Postpartum Case Analysis Study Guide

POSTPARTUM CASE ANALYSIS 1. Which factor in Pamela’s health history makes her high risk for hemorrhage during the postpartal period? A. Her placenta was implanted on the posterior uterus. B. Her baby weighed more than 9 pounds. C. Her family earns their living caring for dairy cows. D. Pamela was in labor longer than 12 hours. 2. To estimate blood loss postpartally, you assess Pamela’s perineal pads. A saturated perineal pad contains approximately how much blood? A. 10 to 20 mL B. 25 to 50 mL C. 100 Ml D. 250 Ml 3. A common drug used to cause a uterus to contract postpartally to prevent or control bleeding is A. Levodopa. B. Prilosec. C. Oxytocin D. Meperidine 4. Massaging a uterus is a measure to control postpartal bleeding. To do this, you would A. use a light rapid effleurage technique for this. B. place one hand in the vagina to steady the cervix. C. always massage from side to side to decrease pain. D. place one hand at the base of the uterus to anchor it. 5.Which factor in Pamela’s history puts her at high risk for postpartal infection of the uterus? A. Birth from a lithotomy position B. Rupture of membranes over 24 hours C. Birth of a 9-pound male infant D. Breastfeeding her infant on demand 6. Postpartal infection of the uterus is termed A. vaginitis. B. cystitis. C. Endometritis D. Cervicitis 7. Pamela has a perineal hematoma. A common cause of this is A. a clotting defect from the interaction of epidural anesthesia. B. bruising of the perineum from a vertex presentation. C. bleeding from the placing of perineal episiotomy sutures. D. D. urine seeping into the perineum from the anterior bladder 8. Pamela has a WBC of 25,000 mm3. For a postpartal woman, you would assess this as A. below average. B. a normal count. C. an elevated count. D. normal if it consists of only lymphocytes. 9. Which temperature best signals postpartal infection? A. 101°F at 8 hours postpartum B. 102°F immediately after birth C. 99°F at 2 weeks postpartum D. 101.2°F on the third postpartal day 10. All women in the postpartum period are at high risk for thrombophlebitis. This is because A. placental toxins may lead to anticoagulation. B. vaginal tears can lead to minimal infections. C. fetal blood mixes with maternal blood at birth. D. stasis of lower extremity vessels due to dilation. 11. If a woman develops a deep vein thrombus in the femoral vein, a common intervention would be to A. keep her legs in a dependent position. B. apply alcohol soaks to the site. C. apply moist heat over the site. D. use a sterile needle to aspirate the clot.. 12. Warfarin (Coumadin) is a common drug prescribed for deep vein thrombus. Which factor in Pamela’s history would make you question an order for this drug postpartally? A. She is breastfeeding her newborn. B. She is less than 25 years of age. C. She has no history of a previous blood clot. D. She has been exposed to dairy cows. E. 13. The antidote for Warfarin (Coumadin) is A. acetylsalicylic acid. B. vitamin K. C. Heparin. D. serotonin 14. Which of the following denotes the correct technique for fundal massage for a postpartum client exhibiting a large amount of blood on the perineal pad? A. Compressing the fundus on one side while supporting the other side of the uterus B. Massaging above the symphysis pubis while one hand supports the uterine fundus C. Pressing deeply into the abdomen while compressing the fundus with both hands D. Supporting the fundus while massaging the uterus just above the symphysis pubis 15. When teaching a childbirth education class on infection prevention after delivery, the nurse would instruct the woman to perform perineal care how often? A. After each voiding or defecation B. Every 8 hours C. Once each day D. When she has perineal pain 16. A client who is 24 hours postpartum has the following morning vital signs: Temperature 100° F; BP 124/78; P58; R16. The nurse should do which of the following? A. Assess the vital signs hourly instead of every 4 hours. B. Report the changes in vital signs to the physician. C. Retake the pulse rate after the client ambulates. D. Recognize the client’s vital signs are normal 17. A client begins preterm labor and the physician orders terbutaline sulfate (Brethine). After its administration, the nurse assesses the client for the therapeutic effect of a. Reduction of pain in the perineal area b. Decrease in blood pressure from 120/80 to 90/60 c. Decrease in frequency and duration of contractions d. Dilation of the cervix from 1 to 1.5 cm for every hour of labor. 18. The postpartum client is bleeding heavily 2 hours after delivery. The fundus of the uterus is firm; uterus at the center of the abdomen. Which of the following actions should the nurse do next? A. change perineal pads B. notify the physician C. massage the uterus D. check perineu 19. Which of the following techniques during labor and delivery can lead to uterine inversion? A. Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head B. Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation C. Massaging the fundus to encourage the uterus to contract 20. Lochia normally disappears after how many days postpartum? A. 5 days B. 7-10 days C. 18-21 days D. 28-30 days 21. An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is A. Encourage the mother to ambulate to relieve the pain in the leg B. Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow C. Apply warm compress on the affected leg to relieve the pain D. Elevate the affected leg and keep the patient on bedrest 22. Which of the following denotes the correct technique for fundal massage for a postpartum client exhibiting a large amount of blood on the perineal pad? A. Compressing the fundus on one side while supporting the other side of the uterus B. Massaging above the symphysis pubis while one hand supports the uterine fundus C. Pressing deeply into the abdomen while compressing the fundus with both hands D. Supporting the fundus while massaging the uterus just above the symphysis pubis 23. Cefelita, 38 years old multipara is admitted with a tentative diagnosis of femoral thrombophlebitis. The nurse assesses the patient with A. burning sensation B. leg pain C. abdominal pain D. increased lochial flow 24. In the immediate postpartum period the action of methyergonovine is to A. cause sustained uterine contractions. B. cause intermittent contractions. C. relax the uterus. D. induce sleep so the mother can rest after an exhausting labor. 25. Management of thrombosis and thrombophlebitis includes A. Checking the homan’s sign B. Monitoring signs of inflammation in the lower extremities. C. Starting on anticoagulant therapy D. A and B E. All of the above CARE STUDY QUESTIONS: INFERTILITY 1. Amy talks as if her problem of temporary subfertility is unique. Subfertility affects what percentage of couples who want to have children? A. 1% to 5% B. 10% to 15% C. 35% to 40% D. 55% 2. . Amy and her husband have been trying for a year and a half to conceive a third child. What is the average time span it takes a couple to conceive? A. Pregnancy usually occurs within 1 year of unprotected coitus. B. Three years is not an unusual for the average healthy couple. C. Almost all couples become pregnant within 3 months. D. Most couples become pregnant in 6 months. 3. What finding in Amy’s history is often associated with female subfertility? A. Amy works at a job where she stands for a long time every day. B. Amy had an endometritis following her last baby’s birth. C. Amy’s last baby was a boy and weighed over 8 pounds. D. Amy works at craft projects that could include applying glue.. 4. What finding in Ross’ history is often associated with male subfertility? A. He has a beer on Saturday nights. B. He had rubella as a child. C. He enjoys sailing on weekends. D. He works at a desk job. 5. Ross brings a sperm sample into the fertility clinic for analysis. Which of the following is a question you would want to ask him? A. Was he certain to omit any spicy or pickled food for lunch? B. Did he keep the sample at body temperature during transport? C. Is he certain that his car does not emit carbon monoxide fumes? D. Did he restrain from urinating for 4 hours before the sample? 6. Ross’ sperm count is estimated to be 25 million per mL. Your analysis of this is that this A. is a very low sperm count so accounts for their subfertility. B. is a normal sperm count for a 40-year-old male. C. number suggests Ross’ sperm must be immobile. D. number is meaningless without knowing the semen amount. 7. Amy refers to herself as sterile. Sterility is actually defined as a condition where A. a couple has not conceived a child even though they want to. B. the couple has a documented reason for not conceiving. C. a woman has never birthed a child although she has tried. D. people feel they will not ever be able to have children. 8. Which of the following would be the best nursing diagnosis for Amy? A. Anxiety related to difficulty conceiving a third child B. Guilt related to a previous therapeutic abortion. C. Pain related to current monthly menstrual periods D. Difficulty with fertility related to current lifestyle 9. Amy had a hysterosalpingogram. It is important that this test is scheduled A. on the 14th day of the menstrual cycle. B. after the midpoint of the cycle C. immediately following a menstrual flow. D. anytime; time of the month is unimportant 10. Following a hysterosalpingogram, you would want to advise Amy that she might experience A. nausea and vomiting from the large amount of water she has to drink. B. sharp shoulder pain afterward from the carbon dioxide infusion. C. pain in her leg from pressure on the sciatic nerve afterward. D. dull nagging ovarian pain from introduction of the catheter. 11. B. Amy reports that she takes her basal body temperature (BBT) daily and it shows no fluctuations. Which of the following techniques would you want to be certain she is using? A. She takes her temperature immediately after every meal daily. B. She takes her temperature before she has activity in the morning. C. She is certain not to drink coffee with either breakfast or lunch. D. She records her temperature every night before falling asleep. 12. If Amy is ovulating, you would expect a basal body temperature graph to show A. first an increase, then a decrease, and then a second increase of temperature. B. an increase of 5° temperature that remains increased for 3 days. C. a decrease of at least 1° temperature that lasts 2 days. D. a slight dip of 0.5° followed by a 1° increase. 13. . Amy is prescribed the drug clomiphene citrate (Clomid). Clomid is a(n) A. estrogen agonist that causes the pituitary to release FSH hormone. B. corticosteroid that reduces ovarian inflammation and scarring. C. mild analgesic that can reduce the pain of ovulation. D. progesterone that stimulates follicle stimulating hormone. 14. A precaution you would want Amy to know before taking this drug is that she A. should take it on an empty stomach or only with water. B. should never take aspirin with it to avoid side effects. C. needs to coordinate coitus with ovulation while on the drug. D. needs to avoid both tomatoes and spinach while on the drug. 16. Amy has no history of pelvic inflammatory disease (PID). PID can cause subfertility because it A. increases the rate of ova transport so the ova cannot meet sperm. B. leaves a scarred uterine surface so implantation can not occur. C. creates excessive cervical mucus that then “drowns” sperm. D. can cause inflammation and scarring of fallopian tubes. 17. Amy is to have an endometrial biopsy later this month. The purpose of this test will be to A. analyze how many follicles are still present in her ovaries. B. examine if her fallopian tubes are of average length. C. analyze the type of endothelium she has present. D. inspect and test cervical mucus for white blood cell content. 18. Amy says she could never undergo in vitro fertilization. This is A. transferring embryos from the left to right ovary to improve conception. B. transferring an ovum from the ovary to the vagina so it can meet sperm. C. encouraging sperm to enter the fallopian tubes through vacuum pressure. D. transferring a woman’s fertilized ovum into her uterus for implantation.. 19. A possible side effect of in vitro fertilization that women need to be cautioned may occur is A. women may have multiple pregnancies with this intervention. B. children born this way may be more prone to allergies than usual. C. husbands may develop a bleeding defect following the procedure. D. women may experience shortness of breath from the drug therapy. 20. An instruction you would want to be sure Amy understands before having an in vitro fertilization procedure is A. that it is an expensive procedure and the success rate is not 100%. B. even though she is pregnant, a pregnancy test will not test positive. C. the pregnancy will be shorter by one month than a usual pregnancy. D. she may feel dull pain from ovarian stimulation throughout pregnancy. PROBLEMS OF POWER 1. The cervical dilatation taken at 8:00 A.M in a G1P0 patient was 6 cm. A repeat IE done at 10 AM showed that cervical dilation was 7 cm. The correct interpretation of this result is A. the duration of labor is normal. B. labor is progressing as expected. C. the latent phase of stage 1 is prolonged. D. the active phase of stage 1 is protracted. 2. A nurse is monitoring the client who is in the active stage of labor. The client has been experiencing contractions that are short, irregular and weak. The nurse documents that the client is experiencing which type of labor dystocia? A. Hypotonic B. Precipitous C. Hypertonic D. Preterm labor 3. After 4 hours of active labor, the nurse notes that the contractions of a primigravida client are not strong enough to dilate the cervix. Which of the following would the nurse anticipate doing? A. Obtaining an order to begin IV oxytocin infusion B. Administering a light sedative to allow the patient to rest for several hour C. Preparing for a cesarean section for failure to progress D. Increasing the encouragement to the patient when pushing begins 4. The client is in active labor. She is on oxytocin per IV infusion drip. Which of the following situations would require that the infusion be stopped? A. Contractions occur every 3-5 minutes, last 50-60 seconds B. The cervix is 8cm, dilated, contractions occur every 3-5 minutes C. Contractions occur at less than 2 minute intervals or last for longer than 90 seconds D. The cervix is 6cm, dilated, partially effaced, duration of contractions is 50-60 seconds 5. When uterine rupture occurs, which of the following would be the priority? A. Limiting hypovolemic shock B. Obtaining blood specimens C. Instituting complete bed rest D. Inserting a urinary catheter 6. Which of the following would be a sign that uterine rupture has occurred? A. A sudden blood pressure increase B. Leak of amniotic fluid from the vagina C. Bleeding from an IV or intramuscular site D. Sharp abdominal pain in between contractions 7. A woman develops a pathologic retraction ring during labor. On assessment, you would expect to find its appearance as A. mottling surrounding the cervix. B. a protruding ring over the uterine fundus. C. a line of indentation over the lower abdomen. D. an ecchymotic area over the symphysis pubis. 8. In terms of planning care, why is the development of a pathologic retraction ring important? A. It precedes surrounding rupture B. It denotes a multiple pregnancy is present C. It suggests caesarian birth is no longer possible D. It identifies that the pelvic division of labor is beginning 9. If the labor period lasts only for 3 hours, the nurse should suspect that the following conditions may occur. Select all that apply A. fetal anoxia. B. laceration of the cervix C. laceration of perineum. D. cranial hematoma in the fetus. 10. Which of the following best describes preterm labor? A. Labor that begins after 20 weeks gestation and before 37 weeks gestation B. Labor that begins after 15 weeks gestation and before 37 weeks gestation C. Labor that begins after 24 weeks gestation and before 28 weeks gestation D. Labor that begins after 28 weeks gestation and before 40 weeks gestation 11. To prevent preterm labor from progressing, drugs are usually prescribed to halt labor. The drugs commonly given are A. Prostaglandin and oxytocin B. Progesterone and estrogen. C. Dexamethasone and prostaglandin. D. Magnesium sulfate and terbulaline 12. Mrs. Ramos has prolonged labor. What is the most common cause for arrest of descent during the second stage of labor? A. Cephalopelvic disproportion B. Maternal calcium deficiency C. The maternal outlet is narrow D. The fetus is asleep during labor 13. When giving narcotic analgesics to mother in labor, the special consideration to follow is A. the progress of labor is well established reaching the transitional stage. B. uterine contraction is progressing well and delivery of the baby is imminent. C. cervical dilatation has already reached at least 8 cm and the station is at least (+) 2. D. uterine contractions are strong and the baby will not be delivered yet within the next 3 hour 14. A woman you care for during labor is having contractions 2 minutes apart but rarely over 5ommHg in strength; the resting tone is high, 20-25 mmHg. She asks what she can do to make contractions more effective. Your best response would be that A. walking around will make her contractions more regular. B. she needs to rest because her contractions are hypertonic. C. her physician will order oxytocin to strengthen contractions. D. hypotonic contractions of this kind will strengthen by themselves 15. A gravid 7, para 6 woman is in the hospital only 15 minutes when she begins to deliver precipitously. The fetal head begins to deliver as you walk into the labor room. Your best action would be to A. attach a fetal monitor to determine fetal status. B. ask her to push with the next contraction so delivery is rapid. C. assess blood pressure and pulse to detect placental bleeding. D. place a gloved hand gently on the fetal head to guide delivery. 16. The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage? A. Full bladder B. Cervical rigidity C. Pelvic bone contraction D. Extension rather than flexion of the head 17. The danger of a resting tone that is too high is that A. newborns are born tense or irritated from lack of rest. B. the woman becomes intoxicated with breakdown products. C. amniotic fluid increases in amount from poor fetal swallowing. D. lack of relaxation prevents optimal uterine artery filling. 18. Which of the following describes why hypertonic contractions tend to become very painful? A. More than one contraction may begin at the same time, as receptor in the myometrium act independently of each other. B. The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells. C. The number of uterine contractions is very low r infrequent. D. There is an increase in the length of labor because so many contractions are needed to achieve cervical dilatation 19. Uterine prolapsed is associated to the following. Select all that apply A. Lack of estrogen B. Weak pelvic musculature C. Chronic cough D. constipation 20. Which of the following is NOT a sign of uterine prolapsed? A. Feeling of something descending in the vagina B. Itchiness of the vulva C. Backache or pain in the pelvis Large baby QUIZ #1: 1. The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn becomes too cool, the neonate requires: o Less oxygen, and the newborns metabolic rate increases o More oxygen and the newborns metabolic rate decreases o More oxygen, and the newborns metabolic rate increases o Less oxygen, and the newborns metabolic rate decrease 2. Hypothermia is common in newborn because of their inability to control heat. The following would be an appropriate nursing intervention to prevent heat loss. Except: o Doing kangaroo o Place the crib beside the wall o Drying and wrapping the baby o Regulation room temperature between 25-28C 3. Which of the following nursing diagnoses would be given priority in then care of a newborn one hour of age? o Risk for infection o Altered nutrition o Impaired skin integrity o Ineffective thermoregulation 4. Heat regulation is the most critical factor for a newborns survival next to establishing respiration. Which of the following characteristics of newborns predispose them to poor heat regulation? o Newborns cannot shiver. o Newborn cannot assess environmental temperature yet. o The newborns small surface area relative to his or her weight o None of the above 5. A baby girl is born 8 weeks premature. At birth, she has no spontaneous respiration but is successfully resuscitated. Within several hours she develops respiratory grunting, cyanosis, tachypnea, nasal flaring and retractions. She’s diagnosed with respiratory distress syndrome, intubated, and place a ventilator. Which nursing action should be included in the baby’s plan of care to prevent retinopathy of prematurity. o Cover his eyes while receiving oxygen o Keep her body temperature low. o Monitor partial pressure of oxygen (PaO2)levels o Humidify the oxygen 6. Andrea has no spontaneous respiration at birth. Suppose her amniotic fluid is heavily stained with meconium. Which would be your best action? o Rub her back to stimulate respiration o Administer oxygen at 40 cm H20 pressure o Begin chest massage to force out meconium o Keep her warm until a laryngoscope can be passed 7. A nurse in the nursery is caring for a neonate. On assessment the infant is exhibiting grunting, tachypnea, nasal flaring and grunting. Respiratory distress syndrome is diagnosed and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: o Subcutaneous injection o Intravenous injection o Intramuscular injection o Instillation of the preparation into the lungs through an endotracheal tube. 8. Which of the following manifestations in a six month old infant who was born prematurely would lead a nurse to suspect that the infant has apnea? o Intermittent acrocyanosis o Episodes of breath holding during periods of stress. o Transient episodes of temperature changes. o A lapse of spontaneous breathing for 20 seconds or more 9. Which of the following is the most important concept associated with high risk newborn? o Support the high risk newborns cardiopulmonary adaptation by maintaining adequate airway o Identify complications with early intervention in the high risk newborn to reduce morbidity and mortality o Assess the high risk newborn for any physical complications that will assist the parent with bonding o Support the mother and significant others in their request toward adaptation to the high risk newborn 10. After therapeutic interventions, a newborn demonstrates adequate lung expansion. The amount of pressure that would enable her to continue to reinflate the alveoli of her lungs would be: o 10-15 cm H2O o 15-20 cm H2O o 20-25 cm H2O o 40 cm H20 QUIZ # 2: 1. Baby Jorge develops hyperbilirubinemia. What is a method used to treat hyperbilirubinemia in a newborn? o Gentle exercise to stop muscle breakdown o Administration of a cardiovascular stimulant o Keeping infants in a warm and dark environment o Early feeding to speed passage of meconium 2. Therese has just given birth at 42 weeks gestation. When the nurse assesses the neonate, which physical finding is expected? o A sleepy, lethargic baby o Lanugo covering the body o Desquamation of the epidermis o Vernix caseosa covering the body 3. Which of the following would the nurse needs to incorporate in the plan of care for a newborn who is large for gestational age (LGA)? Select all that apply o Observe closely for signs of hyperbilirubinemia o Decrease feedings to reduce size and prevent obesity o Anticipate that the LGA newborn will have strong sucking ability o Decrease stimulation such as holding and talking to prevent seizure o Be alert for respiratory problems due to increase intracranial pressure o Assess for possible impaired parenting due to newborns high risk status 4. Which of the following newborn characteristics would suggest that there was nutritional deprivation during fetal growth? o Excessive lanugo o Excessive brown fat o Widely spread sutures o Disproportionally small head to large body 5. Baby girl Andrea born vaginally was determined to be large for gestational age. The nurse would assess this newborn carefully for o Increased intracranial pressure o Hypothermia o Decreased red blood levels o Hyperglycemia 6. Baby jenny who is small for gestation is at increased risk during the transitional period for which complication? o Anemia probably due to chronic fetal hypoxia o Hyperthermia due to decreased glycogen stores o Hyperthermia due to decreased glycogen stores o Polycythemia probably due to chronic hypoxia 7. An insulin dependent diabetic delivered a 10 pound male. When the baby is brought to the nursery, the priority care is to o Clean the umbilical cord with betadine to prevent infection o Give the baby a bath o Call the laboratory to do screening test o Check the baby’s serum glucose level and administer glucose if 40mg/dl 8. Small for gestational age newborns are at risk for difficulty of maintaining body temperature due to o Their skin is more susceptible to conduction of cold o They are preterm so they are born relatively small in size o They are more active than usual so they grow off covers o They do not have as much fat stores as do other infants 9. The physical finding you would expected to be seen in ljezie because of prematurity o Continuous irritability or crying o Low et ears that will rise later o Lack of sole creases on her feet o Scant lanugo on her back and arm 10. A nurse is assessing a newborn who was born at 3 weeks gestation. Which of the following would the nurse most likely find? Select all that apply o Ruddy skin o Scant lanugo o High pitched cry o Minimal acrocyanosis o Copious vernix caseosa o Head small in proportion to chest QUIZ # 3: 1. You are conducting a preoperative teaching to the parents of a child who is to undergo a cardiac surgery for correction of septal defect. Which of the following should you include in the health teaching? o A tour of the general pediatric care unit o Concepts of pain management o Warn the parents not to bring the siblings in the hospital. o Warn the parents not to bring toys from the home to the hospital 2. A parent of an infant who has a small atrial septal defect makes all of the following comments. Which one indicates an accurate understanding of an infant’s condition? o “I won’t let my baby get upset and cry. “ o “My baby needs to have a heart surgery immediately.” o “My baby may need to rest more so than other infants while feeding.” o “I understand that my baby will grow at a slower pace. 3. Myer, 2 months is suspected of having coarction of the aorta. The cardinal sign of this defect is: o Clubbing of the digits and circumoral cyanosis o Pedal edema and portal hypertension o Systolic ejection murmur o Upper extremity hypertension 4. Which independent nursing interventions are appropriate for a client who is experiencing alteration in oxygenation? Select all that apply. o Provide suctioning o Prescribing bronchodilators o Assisting with positioning o Monitoring activity intolerance o Encouraging deep breathing exercises 5. A 10 year old boy who is suspected of having coarction of the aorta is hospitalized. It is essential that the nurse performs which of the following during the initial physical examination? o Palpating the lower margin of the liver o Monitor the BP in all four extremities o Measuring the abdominal girth o Performing pulmonary function tests. 6. The most common adaptation of a child with tetralogy of fallot o Decorticate positioning o Flushed appearance o Clubbing fingers o Decrease RBC count 7. When developing the initial plan of care for a neonate who was born at 41 weeks gestation, was diagnosed with meconium aspiration syndrome (MAS), and requires mechanical ventilation, which of the following should the nurse include: o Care of an umbilical arterial line o Frequent ultrasound scans o Orogastric feedings as soon as possible. o Assessment for symptoms of hyperglycemia 8. The family is caring for their youngest child Justin who is suffering from tetralogy fallot. Which of the following are defects associated with this congenital heart condition? o Aorta exist from the right ventricle, pulmonary artery exist from the left ventricle and two non- communicating circulations o Ventricular septal defect , overriding aorta, pulmonic stenosis, and right ventricular hypertrophy o Coarction of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus o Tricuspid valve atresia, atrial septal defect, ventricular septal defect and hypoplastic right ventricle 9. Which data supports the nurse’s assessment that a newborn with acute respiratory distress syndrome is improving? o Increased in PaCo2 o Oxygen saturation of 92% o Pulmonary vascular resistance increases o Thick secretions from the respiratory tract 10. A baby girl is born 8 weeks premature. At birth, she has no spontaneous respirations but is successfully resuscitated. Within several hours she develops respiratory grunting, cyanosis, tachypnea, nasal flaring, and retractions. She’s diagnosed with respiratory distress syndrome, intubated, and placed on a ventilator. Which nursing action should be included in the baby’s plan of care to prevent retinopathy of prematurity? o Humidify the oxygen o Keep her body temperature low o Cover her eyes while receiving oxygen o Monitor partial pressure of oxygen (PaO2) levels 11. A 4 year old with tetralogy of fallot is seen in a squatting position near his bed. The nurse should: o Administer oxygen o Take no action if he looks comfortable but continue to observe him o Pick him up and place him in Trendelenberg’s position in bed. o Have him stand up and walk around the room. 12. Five days after admission, you have notes on assessment the presence of machinery like murmur during heart auscultation, wide pulse pressure and decreased diastolic blood pressure. Which congenital cardiac anomaly is most likely to be present? o Atrial Septal Defect o Patent Ductus Arteriosus o Ventricular Septal Defect 13. MAS can be prevented by o Exposing the baby to phototherapy o Tracheal suctioning once baby is delivered o Oxygen administration upon delivery of the baby’s head. o Suctioning mouth, nose and posterior pharynx just after the head is delivered. 14. During assessment of a newborn diagnosed with a cardiac anomaly, you detected that the infant’s femoral pulses are absent. Which of the following diseases is most likely presented by the symptom? o Atrial septal Defect o Ventricular Septal Defect o Coartation of the aorta o Patent Ductus Arteriosus 15. Usually PDA closes as the oxygen level increases and the prostaglandin levels fall. If it does not close, which of the following drugs is given? o Indomethacin IV o Ritodrine Hydrochloride (yutopar) o Oncovin IV o Ibutilide (Corvent) IV 16. The nurse admits in the pediatric ward an infant with respiratory distress. Expected assessment would be? o Nasal flaring o Yellowish skin o Cool and clammy skin o Jugular vein distention 17. When assessing a newly delivered neonate, then nurse notes the following findings: arms and legs slightly flexed: skin smooth and transparent: abundant lanugo on the back: slow recoil of pinna: and few sole creases. In light of these findings, the care plan for this neonate should include nursing orders to monitor for: o Polycythemia o Hyperglycemia o Postmaturity syndrome o Respiratory distress syndrome 18. A nurse in the nursery is caring for a neonate. On assessment the infant is exhibiting grunting, tachypnea, nasal flaring and grunting. Respiratory distress syndrome is diagnosed and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: o Subcutaneous injection o Intravenous injection o Intramuscular injection o Instillation of the preparation into the lungs through an endotracheal tube. 19. Baby Elmo has surfactant administered at birth. The purpose of surfactant is to: o Prevent alveoli from collapsing on expiration o Help raise lung secretions by relaxing the airway o Reduce gastric secretions by action on the pancreas. o Paralyze respiratory muscles to synchronize breathing 20. A nurse in the nursery is monitoring a preterm infant for respiratory distress syndrome. Which assessment signs if noted in the newborn would alert the nurse to possibility of this syndrome? o Hypotension and bradycardia o Tachypnea and retraction o Acrocyanosis and grunting o Barrel chest with grunting QUIZ # 4: 1. Overhydration is serious as dehydration because the ECF overload can lead to cardiovascular overload and cardiac failure. All of the following are true about overhydration except: o It generally occurs in children who are receiving IV fluid. o The excess fluid in these instances is usually extracellular. o When large quantities of salt-poor fluid (hypotonic solutions) such as tap water are ingested or are given by enema, the body transfer water from extracellular space into the intracellular space to restore normal osmotic relationships. o The excess fluid in these instances is usually intravascular and interstitial. 2. What is the common complication if the child has cleft palate? o Otitis media 3. If an infant continues to lose fluid after this point, the volume of the plasma will continue to fall rapidly, resulting ultimately in cardiovascular collapse. o True o False 4. Infant do not concentrate urine as well as adults because their kidneys are immature. o True o False 5. For a child with a diagnosis of Hirschsprung’s disease, you expect the childs stool to be: o Ribbon like o Currant jelly stool o Tarry and tenacious o Frothy and smelling 6. The ph of blood is normally slightly alkaline raging from o 7.35 to 7.45 o 7.20 to 7.30 o 7.40 to 7.50 o 7.10 to 7.20 7. The child has cleft lip. Chieloplasty was done what are the post-operative nursing care to be observe? Select all that apply. o Place the infant in a supine position o Maintain patent airway o Let the baby cry o Clean the suture line using water 8. When diarrhea occurs, or when a child becomes diaphoretic because of fever, the fluid output can be markedly decrease. o True o False 9. All of the following are included in the assessment in metabolic alkalosis. Select all that apply. o HCO3 level will near or below 28 mEq/L o The child will breathe slowly and shallowly o PH will be elevated ( near or above 7.45) o HCO3 level will be near or above 28 mEq/L 10. The GI system plays a major role in maintaining fluid, electrolyte, and acid base balance. The GI system often is involved with two severe acid base imbalances which is: o Metabolic acidosis and metabolic alkalosis o Metabolic acidosis and respiratory acidosis o Respiratory acidosis and metabolic alkalosis o Respiratory acidosis and metabolic alkalosis 11. A child is diagnosed with intussusceptions. The nurse performs an assessment on a child knowing that which of the following is a characteristic of this disorder. o The presence of fecal incontinence o Incomplete development of the anus o The infrequent and difficult passage of stool o Invagination of a section of the intestine into distal bowel 12. Isotonic dehydration is when a child’s body losses more water than it absorbs ( as with diarrhea) or absorbs less fluid than it excretes ( as with nausea and vomiting). As a result, all of the following will occur. Select all that apply. o There will be a decrease in the volume of blood plasma. o The body compensates for this rapidly by shifting interstitial fluid into the blood vessels. o There will be an increase in the volume of blood plasma. o There will be normal in the volume of blood plasma. 13. A nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child’s record and expects which of this disorder documented? o Ribbon like o Watery diarrhea o Profuse projectile vomiting o Bright red and mucus in the stool 14. Joel’s father reports that his son was constipated until this morning. Hirschsprung disease can be a cause of constipation in infants. This is: o A form of volvulus that leads to obstruction o Lack of nerve endings in the sigmoid colon o Lack of pancreatic enzymes that impair digestion o Necrotic patches that form in the large intestine. 15. For hirschsprung’s disease, there is no stool in the rectum. o True o False 16. The most common diagnostic procedure used for hirschsprungs disease and intussuception is barium enema o True o False 17. In hypertonic dehydration water is lost in a greater proportion than electrolytes and it occurs when fluid intake decreases in conjunction with a fluid loss increase/ it occurs in a child with: Select all that apply. o Nausea (preventing fluid intake) o Fever ( increased fluid loss through perspiration) o Profuse diarrhea – where there is a greater loss of fluid than salt. o Renal disease- associated with polyuria such as nephrosis with diuresis 18. Hypotonic dehydration occurs when there is a disproportionately high loss of electrolytes relative to fluid lost. The plasma concentration of sodium and chloride will be low. This could result from all of the following except? o Excessive loss of electrolytes by vomiting o Low intake of salt associated with extreme losses through diuresis o Excessive intake of salt associated with great gain through intake o In diseases—adrenocortical insufficiency or diabetic acidosis. 19. Gastrointestinal tract is the main route by which substances are taken into the body and can be a major source of loss if vomiting or diarrhea occurs. o True o False 20. Mr. and Ms. Garcia’s child failed to pass meconium within the first 24 hours after birth. This may indicate which of the following? o Celiac disease o Intussusception o Hirschsprung’s disease o Abdominal defect 21. Metabolic acidosis may result from diarrhea. When diarrhea occurs, a great deal of sodium is lost with stool. This excessive loss of NA, in turn, causes the body to conserve Hions in an attempt to keep the total number of positive and negative ions in serum balanced. As a result, all of the following will occur except: o A child becomes acidotic as the number of Hions in the blood increases proportionately over the OH ions present. o Arterial blood gas analysis reveal a increased ph. o A low HCO3 value (near or below 22 MEq/L) o Arterial blood gas analysis will reveal a decrease ph. 22. The following are signs and symptoms of intussusception EXCEPT o Distended adomen o Dances sign o Slow PR o Hematochezia 23. Fluid shifts from the blood stream to interstitial and intracellular spaces (from areas of great osmotic pressure to areas of lesser pressure). o True o False 24. An infant with hirschsprung’s disease may need a daily enema to help with bowel evacuation. When giving parents instructions for this, what solution would you recommend them to use? Note : answer in small letters, do not include anymore the word solution in your answer. o Isotonic (example: normal saline 9%) 25. Signs and symptoms of hypotonic dehydration includes all of the following except: o Reduce derum sodium level o Very poor skin turgor o Cool skin temperature o Increase urine output 26. What is the position of an infant after operation with cleft palate? o PRONE Trendelenburg position 27. What is the position of an infant after operation with cleft lip? o Supine position 28. The levels of bicarbonate (HCO3) in arterial blood is normally: o 20 to 2 mEq/L o 22 to 28 mEq/L o 22 to 26 mEq/L o 26 to 28 mEq/L 29. The following are signs and symptoms of intussusception. Select all that apply. o Abdominal pain o Ribbon like stool o Currant jelly stool o Draw legs towards the chest ¬______________________________________________________________________ PAPASA TAYO!