NUR2513 Exam 3 Blueprint Final
➔ OB/Newborn
◆ What does GTPAL mean? In a case scenario, how will you number a woman’s pregnancy/birth history?
● G-How many times they have been pregnant (include abortions)
● T- term deliveries
● P- Preterm deliveries
● A- Abortions (sponataneous or elective)
● L- Living children
◆ How is a due date calculated by Naegele’s rule?
● -3 months, +7 days, +1 year
◆ To monitor baby’s heart tones best, what part of the abdomen would the best place be to hear if the baby is
vertex versus breech?
● Vertex- side of belly
● Breech- belly button
◆ What are the differences between placenta previa and placental abruption? How will each manifest/what
signs will you notice with each?
● Placenta previa- placenta occlude the cervix opening
○ S/S: painless, bright red bleeding
● Placental abruption: Placenta has torn from the uterus wall
○ S/S: contractions q1/min, painful, firm/rigid/board like abdomen, dark red bleeding to absent
bleeding (depends on location of tear)
◆ VEAL CHOP MINE
◆ V- Variable C- Cord Compression M- Move mother
◆ E- Early H- Head compressions I- I.D progress/Normal
◆ A- Accelerations O- Ok! N-No intervention/monitor
◆ L- Late P- Placental insufficiency E- Execute delivery
➔ Variable: vagal reflex triggered by head compression during pushing and cord compression from short cord, nuchal
cord, body entanglement, prolapsed cord, decreased amniotic fluid, fetal descent
➔ Decelerations: temporary drops in FHR.
◆ Early: generally normal, not concerning, monitor progress/mom/baby
◆ Late: May indicate placental insufficiency. Execute interventions: turn on side, O2, IV fluids, prepare for
delivery
➔ Accelerations: transient increase in FHR. Associated w/ fetal movement, vag exams, contractions, external acoustic
stimulation, fetal scalp stimulation
◆ No alarming, monitor, no interventions needed
➔ NTS (non stress test):
◆ Used to evaluate health before birth by monitoring FHR during 20 min window, assessing for two
accelerations with fetal movements
◆ Assess FHR (all variable, accelerations, decels)
◆ What are the assessment criteria for each component of the Apgar score? Be able to calculate
● Completed at 1 and 5 min
● Heart Rate: >100 BPM
● Respiratory effort: strong, vigorous cry
● Muscle Tone: Flexion of extremities
● Reflex irritability: Cry with stimulation (suction or slap on foot)
● Color: Body and extremities pink
◆ If the purpose of the infant’s fontanelle (3-4 cm anterior opening) and cranial bones is to be movable for the
birthing process, when does the anterior fontanelle close? p. 445
● Anterior: 12-18 months
● Posterior: 2 months
◆ What is the Moro reflex? How is it elicited and how long before it fades (as neuromuscular maturity
increases)? p. 434
● Startle reflex: Hold baby in supine position, allow head to drop back wards and baby response should
elicit arms and legs to extend and then legs pull into abdomen
● Strong for first 8 week and fades by 4-5 months
● If present at 8 months/overactive= cerebral palsy
◆ If a mother is using a substance (Vidocen and cocain), what are the risks to the baby? Besides the need to
assess toxicology on mom and baby, what other assessments/cares are necessary? pp. 584, 709-710.
● Here’s an interesting link about urine testing for drugs in pregnancy (and possible legal consequences).
Urinalysis for toxicology…
, ● STI, Hepatitis, HIV screening
● Nutritional, spiritual, financial support
● If not planning to be drug free, then don't breastfeed
● NB Care
○ Asses for withdraw
○ Swaddling, decreased stimuli, quiet/dark room, allow nonnutritive sucking
○ Assess sucking and feeding ability
○ Prevent dehydration from N/V/D
◆ What are signs of respiratory distress in a newborn? Is acrocyanosis a normal finding? Why?
● Nasal flaring, retractions, grunting, cyanosis, pallor, tachypnea
● Acrocyanosis is normal in newborn r/t breathing has been initiated by newborn and not placenta. Blood
and oxygen are circulating to main body components as newborn elicits breathing and then color
stabilizes mostly by 5 minute APGAR score
◆ What are the signs and symptoms of prolapsed cord?
● Seeing or feeling cord before baby has descended or delivered
● Fetal distress from lack of oxygen; sudden, prolonged deceleration
● Encourage left lateral position, if head is presenting (hold to prevent delivery), wrap cord in sterile
soaked gauze
◆ What are risk factors for postpartum hemorrhage? Think of reasons that make the uterus have to work harder
to contract back down to size.
● HTN, prolonged labor, precipitous labor, infection, multiple births, LGA baby
● Placenta previa, placental abruption, multiple pregnancy
◆ Pitocin (oxytocin): If too much is given, little rest time between contractions (we like at least 1 minute) means the
baby will have less circulation since a contraction really slows blood flow through the uterus. It’s like a baby is
holding their breath during the contraction. What are safe ways to use this high-risk medication? pp. 603-604
● Continuous fetal, maternal, and contraction monitoring
● IV infusion pump and titrated to mimic labor
○ Min 2 min apart, lasting 60-90sec
○ I selected to check patient since numbers where WNL
● Increase in small increments (no more than 2mu/min at a time q30-60m)
● Piggy back with maintenance IV fluid (150mL/hr to prevent intoxication)
● Stop infusion if hypotension occurs, nonreassuring FHR, tachysystole
○ turn on side and admin oxygen as needed
○ Terbutaline may be given for tachysystole
◆ Routine testing
● 24-28 weeks: 1 Hr GTT
● 36 weeks: GBS
➔ From Module 6: Growth and Development
◆ What are ways a parent can respond to a child to help them achieve the Erickson’s developmental task of
their age? (Infant, toddler)
● Infant: Trust vs. Mistrust:
○ Learn delayed gratification
○ Trust is developed by meeting comfort, feeding, simulation, and caring needs
○ Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously
met before being vocalized by the infant
○ Meet the child needs
● Toddler: Autonomy vs. Shame and Doubt
○ Independence is paramount for toddlers who are attempting to do everything for themselves
○ Use negativism or negative responses to express their independence
○ Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as
they begin to explore the environment beyond those most familiar to them
○ Like doing things on their own
● From kahoot:
○ School-age: develops sense of confidence through mastery task
○ Adolescent: sees oneself as unique, integrated person
◆ How might the nurse incorporate the developmental perceptions into explaining a test or procedure to a
preschool-aged child?
, ● Fears related to magical thinking
● Can experience separation anxiety
● Might believe illness and hospitalization are a punishment
● Explain procedures using simple, clear language
● Avoid medical jargon
● Give choices when possible, such as, “Do you want your medicine in a cup or spoon?”
● Testing: pretend, make it a game and fun for them
◆ NB vital signs
● HR: 110-160
● RR: 30-60
● T: >97.7
◆ What growth assessments are done at clinic visits?
● height, weight
● Birth weight doubles by 6 months, triples by 1 yr
◆ Measles: Given t 12-18 months
◆ Chicken pox (varicella)
● S/S: macules that turn into papules and then vesicles
● High fever, fatigue
➔ Module 7 (Chp 34, 38, 40, 41): Interventions for hospitalized peds client, Respiratory, Cardiac Diseases/Disorders
◆ What are techniques for administration of ear drops
● Children younger than 2 years:
○ Pull the pinna downward and straight back
● Children older than 3 years:
○ Pull the pinna upward and back
● Massage after administration
◆ What are tips for helping a child take oral medication?
● This route of medication administration is preferred for children
● Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not
take the entire feeding, and the medication can alter the taste of the formula
● Use the smallest measuring liquid medication for doses of liquid medication
● Avoid measuring liquid medication in a tsp. or tbsp.
● Administer the medication in the side of the mouth in small amounts
● Stroke the infant under the chin to promote swallowing while holding the cheeks together
● Give bottle, pacifier, breastfeed, treat after
◆ What are teaching tips for use of a metered-dose inhaler? SATA
● Shake 5-6X
● Attach spacer for proper inhalation
● Open-mouth method: hold 3-4cm away from mouth
● Closed-mouth method: inhaler between lips and create seal
● Deep breath and exhale
● Tilt head back slightly, slow, deep breath of 3-5 sec
● Hold breath for 5-10 sec
● Wait 1 min before next puff (if needed)
◆ What’s important to know about the newborn/infant nose and breathing? What assessments are
important? p. 932
● They are nose breathers: Avoid anything in the nose
● Use orogastric tube
● Become disturbed when checking for patency r/t temporarily block
◆ What are signs of dehydration?
● Mild: weight loss 3-5%
○ Behavior, membranes, fontanels, pulse, BP WNL
○ Cap refill >2 sec and possible thirst
● Moderate: weight loss 6-9%
○ Cap refill 2-4sec
○ Thirst, irritability, increased pulse, normal/ortho BP
○ Dry mucous membranes, decreased tears, skin turgor
○ Slight tachypnea, sunken fontanel
, ● Severe: weight loss 10%
○ Cap refill >4sec
● Sodium levels will remain normal
● Hematocrit high
○ Tachycardia, ortho BP, extreme thirst, very dry membranes, tented skin, hyperpnea, no tears
w/ sunken eyes, sunken fontanels, oliguria/anuria
◆ What are interventions for mild/moderate versus severe dehydration from gastroenteritis?
● Mild/moderate: oral rehydration
● Severe: IV fluids
● Fluid requirements:
○ Up to 10 kg = 100mL/kg
○ 11-20 kg = 1,000 mL + 50mL/kg for each additional kg over 10 kg
○ Over 20 kg = 1500mL + 20mL/kg for each additional kg over 20
◆ What are therapeutic interventions to manage croup (bronchiolitis)?
● Cool mist, humidifier
● Hydration
● One review says corticosteroids?
● Croup w/ stridor: racemic epinephrine via nebulizer
○ Used to temporarily relieve symptoms associated with bronchial asthma and croup
○ AsthmaNefrin and S2
◆ What are symptoms of streptococcal pharyngitis and complications/risks?
● Complications: Rheumatic fever
◆ Bronchoscopy:
● Admitted for respiratory observation
◆ Pertussis
● S/S: loud brassy/whoop cough, violent, rapid coughing,
◆ Epiglottitis:
● TX: upright-tripod position
◆ What are post-tonsillectomy nursing cares?
● Cold, clear liquids
● No colored liquids
● No dairy or citrus or acidic
◆ What are signs/clinical manifestations/assessment findings in a child with pneumonia?
● Rhonchi(crackles), SOB, Fever
◆ What are treatments and teaching topics for management of cystic fibrosis?
● Chest physiotherapy: Is a set of techniques that includes manual or mechanical percussion, vibration,
cough, forceful expiration (or huffing), and breathing exercises
○ Helps loosen respiratory secretions
○ Schedule treatments before meals or at least 1 hr after meals and at bedtime
○ Administer bronchodilator medication or nebulizer treatment prior
● Pancreatic enzymes 30 min prior to meals
● High protein/calorie
● Multivitamin A,D,E, and K
● Medications
○ Bronchodilators: albuterol
○ Anticholinergics: ipratropium bromide
○ Dornase alfa (pulmozyme): decreases viscosity of mucus and improves lung function
◆ What are the mechanisms of asthma and assessment findings you will note?
● Dyspnea, cough, audible wheezing, use of accessory muscles
● How to use a peak flow meter
○ Ensure the marker is zeroed
○ Close lips tightly around the mouthpiece
○ Blow out as hard and as quickly as possible
○ Repeat 3 more times
○ Record highest number
◆ When would digoxin be used for a heart condition and what effect/action does it have?
● Heart failure
● Improves cardiac contractility
➔ OB/Newborn
◆ What does GTPAL mean? In a case scenario, how will you number a woman’s pregnancy/birth history?
● G-How many times they have been pregnant (include abortions)
● T- term deliveries
● P- Preterm deliveries
● A- Abortions (sponataneous or elective)
● L- Living children
◆ How is a due date calculated by Naegele’s rule?
● -3 months, +7 days, +1 year
◆ To monitor baby’s heart tones best, what part of the abdomen would the best place be to hear if the baby is
vertex versus breech?
● Vertex- side of belly
● Breech- belly button
◆ What are the differences between placenta previa and placental abruption? How will each manifest/what
signs will you notice with each?
● Placenta previa- placenta occlude the cervix opening
○ S/S: painless, bright red bleeding
● Placental abruption: Placenta has torn from the uterus wall
○ S/S: contractions q1/min, painful, firm/rigid/board like abdomen, dark red bleeding to absent
bleeding (depends on location of tear)
◆ VEAL CHOP MINE
◆ V- Variable C- Cord Compression M- Move mother
◆ E- Early H- Head compressions I- I.D progress/Normal
◆ A- Accelerations O- Ok! N-No intervention/monitor
◆ L- Late P- Placental insufficiency E- Execute delivery
➔ Variable: vagal reflex triggered by head compression during pushing and cord compression from short cord, nuchal
cord, body entanglement, prolapsed cord, decreased amniotic fluid, fetal descent
➔ Decelerations: temporary drops in FHR.
◆ Early: generally normal, not concerning, monitor progress/mom/baby
◆ Late: May indicate placental insufficiency. Execute interventions: turn on side, O2, IV fluids, prepare for
delivery
➔ Accelerations: transient increase in FHR. Associated w/ fetal movement, vag exams, contractions, external acoustic
stimulation, fetal scalp stimulation
◆ No alarming, monitor, no interventions needed
➔ NTS (non stress test):
◆ Used to evaluate health before birth by monitoring FHR during 20 min window, assessing for two
accelerations with fetal movements
◆ Assess FHR (all variable, accelerations, decels)
◆ What are the assessment criteria for each component of the Apgar score? Be able to calculate
● Completed at 1 and 5 min
● Heart Rate: >100 BPM
● Respiratory effort: strong, vigorous cry
● Muscle Tone: Flexion of extremities
● Reflex irritability: Cry with stimulation (suction or slap on foot)
● Color: Body and extremities pink
◆ If the purpose of the infant’s fontanelle (3-4 cm anterior opening) and cranial bones is to be movable for the
birthing process, when does the anterior fontanelle close? p. 445
● Anterior: 12-18 months
● Posterior: 2 months
◆ What is the Moro reflex? How is it elicited and how long before it fades (as neuromuscular maturity
increases)? p. 434
● Startle reflex: Hold baby in supine position, allow head to drop back wards and baby response should
elicit arms and legs to extend and then legs pull into abdomen
● Strong for first 8 week and fades by 4-5 months
● If present at 8 months/overactive= cerebral palsy
◆ If a mother is using a substance (Vidocen and cocain), what are the risks to the baby? Besides the need to
assess toxicology on mom and baby, what other assessments/cares are necessary? pp. 584, 709-710.
● Here’s an interesting link about urine testing for drugs in pregnancy (and possible legal consequences).
Urinalysis for toxicology…
, ● STI, Hepatitis, HIV screening
● Nutritional, spiritual, financial support
● If not planning to be drug free, then don't breastfeed
● NB Care
○ Asses for withdraw
○ Swaddling, decreased stimuli, quiet/dark room, allow nonnutritive sucking
○ Assess sucking and feeding ability
○ Prevent dehydration from N/V/D
◆ What are signs of respiratory distress in a newborn? Is acrocyanosis a normal finding? Why?
● Nasal flaring, retractions, grunting, cyanosis, pallor, tachypnea
● Acrocyanosis is normal in newborn r/t breathing has been initiated by newborn and not placenta. Blood
and oxygen are circulating to main body components as newborn elicits breathing and then color
stabilizes mostly by 5 minute APGAR score
◆ What are the signs and symptoms of prolapsed cord?
● Seeing or feeling cord before baby has descended or delivered
● Fetal distress from lack of oxygen; sudden, prolonged deceleration
● Encourage left lateral position, if head is presenting (hold to prevent delivery), wrap cord in sterile
soaked gauze
◆ What are risk factors for postpartum hemorrhage? Think of reasons that make the uterus have to work harder
to contract back down to size.
● HTN, prolonged labor, precipitous labor, infection, multiple births, LGA baby
● Placenta previa, placental abruption, multiple pregnancy
◆ Pitocin (oxytocin): If too much is given, little rest time between contractions (we like at least 1 minute) means the
baby will have less circulation since a contraction really slows blood flow through the uterus. It’s like a baby is
holding their breath during the contraction. What are safe ways to use this high-risk medication? pp. 603-604
● Continuous fetal, maternal, and contraction monitoring
● IV infusion pump and titrated to mimic labor
○ Min 2 min apart, lasting 60-90sec
○ I selected to check patient since numbers where WNL
● Increase in small increments (no more than 2mu/min at a time q30-60m)
● Piggy back with maintenance IV fluid (150mL/hr to prevent intoxication)
● Stop infusion if hypotension occurs, nonreassuring FHR, tachysystole
○ turn on side and admin oxygen as needed
○ Terbutaline may be given for tachysystole
◆ Routine testing
● 24-28 weeks: 1 Hr GTT
● 36 weeks: GBS
➔ From Module 6: Growth and Development
◆ What are ways a parent can respond to a child to help them achieve the Erickson’s developmental task of
their age? (Infant, toddler)
● Infant: Trust vs. Mistrust:
○ Learn delayed gratification
○ Trust is developed by meeting comfort, feeding, simulation, and caring needs
○ Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously
met before being vocalized by the infant
○ Meet the child needs
● Toddler: Autonomy vs. Shame and Doubt
○ Independence is paramount for toddlers who are attempting to do everything for themselves
○ Use negativism or negative responses to express their independence
○ Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as
they begin to explore the environment beyond those most familiar to them
○ Like doing things on their own
● From kahoot:
○ School-age: develops sense of confidence through mastery task
○ Adolescent: sees oneself as unique, integrated person
◆ How might the nurse incorporate the developmental perceptions into explaining a test or procedure to a
preschool-aged child?
, ● Fears related to magical thinking
● Can experience separation anxiety
● Might believe illness and hospitalization are a punishment
● Explain procedures using simple, clear language
● Avoid medical jargon
● Give choices when possible, such as, “Do you want your medicine in a cup or spoon?”
● Testing: pretend, make it a game and fun for them
◆ NB vital signs
● HR: 110-160
● RR: 30-60
● T: >97.7
◆ What growth assessments are done at clinic visits?
● height, weight
● Birth weight doubles by 6 months, triples by 1 yr
◆ Measles: Given t 12-18 months
◆ Chicken pox (varicella)
● S/S: macules that turn into papules and then vesicles
● High fever, fatigue
➔ Module 7 (Chp 34, 38, 40, 41): Interventions for hospitalized peds client, Respiratory, Cardiac Diseases/Disorders
◆ What are techniques for administration of ear drops
● Children younger than 2 years:
○ Pull the pinna downward and straight back
● Children older than 3 years:
○ Pull the pinna upward and back
● Massage after administration
◆ What are tips for helping a child take oral medication?
● This route of medication administration is preferred for children
● Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not
take the entire feeding, and the medication can alter the taste of the formula
● Use the smallest measuring liquid medication for doses of liquid medication
● Avoid measuring liquid medication in a tsp. or tbsp.
● Administer the medication in the side of the mouth in small amounts
● Stroke the infant under the chin to promote swallowing while holding the cheeks together
● Give bottle, pacifier, breastfeed, treat after
◆ What are teaching tips for use of a metered-dose inhaler? SATA
● Shake 5-6X
● Attach spacer for proper inhalation
● Open-mouth method: hold 3-4cm away from mouth
● Closed-mouth method: inhaler between lips and create seal
● Deep breath and exhale
● Tilt head back slightly, slow, deep breath of 3-5 sec
● Hold breath for 5-10 sec
● Wait 1 min before next puff (if needed)
◆ What’s important to know about the newborn/infant nose and breathing? What assessments are
important? p. 932
● They are nose breathers: Avoid anything in the nose
● Use orogastric tube
● Become disturbed when checking for patency r/t temporarily block
◆ What are signs of dehydration?
● Mild: weight loss 3-5%
○ Behavior, membranes, fontanels, pulse, BP WNL
○ Cap refill >2 sec and possible thirst
● Moderate: weight loss 6-9%
○ Cap refill 2-4sec
○ Thirst, irritability, increased pulse, normal/ortho BP
○ Dry mucous membranes, decreased tears, skin turgor
○ Slight tachypnea, sunken fontanel
, ● Severe: weight loss 10%
○ Cap refill >4sec
● Sodium levels will remain normal
● Hematocrit high
○ Tachycardia, ortho BP, extreme thirst, very dry membranes, tented skin, hyperpnea, no tears
w/ sunken eyes, sunken fontanels, oliguria/anuria
◆ What are interventions for mild/moderate versus severe dehydration from gastroenteritis?
● Mild/moderate: oral rehydration
● Severe: IV fluids
● Fluid requirements:
○ Up to 10 kg = 100mL/kg
○ 11-20 kg = 1,000 mL + 50mL/kg for each additional kg over 10 kg
○ Over 20 kg = 1500mL + 20mL/kg for each additional kg over 20
◆ What are therapeutic interventions to manage croup (bronchiolitis)?
● Cool mist, humidifier
● Hydration
● One review says corticosteroids?
● Croup w/ stridor: racemic epinephrine via nebulizer
○ Used to temporarily relieve symptoms associated with bronchial asthma and croup
○ AsthmaNefrin and S2
◆ What are symptoms of streptococcal pharyngitis and complications/risks?
● Complications: Rheumatic fever
◆ Bronchoscopy:
● Admitted for respiratory observation
◆ Pertussis
● S/S: loud brassy/whoop cough, violent, rapid coughing,
◆ Epiglottitis:
● TX: upright-tripod position
◆ What are post-tonsillectomy nursing cares?
● Cold, clear liquids
● No colored liquids
● No dairy or citrus or acidic
◆ What are signs/clinical manifestations/assessment findings in a child with pneumonia?
● Rhonchi(crackles), SOB, Fever
◆ What are treatments and teaching topics for management of cystic fibrosis?
● Chest physiotherapy: Is a set of techniques that includes manual or mechanical percussion, vibration,
cough, forceful expiration (or huffing), and breathing exercises
○ Helps loosen respiratory secretions
○ Schedule treatments before meals or at least 1 hr after meals and at bedtime
○ Administer bronchodilator medication or nebulizer treatment prior
● Pancreatic enzymes 30 min prior to meals
● High protein/calorie
● Multivitamin A,D,E, and K
● Medications
○ Bronchodilators: albuterol
○ Anticholinergics: ipratropium bromide
○ Dornase alfa (pulmozyme): decreases viscosity of mucus and improves lung function
◆ What are the mechanisms of asthma and assessment findings you will note?
● Dyspnea, cough, audible wheezing, use of accessory muscles
● How to use a peak flow meter
○ Ensure the marker is zeroed
○ Close lips tightly around the mouthpiece
○ Blow out as hard and as quickly as possible
○ Repeat 3 more times
○ Record highest number
◆ When would digoxin be used for a heart condition and what effect/action does it have?
● Heart failure
● Improves cardiac contractility
