Final Exam Flashcards
(244 cards)
1
Q
What is the function of the placenta?
A
It serves as the interface between mother and fetus, makes hormones, protects the fetus from immune attack, removes fetal waste, and promotes nutrient and oxygen transfer.
2
Q
What protects the umbilical cord from compression?
A
Wharton’s jelly surrounds the vein and arteries in the cord to prevent compression.
3
Q
What are the functions of amniotic fluid?
A
It provides protection, regulates temperature, allows fetal growth and movement, and is constantly replenished by fetal urination and swallowed by the fetus.
4
Q
Name the three fetal circulation shunts.
A
Ductus venosus, ductus arteriosus, and foramen ovale.
5
Q
How do you calculate the estimated due date using Naegele’s Rule?
A
Subtract 3 months from the first day of the last menstrual period (LMP), add 7 days, then add 1 year.
6
Q
What are presumptive signs of pregnancy?
A
Subjective signs reported by the woman, such as amenorrhea, nausea, fatigue, breast changes, urinary frequency, and quickening.
7
Q
What are probable signs of pregnancy?
A
Objective signs noted by an examiner, including Hegar’s sign, Chadwick’s sign, Goodell’s sign, Braxton Hicks contractions, a positive pregnancy test, abdominal enlargement, and ballottement.
8
Q
What are positive signs of pregnancy?
A
Direct evidence of pregnancy such as seeing the fetus on ultrasound, hearing fetal heart tones, or palpating fetal movement.
9
Q
What is the GTPAL system?
A
It stands for Gravida, Term births, Preterm births, Abortions, Living children — a detailed way to record obstetric history.
10
Q
When is a nonstress test (NST) considered reactive?
A
When there are at least 2 accelerations of fetal heart rate that are 15 bpm above baseline, each lasting at least 15 seconds within a 20-minute period.
11
Q
What does a low alpha-fetoprotein (AFP) level suggest?
A
Possible Down syndrome.
12
Q
What is a high alpha-fetoprotein (AFP) level associated with?
A
Neural tube defects such as spina bifida.
13
Q
When is the Non-Invasive Prenatal Test (NIPT) offered and what does it test for?
A
It can be offered as early as 10 weeks and screens for trisomy 21 (Down syndrome), trisomy 18, and trisomy 13.
14
Q
Why might amniocentesis be performed?
A
To assess for genetic defects, fetal lung maturity, uterine infection, or Rh sensitization. RhoGAM is given to Rh-negative women after the procedure.
15
Q
What is the typical duration of pregnancy?
A
40 weeks, or 266–280 days, counted from the first day of the last menstrual period.
16
Q
What are the five Ps of labor?
A
Passageway, Passenger, Powers, Position, Psyche.
17
Q
What is the difference between true and false labor?
A
True labor has regular, increasing contractions that cause cervical change. False labor has irregular contractions that do not lead to dilation or effacement and may go away with rest.
18
Q
What are the stages of labor?
A
First Stage: Onset of labor to full dilation (0–10 cm)
Latent phase: 0–6 cm
Active phase: 6–10 cm
Second Stage: Full dilation to birth
Third Stage: Birth to delivery of placenta
Fourth Stage: First few hours postpartum.
19
Q
What are the cardinal movements of labor?
A
Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, Expulsion.
20
Q
What is cervical effacement?
A
Thinning and shortening of the cervix, measured from 0% (thick) to 100% (completely effaced).
21
Q
What is cervical dilation?
A
Opening of the cervix from 0 to 10 cm during labor.
22
Q
What are normal fetal heart rate parameters?
A
Baseline 110–160 bpm, moderate variability, accelerations present, no late or variable decelerations.
23
Q
What does VEAL CHOP stand for in fetal monitoring?
A
Variable decelerations → Cord compression
Early decelerations → Head compression
Accelerations → OK (oxygenated)
Late decelerations → Placental insufficiency.
24
Q
What is a late deceleration and what does it indicate?
A
A deceleration that begins after the contraction starts and ends after it finishes; indicates uteroplacental insufficiency and fetal hypoxia.
25
What is a variable deceleration and what is it associated with?
Abrupt drop in FHR, variable in shape (U, V, W); associated with umbilical cord compression.
26
What are the interventions for late or variable decelerations?
Reposition mother, provide oxygen, stop oxytocin, increase IV fluids, perform vaginal exam for cord prolapse, assist with amnioinfusion if ordered.
27
What are the risks of epidural analgesia?
Maternal hypotension, fetal distress, motor loss, urinary retention, prolonged second stage of labor.
28
What is the nurse’s responsibility during an epidural?
Administer IV bolus, assist with positioning, monitor maternal vitals and FHR, insert Foley catheter.
29
What are signs that labor is near (premonitory signs)?
Lightening, bloody show, cervical ripening, stronger Braxton Hicks, energy burst, spontaneous rupture of membranes (SROM).
30
What is the definition of “crowning”?
When the widest part of the baby’s head remains visible and does not recede during contractions.
31
What is the schedule for postpartum vital sign and fundal checks?
Every 15 minutes × 1–2 hours post delivery
Every 4 hours × 24 hours
Every 8 hours after 24 hours until discharge
32
What are normal postpartum cardiovascular findings?
Increased cardiac output for 48 hours
Bradycardia common during the first week
BP stable
WBCs can be up to 25,000
Hypercoagulable state (risk of DVT)
Temp up to 100.4°F (38°C) may be normal in the first 24 hours
33
What does BUBBLE HEE stand for in postpartum assessment?
Breasts
Uterus (fundus)
Bladder
Bowel
Lochia
Episiotomy/perineum
Homan’s sign/Extremities
Emotional status
Education
34
What is colostrum and when does it appear?
Colostrum is the first form of milk produced, rich in antibodies. It appears in the first few days postpartum.
35
How do you manage breast engorgement?
Lactating: frequent breastfeeding, warm compresses before and ice packs after feeds, cabbage leaves
Non-lactating: firm supportive bra, ice packs, avoid stimulation
36
What are normal uterine changes postpartum?
Fundus should be firm, midline, and at or below the umbilicus; assess with the bed flat.
37
How do you promote postpartum urinary elimination?
Encourage voiding within 6 hours using privacy, running water, peppermint oil, or hand in warm water. Catheterize only if necessary.
38
What increases risk of urinary retention postpartum?
Decreased bladder tone, increased capacity, and displacement of the uterus by a full bladder, which can lead to uterine atony and increased lochia.
39
What bowel changes are expected postpartum?
Delayed bowel movement (2–3 days)
Common issues: constipation, hemorrhoids
Increased risk with episiotomy, large baby, or instrument-assisted delivery
40
How can bowel elimination be promoted postpartum?
Ambulation, fluids, fiber, stool softeners, and encouraging response to urge to defecate.
41
What comfort measures help postpartum perineal pain?
Ice packs, sitz baths, peri care with peri bottles and medications, gentle sitting, and relaxation techniques.
42
What are afterpains and how are they treated?
Cramping due to uterine involution; treated with warm blankets, relaxation, and analgesics.
43
When does menstruation typically return postpartum?
Non-lactating: 7–9 weeks
Lactating: 3–18 months (delayed with exclusive breastfeeding)
Ovulation can occur before first menses
44
When is RhoGAM given and why?
Within 72 hours of birth
Given to Rh-negative mothers with Rh-positive babies
300 mcg IM in the deltoid to prevent maternal sensitization
45
When is the rubella vaccine given postpartum?
Given prior to discharge if the mother is non-immune
SubQ injection
Avoid pregnancy for 4 weeks afterward
Can be given with RhoGAM
46
What are the phases of maternal postpartum adjustment?
Taking-in: Passive, preoccupied with own needs
Taking-hold: Active, focuses on baby care, needs reassurance
Letting-go: Accepts new role, sees infant as individual
47
What is engrossment in the partner’s adjustment?
The partner’s deep interest and preoccupation with the newborn.
48
What are positive signs of parent-infant attachment?
Direct eye contact, en face position, progressive touch, positive speech about baby, responding to infant’s needs.
49
What are signs of potential bonding issues?
Lack of eye contact, stiffness, disinterest, expressing disappointment, not holding baby close.
50
What does APGAR stand for?
Appearance, Pulse, Grimace, Activity, Respirations — scored at 1 and 5 minutes after birth.
51
What is the normal heart rate and respiratory rate for a newborn?
HR: 110–160 bpm, RR: 30–60 breaths per minute (irregular and shallow with periods of apnea <15 sec).
52
What triggers the newborn’s first breath?
Chemical changes (↓O₂, ↑CO₂, ↓pH), mechanical pressure release, temperature drop, and light/sound stimuli.
53
What is the role of surfactant in newborns?
It reduces surface tension to prevent alveolar collapse, allowing effective gas exchange.
54
Why are newborns at risk for heat loss?
Large surface area-to-weight ratio, thin skin, minimal fat, immature thermoregulation, and inability to shiver.
55
What is brown adipose tissue and its role?
Brown fat is a one-time heat source in term infants. It generates heat via non-shivering thermogenesis, using oxygen and glucose.
56
What are signs of cold stress in newborns?
Hypothermia (<97.7°F or 36.5°C), lethargy, hypoglycemia, poor feeding, and respiratory distress.
57
What are the three periods of newborn transition?
1st period of reactivity: alert and active, bonding/nursing
Period of decreased responsiveness: sleepy, hard to rouse
2nd period of reactivity: alert again, increased tone/hunger cues
58
What is acrocyanosis and is it normal?
Bluish hands and feet due to immature circulation — normal in the first 24–48 hours.
59
What is caput succedaneum vs. cephalohematoma?
Caput: soft, crosses sutures, reabsorbs quickly
Cephalohematoma: firm, does not cross sutures, can take weeks to resolve
60
What are normal newborn void and stool patterns?
Voids: 6–8 times/day by 1 week
Stools: meconium within 24 hrs, yellow stools by day 5
61
What are common normal skin findings in newborns?
Vernix, lanugo, milia, erythema toxicum, and mottling.
62
What are five newborn behavioral responses?
Orientation, habituation, motor maturity, self-quieting, social behaviors.
63
What are benefits of breastfeeding for the mother?
Decreased risk of certain cancers, diabetes, cardiovascular disease, postpartum depression, and faster uterine involution.
64
What are signs of a good breastfeeding latch?
Flanged lips, wide open mouth, more areola covered by lower lip, audible swallowing, minimal maternal pain.
65
What are early hunger cues in infants?
Rooting, sucking on hands, clenched fists. Crying is a late sign.
66
How often should a newborn be breastfed?
8–12 times per 24 hours, on demand. Alternate starting side each time.
67
What is the expected weight change pattern for newborns?
Lose 5–10% of birthweight initially
Regain by day 10
Gain ~1 oz/day for first 3–4 months
Double weight by 6 months, triple by 1 year
68
What are the components of newborn screening?
PKU: Cannot metabolize phenylalanine
Galactosemia: Cannot metabolize galactose
Congenital hypothyroidism: Risk of intellectual disability if untreated
All require early detection and dietary/hormonal treatment.
69
What newborn medications are given after birth and why?
Erythromycin ointment: Prevents eye infections
Vitamin K injection: Prevents bleeding (clotting factor synthesis)
Hepatitis B vaccine: First dose of lifelong protection, given with consent.
70
What is the nurse's role in newborn circumcision care?
Provide analgesia, educate on care, apply petroleum jelly, expect yellow crust for 2–3 days, monitor for bleeding and urination.
71
What is preterm labor (PTL) and how is it managed?
Defined as labor between 20–36 6/7 weeks with cervical change.
Home management: hydrate, side-lying, call MD if ≥6 contractions/hour. Hospital: bedrest, hydration, vaginal exam, tocolytics (MgSO₄, indomethacin, nifedipine), and betamethasone to mature fetal lungs.
72
What is the purpose of betamethasone in preterm labor?
Steroid given IM in 2 doses, 24 hours apart, to accelerate fetal lung maturity between 24–34 weeks; reduces risk of respiratory distress syndrome.
73
What is umbilical cord prolapse and what are the nursing priorities?
Cord slips below presenting part and gets compressed. Emergency! Nursing care: Lift presenting part off cord, position mom in Trendelenburg or knee-chest, keep cord moist if exposed, prepare for C-section.
74
What are signs and management of shoulder dystocia?
Turtle sign: fetal head retracts after delivery. Interventions: McRoberts maneuver (legs flexed), suprapubic pressure, Gaskin maneuver (all fours), emergency delivery if unresolved.
75
What is the action and risk of oxytocin (Pitocin) in labor?
Induces or augments labor. Titrated to contractions every 2–3 min, lasting 60–90 seconds. Risks: uterine hyperstimulation, fetal distress, increased hemorrhage risk.
76
What is a Bishop score, and what does it indicate?
Assesses cervical favorability for induction (score 0–13). ≥8 suggests likely success of vaginal delivery. <6 indicates need for cervical ripening.
77
What is dystocia?
Difficult or abnormal labor due to uterine dysfunction (hypo/hypertonic), CPD, malpresentation, macrosomia, or failure to progress (FTP).
78
What are indications for Cesarean section?
CPD, breech, previous C/S, failure to progress, fetal distress. Preferred incision: low transverse. Risks include hemorrhage, infection, DVT.
79
What are contraindications for VBAC (vaginal birth after Cesarean)?
>2 prior C/S, vertical uterine scar, macrosomia, malpresentation. VBAC increases uterine rupture risk with cervical ripeners.
80
What are the four causes of postpartum hemorrhage (4 Ts)?
Tone: uterine atony (most common). Trauma: lacerations. Tissue: retained placenta. Thrombin: coagulation disorders.
81
What are interventions for postpartum hemorrhage?
Fundal massage. Empty bladder. Oxytocin, misoprostol, carboprost, methergine (contraindicated if HTN). Foley catheter. Balloon tamponade or vacuum suction (Jada).
82
What is a postpartum thromboembolic disorder and how is it managed?
Example: DVT (pain, heat, swelling). Treat with anticoagulants, rest, elevate leg, SCDs once stable, education on prevention.
83
What are signs of endometritis?
Fever >100.4°F, foul lochia, uterine tenderness, elevated WBC, malaise. Treat with IV antibiotics and supportive care.
84
What is mastitis and how is it treated?
Unilateral breast infection with redness, pain, fever. Frequent breastfeeding (start on affected side), rest, heat, antibiotics if needed.
85
What is the difference between postpartum blues, depression, and psychosis?
Blues: resolves in 1–2 weeks, mild mood swings. Depression: persists >2 weeks, affects function, may involve guilt, insomnia. Psychosis: hallucinations, confusion, euphoria, medical emergency.
86
What defines Small for Gestational Age (SGA) and what are risks?
Weight <10th percentile or <2500 g
Risks: hypoglycemia, developmental delay, poor thermoregulation
87
What defines Large for Gestational Age (LGA) and what are risks?
Weight >90th percentile or >4000 g
Risks: birth trauma, hypoglycemia, respiratory distress
88
What are characteristics of a preterm infant?
Born <37 weeks
Poor muscle tone, minimal fat, immature lungs
Risks: RDS, NEC, hypoglycemia, hypothermia, cerebral palsy
89
What are characteristics of a postterm infant?
Born >42 weeks
Dry, cracked skin, little vernix/lanugo
Risks: meconium aspiration, birth trauma, hypoglycemia, asphyxia
90
What is transient tachypnea of the newborn (TTN)?
Self-limiting condition due to delayed fluid clearance in lungs
Risk: C-section, male sex, fast labor
Tx: supportive care, O₂/CPAP, usually resolves in 72 hrs
91
What are signs and treatment for neonatal respiratory distress?
Signs: tachypnea, nasal flaring, retractions, cyanosis, grunting
Tx: surfactant, oxygen/ventilation support, ABG monitoring
No oral feeds if RR > 60
92
What is meconium aspiration syndrome?
Inhalation of meconium into lungs
Signs: respiratory distress, meconium staining, low Apgar
Suction airway after birth, intubate if needed
93
What is necrotizing enterocolitis (NEC)?
GI ischemia/inflammation common in preemies
Signs: distention, bloody stool, bilious vomiting
Tx: NPO, IV fluids, antibiotics, surgery
94
What are complications of being an Infant of a Diabetic Mother (IDM)?
Macrosomia, RDS, hypoglycemia, congenital defects
Tx: monitor BG, treat if <45 mg/dL
95
What is the management for newborn hypoglycemia?
Treat if BG <45 mg/dL
Feed immediately (breast/formula/donor milk)
If <25 mg/dL: NICU admission for IV D10W
96
What causes ABO and Rh incompatibility?
ABO: Type O mom + A/B fetus → mild jaundice
Rh: Rh- mom + Rh+ fetus → severe hemolysis in subsequent pregnancies
Prevent with RhoGAM at 28 wks and postpartum
97
What are the differences between physiologic and pathologic jaundice?
Physiologic: after 24 hrs, bilirubin ≤15
Pathologic: before 24 hrs, can be due to ABO/Rh issues
98
What is kernicterus and how is it prevented?
Bilirubin-induced brain damage (encephalopathy)
Prevent with early phototherapy, hydration, and frequent feeding
99
What are signs and treatments for neonatal sepsis?
Lethargy, temp instability, poor feeding, apnea
Causes: GBS, prolonged ROM
Tx: cultures, IV antibiotics
100
What are complications and management of cleft lip/palate?
Difficulty feeding, aspiration, poor weight gain
May need special nipples or surgery
Follow-up with speech therapy & ENT
101
What is Neonatal Abstinence Syndrome (NAS)?
Withdrawal from opioids in utero
Symptoms: tremors, hypertonia, poor feeding, diarrhea, sneezing
Tx: swaddle, reduce stimuli, Finnegan scoring, meds (morphine, phenobarbital)
102
What is Fetal Alcohol Syndrome (FAS)?
Brain damage + characteristic facial features (thin upper lip, smooth philtrum, flat midface)
Causes intellectual disability, behavior issues, microcephaly
No known safe level of alcohol during pregnancy
103
What are therapeutic nursing actions for perinatal loss?
Provide privacy, consistent staff, and time with the infant
Offer mementos (photos, footprints), support cultural practices
Avoid minimizing statements, validate grief
104
How does Depo-Provera work and what are key considerations?
Progestin-only IM injection every 12 weeks. Inhibits ovulation, thickens cervical mucus. Highly effective (96%). Safe for breastfeeding. Can delay return to fertility up to 9 months. Risk: bone loss → limit to 2 years.
105
How does emergency contraception work and what are options?
Delays ovulation or inhibits fertilization. Plan B: OTC, best within 72 hrs; less effective if >165 lbs. Ella: prescription, best within 120 hrs; less effective if >195 lbs. IUDs (e.g., Paragard) may also be used within 5 days.
106
What is the mechanism and advantage of IUDs?
T-shaped device inserted into uterus. Hormonal (Mirena, Skyla): releases progestin, 3–8 years. Non-hormonal (Paragard): copper, lasts 10 years. Causes endometrial inflammation that prevents implantation. Over 99% effective; long-acting, reversible.
107
What are key points about oral contraceptives (OCPs)?
Contain estrogen + progestin (COCs) or progestin only (POPs). Suppress ovulation, thicken mucus, thin lining. Benefits: reduces flow/cramps, improves acne, prevents bone loss. Risks: blood clots (thromboembolism), no STI protection.
108
What contraceptive is safest for breastfeeding and those with estrogen risk?
Progestin-only pills (POPs) or Depo-Provera.
109
What are fertility awareness methods (FAMs)?
Track ovulation and avoid sex during fertile window. Failure rate: ~25%. Pros: no hormones; Cons: high user error, no STI protection.
110
What is the effectiveness and consideration for condoms?
Male: ~87%, Female: ~79%. Only method that protects against STIs. Use water-based lubricant; avoid oil with latex. Polyurethane recommended for latex allergy.
111
What is the purpose of emergency contraception?
Prevents ovulation/fertilization after unprotected sex. Most effective when taken ASAP. Plan B (levonorgestrel) or Ella (ulipristal). Nausea common; consider antiemetic.
112
What is the key difference between medical and surgical abortion?
Medical: mifepristone + misoprostol ≤ 11 weeks. Surgical: vacuum aspiration (<16 wks) or D&E (>16 wks).
113
What is the treatment for chlamydia?
Doxycycline 100 mg PO BID × 7 days. Azithromycin 1g single dose as alternative. Treat partners; abstain until cured. Reportable to public health.
114
What are symptoms and treatment for gonorrhea?
Women: often asymptomatic or cervicitis. Men: dysuria, purulent discharge. Tx: ceftriaxone IM + doxycycline. Causes neonatal conjunctivitis if untreated.
115
What is the treatment and complication of syphilis?
Penicillin G IM 2.4 million units. Primary: painless chancre; Secondary: rash, fever. Tertiary: organ damage, death. Crosses placenta → stillbirth, congenital syphilis. Reportable.
116
Which STI causes genital warts and cervical cancer?
HPV (human papillomavirus). S/Sx: painless warts on genitals or anus. Preventable via vaccine (e.g., Gardasil). No cure, only treatment of warts.
117
What is PID and what causes it?
Infection of reproductive tract, often due to untreated STIs. S/Sx: pelvic pain, fever, abnormal discharge. Tx: ceftriaxone + doxycycline + metronidazole. Can lead to infertility or ectopic pregnancy.
118
What is the cause and treatment of trichomoniasis?
Parasite → frothy green-yellow discharge, strawberry cervix. Tx: metronidazole 500 mg BID × 7 days. Treat partners; abstain until cured.
119
What is vaginal candidiasis and how is it treated?
Yeast overgrowth; not an STI. Itching, redness, cottage cheese discharge. Tx: antifungal creams (miconazole, clotrimazole) or fluconazole PO. Prevent with hygiene, cotton underwear, no douching.
120
What are signs and risks of herpes simplex virus (HSV)?
Painful genital blisters; highly contagious. Risk to newborn if active lesion at birth → C-section. No cure; Tx: acyclovir for symptom control.
121
What is pelvic inflammatory disease (PID) and how is it treated?
Infection of uterus/fallopian tubes from untreated STIs. Can lead to infertility, ectopic pregnancy. Tx: ceftriaxone IM + doxycycline + metronidazole.
122
What is intimate partner violence (IPV)?
Actual or threatened physical, sexual, or psychological/emotional abuse used to control a partner. Includes physical harm, threats, intimidation, and coercive control.
123
What are the phases in the cycle of violence?
Phase 1: Tension-building
Phase 2: Acute battering
Phase 3: Honeymoon phase
The cycle escalates over time if left unaddressed.
124
Is the tendency to be violent inherited?
No. Violence is a learned behavior that becomes self-perpetuating without intervention.
125
Do victims of IPV usually recognize themselves as abused?
No. Most victims do not describe themselves as abused, often believing the issue is their fault.
126
What are risk factors for committing IPV?
Substance abuse
History of childhood abuse
Negative affect (e.g., depression, anger)
Traditional gender role beliefs
Learned violence from previous generations
127
What are the types of abuse?
Emotional
Physical
Sexual
Financial
128
Why is pregnancy a high-risk time for IPV?
Pregnancy may escalate existing violence
Associated with threats to maternal and fetal well-being
New stressors may trigger abuse
Nurses should screen for IPV during prenatal care
129
What are common forms of elder abuse?
Physical abuse
Neglect
Emotional abuse
Sexual abuse
Financial exploitation
130
What are the types of sexual violence?
Rape (acquaintance, date, statutory)
Human trafficking
Incest
Sexual assault
Female genital cutting
Exploitation and neglect
131
What defines rape?
Non-consensual penetration (vaginal, anal, or oral) by any object or body part. Includes date rape, acquaintance rape, and statutory rape.
132
What are signs of PTSD hyperarousal after assault?
Difficulty sleeping
Irritability
Hypervigilance
Exaggerated startle response
133
What is the nursing role in rape care?
Provide early intervention and support
Collect forensic evidence
Screen for STIs and pregnancy
Assess for PTSD
Educate on follow-up care
134
What is female genital cutting (FGC)?
Cultural procedure involving removal or injury to female genitalia for non-medical reasons. Leads to reproductive health issues. Nurses must approach with cultural sensitivity.
135
What is the SAVE model in IPV assessment?
Screen routinely
Ask direct questions
Validate client’s experience
Evaluate safety and provide a safety plan
136
What are the three levels of abuse prevention?
Primary: prevent violence through community programs
Secondary: identify and intervene early
Tertiary: help victims recover; rehabilitate abusers
137
What is the nurse’s primary goal when caring for an IPV victim?
Help the victim gain control of their life through emotional support, safety planning, and community resources.
138
What is the difference between growth and development?
Growth: increase in size (e.g., weight, height)
Development: maturation of function and skills (e.g., motor, cognitive)
139
What is the pattern of child development?
Cephalocaudal: head-to-toe
Proximodistal: center-outward (trunk → extremities)
140
When should an infant regain birth weight, double, and triple it?
Regain: by 7–10 days
Double: by 4–5 months
Triple: by 1 year
141
What is object permanence and when does it develop?
The understanding that objects exist even when not seen; develops in sensorimotor stage (birth to 2 years)
142
What is the concept of conservation, and when is it learned?
Understanding that quantity remains the same despite shape change; learned in concrete operational stage (7–11 years)
143
What is the correct developmental age adjustment for prematurity?
Subtract weeks premature from chronological age. Stop adjusting at age 2.
144
What are Erickson’s Psychosocial Stages?
Infant (0–1 yr): Trust vs. Mistrust
Toddler (1–3 yrs): Autonomy vs. Shame/Doubt
Preschooler (3–6 yrs): Initiative vs. Guilt
School-age (6–12 yrs): Industry vs. Inferiority
Adolescent (11–20 yrs): Identity vs. Role Confusion
145
What is parallel play and which age group exhibits it?
Playing alongside but not with others; typical in toddlers (1–3 years)
146
What are toddler discipline strategies?
Firm, consistent limits; offer choices; no physical punishment; time-outs and redirection
147
What are preschooler discipline strategies?
Positive reinforcement, redirection, reward charts, time-ins
148
What are school-age discipline tips?
Promote self-control, calm correction, reinforce positive behavior, natural consequences
149
What are adolescent safety concerns?
MVAs (leading cause of death)
Risk-taking behavior
Firearm injuries
Suicide (3rd leading cause ages 15–19)
150
What are safe sleep recommendations to prevent SIDS?
Supine position
Firm mattress, no soft bedding
Room-share, no bed-share
Pacifier use
Breastfeeding
Avoid overheating
151
What is rear-facing car seat law in CA?
Required until age 2, unless child is ≥40 lbs or ≥40 inches
152
When can children legally ride in the front seat?
Age 8, but NHTSA recommends waiting until age 13
153
What are adolescent suicide risk factors?
Depression, LGBTQ identity, poor academics, family dysfunction, ATOD use, access to firearms
154
What are appropriate gross motor skills in school-age children?
Jump rope, team sports, bike riding, stair climbing
155
What is the difference between active and passive immunity?
Active: body makes antibodies (e.g., after vaccine or illness)
Passive: temporary antibodies passed (e.g., maternal, immune globulin)
156
What vaccines are live attenuated?
MMR
Varicella
Rotavirus
Nasal influenza
Zoster (older adults)
157
What are contraindications for vaccination?
Moderate/severe illness
Anaphylaxis to prior vaccine
Live vaccine: immunocompromised or pregnant
158
When is RhoGAM given and why?
Given at 28 weeks and within 72 hours postpartum if mom is Rh- and baby is Rh+
Prevents maternal Rh sensitization in future pregnancies
159
What is Synagis (palivizumab) and who gets it?
Monoclonal antibody for RSV prevention
Given monthly during RSV season to high-risk infants (e.g., prematurity, lung disease)
160
What is the communicability period of chickenpox (Varicella)?
1 day before rash appears until all vesicles crusted over
161
What are complications of varicella?
Pneumonia, encephalitis, Reye’s syndrome, fetal death
162
What are hallmark signs of measles (Rubeola)?
Koplik spots, cough, coryza, conjunctivitis
Cephalocaudal rash, photophobia
Complications: otitis, pneumonia, encephalitis
163
What is the “slapped cheek” rash disease?
Fifth disease (erythema infectiosum), caused by parvovirus B19
Spread via droplets
Rash on cheeks → lacy body rash
Complications: fetal death, arthritis
164
What are signs of mumps and a key complication?
Fever, HA, parotitis (swollen cheeks)
Complications: male infertility, orchitis, hearing loss
165
What is the major complication of roseola?
Febrile seizures (due to rapid high fever before rash appears)
166
What is the classic symptom of scarlet fever?
Strawberry tongue
Sandpaper rash
Caused by Group A strep
Complication: rheumatic fever
167
What are signs of pertussis and how is it managed?
URI symptoms, paroxysmal whooping cough
Tx: airway support, hydration, nutrition, antibiotics
Highly contagious before cough begins
168
What is the treatment for pinworms?
S/Sx: anal itching, especially at night
Confirm with tape test
Treat all household with mebendazole or pyrantel pamoate
169
What is the transmission and treatment for lice?
Contact with hair or belongings
S/Sx: scalp itching, visible nits
Tx: permethrin, nit comb, hot laundry, vacuum items
170
What is conjunctivitis (pinkeye) and how is it managed?
Bacterial or viral eye infection
S/Sx: red eyes, discharge, itching
Clean from inner to outer canthus
Abx drops if bacterial, isolate until 24 hrs of treatment
171
Who can legally give informed consent for a child under 18?
A parent or legal guardian. In emergencies, verbal/phone consent may be used; otherwise, written permission is required.
172
What is the difference between assent and consent in pediatrics?
Consent: legal permission from parent/guardian
Assent: child's agreement to care, based on developmental level
Dissent should be respected when possible.
173
What are California exceptions to parental consent?
Minors may self-consent for:
Pregnancy prevention/treatment (any age)
STI diagnosis/treatment, HIV testing/treatment, sexual assault care (age ≥12)
Emancipated minors: military, married, or court-declared.
174
What is normalization in pediatric chronic illness care?
Helping children and families maintain regular routines, include the child in decision-making, and focus on the child's abilities — not just the illness.
175
What are common stress points for parents of chronically ill children?
Time of diagnosis
School start
Adolescence
Milestones
End-of-life decisions.
176
How can nurses support siblings of children with chronic illness?
Explain the illness, encourage questions, praise strengths, and involve them in care.
177
What are signs of physical abuse?
Bruises in various stages, handprints, burns, bite marks
Child fears adults, aggressive or self-harming
Story inconsistent with injury.
178
What are signs of emotional abuse?
Delayed development
Overly adult/immature behavior
Repetitive habits: rocking, biting
No warmth in parent-child bond.
179
What is Munchausen Syndrome by Proxy?
A caregiver (often the mother) fabricates or induces illness in a child for attention. The child improves when separated from the caregiver.
180
What is the nurse’s legal duty regarding suspected abuse?
Mandated to report suspected abuse. Failure to do so is punishable by law. Reports are protected and do not require proof.
181
What are signs of respiratory distress in infants/children?
Retractions
Nasal flaring
Grunting
Tachypnea
Cyanosis
Adventitious sounds (stridor, wheezing, crackles).
182
What is croup and how is it treated?
Viral laryngotracheitis in kids <5
Barking cough, stridor at night
Tx: cool mist, dexamethasone, racemic epinephrine if severe.
183
What is epiglottitis and why is it an emergency?
Caused by Hib (preventable with vaccine)
Rapid onset fever, drooling, dysphagia
Do not examine throat; prepare for airway support.
184
What is RSV and how is it managed?
Viral bronchiolitis in infants
Dx: nasal swab
Tx: humidified O₂, suction, rest, fluids
Prevention: Synagis (palivizumab) for high-risk infants.
185
What are signs and treatment of otitis media?
Ear pain, bulging red tympanic membrane, irritability
Tx: amoxicillin, possibly tympanostomy tubes for recurrent AOM.
186
What is the cause of cystic fibrosis?
Autosomal recessive mutation of the CFTR gene → thick secretions in lungs, pancreas, intestines.
187
What are respiratory symptoms of CF?
Chronic cough, wheezing, frequent infections
Barrel chest, clubbing, hemoptysis
Most die from respiratory failure.
188
What are digestive signs of CF?
Steatorrhea, malnutrition, vitamin deficiencies
Meconium ileus in neonates
Risk of diabetes and liver disease.
189
What are reproductive and exocrine effects of CF?
95% of males are sterile
Women may have reduced fertility
High sweat chloride → risk for dehydration.
190
What is the role of pancreatic enzymes in CF?
Taken before meals/snacks to aid digestion
Require high-calorie, high-protein diet
Supplement with vitamins A, D, E, K.
191
What therapies improve CF outcomes?
Chest physiotherapy (vest, percussion)
Mucolytics, bronchodilators, antibiotics
CFTR modulators like Trikafta
Emotional support, foster independence.
192
What are the 3 fetal circulation shunts?
Ductus venosus: bypasses liver
Foramen ovale: right atrium → left atrium
Ductus arteriosus: pulmonary artery → aorta
193
What changes occur at birth to establish neonatal circulation?
First breath inflates lungs
Pulmonary resistance drops
Left heart pressure increases
Foramen ovale closes, ductus arteriosus constricts, ductus venosus closes
194
What are common signs of pediatric heart failure?
Tachypnea
Poor feeding
Slow weight gain
Lethargy
Hepatomegaly
195
What are the 4 components of Tetralogy of Fallot?
Pulmonary stenosis
Ventricular septal defect
Overriding aorta
Right ventricular hypertrophy
196
What are signs and symptoms of Tetralogy of Fallot?
Cyanosis
Clubbing
Harsh systolic murmur
Polycythemia
Squatting behavior
Hypoxic spells (Tet spells)
197
What is the nursing intervention during a Tet spell?
Place in knee-chest position
Calm the child
Administer oxygen and morphine
IV fluids to decrease blood viscosity
198
What is coarctation of the aorta and a key assessment clue?
Narrowing of the aorta → upper body HTN, lower body hypotension
S/Sx: bounding pulses in arms, weak in legs, headache, leg pain
199
What is patent ductus arteriosus (PDA) and how is it treated?
Ductus arteriosus fails to close → left-to-right shunt
Tx: Indomethacin (prostaglandin inhibitor) or surgical ligation
200
What is transposition of the great vessels and its management?
Aorta and pulmonary artery are switched
Parallel circulation, not compatible with life unless PDA/PFO present
Tx: Prostaglandin E1 to keep ductus open, followed by arterial switch surgery
201
What is hypoplastic left heart syndrome?
Underdeveloped left heart
Requires PDA/ASD to maintain circulation
Tx: surgical reconstruction or heart transplant; 50–75% survival if treated
202
What are signs of pediatric hypoxemia?
Poor feeding
Nares flaring
Stridor
Sternal retractions
Grunting
Cyanosis
203
What is polycythemia and why is it a concern?
Chronic hypoxia → excess RBCs
Increases risk of stroke and clotting
Tx: IV fluids or exchange transfusion
204
What are key medications for managing pediatric heart failure?
Digoxin to improve contractility
Diuretics to remove fluid
ACE inhibitors to reduce afterload
Oxygen to improve perfusion
Nutritional support: high-calorie feeds
205
What is Kawasaki disease and its hallmark signs (acute phase)?
Vasculitis in children <5
S/Sx:
Fever ≥5 days
Non-purulent conjunctivitis
Red, cracked lips; strawberry tongue
Rash
Swollen hands/feet
Cervical lymphadenopathy
206
What is a major complication of Kawasaki disease?
Coronary artery aneurysm, which may lead to MI or death
207
What are the 3 phases of Kawasaki disease?
Acute: fever, inflammation
Subacute: peeling skin, arthritis, aneurysm risk highest
Convalescent: symptoms resolve, ESR returns to normal
208
What is the treatment for Kawasaki disease?
IVIG within first 10 days to prevent aneurysm
High-dose aspirin (anti-inflammatory) until fever resolves, then low-dose (antiplatelet) for 6–8 weeks
Comfort care: popsicles, lip balm, lotion, rest
209
What are the main functions of the 3 blood cell types?
RBCs (erythrocytes): carry oxygen and nutrients
WBCs (leukocytes): fight infection
Platelets (thrombocytes): blood clotting
210
What are signs of lead poisoning and how is it treated?
Behavioral changes, seizures, brain damage
Causes: old paint, pipes, imported toys
Tx: chelation therapy, notify health department
211
What is sickle cell anemia?
Inherited RBC disorder
RBCs sickle under stress, causing blockages, pain, and hypoxia
212
What are priorities in treating sickle cell crisis?
Pain management
Hydration (IV fluids)
Oxygen if needed
Transfusions for severe anemia
Hydroxyurea may reduce crisis frequency
Prophylactic penicillin until age 5
213
What is the pathophysiology of leukemia?
Overproduction of immature WBCs (blasts)
Blasts crowd bone marrow → anemia, neutropenia, thrombocytopenia
Can infiltrate CNS, liver, spleen, lymph nodes
214
What are symptoms of ALL in children?
Fatigue, bruising, pallor, low-grade fever
Bone pain, lymphadenopathy, weight loss, anorexia
Hepatosplenomegaly
215
What are the 3 phases of chemotherapy for ALL?
Induction – IV chemo to induce remission
Consolidation – eliminate residual cells
Maintenance – PO meds to maintain remission
Intrathecal chemo given during all 3 phases to prevent CNS spread
216
What is a hematopoietic stem cell transplant (HSCT)?
Replaces bone marrow after high-dose chemo
Used for relapsed leukemia
Sources: bone marrow, peripheral blood, umbilical cord
217
What are signs of infection in a neutropenic child?
Fever (any elevation is urgent!)
Irritability, chills, sore throat
ANC <500 = severe risk
Use neutropenic precautions
218
What are precautions to reduce bleeding in thrombocytopenia?
Soft toothbrush, avoid rectal temps or sharp foods
Avoid nose picking
Platelet transfusions as ordered
Gentle activities, no contact sports
219
How do you manage nutrition and comfort during chemo?
Small frequent meals, let child choose foods
Antiemetics, mouth rinses, mouth analgesics
Weigh daily; offer supplements
220
What psychosocial supports are important for pediatric cancer care?
Play therapy, comfort objects, truth-telling
Parental presence, involve child in choices
Prepare for hair loss, fatigue, body image changes
221
What is a hallmark diagnostic sign of Hodgkin disease?
Presence of Reed-Sternberg cells in lymph node biopsy
222
What are common symptoms of Hodgkin lymphoma?
Painless, movable, enlarged lymph nodes
Night sweats, weight loss, fever, fatigue
If mediastinal: cough, dyspnea
223
How is Hodgkin disease staged and treated?
Stages I–IV based on spread (I = 1 node, IV = diffuse)
Tx: chemo + low-dose radiation, possibly surgery for isolated tumor
224
How does Non-Hodgkin lymphoma differ from Hodgkin?
No Reed-Sternberg cells
Often more aggressive and disseminated at diagnosis
More extranodal involvement (abdomen, CNS, mediastinum)
Metastasizes rapidly
225
What are common symptoms of Non-Hodgkin lymphoma?
Abdominal mass, cramping, constipation, weight loss
Respiratory symptoms if mediastinal
Lymphadenopathy, malaise
226
What is scoliosis and how is it screened?
Lateral spine curvature >10°.
## Footnote
Screen with forward bend test (school-age). Common in adolescent girls.
227
What are treatments for scoliosis?
Mild: monitor only.
Moderate: bracing (e.g., Boston, Charleston) to prevent progression.
Severe: spinal fusion with rods.
228
What are signs of DDH in infants?
Limited abduction.
Asymmetrical thigh folds.
Positive Ortolani & Barlow tests.
Limp in walking child.
229
How is DDH treated?
<6 months: Pavlik harness.
6–12 months: Spica cast.
Older: surgery.
## Footnote
Goal: maintain femoral head in acetabulum.
230
What is cerebral palsy and its causes?
Non-progressive brain injury affecting motor function.
## Footnote
Causes: prenatal infection, hypoxia, prematurity, birth trauma.
231
What are the 3 main types of CP?
Spastic (most common): tight/stiff muscles.
Dyskinetic: involuntary writhing.
Ataxic: poor balance/coordination.
232
What are key interventions for CP?
Early intervention, PT/OT/ST.
Meds: baclofen pump, botulinum toxin.
Assistive devices, braces, nutrition support.
233
What defines intellectual disability?
IQ <70 and impairments in adaptive functioning (conceptual, social, practical).
## Footnote
Must be diagnosed before age 18.
234
What are common causes of intellectual disability?
Genetic: Down syndrome, Fragile X.
Prenatal: alcohol, infection.
Perinatal: prematurity, hypoxia.
Postnatal: trauma, lead, infections.
235
What is the goal of care for children with intellectual disability?
Promote self-care and development.
Support communication and social skills.
Early education and family support.
236
What are physical features of Down syndrome?
Flat face, epicanthal folds, short neck.
Single palmar crease.
Wide toe gap, short stature.
Hypotonia.
237
What are common medical complications in Down syndrome?
Congenital heart defects, leukemia, hypothyroidism.
Chronic ear infections, vision/hearing loss.
Constipation (Hirschsprung’s), Alzheimer’s.
238
What are nursing interventions for Down syndrome?
Cardiac/thyroid/hearing screening.
Respiratory hygiene, swaddling.
Feed modifications, high-fiber diet.
239
What are core deficits in autism spectrum disorder?
Impaired social interaction and communication.
Restricted, repetitive behaviors (e.g., hand-flapping, lining toys).
240
What are early signs of autism?
Lack of eye contact, speech delay.
Echolalia, obsessive routines, solitary play.
Sensory sensitivities, unusual reactions to stimuli.
241
What are nursing strategies for children with autism?
Use simple, direct language.
Maintain routine and minimize stimulation.
Include parents, use comfort items.
Early intervention improves outcomes.
242
What causes Fragile X syndrome and who is affected more?
X-linked mutation of FMR1 gene.
## Footnote
Boys more severely affected; girls may show mild symptoms.
243
What are signs of Fragile X syndrome?
Intellectual disability, autism traits.
Long face, large ears, large testes.
Hyperactivity, ADHD, language delays.
Mitral valve prolapse, GERD.
244
How is Fragile X managed?
Special education, structure, minimize distractions.
Meds for hyperactivity.
Genetic counseling and support groups.
