Maternity and Peds Hesi Review 3,100% CORRECT

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Maternity and Peds Hesi Review 3 • Mother of a preschool-aged child calls school RN to report her child was bitten by a tick while on a school outing last wk. Mother tells RN she removed tick&flushe... d it down toilet. What action should school RN take? Schedule test for Lyme disease if rash appears. • Dr. prescribes phenytoin (Dilantin) for school-aged child diagnosed with tonic-clonic epilepsy. Which info should RN provide parents when teaching about seizure management with phenytoin?Monitor child’s serum phenytoin levels routinely while taking Dilantin. • During newborn admission assessment, RN palpates newborn’s scrotum&does not feel the testicles. Which assessment technique should RN perform next to verify absence of testes: Perform transillumination of scrotal sac to visualize shadows of testes. • The parents of a 14-month-old-child who is hospitalized due to febrile seizures tell RN that they fear their child will have lifelong seizures. What info should RN convey to these parents?Reassure the parents that febrile seizures decrease as child grows older. • In determining the one min Apgar score of a male infant, RN assesses a heart rate of 120 beats per min&44 respirations per min. He has a loud cry with stimulation, good muscle tone,&his color is acrocyanotic. What Apgar score should RN assign?9 • School-aged child with otitis media receives prescription for azithromycin (Zithromax) 100 mg once, then 50 mg daily for 4 days. Medavailable in solution containing 200 mg/5 ml. How many ml should RNgive on first day? 2.5 • 39-wk-gestational multigravida is admitted to L & D with spontaneous rupture of membranes (SROM)&contractions occurring every 2-3 mins.A vaginal exam indicates that cervix is dilated 6 cm, 90% effaced,&the fetus is at a +2 station. During last 45 mins FHR has ranged • • • between 170&180 beats/min. What action should RN implement?Take oral maternal temp. • During admission of newborn, RN identifies localized swelling that does not cross suture line on the posterior area of the parietal bone. What action should RN implement?Notify Dr ofcephalhematoma. • Mother of 6 y/o girl is concerned about her child’s obesity. The child’s weight plots at 75 percentile,&the height at the 25 percentile. The child’s BMI is at 85 percentile for age&gender. Which interventions should RN implement? SATA: Determine child’s usual physical activity pattern, Ask if school has PE program, Obtain child’s 3-day diet history based on mother’s input. • Woman 36-wks &Rh negative admitted to L & D with abdominal cramping. She is placed on strict bedrest&FHR&contraction pattern are monitored with external fetal monitor. Two hrs later, RN notes large amount of bright red vaginal bleeding. Highest priority nursing action? Assess FHR& Pt’s contraction pattern. • Nutritional infoRNshould give mother of 6-mo-oldon introducing solid foods?Introduce foods one at a time, at 4-7day intervals. • Digoxin is prescribed to 3-month-old with congenital heart disease. RN should teach parents to do what if they miss giving a dose of this med?If less than four hrs have elapsed, give the missed dose. • A 10 y/o boy has been seen frequently by the school RN over the past three wks after school begins in the fall. He reports headaches, stomach aches,&difficulty sleeping. What intervention should RN implement?a. Ask the boy to describe a typical day at school. • Pt who had her first baby three months ago&is breastfeeding tells RN that she is currently using the same diaphragm that she used before becoming pregnant. What info should RN provide this Pt?Use other form of conception until new diaphragm obtained. • In assessing child with suspected bacterial meningitis, RN should anticipate a recent history of which problem?a. Ear ache • Following the vaginal delivery of a 10-pound infant, RN assesses a new mother’s vaginal bleeding&finds that she has saturated two pads in 30 mins&has a boggy uterus. What action should RN implement first?a. Perform fundal massage until firm. • Mother brings her 3 y/o son to ER&tells RN he has had an upper respiratory infection for past two days. Assessment of child reveals rectal temp of 102 F. He is drooling&becoming increasingly more restless. First RN acton?d. Notify Dr&obtain a tracheostomy tray. • Mother brings 3-month-old toclinic because baby does not sleep through the night. Which finding is most significant in planning care for this family?diaper area shows severe skin breakdown. • Pt 18-wks was informed this morning that she has elevated alpha-fetoprotein (AFP) level. After Dr. leaves room, Pt asks what she should do next. What info should RN provide?Explain sonogram should be scheduled for definitive results. • A 4 y/o boy was recently diagnosed with Duchenne muscular dystrophy (DMD). Which characteristic of the disease is most important for RN to focus on during the initial teaching?c. Lower legs become progressively weaker, causing a waddling, unsteady gait. • While caring for laboring Pt on continuous fetal monitoring, RN notes FHR pattern that falls&rises abruptly with “V” shaped appearance. First RNaction?Change maternal position. • Woman returns to clinic for 2-wk postpartum checkup&has signs of left breast mastitis. Which instructions should RN suggest Pt follow at home? SATA: Wear bra with good breast support, Takeantibitotics at regular intervals, Apply warm compress to left breast. • A one-month old male infant is brought to clinic by his mother who states son has been vomiting forcefully after each meal for last three days. Infant is afebrile, dehydrated,&pyloric stenosis is suspected. What other findings should RN identify that are consistent with pyloric stenosis?olive-shaped mass in abdominal area • Babysitter of 7 y/o with type 1 diabetes calls clinic to report that child is very irritable, perspiring,&shaking. Which instructions should RN provide to the babysitter?Give child 8oz glass of milk. • Pt in preterm labor has had infusion of mag sulfate running for 8 hrs. Current findings:RR 14 breaths/min; urine output 25 ml/hr; DTRs 1+; serum mag level 8 mEq/L. Based on these findings, what conclusion should RN reach?c. Findings indicate potential toxicity to magnesium sulfate&close follow-up is indicated. • Teen with pelvic inflammatory disease (PID) is admitted to hospital after 14 days of taking levofloxacin (Levaquin) 500 mg orally once daily&metronidazole (Flagyl) 500 mg twice daily. She asks RN, “Why do I have to be in hospital? Why can’t I get my Tx at home?” Which purpose should RN provide that supports effective outcome?Administration of a supervised parenteral antibiotic protocol. • A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4)&high levels of thyroid stimulating hormone (TSH). Best explanation for this finding?TSH is high because of the low production of T4 by the thyroid • During well-baby visit, parents explain a soft bulge appears in groin of 4-month-old son when he cries or strains during stooling. Infant is scheduled for surgical repair of inguinal hernia in 2wks. Parents should be instructed to do what if hernia becomes incarcerated prior to surgery?Gently manipulate hernia for reduction. • 6 y/o child diagnosed with rheumatic fever&demonstrates associated chorea (Sudden aimless movements of arms&legs). Which info should RNgive parents? The chorea or movements are temporary&will eventually disappear. • A 32 wk multipara with a history of preeclampsia arrives to the clinic for her routine appointment. The RN observes Pt has an elevated blood pressure of 155/90 mmHg. Which action should RN take?d. Collect a urine specimen to screen for protein. • A child who received multiple blood transfusions after correction of a congenital heart defect is demonstrating muscular irritability&is oozing blood from the surgical incision. Which serum value is most important for RN to review before reporting to Dr?b. Calcium • 3 y/o girl who has been blind since birth is hospitalized with compound fracture of femur& in traction. Which intervention is best for RN to implement to address this child’s blindness?Request parents bring familiar objects such as a stuffed animal from home. CHD priority in newborns- Tetralogy of Fallot results in decreased pulmonary blood flow that allows desaturated blood to shunt from right to left side of heart&then into systemic circulation. This can cause hypercyanoticspells during exertion efforts such as crying& child should be given immediate blow-by O2&placed in a knee-chest positioning until help arrives. Coarctation of the aorta is an obstructive defect that can cause hypertension&precipitate HF. The hemodynamic flood flow of children with patent ductus arteriosus&VS defects have increased pulmonary blood flow&based on size of defect, may be clinically asymptomatic or have manifestations of heart failure (HF), which reduce systemic O2ation. • Anchor the lower part of the uterus - then massaging the fundus • HIV AZT is given to slow down the transmission to the fetus • Clear water to clean for diaper change • Muscular irritability from hemorrhaging • Osteomyelitis - give milkshake as a snack- high protein, high fiber • Hypoglycemic: give milk • Croup- barking sound, high pitch on breathing - bring in shower with warm mist • Tetralogy of Fallot - cyanotic limbs crying • 30 wks&38 in fundal height - do ultrasound – should be equal • Breastfeeding 5 day with yellow stools - this is normal • Spontaneous rupture of membranes - ask the color&consistency • 3+ pitting edema with GERD- normal during pregnancy?? • Postpart depression - may need evaluation - Know length of PPD • Tonsillitis-signs of bleeding - need to inspect the oral cavity • Braxton Hicks will go away with walking it is not true labor • Placenta Previa - check fetal HR • I’m having pain in my stitches - look at the episiotomy • Use breathing techniques after giving pain meds 30 mins ago • UTI child - return for another urine sample • 3 hr newborn with irregular respirations&small/soft murmur - put pulse ox on the foot • Gonorrhea infection tell other partners to seek Tx • Adolescent gets a rubella vaccine at maternal bearing age - use another form of birth control? • Tonic clonic seizure&heart issue - monitor calcium • Pt comes in for Amniocentesis you do BP/HR next is - something with to get Rh factor for rhogam • Celiac disease: crackers no good need gluten free foods • Breasts- need supportive bra, antibiotics, cold compress • infant vital signs: normal • DMD- weak muscles&gait - something with DMD & serum Ca+ • Preeclampsia: check urine for protein • A 4-year old girl in waiting room& RN is observing her behavior. Which one was normal? Talking to an imaginary friend • Diabetic malehas blood glucose 180mg/dL before playing soccer; what to do? Give go ahead to play because glucose is within normal • HIV+ Mother gave birth; AZT therapy during labor; what should RN do? Ensure to take AZT within 6 hrs after Birth • SATA: 2 y/o drinking soda from bottle. Dental caries are associated with drinking soda; Drinking soda is related to childhood obesity; Toddlers should be drinking from a cup by age 2 • A 10 y/o boy on bed rest. Checkers • Pt3cm dilated; 50%effaced, 0 station. After 1 hr, she wants to go to bathroom; what should RN do? determine current cervical dilation • Pt in L&D because of non reactive result on non-stress test. Does contraction test. Most important finding? Pattern of fetal late deceleration • Dosage calcfor 1st day to give. 100 mg/200 mg x 5 ml = 2.5 ml • Dosage calculation= 25 ml/hr [500 ml/ 20 gm * 1gm/1 hr] • Postpartum depression findings: trouble sleeping, decreased appetite, feelings of sadness • Intussusception - passage of soft brown stool notify provider • Pt was given pitocin&delivered infant. Why is it given? To stimulate uterine contractions, you never give pitocin before placental delivery because it will retain the placental part. • Pt on mag sulfate; RR 14; urine output 25ml; +1 reflex.Maglevel of 8. RN action? Mag level reaching toxic - monitor for further deterioration • Oozing blood&muscle irritability; what should RN check? Calcium • Newborn ready for discharge from hospital: Consent for Hep B from Mother • Pt w/ increasing restlessness, drooling&102 temp: Bring trach kit • Pt had episiotomy&complaining of pain: Check the perineal area&sutures (Visualize perineal area&episiotomy sites) • Pt w/ heartburn&edema: ask about headache or blurred vision • **********Constant vaginal pressure? Sitz bath? • Tetracyclines: Do not give with Milk&antacids • Pt with PID (pelvic inflammatory disease) getting 14 days of antibiotics at hospital. She asks“Why can’t I go home&take these meds?”RN responsefor positive outcome? Supervise parenteral administration of antibiotics according to protocol? • Salt wasting syndrome ATCH Level • Tanner Stage for 11 y/o girl - Tanner Stage II • Probable sign of pregnancy - Hegar’s sign • Child has respiratory distress: Nasal flaring • **Oxytocin administered for : (let down reflex?) or stimulate uterine contractions? It does both,&both were in the answer choices • Parents of 3 y/o boy w/ Duchenne muscular dystrophy (DMD) ask “how can our son have this? Should we have any more children” What info should RNgive? It is inherited X-linked recessive disorder, which primarily affects male children in family • Safe thermoregulation: temp probe on mid, in line with radiant heat source • **C8 Spinal cord injury, the girl is incontinent&bladder is distended - due to absence of motor neuron stimulation to bladder. • **Pt with PDA; RN about to give prostaglandin; which finding causes RN to immediately stop? 80/Heart rate 50? RR 34 breaths/min? (It would be HR right?) - I picked HR, but I think this is asking for side effects of prostaglandins* • **2 hands for palpating fundal height&(Leopolds?): other hand to anchor uterus • Child holding abdomen&complaining of pain. Describe pain level • DM type 1 mother - what is the priority nursing action? Strict glucose monitoring or to preventfetal complications • Purpose of ultrasound at 20 wks? To see baby’s growth/gestation • Gestational diabetic mom scheduled for amniocentesis because fetus has estimated wtof 8lbs at 36 wks. This checks: Fetal Lung Maturity • Excessive uncontrolled vaginal bleeding after the IV Pitocin is infused, what info should RNprovide to the provider? Maternal BP • **70% effaced, 2 cm dilated. The pt demands epidural. RN response? Don’t give epidural because will slow the labor process • Breastfed baby yellow sticky,sour : normal finding • Cleft lip/palate question. Mom had cleft lip. The uncle from dad’s family has cleft lip. RN response? Refer them to genetic counselling or tell them it that the inheritance of cleft lip/palate is not genetic • Pt bleeding bright red, rigid abdomen&pain - prepare for emergency CS • Tonsillectomy Pt Irritated&swallowing. Look at oropharynx w/ flashlight • 2 month oldat clinic for well baby exam. RN findsright testicle not descended into scrotum but left is palpable. What action should RN take? Ask parents if the right testis has been in scrotum before • School age boy fell off bike&hit tree tells school RN“there is stuff in my eyes.”- Patch both eyes&send toophthalmologist • Digoxin missed doses for a 3 month old. RN response? Give the missed dose if less than four hrs • 7 y/o with history of UTI. What should girl/parents lookout for? Check urinary odor • Parents worried about febrile seizures & that it is lifelong condition. RN response? Tell them febrile seizures disappear as child grows old • End stage chronic liver condition in a child. The parents know that the child will die. RN response? Reassure the parents that the staff are available for their needs or Tell the nursing supervisor to anticipate death (something like that)?Or check DNR is in records? • 5 month old, abnormal finding? Moro reflex • A school age girl has frequent absences at school due to episodes of abdominal pain, etc&comes tothe school RN. What should the school RN do? The choices were: Refer to primary healthprovider? Ask about sleep/night routine? The other 2 didn’t make sense • Fluid filled vesicles Put on transmission precautions • Meningitis question. History of Ear ache • Mother received Rubella vaccine after delivering baby. What should RNtellMother regarding Rubella vaccine?Don’t get pregnant for 1st month? Becauserubella live virus vaccine can cause birth defects • **The neonate 3 hrs old vitals are given: 160 beats/min with soft murmur, 97.7 temp, etc. The choices were: Put baby in radiant heat source? Document the finding (correct choice, the soft murmur is from the PDA) Apply O2 saturation at heel? Glucose check? • Ulnar fracture after applying splint: Check for wrist pulse • Woman with history of chicken pox&syphilis as a teenager in for first prenatal visit. RN action? Prenatal blood&urine tests Maternity & Pediatric HESI • 5 in head increase at 3months – assess anterior fontanel for bulging • Pt had a cold 2 to 3 days ago&has a hacking cough, difficulty breathing, further assessment def. Respiratory distress – nasal flaring • Synagist (who to administer to): Pt in high-risk criteria • Pertussis Pt with paroxysmal cough nursing intervention: small frequent feeding • Child having difficulty feeding with spoon (15 months) Parents are concerned. Question Mothers concern • Erwin sarcoma dx on adolescent meds: degree of metastasis • Meconium stain amniotic fluid report: fetal HR 100-110 • Genital hyperplasia (ambiguous genitalia) Sonogram & ultrasound to check sex of baby • Pre-eclampsia Pt: Ensure Airway by the bedside • Bleeding with abdominal pain: call physician while at the bedside • Increase of pitocin: check contractions • Pt feeling pressure in vagina, postpartum: assess perineal&rectal area • Pt bleeding & experiencing muscle cramps: calcium • osteomyelitis pt bed bound:milkshake • Doesn't cross the suture line: cephalohematoma • Crosses the suture line: Caput succedaneum • Test on a 3 yr old, what to do after: give parents a list of stimulating activities • Tanner Stage: scant pubic hair stage II • Pt with HTN, edema: give apple • Probable signs of pregnancy: Hegars sign • Pet that a primigravida cannot have (taxoplasmosis): CAT: BUT they actually can have cats, they just have to avoid litter box • Yellow patches on forehead, sternum &abd.: check bilirubin level • 3cm dilation&50% effaced an hr later: determine cervical dilation, pt wants to use the bathroom. • SROM, amniotic fluid greenish brown.RN do first: assess FHR • Jittery baby: assess glucose level • Babysitter repots signs of hypoglycemia: 8 oz of milk • Jewish lady asking about genetic testing: Risk for Tay-Sachs • Blood transfusion for Jehovah witness: Clarify blood transfusion preference • Tetracycline education: Don't give with milk • Reduce risk of respiratory issues in preterm: Betamethasone • Woman receiving rubella vaccine has:encourage to immunize the children at home (13mth & 3 yr) • Oral contraceptive contraindication: family history of stroke • Hypothyroidism, assessment of therapy effectiveness:laughs readily, turns from back to side • “When can I go home” asked by new mom after delivery, when there is no significant bleeding • Reason for temporary bed rest: Homans sign • Risk for otitis media in children: Eustachian tube is shorter in children than adults • Hemophilia Pt: discharge teaching (RICE) • Teenager with ulna fracture&splint applied: check radial pulse • Pt on rehydration therapy&vomiting: continue ORS in small frequent quantities • Pt with mastitison antibiotics: start feeding on unaffected side first • Cryptorchidism pt assessment: warm the room • pt concerned about high AFP: confirm with sonogram • Newborn survival after delivery: prevent heat loss • Dosage: 8.6 • Dosage 12.5 • Momworried about thumb sucking: normal for children at this age OB Hesi • Pregnant Pt, with contractions 5 min apart, goes to bathroom&you hear baby crying. Best RN action? hit call light to call for help • Pt has spinal headache 24 hrs post delivery. Before anesthesiologist’s arrival, what is best RN action? have equipment at bedside • Pt 20 wks gestation has HPV. What is the best info for RN to provide? treatment is available but limited due to pregnancy • 1 hrpost deliveryRN unable to palpate fundus. Large amount of lochia on pad. Massage umbilicus&get vitals. Next RN action?palpate for bladder distention • Baby with cephalatoma. Next RN action?assess for jaundice q 8 hrs • Math: Pitocin 4 mU/min. 1000 mL/2 mU. mL/hr?:12 mL/hr • Pt receiving Pitocin is experiencing tetanic contractions with variable FHR. RN action to implement? turn off the Pitocin drip • Pt scheduled for cesarean @ 0600 tells RN she drank coffee at 0400 to avoid getting headache.RNaction? tell anesthesiologist • 2 hrs post delivery of 10lb baby, fundus is above&to right of umbilicus. Pt voids 250 mL in bed pan.RN action? palpate suprapubic region for distention • 33 wks gestation. Moderate bleeding. No contractions. What intervention to implement? Weigh pads • Primipara 42 wks. On Pitocinthen stopped. O2 given. Contractions 5 mins apart for 20 secs. Nurse action? restart Pitocin per protocol • Pt with continuous fetal monitoring notices FHR fall&rise abruptly with “v” shaped pattern. RN action to do first? change Pt position • 28 wks with twins. Fundal height 27cm.3 wks ago it was 28 cm. What does RN conclude from this? may indicate IUGR • Pt received prostaglandin gel vaginally to induce labor. 30 mins after insertion of gel, Pt complains of vaginal warmth. What action should RN implement first?:turn Pt to side lying position • Parents say baby trying to walk. RN’s response? normal stepping reflex • Pt delivered baby 24 hrs ago&complains of urinating every hr or so. She asks “is that ok?” RN’s action? measure next voiding • Magnesium sulfate infusion begins. Pt develops slurred speech&decreased reflexes. What RNRN action? stop infusion • After breastfeeding for 10 mins on each breast, baby spits up. RN action first? turn baby to the side&suction • 35 wks, Breech, Contractions 3‐5 mins apart&mom says “I think my water just broke”. RN sees umbilical cord protruding. Intervention to implement? place Pt in knee‐chest position • Extrauterine transition: cries vigorously when stimulated • 3 day old baby. Feeds every 2 hrs. RN notes white curd patches on oral mucus membranes. RN action?:needs medicine • 38 wks, hx of PIH. Pitocin started. Gets headache 1 hr later. Contractions 1‐2 mins apart 60‐75 secs. long.Most important action? Stop Pitocin • After delivery Pt asks RN when she can leave to go home. Information most important to provide? when bleeding stops • Mother who is lactoovovegetarian plans to breastfeed. Information to provide before discharge? continue taking prenatal vitamins • Teaching how to perform kick counts. Instruction to include?10 kicks not felt, drink orange juice&count again • 40 wks gestation, spontaneous rupture of membranes &meconium stained. What additional finding should RN report? FHR 100‐110 • Pt with gestational diabetes has an amniocentesis. Why is the amniocentesis being performed? fetal lung maturity • Jehovah’s Witness Pt hemorrhaging is in the ICU. RN action to take? clarify the wishes of Pt • Pt breastfeeding: decrease need for insulin • Newborn receiving positive pressure intubation after delivery. Which finding should RN initiate chest compressions? HR 54 • 30 y/o primigravida delivers 9 pound vaginally after 30 hr labor. Priority nursing action? observe for signs of hemorrhage • Magnesium Sulfate in D5W 500 mL. 20 g Mag Sulfate at 1 g/hr. How many mL/hr? 25 • 32 wks with possible UTI. RN action? collect urine for culture • 38 wks, tachycardia, tremulous, hypertensive. Assessment action most important? obtain a drug screen • Pt requests epidural. First RN action? check cervical dilation • Pt presents with bright red blood, rigid abdomen&in pain. RN suspects possibility? abruptio placentae • LGA infant. First RN action? obtain blood glucose • After delivery Pt presents with profuse hemorrhage. RN action? check maternal blood pressure • Discussing involution. Pt understands effect of breastfeeding when states? period may be delayed • Baby born with congenital heart defect. Which assessment finding warrants immediate intervention? bluish tinge to tongue • Rh‐Mom suffers abdominal trauma in car accident. Which finding is most important to tell Dr.? positive fetal hemoglobin • Which hormone is responsible for positive pregnancy test? HcG • Doctor hands baby to RN immediately after delivery. Which action is most important to implement? place under warmer • Education most important for RN to implement to teenage pregnant Pt? irondeficiency anemia • RN identifies localized swelling that does not cross the suture line of parietal bone. RN action? notify Dr. of cephalhematoma • RN action before giving Hep B vaccine? get consent signed • Beractant given for RDS in preemie. Assessment finding indicates condition is improving? urinary output increased • 34 wks gestation. Bimonthly visit. Assessment finding important to report to health care provider? weight gain 7 pounds • Primigravida asks RN about exercise during pregnancy. What recommendation? stretching • Cyanotic 3 hr old infant temperature 96.5, 40 breaths/min, 165 beats/min. Best Intervention? gradually warm under heat source • Pt comes in stating that she is in labor. Which finding confirms not in labor? contractions decrease when walks • Multigravida asks for more pain meds. Just received pain meds, Stadol 2 mg, 30 mins ago. RN action? instruct to deep breathe • Postpartum Ptw/ severe pain&pressure in perineal area. RN finds hematoma beginning to form. What should RNget first? BP & HR • Pt complains of morning sickness. RN recommends? ginger • 3 day postpartum Pt. Husband calls states wife is crying, irritable - Tell husband to contact clinic in 2 wks if symptoms become worse • Postpartum&rubella vaccine: can give while mom breastfeeding. • 2 month old – vaccine given is: Hep. B • Croup – mother brings toy to hospital, what should RN do? Allow child to have stuffed toy inside tent • 18 -month – Pertussis: What do you give? Orange juice • Reddish vesicles on legs – Impetigo Contagioso: What type of scarring will it leave? • 1000mL/8hr = 125mL/hr. • Toxoplasmosis = Wore no gloves when gardening (cat feces may be in flower beds) • Pavlik Harness – Congenital hip dysplasia with Subluxation at risk with harness: skin integrity • Rubella Vaccine – info provides: Use birth control for 28 days (rubella is tetragenic) • Newborn tries to walk. RN explains normal newborn stepping reflex • 3 y/o w/HIV infection. Other child with Pertussis: Protect HIV child; they are immunocompromised due to the meds they are on. • Healthy newborn delivery – Discharge – can go home when: • Diaper rash advice – prevent diaper rash: leave a small amount of ointment on with diaper change as skin barrier • Acute otitis media – URT: Eustachian tubes in children are shorter&straighter than in adults • 4 y/o girl with moderate development disability (Autism) – Goal: • Postpartum &lying in pool of blood: Check lochia flow&fundus consistency • 3 wks. Postpartum vaginal delivery – breastfeeding – small crack left nipple – feels sick: Continue breastfeeding • 4 Wk. infant with Pyloric Stenosis: Projectile Vomiting after feeding • Tonsillectomy & excessive swallowing: Tell RN VS&swallowing • Nephrosis (Nephrotic Syndrome) – Prednisone (corticosteroid) – decrease in: Generalized Edema • 8 wk. gestation Hgb. 9.5 mg/dL (Normal for female: Hemoglobin 12-16) On Iron – recommended dietary: Iron rich foods • Newborn chocking – cyanotic – x-ray – diagnosis – Trachea-esophageal fistula – RN action: NPO, HOB 30 degree • Toddler Admission. For less stress to Pt? caregiver hold child • Basic prenatal physical exam: Chicken pox & Syphilis – RN: collect blood & urine for prenatal screens • Who does RN see 1st? Pt discharge has questions about yesterday teaching, Tired mother with twins? • Placenta Previa 31 wks. Gestation – blood loss calculation: Calculate difference in weight of perineal pad before&after use • 3 month infant &prop bottle on pillow to feed: RN encourage mother not to prop bottle • 6 month infant w/ bronchiolitis symptoms &Respiratory distress: a high pitched cry, RR of 56 breaths/min. • School aged child – frequent urination – increased thrust – hunger within 2 hrs. of eating: Serum glucose test • 10 y/o with acute appendicitis scheduled for surgery tells RN sudden relief of abdominal pain. RN action: Report to charge RN • Highest priority after birth: Prevent heat loss&neonatal cold stress • Hypospadias – surgical repair before 6 months of age – tell parents not to circumcise child: Prepuce used in reconstruction • G2P1, 10hr. no epidural, IV pain med., increased contraction every 2 min., cervix 100% effaced, dilation 8cm Pt ask for IV Nalbuphine (Narcotic): Reinforce relaxation technique&breathing • Fundus – primipara – 2hrs. postpartum – balloon like bulge: • “Squatting” Corrective Surgery Congenital Heart defect – upon rising child is tachypnea & tachycardia, cyanotic, hypoxic: Administer Digoxin (don't give if HR BELOW 110) • Care of Circumcision: Apply ointment • 38 wks, already has twin daughters, 1 son, 1 miscarriage: 5 pregnancies, 3 living children • 5 y/o – Tricycle • Conception – ovulation occurs: 14 days after menstruation • RN should assess which Pt first? 10 hr. cyanosis: blue, cyanotic, hypoxic; stork bite: salmon patch, pink flat appearance; Ortalini’s sign: click or popping sensation hip dislocation, Babinskis & Reflex: normal newborn reflex • 1 wk. full term – hyperbilirubinemia: • 250 micrograms/4 hr. [(250mcg) 0.25mg/1mg X x/mL = 0.25 mL • 12 wks, positive TB, Chest X-ray: Lead apron over pregoabdomen • Laboring Pt – withhold solid food while in labor: Increased risk for aspiration can occur if general anesthesia is needed • Hemo/philia (bleeding problem) – hem/arthr/o/sis – right knee: elevate&immobilize the right knee in a flexed position • 39 wks in L&D – contractions at reg. intervals – miscarriage at 16 wks. – fetal demise (death) at 31 wks.: Gravida3 (pregnant 3 times) • 8 y/o kids go to playroom RN selects a board game • 1 y/o with neuroblastoma: • Child vomits meds. Digoxin: skip dose, give next dose on time. • Gravida 5, Para 5: uterine muscle tone (uterine atony) • 4 y/o with a fracture RT. Ulna – 12 hrs.: Elevate the arm above the level of the heart • 250mg/6 hr.250mg/200mg X x/5mL = 200x=1250/200= 6.25 • UAP – vitals on a Pt with subdural hematoma to report: LOC • Protruding cord: knee to chest position • child with a slipped capital femoral epiphysis: pin & hygiene • 4 month old what to do to prevent diaper rash: use a barrier cream such as zinc oxide that doesnt have to be fully removed • mom with mastitis: start on the unaffected breast first • mother of 18 y/o calls for lab results: must get daughter’s consent • breastfeeding mom wants to avoid having another pregnancy - what do you tell her: use condoms & gel • infant getting phototherapy what do you do: cover their eyes • 6 month old presents for routine vaccine & flu shot: give all immunizations & influenza but alternate site & injection • med to prevent respiratory issues in baby: bethamethasone IM • 15 month breastfeeding & 6 months prego: get nutritional hx • postpartum hemorrhage even after finishing oxytocin infusion: check maternal BP • baby got otitis media after an acute respiratory infection - why do infants get otitis media: shorter eustacian tubes • boy with spine injury after MVA: maintain spine alignment • obesity in teens: what physical activity they do, does school have PE, 3 day diet history from mom • iron supplements: take with meals • preeclamptic woman on Pitocin IV & having contractions 1-2 minutes apart: discontinue pitocin • lyme disease: if a rash presents then get tested • esophageal atresia - highest priority for infant: body temp • baby regurgitating & vomiting - priority: suction mouth & nose • adolescent received an above knee amputation what do you tell them to do every day: inspect the stump daily • woman thinks shes about 6 months pregnant & smokes - how to check for estimated gestational age: ultrasound • 8 month old development you would notice: sitting unassisted • glucose was 800 mg: give IV NS & insulin • Rubella: give after delivery within 72 hours • newborn has swollen tender testicles, you suspect a hydrocele, what do you do: use transillumination to check for fluid • fetal heart rate dropped abruptly in a V formation - what do you do: change mothers position • pregnant woman with a temp of 101 - what can it indicate: chorioamionitis • woman has epidural anesthesia - monitor: maternal HR & BP • prego teens: teach nutrition requirements during pregnancy • transitional phase of labor - most important: assess uterine contractions • infertile couple goes to a fertility doc: allow them to control if they want to stop or go to a support group before the next cycle • school age children - Erikson: industry vs inferiority • child dehydrated - physical findings: weak cry & no tears • pyloric stenosis, what will occur: metabolic alkalosis • to assess for cryptorchidism: warm the hands/room • newborn infant crying, cyanotic & has elevated bp: warm baby • girl with precocious sexual development on LHRH - tell mom: daughter will have similar sexual growth patterns as peers • Source of folic acid: peanuts • mom getting hypotensive on spine board after MVA: roll her on her side on spine board • mom goes to bathroom with contractions 5 min apart - you hear her baby cry: hit call light for help • Iron: dark stool is normal, give at bed time • man calls clinic says his wife has been sad, happy, moody: tell him these are normal hormonal changes • magnesium: stop infusion due to magnesium toxicity • contractions get close & mom is dilated, stop pitocin, then contractions get 5 min apart: restart Ptocin per agency policy • bright red trickling blood: lacerated cervix • teach adolescent pregnant girls: proper nutritional needs • 42 weeks Ballard score: check blood sugar • breast feeding woman asks about birth control: breast feed only every 2-3 hours • rubella vaccine: use birth control for 28 days • baby has white curd patches in mouth: discuss medicine with mother (candidiasis infection) • mom has baby, what is to be expected for first meeting: she reaches out & traces profile with fingertips • HIV positive mom gives birth & is worried about passing it to her baby: explain to mom AZT for the baby after birth • HSV 2, baby born via vaginal delivery: isolate in nursery • hormone for positive pregnancy test: human chorionic gonasotropin (HCG) • is swollen vagina normal in an infant: yes • woman on magnesium sulfate has 800 mL output in 1 hr. what do you do: continue what you are doing • woman has baby in a cab & arrives at hospital, what do you do: start pitocin, massage fundus • woman comes in with abdominal pain: start IV, not type & cross blood • put eye ointment in conjunctival sac of a newborn as prophylactic eye ointment for prevention of eye infections contracted from bacteria in birth canal: ... • mom had a child but now complains of vaginal pain & fullness: check vaginal & perianal area • salt wasting & swollen vagina: normal finding - androgens • -1 placement of baby, mom in active labor, 3 cm dilated, mom has to go to the bathroom: check her cervix • baby born to diabetic mother: check babys blood sugar • PKU baby: 25% any further baby will have it too • baby with clavicle problem: it will have intracurvature • woman who drinks but has cut down: good job & encourage her to reduce even more • woman on radiation iodine: hold off on test to confirm if pregnant or not • fertility drugs: report sudden increase in abdominal girth • breast feeding & sore nipples: start off feeding on unaffected breast • breast feeding mother has a diaphragm: use condom & foam until diaphragm can be refitted • newborn of mom w/ positive drug test: monitor for seizures • baby has apgar of 3: continue recuscitation • baby is jaundiced & brought back to the hospital after 7-10 days: provide eye protection & place under light/phototherapy • Boy with spine injury from diving accident - alignment • Breast feeding mother contraception – condom & contraceptive form and gel • Slipped Capital Femoral Epiphysis– clean pin and incision site • Mother of a 4 month old asks RN for preventing diaper rash - use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change • Missed Digoxin dose, what to do? if less than 4 hrs, give next dose • Which condition would a nurse inform a dr.? – RR 76 (infant) • Mother calls to get her 18 years old daughter’s lab result? – tell her that her daughter’s permission is needed. • One side mastitis – initiate breast feeding with unaffected breast • pCO2 44, …? – normal acid-base balance • mother 6wks prego w/15mons child – ask for daily nutritional habit • Influenza shot – all immunizations, but influenza at another site • Postpartum hemorrhage after finishing oxytocin infusion, which is the most important to tell dr?Maternal BP • A child w/ otitis and URI attending day care, which is the reason why the child get otitis?Children have short euch tube • A woman w/ iron deficiency anemia, vomit and diarrhea after taking iron - Take iron with meal • Tick bite – if rash then test • Newborn w/ esophageal atresia – check temp. • An infant regurgitates…- suction • A girl w/ above know amputation – inspect stump daily • BS 800 K 5 – IV normal saline with insulin • 8 mons old developmental – sitting unassisted • A pregnant woman who smokes doesn’t remember last menstrual date, the best method to check for gestational age – ultrasonography • During delivery, protruding umbilical cord – Knee chest position • Hydrocele – Transillumination w/ red light • A pregnant woman has tenderness w/ palpation & pain gets worse whenever a fetus moves – Chorioamniotitis • Epidural anesthesia – check maternal HR and BP • Teenagers who are pregnant – teach nutrition • 90% effacement 6cm dilation – push 3 times with each contraction? • Variable deceleration “V” fetal HR – change position Nursing actions for variable decelerations: Change maternalposition, Stimulate fetus if indicated, Discontinue oxytocin if infusing, Give O2 at 10 L by tight face mask, Perform a vaginalexamination to check for cord prolapse • Transitional phase – assess for uterine contraction • 4 neonates, which one need to be seen first – Tetralogy of fallot • 9 year old boy – industry (Erikson) • Child with pneumonia – auscultate lungs • Child dehydrate sign – cry without tear • Assessment of cryptorchidism – warm the room • Obese 6 year old girl 75% percentile wt. (SATA): Ask a child’s physical activities, Ask whether the school has physical program, Diet history for last 3 days • Parents think 2 yr old son is different from his sister, abnormal sign? He doesn’t feed himself, I make him eat veggies and meat • A postpartum woman not immunized w/ Rubella, when she can get vaccine?After birth w/in 72 hrs? HESI Hint Rubella is teratogenic to the fetus during the first trimester, causing congenital heart disease, congenital receive the vaccine after delivery and be instructed not to get pregnant within 3 months. Breastfeeding mothers may take the vaccine. P.275 • Which is the understanding of LHRH (luteinizing hormone releasing hormone) for precocious puberty (sexual development)?Your daughter will be grown same as her peers after therapy. • HESI Hint Dystocia frequently requires the use of oxytocin for augmentation or induction of labor. Uterine tetany is a harmful complication, and careful monitoring is required. The desired effect is contractions every 2 to 3minutes, with duration of contractions no longer than 90 seconds. Continuously monitor FHR and uterine resting tone. If tetany occurs, turn off oxytocin (Pitocin), turn client to a side-lying position, O2by face mask. Check output (should be at least 100mL/4hr). Oxytocin’s most important side effect is its antidiuretic (ADH) effect, which can cause water intoxication. Using IVfluids containing electrolytes decreases the risk for water intoxication. P.291 refer p.280 [Show More]

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