Final Exam: Quizzes/Test Banks Flashcards
Which of the following statements is TRUE?
1. Women who are depressed during pregnancy are more likely to have OB complications
2. Paroxetine (Category D) should always be stopped in first trimester
2. The combination of antidepressant medication and CBT has not been shown beneficial
4. Venlafaxine crosses the…
Women who are depressed during pregnancy are more likely to have OB complications
Postpartum depression affects _______ women
1 in 8
Lisa is a 32 y/o white woman who visits the NP at her OB/GYNs office for a routine checkup during their first pregnancy. On her pt history form, she checks “yes” for asthma and psychiatric disorder but “no” for all others. She notes that her psychiatric condition was a brief episode of mild depression about 6 years ago. Lisa takes a daily prenatal, no other routine medications or supplements. She does not drink or smoke. She was using BC pills but stopped to start a family. After reviewing Lisa’s history, the NP decides Lisa has an increased risk of perinatal depression. Which of the following represents Lisa’s greatest risk factor for perinatal depression and/or anxiety?
History of depression
At later routine pregnancy appointments, the NP checks with Lisa about symptoms of depression and anxiety. At the end of Lisa’s second trimester, the OB/GYN in the practice asks Lisa how she is sleeping and eating. Lisa says fine except for adding an ice cream snack before bedtime. She says she only sleeps a few hours each night because of belly. The physician asks about Lisa’s mood. Lisa’s husband mentions she’s been tearful for the past few weeks. Lisa admits this is true lately. Lisa’s husband adds “you used to have lunch every Saturday with your friends. I can’t remember the last time you went to lunch with them. Lisa says “sometimes I feel like I’m in a fog. I forget what I going to say and can’t make decisions about somethings”. All of the following symptoms suggest that Lisa might be experiencing anxiety/depression EXCEPT:
1. Irritability
2. Change in eating habits
3. Racing thoughts
4. Diminished ability to think or concentrate
Change in eating habits
Which of the following is the immediate next step that Lisa’s OB/GYN should take?
Screen Lisa for prinatal dpression
Tonya is a 26 y/o single mother who brings her son Ryan to the pediatricians office for his 2-month vaccinations. He is healthy and his growth is on target. “Are you sure he’s OK?” Tonya says “Because I feel like I’m doing everything wrong”. The NP assures her Ryan is fine and asks how she is feeling. “Sometimes I feel overwhelmed, like I can’t handle everything”. The NP patiently listens to her explain more about her feelings and reassures her that she is not a bad mother and that there are things that can help if she does have perinatal depression and/or anxiety. Which of the following would be the most appropriate next step for the NP to take?
Screen Tonya and refer her to an OB/GYN or a PCP if results show she is at risk for PPD
The DSM-V currently defines PPD as depression beginning ______ after childbirth?
4 weeks
What can you accurately tell this patient when discussing whether to continue her current antidepressant medication in pregnancy?
In most situations, switching to a different antidepressant medication during pregnancy is not recommended
Which of the following is most commonly used for PPD?
EPDS (Edinburgh Postnatal Depression Scale)
Lifetime prevalence for depression in women compared to men is:
2:1
A 27 y/o F with a diagnosis of depression comes to your office in the 5th week of her 1st pregnancy. She wants to know if her antidepressant medication, sertraline, is safe for her baby. Which is the BEST answer you can provide to her?
While no medication is “safe” during pregnancy, it may be safer to continue the medication than to switch it
A child born with Dandy Walker malformation is receiving palliative care in the pediatric unit. A nurse should:
Provide the parents, patient, and family members with supportive care
Ask the parents to be part of the plan of care as much as possible
Attempt to provide a primary nurse for this particular patient on each shift
A head circumference is being measured at a 4 month well-baby checkup. It is noted that the head circumference has not grown since the prior assessment. The NP should:
Re-measure the head circumference, check developmental milestones, assess the nutritional status and discuss with the doctor
A child with a diagnosis of schizencephaly is assign to a new nurse on the pediatric floor. The new nurse has not worked with a child with this diagnosis before. A career nurse discusses the POC needed for this child with the new nurse. It will be important to:
Assess the side of the body that has paralysis for any lesions or sores
A nurse is assessing a 6 month-old M suture lines. They note that the baby has craniosynostosis. The NP should be concerned because:
The suture line closure will not allow the brain to grow
A child that had a shunt placed 4 years ago for hydrocephalus is brought to the ED c/o rapid onset vomiting and increased lethargy. The NP knows that this child will need:
This to be considered a medical emergency, check the head circumference, get neuro
Night terrors can occur in adolescents because of:
Emotional stress, alcohol use, bullying
When speaking with a family about their 9 year old daughters nightmares, it is important to ask:
If the child has a history of daytime napping
What medications the child takes during the day
How often the child consumes caffeine
A quality of a partial seizure is:
Clonic movements
A mother is asking the nurse why her daughter continues to have temporal lobe seizures even though she is on medication. The NP knows this is occurring because:
Temporal lobe seizures do not respond well to medications
Which of the following types of epilepsy are photosensitive?
Juvenile myoclonic epilepsy
A child who had a seizure one hour ago is exhibiting signs of paralysis on the L side of the body. The NP understand the child is exhibiting signs of:
Postictal paralysis
A child with a known history of Benign Rolandic Epilepsy is having a seizure during lunch at the middle school. The school nurse is called to the cafe. What is the priority at this time?
Prevent a possible choking incident by checking the mouth for food
An 18 month old is having a seizure when the NP is assessing him. The NP notes the child is fluttering his eyes and smacking his lips. The NP should document this seizure as:
An absence seizure
A 9 month old is admitted to the pediatric unit for seizures of unknown origin. The child has an EEG performed for several hours. The EEG notes several seizures occurring at different intervals. The NP knows this child:
May have severe mental and physical challenges due to the frequent seizure activity
A child has been status epileptics for the last 20 minutes. The child has Depakote, Valproic Acid, and Diazepam ordered. The nurse should prep which medication?
Diazepam
Care for a child during status epilepticus should include all of the following except:
Turn the patient to the R side
The NP is identifying the difference between primary headaches to secondary headaches. Secondary headaches can occur:
Because of concussions
Cyclic vomiting may:
Not be associated with a headache
A child that has rhythmic, repetitive, involuntary movements is exhibiting:
Dystonia
Identify a therapeutic management technique for a child with a tic disorder.
Education and support for the child and the family
Identify a true statement about Tourettes Syndrome it that:
The tics are involuntary, and the person cannot control the behavior
The assessment an NP preformed on a 12 y/o M demonstrated a positive Kernig’s sign and a positive Brudzinski’s sign. Identify the priority for the NP’s next action:
Further assess the neurological function of the child and call ED with report if needed
Results from CSF that was tested for meningitis have been received. They results indicate bacterial meningitis. The NP knows this because the results show:
An elevated protein count and a low glucose level
A child who as ADHD has difficulty stopping activities to begin other activities at school. The PCP understands that this is due to the difficulty with the self-regulation component of
Flexibility
The PCP cares for a preschoolage child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. The child most likely has a disorder of:
Executive functioning
The PCP uses the Neurodevelopmental Learning Framework to assess cognition and learning in adolescents. When evaluating social cognition, the NP will ask the adolescent:
About friend and activities at school
The PCP is evaluating a school-age child who has been diagnosed with ADHD. Which plan will the NP recommend asking the child’s school about to help with academic performance?
504 plan
The parent of a child diagnosed with ADHD tells the PCP that the child gets overwhelmed by homework assignments, doesn’t seem to know which ones to do first, and the doesn’t do any assignments. The NP tells the parent that this represents impairment in which executive function?
Activation
The PCP is considering medication options for a school-age child recently diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the NP select?
Moderate dose stimulant
The parent of a 4 y/o reports that the child gets upset when the hall light is on at night and won’t leave the house unless both shoes are tied equally tight. The PCP recognizes this child likely has which type of sensory processing disorder?
Over-responder
The parent of a preschool-age child who is diagnosed with sensory processing disorder ask the PCP how to help the child manage the symptoms. The NP will recommend:
Maintaining predictable routines as much as possible
The PCP is performing an examination on a 5 y/o who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the NP do first?
Ask the parent to describe the child’s earlier behaviors from infancy through preschool
The PCP is examining a 3 y/o who speaks loudly, in a monotone voice, does not make eye contact, and prefers to sit on the exam room floor moving a truck back and forth in a repetitive manner. Which disorder does the NP suspect?
Autism spectrum disorder
The PCP is selecting a medication for a 12 y/o who is newly diagnosed with ADHD. The child is overweight, has a history of an ASD at birth and reports mild SOB with exercise. What will the NP prescribe?
Cardiovascular prescreening
The PCP is conducting a follow-up examination on a child who has recently begun taking a low-dose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved. The child’s parent reports noticing a few tics, such as twitching of the eyelids, but the child is unaware of them and isn’t bothered by them. What will the NP recommend?
Continue the medication as prescribed
The PCP is examining a 2 week old infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent?
ASD
The PCP auscultates a new grade II vibratory midsystolic murmur at the mid-sternal border in a 4 y/o that is louder when the child is supine. What type of murmur is this most likely?
Still’s murmur
During a well child assessment, the PCP auscultates a hard, blowing, grade IV/VI murmur in a 6 m/o. What will the NP do next?
Refer to pedi cards for further evaluation
The PCP provide care for a 4 m/o with a VSD. The infant has been breastfeeding well but in the past month has dropped from the 20th to the 5th percentile for weight. What will the NP do?
Fortify breast milk to increase the number of calories per ounce
A 12 m/o infant who had cardiopulmonary bypass with RBC and plasma infusions during surgery at 8 m/o is seen for a well-child exam. What vaccine may be administered this visit?
PCV13
The PCP performs a well child exam on a 12 m/o who had repair of a congenital heart defect a 8 m/o. The child has a normal exam. The parent reports the child is not taking any medications. The NP will contact the child’s cardiologist to discuss whether the child needs which medication?
Amoxicillin
During a well baby exam of a 6 week old infant, the PCP notes poor weight gain, acrocyanosis of the hands and feet, and a RR of 60 breaths per minute. SpO2 is 93% on room air. The remainder of the exam is unremarkable. Which action is correct?
Refer to a pediatric cardiologist
A 3 m/o infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The PCP auscultates a grade III/VI, low-pitched holosystolic murmur over the L lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?
VSD
An infant with Trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the PCP expect?
Oxygen desaturation
A 9 m/o infant with a grade III/VI harsh, rumbling, continuous murmur in the L infraclavicular fossa and pulmonic area. A CXR reveals cardiac enlargement. The PCP will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
Coil insertion in the catheterization lab
A 5 y/o child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The PCP notes mild SOB with exertion and upon questioning learns that the child has recently c/o dizziness. What will the NP do?
Refer the child to the cardiologist immediately
The PCP is performing a well child exam on a school-age child who had complete repair of Tets in infancy. What is important in this child’s health maintenance regimen?
Cardiology clearance for sports participation
The PCP is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the NP recommend?
Evaluation by cardiologist prior to participation
During a routine well child exam of a 5 y/o child, the PCP auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper L sternal border that transmits to both lung fields. The child has normal growth and development. What will the NP suspect?
Pulmonic stenosis
A 5 y/o child has an elevated BP during a well child exam. The PCP notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the L infraclavicular region radiating to the child’s back. the NP will suspect which condition?
Coarctation of the aorta
An adolescent female has a history of repaired Tets. Which longterm complication is a concern for this patient?
Mitral valve prolapse
A 6 y/o child has a systolic BP between the 95th and 99th percentile for age, sex, and height and a DBP between the 90th and 95th percentile on three separate clinic visits. This BP is classified as…
Stage 1 HTN
A 12 y/o child whose weight and BMI are in the 75th percentile has a DBP that is between the 95th and 99th percentiles for age, sex, and height on 3 separate occasions. Initial tests for this child will include….
Renal function and plasma renin tests
A 12 y/o child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child’s BMI drops to the 90th percentile, but the BP remains the same. What is the PCP’s next step in treating this child?
Referral to a nephrologist or cardiologist
A 7 y/o child who has a history of a repaired CHD has many dental caries along with gingival erythema and irritation and a temperature of 102.5F. What will the PCP do next?
Admit to the hospital with a pediatric cardiology consult
A 15 y/o F reports fainting at school in class on two occasions. The adolescent’s orthostatic BPs are normal. The PCP suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?
12 lead EKG
When performing a neurologic exam to assess for meningeal signs in an infant, the PCP will attempt to elicit the Kernig sign by…
Extending the leg at the knee with the infant supine
To evaluate brain tissue disorders in infants, which test is useful?
Ultrasound
A female infant who was developing normally stops meeting developmental milestones at age 12 months and then begins losing previously acquired skills. What will the PCP expect to tell the parents about this child’s prognosis?
The child’s intellectual development will not progress further
A 14 y/o child has a headache, unilateral weakness, and blurred vision preceded by fever and nausea. The child’s parent reports a similar episode several months prior. The PCP will consult with a pediatric neurologist to order…
Neuroimaging with MRI
During a well baby exam on a 9 m/o infant, the parents reports that the baby always uses the L hand to pick up objects and asks if the baby will be L handed. What will the PCP do?
Perform a careful assessment of fine and gross motor skills
The PCP caring for a 5 y/o child who has CP who exhibits athetosis and poor weight gain in spite of receiving high calorie formula and supplement intake. The child has had several episodes of PNA in the past year. Which specialty consultation is a priority for this child?
Surgery for possible fundoplication and gastrostomy
Because of their inability to ambulate, children with CP should be evaluated for which nutrients?
Calcium and Vitamin D
A child with recent history of URI reports tingling and pain in one ear followed by sagging of one side of the face. The PCP observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the NP do?
Prescribe oral prednisone 1mg/kg/day
A child who has had a single nonfebrile seizure has a normal neurologic exam. Which diagnostic test is indicated?
EEG
The parents of an 18 m/o child bring the child to the clinic after observing a brief seizure of less than 2 minute in their child. In the clinic, the child has a temp of 103.1F and the PCP notes a L otitis media. The child is alert and responding normally. What will the NP do?
Prescribe an antibiotic for the ear infection and reassure the parents
An adolescent female reports unilateral headache pain associated with abdominal pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the PCP do?
Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours.
A child who has sustained a head injury after falling on the playground is brought to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The PCP notes slight slurring of the child’s speech and the child has vomited twice in the exam room. Which course of action is warranted?
Admit the child to the hospital for a neurology consult
The PCP performs a well baby exam on a term 4 m/o infant and observes flattening of the L occiput, bossing of the R occiput, and anterior displacement of the L ear. The parents report performing various positioning maneuvers, but say that the baby’s head shape has worsened. What will the NP recommend to correct this finding?
Refer the infant for orthotic cranial molding helmet therapy
A 4 y/o child who has previously met developmental milestones is not toilet trained. The PCP notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?
Tethered cord
The PCP is discussing newborn care with parents prior to the delivery of their first child. What will the NP tell them about circumcision?
The benefits of the procedure outweigh the risks of the procedure
The PCP performs a well baby exam on a 2 day old infant and notes clusters of firm, yellow-white papules with a surrounding erythematous flare. What will the NP do?
Reassure the parents that no treatment is necessary
A well baby exam of a 3 day old infant born to a primigravida mother reveals swelling on the R parietal area of the scalp that stops at the suture line. What action will the PCP take based on this finding?
Observe the infant for hyperbilirubinemia
The parent of a 2 week old infant reports that the infant was diagnosed with transient tachypnea of the newborn shortly after birth. The PCP understands that…
Recovery is usually complete with minimal intervention and treatments
The parent of a 4 week old infant reports that the infant began having forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse well but is losing weight. A physical examination reveals a 90g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the PCP do?
Obtain serum electrolytes and hospitalize for surgical intervention
A 5 day old infant who was delivered at home has abdominal distention and poor feeding. The mother is worried that the infant is constipated because he didn’t have a first stool until yesterday and has only passed a small amount of meconium. What will the PCP do?
Order and abdominal radiograph and refer the infant to a pediatric surgeon
The parent of a 4 day old infant tells the PCP that the infant was diagnosed with hydronephrosis while in utero and asks what will be done. What will the NP tell this parent?
Spontaneous resolution occurs within 6 months to a year of age
A 2 m/o infant has increased head circumference from the 10th percentile at the 2 week exam to the 30th percentile today. What will the PCP do?
Refer the infant immediately to a pediatric neurosurgeon
A 3 day old infant has a total serum bilirubin level of 15.7 mg/dL after having a TSB of 10.8 mg/dL 24 hours prior. The infant nursed 8 times, had 7 wet diapers, and passed 4 stools in the past 24 hours. What is the indicated treatment for this infant?
Recommend nursing every 2 hours, order a biliblanket, and recheck TSB in 24 hours
The PCP is performing a well baby exam on a 7 day old infant born to a Chlamydia positive mother. The infant’s eyes are clear without exudate. The infant is free from cough and lungs are clear. What will the NP do to prevent illness in this infant?
Schedule a follow up appointment in 1 week
The US ranks 50th in the world for maternal mortality and 41st among industrialized nations for infant mortality rate. When developing programs to assist in decreasing these rates, which factor would most likely need to be addressed as having the greatest impact?
Assuring early and adequate prenatal care
When integrating the principles of family-centered care, the nurse would include which of the following?
Childbirth results in changes in relationships
When preparing a teaching plan for a group of first-time pregnant women, the nurse expects to review how maternity care has changed over the years. Which of the following would the nurse include when discussing events of the 20th century?
Creation of free-standing birth centers
After teaching a group of students about pregnancy-related mortality, the instructor determines that additional teaching in needed when the students identify which condition as a leading cause?
Embolism
The nurse is working with a group of community health members to develop a plan to address the special health needs of women. Which of the following conditions would the group address as a major problem?
Heart disease
When assessing a family for possible barriers to health care, the nurse would consider which factor to be most important?
Finances
After teaching a group of nursing students about the issue of informed consent. Which of the following, if identified by the student, would indicate an understanding of a violation of informed consent?
Performing a procedure on a 15 year old without consent
After teaching nursing students about the basic concepts of family-centered care, the instructor determines that the teaching was successful when the students states which of the following?
Childbirth affects the entire family and relationships will change
A nursing instructor is preparing a class discussion on the trends in health care and health care delivery over the past several centuries. When discussing the changes during the past century, which of the following would the instructor be least likely to include?
Analysis of morbidity and mortality
A nurse is assigned to care for an Asian American client. The nurse develops a plan of care with the understanding that based on this clients cultural background, the client most likely views illness as which of the following?
From an imbalance of yin and yang
A nurse is developing a plan of care for a woman to ensure continuity of care during pregnancy, labor, and childbirth. Which of the following would be most important for the nurse to incorporate into the plan?
Educating the client about the importance of a support person
A nursing instructor is preparing a class discussion on case management in maternal and newborn health care. Which of the following would the instructor include as a key component?
Advocacy
Coordination
Communication
Resource management
After teaching a group of students about the concept of maternal mortality, the instructor determines that additional teaching is needed when the students state which of the following?
The rate includes accidental causes for deaths
A group of students are reviewing the historical aspects about childbirth. The students demonstrate understanding of the information when they identify the use of twilight sleep as a key event during which time frame?
1900’s
A nurse is providing care to a woman who has just delivered a healthy newborn. Which action would least likely demonstrate application of the concept of family-centered care?
Encouraging the woman to keep her other children at home
When discussing fetal mortality with a group of students, a nurse addresses maternal factors. Which of the following would the nurse most likely include?
Malnutrition
Preterm cervical dilation
Underlying disease condition
A nurse is preparing a presentation for a local community group about health status and children’s health. Which of the following would the nurse include as one of the most significant measures?
Infant mortality rate
A group of students are reviewing an article describing information related to indicators for women’s health and the results of a national study. Which of the following would the students identify as satisfactory for women?
Colorectal cancer screening
Mammograms
A nurse is preparing a presentation for a local women’s group about heart disease and women. Which of the following would the nurse expect to address when discussing measures to promote health?
Women experiencing a heart attack are at greatest risk for dying
A nurse is working to develop a health education program for a local community to address breast cancer awareness. Which of the following would the nurse expect to include when describing this problem to the group?
White women have higher rates of breast cancer than African American women
African American women are most likely to die from breast cancer at any age
A group of nursing students are reviewing information about factors affecting maternal, newborn, and women’s health. The students demonstrate understanding of the information when they identify which of the following deficiencies as being associated with poverty?
Literacy
Employment opportunities
Mobility
Political representation
Skills
