OB/Peds Hesi Flashcards
When is the screening test for PKU done?
At 2-3 days of life, or after enough breast or formula (usually after 24 hours) is ingested to allow for determination of body’s ability to metabolize amino acid phenylalanine.
The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are in keeping with the child’s dietary restrictions. Which foods are contraindicated for this child?
Foods sweetened with aspartame
During a routine first trimester prenatal exam, a pregnant client tells the nurse that she has noticed an increase in vaginal discharge that is white, thin, and watery. What action should the nurse implement?
Inform her that this is a normal physiological change.
A client at 30 weeks of gestation is on bed rest at home because of increased blood pressure. The home health nurse has taught her how to take her own blood pressure and gave her parameters to judge a significant increase in blood pressure. When the client calls the clinic complaining of indigestion, which instruction should the nurse provide?
Take your blood pressure now and if it is seriously elevated, go to the hospital.
What is the difference between caput succedaneum and cephalhematoma?
Cephalhematoma does NOT cross suture lines and manifests a few hours after birth
A new mother asks the nurse about an area of swelling on her baby’s head near the posterior fontanel that lies across the suture line. How should the nurse respond?
“This is called caput succedaneum. It will absorb and cause no problems.”
Patient with continuous fetal monitoring notices FHR fall and rise abruptly with “v” shaped pattern. Nurse action to take first?
change position of patient
When planning care for a laboring client , the nurse identifies the need to withhold solid foods while the client is in labor . What is the most important reason for this nursing intervention ?
An increased risk for aspiration can occur if general analgesic is needed
Which physiological parameter is most important for the nurse to monitor during administration of oxytocin (Pitocin)?
fetal heart rate
A multiparous woman at 38 weeks gestation with a history of rapid progression of labor is admitted for induction due to signs and symptoms of pregnancy induced hypertension (PIH). One hour after the oxytocin infusion is initiated she complains of a headache. Her contractions are occurring every 1-2 mins , lasting 60-75 seconds and a vaginal exam reveals that her cervix is 90% and dilated 6 cm.What intervention is most important for the nurse to implement?
Discontinue the Pitocin infusion
A client receiving oxytocin (Pitocin) to augment early labor. Which
assessment is most important for the nurse to obtain each time the infusion rate
is increased?
Contraction pattern.
A 38-week primigravida is admitted to labor and delivery after a non-reactive stress test (NST). The nurse begins a contraction stress test (CST) with an oxytocin (Pitocin) infusion. Which finding is most important for the nurse to report to the healthcare provider?
pattern of fetal late decelerations.
A 4-day postpartum client calls the clinic and reports that her nipples are so sore that she does not know if she can continue to breastfeed her infant. What instruction is best for the nurse to provide?
Apply hot packs just before each feeding.
A new mother is having trouble breastfeeding her newborn. The child is making frantic rooting motions and will not grasp the nipple. Which intervention should the nurse implement?
Encourage the mother to stop feeding for a few minutes and comfort the infant.
A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breasts are swollen, warm, and tender upon palpation. What action should the nurse take?
Apply cold compresses to both breasts for comfort
The client is experiencing engorgement even though she is bottle-feeding her infant, and cold compresses
may help reduce discomfort.
The nurse observes a new mother avoiding eye contact with her newborn. Which action should the nurse take?
Observe the mother for other attachment behaviors.
The nurse receives a newborn within the first minutes after a vaginal delivery and intervenes to establish adequate respirations. What priority issue should the nurse address to ensure the newborn’s…
Heat loss
Upon admission to the nursery, the nurse places a newborn supine under radiant warmer , an external heat source. What should the nurse implement first to ensure safe thermoregulation?
Place temperature probe on the abdomen in the line with the radiant heat source
The nurses assessment on a preterm infant reveals decreased muscle tone , sign of respiratory distress , irritability , mottled cool skin.Which intervention should the nurse implement first ?
Position a radiant warmer on the crib
A new mother asks the nurse why her infant son has a needle mark on his leg. Which response is best for the nurse to provide the mother?
Your baby was given an injection of vitamin K to prevent bleeding
The parents of a male newborn have signed an informed consent for circumcision. What priority intervention should the nurse implement upon completion of the circumcision?
Place petroleum gauze dressing on the site.
A mother expresses fear about changing the infant’s diaper after circumcision. What information should the nurse include in the teaching plan?
Place petroleum ointment around the glans with each diaper change and cleansing.
A client breastfeeding her child reports a painful swollen breast with cracked and sore nipple on the right side. What should the nurse instruct the client?
feed the child every 2 to 4 hours and empty each breast completely
A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is prescribed. Which instruction should the nurse provide to this client?
Breastfeed the infant, ensuring that both breasts are completely emptied.
A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective in preventing nipple soreness?
Ensure that the baby is positioned correctly for latching on.
The nurse should be aware that which condition is a contraindication to inducing labor
Placenta previa.
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?
Placenta previa: painless bright red bleeding occurring in the third trimester
A healthcare provider informs the charge nurse of a labor and delivery unit that a client is coming to the unit with suspected abruptio placentae. What findings should the charge nurse expect the client to demonstrate? (Select all that apply.)
a. Dark, red vaginal bleeding.
b. Increased uterine irritability.
c. A rigid abdomen.
The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?
Monitor bleeding from IV sites. Monitoring bleeding from peripheral sites is the priority intervention. This client is presenting with signs of placental abruption
Patient presents with bright red blood, rigid abdomen and in pain. Nurse suspects possibility?
abruptio placentae
The nurse notes a visible prolapse of the umbilical cord after a client experiences spontaneous rupture of the membranes during labor. What intervention should the nurse implement immediately?
Elevate the presenting part off the cord.
The nurse is interacting with a female client who is diagnosed with postpartum depression. Which finding should the nurse document as an objective signs of depression? (Select all that apply.)
A. Avoids eye contact.
B. Interacts with a flat affect.
C. Reports feeling sad.
D. Expresses suicidal thoughts
A 2-day-old full-term infant is brought to the neonatal ICU for treatment of early onset sepsis. Which is the most likely infecting organism in this client?
Group B Strep
The nurse is giving an intramuscular injection of an antibiotic to a 16-month-old toddler with pneumonia. The toddler does not have any known allergies and been walking without assistance for one month. Which technique should the nurse select for administration?
Administer the injection into the middle of the lateral aspect of the thigh.
The nurse is administering an oral medication to a reluctant preschool-age boy. Which
intervention should the nurse implement?
Use straightforward approach with the child
A new mother calls the nurse stating that she wants to start feeding her 6-month-old child something besides breast milk, but is concerned that the infant is too young to start eating solid foods. How should the nurse respond?
reassure the mother that the infant is old enough to eat iron-fortified cereal
While auscultating the lung sounds of a 5 year old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. What action is best for the nurse to take?
Inquire about the use of alternative methods of treatment.
(Cupping is popular form of tx in Asian cultures)
The nurse is caring for a female client with scoliosis who had a posterior spinal fusion and is in a body jacked cast. Which assessment finding indicates to the nurse the client is developing cast syndrome?
Abdominal distention.
Nurse screening only the highest risk children for scoliosis?
Girls between ages 10 and 14
An adolescent boy is hospitalized with full-thickness (third degreed) burns to both hands following a house fire. Three days after his admission to the burned unit, the nurse notes that teenager’s hands are becoming more edematous. Which intervention is most important for the nurse to include in this client’s plan care?
Assess radial pulses every 2 hours
Upon inspection, a nurse visualizes a blade of grass clipping stuck under the right upper eyelid of a teenage client complaining of eye pain, increased tear production, and redden sclera. What should the nurse use to remove the grass clipping?
Moist gauze pad.
During a routine well-child exam, the nurse observes that a 12-month-old child is unable to pronounce any simple words or syllables. Which possible cause should the child be evaluated for first?
Hearing loss.
In caring for an client with acute epiglottitis, which nursing action takes priority?
Prepare for endotracheal intubation
During a follow up clinical visit a mother tells the nurse that her 5 month old son who had surgical correction for tetralogy of Fallot has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held and his growth is in the expected range. Which intervention should the nurse implement?
Auscultate heart and lungs while infant is held
Which instruction should the nurse include in the parents’ discharge teaching plan for a three-year-old child with diarrhea?
Monitor for the absence of tears
A pt at 32 weeks gestation present with possible UTI. Action to implement?
collect urine for culture
One day after a vaginal delivery of a full-term baby, a postpartum client’s white blood cell count is 15,000/mm2. What action should the nurse take first?
Check the differential, since the WBC is normal for this client.
Safety is of the utmost concern in children with aplastic anemia. It is important to prevent injury in order to avoid hemorrhage.
Risk of epistaxis
The nurse is reviewing the lab values for an eight-year-old client and notes that the child’s absolute neutrophil count (ANC) is below 500 cells/mm3. Which nursing intervention should the nurse implement first?
Answer: . Initiate reverse isolation precautions for this child
The nurse is caring for a one-year-old boy who has type 1 diabetes mellitus (DM). His mother asks how will she recognize hypoglycemia in her infant who cannot tell her how he feels. Which information should the nurse provide?
Answer: Hypoglycemia in infants causes changes in behavior and cold clammy skin
A new mother who is breastfeeding her 4 week old infant has type 1 diabetes , reports that her insulin needs have decreased after the birth of her child. What action should the nurse implement ?
Inform her that a decreased need for insulin occurs while breastfeeding
Which information is most important for the nurse to provide parents about long-term care for their child with hydrocephalus and a VP shunt?
Shunt malfunction or infection requires immediate treatment.
During a prenatal visit, a client at 30 weeks gestation reports persistent heartburn during the past two weeks . The nurse notes the client has 3+ bilateral, pitting , pedal edema. Which action should the nurse implement?
Ask if blurred vision and headche have occured
A 3 month old has a VP shunt. The mother states, “Once the shunt is removed, the pressure in my baby’s head will be reduced.” What do you say?
Answer: The shunt will be replaced as the child grows to reduce the pressure in the child’s head
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?
inability to push effectively in the 2nd stage
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?
perform fundal massage
A nurse consults a mother and detects cord prolaspe. How should the examiner position the pregnant woman to relieve pressure on the cord
knee to chest position
When assessing a client who is at 12 week gestation, the nurse recommends that she and her husband consider attending childbirth preparation classes. When is the best time for the couple to attend these classes?
at 30 weeks gestation
A 42 week gestational client is receiving an intravenous infusion of oxytocin(Pitocin) to augment early labor. The nurse should discontinue the oxytocin infusion for with pattern of contractions?
transation labor with contraction every 2 mins , lasting 90 secs
Immediately after birth a newborn infant is suctioned, dried and placed under a radiant warmer. The infant has spontaneous respirations and the nurse assesses an apical HR of 80 beats/minute and respirations of 20 breaths/min. What action should be performed next
initiate positive pressure ventilation
A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse perform first?
A.Bathe the infant with an antimicrobial soap. B.Measure the head and chest circumference. C. Obtain the infant’s footprints. D. Administer vitamin K (AquaMEPHYTON
A woman who thinks she could be pregnant calls her neighbor, a nurse, to ask when she could use a home pregnancy test to diagnose pregnancy. Which response is best?
home pregnancy test can be used right after your first missed period.
A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?
correctly place the infant on the breast
oral contraceptives
What to assess
Poor candidates
Before advising a client about oral contraceptives, the nurse needs to assess
the client for signs and symptoms of hypertension. Clients who have hypertension,
thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are
poor candidates for oral contraceptives.
Genetics of PKU
25% any babies born later will have it too
pregnancy test hormone
HCG (human chorionic gonadotropin)
Pregnancy - positive signs?
fetal movement felt by experienced clinician at 20 wk
urinary chnages
Dilation of renal pelvis; elongation, widening, and
increase in curve of ureters
Increase in length and weight of kidneys
Increase in glomerular filtration rate; increased urine
flow and volume
Increase in kidney activity with woman lying down;
greater increase in later pregnancy with woman lying
on side
Weight gain during pregnancy
20lbs weight gain in 20 weeks is a lot
Prenatal care-type 1 DM
Insulin needs are reduced while breastfeeding
or tight control
A pregnant woman have type 1 diabetes and is going to receives insulin teaching she tells the nurse that she is going to not eat in the morning because religion and is a holy month, what is the nurse best teaching:
collaborative work to create a new insulin schedule
insulin needs are also decreased during breastfeeding
Pregnancy air travel
Flexion and extension of the ankle promotes venous return and aid in the prevention of thrombophlebitis
Vaginal Exam During Labor
use a glove and lubricants
ruptured membrane
Assessment of the fetal heart rate is important after rupture of the membrane to determine decelerations that could indicate cord prolapse
A multigravida client arrives at the labor and delivery unit and tells the nurse that her bag of water has broken. The nurse identifies the presence of meconium fluid on the perineum and determines the fetal heart rate is between 140 to 150 beats/minute. What action should the nurse implement next?
Complete a sterile vaginal exam
fetal position
the best way to find out fetal position is through an ultrasound
A client receiving epidural anesthesia begins to experience nausea and becomes pale and clammy. What intervention should the nurse implement first?
Raise the foot of the bed.
If a mom scheduled for a C-section tells “I ate a big breakfast and had OJ”, what do you do?
TELL the anesthesiologist; she is at risk for aspiration
Woman on Pitocin suddenly has problems and has variable decelerations. What do you do?
turn of the pitocin
So you’re going in to see a patient that had an episiotomy and she said her stitches hurt, they ask her what to do next, they had two choices, either to put the ice pack there, or look at the episiotomy.
look at episiotomy
A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with “latch on” and recommends that the mother do which of the following?
Rotate infant positions at each feed.
Fundal massage technique
one hand on the lower segment of the uterus
Cyanotic 3 hour old infant temperature 96.5, 40 breaths/min, 165 beats/minute. Intervention best to implement?
gradually warm under heat source
Newborn Immunity
present in newborns and involves physical and chemical barriers as well as nonpathologic organisms
diaper chnage : substance
use clean water
Mother of a 4 month old asks RN for preventing diaper rash -
use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change
postpartum hemorrhage even after finishing oxytocin infusion:
check maternal BP
During delivery, protruding umbilical cord
knee chest posiiton
The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?
monitor bleedinf from IV site
postpatrum hemorrhage leads to what
DIC
mother was diagnosed with Coke. Baby is irritable, cries a lot.
What do you do?
initiate seizure percaution
Cocaine-exposed newborns are typically fussy, irritable, and inconsolable at times. Cocaine-exposed infants demonstrate poor coordination of sucking and swallowing, making feeding time frustrating for the newborn and caregiver alike
neonatal sepsis risk factor
a. prolonged rupture of membrane
b. fetal distress
c. preterm delivery
Injection Prep: pedi
: IM injection for children under 3 of age should not exceed 1ml. divide the dose into smaller volumes for injection in two different sites.
IM injection-school-aged-PEDI
let the child choose
Solid foods-6 months introduce
introduce food one at a time
the child was obese and they wanted to know the highest contributing factor to the obesity
child had infant cereal before six months of age
You are the school nurse and the teen got a chemical in his eye
flush the eye out for 20 sec
You have a deaf baby. What mode of communication would you choose and why?
communicate with pictures
Pneumonia-oxygen
administer oxygen
You have a baby with vomiting and diarrhea. What do you do first?
Give electrolytes or IV NS?
Newborn - bowel. Hirschsprungs disease
newborns with hirschsprungs disease have a failure to have a bowel movement within 48hours after birth
UTI - assess
Symptoms of this infection in children can differ from those of adults and can include abdominal pain, fever, nausea, vomiting, poor appetite, enuresis, incontinence, frequency or urgency
Aplastic anemia-epistaxis
they are at risk for epistaxis
The nurse is reviewing the lab values for an eight-year-old client and notes that the child’s absolute neutrophil count (ANC) is below 500 cells/mm3. (NEUTROPENIA). Which nursing intervention should the nurse implement first?
Initiate reverse isolation precautions for this child
A babysitter calls in regarding the child she is caring for who is a diabetic. Currently he is diaphoretic, weak, what instructions should be provided?
give the milk before bringing in (hypoglycemia)
If mother has DM type 1, what do you expect for fetal complications?
hypoglycemia
A pt is Rh neg and goes into preterm labor, what do you do?
Give Rh factor and do a coombs test
A pudendal block
anesthetize the perineum.
how to promote attachemnt for mother and baby
rooming in.
prefered IM injection site for infamts 12 months or older
vastuslateralis
injection site for school age or children older than 6 years old
deltiod muscle
screening for postpatrum depression
use Edinburgh scale
