 by the thyroid • During well-baby visit, parents explain a soft bulge appears in groin of 4-month-old son when he cries or strains during stooling. Infant is scheduled for surgical repair of inguinal hernia in 2 wks. Parents should be instructed to do what if hernia becomes incarcerated prior to surgery? Gently manipulate hernia for reduction. • 6 y/o child diagnosed with rheumatic fever & demonstrates associated chorea (Sudden aimless movements of arms & legs). Which info should RN give parents? The chorea or movements are temporary & will eventually disappear. • A 32 wk multipara with a history of preeclampsia arrives to the clinic for her routine appointment. The RN observes Pt has an elevated blood pressure of 155/90 mmHg. Which action should RN take? d. Collect a urine specimen to screen for protein. • A child who received multiple blood transfusions after correction of a congenital heart defect is demonstrating muscular irritability & is oozing blood from the surgical incision. Which serum value is most important for RN to review before reporting to Dr? b. Calcium • 3 y/o girl who has been blind since birth is hospitalized with compound fracture of femur & in traction. Which intervention is best for RN to implement to address this child’s blindness? Request parents bring familiar objects such as a stuffed animal from home. CHD priority in newborns - Tetralogy of Fallot results in decreased pulmonary blood flow that allows desaturated blood to shunt from right to left side of heart & then into systemic circulation. This can cause hypercyanotic spells during exertion efforts such as crying & child should be given immediate blow-by O2 & placed in a knee-chest positioning until help arrives. Coarctation of the aorta is an obstructive defect that can cause hypertension & precipitate HF. The hemodynamic flood flow of children with patent ductus arteriosus & VS defects have increased pulmonary blood flow & based on size of defect, may be clinically asymptomatic or have manifestations of heart failure (HF), which reduce systemic O2ation. • Anchor the lower part of the uterus - then massaging the fundus • HIV AZT is given to slow down the transmission to the fetus • Clear water to clean for diaper change • Muscular irritability from hemorrhaging • Osteomyelitis - give milkshake as a snack- high protein, high fiber • Hypoglycemic: give milk • Croup - barking sound, high pitch on breathing - bring in shower with warm mist • Tetralogy of Fallot - cyanotic limbs crying • 30 wks& 38 in fundal height - do ultrasound – should be equal • Breastfeeding 5 day with yellow stools - this is normal • Spontaneous rupture of membranes - ask the color & consistency • 3+ pitting edema with GERD- normal during pregnancy?? • Postpart depression - may need evaluation - Know length of PPD • Tonsillitis-signs of bleeding - need to inspect the oral cavity • Braxton Hicks will go away with walking it is not true labor • Placenta Previa - check fetal HR • I’m having pain in my stitches - look at the episiotomy • Use breathing techniques after giving pain meds 30 mins ago • UTI child - return for another urine sample • 3 hr newborn with irregular respirations & small/soft murmur - put pulse ox on the foot • Gonorrhea infection tell other partners to seek Tx • Adolescent gets a rubella vaccine at maternal bearing age - use another form of birth control? • Tonic clonic seizure & heart issue - monitor calcium • Pt comes in for Amniocentesis you do BP/HR next is - something with to get Rh factor for rhogam • Celiac disease: crackers no good need gluten free foods • Breasts - need supportive bra, antibiotics, cold compress • infant vital signs: normal • DMD - weak muscles & gait - something with DMD & serum Ca+ • Preeclampsia: check urine for protein • 4 y/o girl in waiting room & RN is observing her behavior. Which one was normal? Talking to an imaginary friend • Diabetic male has blood glucose 180mg/dL before playing soccer; what to do? Give go ahead to play because glucose is within normal • HIV+ Mother gave birth; AZT therapy during labor; what should RN do? Ensure to take AZT within 6 hrs after Birth • SATA: 2 y/o drinking soda from bottle. Dental caries are associated with drinking soda; Drinking soda is related to childhood obesity; Toddlers should be drinking from a cup by age 2 • A 10 y/o boy on bed rest. Checkers • Pt 3cm dilated; 50% effaced, 0 station. After 1 hr, she wants to go to bathroom; what should RN do? determine current cervical dilation • Pt in L&D because of non reactive result on non-stress test. Does contraction test. Most important finding? Pattern of fetal late deceleration • Dosage calc for 1st day to give. 100 mg/200 mg x 5 ml = 2.5 ml • Dosage calculation= 25 ml/hr [500 ml/ 20 gm * 1gm/1 hr] • Postpartum depression findings: trouble sleeping, decreased appetite, feelings of sadness • Intussusception - passage of soft brown stool notify provider • Pt was given pitocin& delivered infant. Why is it given? To stimulate uterine contractions, you never give pitocin before placental delivery because it will retain the placental part. • Pt on mag sulfate; RR 14; urine output 25ml; +1 reflex. Mag level of 8. RN action? Mag level reaching toxic - monitor for further deterioration • Oozing blood & muscle irritability; what should RN check? Calcium • Newborn ready for discharge from hospital: Consent for Hep B from Mother • Pt w/ increasing restlessness, drooling & 102 temp: Bring trach kit • Pt had episiotomy & complaining of pain: Check the perineal area & sutures (Visualize perineal area & episiotomy sites) • Pt w/ heartburn & edema: ask about headache or blurred vision • **********Constant vaginal pressure? Sitz bath? • Tetracyclines: Do not give with Milk & antacids • Pt with PID (pelvic inflammatory disease) getting 14 days of antibiotics at hospital. She asks “Why can’t I go home & take these meds?” RN response for positive outcome? Supervise parenteral administration of antibiotics according to protocol? • Salt wasting syndrome ATCH Level • Tanner Stage for 11 y/o girl - Tanner Stage II • Probable sign of pregnancy - Hegar’s sign • Child has respiratory distress: Nasal flaring • **Oxytocin administered for : (let down reflex?) or stimulate uterine contractions? It does both, & both were in the answer choices • Parents of 3 y/o boy w/ Duchenne muscular dystrophy (DMD) ask “how can our son have this? Should we have any more children” What info should RN give? It is inherited X-linked recessive disorder, which primarily affects male children in family • Safe thermoregulation: temp probe on mid, in line with radiant heat source • **C8 Spinal cord injury, the girl is incontinent & bladder is distended - due to absence of motor neuron stimulation to bladder. • **Pt with PDA; RN about to give prostaglandin; which finding causes RN to immediately stop? 80/Heart rate 50? RR 34 breaths/min? (It would be HR right?) - I picked HR, but I think this is asking for side effects of prostaglandins* • **2 hands for palpating fundal height & (Leopolds?): other hand to anchor uterus • Child holding abdomen & complaining of pain. Describe pain level • DM type 1 mother - what is the priority nursing action? Strict glucose monitoring or to prevent fetal complications • Purpose of ultrasound at 20 wks? To see baby’s growth/gestation • Gestational diabetic mom scheduled for amniocentesis because fetus has estimated wt of 8lbs at 36 wks. This checks: Fetal Lung Maturity • Excessive uncontrolled vaginal bleeding after the IV Pitocin is infused, what info should RN provide to the provider? Maternal BP • **70% effaced, 2 cm dilated. The pt demands epidural. RN response? Don’t give epidural because will slow the labor process • Breastfed baby yellow sticky, sour : normal finding • Cleft lip/palate question. Mom had cleft lip. The uncle from dad’s family has cleft lip. RN response? Refer them to genetic counselling or tell them it that the inheritance of cleft lip/palate is not genetic • Pt bleeding bright red, rigid abdomen & pain - prepare for emergency CS • Tonsillectomy Pt Irritated & swallowing. Look at oropharynx w/ flashlight • 2 month old at clinic for well baby exam. RN finds right testicle not descended into scrotum but left is palpable. What action should RN take? Ask parents if the right testis has been in scrotum before • School age boy fell off bike & hit tree tells school RN “there is stuff in my eyes.”- Patch both eyes & send to ophthalmologist • Digoxin missed doses for a 3 month old. RN response? Give the missed dose if less than four hrs • 7 y/o with history of UTI. What should girl/parents lookout for? Check urinary odor • Parents worried about febrile seizures & that it is lifelong condition. RN response? Tell them febrile seizures disappear as child grows old • End stage chronic liver condition in a child. The parents know that the child will die. RN response? Reassure the parents that the staff are available for their needs or Tell the nursing supervisor to anticipate death (something like that)? Or check DNR is in records? • 5 month old, abnormal finding? Moro reflex • A school age girl has frequent absences at school due to episodes of abdominal pain, etc& comes to the school RN. What should the school RN do? The choices were: Refer to primary health provider? Ask about sleep/night routine? The other 2 didn’t make sense • Fluid filled vesicles Put on transmission precautions • Meningitis question. History of Ear ache • Mother received Rubella vaccine after delivering baby. What should RN tell Mother regarding Rubella vaccine? Don’t get pregnant for 1st month? Because rubella live virus vaccine can cause birth defects • **The neonate 3 hrs old vitals are given: 160 beats/min with soft murmur, 97.7 temp, etc. The choices were: Put baby in radiant heat source? Document the finding (correct choice, the soft murmur is from the PDA) Apply O2 saturation at heel? Glucose check? • Ulnar fracture after applying splint: Check for wrist pulse • Woman with history of chicken pox & syphilis as a teenager in for first prenatal visit. RN action? Prenatal blood & urine tests Maternity & Pediatric HESI • 5 in head increase at 3 months – assess anterior fontanel for bulging • Pt had a cold 2 to 3 days ago & has a hacking cough, difficulty breathing, further assessment def. Respiratory distress – nasal flaring • Synagist (who to administer to): Pt in high-risk criteria • Pertussis Pt with paroxysmal cough nursing intervention: small frequent feeding • Child having difficulty feeding with spoon (15 months) Parents are concerned. Question Mothers concern • Erwin sarcoma dx on adolescent meds: degree of metastasis • Meconium stain amniotic fluid report: fetal HR 100-110 • Genital hyperplasia (ambiguous genitalia) Sonogram & ultrasound to check sex of baby • Pre-eclampsia Pt: Ensure Airway by the bedside • Bleeding with abdominal pain: call physician while at the bedside • Increase of pitocin: check contractions • Pt feeling pressure in vagina, postpartum: assess perineal & rectal area • Pt bleeding & experiencing muscle cramps: calcium • osteomyelitis pt bed bound: milkshake • Doesn't cross the suture line: cephalohematoma • Crosses the suture line: Caput succedaneum • Test on a 3 yr old, what to do after: give parents a list of stimulating activities • Tanner Stage: scant pubic hair stage II • Pt with HTN, edema: give apple • Probable signs of pregnancy: Hegars sign • Pet that a primigravida cannot have (taxoplasmosis): CAT: BUT they actually can have cats, they just have to avoid litter box • Yellow patches on forehead, sternum &abd.: check bilirubin level • 3cm dilation & 50% effaced an hr later: determine cervical dilation, pt wants to use the bathroom. • SROM, amniotic fluid greenish brown. RN do first: assess FHR • Jittery baby: assess glucose level • Babysitter repots signs of hypoglycemia: 8 oz of milk • Jewish lady asking about genetic testing: Risk for Tay-Sachs • Blood transfusion for Jehovah witness: Clarify blood transfusion preference • Tetracycline education: Don't give with milk • Reduce risk of respiratory issues in preterm: Betamethasone • Woman receiving rubella vaccine has: encourage to immunize the children at home (13mth & 3 yr) • Oral contraceptive contraindication: family history of stroke • Hypothyroidism, assessment of therapy effectiveness: laughs readily, turns from back to side • “When can I go home” asked by new mom after delivery, when there is no significant bleeding • Reason for temporary bed rest: Homans sign • Risk for otitis media in children: Eustachian tube is shorter in children than adults • Hemophilia Pt: discharge teaching (RICE) • Teenager with ulna fracture & splint applied: check radial pulse • Pt on rehydration therapy & vomiting: continue ORS in small frequent quantities • Pt with mastitis on antibiotics: start feeding on unaffected side first • Cryptorchidism pt assessment: warm the room • pt concerned about high AFP: confirm with sonogram • Newborn survival after delivery: prevent heat loss • Mom worried about thumb sucking: normal for children at this age OB Hesi • Pregnant Pt, with contractions 5 min apart, goes to bathroom & you hear baby crying. Best RN action? hit call light to call for help • Pt has spinal headache 24 hrspost delivery. Before anesthesiologist’s arrival, what is best RN action? have equipment at bedside • Pt 20 wks gestation has HPV. What is the best info for RN to provide? treatment is available but limited due to pregnancy • 1 hrpost delivery RN unable to palpate fundus. Large amount of lochia on pad. Massage umbilicus & get vitals. Next RN action? palpate for bladder distention • Baby with cephalatoma. Next RN action? assess for jaundice q 8 hrs • Math: Pitocin 4 mU/min. 1000 mL/2 mU. mL/hr?: 12 mL/hr • Pt receiving Pitocin is experiencing tetanic contractions with variable FHR. RN action to implement? turn off the Pitocin drip • Pt scheduled for cesarean @ 0600 tells RN she drank coffee at 0400 to avoid getting headache. RN action? tell anesthesiologist • 2 hrspost delivery of 10lb baby, fundus is above & to right of umbilicus. Pt voids 250 mL in bed pan. RN action? palpate suprapubic region for distention • 33 wks gestation. Moderate bleeding. No contractions. What intervention to implement? Weigh pads • Primipara 42 wks. On Pitocin then stopped. O2 given. Contractions 5 mins apart for 20 secs. Nurse action? restart Pitocin per protocol • Pt with continuous fetal monitoring notices FHR fall & rise abruptly with “v” shaped pattern. RN action to do first? change Pt position • 28 wks with twins. Fundal height 27cm. 3 wks ago it was 28 cm. What does RN conclude from this? may indicate IUGR • Pt received prostaglandin gel vaginally to induce labor. 30 mins after insertion of gel, Pt complains of vaginal warmth. What action should RN implement first?: turn Pt to side lying position • Parents say baby trying to walk. RN’s response? normal stepping reflex • Pt delivered baby 24 hrs ago & complains of urinating every hr or so. She asks “is that ok?” RN’s action? measure next voiding • Magnesium sulfate infusion begins. Pt develops slurred speech & decreased reflexes. What RN RN action? stop infusion • After breastfeeding for 10 mins on each breast, baby spits up. RN action first? turn baby to the side & suction • 35 wks, Breech, Contractions 3‐5 mins apart & mom says “I think my water just broke”. RN sees umbilical cord protruding. Intervention to implement? place Pt in knee‐chest position • Extrauterine transition: cries vigorously when stimulated • 3 day old baby. Feeds every 2 hrs. RN notes white curd patches on oral mucus membranes. RN action?: needs medicine • 38 wks, hx of PIH. Pitocin started. Gets headache 1 hr later. Contractions 1‐2 mins apart 60‐75 secs. long. Most important action? Stop Pitocin • After delivery Pt asks RN when she can leave to go home. Information most important to provide? when bleeding stops • Mother who is lactoovovegetarian plans to breastfeed. Information to provide before discharge? continue taking prenatal vitamins • Teaching how to perform kick counts. Instruction to include? 10 kicks not felt, drink orange juice & count again • 40 wks gestation, spontaneous rupture of membranes & meconium stained. What additional finding should RN report? FHR 100‐110 • Pt with gestational diabetes has an amniocentesis. Why is the amniocentesis being performed? fetal lung maturity • Jehovah’s Witness Pt hemorrhaging is in the ICU. RN action to take? clarify the wishes of Pt • Pt breastfeeding: decrease need for insulin • Newborn receiving positive pressure intubation after delivery. Which finding should RN initiate chest compressions? HR 54 • 30 y/o primigravida delivers 9 pound vaginally after 30 hr labor. Priority nursing action? observe for signs of hemorrhage • Magnesium Sulfate in D5W 500 mL. 20 g Mag Sulfate at 1 g/hr. How many mL/hr? 25 • 32 wks with possible UTI. RN action? collect urine for culture • 38 wks, tachycardia, tremulous, hypertensive. Assessment action most important? obtain a drug screen • Pt requests epidural. First RN action? check cervical dilation • Pt presents with bright red blood, rigid abdomen & in pain. RN suspects possibility? abruptio placentae • LGA infant. First RN action? obtain blood glucose • After delivery Pt presents with profuse hemorrhage. RN action? check maternal blood pressure • Discussing involution. Pt understands effect of breastfeeding when states? period may be delayed • Baby born with congenital heart defect. Which assessment finding warrants immediate intervention? bluish tinge to tongue • Rh‐ Mom suffers abdominal trauma in car accident. Which finding is most important to tell Dr.? positive fetal hemoglobin • Which hormone is responsible for positive pregnancy test? HcG • Doctor hands baby to RN immediately after delivery. Which action is most important to implement? place under warmer • Education most important for RN to implement to teenage pregnant Pt? iron deficiency anemia • RN identifies localized swelling that does not cross the suture line of parietal bone. RN action? notify Dr. of cephalhematoma • RN action before giving Hep B vaccine? get consent signed • Beractant given for RDS in preemie. Assessment finding indicates condition is improving? urinary output increased • 34 wks gestation. Bimonthly visit. Assessment finding important to report to health care provider? weight gain 7 pounds • Primigravida asks RN about exercise during pregnancy. What recommendation? stretching • Cyanotic 3 hr old infant temperature 96.5, 40 breaths/min, 165 beats/min. Best Intervention? gradually warm under heat source • Pt comes in stating that she is in labor. Which finding confirms not in labor? contractions decrease when walks • Multigravida asks for more pain meds. Just received pain meds, Stadol 2 mg, 30 mins ago. RN action? instruct to deep breathe • Postpartum Pt w/ severe pain & pressure in perineal area. RN finds hematoma beginning to form. What should RN get first? BP & HR • Pt complains of morning sickness. RN recommends? ginger • 3 day postpartum Pt. Husband calls states wife is crying, irritable - Tell husband to contact clinic in 2 wks if symptoms become worse • Postpartum & rubella vaccine: can give while mom breastfeeding. • 2 month old – vaccine given is: Hep. B • Croup – mother brings toy to hospital, what should RN do? Allow child to have stuffed toy inside tent • 18 -month – Pertussis: What do you give? Orange juice • Reddish vesicles on legs – Impetigo Contagioso: What type of scarring will it leave? • 1000mL/8hr = 125mL/hr. • Toxoplasmosis = Wore no gloves when gardening (cat feces may be in flower beds) • Pavlik Harness – Congenital hip dysplasia with Subluxation at risk with harness: skin integrity • Rubella Vaccine – info provides: Use birth control for 28 days (rubella is tetragenic) • Newborn tries to walk. RN explains normal newborn stepping reflex • 3 y/o w/HIV infection. Other child with Pertussis: Protect HIV child; they are immunocompromised due to the meds they are on. • Healthy newborn delivery – Discharge – can go home when: • Diaper rash advice – prevent diaper rash: leave a small amount of ointment on with diaper change as skin barrier • Acute otitis media – URT: Eustachian tubes in children are shorter & straighter than in adults • 4 y/o girl with moderate development disability (Autism) – Goal: • Postpartum & lying in pool of blood: Check lochia flow & fundus consistency • 3 wks. Postpartum vaginal delivery – breastfeeding – small crack left nipple – feels sick: Continue breastfeeding • 4 Wk. infant with Pyloric Stenosis: Projectile Vomiting after feeding • Tonsillectomy & excessive swallowing: Tell RN VS & swallowing • Nephrosis (Nephrotic Syndrome) – Prednisone (corticosteroid) – decrease in: Generalized Edema • 8 wk. gestation Hgb. 9.5 mg/dL (Normal for female: Hemoglobin 12-16) On Iron – recommended dietary: Iron rich foods • Newborn chocking – cyanotic – x-ray – diagnosis – Trachea-esophageal fistula – RN action: NPO, HOB 30 degree • Toddler Admission. For less stress to Pt? caregiver hold child • Basic prenatal physical exam: Chicken pox & Syphilis – RN: collect blood & urine for prenatal screens • Who does RN see 1st? Pt discharge has questions about yesterday teaching, Tired mother with twins? • Placenta Previa 31 wks. Gestation – blood loss calculation: Calculate difference in weight of perineal pad before & after use • 3 month infant & prop bottle on pillow to feed: RN encourage mother not to prop bottle • 6 month infant w/ bronchiolitis symptoms & Respiratory distress: a high pitched cry, RR of 56 breaths/min. • School aged child – frequent urination – increased thrust – hunger within 2 hrs. of eating: Serum glucose test • 10 y/o with acute appendicitis scheduled for surgery tells RN sudden relief of abdominal pain. RN action: Report to charge RN • Highest priority after birth: Prevent heat loss & neonatal cold stress • Hypospadias – surgical repair before 6 months of age – tell parents not to circumcise child: Prepuce used in reconstruction • G2P1, 10hr. no epidural, IV pain med., increased contraction every 2 min., cervix 100% effaced, dilation 8cm Pt ask for IV Nalbuphine (Narcotic): Reinforce relaxation technique & breathing • Fundus – primipara – 2hrs. postpartum – balloon like bulge: • “Squatting” Corrective Surgery Congenital Heart defect – upon rising child is tachypnea & tachycardia, cyanotic, hypoxic: Administer Digoxin (don't give if HR BELOW 110) • Care of Circumcision: Apply ointment • 38 wks, already has twin daughters, 1 son, 1 miscarriage: 5 pregnancies, 3 living children • 5 y/o – Tricycle • Conception – ovulation occurs: 14 days after menstruation • RN should assess which Pt first? 10 hr. cyanosis: blue, cyanotic, hypoxic; stork bite: salmon patch, pink flat appearance; Ortalini’s sign: click or popping sensation hip dislocation, Babinskis & Reflex: normal newborn reflex • 1 wk. full term – hyperbilirubinemia: • 250 micrograms/4 hr. [(250mcg) 0.25mg/1mg X x/mL = 0.25 mL • 12 wks, positive TB, Chest X-ray: Lead apron over prego abdomen • Laboring Pt – withhold solid food while in labor: Increased risk for aspiration can occur if general anesthesia is needed • Hemo/philia (bleeding problem) – hem/arthr/o/sis – right knee: elevate & immobilize the right knee in a flexed position • 39 wks in L&D – contractions at reg. intervals – miscarriage at 16 wks. – fetal demise (death) at 31 wks.: Gravida3 (pregnant 3 times) • 8 y/o kids go to playroom RN selects a board game • 1 y/o with neuroblastoma: • Child vomits meds. Digoxin: skip dose, give next dose on time. • Gravida 5, Para 5: uterine muscle tone (uterine atony) • 4 y/o with a fracture RT. Ulna – 12 hrs.: Elevate the arm above the level of the heart • 250mg/6 hr. 250mg/200mg X x/5mL = 200x=1250/200= 6.25 • UAP – vitals on a Pt with subdural hematoma to report: LOC • Protruding cord: knee to chest position • child with a slipped capital femoral epiphysis: pin & hygiene • 4 month old what to do to prevent diaper rash: use a barrier cream such as zinc oxide that doesnt have to be fully removed • mom with mastitis: start on the unaffected breast first • mother of 18 y/o calls for lab results: must get daughter’s consent • breastfeeding mom wants to avoid having another pregnancy - what do you tell her: use condoms & gel • infant getting phototherapy what do you do: cover their eyes • 6 month old presents for routine vaccine & flu shot: give all immunizations & influenza but alternate site & injection • med to prevent respiratory issues in baby: bethamethasone IM • 15 month breastfeeding & 6 months prego: get nutritional hx • postpartum hemorrhage even after finishing oxytocin infusion: check maternal BP • baby got otitis media after an acute respiratory infection - why do infants get otitis media: shorter eustacian tubes • boy with spine injury after MVA: maintain spine alignment • obesity in teens: what physical activity they do, does school have PE, 3 day diet history from mom • iron supplements: take with meals • preeclamptic woman on Pitocin IV & having contractions 1-2 minutes apart: discontinue pitocin • lyme disease: if a rash presents then get tested • esophageal atresia - highest priority for infant: body temp • baby regurgitating & vomiting - priority: suction mouth & nose • adolescent received an above knee amputation what do you tell them to do every day: inspect the stump daily • woman thinks shes about 6 months pregnant & smokes - how to check for estimated gestational age: ultrasound • 8 month old development you would notice: sitting unassisted • glucose was 800 mg: give IV NS & insulin • Rubella: give after delivery within 72 hours • newborn has swollen tender testicles, you suspect a hydrocele, what do you do: use transillumination to check for fluid • FHR dropped abruptly in a V formation - what do you do: change mothers position • pregnant woman with a temp of 101 - what can it indicate: chorioamionitis • woman has epidural anesthesia - monitor: maternal HR & BP • prego teens: teach nutrition requirements during pregnancy • transitional phase of labor - most important: assess uterine contractions • infertile couple goes to a fertility doc: allow them to control if they want to stop or go to a support group before the next cycle • school age children - Erikson: industry vs inferiority • child dehydrated - physical findings: weak cry & no tears • pyloric stenosis, what will occur: metabolic alkalosis • to assess for cryptorchidism: warm the hands/room • newborn infant crying, cyanotic & has elevated bp: warm baby • girl with precocious sexual development on LHRH - tell mom: daughter will have similar sexual growth patterns as peers • Source of folic acid: peanuts • mom getting hypotensive on spine board after MVA: roll her on her side on spine board • mom goes to bathroom with contractions 5 min apart - you hear her baby cry: hit call light for help • Iron: dark stool is normal, give at bed time • man calls clinic says his wife has been sad, happy, moody: tell him these are normal hormonal changes • magnesium: stop infusion due to magnesium toxicity • contractions get close & mom is dilated, stop pitocin, then contractions get 5 min apart: restart Ptocin per agency policy • bright red trickling blood: lacerated cervix • teach adolescent pregnant girls: proper nutritional needs • 42 weeks Ballard score: check blood sugar • breast feeding woman asks about birth control: breast feed only every 2-3 hours • rubella vaccine: use birth control for 28 days • baby has white curd patches in mouth: discuss medicine with mother (candidiasis infection) • mom has baby, what is to be expected for first meeting: she reaches out & traces profile with fingertips • HIV positive mom gives birth & is worried about passing it to her baby: explain to mom AZT for the baby after birth • HSV 2, baby born via vaginal delivery: isolate in nursery • hormone for positive pregnancy test: human chorionic gonasotropin (HCG) • is swollen vagina normal in an infant: yes • woman on magnesium sulfate has 800 mL output in 1 hr. what do you do: continue what you are doing • woman has baby in a cab & arrives at hospital, what do you do: start pitocin, massage fundus • woman comes in with abdominal pain: start IV, not type & cross blood • put eye ointment in conjunctival sac of a newborn as prophylactic eye ointment for prevention of eye infections contracted from bacteria in birth canal: ... • mom had a child but now complains of vaginal pain & fullness: check vaginal & perianal area • salt wasting & swollen vagina: normal finding - androgens • -1 placement of baby, mom in active labor, 3 cm dilated, mom has to go to the bathroom: check her cervix • baby born to diabetic mother: check babys blood sugar • PKU baby: 25% any further baby will have it too • baby with clavicle problem: it will have intracurvature • woman who drinks but has cut down: good job & encourage her to reduce even more • woman on radiation iodine: hold off on test to confirm if pregnant or not • fertility drugs: report sudden increase in abdominal girth • breast feeding & sore nipples: start off feeding on unaffected breast • breast feeding mother has a diaphragm: use condom & foam until diaphragm can be refitted • newborn of mom w/ positive drug test: monitor for seizures • baby has apgar of 3: continue recuscitation • baby is jaundiced & brought back to the hospital after 7-10 days: provide eye protection & place under light/phototherapy • Boy with spine injury from diving accident - alignment • Breast feeding mother contraception – condom & contraceptive form and gel • Slipped Capital Femoral Epiphysis– clean pin and incision site • Mother of a 4 month old asks RN for preventing diaper rash - use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change • Missed Digoxin dose, what to do? if less than 4 hrs, give next dose • Which condition would a nurse inform a dr.? – RR 76 (infant) • Mother calls to get her 18 years old daughter’s lab result? – tell her that her daughter’s permission is needed. • One side mastitis – initiate breast feeding with unaffected breast • pCO2 44, …? – normal acid-base balance • mother 6wks prego w/15mons child – ask for daily nutritional habit • Influenza shot – all immunizations, but influenza at another site • Postpartum hemorrhage after finishing oxytocin infusion, which is the most important to tell dr? Maternal BP • A child w/ otitis and URI attending day care, which is the reason why the child get otitis? Children have short euch tube • A woman w/ iron deficiency anemia, vomit and diarrhea after taking iron - Take iron with meal • Tick bite – if rash then test • Newborn w/ esophageal atresia – check temp. • An infant regurgitates…- suction • A girl w/ above know amputation – inspect stump daily • BS 800 K 5 – IV normal saline with insulin • 8 mons old developmental – sitting unassisted • A pregnant woman who smokes doesn’t remember last menstrual date, the best method to check for gestational age – ultrasonography • During delivery, protruding umbilical cord – Knee chest position • Hydrocele – Transillumination w/ red light • A pregnant woman has tenderness w/ palpation & pain gets worse whenever a fetus moves – Chorioamniotitis • Epidural anesthesia – check maternal HR and BP • Teenagers who are pregnant – teach nutrition • 90% effacement 6cm dilation – push 3 times with each contraction? • Variable deceleration “V” fetal HR – change position Nursing actions for variable decelerations: Change maternal position, Stimulate fetus if indicated, Discontinue oxytocin if infusing, Give O2 at 10 L by tight face mask, Perform a vaginal examination to check for cord prolapse • Transitional phase – assess for uterine contraction • 4 neonates, which one need to be seen first – Tetralogy of fallot • 9 year old boy – industry (Erikson) • Child with pneumonia – auscultate lungs • Child dehydrate sign – cry without tear • Assessment of cryptorchidism – warm the room • Obese 6 year old girl 75% percentile wt. (SATA): Ask a child’s physical activities, Ask whether the school has physical program, Diet history for last 3 days • Parents think 2 yr old son is different from his sister, abnormal sign? He doesn’t feed himself, I make him eat veggies and meat • A postpartum woman not immunized w/ Rubella, when she can get vaccine? After birth w/in 72 hrs? HESI Hint Rubella is teratogenic to the fetus during the first trimester, causing congenital heart disease, congenital receive the vaccine after delivery and be instructed not to get pregnant within 3 months. Breastfeeding mothers may take the vaccine. P.275 • Which is the understanding of LHRH (luteinizing hormone releasing hormone) for precocious puberty (sexual development)? Your daughter will be grown same as her peers after therapy. • HESI Hint Dystocia frequently requires the use of oxytocin for augmentation or induction of labor. Uterine tetany is a harmful complication, and careful monitoring is required. The desired effect is contractions every 2 to 3minutes, with duration of contractions no longer than 90 seconds. Continuously monitor FHR and uterine resting tone. If tetany occurs, turn off oxytocin (Pitocin), turn client to a side-lying position, O2by face mask. Check output (should be at least 100mL/4hr). Oxytocin’s most important side effect is its antidiuretic (ADH) effect, which can cause water intoxication. Using IV fluids containing electrolytes decreases the risk for water intoxication. P.291 refer p.280 [Show More]

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