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PEDS & OB HESI Exam STUDY SET
Monitoring for fetal position is important because the mother cannot tell you she has back pain, which is the cardinal sign of persistant posterior fetal position. Why do the regional blocks, especially epidural and caudal, often result in assisted delivery? A. inability to push effectively in 3rd stage B. inability to push effectively in 4th stage C. inability to push effectively in 1st stage D. inability to push effectively in 2nd stage - Solution D. Regional blocks, especially epidural and caudal, often result in assisted delivery due to inability to push effectively in the 2nd stage. Early detection of rheumatoid arthritis can decrease the amount of bone and joint destruction and often the disease will go into remission. What activity recommendations should the nurse provide a client with rheumatoid arthritis? A. Exercise of painful, swollen joints to strengthen them B. Exercise joint to the point of pain so that the pain lessens C. Make Jerky movements during the exercise so that the pain lessens D. Perform exercises slowly and smoothly - Solution D. A nurse should advise the client to perform exercises slowly and smoothly so that no extra pain occurs A patient who is 32 weeks gestation has the following symptoms: dark, red vaginal bleeding, 100 bpm FHR, rigid abdomen and severe pain. What is the difference between abruptio placentae and placenta previa? A. Aruptio placentae: painless bright red bleeding occurring in the third trimester B. Abruptio placentae: occurs in the second trimester C. Placenta previa: occurs in the second trimester D. Placenta previa: painless bright red bleeding occurring in the third trimester - Solution D. The nurse must use knowledge base to diffferentiate betewwn abruptia placentae from placenta previa. A patient who is 32 weeks gestation is experiencing dark red vaginal bleeding and the nurse determines the FHR to be 100 bpm and her abdomen is rigid and board like. What action should the nurse take first?
A. Administer O2 per face mask B. Abdominal manipulation C. vaginal manipulation D. Abdominal exam - Solution A. The nurse should immediately notify the healthcare provider and no abdominal or vaginal manipulation or exams should be done. Administer O2 per face mask and monitor for bleeding at IV sites and gums due to the increased risk of DIC A nurse must use knowledge base to differentiate between abruptio placentae from plaventa previa. What assessments should be done in case of a patient suspected of abruptio placentae or placenta previa. A. abdominal or vaginal manipulation B. Leopold's maneuvers C. internal monitoring D. Monitor for bleeding at IV sites and gums due to increased risk of DIC - Solution D. Patients with abruptio placentae or placventa previa should have No abdominal or vaginal manipulation. No Leopold's maneuvers. No vaginal exams. No rectal exams, enemas, or suppositories. No internal monitoring A patient suspected of abruptio placentae or placenta previa should be monitorized for bleeding at IV sites and gums due to increased risk of DIC. What isn't DIC related to? A. cervical carcinoma B. fetal demise C. infection/sepsis D. pregnancy-induced hypertension - Solution A. DIC is related to fetal demise, infection/sepis, pregnancy-induced hypertension ( Preeclampsia) and abruptio placentae. Cervical carcinoma is related to podophyllin If a child is on oral iron medication, the family should be taught by the nurse how it should be administered. Out of the following options, what oral iron administration advise is inappropriate? A. Oral iron should be given on empty stomach B. Oral iron should be given with citrus juices C. Oral iron shoule be given with dairy products D. A dropper or straw should be used to avoid discoloring teeth - Solution C.
An infant with hypothyroidism is often described as a "good, quite baby" by the parents. What early disease detection is essential in preventing mental retardation in infants? A. Hyperthyroidism B. Phenylketonuria C. Diabetes Mellitus D. Ketoacidosis - Solution B. Early detection of hypothyroidism and phenylketonuria is essential in preventing mental retardation in infants. Knowledge of normal groth and development is important, sin a lack of attaintment can be used to detect the existence of these metabolic/endocrine disorders and attainment can be used for evaluating the treatments effecct Diabetis mellitus (DM) in children was typically diagnosed as insulin dependent diabetes until recently. What diabetes type has been discovered to occur more often in Native Americans, African Americans, and Hispanic children and adolescents? A. Type 1 B. Type 2 C. Type 3 D. Type 4 - Solution B. DM in children was typicall diagnosed as insulin dependent until recently. A marked increase in Type 2 DM has occurred recently in the US. There has been an increase in the number of children diagnosed with Type 2 diabetes with the increasing rate of obesity in children thought to be a contributing factor. What other factors are thought to be contributing in the increase of Type 2 cases? A. Hypotension B. Hypokalemia C. Lack of physical activity D. Hyperkalemia - Solution C. There has been an increase in the number of children diagnosed with Type 2 diabetes. The increasing rate of obesity is children is thought to be a contributing factor. Other contributing factors include lack of physical activity, and a family history of Type 2 diabetes. Fractures in older children are common as they fall during play and are involved in motor vehicle accidents. What fractures in children are related to child abuse?
A. Greenstick Fracture B. Growth plate Fracture C. Torus Fracture D. Spiral fracture - Solution D. Spiral fractures (caused by twisting) anf fractures in infants may be related to child abuse Skin traction for fracture reduction should not be removed unless prescribed by healthcare provider. What fractures have serious consequences interms of growth of the affected limb? A. Greenstick fracture B. Plate fracture C. Torus fracture D. Spiral fracture - Solution B. Fractures involving the epiphyseal plate ( growth plate) can have serious consequences in terms of growth of the affected limb Corticosteroids are used shor term in low doses suring exacerbations. What side effect do corticosteroids have on long term? A. Adverse effects on growth B. Adverse effects on bone structure C. Hypoglycemia D. Hypocalcemia - Solution A. Corticosteroids are used short term in low doses during exacerbations. Long term use is avoided due to side effects and their adverse effect on growth Skin traction for fracture reduction should not be removed unless prescribed by healthcare provider. What do the pin sites usually cause in an infant client? A. Hypoglycemia B. Hypocalcemia C. Infection D. Low vitamin K concentration - Solution C. Pin sites can be sources of infection. The nurse should monitor signs of infection and cleanse and dress sites as prescribed. The menstrual phase varies in length for most women. How many days usually are from ovulation to the beginning of the next menstrual cycle? A. 12 days
At approximately 28 - 32 weeks gestation, the maximum plasma volume increase of 25 - 40% occurs, resulting in normal hemodilution of pregnancy and Hct values of 32 - 42%. What does Hct in reality represent, even if its values may look "good"? A. Pregnancy induced hyperglycemia B. Pregnancy induced hypoglycemia C. Pregnancy induced hypertension D. pregnancy induced hypotension - Solution C. High Hct values may look "good" but in reality represent pregnancy induced hypertension and depleted vascular space A 22 year old primigravida at 12 weeks gestation has a high Hgb of 9.6 g/dl and a Hct of 31% and she has gained 3 pounds during the first trimester, even if the gain of 3.5 to 5 pounds during the first trimester is recommended. Taking into consideration that the client is anemic, what supplements should be recommended to her? A. Potassium B. Magnesium C. Iron D. Calcium - Solution C. For the anemic pregnant client, supplemental iron and a diet high in iron is needed As pregnancy advances, the uterus presses on the abdominal vessels ( vena cava and aorta). What position is best for increasing perfucion according to the latest research? A. Left side lying position B. Knee chest position C. Side lying position D. Right side lying position - Solution B. Recent research indicated that the knee chest position is best for increasing perfusion and that the sid lying position (either left or right side lying) is the second most disirable position to increase perfusion. Prior to this research, the left side lying position was usually encouraged Fetal well being is determined by assessing fundal height, fetal heart tones/rate, fetal movement and uterine activity (contractions). What do changes in fetal heart rate indicate? A. Leukorrhea B. Compromised blood flow to the fetus
C. Fluid discharge from vagina D. Change in fetal movement - Solution B. Changes in fetal heart rate are the first and most important indicator of compromised blood flow to the fetus, and these changes require action Changes in fetal heart rate are the first and most important indicator of compromised blood flow to the fetus, and these changes require action! What is the normal FHR in a pregnant woman? A. 150 - 180 bpm B. 160 - 190 bpm C. 110 - 160 bpm D. 120 - 150 bpm - Solution C. Changes in fetal heart rate are the first and most important indicator of compromised blood flow to the fetus, and these changes require action! Remember, the normal FHR is 110 to 160 bpm. A 28 year old porgnant woman has the following symptoms: visual disturbance, persistant vomiting, swelling of face, fingers or sacrum and severe continuous headache. What do these symptoms most probably indicate? A. Preeclampsia/eclampsia B. Dysuria C. Chills D. Fluid discharge from the vagina - Solution A. Visual distubance, persistant vomiting, swelling of face, fingers or sacrum and severe continuous headache in pregnant woman possible indications of preeclampsia/ eclampsia A nurse should teach the pregnant clients to immediately report any of the following danger signs because early intervention can optimize maternal and fetal outcome. Which are the signs of infection in a pregnant woman? A. FHR 110 - 160 bpm B. Chills C. Persistant vomition D. Visual disturbances - Solution B. Signs of infection in a pregnant woman are Chills, Dysuria, pain in abdomen, fluid discharge from vagina, and increased FHR A pregnant client has a temperature over 100.4 F, Dysuria and fluid discharge from vagina. What could these signs most probable indicate?
When an amniocentesis is done in early pregnancy, the bladder must be full to help support the urerus and to help push the uterus up in the abdomen for easy access. In a 24 year old pregnant woman, the amniocenteses is done in late pregnancy. How should the bladder be to avoid puncturing the bladder? A. Empty B. Full C. 1/4 empty D. 1/2 full - Solution A. When an amniocentesis is done in late pregnancy, the bladder must be empty to avoid puncturing the bladder Pitocin should be given with caution to clients with hypertension. What drug shouldn't be given to clients with hypertension due to its vasoconstrictive action? A. Analgesics B. Meperidine C. Codeine D. Methergine - Solution D. Methergine is NOT given to clients with hypertension due to its vasoconstrictive action. Pitocinis given with caution to those with hypertension Oxytocin should be administered after the placenta is delivered because the drug will cause the uterus to contract. What can happen if the drug is administered before the placenta is delivered? A. Will predispose the client to nausea B. Will predispose the client to amnesia C. Will predispose the client to hemorrhage D. Will predispose the client to hypocalcemia - Solution C. If the oxytocic durg is administered before the placenta is delivered, it may result in a retained placenta, which predisposed the client to hemorrhage and infection In the first 12 hours after delivery, the 22 year old client shows signs of hemorrhage. What is one of the common reasons for uterine atony and/or hemorrhage in the first 24 hours after delivery? A. Empty bladder B. Full bladder
C. Hypoglycemia D. Low blood pressure - Solution B. FULL BLADDER is one of the most common reasons for uterine atony and/or hemorrhage in the first 24 hours after delivery When examining a client after delivery, the nurse finds the fundus soft, boggy, and displaced above and to the right of the umbilicus. What action should the nurse take first in this case? A. Have the client empy her bladder B. Perform fundal massage C. Administer narcotic analgesics D. Administer codeine and meperidine - Solution B. First the nurse should perform fundal massage; then have the client empt her bladder When examining a client after delivery, the nurse finds the fundus soft, boggy, and displaced above and to the right of the umbilicus. After perfoming fundal massage and having the client empy her bladder when should the nurse recheck fundus? A. q 15 minutes *4 (1 hour) B. q 45 minutes *2 (1.5 hour) C. q 30 minutes *4 (2 hours) D. q 30 minutes *2 (1 hour) - Solution A. The nurse should recheck fundus q 15 minutes *4 (1 hour); q 30 minutes * hours Internal rotation is harder to achieve when the pelvic floor is relaxed by anesthesia resulting in persistent occiput posterior of fetus. What regional blocks often result in assissted delivery due to the inability to push effectively in the 2nd stage? A. Epidermis B. Anal Spincter C. Rectal mucosa D. Caudal - Solution D. Regional blocks, especially epidural and caudal, often result in assissted delivery due to the inability to push effectively in 2nd stage Nerve lock anesthesia (spinal or epidural) during labor bloks motor as well as nerve fibers. What does result from vasodilation below the level of the block?
Postpartum blues are usually normal, especially 5 - 7 days after deliverry. In what case is RhoGAM given to a mother after delivery? A. If mother is Rh positive B. If mother is Rh negative C. If the mother has a positive Coombs D. If the mother has a Rh negative fetus - Solution B. Remember RhoGRAM is given to a Rh negative mother who delivers a Rh positive fetus and has a negative direct Coombs. If the mother has a positive Coombs, there is no need to give RhoGRAM since the mother is already sensitized The umbilical cord should always be checked at birth. What should the umbilical card contain in a newborn? A. 3 vessels, 2 veins which carry oxygenated blood to the fetus and 1 artery whic carries unoxygenated blood back to placenta B. 4 vessels, 2 veins which carry oxygenated blood to the fetus and 2 arteries which carries unoxygenated blood back to placenta C. 3 vessels, 1 veins which carries oxygenated blood to the fetus and 2 arteries which carries unoxygenated blood back to placenta D. 3 vessels, 1 artery which carries oxygenated blood to the fetus and 2 veins which carries unoxygenated blood back to placenta - Solution C. It should contain 3 vessels, 1 vein which carries oxygenated blood to the fetus nad 2 arteries whic carry unoxygenated blood back to the placenta. This is opposite of normal circulation. The umbilical cord in a newborn should contain 3 vessels, 1 vein which carries oxygenated blood to the fetus and 2 arteries which carry unoxygenated blood back to the placenta. What do cord abnormalities usually indicate? A. Neurologic anomalies B. Renal anomalies C. Congenital vertebral anomaly D. Chromosome anomaly - Solution B. Cord abnormalities usually indicate cardiovascular or renal anomalies. Cord abnormalities usually indicate cardivascular or renal anomalies. What happens if fetal structures of foramen ovale, ductus arteriosus and ductus venous do no close postnatal? A. Cardia pulmonary compromise B. Renal compromise
C. Gastro intestinal compromise D. Neurological compromise - Solution A. Postnatally, the fetal structures of foramen ovale, ductus arteriosus and ductus venosus shoul close. If they do not, cardiac and pulmonary compromise will develop if the structures of the foramen ovale, ductus arteriosus and ductus venosus don't close postnatally, cardiac and pulmonary compromise will develop. What should be suctioned by the nurse firstly? A. Nose B. Mouth C. Lungs D. Kidney - Solution B. Suctioning the mouth first and then the nose. Stimulating the nares can initiate inspiration which could cause aspiration of mucus in oral pharynx Physiologic jaundice is the normal inability of the immature liver to keep up with normal RBC destruction. When does jaundice occur in newborns? A. 5-6 days of life B. 2-3 days of life C. 7-8 days of life D. 9-10 days of life - Solution B. Physiologic jaundice (normal inability of the immature liver to keep up with normal RBC destruction) occurs at 2-3 days of life Physiologic jaundice (normal inability of the immature liver to keep up with normal RBC destruction) occurs 2-3 days of life.When does jaundice become pathologic? A. When it occurs before 24 hurs or persists beyond 7 days B. When it occurs before 14 hours or persists beyond 8 day C. When it occurs before 12 hours or persists beyond 3 days D. When it occurs before 10 hours or persists beyond 2 days - Solution A. Physiologic jaundice (normal inability of the immature live to keep up with normal RBC destruction) occurs at 2-3 days of life. It occurs before 24 hours or persists beyond 7 days, it becomes pathologic Physiologic jaundice which occurs 2-3 days after birth due to the liver's inability to keep up with RBC destruction. Who is the culprit in this case? A. Conjugated bilirubin B. Unconjugated bilirubin
A client with prior traumatic delivery and history fo D&C may experience miscarriage or preterm. What is the most common cause of miscarriages? A. Incompetent cervix B. Incompetent pelvis C. Incompetent uterus D. Incompetent vagina - Solution A. Clients with prior traumatic delivery, history of D&C, multiple abortions, or daughters of DES motheres may experience miscarriage or preterm labor related to incompetent cervix. The cervix may be surgically repaired prior to pregnancy, or during gestation A woman of childbearing age present at an emergency room with unilateral and bilateral abdominal pain. What should the nurse correctly suspect in this case? A. Appendicitis B. Ectopic pregnancy C. Entopic pregnancy D. Etiopic pregnancy - Solution B. Suspect ectopic pregnancy in any woman of childbearing age who presents at an emergency room, clinic, or office with unilateral or bilateral abdominal pain. Most are misdiagnosed with appendicitis. The early decelerations in fetal heart rate monitoring are the transient decrease in heart rate which coincides with the onset of the uterine contraction. Between what cm do the early decelerations caused by head compression and fetal descent usually occur in the 2nd stage? A. 2 and 6 cm B. 4 and 7 cm C. 3 and 8 cm D. 7 and 10 cm - Solution B. Early decelerations, caused by head compression and fetal descent, usually occur between 4 and 7 cm in the 2nd stage. Check for labor progress if early decelerations are noted A nurse consults a mother and detects cord prolaspe. How should the examiner position the pregnant woman to relieve pressure on the cord? A. Side lying position B. Right side lying position C. High Fowlers position D. Knee chest position - Solution D.
If cord prolaspe is detected, the examiner should position the mother to relieve pressure on the cord, Knee chest position, or push the presenting part off the cord until Immediate cesarean delivery can be accomplished A nurse consults a pregnant mother and detects late decelerations which indicate uteroplacental insufficiency. What conditions are late decelerations associated with? A. Down Syndrome, AIDS, abruptio placentae B. Postmaturity, preeclampsia, diabetes mellitus, cardiac disease, and abruptio placentae C. Autism, renal insufficiency and cardiac disease D. Kidney failure, cardiac disease, Digialis toxicity - Solution B. Late decelerations indicate unteroplacental insufficiency and are associated with conditions such as postmaturity, preeclampsia, diabetes mellitus, cardiac disease, and abruptio placentae At the examination of a expecting woman, the deceleration patterns are associated with decreased or absent variability and tachycardia. What should be done immediately in this case? A. Position the mother in High Fowlers position B. Position the mother in knee chest position C. Immediate intervention and fetal assessment D. Spontaneous abortion - Solution C. When deceleration patterns (late or variable) are associated with decreased or absent variability and tachycardia, the situation is OMINOUS (potentially disastrous) and requires immediate intervention and fetal assessment Which of the following neonates is at highest risk for cold stress syndrome?
- Infant of diabetic mother
- Infant with Rh incompatibility
- Postdates neonate
- Down syndrome neonate - Solution 3. Postdate babies are at high risk for cold stress syndrome because while still in utero they often metabolize the brown adipose tissue for nourishment when the placental function deteriorates Which of the following would lead the nurse to suspect cold stress syndrome in a newborn with a temperature of 96.5 F?
- Blood glucose of 50 mg/dL
Because the central nervous system may have been damaged by the high bilirubin levels, testing of the senses as well as motor and cognitive assessment are aappropriate A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform?
- Cover the baby's eyes with eye pads
- Turn the lights on for ten minutes every hour
- Clothe the baby in a shirt and diaper only
- Tightly swaddle the baby in a baby blanket - Solution 1. When phototherapy is administered, the baby's eyes must be protected from the light source A baby is born with erythroblastosis fetalis. Which of the following signs/symptoms would the nurse expect to see?
- Ruddy complexion
- Anasarca
- Alopecia
- Erythema toxicum - Solution 2. Babies born with erythroblastosis fetalis often ore in severe congestive heart failure and, therfore, exhibit anasarca Which of the following laboratory findings would the nurse expect to see in a baby diagnosed with erythroblastosis fetalis?
- Hemacrit 24%
- Leukocyte count 45,000 cells/mm
- Sodium 125 mEq/L
- Potassium 5.5 mEq/L - Solution 1. The baby with erythroblastosis fetalis would exhibit signs of severe anemia, which a hematocrit of 24% reflects A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types?
- Type O negative
- Type A negative
- Type B positive
- Type AB positive - Solution 1. ABO incompatibility can arise when the mother is type O and the baby is either type A or B
A baby, born at 3,199 grams, now weighs 2,746 grams. The baby is being monitored for dehydration because of the following percent weight loss? (calculate to the nearest hundreth) ____________________________% - Solution 14.16% The formula for percentage of weight loss is : Original weight minus current weight divided by original weight. The value is then multiplies by 100 to convert the number to percentage: 3199-2746= 453/3199=0.1416*100=14.16% A baby exhibits weak rooting and sudking reflexes. Which of the following nursing diagnoses would be appropriate?
- Risk for deficient fluid volume
- Activity intolerance
- Risk for aspiration
- Feeding self care deficit - Solution 1. When a boby roots and sucks poorly, the baby is unable to trasnsfer milk effectively. Because milk intake is the baby's source of fluid, the baby is high risk for fluid volume deficit The macrosomic baby in the nursery is suspected of having a fractured clavicle from a traumatic delivery. Which of the following signs/symptoms would the nurse expect to see? ( Select all the apply)
- Pain with movement
- Hard lump at the fracture site
- Malpositioning of the arm
- Asymmetrical Moro reflex
- Marked localized ecchymosis - Solution 1,2,3, 1.The baby will complain of pain at the site. 2.If not in the immediate period after the injury, within a few days there will be a palpable lump on the bone at the site of the break 3.Because of the break, the baby is likely to position the arm in an aytpical posture 4.Because of the injury to the bone, the baby is unable to respond with symmetrical arm movement Four babies in the well baby nursery were born with congenital defects. Which of the babies' complications developed as a result of the delivery method?
