Nursing 226 Maternity and Pediatric Nursing Exam 2
- The nurse is counseling the parents of an infant who developed a chronic lung disease during their stay in the intensive care unit. One of the parents tells the nurse that they do not understand why their child developed this issue, since the child was born at 36 6/7 weeks. What will the nurse explain to the parents?
“chronic lung disease probably resulted from your baby needing breathing support and oxygen for more than a month.”
“Even if your child was only one day premature, he was still premature.”
“Both you and your spouse have chronic lung issues and it is possible that your child inherited that trait from either of you.”
“You delivered soon after you arrived at the hospital, so your child did not benefit from the antenatal steroids.”
- The nurse is caring for an infant with myelomeningocele prior to surgery to close the defect. Which interventions are appropriate? Select all that apply.
Gently cleaning the sac with a chlorhexidine spray every two to three hours
Avoid keeping the infant in the supine position
Monitoring head circumference
Maintaining the sac free of feces and urine
Apply saline soaked non-adhesive gauze to the sac.
- A nurse is assessing the toddler who has coarctation of the aorta. Which assessment finding will the nurse identify related to this condition
Bounding pedal pulses
Clubbing of the fingernails
Cool skin of lower extremities
Severe cyanosis of upper body
- The nurse is planning pre-operative and post-operative care for a patient who is scheduled to have a Caesarian birth. Which interventions will the nurse include in the plan of care? Select all that apply
Apply compression stockings
Encourage the use of incentive spirometer
Decrease the oxytocin
Allow the patient to have a regular diet right after the surgery
Assess bowl sounds and flatus post operatively
- The nurse is caring for a hospitalized child of a family observing Ramadan, which will start the following day. How will the nurse facilitate atraumatic care for this family?
Advise the family to delay Ramadan celebrations
Request that the chaplain visit the family
Ask the family about accommodations that they mayned
Withhold food from the child during daytime.
- The school teacher approaches the nurse with concerns regarding a new student who is wheelchair bound due to sequeiae from a myelomeningocele. The teacher explains that when giving slips for the upcoming field trip, the new student looked down and whispered. “Don’t bother. My parents won’t let me go. “ what action by the nurse would be most helpful to the child?
Contact the parents to discuss their concerns about the upcoming field trip
Explain the child the rationale for the parents not allowing the child to participate
Explain to the teacher that the parents have the child’s best interest in mind
Contact the child’s primary care provider and have them assess the situation
- The nurse is teaching patents of an infant diagnosed with Tetralogy of Fallot. What information will the nurse include in the teaching? Select all that apply
“Your child may develop a change in the fingers, known as clubbing.”
“ Your child may require cardiac catheterization to open a narrowing of the aorta.”
“Your child will likely require surgery between 1 and 2 years of age”
“Your child will require continuous oxygen to maintain acceptable oxygen saturations
“Observe for change in skin color during feeding. “
- The nurse is working on a unit with patients with congenital heart disease. Match the medication with the condition it is used for. Each option can only be used once.
Alprostadil
Propranolol
Ibuprofen
aspirin
- The nurse makes an initial home visit for an infant recently diagnosed with cerebral palsy. When talking to the patients , they expressed being concerned about having another child with this condition. Which risk factor from the patient’s chart will the nurse identify as a possible contributor to CP?
The infant was found to have bilateral extra fingers after birth
The infant was born at 31 weeks gestation
The infant needed formula supplementation the first week of life
The mother started prenatal care late in the second trimester
18. The nurse makes an initial home visit for an infant recently diagnosed with cerebral palsy. When talking to the patients , they expressed being concerned about having another child with this condition. Which risk factor from the patient’s chart will the nurse identify as a possible contributor to CP?
The infant was found to have bilateral extra fingers after birth
The infant was born at 31 weeks gestation
The infant needed formula supplementation the first week of life
The mother started prenatal care late in the second trimester
19 The nurse receives an order to being IV oxytocin augmentation, starting with a rate of 2 milliunits per minute. Available in a bag of 500 ml of D5LR with 30 units of oxytocin. At what hourly rate (ml/hr) will the nurse set the pump?
20. The nursing is caring for a laboring patient experiencing a long and difficult labor. The nurse explains that the cause is most often when the fetus is in what position?
Occiput transverse
Occiput posterior
Occiput anterior
Occiput oblique
21 Place the cardinal movements in chronological order
Internal rotation
External rotation
Engagement
Descent
Expulsion
Flexion
Extension
22 The operating room nurse is reviewing a list of scheduled surgeries . The nurse will prepare the OR for a surgical patch procedure for which cardiac abnormality
Coarctation of the aorta
Right ventricular hypertrophy
Transposition of the great vessels
Ventricular septal defect
23. the nurse is performing an internal vaginal exam and palpates the posterior fontanel of the fetus to be at the right side of the mother in the front of the pelvis. What is the position of the fetus?
LOA
ROA
LOP
ROP
24 The nurse is caring for a patient experiencing a precipitous labor. What will the nurse monitor for after the delivery?
Fetal hyperglycemia
Premature rupture of membranes
Maternal hypertension
Cervical laceration
25. The nurse observes an increase in the fetal heart rate from 150 bpm to 165 bpm between contractions on the electronic fetal monitor (EFM). The fetal heart rate returns to baseline after 15 seconds. What will the nurse attribute this periodic change to?
Cord compression
Fetal wellbeing
Head compression
Placental insufficiency
26 The nurse is caring for a child with sever autism who will be having labs drawn today . The mother tells the nurse that the child relaxes by watching nature shows and asks if there is a TV in the clinic for that purpose. What will the nurse reply?
“Let me see if we can accommodate your request”
“Thank you for letting us know. Unfortunately, that is not feasible.”
“It is not advisable to enable inappropriate behaviors.”
“ He needs to learn to adapt to different environments.”
27 The Labor and Delivery nurse is caring for a woman in labor being prepared for epidural anesthesia. What information will the nurse expect the mother to have received from the provider to make informed decision? Select all that apply
Increases the duration of the second stage of labor
Allows the woman to continue ambulating even after administration
Is completely free of risks to the fetus
Increases the need for oxytocin administration
Is contraindicated for women with previous spinal surgery
28. The nurse doing a L&D admission assesses fetal life as part of the evaluation of the patient. Which fetal life is necessary for a normal vaginal delivery to occur?
Oblique
Longitudinal
Transverse
Perpendicular
29. The nurse is caring for a patient undergoing labor induction. External monitoring reveals contractions every 3 to 4 minutes, each lasting 30 to 40 seconds. The fetal heart rate slows down mirroring the contraction and returns to the baseline before the contraction ends. What is the nurse’s appropriate intervention
Explain the reason for the deceleration is cord compression
Continue the oxytocin infusion
Decrease the oxytocin
Decrease IV fluids
30. The clinic nurse is completing the chart for an infant who was born at 32 weeks gestation four months ago. The nurse calculates the infant’s corrected age as ___ months
31 The nurse is admitting a six month old former premature infant, to the hospital after the care provider referred him for failure to thrive. The child is accompanied by their single mother. Which interventions will the nurse include in the plan of care at this time? Select all that apply
Perform a thorough assessment of feeding practices and have the parent describe specific times and good amounts fed in a typical day.
Provide teaching and guidance about all anticipated diagnostic tests and procedures
Weight the infant, using the same scale, every day at the same time
Request an immediate social services consult to institute continuous video surveillance
Observe the mother’s interaction with the infant and document findings
32. The nurse is providing an ISBARR report tot eh obstetrician. Who asks about the frequency of a laboring patient’s contraction. How will the nurse assess the patient’s contractions?
From the beginning until the end of each contraction
When the uterus becomes completely firm
When early decelerations are noted
From the start of one contraction to the start of the next contraction.
33. The nurse is caring for a patient undergoing labor induction for post dates. What will the nurse do after reviewing this strip?
Stop the oxytocin drip
Prepare for amnioinfusion
Request placement of internal monitors
Asses for spontaneous rupture of membranes
34. The pediatric ED nurse needs to start an IV on preschooler. Which interventions are consistent with principles of atraumatic care? Select all that apply.
Tell the child they can cry, but they need to try to stay still
Tell the child that they will receive a reward after the procedure is over
Apply numbing cream to the area where the IV will be placed per ED protocol
Encourage both parents to leave the room
Allow the child to hold a security item if desired.
35. The nurse is caring for a typical 14 year old who will need to have a lumbar puncture to test the cerebrospinal fluid. Which statement is best suited to explain the procedure to this adolescent
“You will go to a room where people are wearing masks and maybe even funny hats. They will tell you to lie down and then they wash your back with a cold liquid that smells funny. You can bring your stuffed animal with you to keep you company.”
“Cerebrospinal fluid will be collected suing sterile procedure. First a local injection of lidocaine is administered. This is followed by the use of a chlorhexidine prep solution. An appropriate bore needle is placed so that the CSF can flow into the collection tubes.”
“The doctors need to get a sample of the fluid around your spine. You will go to a room where your lower back will be cleaned with antiseptics. Then they will numb the area with an injection. Last, they use a thicker needed to get a sample of the fluid.”
“ You might panic a little when I tell you what is going to happen next. You need a lumbar puncture, but I guarantee you that you will be fine. And you may even get a reward after.”
36. The nurse is caring for a patient who is in the first stage of labor, with ruptured membranes. Vaginal exam reveals 5/100/-2 What is the patient at high risk for ?
Placenta previa
Prolapsed cord
Hypertonic contractions
Placental abruption
37. The nurse is preparing a prenatal class for a group of primigravidas and plans to use the picture below to show the pelvic types. Which one will the nurse identify as the optimal pelvic type for a vagina
Type labeled “A”
Type labeled “B”
Type labeled “C”
Type labeled “D”
38 The nurse is caring for a woman experiencing contractions at 34 weeks gestation. What medications will the nurse anticipate administering? Select all that apply
Labetolol
Nifedipine
Dinotoostome (Cervidil)
Magnesium sulfate
betamethasone
39 The nurse assesses that a fetal heart rate (FHR) pattern is reassuring when it meets which of the following criteria?
A baseline from 100-140 bpm
Decelerations that occur throughout the contraction
Variability ranging from 6-25 bpm
Fetal heartrate remains unchanged with fetal movement
40. The Labor and Delivery nurse is caring for a laboring patient and observes a decrease in fetal heart rate after the peak of the contraction, returning to the baseline after the contraction has ended. Which intervention will the nurse implement in response to this assessment? Select all that apply?
Administer 02 8L via nasal cannula per protocol
Administer IV fluids
Discontinue oxytocin
Decrease the rate of the epidural
Place the patient in a lateral position.
41 The nurse is caring for a child with Tetralogy of Fallot that rapidly becomes restless and cyanotic. Which intervention would the nurse include in the care of this patient?
Administer an IV fluid bolus
Provide humidified air
Administer spironolactone IV
Place the patient in prone position
42 The nurse is caring for a patient whose cervix is completely dilated and effaced, +2 to +3 station and feels the urge to bare down. The fetal heart rate is 100-120 with no decelerations. Which nursing action is appropriate at this time
Administer oxygen at 10 liters per minutes via mask
Allow the women to bare down with contractions when feeling pressure
Instruct the woman to delay pushing until the fetus descends further
Place the woman in left lateral position and increase her IV rate
- The nurse is meeting with an adolescent with congenital heart disease and the family about transition from pediatric to adult care. What statement by the family shows an understanding of the process?
A comprehensive transition can help prevent cardiac complications and hospitalizations
The adult care system will be centralized, like the pediatric system has been
Patients need to continue with the same level of involvement after the child becomes an adult
When the pediatric team sends the records to the adult team the transition will be complete
- The nurse is completing discharge teaching for the parents of a six year old child who just had a baclofen pump surgically placed. What will the nurse include in the teaching? Select all that apply
Have the child sleep on their back for the next four weeks
Wear loose fitting clothes
Avoid tub baths for two weeks
Notify the child’s care provider if the child’s oral temperature is greater than 101.5
Encourage daily abdominal exercises, twisting at the waist, and stretching
- The nurse is preparing to administer acetaminophen to a child weighing 23.9 lbs. The acetaminophen dose ordered 10mg /kg/dose. Acetaminophen is available in liquid form of 160 mg/5ml. How much acetaminophen will the nurse administer?
- The nurse is caring for a patient in labor where vaginal examination indicates 7cm cervical dilation with 90% effacement, fetus at 1% station. What is the appropriate nursing action?
Allow the patient to eat
Encourage breathing exercise
Turn off the oxytocin
Place the patient in a supine position
- The nurse is caring for a woman during the second stage of labor when the health care provider announces presence of shoulder dystocia. What will the nurse do?
Have the woman life on her left side and lift her right knee
Apply suprapubic pressure when instructed
Place patient in Trendelenberg position
Place both hands on the patient’s fundus and apply pressure
- the nurse is assisting in the delivery of the placenta of a multipara patient. After the placenta is delivered, the nurse must do which of the following actions first?
Inspect the placenta for intactness
Place the placenta in a biohazard bag
Label the placenta properly
Inform the placenta provider
49 A nurse is reviewing the record of a patient in the labor room and notes that the nurse midwife has documented that the fetus is at (-2) station. The nurse determines that the fetal presenting part is located at which location?
2 cm above the ischial spine
2 fingerbreadth below the symphysis pubis
2 inch below the coccyx
2 inch below the iliac crest
- The nurse is assessing a term patient who came into the hospital with uterine contractions. Which assessment finding indicates that this patient is in true labor?
She has had nausea and vomiting for the past 24 hours
She is having contractions every 4 minutes and the cervix is completely effaced
The vaginal exam indicates that her cervix is thick, long, and closed
The contractions stop or slow down while ambushing
- The nurse is caring for a post-term patient who is admitted for labor induction. The nurse is preparing to administer misoprostol. The patient asks “What is the purpose of this medication.” What is the rationale for using this medication at this time?
To numb the perineum in case of an episiotomy
To soften and efface he cervix
To prevent hypertonic contractions
To promote fetal descent into the mid pelvis
- A nurse is monitoring a patient in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing?
Variable decelerations
Early decelerations
Late decelerations
Accelerations
- The nurse is caring for a child whose family lives three hours away. Which intervention is consistent with atraumatic care?
Provide parents with the available overnight options during their stay
Direct parents to cafeteria for meals
Remind parents that the law entitles them to paid leave while their child is hospitalized
Instruct parents to take turns being with the child.
- The nurse is caring for an infant undergoing testing for possible congenital heart disease. Echocardiogram results show a ventricular septal defect. Which finding would help confirm the child does not have Tetralogy of Fallot?
Intact atrial septum
Normal right ventricular function
Presence of a murmur
Cyanosis with feeding.
55.The nurse is caring for a hospitalized 3 month old infant. What will the nurse implement to facilitate atraumatic care?
Allowing the infant to handle equipment prior to assessment
Limiting overnight stays with the infant to one parent at a time
Keeping parents informed about all aspects of their infant’s condition
Limiting the amount of parental care to holding and cuddling.
- The L & D nurse is caring for a patient in labor who just received epidural anesthesia. What is the nurse’s immediate action?
Assess the fetal heart rate for accelerations
Assess the patient’s blood pressure
Administer oxygen 2 L via nasal cannula
Place the patient in a supine position
57 A woman is being assessed in the triage area of labor and delivery. The contractions are 5-10 minutes apart, duration 30-45 seconds on palpitation. The cervix is dilated 1 cm. What stage of labor is the patient experiencing?
Pelvic Phase
Latent Phase
Active Phase
Perineal phase
58 the nurse is caring for a woman who is having hypotonic contractions. What is an appropriate intervention for this situation?
Titrate ocytocin every 30 minutes
Prepare for a vacuum delivery
Insert fetal scalp electrode
Provide oxygenation via non rebreather face mask
59 The nurse is caring for a patient with a patent ductus arteriosis who tires easily when feeding. What will the nurse include in the care?
Use bottles with smaller holes in the nipple
Limit feeding time to no more than 10 minutes
Provide higher calorie formulas
Provide more diluted formulas
- The nurse is caring for a pregnant patient during labor whose membranes rupture spontaneously. What is the nurse’s priority action?
Assess the fetal heart
Change the bed pad and give peri care
Report the color and the consistency of the fluid
Use nitrazine paper to test the field
