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Health Promotion and Maintenance Maternity; Newborn; Growth and Development; Elderly Pediatrics.

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Presentation on theme: "Health Promotion and Maintenance Maternity; Newborn; Growth and Development; Elderly Pediatrics."— Presentation transcript:

1 Health Promotion and Maintenance Maternity; Newborn; Growth and Development; Elderly Pediatrics

2 1. Use Nagele’s rule to estimate the EDC for a patient whose LMP began on October October 11, August 1, July 1, July 8, 2008

3 1. Use Nagele’s rule to estimate the EDC for a patient whose LMP began on October October 11, August 1, July 1, July 8, 2008 Add 7 days to the first day of LMP Subtract 3 months Add One year

4 2. The client has been pregnant 4 times. Her first died in utero at 16 weeks gestation. She delivered one infant at 24 weeks. Twins were born at 36 weeks gestation. The youngest delivered at 41 weeks. This client’s GTPAL would be _____. (G)4,(T)1,(P)3,(A)1,(L)4 Gravidity = # pregnancies Term = # term births Preterm Births = occurring before 40 weeks Abortions/Miscarriages. Living = # live births

5 3. The pregnant client’s hemoglobin and hematocrit levels are 11g/dL and 30g/dL. What is the most appropriate intervention for this client? 1.Administration of 1 unit of packed cells 2.Administration of 1000ml of D5NS with 40 KCL 3.Administration of Epoetin sq QD. 4.No intervention is indicated.

6 3. The pregnant client’s hemoglobin and hematocrit levels are 11g/dL and 30g/dL. What is the most appropriate intervention for this client? 1.Administration of 1 unit of packed cells 2.Administration of 1000ml of D5NS with 40 KCL 3.Administration of Epoetin sq QD. Stimulates RBC production. 4.No intervention is indicated. If drops below Hgb 10 g/dl and/or Hct 30% indicates anemia and need for intervention.

7 4. Which of the following clients requires further teaching regarding nutrition during pregnancy/lactation? 1.Client #1 is at the beginning of her third trimester. She has gained 40 lbs at this point of her pregnancy. 2.Client #2 is at the beginning of the 2 nd trimester. She has increased calories by adding additional servings of fruits and vegetables. 3.Client #3 is in the middle of her 3 rd trimester. She has been feeling “bloated” and “full” over the past few days. She has decided to limit her fluid intake to 8 glasses of water per day to correct this problem. 4.Client #4 has eliminated all foods with folic acid from her diet. She has read that folic acid might cause cancer in laboratory rats.

8 4. Which of the following clients requires further teaching regarding nutrition during pregnancy/lactation? 1.Client #1 is at the beginning of her third trimester. She has gained 30 lbs at this point of her pregnancy lb OK 2.Client #2 is at the beginning of the 2 nd trimester. She has increased calories by adding additional servings of fruits and vegetables. Increase by 300 cal. / day 3.Client #3 is in the middle of her 3 rd trimester. She has been feeling “bloated” and “full” over the past few days. She has decided to limit her fluid intake to 8 glasses of water per day to correct this problem. 8 glasses minimal OK 4.Client #4 has eliminated all foods with folic acid from her diet. She has read that folic acid might cause cancer in laboratory rats. Should consume a diet rich in folic acid.

9 5. The nurse is caring for a client in labor. The FHR has averaged around 150 beats/minute for the past hour. The nurse notices now that as the client’s contraction begins, the FHR begins to decline. The decline returns to the 150 baseline by the end of each contraction. Which nursing intervention is indicated for this deceleration pattern? 1.Continue to monitor the client. 2.Turn the client on her left side. 3.Place the client in the Lithotomy position. 4.Decrease the rate of the Pitocin drip, notify the MD.

10 5. The nurse is caring for a client in labor. The FHR has averaged around 150 beats/minute for the past hour. The nurse notices now that as the client’s contraction begins, the FHR begins to decline. The decline returns to the 150 baseline by the end of each contraction. Which nursing intervention is indicated for this deceleration pattern? 1.Continue to monitor the client. 2.Turn the client on her left side. 3.Place the client in the Lithotomy position. 4.Decrease the rate of the Pitocin drip, notify the MD. Early decelerations

11  Early decelerations: –decr in FHR below baseline –Occur during contractions as fetal head in pressed against the woman's pelvis or soft tissues –Return to baseline by the end of the contraction –Tracing shows uniform shape and mirror image of uterine contractions –Not asso with fetal compromise and require no intervention

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13  Late decelerations: –Nonreassureing patterns –Reflect impaired placental exchange or uteroplacental insufficiency – look similar to early decelerations –Begin well after the contraction begins and return to baseline after the contraction ends –Tx: improve placental bld flow and fetal oxygenation

14  Variable decelerations: –Caused by conditions that restrict Bld flow through the umbilical cord –Do not have uniform appearance –Shape, duration, degree of fall below baseline HR are variable –Fall and rise abruptly with the onset and relief of cord compression –Can appear to be unrelated to contractions –Significant when FHR repeatedly decr to less than 70 and persists at that level for at least 60 seconds.

15

16 Problems with L&D  Dystocia –Difficult, prolonged labor –Excessive abdominal pain, abnormal contraction pattern, fetal distress, lack of progress in labor –Assessment: FHR, uterine contractions, maternal temp and HR –adm prophylactic antibiotics as prescribed, IVF as prescribed –monitor I&O –Monitor color of amniotic fluid

17 Problems with L&D  Prolapsed cord –Compromises fetal circulation –Assessment: mother feeling that something is coming through vagina, visible/palpable umbilical cord –FHR irregular and slow –Fetal monitor shows variable decelerations or bradycardia after rupture of membrane –Fetal hypoxia: violent fetal activity then no/minimal movement –TX:  Relieve cord pressure: extreme Trendelenburg or modified Sims’s, knee-chest  Elevate fetal presenting part (sterile gloved hand apply finger pressure  Monitor FHR  Oxygen to mother  Prepare for emergency C section

18 Problems with L&D  Precipitous L&D –Labor lasting less than 3 hrs –Delivery tray available –Stay with mother –Do not try to keep fetus from being delivered –Asst with delivery if MD unavailable  Preterm Labor –Occurs after 20 th wk but before the 37 th wk of gestation –Contractions occur more frequ than q10 min and last 30 seconds or longer, persist –May be assoc with infection (UTI)

19 Problems with L&D  Premature Rupture of Membranes –Spontaneous rupture of the amniotic membrane before the onset of labor –Gestational age determines the plan –Risk of infection –TX:  tests to assess gestational age,  monitor maternal and fetus status,  adm antibiotics as prescribed

20 Problems with L&D  Rupture of uterus –Complete or incomplete separation of the uterus as a result of tear in the wall of the uterus from the stress of labor –Complete: direct communication betw uterine and peritoneal cavities –Incomplete: rupture into the peritoneum covering the uterus but not the peritoneal cavity –Assessment: abd pain, chest pain, contractions may stop or fail to progress, rigid abdomen, absent FHR, maternal shock, fetus palpated outside uterus –TX: monitor and TX s/s shock (Oxygen, IVF, Bld products) –Prepare for c-section –Emotional support

21 Problems with L&D  Placenta Previa –Improperly implanted placenta in the lower uterine segment –Assessment:  Sudden onset of painless, bright reg vatinal bleedings in the last half of pregnancy  Uterus soft, relaxed, nontender,  Fundal height amy be more than epected for gestational age –Tx:  Monitor maternal v/s, FHR, fetal activity  Ultrasound to confirm dx  No vaginal exam  Bedrest in a side-lying postion  Montor bleeding, tx s/s shock  Adm IVF, bld products, tocolytic medicaitons  Perhaps c section

22 Abruptio Placentae  Premature separation of the placenta from the uterine wall after the 20 th wk of gestation and before the fetus is delivered  Assessment: –Dark red vaginal bleeding…or absence of Bld if bleed is higher in the uterus –Uterine pain/tenderness –Uterine rigidity –Severe abd pain –Signs of fetal distress –s/s maternal shock (excessive bleeding)  Tx: –Monitor maternal v/s and FHR –Assess vaginal Bld, abd pain, incr in fundal ht –Bedrest, oxygen, IVF, blood products –Trendelenburg’s position if indicated to decr pressure of fetus on placenta or lateral position with HOB flat if shock occurs –Monitor for s/s of disseminated intravascular coagulation

23 Amniotic Fluid Embolism  Escape of amniotic fluid into the maternal circulation  Debris-containing amniotic fluid deposits in the pulmonary arterioles and is usu fatal to mother  Assessment: –abrupt onset of resp distress and chest pain –Cyanosis, seizures, heart failure, PE  TX –Emergency measures to maintain life –Oxygen –Prepare for intubation and mechanical ventilation –Position mother lateral –IVF, Bld products, medications to correct coagulation failure –Monitor fetal status –Prepare for emergency delivery once the woman is stable

24 Problems with L&D Supine hypotensive syndrome  Venous return to the heart impaired by the wt of the fetus  Assessment: –faintness, light-headedness, dizziness –Hypotension –fetal distress  TX: –Left lateral recumbent –Monitor v/s and FHR

25 Problems with L&D  Fetal Distress –Assessment:  FHR less than 120 or greater than 160  Meconium-stained amniotic fluid  Fetal hyperactivity  Progressive decr in baseline variability  Severe variable decelerations  Late decelerations –TX:  Position mother lateral position  Oxygen (8-10 L via face mask)  d/c oxytocin  Monitor…

26 6. The FHR has been 105 for 15 minutes. Select the appropriate actions for the nurse: 1.Increase the rate of the Pitocin drip. 2.Turn the client to her side. 3.Notify the MD. 4.Administer facemask oxygen at 8 L/minute. 5.Elevate the foot of the bed.

27 6. The FHR has been 105 for 15 minutes. Select the appropriate actions for the nurse: 1.Increase the rate of the Pitocin drip. 2.Turn the client to her side. 3.Notify the MD. 4.Administer facemask oxygen at 8 L/minute. 5.Elevate the foot of the bed.

28 7. Which change in the FHR described below would necessitate a nursing intervention? 1.The FHR goes from 145 to 155 when a vaginal exam is performed on the mother. 2.The FHR goes from 145 to 143 as the mother’s contraction begins. 3.The FHR goes from 145 to 142 after the mother’s contraction begins. 4.The FHR goes from 145 to 160 as the fetus moves about in the uterus.

29 7. Which change in the FHR described below would necessitate a nursing intervention? 1.The FHR goes from 145 to 155 when a vaginal exam is performed on the mother. Normal acceleration 2.The FHR goes from 145 to 143 as the mother’s contraction begins. Early deceleration 3.The FHR goes from 145 to 142 after the mother’s contraction begins. Late deceleration 4.The FHR goes from 145 to 160 as the fetus moves about in the uterus. Normal acceleration

30 8. The nurse is caring for a client in labor. Her BP is 70/52. What nursing action is indicated first? 1.Turn her on her left side. 2.Administer facemask oxygen. 3.Notify MD. 4.Monitor FHR.

31 8. The nurse is caring for a client in labor. Her BP is 70/52. What nursing action is indicated first? 1.Turn her on her left side. 2.Administer facemask oxygen. 3.Notify MD. 4.Monitor FHR.

32 9. The nurse has just received report from the night shift. Which of the following postpartum clients should the nurse see first? 1.The client in room #1 who is complaining of pain secondary to breast engorgement. 2.The client in room #2 who is 24 hours post caesarian section and needs assistance to ambulate. 3.The client in room #3 who has not voided since delivery at 2 AM. 4.The client in room #4 who delivered 24 hours ago and continues to have rubra described as bright red.

33 9. The nurse has just received report from the night shift. Which of the following postpartum clients should the nurse see first? 1.The client in room #1 who is complaining of pain secondary to breast engorgement. psychosocial 2.The client in room #2 who is 24 hours post caesarian section and needs assistance to ambulate. Not an acute need 3.The client in room #3 who has not voided since delivery at 2 AM. 4.The client in room #4 who delivered 24 hours ago and continues to have rubra described as bright red. See 2 nd – no info to indicate acute need.

34 Newborn, Concepts r/t G&D

35 10.All of the following interventions are indicated during the initial care of a newborn. Sequence the interventions as appropriate immediately following the birth: 1.Position newborn on his side. 2.Dry newborn and stimulate crying by rubbing. 3.Wrap newborn in warm blankets. 4.Suction mouth and nares with bulb syringe.

36 10.All of the following interventions are indicated during the initial care of a newborn. Sequence the interventions as appropriate immediately following the birth: 1.Position newborn on his side… 4 2.Dry newborn and stimulate crying by rubbing…. 2 3.Wrap newborn in warm blankets…. 3 4.Suction mouth and nares with bulb syringe… 1

37 11.The newborn’s initial Apgar score is 8. What nursing interventions are indicated? 1.Rub the infant’s back. 2.Tickle the infant’ s feet. 3.Administer nasal cannula oxygen at 2L/min. 4.Place the infant on his side.

38 11.The newborn’s initial Apgar score is 8. What nursing interventions are indicated? 1.Rub the infant’s back. 2.Tickle the infant’ s feet. 3.Administer nasal cannula oxygen at 2L/min. 4.Place the infant on his side. Apgar of 8-10 OK and no intervention is indicated.

39 12.Which of the following sets of vital signs would be considered to be within normal limits for a newborn? 1.HR90, R32, Axillary Temp. 99 degrees F. 2.HR 110, R45, Axillary Temp. 99 degrees F. 3.HR152, R20, Axillary Temp degrees F. 4.HR98, R16, Axillary Temp. 100 degrees F.

40 12.Which of the following sets of vital signs would be considered to be within normal limits for a newborn? 1.HR90, R32, Axillary Temp. 99 degrees F. 2.HR 110, R45, Axillary Temp. 99 degrees F. 3.HR152, R20, Axillary Temp degrees F. 4.HR98, R16, Axillary Temp. 100 degrees F.

41 Normal newborn vital signs HR , Resp , Axillary temp degrees F BP 73/55.

42 13. Vitamin K is prescribed for a neonate. The nurse prepares the medication and selects which muscle site to administer the medication? 1.Deltoid 2.Triceps 3.Vastus lateralis 4.Biceps

43 13. Vitamin K is prescribed for a neonate. The nurse prepares the medication and selects which muscle site to administer the medication? 1.Deltoid 2.Triceps 3.Vastus lateralis 4.Biceps

44 14.Magnesium sulfate is being used in a client diagnosed with preeclampsia. Assessment of the client reveals respirations of 8, sluggish reflexes, and a HR of 42. Which intervention described below would be appropriate? 1.Increase the dosage of Magnesium sulfate. 2.Administer calcium gluconate. 3.Turn the client on her right side. 4.Elevate the foot of the bed.

45 14.Magnesium sulfate is being used in a client diagnosed with preeclampsia. Assessment of the client reveals respirations of 8, sluggish reflexes, and a HR of 42. Which intervention described below would be appropriate? 1.Increase the dosage of Magnesium sulfate. 2.Administer calcium gluconate. s/s of magnesium toxicity…Ca gluconate raises Ca levels and therefore decr Magnesium level 3.Turn the client on her right side. 4.Elevate the foot of the bed.

46 15.Which of the following represents a developmental task of a 13 year old girl? 1.Jane reminisces about the major events of her life. 2.Mary is looking for some one to share her life with. 3.Jennifer enjoys working on service projects with the other members of her girl scout troop. 4.Lilly is trying hard to improve her grades in Math.

47 15.Which of the following represents a developmental task of a 13 year old girl? 1.Jane reminisces about the major events of her life...Later (65 yrs +) 2.Mary is looking for some one to share her life with …Early adulthood(20-35yrs) 3.Jennifer enjoys working on service projects with the other members of her girl scout troop...Adolescence (12- 20yrs) 4.Lilly is trying hard to improve her grades in Math...School Age (6-12yrs)

48 16.The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. The most appropriate nursing response would be which of the following? 1.“You need to be concerned.” 2.“You need to monitor the child’s behavior closely.” 3.“At this age the child is developing his own personality.” 4.“You need to provide more praise to the child to stop this behavior.”

49 16.The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because the child seems to be more attentive to friends than anything else. The most appropriate nursing response would be which of the following? 1.“You need to be concerned.” 2.“You need to monitor the child’s behavior closely.” 3.“At this age the child is developing his own personality.” 4.“You need to provide more praise to the child to stop this behavior.”

50 17.Which patient described below would experience the greatest distress when separated from his parent(s)? 1.Joshua who is 18 months old and the youngest of three children. 2.Jonathon who is 4 years old and is the oldest of 2 children. 3.Michael who is 10 years old and is the second of three children in his family. 4.Michael who is 13 years old and is an only child.

51 17.Which patient described below would experience the greatest distress when separated from his parent(s)? 1.Joshua who is 18 months old and the youngest of three children. 2.Jonathon who is 4 years old and is the oldest of 2 children. 3.Michael who is 10 years old and is the second of three children in his family. 4.Michael who is 13 years old and is an only child… might not experience at all…

52 18. Select the statement below that is true regarding the use of Vitamin K (Aquamephyton) with a neonate. 1.This medication should be administered at the 1 week check up. 2.Vitamin K is light activated and must be placed in direct sunlight 1 hour prior to administration. 3.Vitamin K is administered in the deltoid. 4.Vitamin K can precipitate hyperbilirubinemia in the newborn.

53 18. Select the statement below that is true regarding the use of Vitamin K (Aquamephyton) with a neonate. 1.This medication should be administered at the 1 week check up. …early neonatal period… 2.Vitamin K is light activated and must be placed in direct sunlight 1 hour prior to administration...light sensitive… 3.Vitamin K is administered in the deltoid. …vastis lateralis… 4.Vitamin K can precipitate hyperbilirubinemia in the newborn.

54 19. A mother calls for assistance in picking a formula for her 6 month old. Which of the following is her BEST choice? 1.Soy-based formula 2.Whole milk fortified with iron 3.2% milk 4.Iron-fortified formula

55 19. A mother calls for assistance in picking a formula for her 6 month old. Which of the following is her BEST choice? 1.Soy-based formula 2.Whole milk fortified with iron 3.2% milk 4.Iron-fortified formula

56 20. The parents of a 10 month old who weighs 38 pounds are seeking advice regarding a car seat. Which of the following is a true statement? 1.This child should travel in a semi-reclined rear-facing car seat. 2.This child should travel in a front-facing car seat, strapped into the back seat. 3.This child should travel in a toddler booster seat. 4.This child weighs enough to travel without a car seat of any type – he just needs to be buckled in with the vehicles’ seat belts.

57 20. The parents of a 10 month old who weighs 38 pounds are seeking advice regarding a car seat. Which of the following is a true statement? 1.This child should travel in a semi-reclined rear-facing car seat. Travel in a semi reclined, rear-facing position until they weigh at least 20 lbs and have reached at least 1 year of age. 2.This child should travel in a front-facing car seat, strapped into the back seat. 3.This child should travel in a toddler booster seat. 4.This child weighs enough to travel without a car seat of any type – he just needs to be buckled in with the vehicles’ seat belts.

58 21.The RN is supervising a nursing student who is caring for a 4 year old girl. Which scenario described below indicates that the student needs to review growth and development concepts r/t the care of the child? 1.The child is allowed to wear her Barbie panties. 2.The nursing student sits and listens as the child talks to her. 3.The nursing student allows the child to play with other 4 year olds in the playroom. 4.The nursing student encourages the child’s parents to leave the hospital for the night so that the child can become more independent.

59 21.The RN is supervising a nursing student who is caring for a 4 year old girl. Which scenario described below indicates that the student needs to review growth and development concepts r/t the care of the child? 1.The child is allowed to wear her Barbie panties. 2.The nursing student sits and listens as the child talks to her. 3.The nursing student allows the child to play with other 4 year olds in the playroom. 4.The nursing student encourages the child’s parents to leave the hospital for the night so that the child can become more independent.

60 22.Select the nursing interventions below that would be appropriate when caring for an 8 year old child. Select all that apply: 1.Encourage the child’s parents to stay with the child. 2.Allow the child to assist with the completion of the dietary menu for the next day. 3.Facilitate contact with friends from school. 4.Allow the child to perform ADL’s according to his abilities. 5.Do not explain procedures, tell the child shortly before the procedure is to be performed to decrease anxiety. 6.Minimize the use of pain control therapies to prevent masking of symptoms.

61 22.Select the nursing interventions below that would be appropriate when caring for an 8 year old child. Select all that apply: 1.Encourage the child’s parents to stay with the child. 2.Allow the child to assist with the completion of the dietary menu for the next day. 3.Facilitate contact with friends from school. 4.Allow the child to perform ADL’s according to his abilities. 5.Do not explain procedures, tell the child shortly before the procedure is to be performed to decrease anxiety. 6.Minimize the use of pain control therapies to prevent masking of symptoms.

62 23.Which of the following is not a true statement about nutrition for an infant? 1.An 8 month old can be offered rice cereal. 2.Yellow fruits should be the first fruit introduced. 3.Popcorn can be introduced as a snack food at 6 months. 4.Peanuts should be avoided.

63 23.Which of the following is not a true statement about nutrition for an infant? 1.An 8 month old can be offered rice cereal….solid fds introduced at 6 months… 2.Yellow fruits should be the first fruit introduced….yes, rice cereal, then yellow fruits/veges, then green… 3.Popcorn can be introduced as a snack food at 6 months….choking hazard … 4.Peanuts should be avoided….choking hazard…

64 Elderly

65 24.Which of the following assessment findings occur as part of the physiological process of aging. Select all that apply. 1.Skin turgor is elastic. 2.The client is unable to remember events that occurred yesterday. 3.The client is unable to remember events that occurred 10 years ago. 4.Range of motion is decreased for the upper and lower extremities. 5.Peripheral pulses are weak. 6.Increased need for calories.

66 24.Which of the following assessment findings occur as part of the physiological process of aging. Select all that apply. 1.Skin turgor is elastic. 2.The client is unable to remember events that occurred yesterday. 3.The client is unable to remember events that occurred 10 years ago…long term memory intact… 4.Range of motion is decreased for the upper and lower extremities. 5.Peripheral pulses are weak. 6.Increased need for calories…Caloric needs decrease…

67 25.Mrs. M. brings her 85 year old father to the emergency room because he suddenly became confused and disoriented last night. Each alternative below provides a piece of his medical history. Which is most likely related to his change in mental status? 1.history of heart disease 2.History of rheumatoid arthritis 3.takes Digoxin every day. 4.M.D. started him on a new NSAID for arthritis two days ago.

68 25.Mrs. M. brings her 85 year old father to the emergency room because he suddenly became confused and disoriented last night. Each alternative below provides a piece of his medical history. Which is most likely related to his change in mental status? 1.history of heart disease 2.History of rheumatoid arthritis 3.takes Digoxin every day. 4.M.D. started him on a new NSAID for arthritis two days ago.

69 Pediatrics

70 26.The parents of a 2 year old are about to purchase a vaporizer for their child’s room. What information described below is most important for the nurse to convey to the parents? 1.Vaporizers poise a risk of infection if not cleaned properly. 2.Steam vaporizers are ideal because they optimize the distribution of vapor. 3.Cool vaporizers should be used instead of steam to prevent burn injuries. 4.Cool vaporizers are ideal because they optimize the distribution of vapor.

71 26.The parents of a 2 year old are about to purchase a vaporizer for their child’s room. What information described below is most important for the nurse to convey to the parents? 1.Vaporizers poise a risk of infection if not cleaned properly. 2.Steam vaporizers are ideal because they optimize the distribution of vapor. 3.Cool vaporizers should be used instead of steam to prevent burn injuries. 4.Cool vaporizers are ideal because they optimize the distribution of vapor.

72 27.The nurse is caring for a 5 year old admitted with a head injury. Which of the following is the earliest sign of an increase in intracranial pressure? 1.Headache 2.Diplopia 3.Nausea 4.Change in the level of consciousness

73 27.The nurse is caring for a 5 year old admitted with a head injury. Which of the following is the earliest sign of an increase in intracranial pressure? 1.Headache 2.Diplopia 3.Nausea 4.Change in the level of consciousness

74 28.Which of the following is the BEST position for a child who has a head injury? 1.Left side 2.Semi-fowlers 3.Fowlers 4.supine

75 28.Which of the following is the BEST position for a child who has a head injury? 1.Left side 2.Semi-fowlers 3.Fowlers 4.supine

76 29.The nurse is caring for a patient who is postop placement of a ventriculoperitoneal shunt on the left side of his head. How should this child be positioned postop? 1.Supine, Head of bed elevated 40 degrees. 2.Prone, Head of the bed flat. 3.Laterally on the left side, head of bed flat. 4.Laterally on the right side, head of bed flat.

77 29.The nurse is caring for a patient who is postop placement of a ventriculoperitoneal shunt on the left side of his head. How should this child be positioned postop? 1.Supine, Head of bed elevated 40 degrees. 2.Prone, Head of the bed flat. 3.Laterally on the left side, head of bed flat. 4.Laterally on the right side, head of bed flat. Unoperative side to prevent pressure on the shunt, flat to prevent rapid reduction of intracranial fluid.

78 30.An eight year old diagnosed with conjunctivitis is preparing for discharge. Which statement, if made by his mother, would indicate the need for more teaching? 1.“His father and I will be careful to not share towels with him”. 2.“He can return to school today as long as he receives his first dose of medication before returning to school.” 3.“Warm compresses will lesson his discomfort.” 4.“He cannot wear contacts until the infection clears”.

79 30.An eight year old diagnosed with conjunctivitis is preparing for discharge. Which statement, if made by his mother, would indicate the need for more teaching? 1.“His father and I will be careful to not share towels with him”. 2.“He can return to school today as long as he receives his first dose of medication before returning to school.” Should be kept home form school or day care until antibiotic eye drops have been adm for 24 hrs. 3.“Warm compresses will lesson his discomfort.” 4.“He cannot wear contacts until the infection clears”.

80 31. Which of the following is the best method for administering ear drops to a 2 year old? 1.Position the child side-lying with the affected ear up, administer the drops directly into the ear. 2.Position the child prone, pull the pinna up and back. 3.Sit the child in the mother’s lap, pull the pinna toward the back of the head. 4.Pull the pinna down and back.

81 31. Which of the following is the best method for administering ear drops to a 2 year old? 1.Position the child side-lying with the affected ear up, administer the drops directly into the ear. Must reposition pinna 2.Position the child prone, pull the pinna up and back. Up and back if older than 3 years 3.Sit the child in the mother’s lap, pull the pinna toward the back of the head. Close…must include “down” 4.Pull the pinna down and back.

82 32.A 4 year old child and his mother have received discharge instructions post surgical placement of tympanoplasty tubes. Which statement below, if made by the mother, indicates that further teaching is necessary? 1.He must wear earplugs when I wash his hair. 2.He can go swimming this summer if he wears earplugs. 3.I have to be careful to not get water in his ears for the next 6 months. 4.He cannot swim on the bottom of the pool even with his earplugs in.

83 32.A 4 year old child and his mother have received discharge instructions post surgical placement of tympanoplasty tubes. Which statement below, if made by the mother, indicates that further teaching is necessary? 1.He must wear earplugs when I wash his hair. true 2.He can go swimming this summer if he wears earplugs. true 3.I have to be careful to not get water in his ears for the next 6 months. Careful of water in ears until tubes are no longer in place 4.He cannot swim on the bottom of the pool even with his earplugs in. true

84 33.What is the drug of choice for a child who has had a tonsillectomy and is experiencing a sore throat postop? 1.Advil 2.Aspirin 3.Codeine 4.Tylenol

85 33.What is the drug of choice for a child who has had a tonsillectomy and is experiencing a sore throat postop? 1.Advil 2.Aspirin 3.Codeine 4.Tylenol drug of choice …avoid red liqu which simulates the appearance of blood if the child vomits.

86 34.The RN is caring for a child who is 4 hours postop tonsillectomy. Which of the following actions indicate that this nurse needs further review regarding the postop care of this type patient? Select All that apply: 1.The child is positioned prone. 2.The child is allowed to drink cool milk. 3.The child is not allowed to use straws. 4.The child is allowed to drink room temperature cherry Kool-Aid. 5.The child’s vital signs are assess every 4 hours as ordered by the MD.

87 34.The RN is caring for a child who is 4 hours postop tonsillectomy. Which of the following actions indicate that this nurse needs further review regarding the postop care of this type patient? Select All that apply: 1.The child is positioned prone true…or sidelying is OK 2.The child is allowed to drink cool milk. No, milk products coat the throat. 3.The child is not allowed to use straws true …no straws, forks, sharp objects… 4.The child is allowed to drink room temperature cherry Kool-Aid no …Red liquid… 5.The child’s vital signs are assess every 4 hours as ordered by the MD true …monitoring for s/s of infection

88 35.Which of the following calls should the RN return first? 1.The parent describes the child’s cough as “sounding like a seal”. 2.The child is 72 postop tonsillectomy and continues to refuse fluids because her “throat hurts”. 3.The child has had an upper respiratory infection for 2 days and now has a temp of 101 degrees F. and is complaining of an earache. 4.The child has clear drainage from the left eye, the eye is red, and the child complains that it “itches”.

89 35.Which of the following calls should the RN return first? 1.The parent describes the child’s cough as “sounding like a seal”. Indicative of Inspiratory stridor…ABC’s 2.The child is 72 postop tonsillectomy and continues to refuse fluids because her “throat hurts”. Maslow’s Hierarchy…potential for fluid volume deficit 3.The child has had an upper respiratory infection for 2 days and now has a temp of 101 degrees F. and is complaining of an earache. Upper resp could be significant…but deal with most acute actual problem first. 4.The child has clear drainage from the left eye, the eye is red, and the child complains that it “itches”.

90 36.Which of the following is a true statement regarding Tuberculosis? 1.If the Mantoux test is negative 1 week after exposure then the individual was not infected. 2.A definitive diagnosis of Tuberculosis is made with a positive Chest X-ray. 3.A child infected with Tuberculosis will most likely be required to take isoniazid, rifampin, and pyrazinamide daily for 2 months. 4.Children infected with Tuberculosis are placed on airborne precautions until the medication regime has been completed.

91 36.Which of the following is a true statement regarding Tuberculosis? 1.If the Mantoux test is negative 1 week after exposure then the individual was not infected … weeks… 2.A definitive diagnosis of Tuberculosis is made with a positive Chest X-ray. …Positive sputum culture… 3.A child infected with Tuberculosis will most likely be required to take isoniazid, rifampin, and pyrazinamide daily for 2 months. Then isoniazid and rifampin twice weekly for 4 months 4.Children infected with Tuberculosis are placed on airborne precautions until the medication regime has been completed. …meds initiated, sputum cultures demo improvement, cough improves…

92 37.The nurse continues to monitor a 5 year old who is admitted because of an acute exacerbation of her asthma. Which assessment finding below would necessitate an immediate intervention? 1.Wheezing is not heard on auscultation. 2.Lips are dark red. 3.Episodes of coughing occur with minimal exertion. 4.Percussion of the lower chest reveals hyperresonance.

93 37.The nurse continues to monitor a 5 year old who is admitted because of an acute exacerbation of her asthma. Which assessment finding below would necessitate an immediate intervention? 1.Wheezing is not heard on auscultation. Suggest that the condition has worsened 2.Lips are dark red. 3.Episodes of coughing occur with minimal exertion. 4.Percussion of the lower chest reveals hyperresonance.

94 38.The MD has prescribed chest physiotherapy ad lib for a child who is experiencing an acute asthmatic episode. When should this therapy be begun? 1.Immediately 2.During an acute episode of coughing 3.After an acute episode of coughing 4.After the symptoms of the acute episode have diminished and the child is improving.

95 38.The MD has prescribed chest physiotherapy ad lib for a child who is experiencing an acute asthmatic episode. When should this therapy be begun? 1.Immediately could exacerbate the attack 2.During an acute episode of coughing 3.After an acute episode of coughing 4.After the symptoms of the acute episode have diminished and the child is improving.

96 39.A child with cystic fibrosis has been admitted to the pediatric unit. Which assessment finding(s) below would be consistent with this diagnosis? 1.Clubbing of the toes. 2.Multiple bruises over the arms and legs. 3.Steatorrhea. 4.Negative Sweat Chloride test. 5.Signs/symptoms of emphysema. 6.Brisk refill of the nail beds of the fingers.

97 39.A child with cystic fibrosis has been admitted to the pediatric unit. Which assessment finding(s) below would be consistent with this diagnosis? 1.Clubbing of the toes. …chronic hypoxia 2.Multiple bruises over the arms and legs. …Deficiency of fat-soluble vitamins (ADEK)… 3.Steatorrhea. ….deficiency of fat-soluble vitamins – frothy, foul-smelling… 4.Negative Sweat Chloride test. Positive sweat chloride test 5.Signs/symptoms of emphysema. …thick secretions obstruct airway – trap air… 6.Brisk refill of the nail beds of the fingers. Sluggish refil

98 40.The RN is caring for an infant who is experiencing the following signs/symptoms: HR 200, R 92, scalp sweating, suprasternal retractions. Which intervention listed below is indicated in the care of this infant? 1.Assess carotid pulse every 30 minutes. 2.Weigh diapers. 3.Position the infant supine with head of bed in high-fowlers. 4.Awaken the infant every hour for neuro checks.

99 40.The RN is caring for an infant who is experiencing the following signs/symptoms: HR 200, R 90, scalp sweating, suprasternal retractions. Which intervention listed below is indicated in the care of this infant? 1.Assess carotid pulse every 30 minutes. …apical pulse, count for full minute… 2.Weigh diapers. …I and O 3.Position the infant supine with head of bed in high- fowlers. …semi-fowlers… 4.Awaken the infant every hour for neuro checks. …Needs periods of uninterrupted sleep… Infant has signs of CHF

100 41.A student nurse is preparing to administer Digoxin to an infant. Which of the following would indicate that this student needs further teaching regarding this drug? 1.The student questions the MD’s prescribed dosage of 5 mg. 2.The medication is administered 60 minutes ac. 3.Oral care is performed immediately post medication administration. 4.The student nurse notes that she is 5 hours late administering this medication. She administers the medication and changes the time for the next dosage.

101 41.A student nurse is preparing to administer Digoxin to an infant. Which of the following would indicate that this student needs further teaching regarding this drug? 1.The student questions the MD’s prescribed dosage of 5 mg. …0.05mg normal infant dose… 2.The medication is administered 60 minutes ac. 3.Oral care is performed immediately post medication administration. 4.The student nurse notes that she is 5 hours late administering this medication. She administers the medication and changes the time for the next dosage. … skip missed dose if over 4 hours late…

102 Cardiac Defects Increased Pulmonary Blood Flow (ASD, VSD, Atrioventircular canal defect, Patent ductus)…s/s CHF Obstructive Defects (Coarctation of the aorta, Aortic Stenosis, Pulmonary Stenosis) …s/s CHF Decreased Pulmonary Blood Flow (ASD, VSD, Tetralogy of Fallot, Tricuspid atresia, )….s/s hypoxemia, cyanosis Mixed Defects (Transposition, etc.)

103 42.The RN is supervising the feeding of an infant with a cleft palate. Which behavior, if observed below, would necessitate an intervention by the nurse? 1.The opening of the nipple is enlarged. 2.The child is positioned in high Fowler’s position for the feeding. 3.The child is fed small amounts and then burped every 5-10 minutes. 4.The child is positioned prone after the feeding.

104 42.The RN is supervising the feeding of an infant with a cleft palate. Which behavior, if observed below, would necessitate an intervention by the nurse? 1.The opening of the nipple is enlarged. ESSR method of feeding (enlarge the nipple, stimulate suck reflex, swallow, rest to allow child to finish swallowing) 2.The child is positioned in high Fowler’s position for the feeding. Hold upright and direct feeding to side and back of mouth to prevent aspiration. 3.The child is fed small amounts and then burped every 5-10 minutes. ESSR method…must allow time for swallowing 4.The child is positioned prone after the feeding. Position child upright

105 43.The RN is assessing the lunch tray that has been prepared for a child with Celiac Disease. Which of the following trays would be suitable for this child? 1.Cheeseburger on whole wheat bun, fruit salad, glass of milk. 2.Fish fillet, french fries, sliced cantaloupe, chocolate milkshake. 3.Spaghetti with meat sauce, watermelon, ice cream, glass of orange juice. 4.Chicken leg, corn on the cob, apple, glass of milk.

106 43.The RN is assessing the lunch tray that has been prepared for a child with Celiac Disease. Which of the following trays would be suitable for this child? 1.Cheeseburger on whole wheat bun, fruit salad, glass of milk. …bun with cheeseburger… 2.Fish fillet, french fries, sliced cantaloupe, chocolate milkshake....french fries, milkshake not sure… 3.Spaghetti with meat sauce, watermelon, ice cream, glass of orange juice... …spaghetti, ice cream…. 4.Chicken leg, corn on the cob, apple, glass of milk.

107 44.Which of the following is a true statement about Phenylketonuria? 1.All newborns should be screened before they have begun formula or breast milk feedings. 2.If initial screening is positive, dietary restrictions are implemented immediately. 3.If the initial screening was before the child was 48 hours old, the child should be rescreened in 2 weeks. 4.Individuals with Phenylketonuria cannot eat fruits.

108 44.Which of the following is a true statement about Phenylketonuria? 1.All newborns should be screened before they have begun formula or breast milk feedings. Must have begun formula or breast milk feeding before specimen collection 2.If initial screening is positive, dietary restrictions are implemented immediately. Always repeat test and perform further diagnostic evaluation 3.If the initial screening was before the child was 48 hours old, the child should be rescreened in 2 weeks. true 4.Individuals with Phenylketonuria cannot eat fruits. … fruits OK - no protein …

109 45.The 13 year old girl in room 411 has been admitted in sickle cell crisis. Which of the following does the RN anticipate as part of her prescribed plan of care? 1.Minimize the use of prn pain medication as these drugs can be addictive. 2.Limit fluid intake to 200 ml/shift. 3.Position the child so that she is in a comfortable position with extremities extended. 4.Assist the child to select dietary items that are low-calorie, low protein..

110 45.The 13 year old girl in room 411 has been admitted in sickle cell crisis. Which of the following does the RN anticipate as part of her prescribed plan of care? 1.Minimize the use of prn pain medication as these drugs can be addictive. Not true: Pain is subjective experience…pain control important for these pts – avoid use of Demerol 2.Limit fluid intake to 200 ml/shift. Not true: Promote fluid intake 3.Position the child so that she is in a comfortable position with extremities extended. 4.Assist the child to select dietary items that are low- calorie, low protein. Not true: Promote high calorie, high protein

111 46.Which of the following is a true statement regarding the administration of iron supplements? 1.Iron supplements should be taken with fruit juices. 2.Iron supplements should be taken with milk. 3.Liquid iron supplements should be administered via a nasogastric tube. 4.Iron supplements should be administered with meals.

112 46.Which of the following is a true statement regarding the administration of iron supplements? 1.Iron supplements should be taken with fruit juices. …Vit. C promotes absorption 2.Iron supplements should be taken with milk. … Calcium interferes with absorption… 3.Liquid iron supplements should be administered via a nasogastric tube. …NGT not needed… 4.Iron supplements should be administered with meals. … between meals for maximum absorption

113 47.Medication B 5 mg/kg/day is prescribed PO BID for Little Lisa. Lisa weighs 44 pounds. Calculate Lisa’s AM dose if the medication is supplied in a 10mg/ml solution. First calculation mg/day. 5 mg/1kg = x mg to a child who weighs 44 pounds. 5 mg/1kg = x mg /20 kg; cross multiply: 100= mg/day

114 47.Medication B 5 mg/kg/day is prescribed PO BID for Little Lisa. Lisa weighs 44 pounds. Calculate Lisa’s AM dose if the medication is supplied in a 10 ml/ml solution. Next calculate mg/dose. 100 mg divided by # doses in 24 hours = 50 mg/dose.

115 47.Medication B 5 mg/kg/day is prescribed PO BID for Little Lisa. Lisa weighs 44 pounds. Calculate Lisa’s AM dose if the medication is supplied in a 10 mg/ml solution. First calculation mg/day. 5 mg/1kg = x mg to a child who weighs 44 pounds. 44lbs/xkg = 2.2lbs = 1 kg; x = 20 kg 5 mg/1kg = x mg /20 kg; cross multiply: 100= mg/day Next calculate mg/dose. 100 mg divided by # doses in 24 hours (BID=2 doses) = 50 mg/dose. Finally calculate ml to administer: 50 mg/x ml = 10 mg/ml solution. 5 ml.

116 48.Larry weighs 22 lbs and is to receive Drug W QID. The proper dosage is 20 mg/kg/day. Calculate his per dose dosage if the medication is supplied as an 10 mg/ml solution.

117 Mg/day: ( 22 lbs/x kg = 2.2 lbs\1 kg…. 10 kg) 20mg/1 kg = x mg\10 kg. 200 mg/day. Mg/dose: 200 divided by 4 = 50 mg/dose.

118 48.Larry weighs 22 lbs and is to receive Drug W QID. The proper dosage is 20 mg/kg/day. Calculate his per dose dosage if the medication is supplied as an 10 mg/ml solution. 50 mg/x ml = 10 mg/1ml 5 ml

119 49.Which of the following would be the most appropriate meal for a child with HIV or AIDS? 1.Baked chicken, green beans, apple 2.Roast Beef, fruit salad, water 3.Cheeseburger, cheese fries, milkshake. 4.Salad with low calorie dressing, cantaloupe, water.

120 49.Which of the following would be the most appropriate meal for a child with HIV or AIDS? 1.Baked chicken, green beans, apple 2.Roast Beef, fruit salad, water 3.Cheeseburger, cheese fries, milkshake. 4.Salad with low calorie dressing, cantaloupe, water. High calorie, high protein

121 50.The parents of a child with HIV have just completed an educational seminar on caring for a child with HIV. Which statement, if made by the parents, indicates that they understand this material? 1.“We’ll keep her home from school when she’s sick”. 2.“Her eating utensils will have to be soaked in bleach for 15 minutes after use.” 3.“ She should receive the vaccine for varicella (chickenpox)”. 4.“We can never kiss our child.”

122 50.The parents of a child with HIV have just completed an educational seminar on caring for a child with HIV. Which statement, if made by the parents, indicates that they understand this material? 1.“We’ll keep her home from school when she’s sick”. 2.“Her eating utensils will have to be soaked in bleach for 15 minutes after use.”.. dishwasher OK… 3.“ She should receive the vaccine for varicella (chickenpox)”. …no, but keep others UTD… 4.“We can never kiss our child.”..not on mouth…

123 51.A child who is immediately postop removal of a supratentorial brain tumor should be place in which of the following positions? 1.Lateral on the unoperative side, HOB flat. 2.Lateral on the operative side, HOB flat. 3.Lateral on the unoperataive side, HOB 20 degrees elevated. 4.Lateral on the operative side, HOB 20 degrees elevated.

124 51.A child who is immediately postop removal of a supratentorial brain tumor should be place in which of the following positions? 1.Lateral on the unoperative side, HOB flat. Not flat…HOB at least 15 degrees to allow for ICP 2.Lateral on the operative side, HOB flat. Not flat…HOB at least 15 degrees to allow for ICP 3.Lateral on the unoperataive side, HOB 20 degrees elevated. 4.Lateral on the operative side, HOB 20 degrees elevated. These pts have large dressing on operative side – do not position on operative side.

125 52.The child in bed 2 is postop removal of a brainstem tumor. Which of the following represents the BEST position for this patient? 1.Supine, HOB elevated 45 degrees 2.Lateral, HOB elevated 20 degrees 3.Sims position, HOB elevated 90 degrees 4.Lateral, HOB flat.

126 52.The child in bed 2 is postop removal of a brainstem tumor. Which of the following represents the BEST position for this patient? 1.Supine, HOB elevated 45 degrees 2.Lateral, HOB elevated 20 degrees 3.Sims position, HOB elevated 90 degrees 4.Lateral, HOB flat. Infratentorial tumor…postop position with HOB flat to promote cerebral perfusion.


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