Maternity Peds Hesi Review – EVERYTHING,100% CORRECT

Maternity Peds Hesi Review – EVERYTHING Mastitis: antibiotic therapy, wear a supportive bra, warm compress • Pyloric stenosis: olive size obstruction on abdomen • Anchor the lower part of the uterus - then massaging the fundus • High bp maybe with preeclampsia: check for protein in the urine (proteinuria) • Boy child frequent visits to the school nurse headache, irritable for few weeks: ask how daily school day is • BMI 6 -year old: physical activity at the school, girls physical activity at home, and diet • Saturated 2 pads in 30 mins: massage the fundus • Tick bite: test for Lyme disease • HIV AZT is given to slow down the transmission to the fetus • Clear water to clean for diaper change • APGAR = 9, acrocyanotic only gets 1 point for color • Mom says baby not sleeping through night, nurse should assess severe skin breakdown on the baby to plan family care • Blind child with traction - bring familiar objects or stuff animals from home • Drooling, temp - epiglottitis need to notify the provider • Muscular irritability from hemorrhaging • Osteomyelitis - give milkshake as snack- high protein, high fiber • Hypoglycemic: give milk • Croup- barking sound, high pitch on breathing - bring in shower with warm mist • Transillumination through scrotal sac to test if testes are present • Earache if meningitis • Hypothyroidism: D- TSH is high so T4 is low by thyroid gland • Tetralogy of Fallot - cyanotic limbs crying Cephalohematoma noticed near occiptal sutures- notify Dr • Increase AFP- need to do an sonogram • 30 week gestation age 38 inches fundal height - do an ultrasound, bc should’ve been equal • Inguinal Hernia - palpate to get it back in • Breastfeeding 5 day with yellow stools - this is normal • Spontaneous rupture of membranes - ask the color and consistency • 3+ pitting edema with GERD- normal during pregnancy?? • Postpartum depression - may need to be evaluated ** Know the length of PPD • Afebrile seizures - will eventually go away • MD - wobble legs at this stage • Tonsillitis-signs of bleeding - need to inspect the oral cavity • Movements caused from rh??? they temporary something a C -- wasn’t this the amniocentesis- testing the rh for rhogam? Yes testing maternal blood to see if they need to administer RhoGam • Fetal heart pattern in V form - priority is change mother’s position • 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 • Female - parenteral antibiotics administration is most effective • Introducing solid foods - 1 food at a time for 4-7 days • Digoxin - missed dose can give if it’s been less than 4hrs /if more than 4 hrs wait until next dose/If miss 2 doses, call HCP • Dilantin - check the serum levels • UTI child - return for another urine sample • 3 hour newborn with irregular respirations and small/soft murmur - put pulse ox on the foot • Mag toxicity possibility: mag was 8? With hypoactive reflexes • Gonorrhea infection tell other partners to seek treatment • Adolescent gets a rubella vaccine at maternal bearing age - use another form of birth control? • Diaphragm – use same as before giving birth - get resized? Use another form of bc? • Tonic clonic seizure and heart issue - monitor calcium • Amniocentesis priority - something with to get Rh factor for rhogam *Breasts- need supportive bra, antibiotics, cold compress *infant vital signs- normal *DMD- weak muscles and gait - I remember something with DMD & serum Ca+ *preeclampsia- check urine for protein MP Hesi 2017 1. dosage : 700. 77 lb baby. 2. 20 units of oxytocin+1L LR→ 125 . 3. Gerd: sugar cookies 4. Mom is Rh-: check Rh immunoglobulin or check FHR 5. Cystic fibrosis: infertility 6. Tetanus questions: clean and antibiotic!!! 7. folic acid, doesn’t like green lefy veggies: strawberries 8. Diaper rash: zinc oxide 9. young parents, 24hrs birth: evaluate feeding 1 0. mom forcing kid to eat means and veggie(requires further. 11. sickle cell: hot and thirsty 12. pyloric stenosis: olive-shaped 13. Pyloric stenosis, hungry and irritable after feelings, first intervention→ crying or weight 14. turn to side and suction 15. fractured clavicle 16. jitteriness: check glucose 17. Normal primipara finding: 2 saturated pads for 1st hr. I put pulse 56. 18. Dad called few days post-partum - hormonal swings are normal. 19. MgSO4 priority: calcium gluconate 20. HIV: AZT 21. Assess FHR and coombs 22. check for after amniocentesis: monitor for labor 23. Post-partum mood swings vs. depression: fatigue & not making decisions? 24. eye ointment: prevent eye infection 25. intussuception: brown stool notify HCP 26. girl SATA: 27. girl who druinks: atta boy 28. ADHD: refer or help with HW?? 29. transitional phase: monitor contractions, help mantain control 30. AFP: Sonogram 31. Priority pt: ARF and hyperkalemia!!! 32. mastitis: antibiotics, bra support, warm support 33. Open heart surgery: demonstration of splintintg, deep breathing etc 34. rupture membranes 12hrs ago--: temperature 35. C-section priority: uterine atony or positive homans??? 36. AGN: Sore throat 37. hemophilia: NOT motrin(elevate and immobilize. 38. Resp distress: nasal flaring 39. Leopolds: anchoring fundus 40. Drooling, s/o epiglotitis→ emergency response!!! 41. flick the sole 42. RF: Chorea 43. after c section lacerated. trickle of blood: BP 44. +2 edema: MgSO4 45. position on stomach 46. HPV: C “immunization is a must to prevent it” 47. scoliosis: girls 10-14 48. metabolic alkalosis-vomiting or pyloric 49. MDI: spacer or cold??? 50. position on stomach 51. sesnse of security 52. IUGR: sonogrm 53. Flaring of the nare 54. Developmental delay: maximum potential 55. 8 mos expected: sitting up unassisted MP Hesi 2017 • Protruding cord - knees to chest • Child who had Slipped Capital Femoral Epiphysis (SCFE. - pin and something • 4-month old what to do to prevent diaper rash - use a barrier cream, such as zinc oxide • Mother with mastitis, what would you advise - start on the unaffected breast first • Adolescent turns 18 and mother calls for lab results - must get permission from daughter • Different acid base levels - normal acid base • A breastfeeding mother wants to avoid having another pregnancy. What do you do? use condoms and gel • Infant getting phototherapy - Cover the infant’s eyes • 6 month baby goes in for routine vaccine and flu shot - give all immunization and influenza but alternate site and injection • Medication to prevent respiratory issues in the baby - betamethasone IM • 15 mo breastfeeding & now 6 mos prego - get nutrition history • Postpartum hemorrhage even after finishing oxytocin infusion - check maternal BP • Math questions were 10 and 10 • Baby got otitis media after an acute respiratory infection, why do infants get otitis media - shorter eustachian tubes • Boy with spine injury after driving accident - maintain alignment • Obese question SATA - find out what physical activities she does & if school has PE class, 3 day diet history from mother • Iron supplement - take with meal • Preeclamptic women received Pitocin IV and is having contractions 1 to 2 minutes apart - discontinue Pitocin • Lyme disease - if rash, then test • Esophageal atresia, highest priority - body temperature • Baby regurgitation and vomiting - suction the mouth and nose • An adolescent received an above the knee amputation. Would do you tell them to do everyday - inspect the stump daily • Women says about 6 mos pregnant & smokes a pack of cigs/day, how to check for estimated gestation age: ultrasonography • 8 month old development, you would notice - sitting unassisted • Glucose was 800 mg - give IV normal saline and insulin • Rubella - give after delivery within 72 hours • Newborn has swollen, tender, testicles. Suspect hydrocele. What do you do? Use transillumination to check for fluid • Fetal heart rate dropped abruptly to a V - change mom’s position • Pregnant had a temp of 101 – chorioamnionitis • Epidural anesthesia - check maternal HR and BP • Teenagers who are pregnant, be sure to include - nutrition requirement during pregnancy • Patient who was 9 cm and 80% effacement - ? • Transitional phase - assess uterine contractions • Infertile couple - allow them to control if they want to stop or support group before another IVF cycle • 4 neonates, who to see first – Tet • 9yr old (school age. – industry • Child with pneumonia - assess lung sounds • Child is dehydrated. What to check for? Weak cry but no tears • Pyloric stenosis - metabolic alkalosis • Assess for cryptorchidism - warm the room • “He doesn’t feed himself, I make him eat vegetables and meat” • A newborn infant is crying, temperature is 96.5, has elevated bp and is cyanotic. What do you do? Warm that baby up (answer) MP Hesi 2017 • What put kid at risk for bacterial meningitis?? Earache NOT VARICELLA IT’S A VIRUS • Tree bark flies in eyes Put on patches & call ophthalmologist • Kid is 2 years old drinking with bottle drinking sweetened soda, what should Nurse discuss? Don’t drink out of a cup, soda leads to obesity, & soda lead to dental caries • Kid with type I Diabetes & Blood sugar 180 wants to play in his soccer game what does Nurse recommend? The kid can play soccer w/o eating a snack or taking insulin • Mom depressed how does she feel? Tired, sad, dec. appetite • Mag toxicity DTR +1, UO was 25, Mag was 8, Respiration 14 Closely follow up • Intussusception & now has brown poop Notify HCP • Kid sees the school nurse with stomach ache Notify HCP • Cleft Lip/Cleft Palate See genetic counselor • Hx of syphilis & chicken pox urine sample/blood sample • Salt wasting Check the Perineum • What do you report to Dr first with an epidural? Blood Pressure, • She has excessive bleeding, what do you let the dr know Report BP or Apical HR • Administering Epidural slows the labor process • Palpate with one hand & the other hand is there to do what? Anchor the uterus • The uterus was firm midline & in place she felt like she had vag pressure check perineum • Episitomy visualize the perineum • The person is oozing blood & has muscle irritability, what electrolyte level are you most concerned about? Calcium • Budding breasts & □Tanner II • A 7 year old girl has a UTI & discharged what do you tell her to check? check urine odor • 4 year old girl what is a normal finding? imaginary friend • 10 year old had rheumatic fever & is on strict bed rest. What is an appropriate form of play? checkers • Rubella vaccine don’t get pregnant for 1 month • Pitocin after labor to stimulate uterine contractions • MOM has HIV & is administered AZT during birth what do you need to do with the newborn after? Administer AZT • What is most likely a sign of pregnancy Hegars • 5 month with hypothyroidism laughs & rolls to side • Immunization question Need Consent for Hep B • Mom is 36 wks pregnant, nonreactive nonstress test then has contraction Stress Test with an infusion of Pitocin. What is the priority to let the doctor know? Fetal Late decelerations • When do you have to notify the HCP? When the deceleration is after the peak of the contraction. • Pt has a hard, rigid abdomen, is bleeding profusely what do you do next? Stay with Pt & call the health care provider • Administering prostaglandins. What is the finding you make the doctor aware of?Fetal HR of 50 • Woman is 3 cm dilated & she wants to pee? Check her cervix • C8 injury looses bladder control doesn’t have reflex? • How do you know the baby is in distress? Nasal Flaring • Temp was 97.7 Pulse of 140, 42 breaths per minute but irregular Put in EMR • What would you do when the newborn nurse comes in the nursery put the thermal regulator in line with the abdomen • She was 30 wks & edema was +3, Ask about blurred vision • The little kid has abdominal pain, fever & is vomiting what do you ask him? Ask him the quality & location of his pain • Mother DM. What is most important about her care? Strict glucose control • Amniocentesis at 36wks Mother has 8 1/2 lb baby what do you assess in her? Fetal lung status • Muscle dystrophy X linked recessive • Teen has Pelvic inflammatory disease & finished with a 14 day antibiotics & flagyl orally. She wants to know if she can be treated at home. Why not? Monitor parental antibiotics IV • The girl has a fractured ulnar & her wrist is in splints. What do you do next Check wrist pulses • Digoxin: Can administer a first missed dose within 4 hours • A child has liver disease & the parents are aware that they are dying. What is the priority for the nurse? Reassure the parents • 5 day old newborn yellow sticky poop that smells like sour milkThis was normal • What to do for cryptochism Ask parent if they felt it before? • Dosage Calculation: 2.5 • Dosage Calculation: 25 • Kid is drooling Notify HCP & trach kit by bedside • Lyme Disease/tetracycline Don’t take with milk or antacids • The point of an ultrasound Growth & age • What’s the intervention when the kid has puss filled vesicles Prevent transmission • The kid has a tonsillectomy & is swallowing a lot. What do you do first? Look in their throat with a flashlight • Afebrile Seizures The kid will grow out of them MP Hesi 2016 • Rubella Vaccine Teaching, wait 1 month before having sex • Esophageal atresia (check body temp) • 2 year speech • Tremors in a newborn suspect cocaine addiction • 5 months pregnant mothers which assessment info is the most vital (dribbling urine or blood. • betamethasone (30 weeks) • Tetracycline don’t take with milk/antacids • Boggy fundus 10lb baby and has 2 soaked pad in 30 mins do what next Message her fundus Check the perineum • Yellow sticky stool • Hypospadias post circumcision no physical sports • Nephrotic syndrome treatment evaluation the edema is reducing • Blinds 5 years fracture leg and in traction what does the nurse do next Teach the family, Familiarize pt with her surrounding • 4 month old baby with hypothyroidism how do u=you evaluate treatment The baby can pick up his head, The baby laughs and turns it self from his back to his stomach • Digoxin the HR was WNL give the treatment • Sickle cell crisis what’s the manifestation pain • Soccer player with a type 1 DM, ask child to go and play • Scoliosis demographic 10-14 y/o girls • Play (game. for 10y/o on bed rest: checkers • Croup under a Mist tent the parent brings child a stuff animal what do you do • Moro reflex in child of 6 months Moro reflex is gone by 3-4 mos • Mother is schedule for C-SECTION stated to the nurse that she drank a cup of coffee before coming in what should the nurse do Inform the pt doctor, Informed the anesthesiologist • Grandfather molesting child (call social work/report) • Coarctation or aorta Lumen obstruction • MMR is given at 12-15 months • Open heart surgery • What drug not for child under 9: Tetracycline, Aminoglycoside HESI 2015 • What is the probable sign of pregnancy? Hegar’s Sign • Taner’s Sign ans: II • Jewish Lady & genetic disorder Tay-Sachs gene • Tetryacyclines Do not give with Milk and antacids • Child with 95th percentile BMI Exercise, eat fruits & vegetables • Young girl with UTI Girl must come back for urine test • Mom states she can’t stop crying but so happy she had baby It is normal because Milk is coming and hormonal level change • How to encourage newborn bonding? Provide for mother’s needs and demonstrate warmth for infant • Left breast Mastitis (SATA. Warm compress, Wear supportive bra, Continue breastfeeding while on antibiotics • Ear infection with exudate SATA. Remove exudate from ear before putting med in, Tylenol, q4hrs, Don’t use tongue blade, Don’t pick palpate around ear, Don’t use sterile water to ear • Patient had eclampsia Keep airway at bedside • Boggy uterus- what priority do you do? Massage uterus • Crackling in the temporal after getting hit by a swing Refer to PCP for further evaluation • Patient wanted to use oral contraceptives, what is a contradiction? Family history of stroke • Patient complaining of sore nipple, what to do? Assess breastfeeding positioning • Patient had preeclampsia Lift foot of the bed • Pregnant lady fell, what do you assess first? Dribbling urine • Infant being treated for hypothyroidism, how do you know tx is working? Infant is laughing & moving from back to side • Nurse held solid food for pregnant lady while in labor-why? Can aspirate food in case general anesthesia is used • Increased levels of APF - Do sonogram to confirm • Infant has RR of 35, axillary temperature of 96.85, HR 165, what do you do Gradually warm baby in heat source (radiant warmer) • Dosage calculation-8.6 • Dosage calculation-12.5 • Infant was oozing blood from incision, experiencing muscle irritability, what do you assess? Calcium • Infant boy experiencing circumcision, what do you teach parents? Apply prescribed ointment at every diaper change • Pt had ulnar fraction with splint, what do you check? wrist pulse • Four patients came in, who do you assess first? Patient having 3 minute contractions. • Herpes mom delivered child Isolate baby from others in nursery • Salt wasting: assess perineal edema • Does not cross suture lines: cephalohematoma • weight loss of baby, 7.5 yesterday and today 7lbs It is normal • The woman had 20wks gestation and gained 20 pounds The gestational weight gain is not normal • 6months old, abnormal finding Startle/ moro reflex • Last miscarriage and pregnant again Increase minerals & vitamins • Woman on bedrest not to move because Homan’s signs • Child has shakiness, baby sitter call, what to do Give 8oz of milk • Osteomyelitis Reoccurrence of recent infection • Rheumatic fever Chorea is temporary, it would go away • The baby in the tent Allow the child play with the Stuffed toy • Head circumference increased by 5cm Bulging fontannel • Child have fever or explosive diarrhea Large bore IV • Child has respiratory distress Nasal flaring • Child is always goes to the nurse for past three weeks What is your typical day at school • Child holding abdomen/complaining of pain Describe pain level • Pregnant, what pet not to have Cat • Two sex ambiguous Offer information on sonogram • Child suck thumb It is normal • You have sore nipple Check infant position • Two pad saturation within 30minute Massage the uterus • 36 weeks pregnant and bleeding Stay with pt & Call Dr • Inguinal hernia visible the child cry Persistent diarrhea • Congenital heart defect. (coartation of aorta. Lumen obstruction • Hirschsprungs syndrome Ribbon-like stools • Non-Reactive test Fetal late deceleration • After the epidural Check FHR. Maternity & Peds 1 Drug reference states Ampicillin should be infused over 30 mins. Nurse adds antibiotic to Pt's soluset chamber that contains 25 mL of IV solution & IV tubing used delivers 60 drops/mL Nurse should set IV pump at _ mL/hour? 25ml/30 min=50 ml/1 hr 2 Nurse is caring for a child with Nephroblastoma (Wilm's tumor. should include which one of the following interventions in the child's plan of care? Wilm’s tumor- altered nutrition or Do not palpate the abdomen 3 Parents of a toddler with sickle cell ask if they will have other children with this illness. How should Nurse respond? Possible that future kids will have it, refer for genetic counseling 4 Dr. orders IV infusion of D5% 1/2 normal saline to infuse at rate of 75 mL/hr via microdrip tubing for child. Nurse hangs 500mL bag at 6:00AM. At what time should a new IV bag be hung? D/H x V D: 75 mL/hr H: 500 mL Hung bag: 6:00 AM500mL/1=1hr/75Ml - 6.6 hours ≈ 6 hours and 30 min - This how long bag is hung for, so if she hung it at 6:00 AM, next time she change it is: 12:30pm -- Another person said: Left In Bag→ 1pm So anywhere from 12:30pm to 1:00 pm 5 Which one of the following statements by the parents indicates understanding of colostomy care for their infant child? 6 Which one of the following nursing diagnoses would be appropriate for a child with nephritis Fluid Volume Excess r/t decreased plasma infiltration, i)Risk for Imbalanced Fluid Volume related to retention of sodium and fluid and dietary fluid restriction. ii. Risk for Activity Intolerance related to fatigue. iii. Risk for Impaired Skin Integrity r/to edema and decreased activity iv. Anxiety r/to insufficient knowledge about disease process or hospitalization 7 Which statement by mom w/ kid on oral Predisone for Nephrosis means understanding of med regime? Take with meals 8 In order to properly measure the abdominal girth of a 2 year old child which techniue should Nurse use? Measure abdominal girth above umbilicus, measure at same area each time 9 As a nurse you are required to report your suspicion of child abuse under which one of the following circumstances? Mother said child doesn’t like her 10 Dr. orders Ampicillin 200mg IV Q6 hrs to infuse over 30 mins. In order for med to infuse as ordered, Nurse adds 25mL of IV solution to soluset chamber & sets the IV pump at a rate of mL/hr using microdrip tubing. 25ml/30 min - 50 ml/1 hr 11 A child with hemophilia has been accidentally hit on knee with a bat during recess. What action should school nurse do? Apply Ice - RICE: rest, ice, compression, elevate 12 Nurse caring for a child with sickle cell disease would expect which abnormal laboratory finding? Hemoglobin (hgb): 8.5 (Low hgb: less than 9.5) 13 Indomethacin (Indocin) may sometimes be used to treat which congenital heart defects prior to any surgical correction. Closes PDA (patent ductus arteriosus) 14 A 9-year old child with a recent diagnosis of rheumatic fever is being seen in the pediatric clinic. In order to evaluate family's compliance with the plan of care Nurse should: Make sure they taking full course of antibiotics 15 An 8-year old child with a diagnosis of glomerulonephritis is complaining of a headache and a blurred view of the television in his room. What action should Nurse take next? Assess BP, Comfort, allow child to rest( seizure precaution), Give vasodilators for hypertension 16 The priority nursing action for a toddler 2-hours post cardiac catheterization is to: Assess both pedal pulses 17 Nurse is teaching family of a toddler w/ hemophilia about disease. Which statement by parents requires additional teaching? Something regarding - Blood transfusion 18 Which diagnosis would be appropriate for infant with ventricular septal defect? Impaired Gas Exchange??? Other choices: Decreased cardiac output, Decreased tissue perfusion, Activity Intolerance, Delayed growth & development 19 Suspected cases of child abuse can be reported by:(SATA. Physicians, nurses, physician assistants, family members 20 Parents of a child with Sickle Cell Disease ask why child is receiving daily doses of oral folic acid. How should Nurse respond? To stimulate RBC production 21 Dr. orders Amoxicillin po 250 mg for a child weighing 25 lbs. The drug reference recommends 25-50/mg/kg. Is this dose safe? No: less than recommended dose: 25 lbs /1 = 1 kg/ 2.2 lbs - 11.36 kg 250 mg/ 11.36 kg - 22 mg/kg - NO 22 Assessing child w/ acute glomerulonephritis, Nurse would expect: ANS-Mild periorbital & lower extremity edema, cloudy urine 23 Sometimes children with Nephrosis may be placed on fluid and sodium restrictions for edema. In order to minimize thirst, Nurse can encourage parents to: ANS-Give child Lollipop for dry mouth, candy, popsicles 24 One-month-old infant is to receive 0.125mg of Digoxin. Bottle of Digoxin is labeled 0.250 mg/ml. Nurse should give milliliters of Digoxin to child? D/H x V D: 0.125 mg H: 0.250 mg V: 1 mL 0.125mg /0.250mg x 1 ml - 0.5 mL 25 When assessing a child with a Tetralogy of Fallott, Nurse would expect to see: cyanosis 26 The mother of a 5-month-old with atrial septal defect tells Nurse at the cardiac clinic that her infant gets tired during feeding. Nurse should advise the mother to: small frequent feeding 27 Dr. in children's clinic orders single dose of penicillin 1,200,000 units IM for an 8yr old child. The med is available 1,200,000 units/2 mL. How should Nurse administer this medication? SATA: D/H x V D: 1,200,000. H: 1,200,000 V: 2mL 1,200,000 / 1,200,000 x 2mL - 2 mL 28 To decrease risk of vaso-occlusive crises in sickle cell kids, Nurse should teach family: Treat Infection, Prevent child from events that increase O2 demand: cold, infections, heat, dehydration 29 Nurse at the pediatric clinic is instructing a mother on proper medication administration. The child is 4-years-old and is receiving oral ferrous sulfate to treat her iron deficiency anemia. What statement by the mother needs further clarification? Giving meals with calcium containing foods; Ex: Milk - Need Vitamin c for absorption 30 Nurse caring for a 5-year old child with suspected Intususception notices the child holding his abdomen and grimacing after eating half of his lunch. Which action should Nurse take next? Call Dr 31 What information should Nurse include when teaching the mother of an 8-month old infant who is receiving oral Digoxin? Notify physician if child is vomiting 32 Nurse is administering oral Digoxin to an infant with a congenital heart defect. Prior to administering the medicine Nurse assesses the apical rate to be 92 BPM. What action should Nurse take next? reassess apical pulse 33 Nurse caring for a 13yr old in sickle cell crisis complaining of pain. Which action should Nurse take first? Assess pain??? Administer fluids as ordered??? 34 Which is an example of potential child maltreatment: 6 and 9 yr old left at home alone& bringing friends over 35 Which maternity situations may be indicative of potential abuse? Isolation, low self-esteem, alcohol and drug use????? 36 Nurse caring for child with rheumatic fever should assess for most serious complication of disease: Checking heart sounds 37 Which findings is Nurse likely to observe in a newborn diagnosed with Hirschsprung's disease (aganglionic megacolon)? Failure to pass stool within 24 hours, Distended abdomen, chronic constipation altering with diarrhea, Enterocolitis in emergency event, Ribbon-like stools- older children 38 In order to minimize incidence of iron deficiency in newborns Nurse in antepartal clinic should instruct pregnant women to: Green leafy vegetables 39 The pediatrician orders a stat dose Furosemide (Lasix. 25mg of IV, for a child. The child weighs 18 lbs. The drug reference states normal dose for Lasix as 2mg/kg. Which action should Nurse take first? 18 lbs/1 = 1kg/2.2lbs - 8.18 kg 2mg/kg = 8.18 kg/1 - 16.36 mg - 16.4 mg - Dose is too large – Call Dr 40 Which explanation regarding an echocardiogram is appropriate for a 5-year old child? Listen to your heart /hear heart sound A 5 year old, whose sister is terminally ill with brain tumor is most likely to believe: Something that they did or said caused Prevent Iron deficiency anemia in toddlers→ 2 boiled eggs Patient with Iron deficiency anemia requires further teaching- something about black hard stool Ventricular Septal Defect (VSD. Post op extubation on ventilator - assess lung fields Hemophilia (S/A. - soft toothbrugh / padded bed rails-soft toys /MedicAlert Bracele/ frequent floss Hemophilia - Normal RBC (missing clotting clotting factors 8,9) Is Rheumatic fever contagious - bring siblings for throat culture Nephrotic syndrome - asses skin breakdown due to peri edema Bruises on face, upper extremity - continue assessment. Ask partner to step out Partner abuse - Help patient Identify options Child neglect→ torso over window When child ask about death - answer honestly Stillborn baby - allow parent private time with baby Prednisone - take with meals The nurse caring for neonates born to substance abusing mothers might expect the following findings: Placental function is affected by the vasoconstrictive properties of many illicit drugs, as well as by cigarette smoke. Which of the following behaviors indicates ineffective coping after the recent death of a child/sibling????? 1. Both lack an understanding of the concept of death 2. Infants react to loss of caregiver with behaviors such as crying, sleeping more, and eating less 3. Aware someone is missing, may exp. separation anxiety 4. Toddlers may develop fearfulness, become more attached to remaining parent, cease walking and talking As a nurse you are required to report your suspicion of child abuse under which one of the following circumstances???? How should the nurse assess for signs of shunt malfunction in an infant with a ventricular-peritoneal shunt? Position child on side that hasn't been operated on, Keep child flat to avoid pressure on shunt valve, Observe for increased ICP, Neuro assessment: pupillary dilation, blood pressure, Monitor for signs of CSF infection: elevated temp, poor feeding, vomiting, decreased responsiveness, seizures MP • Which drug is contraindicated in children under 8? TCA’s • Best indicator of pregnancy? Hegar’s sign • Highest priority for woman receiving mag sulfate? Calcium gluconate on hand • Celestone to which pt? 30 wk with regular contractions & cervical changes • Requires further assessment or 3 or 6 month old with hypothyroidism? Laughing & turning the back 6. Baby goes from 3317 to 3175? Normal 7. Mom that got rubella shot? Can't get pregnant for a month 8. 500 ml 20g at 1 g/hr? 25 ml/hr 9. 100mg on hand 200mg in 5ml? 2.5 10. TCA? Don”t give with milk or antacids 11. Mom w/ boggy fundus & something? Massage fundus til firm 12. Mom on pitocin with contractions every minute that is stopped & given oxygen contractions every 5 mins? Restart pitocin 13. Mom w/boardlike/rigid uterus? Call Dr from bedside 14. Child with hypospadia? puzzle 15. Infant just had ventriculoperitoneal shunt placed? fontanels 16. Child with dark colored scrotum? Review ACTH level 17. Priority nursing action for baby just born & RN making sure it can breath to ensure survival? Heat loss 18. Obese child with hypertension & possible diabetes? tell them to incorporate fruits, vegetables & exercise 19. Girl who broke ulna? check pulses 20. Girl whos asking about contraceptives? Explain risk & benefits of oral contraceptives or teach about all contraceptives 21. Albumin IV child w/ nephrotic syndrome? Swelling/wt decrease 22. Yellow, sticky, sour milk stool? normal 23. Which group to assess for scoliosis (highest risk)? Girls 10-14 24. 2nd stage of labor with hx of heart failure? +1 edema, basilar rales & irregular pulse 25. Pregnant woman 39 weeks fell ;what concurrent symptoms would you see? Urine dribbling 26. Tanner sign breast bud & scant pubic hair? Level 2 27. 10yr old clutching stomach/vomiting? Quantity, pain source 28. Boy hirschsprungs? IV large bore catheter 29. Croup with mist tent with stuffed animal? Give them toy 30. 3 yr old with blind? bring toy from home/orient to sounds 31. Spitting up baby? Turn over & suction 32. (SATA. Mastitis? Continue breast feeding, warm compress, take antibiotics at regular intervals 33. GBS mother in labor? Give antibiotics 34. Mother calls hotline happy crying over baby? influx of hormones 35. 6 months gets MMR? 12-15 month 36. SGA but term? 4lbs, 31 head, smooth skin visible veins & vernix 37. 10yr old going into open heart surgery? demonstrate cough, deep breath & splinting or use incentive spirometer after surgery 38. What is appropriate for 2 y.o? 3 word sentence or understand half what the child says 39. Terbutaline assess? Breath sounds 40. Otitis media ...? 41. Coarctation of the aorta ...? 42. Mom’s prenatal visit? Baseline weight & blood pressure 43. Oral contraceptives who is not supposed to take it? Diabetes 44. Tracheoesophageal fistula? Check temperature 45. Soccer player with Diabetes 1 glucose of 180? Go play 46. 10 year old? Checkers 47. Sickle cell crisis? Pain 48. Immediate intervention? FHR is 60 something 49. C-section woman wants to go to the bathroom why shouldn’t she? Positive homans sign • 50 ml - 25 ml to be infused in 30 mins • 2 ml - 1,000,000 units/ 500,000 units x 1 mL • 325 mL - 500 ml at 10, how much in bag at 17 (25 ml/hr. • What indicates that the mom needs further teaching Digoxin & lasix? take the pulse before administering, but question said after • Kid with 92 bpm taking digoxin - reassess apical pulse for a min Cardiac Defects • VSD - bacterial endocarditis ?? or VSD w. Persistent cyanosis> Increased pulmonary resistance • CHF - poor feeding - give small frequent feedings • For left HF assessment finding = fine, moist crackles • (SATA)Bilateral rales - HOB (30-45 degrees), give Lasix BID • 47. Severe edema - skin breakdown Cardiac Catheterization • 2 hrs post Cardiac cath - check femoral pulses RF • RF what is symptom of severe complication (RHD. - apical pulse • mom w/ CF kid wants to know if siblings will get it – explain disease • RF compliance: ask if they are taking the antibiotics • (SATA)Penicillin shot - 2 syringes & lateral thigh Sickle Cell • Vaso-occlusive crises - drink water & juice • Vaso-occlusive crisis - keep them hydrated • Kid who got hit in knee with bat, disease not specify - ice or immobilize (question getting thrown out; automatic 2 points. • Kid with SCD is jaundiced - high bilirubin Hemophilia • Parents w/ hemo kid. will future kids have it - genetic counseling • (SATA. Prevention of injury for hemo - no contract sports, use electrical shaver, (passive ROM. • Hemophilia ptt> prolonged Acute Glomerulonephritis & Nephrotic Syndrome • Kid with headache & visual disturbances - asses bp or tell Dr • AGN - tea colored urine • Child peeing 80 mL/4hrs, weight 36 kg, AGN - assess for dehydration or report abnormal findings to physician • Fluid shift, glomerulonephritis - weight gain • (SATA)Prednisone - snacks in between, immunizations up to date, & something else • Priority nursing dx for Pt with GU problem - risk for injury r/t htn & pulm. congestion or fluid vol excess r/t decreased filtration • Kid thirsty & has nephrosis - give popsicle • Child Abuse /Sign of maltreatment - windows with no kid guards • (SATA)Who are reporters - nurse, doctor, police; neighbors??? • What is indicative of possible abuse?> mother says child doesn’t like her Intimate Partner Violence • Pregnant lady comes in with partner who answer for her - isolate • Pregnant lady - partner shoved her - help her explore options • (SATA. Women abused - assure her, help her get plan, help her contact domestic violence center • (SATA. options (do not know answer): watch child interact with parent, suggest foster care, role model to child Death & Grief • Mom is bargaining - if I do this, baby will get better • Child w/dying sibling - if I listen to parents, sister will get better • Ineffective coping - Pt won’t talk about loss of child • (SATA)Wilms tumor - measure abdominal circumference, listen to breath sounds • Wilms tumor - refer mom to nephrologist & no known cause • Kid getting chemo - encourage letter to mom • Prevent anemia in toddler - advise mom about diet when pregnant fresh fruits & vegetables or feed kid eggs twice a week • SATA. Give iron> with syringe, empty stomach & possibly something else • Girl with menstruation who is fatigued - advise to get iron studies • Which indicates pt needs further teaching about anemia - give meds after meal Fluid & Electrolyte • Low Plasma protein - risk for infection or fluid vol deficit • (SATA. little girl who’s peeing on herself in school - UTI & school phobia (question may get thrown out b/c select all that applies was not in the question. 15 year old asking about oral contraceptives, parents don't know? Provide pros & cons of use Cold on camping trip got Lyme disease, had to take tetracycline? Don't take with milk or antacids Infant with a variety of burns on right side of body? 16% or 22% 20-week gestation, 20 lb gain, 20 cm fundal height, most concerning assessment finding? 20 lb gain Dosage calculation questions: 20mg in 1000ml of D5...12.5. other was 2.5ml with the first dose Instillation of ophthalmic erythromycin? Instill a strip on lower conjunctival sac Mom brings her son w/ fever, vomiting & abdominal pain for past 12 hours? Ask about quantity & nature of pain or normal BMs. Infant in obvious respiratory distress (retractions, dusky appearance, grunting, RR of 67)? Somehow the answer isn't notify health provider immediately, it was get pulse ox on toe Pt with Hirschsprung Disease, explosive diarrhea? Pregnant & depressed in 1st trimester asking about herbal supplements? Not advised Working at Hotline. Pt asked about post-partum blues. Says she's so happy doesn't understand why she's crying? Milk coming in & the hormones are responsible Newborn weighing 7.5 lbs is down to 7? Part of normal findings cuz newborns can lose 10% of weight lbs? Ashkenazi Jew asking about generic counseling? Tay-Sachs disease Assessing strabismus? 6 cardinal gazes High school athlete with cbg of 180mg/dL? Let him play in game MP Hesi 2015 1. woman had variable deceleration. What is nursing action? Turn her on her side 2. parents asking nurse why heel stick is important for baby? It is routine exam to check for metabolic deficiency 3. patient was on drug; what is side effect? Rapid abdominal girth 4. drug calc: magnesium sulfate, convert from mL to units. 240 mg 5. herpes 2 baby: put baby in isolation room 6. Coke baby: mother was diagnosed with Coke. Baby is irritable, cries a lot. 3.2 What do you do? Initiate seizure precaution 7. Woman on Pitocin suddenly has problems & has variable decelerations. What do you do? Turn off Pitocin decrease Pitocin 8. Mom wants to know what substance to use when changing baby’s diaper: Clean water baby lotion, talcum powder 9. Woman’s hematocrit (values) & hemoglobin (value) levels are abnormal but she says she’s been eating green veggies. She wants to know how pregnancy effects these lab values. nurse says: plasma volume affects 10. Mom has mastitis. She is on antibiotics. Nurse advises patient to: Initially breastfeed on unaffected breast 11. New mother states her nipples are tender after breastfeeding for 2 days: assess position of infant while breastfeeding 12. Mom unsure about being a good parent: determine support from family, friends 13. Mother is breastfeeding & wants to know what contraceptive to use: condoms & diaphragm with spermicide 14. Mother has diaphragm after birth & wants to know if she should get new one? Use alternative contraceptives until she gets new one 15. Nurse discovers postpartum Pt has a boggy uterus & is on left side. Encourage patient to void 16. Mother is given Atropine. What to look out for? Increased pulse & dry oral membranes/secretions 17. Mother has DM type 1, what do you expect for fetal complications? Hypoglycemia 18. forgot question but answer is: start IV of lactated ringers at 200mL/hr 19. Pt has history of “heart damage”. She has potential to have heart failure. What is her nursing Dx? fluid volume excess. MP Hesi 2016 Highlighted = on my HESI 2016 version (it depends on which version you may have which questions you will see below) • Good source of folic acid – peanuts • Mom getting hypotensive on spine board after car wreck – roll her on her side on spine board • Mom goes to bathroom with contractions 5 min apart, you hear baby cry – hit call light for help • Iron (SATA) – dark stool normal, give at bedtime • Man calls clinic says his wife has been sad, happy, moody – tell him normal hormonal changes • Mag question – stop infusion due to mag tox • Contractions get really close & she is dilated, stop Pitocin, then contractions get 5 min apart – restart Pitocin per agency policy • Bright red trickling blood – lacerated cervix • Teach adolescent pregnant girls – proper nutritional needs • 42 wk ballard score – check blood sugar • Breast feeding woman asks about birth control – breast feed only every 2-3 hrs • Rubella vaccine – use birth control for 28 days • Baby as white curd patches in his mouth – discuss medicine with mother (candidiasis infection) • Mom has baby – she reaches out & traces profile with fingertips • HIV positive mom gives birth & is worried about passing it to baby – explain to mom AZT for baby after birth • Baby has to have COOMBS test, mom doesn’t want rhogam but will keep her from building up antibodies for future babies • HSV 2, baby born, vaginal delivery – isolate in nursery • Hormone for positive pregnancy test – human chorionic gonadotropin (HCG) • Swollen vagina is normal in female infant • Moro reflex is normal in infant • 800 ml output in an hour with mag question – just continue whatever you are doing • Woman has baby in a cab – start pitocin, massage fundus • Woman comes in with pain in her stomach – you start an IV, not type & cross blood • Put eye ointment in conjunctival sac of newborn (erythromycin) as prophylactic eye ointment for prevention of eye infections contracted from bacteria in birth canal • Had kid now complains of vaginal pain fullness – check vaginal/perineal area • Swollen vagina question is long & talks about salt wasting – normal finding explain about androgens • -1 placement of baby active labor 3 cm dilated, has to go to bathroom – check Pt’s cervix • Baby born to diabetic mother – check baby’s blood sugar • PKU baby – 25% any babies will have it too • Baby with clavicle problem – will have intracurvature • Question about a woman who drinks & has cut down – give her an “atta boy” & encourage her to reduce amount even more • Woman getting radiation iodine – hold off on test to confirm if pregnant or not • Some type of fertility drugs – you need to report sudden increase in abdominal girth • Breast feeding baby & sore nipples – start feeding on unaffected breast • Breast feeding mother has a diaphragm – use condom & foam until diaphragm can be refitted • Baby born to mother who has a positive drug screen for something – monitor baby for seizures • Baby has an apgar score of 3 – continue resuscitation • Baby is jaundice & brought back to hospital after 7 to 10 days – provide eye protection & placed under light or phototherapy • Pregnant woman with low Hct Hgb levels – this is normal because of increase in plasma levels • Woman in labor lying in supine position states she is finally comfortable – place a wedge under her right hip • Preparing a woman for triple screen or something test – you need to prepare to draw blood lab work • Woman comes in stating her water broke – test with nitrate paper & if it turns blue then prepare to admit • Woman is having an amniocentesis test – nurse should check for signs of labor once it is complete • A newborn weighs 7.5 lbs at birth & weighs 7 lbs 24 hrs later – this is normal weight loss • Something about woman 12 weeks prenatal visit. What is important to discuss at this time? It is a cultural question answer is something about – birthing plans or techniques • Baby weighs over 9 lbs – assess for fracture of clavicle • Pt with non-reassuring pattern – stop Pitocin infusion • Baby 28 weeks – hemodilution – anemia (hemodilution of pregnancy peaks at 28 weeks results in decreased Hct) • Parents in transition stage – maintain relationship with extended family • Which block deadens vagina & perineum – pudendal block • Woman comes in vomiting with low BP – give antiemetic • There are two questions on apneic baby – rub baby’s trunk & flick soles of feet • Neonate is apneic for 20 seconds – rub baby’s trunk • Teaching pregnant teens about – iron deficiency anemia • A woman is 5 hrs postpartum with fundus 3 cm above umbilicus & to left – encourage her to void/urinate • Woman is certain number of weeks, which method is best to determine fetal position - ultrasound • Baby born to mother that tested positive for cocaine – nursing priority is seizure precautions • Neonate respiratory distress – nasal flaring • Mother has a firm fundus but continues to have bright red blood trickling from vagina, what is possible indication – lacerated cervix • During fundal massage, place one hand at fundus, what is second hand used for – to anchor fundus • There is a question that has to be put in order – isolate baby, move mom to private room, collect u/a, start iv • How do you measure frequency of contractions – from beginning of one to beginning of next • Mothers Hemoglobin A1C – give consultation to a nutritionist • Baby shows cyanosis in hands & feet & has elevated respirations – gradually warm baby • Baby is showing signs of mottling – check temp • Mom is at 20 week gestation & has gained 20 lbs, what is of most concern out of data of mom – increased weight gain • Mom asks why her baby is being screened for T4 & TSH levels – it is state protocol to monitor for metabolic abnormalities • Pt having labor back pain – counter pressure on lower back • Woman had cleft lip, uncle had cleft lip – send for genetic testing • Woman in labor & they look at vagina & see cord – put woman in Trendelenburg position • Pregnant woman has a diaphragm – she needs to have it refitted for another diaphragm • Baby starts showing signs of respiratory difficulty (nasal flaring, expiratory grunt, cyanosis) – check O2 saturation levels • Baby progressing in extrauterine life would show what signs – good vigorous cry with stimulation • Baby has peri-oral cyanosis – assess oral mucosa • Before surgery mom is given an anticholinergic/atropine with anesthesia. What is therapeutic response of anticholinergic – increase pulse & decrease oral secretions • Question about cytotec – answer is increased risk for abortion • Pts uterus is above umbilicus & to right during postpartum, what do you do 1st – palpate bladder for distention • Mom feels urge to defecate during labor – do a vagina exam • What is reason to do an ultrasound on a mother at 20 weeks gestation – ultrasound for gestation & fetal growth • Pt is taking mag sulfate & urine output is 25 mL/hr, respirations 14/min, pulse is 116/min, what should Nurse do 1st – discontinue mag sulfate (signs of mag tox) • Postpartum with bathroom privileges, what possible condition would Nurse place Pt on temporary bed rest for – possible thrombus in leg if positive Homan’s sign is present • Pregnant woman has increased costal angle & diaphragm is elevated , how does Nurse document this – as a normal finding • Moms Hgb & Hct is low, what food to tell her to eat that contains most iron? – chicken (other sources: liver, meats, whole grains, enriched bread, cereal, dried fruits) • Mom wakes up in a pool of blood & comes to emergency room. What to check 1st – BP • Nurse anticipates that prenatal lab will be performed at 28 weeks – 1 hr glucose (140 between 24-28 weeks) • What med to give mom to prevent RDS in fetus – betamethasone • Pt induced for labor contractions begin occurring 1 ½ to 2 min apart with no resting in between contractions, what to do 1st – stop pitocin infusion • Mom has been on mag sulfate & is now postpartum, what is she at increased risk for – uterine atony (hemorrhage) • Mom is prescribed hemabate – give antiemetic before hemabate due to s/e (also cause diarrhea so give antidiarrheal) • Mom says baby is trying to walk, what do you say – stepping reflex is normal reflex for babies • Functions of placenta in early pregnancy – estrogen & progesterone production • What does nurse do prior to giveing RhoGAM injection – get second nurse to confirm med & patient • Mom is having third baby at home, her two previous babies were rH negative, does she have to come get a direct coombs test dine on baby – yes • Pt has been breastfeeding for 15 mos & 6 weeks pregnant now, what is major assessment – nutritional intake • Signs of fetal alcohol syndrome – flat nose bridge • Pt is showing signs of mag toxicity (nausea, feeling of warmth, flushing) – stop infusion • What is best method to get hemoglobin & hematocrit on baby – heel stick • Pt is diagnosed with eclampsia, what do you do – keep airway at bedside (immediate goal of care when during convulsion is to maintain a patent airway. When seizures do occur, turn woman on her side to prevent aspiration) • Postpartum after c-section, pt is nauseated & abdominal distention, what to do 1st – auscultate for bowel sounds • Pt is noted to have positive homan sign, what do you do – tell Pt to stay in bed & notify dr • Mom comes to labor & delivery unit screaming “the baby is coming”, what to do 1st – observe perineum • Baby is given surfactant to help RDS, what assessment lets you know that baby is Improving – increased urinary output • Mom has mitral stenosis, what symptom is common with this Dx – persistent cough • Pt is giveed with anesthesia, what is highest priority – side rails up & call bell in reach • Assessment of a normal breast after delivery – expels colostrum (3- 4 days) • Mom is complaining that baby isn’t getting enough to eat, what do you tell her – if baby’s urine is straw colored, baby is ok • Baby has total bilirubin level of 12 after 24 hrs – encourage mom to breastfeed • Baby shows signs of jitteriness & other signs of hypoglycemia. What to do 1st – capillary glucose level • In a gestational diabetic mom, what is most important aspect for a healthy pregnancy – euglycemia • Mom comes out of room screaming that her baby is missing. What do you do – initiate a lockdown • Mom has post partial hemorrhage. What is most likely cause – she is a multigravida • Diaper change – use water • Last trimester UTI – cause preterm labor • IDDM insulin needs – less insulin needed in 1st trimester • Jewish lady – answer something to do with tay sachs • Lady is 30 weeks gestation measuring 38 – get prescription for an ultrasound • Pregnant lady car wreck, report - positive fetal hemoglobin • Lady having baby, no meds – nurse is to help her through contractions • Mom comes to hospital with thoracic respiration, chest circumference is 5 cm with increase intercostal angle – normal sign of respiration in pregnancy • U-shape FHR, nursing intervention – change pt position • Question on after pains, what teaching would you tell pt – lying prone/a pillow on abdomen • Pt is worried about Down syndrome baby – chorionic villus sampling (CVS) test • Pt had baby at home, mom is rH -, what should Nurse do 1st – assess newborn blood typing • Pt comes in worrying about baby – rooming in • Meconium staining – meconium aspirator • Question on betamethasone (Celestone) & weeks of gestation (who gets betamethasone) - 30 weeks & cervical changes • Pt getting an epidural, side effects – assess HR & BP (maternal) HR 120, loud cry, good muscle tone, acrocyanotic – apgar score 9 Pt had cup of coffee & getting epidural – inform anesthesiologist • Mom is frequently voiding – collect a urine sample • Best way to check for pregnancy – vaginal ultrasound • AZT on HIV, what is it for – AZT prevents transmission • Teaching about rubella vaccine – don’t get pregnant for a mo • Pt teaching to avoid inferior vena cava syndrome – teach to roll on left or right side • Breech presentation, assessment – turtling sign • Cesarean section, biggest reason to do – herpes in perineum area • Pt on meds for vagina & rectum area – pudendal block • Turbutaline sulfate, side effects – tachycardia, restlessness or nervousness (tachycardia is main indicator) • Prior to giving immunization of Hep B to a newborn, what to do 1st – get consent from mom • Question on description of vernix – vernix (know what it is) (vernix caseosa is a white, creamy, naturally occurring biofilm covering skin of fetus during last trimester of pregnancy. It is a chees like coating & is natural in newborn) • Greatest cause of developmental delay in infant – (sapa) alcohol, marijuana, tobacco/smoking • Postpartum hemorrhage, nursing intervention – massage fundus • Question on mom with s/s of placental previa (need to know what it is) – placenta previa • baby with cephalhematoma , swelling does not cross suture line in parietal bone, what to do – notify Dr. about cephalhematoma • Perineal hematoma – check BP & HR • Baby presenting with s/s of withdrawal – check for cocaine/drug use • Visual check for episiotomy • Epidural given – check BP 1st • Newborn 1st vaccine – K • Illicit drug that causes learning deficit & mental retardation – marijuana, alcohol, ETOH, tobacco • Postpartum mother, assess breast how will they be – breast filling & colostrum • G2, P1, 28 wks preterm labor, 3 doses of terbutaline sulfate (SE): tachycardia & nervousness/restlessness (tachycardia #1 effect of tocolytics) • G3, P3, Rh- delivers at home, other 2 kids RhO-. What should nurse tell mom – newborn needs to be tested for Rhogam • Anesthesia that causes loss of sensation only to vaginal & perineum area – pudendal block • 17 yo doesn’t know how to care for baby, promote parent infant attachment behaviors: encourage rooming in while in hospital • Gestational diabetes, amniocentesis what info would you find – fetal lung maturity • 32 week freqere has irregular contraction, what should nurse do – collect urine for urine culture • Best method to obtain blood sample on a newborn – heel stick on lateral surface of heel • 6 weeks, Rh-, abdominal trauma in MVA, what assessment is important – hemoglobin testing for fetus • 29 weeks, determine fetal position accurate (tool) – ultrasound • 35 yo, 10 weeks pregnant, concerned baby with Down syndrome, what to give – chorionic villus sample at 12 weeks • Newborn instruction on circumcision site – petroleum jelly with each diaper change • Started Pitocin 6 hrs ago, U shaped pattern on contraction. What to do 1st – change position • Important to mention after epidural is given – get up slowly (orthostatic hypotension) check BP • HIV+, receives AZT, what does drug do – decrease transmission • Breech position – turtling sign • Female taking cytotec gets pregnant – increase risk of miscarriage • Hematoma – check HR & BP 1st • Full term gestation, teach – vernix protects baby & will be in folds of skin • Nurse giving baby immunization to newborn – get consent • After pains – lying prone with pillow on abdomen • Mag tox – absent patellar reflex Cephalahematoma – check for jaundice q 8 hr Mom day 1 postpartum – breast will be filling • Baby has curds on inside of cheek from bottle feeding – needs medicine • Breast pain – wear a supportive bra • Uterus boggy after delivery, info Nurse provide – clots inside • Meconium stained fluid – have meconium aspirator • Pregnancy induced HTN – absent patellar reflexes • Gestational diabetes – maintain euglycemia; check for euglycemia 39 week L&D – 101.2F temp Test for trichomonas – saline wet smear (wbc protozoa (many) positive for trichomonas) • Seroconversion to HIV positive once HIV enters body: 6-12 wks • Babies have IgG & IgM immunoglobulins • Lecithin/sphingomyelin ratio – 2:1 when fetal lungs are mature • G – number of pregnancies (including current pregnancy) T – number of term births (>37 weeks) P – number of preterm births (<37 weeks) A – number of abortions or miscarriages (<20 weeks) L – number of living children • Hegar sign – 6 weeks gestation, softening & compressibility of lower uterine segment • Chadwick sign – 4th week blue violet color of cervix with increased vascularity • Goodell sign – softening of cervical tip 6th week – can be indication of pelvic congestion • More than normal HcG – ectopic pregnancy or Down’s syndrome • Foods rich in iron – liver, whole grain, enriched breads & cereals, green leafy vegetables, legumes, dried fruits • Vit C rich food that aids in absorption of iron – orange slices • Normal protein - +1 urine dipstick, <300 g in 24 hrs • B 12 deficiency in vegans • Iron supplements at bedtime to prevent GI upset • Increase of 30 systolic & 15 diastolic – preeclampsia hypertension HESI Meds: Danazol – endometriosis Lupron – endometriosis & uterine fibroids Nafarelin – endometriosis, menopausal symptoms, blocks estrogen, Gn RH agonist Tomoxifan – breast cancer drug, hypoestrogenism effect, GnRH agonist, menopausal symptoms ERT – menopausal therapy, increased risk of breast cancer Imiquimod, podophyllin, podofilox – treatment for HPV Clomid/serophene – infertility drugs Calcium, evista, Fosamax, Actonel, calcitonin – treatment/prevention of osteoporosis Fluconazole, metronidazole, clotrimazole – treatment of candidiasis Zidovudine – HIV prevention mother/fetus transmission Penicillin – syphilis Doxycycline, azithromycin – chlamydia 1. -1 placement of baby, mom in active labor, 3 cm dilated, mom has to go to bathroom: check her cervix 2. 42 weeks Ballard score: check blood sugar 3. baby born to diabetic mother: check babys blood sugar 4. baby born to mom w/positive drug screen: monitor baby for seizures 5. baby has apgar of 3: continue recuscitation 6. baby has white curd patches in mouth: discuss medicine with mother (candidiasis infection) 7. baby is jaundiced & brought back to hospital after 7-10 days: provide eye protection & place under light/phototherapy 8. baby with clavicle problem: it will have intracurvature. 9. breast feeding & sore nipples: start off feeding on unaffected breast 10. breast feeding mother has a diaphragm: use condom & foam until diaphragm can be refitted 11. breast feeding woman asks about birth control: breast feed only every 2-3 hrs 12. bright red trickling blood: lacerated cervix 13. contractions get close & mom is dilated, stop pitocin, then contractions get 5 min apart: restart Ptocin per agency policy 14. fertility drugs: report sudden increase in abdominal girth 15. HIV positive mom gives birth & is worried about passing it to her baby: explain to mom AZT for baby after birth 16. hormone for positive pregnancy test: human chorionic gonasotropin (HCG) 17. HSV 2, baby born via vaginal delivery: isolate in nursery 18. Iron: dark stool is normal, give at bed time 19. is swollen vagina normal in an infant: yes 20. magnesium: stop infusion due to magnesium toxicity 21. man calls clinic says his wife has been sad, happy, moody: tell him these are normal hormonal changes 22. mom getting hypotensive on spine board after MVA: roll her on her side on spine board 23. mom goes to bathroom with contractions 5 min apart - you hear her baby cry: hit call light for help 24. mom had a child but now complains of vaginal pain & fullness: check vaginal & perianal area 25. mom has baby, what is to be expected for 1st meeting: she reaches out & traces profile with fingertips 26. PKU baby: 25% any further baby will have it too 27. put eye ointment in conjunctival sac of newborn as prophylactic eye ointment for prevention of infections from birth canal 28. rubella vaccine: use birth control for 28 days 29. salt wasting & swollen vagina: normal finding - androgens 30. Source of folic acid: peanuts 31. teach adolescent pregnant girls: proper nutritional needs 32. woman comes in with ab pain: start IV, not type & cross blood 33. woman getting radiation iodine: hold off on test to confirm if pregnant or not 34. woman has a baby in a cab & arrives at hospital, what do you do: start pitocin, massage fundus 35. woman on magnesium sulfate has 800 mL output in 1 hr. what do you do: continue what you are doing 36. woman who drinks but has cut down: good job & encourage her to reduce even more 1. 4 mo old what to do to prevent diaper rash: use a barrier cream such as zinc oxide that doesnt have to be fully removed 2. 6 mo old presents for routine vaccine & flu shot: give all immunizations & influenza but alternate site & injection 3. 8 mo old development you would notice: sitting unassisted 4. 15 mo breastfeeding mom now 6 mos gestation: get nutritional history 5. adolescent received an above knee amputation what do you tell them to do every day: inspect stump daily 6. adolescent turns 18 & mother calls for lab results: must get permission from daughter 7. baby got otitis media after an acute respiratory infection - why do infants get otitis media: shorter eustacian tubes 8. baby is regurgitating & vomiting. priority: suction mouth & nose 9. boy with spine injury after MVA: maintain spine alignment 10. breastfeeding mom wants to avoid having another pregnancy - what do you tell her: use condoms & gel 11. dehydrated child finding: weak cry & no tears 12. child with a slipped capital femoral epiphysis: pin & hygiene 13. esophageal atresia what is highest priority for infant: body temp 14. fetal HR dropped abruptly in a V formation - what do you do: change mothers position 15. girl with precocious sexual development is on LHRH, tell mom: daughter will have similar sexual growth patterns as her peers 16. glucose was 800 mg: give IV NS & insulin 17. infant getting phototherapy what do you do: cover their eyes 18. infertile couple goes to a fertility doc: allow them to control if they want to stop or go to a support group before next cycle 19. iron supplements: take with meals 20. lyme disease: if a rash presents then get tested 21. med to prevent respiratory issues in baby: bethamethasone IM 22. mom with mastitis: start on unaffected breast 1st 23. newborn has swollen tender testicles, you suspect a hydrocele, what do you do: use transillumination to check for fluid 24. newborn infant is crying & has elevated bp/is cyanotic, what do you do: warm baby 25. obesity in teens: what physical activity they do does school have PE, 3 day diet history from mom 26. postpartum hemorrhage even after finishing oxytocin infusion: check maternal BP 27. preeclamptic woman received Ptocin IV & having contractions 1-2 minutes apart: discontinue ptocin 28. pregnant woman with temp 101 - can it indicate chorioamionitis 29. Protruding cord: knee to chest position 30. pyloric stenosis, what will occur: metabolic alkalosis 31. Rubella: give after delivery within 72 hrs 32. school age children - Erikson: industry vs inferiority 33. teach prego teens: nutrition requirements during pregnancy 34. to assess for cryptorchidism: warm hands/room transitional phase of labor -priority is assess uterine contractions 36. woman has epidural anesthesia – monitor maternal HR & BP 37. woman who said she thinks shes about 6 mos pregnant & smokes - how to chest for estimated gestational age: ultrasound MP Hesi 2017 V2 • Pt is admitted to labor & delivery unit with contractions that are 3-5 minutes apart, lasting 60-70 seconds. She reports that she is leaking fluid. A vaginal exam reveals that her cervix is 80 percent effaced & 4 cm dilated & a -1 station. Nurse knows that Pt is in which phase & stage of labor? b. Active Phase of 1st Stage • To assess uterine contractions Nurse would: d. Assess duration from beginning to end of each contraction frequency by measuring time between beginnings of contractions, & palpate fundus of uterus for strength. • Which basic type of pelvis includes correct description & % of occurrence in women? a. Platypelloid: flattened, wide, shallow; 3% • What position would be least effective when gravity is desired to assist in fetal descent? a. Lithotomy • The factors that affect process of labor & birth, known commonly as five Ps, include all EXCEPT: d. Pressure. 5 P's are: 1. Powers (contractions), 2. Passengers (fetus & placenta), 3. Passageway (birth canal), 4. Position (of mother), 5. Psychological Response • While evaluating an external monitor tracing of a woman in active labor, Nurse notes that fetal