ATI PN ob and peds final exams

1. A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. administer an analgesic 2. release the skin traction 3. apply ice to the extremity 4. notify the HCP 2. A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? 1. ensure that all ropes are outside the pulleys 2. ensure that the weights are resting lightly on the floor 3. restrict diversional and play activities until the child is out of traction 4. check the HCP's prescriptions for the amount of weight to be applied 3. The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1. "I will encourage my child to perform prescribed exercises." 2. "I will have my child wear soft fabric clothing under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. "I should avoid the use of powder because it will cake under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my infant will require follow-up care until fully grown." 3. "I need to bring my infant back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic every week with my infant for the casting."Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3 to 6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome. 5The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? SATA A. Use the fingertips to lift the cast while it is drying B. Keep small toys and sharp objects away from the cast C. Use a paddle ruler or another padded object to scratch the skin under the cast if it itches D. Place a heating pad on the lower end of the cast and over the fingers if the finders feel cool E. Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling F. Contact the HCP if the child complains of numbness or tingling in the extremity 6, A nurse is caring for a 10-month-old infant who is in a cast for developmental dysplasia of the hip (DDH). Which of the following strategies would the nurse implement to promote the infant's growth and development? A. Tie colorful latex balloons to the side of the crib. B. Provide a small electronic toy. C. Change the infant's diaper as soon as soiling occurs. D. Allow infant to stand in the crib. D. Allow infant to stand in the crib. Rationale: The infant should not be restricted from normal activities. The infantcan be held and allowed to walk in a cast or orthotic device. Allowing the child to participate in normal developmental activities will promote growth and development. 7, A nurse is providing teaching to a parent of a child who has a fracture of an epiphyseal plate. Which of the following statements should the nurse make? Normal bone growth can be affected 8, A home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. which of the following goals is the priority for the nurse to include in the plan of care? A. provide respite services for the parents B. improve the clients communication skills C. foster self-care activities D. modify the environment Correct answer: D. modify the environment 9, A nurse is caring for a school-age client who possibly has Reye syndrome. Which of the following is a risk factor for developing Reye syndrome? A. Recent history of infectious cystitis caused by Candida B. Recent history of bacterial otitis media C. Recent episode of gastroenteritis D. Recent episode of Haemophilus influenzae meningitis 10, A nurse is caring for a client who has suspected meningitis and a decreased level of consciousness. Which of the following actions by the nurse is appropriate? A. Place the client on NPO status.B. Prepare the client for a liver biopsy. C. Position the client dorsal recumbent. D. Put the client in a protective environment 10, A nurse is caring for a child who has increased intracranial pressure. Which of the following are appropriate actions by the nurse? (Select all that apply.) A. Suction the endotracheal tube every 2 hr. B. Maintain a quiet environment. C. Use two pillows to elevate the head. D. Administer a stool softener. E. Maintain body alignment. 11, A nurse is taking care of a 10-year-old child that weighs 30 kg. The doctor has ordered azithromycin PO 300 mg x 1 dose. Azithromycin comes in an oral suspension 100mg/5 mL in a 15 mL bottle. According to the drug handbook for children 2-15 years of age, 10 mg/kg/day but not to exceed 500 mg/day. How many milliliters should be given? 3 mL 12, A nurse is caring for a child who is on a clear liquid diet. At lunch, the child consumed ½ cup of juice, 3 oz gelatin, 1 oz of an ice pop, and 20 mL ginger ale. How many mL should the nurse record as the child's fluid intake? 260 mL13, What is the most important thing for a nurse to teach parents of a child with Duchenne Muscular Dystrophy to do for their schoolaged-child? A/ Maintain high caloric diet B/ Institute seizure precautions C/ Restrict the use of larger muscles D/ Perform range of motion exercises D/ ROM exercises Rationale: ROMs are essential to help achieve primary objectives of maintaining optimal muscle function for as long as possible and preventing the development of contractures. High caloric diet would make them fat, which would push them to a wheel-chair faster than you can say "fat guy in a little coat". Seizures have nothing to do with duchenne, and restricting large muscles could result is disuse atrophy and contractures. 14, The nurse is counseling the parents of a 12-year-old child with Duchenne muscular dystrophy about problems that may develop during adolescence. What body system does the nurse expect will be affected? Cardiopulmonary Muscle degeneration is advanced in the adolescent with Duchenne muscular dystrophy. The disease process involves the diaphragm, auxiliary muscles of respiration, and the heart, resulting in lifethreatening respiratory infections and heart failure. Central nervous system function is not affected by Duchenne muscular dystrophy; nor is the integumentary system. Nutritional problems related to the gastrointestinal system are less significant than cardiopulmonary problems. 15, A 16-year-old boy comes into the office of the school nurse complaining of left hip pain that began when playing basketball in gym class. The boy is in the 85th percentile for height and weight. He complains of increased pain with weight bearing. The nurse observes out-toeing of the left leg with ambulation. Which nursing action is a priority? Refer the boy to the emergency department.16, A 12 year-old comes into the clinical with left thigh pain and a lump over the distal femur. The nurse is aware that these symptoms can be linked to which of the following medical problems. Osteosarcoma 17, The child has been complaining of joint pain in the knees and jaw for the last 6 weeks, both joints are swollen and warm to touch, but not red. The physician is ordering blood to rule out Junior Idiopathic Arthritis. Which of the following lab tests would the nurse expect the physician to order? (Select all that apply) Antinuclear antibodies CBC with differential 18, A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions should the nurse include in the plan of care? Implement seizure precautions. 19, The 17 year-old Asian patient comes to the clinic with a butterfly rash on the face, photosensitivity, and recently had strep throat. What diagnosis would you expect the doctor to make? Systemic Lupus Erythematosus (SLE) 20, A patient recently came into the Emergency Department with a diagnosis of Guillain-Barre Syndrome (GBS). What is the priority system to initially monitor for this patient? Respiratory21, Which assessment findings should the nurse note in a schoolage child with Duchenne Muscular Dystrophy (DMD)? (Select all that apply.) Lordosis Gower sign Waddling gait 22,The mother brings her child with cerebral palsy in to the clinic and is afraid the child is having seizures as the child has the slow worm like movements in her arms and she drools when this occurs. The nurse explains to the mother that this is not a seizure but what type of activity? Athetoid 23, An 11 year-old child has a recurrence of Ewing sarcoma and is verbalizing wanting to stop all treatments. The nurse is aware that the best ethical practice would be which of the following plan? Plan a meeting with the parents, child, and the medical team to provide an opportunity to discuss the child's concerns. 24, The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? A. Cardiac arrhythmia B. Hypostatic pneumonia C. Heart failure D. Rapidly increasing blood pressure24, Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.) A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry. E. Remove pressure dressing after 4 hours. F. Maintain a patent peripheral intravenous catheter until discharge. 25, Ryan is an 11 month old with Down’s syndrome and Atrial Septal Defect. His parents report that Ryan has been lethargic and has had diarrhea the last 24 hours. His weight is 7 kg (15.4lb). His Vital signs are:  Temperature 36.5C (97.7F) rectal  Pulse 80 beats/minute  Respirations 35 breaths/minute  Pulse ox 95% on room air His lab results are:  Potassium 2.9 mmol/L  Digoxin 2.5 mg/mL 1. The nurse questions digoxin toxicity. What results support this? (Select all that apply). Dig level26, Nisha is a 14 year old girl with sickle cell anemia. She comes into the clinic with complaints for severe generalized pain following a softball game. She is admitted to the pediatric unit. Her vital signs are:  Temperature 37.7 C (99.7 F) orally  Pulse 110 beats/minute  Respirations 30 breaths/minute  Blood Pressure 96/70  O2 sat. 89%  Pain 8/10, sharp, stabbing  Weight 110 lbs Her lab results:  Hemoglobin= 9g/L  Hematocrit= 24%  WBC= 12,000 cells/mm2  Platelet count= 140,000 cells/mm2 The physician has written the following orders for Nisha. Which if any of these orders should the nurse questions? Incorrect answer:Vital signs q 4 hours. Notify the health care provider if temp 38 C (100.4 f). CBC with manual differential in the morning. , Not Selected IV fluids of 3% dextrose in water with 0.43% normal saline to infuse at 175 ml/hr , Not Selected PCA Meperidine 20 mg continuous with 3mg every 8 minutes PCA dose , Not Selected Oxygen 2L per nasal cannula titrating to maintain oxygen sat. 94% , Not Selected All are fine , Not Selected27, An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. Air embolism. c. Hemolytic reaction. b. Allergic reaction. d. Circulatory overload. ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure. 28, Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle stick area for at least 10 minutes.  2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures.  4. Ensure that anyone entering the child's room wears a mask. 29, The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs. 30, A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? The parent is trying to restore normal balance through appropriate "hot" remedies In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy. 31The nurse is preparing to assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate? Ans: Initiate a game of peek-a-boo32, What should nursing care of an infant with oral candidiasis (thrush) include? Ans: Continue medication for the prescribed number of days 33,. Phenylketonuria (PKU) is a genetic disease that results in the bodys inability to correctly metabolize: a. glucose. b. phenylalanine. c. phenylketones. d. thyroxine. ANS: B34. What is the preferred site of intramuscular injections for infants under three? Vastus Lateralis 35. The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction? A. The child exhibits nasal flaring and bradycardia. B. The child is leaning forward, with the chin thrust out. C. The child has a low-grade fever and complains of a sore throat. D. The child is leaning backward, supporting himself or herself with the hands and arms. Ans B . Epiglottitis is a bacterial form of croup. A primary concern is that it can progress to acute respiratory distress. 36. Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care? A. Give pancreatic enzymes between meals if at all possible. B. Do not administer pancreatic enzymes if child is receiving antibiotics. C. Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. D. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at beginning of meal. Ans D. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. 37. The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which of the following actions should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief.c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently. Ans . A, C, D. a. Notify the surgeon if the child swallows frequently. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. Rationale: Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. 38. An appropriate nursing intervention when caring for an unconscious child would be which of the following? a. Change the child's position infrequently to minimize the chance of increased ICP. b. Avoid using narcotics or sedatives to provide comfort and pain relief. c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fever, since antipyretics are contraindicated. ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. 39. A child steps on a nail and sustains a puncture wound of the foot. Which of the following is the most appropriate method for cleansing this wound? a. Wash wound thoroughly with chlorhexidine. b. Wash wound thoroughly with povidone-iodine. c. Soak foot in warm water and soap. d. Soak foot in solution of 50% hydrogen peroxide and 50% water. ANS: C Puncture wounds should be cleansed by soaking the foot in warm water and soap. 40. The school nurse is conducting pediculosis capitis (head lice) assessments. which finding indicates a child has a positive head check? Ans .white sacs attached to the hair shafts in the occipital area 41. 42 . Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs ANS: C One of the essential elements is the family's training and preparation. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care wi 43 . A nurse is teaching an adolescent who has asthma about how to use a peak expiratory flow meter (PEFM). Which of the following responses by the adolescent indicates an understanding of the teaching? Ans .I will record the highest reading of three attempts 44. An important nursing intervention when caring for a child who is experiencing a seizure would be which of the following? a. Describe and record the seizure activity observed. b. Restrain the child when seizure occurs to prevent bodily harm. c. Place a tongue blade between the teeth if they become clenched. d. Suction the child during a seizure to prevent aspiration. ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. 45. When caring for the child with Reye syndrome, the priority nursing intervention would be which of the following? a. Monitor intake and output. b. Prevent skin breakdown. c. Observe for petechiae. d. Do range-of-motion exercises. ANS: A Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. 47. Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain.c. Reposition the child and notify physician. d. Chart the observations and check the extremity again in 15 minutes. ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. 48. he nurse educator is preparing to conduct a teaching session for the nursing staff regarding the theories of growth and development and plans to discuss Kohlberg's theory of moral development. What information should the nurse include in the session? Select all that apply. 1. Individuals move through all six stages in a sequential fashion. 2. Moral development progresses in relationship to cognitive development. 3. A person's ability to make moral judgments develops over a period of time. 4. The theory provides a framework for understanding how individuals determine a moral code to guide their behavior. 5. In stage 1 (punishment-obedience orientation), children are expected to reason as mature members of society. 6. In stage 2 (instrumental-relativist orientation), the child conforms to rules to obtain rewards or have favors returned.  2. Moral development progresses in relationship to cognitive development.  3. A person's ability to make moral judgments develops over a period of time.  4. The theory provides a framework for understanding how individuals determine a moral code to guide their behavior.  6. In stage 2 (instrumental-relativist orientation), the child conforms to rules to obtain rewards or have favors returned. 49. A nurse is planning to use an interpreter during a health history interview of a nonEnglish speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter (Select all that apply)? a. Elicit one answer at a time. b. Interrupt the interpreter if the response from the family is lengthy. c. Comments to the interpreter about the family should be made in English. d. Arrange for the family to speak with the same interpreter, if possible. e. Introduce the interpreter to the family. ANS: A, D, E When using an interpreter, the nurse should pose questions to elicit only one answer at a time, such as: "Do you have pain?" rather than "Do you have any pain, tiredness, or loss of appetite?" Refrain from interrupting family members and the interpreter whilethey are conversing. Introduce the interpreter to family and allow some time before the interview for them to become acquainted. Refrain from interrupting family members and the interpreter while they are conversing. Avoid commenting to the interpreter about family members because they may understand some English. 50. characteristics of physical development of a 30-month-old child are (Select all that apply): A. anterior fontanel is open. B. birth weight has doubled. C. genital fondling is noted. D. sphincter control is achieved. E. primary dentition is complete. D, E D. sphincter control is achieved. E. primary dentition is complete. Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. Anterior fontanel closes between 12-18 months of age. Birth weight should double at 5-6 months of age and quadruple by 2½ years of age. Genital fondling is not a characteristic of physical development of this age group. This is part of the development of gender identity. 51. A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice: a. "Discontinue all contraception now." b. "Lose weight so that you can gain more during pregnancy." c. "You may take any medications you have been taking regularly." d. "Make sure that you include adequate folic acid in your diet." Ans d. "Make sure that you include adequate folic acid in your diet." 52 . While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as: a. Preeclampsia. b. Pyrosis. c. Pica. d. Purging.Ans c. Pica. 53 . 1. A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1-3 b .4-1-2-0-4 c . 3-0-3-0-3c d. 4-2-1-0-3 ANS: B The correct calculation of this woman's gravidity and parity is 4-1-2-0-4. The numbers reflect the woman's gravidity and parity information. Using the GPTAL system, her information is calculated as: G: The first number reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born that currently are living; the woman has four children. 54 . 2. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: a. Amenorrhea. c. Chadwick's sign. b. Positive pregnancy test. d. Hegar's sign. ANS: A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign all are probable signs of pregnancy.55. Probable signs of pregnancy are : Ballottement, Chadwick’s sign, Goodell’s sign, Hegar’s sign, uterine enlargement, Braxton Hicks contractions, positive blood pregnancy test 56. A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2011. Her expected date of birth (EDB) is: a. September 17, 2011 b. November 7, 2011 c. November 21, 2011 d. December 17, 2011 ANS: C Using Nägele's rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2011, her due date is November 21, 2011. September 17, 2011, is too short a period to complete a normal pregnancy. Using Nägele's rule, an EDB of November 7, 2011 is 2 weeks early. December 17, 2011, is almost a month past the correct EDB. 57. . Which statement about pregnancy is accurate? a. A normal pregnancy lasts about 10 lunar months. b. A trimester is one third of a year. c. The prenatal period extends from fertilization to conception. d. The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth. ANS: A A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. The prenatal period covers the full course of pregnancy (prenatal means before birth). The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bed rest. 58. Signs and symptoms that a woman should report immediately to her health care provider include (Select all that apply): a. Vaginal bleeding. b. Rupture of membranes. c. Heartburn accompanied by severe headache. d. Decreased libido. e. Urinary frequency.ANS: A, B, C Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Clients should be advised to report these signs to the health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions. 59. Which of the following positions would be least effective when gravity is desired to assist in fetal descent? Lithotomy 60. The nurse recognizes that a woman is in true labor when she states: a. "I passed some thick, pink mucus when I urinated this morning." b. "My bag of waters just broke." c. "The contractions in my uterus are getting stronger and closer together." d. "My baby dropped, and I have to urinate more frequently now." Ans c. "The contractions in my uterus are getting stronger and closer together." 61. The nurse has received a report regarding a client in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. What is the nurse's interpretation of this assessment? a. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines. b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. c. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines. d. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines. ANS: B The sterile vaginal examination is recorded as centimeters of cervical dilation, percentage of cervical dilation, and the relationship of the presenting part to the ischial spines (either above or below). For this woman, the cervix is dilated 3 cm and effaced 30%, and the presenting part is 2 cm above the ischial spines. 62. A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide at this time? a.Notify the woman's health care provider.b.Administer the prescribed narcotic analgesic. c.Assure her that her labor will be over soon. d.Assist her with simple breathing and relaxation instructions. ANS: D By reducing tension and stress, both focusing and relaxation techniques will allow the woman in labor to rest and conserve energy for the task of giving birth. 63. A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate? a.Fentanyl (Sublimaze) b.Promethazine (Phenergan) c.Naloxone (Narcan) d.Nalbuphine (Nubain) ANS: C An opioid antagonist can be given to the newborn as one part of the treatment for neonatal narcosis, which is a state of central nervous system (CNS) depression in the newborn produced by an opioid. Opioid antagonists, such as naloxone (Narcan), can promptly reverse the CNS depressant effects, especially respiratory depression. Fentanyl (Sublimaze), promethazine (Phenergan), and nalbuphine (Nubain) do not act as opioid antagonists to reduce the postnatal effects of meperidine on the neonate. 64. Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that apply. A) Place the woman in a supine position. B) Place the woman in a lateral position. C) Increase intravenous (IV) fluids. D) Continuous Fetal Monitor E) Administer ephedrine per MD order Ans B, C, E65. A nurse caring for a laboring woman is cognizant that early decelerations are caused by: Altered fetal cerebral blood flow Early decelerations are the fetus's response to fetal head compression. These are considered benign and interventions are not necessary. 66. The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by: a. Altered fetal cerebral blood flow. b. Umbilical cord compression. c. Uteroplacental insufficiency. d. Fetal hypoxemia. Ans b. Umbilical cord compression. 67. Which fetal heart rate (FHR) finding would concern the nurse during labor? a. Accelerations with fetal movement b. Early decelerations c. An average FHR of 126 beats/min d. Late decelerations Ans d. Late decelerations 68. What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. a. Call the provider, reposition the mother, and perform a vaginal examination. b. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. c. Administer oxygen to the mother, increase IV fluid, and notify the care provider. d. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. Ans B 69. As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: a. Hypotension. c. Maternal drug use.b. Cord compression. d. Hypoxemia ans D 70. Five essential components of any fetal heart rate (FHR) tracing must be evaluated regularly. These include (choose all that apply): a. Baseline rate b. Baseline variability c. Accelerations d. Decelerations e. Changes or trends over time f. Frequency of contractions The five essential components of the FHR tracing that must be evaluated regularly are baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time. Whenever one of these five essential components is assessed as abnormal, corrective measures must immediately be taken. 71. When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _________________________ has increased a. Intrauterine infection b. Hemorrhage c. Precipitous labor d. Supine hypotension Ans A. 72. When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign a. Dilation of the cervix. b.Descent of the fetus. c. Rupture of the amniotic membranes. d. Increase in bloody show. that uterine contractions are effective would be Ans A 73. The most critical nursing action in caring for the newborn immediately after birth is:a. Keeping the newborn's airway clear. b. Fostering parent-newborn attachment. c. Drying the newborn and wrapping the infant in a blanket. d. Administering eye drops and vitamin K. ans a. Keeping the newborn's airway clear. 74. Emergency conditions during labor that would require immediate nursing intervention can arise with startling speed. Which situations are examples of such an emergency? (Select all that apply.) a.Nonreassuring or abnormal FHR pattern b.Inadequate uterine relaxation c.Vaginal bleeding d.Prolonged second stage e.Prolapse of the cord ANS: A, B, C, E A nonreassuring or abnormal FHR pattern, inadequate uterine relaxation, vaginal bleeding, infection, and cord prolapse all constitute an emergency during labor that requires immediate nursing intervention. A prolonged second stage of labor after the upper limits for duration is reached. This is 3 hours for nulliparous women and 2 hours for multiparous women. 75. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman's vital signs, the nurse would be concerned to see: a. Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50. b. Temperature 37.4° C, heart rate 88, respirations 36, BP 126/68. c. Temperature 38° C, heart rate 80, respirations 16, BP 110/80. d. Temperature 36.8° C, heart rate 60, respirations 18, BP 140/90. Ans A 76. A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman: a. Discusses her labor and birth experience excessively.b. Believes that her baby is more attractive and clever than any others. c. Has not given the baby a name. d. Has a partner or family members who react very positively about the baby. ANS: C If the mother is having difficulty naming her new infant, it may be a signal that she is not adapting well to parenthood. Other red flags include refusal to hold or feed the baby, lack of interaction with the infant, and becoming upset when the baby vomits or needs a diaper change. A new mother who is having difficulty would be unwilling to discuss her labor and birth experience. An appropriate nursing diagnosis could be Impaired parenting related to a long, difficult labor or unmet expectations of birth. A mother who is willing to discuss her birth experience is making a healthy personal adjustment. The mother who is not coping well would find her baby unattractive and messy. She may also be overly disappointed in the baby’s sex. The client may voice concern that the baby reminds her of a family member whom she does not like. Having a partner and/or other family members react positively is an indication that this new mother has a good support system in place. This support system will help reduce anxiety related to her new role as a mother. 77. A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: Stimulate fetal surfactant production. 78. all of the following are likely complications that obese pregnant women may face except a low-birthweight baby 79. Misoprostol has been ordered for a pregnant woman at 43 week of gestation. The nurse recognized that this medication is administered to 80. Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 pounds. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.81. With regard to the care management of preterm labor, nurses should be aware that: The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. 82. The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. a. Viral b. Periodontal c. Cervical d. Urinary tract Ans A 83. Complications and risks associated with cesarean births include (Select all that apply): a. Placental abruption. b. Wound dehiscence. c. Hemorrhage. d. Urinary tract infections. e. Fetal injuries. Ans . B,C,D,E Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section. 84. Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, "Why is it taking so long?" The most appropriate response by the nurse would be: a. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." b. "I don't know why it is taking so long." c." The length of labor varies for different women." d." Your baby is just being stubborn."ANS: A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. 85. Nurses should be aware that chronic hypertension: Can occur independently of or simultaneously with gestational hypertension. 86. Magnesium sulfate is given to women with preeclampsia and eclampsia to: Prevent and treat convulsions. 87. Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? An African-American client who is 19 years old and pregnant with twins 88. HELLP syndrome is associated with an increased risk for adverse perinatal outcomes, including (choose all that apply) a. placental abruption c. renal failure d. cirrhosis e. maternal and fetal death 89. During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? a. "I will need to eat 600 more calories per day because I am pregnant." b ."I can continue with the same diet as before pregnancy as long as it is well balanced." c. "Diet and insulin needs change during pregnancy." d. "I will plan my diet based on the results of urine glucose testing."ANS: C Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs may double or even quadruple. 90. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for: A. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight ANS: A Fetal macrosomia is a risk to the fetus of a mother with GDM. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. 91. Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that: a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy. ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own insulin around the tenth week92. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: a. uterine atony. b. uterine inversion. c. vaginal hematoma. d. vaginal laceration. ANS: A Uterine atony is marked hypotonia of the uterus. It is the leading cause of after birth hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of this patient's bleeding. Further, if the woman were experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding for vaginal hematoma is pain, not the presence of profuse bleeding. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus. 93. A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: a. establish venous access. b. perform fundal massage. c. prepare the woman for surgical intervention. d. catheterize the bladder. ANS: B The initial management of excessive after birth bleeding is firm massage of the uterine fundus. Although establishing venous access may be a necessary intervention, the initial intervention would be fundal massage. 94. The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by: a. Subinvolution of the placental site. b.Defective vascularity of the decidua. c.Cervical lacerations. d.Coagulation disorders. Ans A 95.The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy for the nurse to adopt?Strict aseptic technique, including hand washing by all health care personnel 96. Nurses need to understand the basic definition and incidence data regarding PPH. which statement regarding this condition is most accurate? Traditionally, PPH has been classidied as early PPH or late PPH with respect to birth 97. What is one initial s/s of puerperal infection in the postpartum client? a. Fatigue continuing for longer than 1 week. b. Pain with voiding. c. Profuse vaginal bleeding with ambulation. d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth. Ans D 98. Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence the causes and incidence of obstetric lacerations of the lower genital tract? (Select all that apply.) a. Operative and precipitate births b. Adherent retained placenta c. Abnormal presentation of the fetus d. Congenital abnormalities of the maternal soft tissue e. Previous scarring from infection Ans A, C, D, E 99. Medications used to manage postpartum hemorrhage (PPH) include (choose all that apply): a.Oxytocin b.Methergine c.Terbutaline d.Hemabate e. Magnesium sulfate ANS: A, B, DOxytocin, methergine, and hemabate are medications used to manage PPH. 100. A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's intravenous fluid for a preprocedural bolus. A. She has thrombocytopenia. b .She is too far dilated. C. She is anemic. D. She is septic. Ans A. She has thrombocytopenia She reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dL, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman She has thrombocytopenia