OB/Peds Hesi

Question 1

When is the screening test for PKU done?

Answer 1

At 2-3 days of life, or after enough breast or formula (usually after 24 hours) is ingested to allow for determination of body’s ability to metabolize amino acid phenylalanine.

Question 2

The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are in keeping with the child’s dietary restrictions. Which foods are contraindicated for this child?

Answer 2

Foods sweetened with aspartame

Question 3

During a routine first trimester prenatal exam, a pregnant client tells the nurse that she has noticed an increase in vaginal discharge that is white, thin, and watery. What action should the nurse implement?

Answer 3

Inform her that this is a normal physiological change.

Question 4

A client at 30 weeks of gestation is on bed rest at home because of increased blood pressure. The home health nurse has taught her how to take her own blood pressure and gave her parameters to judge a significant increase in blood pressure. When the client calls the clinic complaining of indigestion, which instruction should the nurse provide?

Answer 4

Take your blood pressure now and if it is seriously elevated, go to the hospital.

Question 5

What is the difference between caput succedaneum and cephalhematoma?

Answer 5

Cephalhematoma does NOT cross suture lines and manifests a few hours after birth

Question 6

A new mother asks the nurse about an area of swelling on her baby’s head near the posterior fontanel that lies across the suture line. How should the nurse respond?

Answer 6

“This is called caput succedaneum. It will absorb and cause no problems.”

Question 7

Patient with continuous fetal monitoring notices FHR fall and rise abruptly with “v” shaped pattern. Nurse action to take first?

Answer 7

change position of patient

Question 8

When planning care for a laboring client , the nurse identifies the need to withhold solid foods while the client is in labor . What is the most important reason for this nursing intervention ?

Answer 8

An increased risk for aspiration can occur if general analgesic is needed

Question 9

Which physiological parameter is most important for the nurse to monitor during administration of oxytocin (Pitocin)?

Answer 9

fetal heart rate

Question 10

A multiparous woman at 38 weeks gestation with a history of rapid progression of labor is admitted for induction due to signs and symptoms of pregnancy induced hypertension (PIH). One hour after the oxytocin infusion is initiated she complains of a headache. Her contractions are occurring every 1-2 mins , lasting 60-75 seconds and a vaginal exam reveals that her cervix is 90% and dilated 6 cm.What intervention is most important for the nurse to implement?

Answer 10

Discontinue the Pitocin infusion

Question 11

A client receiving oxytocin (Pitocin) to augment early labor. Which
assessment is most important for the nurse to obtain each time the infusion rate
is increased?

Answer 11

Contraction pattern.

Question 12

A 38-week primigravida is admitted to labor and delivery after a non-reactive stress test (NST). The nurse begins a contraction stress test (CST) with an oxytocin (Pitocin) infusion. Which finding is most important for the nurse to report to the healthcare provider?

Answer 12

pattern of fetal late decelerations.

Question 13

A 4-day postpartum client calls the clinic and reports that her nipples are so sore that she does not know if she can continue to breastfeed her infant. What instruction is best for the nurse to provide?

Answer 13

Apply hot packs just before each feeding.

Question 14

A new mother is having trouble breastfeeding her newborn. The child is making frantic rooting motions and will not grasp the nipple. Which intervention should the nurse implement?

Answer 14

Encourage the mother to stop feeding for a few minutes and comfort the infant.

Question 15

A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breasts are swollen, warm, and tender upon palpation. What action should the nurse take?

Answer 15

Apply cold compresses to both breasts for comfort

Question 16

The client is experiencing engorgement even though she is bottle-feeding her infant, and cold compresses

Answer 16

may help reduce discomfort.

Question 17

The nurse observes a new mother avoiding eye contact with her newborn. Which action should the nurse take?

Answer 17

Observe the mother for other attachment behaviors.

Question 18

The nurse receives a newborn within the first minutes after a vaginal delivery and intervenes to establish adequate respirations. What priority issue should the nurse address to ensure the newborn’s…

Answer 18

Heat loss

Question 19

Upon admission to the nursery, the nurse places a newborn supine under radiant warmer , an external heat source. What should the nurse implement first to ensure safe thermoregulation?

Answer 19

Place temperature probe on the abdomen in the line with the radiant heat source

Question 20

The nurses assessment on a preterm infant reveals decreased muscle tone , sign of respiratory distress , irritability , mottled cool skin.Which intervention should the nurse implement first ?

Answer 20

Position a radiant warmer on the crib

Question 21

A new mother asks the nurse why her infant son has a needle mark on his leg. Which response is best for the nurse to provide the mother?

Answer 21

Your baby was given an injection of vitamin K to prevent bleeding

Question 22

The parents of a male newborn have signed an informed consent for circumcision. What priority intervention should the nurse implement upon completion of the circumcision?

Answer 22

Place petroleum gauze dressing on the site.

Question 23

A mother expresses fear about changing the infant’s diaper after circumcision. What information should the nurse include in the teaching plan?

Answer 23

Place petroleum ointment around the glans with each diaper change and cleansing.

Question 24

A client breastfeeding her child reports a painful swollen breast with cracked and sore nipple on the right side. What should the nurse instruct the client?

Answer 24

feed the child every 2 to 4 hours and empty each breast completely

Question 25

A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is prescribed. Which instruction should the nurse provide to this client?

Answer 25

Breastfeed the infant, ensuring that both breasts are completely emptied.

Question 26

A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective in preventing nipple soreness?

Answer 26

Ensure that the baby is positioned correctly for latching on.

Question 27

The nurse should be aware that which condition is a contraindication to inducing labor

Answer 27

Placenta previa.

Question 28

A patient who is 32 weeks gestation has the following symptoms: dark, red vaginal bleeding, 100 bpm FHR, rigid abdomen and severe pain. What is the difference between abruptio placentae and placenta previa?

Answer 28

Placenta previa: painless bright red bleeding occurring in the third trimester

Question 29

A healthcare provider informs the charge nurse of a labor and delivery unit that a client is coming to the unit with suspected abruptio placentae. What findings should the charge nurse expect the client to demonstrate? (Select all that apply.)

Answer 29

a. Dark, red vaginal bleeding. b. Increased uterine irritability. c. A rigid abdomen.

Question 30

The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?

Answer 30

Monitor bleeding from IV sites. Monitoring bleeding from peripheral sites is the priority intervention. This client is presenting with signs of placental abruption

Question 31

Patient presents with bright red blood, rigid abdomen and in pain. Nurse suspects possibility?

Answer 31

abruptio placentae

Question 32

The nurse notes a visible prolapse of the umbilical cord after a client experiences spontaneous rupture of the membranes during labor. What intervention should the nurse implement immediately?

Answer 32

Elevate the presenting part off the cord.

Question 33

The nurse is interacting with a female client who is diagnosed with postpartum depression. Which finding should the nurse document as an objective signs of depression? (Select all that apply.)

Answer 33

A. Avoids eye contact. B. Interacts with a flat affect. C. Reports feeling sad. D. Expresses suicidal thoughts

Question 34

A 2-day-old full-term infant is brought to the neonatal ICU for treatment of early onset sepsis. Which is the most likely infecting organism in this client?

Answer 34

Group B Strep

Question 35

The nurse is giving an intramuscular injection of an antibiotic to a 16-month-old toddler with pneumonia. The toddler does not have any known allergies and been walking without assistance for one month. Which technique should the nurse select for administration?

Answer 35

Administer the injection into the middle of the lateral aspect of the thigh.

Question 36

The nurse is administering an oral medication to a reluctant preschool-age boy. Which intervention should the nurse implement?

Answer 36

Use straightforward approach with the child

Question 37

A new mother calls the nurse stating that she wants to start feeding her 6-month-old child something besides breast milk, but is concerned that the infant is too young to start eating solid foods. How should the nurse respond?

Answer 37

reassure the mother that the infant is old enough to eat iron-fortified cereal

Question 38

While auscultating the lung sounds of a 5 year old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. What action is best for the nurse to take?

Answer 38

Inquire about the use of alternative methods of treatment. (Cupping is popular form of tx in Asian cultures)

Question 39

The nurse is caring for a female client with scoliosis who had a posterior spinal fusion and is in a body jacked cast. Which assessment finding indicates to the nurse the client is developing cast syndrome?

Answer 39

Abdominal distention.

Question 40

Nurse screening only the highest risk children for scoliosis?

Answer 40

Girls between ages 10 and 14

Question 41

An adolescent boy is hospitalized with full-thickness (third degreed) burns to both hands following a house fire. Three days after his admission to the burned unit, the nurse notes that teenager's hands are becoming more edematous. Which intervention is most important for the nurse to include in this client's plan care?

Answer 41

Assess radial pulses every 2 hours

Question 42

Upon inspection, a nurse visualizes a blade of grass clipping stuck under the right upper eyelid of a teenage client complaining of eye pain, increased tear production, and redden sclera. What should the nurse use to remove the grass clipping?

Answer 42

Moist gauze pad.

Question 43

During a routine well-child exam, the nurse observes that a 12-month-old child is unable to pronounce any simple words or syllables. Which possible cause should the child be evaluated for first?

Answer 43

Hearing loss.

Question 44

In caring for an client with acute epiglottitis, which nursing action takes priority?

Answer 44

Prepare for endotracheal intubation

Question 45

During a follow up clinical visit a mother tells the nurse that her 5 month old son who had surgical correction for tetralogy of Fallot has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held and his growth is in the expected range. Which intervention should the nurse implement?

Answer 45

Auscultate heart and lungs while infant is held

Question 46

Which instruction should the nurse include in the parents' discharge teaching plan for a three-year-old child with diarrhea?

Answer 46

Monitor for the absence of tears

Question 47

A pt at 32 weeks gestation present with possible UTI. Action to implement?

Answer 47

collect urine for culture

Question 48

One day after a vaginal delivery of a full-term baby, a postpartum client's white blood cell count is 15,000/mm2. What action should the nurse take first?

Answer 48

Check the differential, since the WBC is normal for this client.

Question 49

Safety is of the utmost concern in children with aplastic anemia. It is important to prevent injury in order to avoid hemorrhage.

Answer 49

Risk of epistaxis

Question 50

The nurse is reviewing the lab values for an eight-year-old client and notes that the child's absolute neutrophil count (ANC) is below 500 cells/mm3. Which nursing intervention should the nurse implement first?

Answer 50

Answer: . Initiate reverse isolation precautions for this child

Question 51

The nurse is caring for a one-year-old boy who has type 1 diabetes mellitus (DM). His mother asks how will she recognize hypoglycemia in her infant who cannot tell her how he feels. Which information should the nurse provide?

Answer 51

Answer: Hypoglycemia in infants causes changes in behavior and cold clammy skin

Question 52

A new mother who is breastfeeding her 4 week old infant has type 1 diabetes , reports that her insulin needs have decreased after the birth of her child. What action should the nurse implement ?

Answer 52

Inform her that a decreased need for insulin occurs while breastfeeding

Question 53

Which information is most important for the nurse to provide parents about long-term care for their child with hydrocephalus and a VP shunt?

Answer 53

Shunt malfunction or infection requires immediate treatment.

Question 54

During a prenatal visit, a client at 30 weeks gestation reports persistent heartburn during the past two weeks . The nurse notes the client has 3+ bilateral, pitting , pedal edema. Which action should the nurse implement?

Answer 54

Ask if blurred vision and headche have occured

Question 55

A 3 month old has a VP shunt. The mother states, "Once the shunt is removed, the pressure in my baby's head will be reduced." What do you say?

Answer 55

Answer: The shunt will be replaced as the child grows to reduce the pressure in the child's head

Question 56

Monitoring for fetal position is important because the mother cannot tell you she has back pain, which is the cardinal sign of persistant posterior fetal position. Why do the regional blocks, especially epidural and caudal, often result in assisted delivery?

Answer 56

inability to push effectively in the 2nd stage

Question 57

when examining a client after delivery, the nurse finds the fundus soft, boggy, and displaced above and to the right of the umbilicus. What action should the nurse take first in this case?

Answer 57

perform fundal massage

Question 58

A nurse consults a mother and detects cord prolaspe. How should the examiner position the pregnant woman to relieve pressure on the cord

Answer 58

knee to chest position

Question 59

When assessing a client who is at 12 week gestation, the nurse recommends that she and her husband consider attending childbirth preparation classes. When is the best time for the couple to attend these classes?

Answer 59

at 30 weeks gestation

Question 60

A 42 week gestational client is receiving an intravenous infusion of oxytocin(Pitocin) to augment early labor. The nurse should discontinue the oxytocin infusion for with pattern of contractions?

Answer 60

transation labor with contraction every 2 mins , lasting 90 secs

Question 61

Immediately after birth a newborn infant is suctioned, dried and placed under a radiant warmer. The infant has spontaneous respirations and the nurse assesses an apical HR of 80 beats/minute and respirations of 20 breaths/min. What action should be performed next

Answer 61

initiate positive pressure ventilation

Question 62

A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse perform first?

Answer 62

A.Bathe the infant with an antimicrobial soap. B.Measure the head and chest circumference. C. Obtain the infant's footprints. D. Administer vitamin K (AquaMEPHYTON

Question 63

A woman who thinks she could be pregnant calls her neighbor, a nurse, to ask when she could use a home pregnancy test to diagnose pregnancy. Which response is best?

Answer 63

home pregnancy test can be used right after your first missed period.

Question 64

A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?

Answer 64

correctly place the infant on the breast

Question 65

oral contraceptives What to assess Poor candidates

Answer 65

Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives.

Question 66

Genetics of PKU

Answer 66

25% any babies born later will have it too

Question 67

pregnancy test hormone

Answer 67

HCG (human chorionic gonadotropin)

Question 68

Pregnancy - positive signs?

Answer 68

fetal movement felt by experienced clinician at 20 wk

Question 69

urinary chnages

Answer 69

Dilation of renal pelvis; elongation, widening, and increase in curve of ureters Increase in length and weight of kidneys Increase in glomerular filtration rate; increased urine flow and volume Increase in kidney activity with woman lying down; greater increase in later pregnancy with woman lying on side

Question 70

Weight gain during pregnancy

Answer 70

20lbs weight gain in 20 weeks is a lot

Question 71

Prenatal care-type 1 DM

Answer 71

Insulin needs are reduced while breastfeeding or tight control

Question 72

A pregnant woman have type 1 diabetes and is going to receives insulin teaching she tells the nurse that she is going to not eat in the morning because religion and is a holy month, what is the nurse best teaching:

Answer 72

collaborative work to create a new insulin schedule insulin needs are also decreased during breastfeeding

Question 73

Pregnancy air travel

Answer 73

Flexion and extension of the ankle promotes venous return and aid in the prevention of thrombophlebitis

Question 74

Vaginal Exam During Labor

Answer 74

use a glove and lubricants

Question 75

ruptured membrane

Answer 75

Assessment of the fetal heart rate is important after rupture of the membrane to determine decelerations that could indicate cord prolapse

Question 76

A multigravida client arrives at the labor and delivery unit and tells the nurse that her bag of water has broken. The nurse identifies the presence of meconium fluid on the perineum and determines the fetal heart rate is between 140 to 150 beats/minute. What action should the nurse implement next?

Answer 76

Complete a sterile vaginal exam

Question 77

fetal position

Answer 77

the best way to find out fetal position is through an ultrasound

Question 78

A client receiving epidural anesthesia begins to experience nausea and becomes pale and clammy. What intervention should the nurse implement first?

Answer 78

Raise the foot of the bed.

Question 79

If a mom scheduled for a C-section tells "I ate a big breakfast and had OJ", what do you do?

Answer 79

TELL the anesthesiologist; she is at risk for aspiration

Question 80

Woman on Pitocin suddenly has problems and has variable decelerations. What do you do?

Answer 80

turn of the pitocin

Question 81

So you're going in to see a patient that had an episiotomy and she said her stitches hurt, they ask her what to do next, they had two choices, either to put the ice pack there, or look at the episiotomy.

Answer 81

look at episiotomy

Question 82

A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following?

Answer 82

Rotate infant positions at each feed.

Question 83

Fundal massage technique

Answer 83

one hand on the lower segment of the uterus

Question 84

Cyanotic 3 hour old infant temperature 96.5, 40 breaths/min, 165 beats/minute. Intervention best to implement?

Answer 84

gradually warm under heat source

Question 85

Newborn Immunity

Answer 85

present in newborns and involves physical and chemical barriers as well as nonpathologic organisms

Question 86

diaper chnage : substance

Answer 86

use clean water

Question 87

Mother of a 4 month old asks RN for preventing diaper rash -

Answer 87

use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change

Question 88

postpartum hemorrhage even after finishing oxytocin infusion:

Answer 88

check maternal BP

Question 89

During delivery, protruding umbilical cord

Answer 89

knee chest posiiton

Question 90

The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?

Answer 90

monitor bleedinf from IV site

Question 91

postpatrum hemorrhage leads to what

Answer 91

DIC

Question 92

mother was diagnosed with Coke. Baby is irritable, cries a lot. What do you do?

Answer 92

initiate seizure percaution Cocaine-exposed newborns are typically fussy, irritable, and inconsolable at times. Cocaine-exposed infants demonstrate poor coordination of sucking and swallowing, making feeding time frustrating for the newborn and caregiver alike

Question 93

neonatal sepsis risk factor

Answer 93

a. prolonged rupture of membrane b. fetal distress c. preterm delivery

Question 94

Injection Prep: pedi

Answer 94

: IM injection for children under 3 of age should not exceed 1ml. divide the dose into smaller volumes for injection in two different sites.

Question 95

IM injection-school-aged-PEDI

Answer 95

let the child choose

Question 96

Solid foods-6 months introduce

Answer 96

introduce food one at a time

Question 97

the child was obese and they wanted to know the highest contributing factor to the obesity

Answer 97

child had infant cereal before six months of age

Question 98

You are the school nurse and the teen got a chemical in his eye

Answer 98

flush the eye out for 20 sec

Question 99

You have a deaf baby. What mode of communication would you choose and why?

Answer 99

communicate with pictures

Question 100

Pneumonia-oxygen

Answer 100

administer oxygen

Question 101

You have a baby with vomiting and diarrhea. What do you do first?

Answer 101

Give electrolytes or IV NS?

Question 102

Newborn - bowel. Hirschsprungs disease

Answer 102

newborns with hirschsprungs disease have a failure to have a bowel movement within 48hours after birth

Question 103

UTI - assess

Answer 103

Symptoms of this infection in children can differ from those of adults and can include abdominal pain, fever, nausea, vomiting, poor appetite, enuresis, incontinence, frequency or urgency

Question 104

Aplastic anemia-epistaxis

Answer 104

they are at risk for epistaxis

Question 105

The nurse is reviewing the lab values for an eight-year-old client and notes that the child's absolute neutrophil count (ANC) is below 500 cells/mm3. (NEUTROPENIA). Which nursing intervention should the nurse implement first?

Answer 105

Initiate reverse isolation precautions for this child

Question 106

A babysitter calls in regarding the child she is caring for who is a diabetic. Currently he is diaphoretic, weak, what instructions should be provided?

Answer 106

give the milk before bringing in (hypoglycemia)

Question 107

If mother has DM type 1, what do you expect for fetal complications?

Answer 107

hypoglycemia

Question 108

A pt is Rh neg and goes into preterm labor, what do you do?

Answer 108

Give Rh factor and do a coombs test

Question 109

A pudendal block

Answer 109

anesthetize the perineum.

Question 110

how to promote attachemnt for mother and baby

Answer 110

rooming in.

Question 111

prefered IM injection site for infamts 12 months or older

Answer 111

vastuslateralis

Question 112

injection site for school age or children older than 6 years old

Answer 112

deltiod muscle

Question 113

screening for postpatrum depression

Answer 113

use Edinburgh scale