Maternity and Peds Hesi Review

Mastitis: antibiotic therapy, wear a supportive bra, warm compress  Pyloric stenosis: olive size obstruction on abdomen  Anchor the lower part of the uterus - then massaging the fundus  High bp maybe with preeclampsia: check for protein in the urine (proteinuria)  Boy child frequent visits to the school nurse headache, irritable for few weeks: ask how daily school day is  BMI 6 -year old: physical activity at the school, girls physical activity at home, and diet  Saturated 2 pads in 30 mins: massage the fundus  Tick bite: test for Lyme disease  HIV AZT is given to slow down the transmission to the fetus  Clear water to clean for diaper change  APGAR = 9, acrocyanotic only gets 1 point for color  Mom says baby not sleeping through night, nurse should assess severe skin breakdown on the baby to plan family care  Blind child with traction - bring familiar objects or stuff animals from home  Drooling, temp - epiglottitis need to notify the provider  Muscular irritability from hemorrhaging  Osteomyelitis - give milkshake as snack- high protein, high fiber  Hypoglycemic: give milk  Croup- barking sound, high pitch on breathing - bring in shower with warm mist  Transillumination through scrotal sac to test if testes are present  Earache if meningitis  Hypothyroidism: D- TSH is high so T4 is low by thyroid gland  Tetralogy of Fallot - cyanotic limbs crying  Cephalohematoma noticed near occiptal suturesnotify Dr  Increase AFP- need to do an sonogram  30 week gestation age 38 inches fundal height - do an ultrasound, bc should’ve been equal  Inguinal Hernia - palpate to get it back in  Breastfeeding 5 day with yellow stools - this is normal  Spontaneous rupture of membranes - ask the color and consistency  3+ pitting edema with GERD- normal during pregnancy??  Postpartum depression - may need to be evaluated ** Know the length of PPD  Afebrile seizures - will eventually go away  MD - wobble legs at this stage  Tonsillitis-signs of bleeding - need to inspect the oral cavity  Movements caused from rh??? they temporary something a C --wasn’t this the amniocentesistesting the rh for rhogam? Yes testing maternal blood to see if they need to administer RhoGam  Fetal heart pattern in V form - priority is change mother’s position  Braxton Hicks will go away with walking it is not true labor  Placenta Previa - check fetal HR  I’m having pain in my stitches - look at the episiotomy  Use breathing techniques after giving pain meds 30 mins ago  Female - parenteral antibiotics administration is most effective  Introducing solid foods - 1 food at a time for 4-7 days  Digoxin - missed dose can give if it’s been less than 4hrs /if more than 4 hrs wait until next dose/If miss 2 doses, call HCP  Dilantin - check the serum levels  UTI child - return for another urine sample  3 hour newborn with irregular respirations and small/soft murmur - put pulse ox on the foot  Mag toxicity possibility: mag was 8? With hypoactive reflexes  Gonorrhea infection tell other partners to seek treatment  Adolescent gets a rubella vaccine at maternal bearing age - use another form of birth control for 28 days  Diaphragm – use same as before giving birth - get resized? Use another form of bc?  Tonic clonic seizure and heart issue - monitor calcium  Amniocentesis priority - something with to get Rh factor for rhogam *Breasts- need supportive bra, antibiotics, cold compress *infant vital signs- normal *DMD- weak muscles and gait - I remember something with DMD & serum Ca+ *preeclampsia- check urine for protein MP Hesi 2017 1. dosage : 700. 77 lb baby. 2. 20 units of oxytocin+1L LR→ 125 . 3. Gerd: sugar cookies 4. Mom is Rh-: check Rh immunoglobulin or check FHR 5. Cystic fibrosis: infertility 6. Tetanus questions: clean and antibiotic!!! 7. folic acid, doesn’t like green lefy veggies: strawberries 8. Diaper rash: zinc oxide 9. young parents, 24hrs birth: evaluate feeding 1 0. mom forcing kid to eat means and veggie(requires further. 11. sickle cell: hot and thirsty 12. pyloric stenosis: olive-shaped 13. Pyloric stenosis, hungry and irritable after feelings, first intervention→ crying or weight 14. turn to side and suction 15. fractured clavicle 16. jitteriness: check glucose 17. Normal primipara finding: 2 saturated pads for 1st hr. Iput pulse 56. 1 MP Hesi Review – EVERYTHING 2 MP Hesi Review – EVERYTHING 18. Dad called few days post-partum - hormonal swings are normal. 19. MgSO4 priority: calcium gluconate 20. HIV: AZT 21. Assess FHR and coombs 22. check for after amniocentesis: monitor for labor 23. Post-partum mood swings vs. depression: fatigue & not making decisions? 24. eye ointment: prevent eye infection 25. intussuception: brown stool notify HCP 26. girl SATA: 27. girl who druinks: atta boy 28. ADHD: refer or help with HW?? 29. transitional phase: monitor contractions, help mantain control 30. AFP: Sonogram 31. Priority pt: ARF and hyperkalemia!!! 32. mastitis: antibiotics, bra support, warm support 33. Open heart surgery: demonstration of splintintg, deep breathing etc 34. rupture membranes 12hrs ago--: temperature 35. C-section priority: uterine atony or positive homans??? 36. AGN: Sore throat 37. hemophilia: NOT motrin(elevate and immobilize. 38. Resp distress: nasal flaring 39. Leopolds: anchoring fundus 40. Drooling, s/o epiglotitis→ emergency response!!! 41. flick the sole 42. RF: Chorea 43. after c section lacerated. trickle of blood: BP 44. +2 edema: MgSO4 45. position on stomach 46. HPV: C “immunization is a must to prevent it” 47. scoliosis: girls 10-14 48. metabolic alkalosis-vomiting or pyloric 49. MDI: spacer or cold??? 50. position on stomach 51. sesnse of security 52. IUGR: sonogrm 53. Flaring of the nare 54. Developmental delay: maximum potential 55. 8 mos expected: sitting up unassisted MP Hesi 2017  Protruding cord - knees to chest  Child who had Slipped Capital Femoral Epiphysis (SCFE. - pin and something  4-month old what to do to prevent diaper rash - use a barrier cream, such as zinc oxide  Mother with mastitis, what would you advise - start on the unaffected breast first  Adolescent turns 18 and mother calls for lab results - must get permission from daughter  Different acid base levels - normal acid base  A breastfeeding mother wants to avoid having another pregnancy. What do you do? use condoms and gel  Infant getting phototherapy - Cover the infant’s eyes  6 month baby goes in for routine vaccine and flu shot - give all immunization and influenza but alternate site and injection  Medication to prevent respiratory issues in the baby - betamethasone IM  15 mo breastfeeding & now 6 mos prego - get nutrition history  Postpartum hemorrhage even after finishing oxytocin infusion - check maternal BP  Math questions were 10 and 10  Baby got otitis media after an acute respiratory infection, why do infants get otitis media - shorter eustachian tubes  Boy with spine injury after driving accident - maintain alignment  Obese question SATA - find out what physical activities she does & if school has PE class, 3 day diet history from mother  Iron supplement - take with meal  Preeclamptic women received Pitocin IV and is having contractions 1 to 2 minutes apart - discontinue Pitocin  Lyme disease - if rash, then test  Esophageal atresia, highest priority - body temperature  Baby regurgitation and vomiting - suction the mouth and nose  An adolescent received an above the knee amputation. Would do you tell them to do everyday - inspect the stump daily  Women says about 6 mos pregnant & smokes a pack of cigs/day, how to check for estimated gestation age: ultrasonography  8 month old development, you would notice - sitting unassisted  Glucose was 800 mg - give IV normal saline and insulin  Rubella - give after delivery within 72 hours  Newborn has swollen, tender, testicles. Suspect hydrocele. What do you do? Use transillumination to check for fluid  Fetal heart rate dropped abruptly to a V - change mom’s position  Pregnant had a temp of 101 – chorioamnionitis  Epidural anesthesia - check maternal HR and BP  Teenagers who are pregnant, be sure to include - nutrition requirement during pregnancy  Patient who was 9 cm and 80% effacement - ?  Transitional phase - assess uterine contractions  Infertile couple - allow them to control if they want to stop or support group before another IVF cycle  4 neonates, who to see first – Tet  9yr old (school age. – industry  Child with pneumonia - assess lung sounds  Child is dehydrated. What to check for? Weak cry but no tears  Pyloric stenosis - metabolic alkalosis  Assess for cryptorchidism - warm the room  “He doesn’t feed himself, I make him eat vegetables and meat”  A newborn infant is crying, temperature is 96.5, has elevated bp and is cyanotic. What do you do? Warm that baby up (answer) 2 MP Hesi Review – EVERYTHING 3 MP Hesi Review – EVERYTHING MP Hesi 2017  What put kid at risk for bacterial meningitis?? Earache NOT VARICELLA IT’S A VIRUS  Tree bark flies in eyes Put on patches & call ophthalmologist  Kid is 2 years old drinking with bottle drinking sweetened soda, what should Nurse discuss? Don’t drink out of a cup, soda leads to obesity, & soda lead to dental caries  Kid with type I Diabetes & Blood sugar 180 wants to play in his soccer game what does Nurse recommend? The kid can play soccer w/o eating a snack or taking insulin  Mom depressed how does she feel? Tired, sad, dec. appetite  Mag toxicity DTR +1, UO was 25, Mag was 8, Respiration 14 Closely follow up  Intussusception & now has brown poop Notify HCP  Kid sees the school nurse with stomach ache Notify HCP  Cleft Lip/Cleft Palate See genetic counselor  Hx of syphilis & chicken pox urine sample/blood sample  Salt wasting Check the Perineum  What do you report to Dr first with an epidural? Blood Pressure,  She has excessive bleeding, what do you let the dr know Report BP or Apical HR  Administering Epidural slows the labor process  Palpate with one hand & the other hand is there to do what? Anchor the uterus  The uterus was firm midline & in place she felt like she had vag pressure check perineum  Episitomy visualize the perineum  The person is oozing blood & has muscle irritability, what electrolyte level are you most concerned about? Calcium  Budding breasts & Tanner II  A 7 year old girl has a UTI & discharged what do you tell her to check? check urine odor  4 year old girl what is a normal finding? imaginary friend  10 year old had rheumatic fever & is on strict bed rest. What is an appropriate form of play? checkers  Rubella vaccine don’t get pregnant for 1 month  Pitocin after labor to stimulate uterine contractions  MOM has HIV & is administered AZT during birth what do you need to do with the newborn after? Administer AZT  What is most likely a sign of pregnancy Hegars  5 month with hypothyroidism laughs & rolls to side  Immunization question Need Consent for Hep B  Mom is 36 wks pregnant, nonreactive nonstress test then has contraction Stress Test with an infusion of Pitocin. What is the priority to let the doctor know? Fetal Late decelerations  When do you have to notify the HCP? When the deceleration is after the peak of the contraction.  Pt has a hard, rigid abdomen, is bleeding profusely what do you do next? Stay with Pt & call the health care provider  Administering prostaglandins. What is the finding you make the doctor aware of?Fetal HR of 50  Woman is 3 cm dilated & she wants to pee? Check her cervix  C8 injury looses bladder control doesn’t have reflex?  How do you know the baby is in distress? Nasal Flaring  Temp was 97.7 Pulse of 140, 42 breaths per minute but irregular Put in EMR  What would you do when the newborn nurse comes in the nursery put the thermal regulator in line with the abdomen  She was 30 wks & edema was +3, Ask about blurred vision  The little kid has abdominal pain, fever & is vomiting what do you ask him? Ask him the quality & location of his pain  Mother DM. What is most important about her care? Strict glucose control  Amniocentesis at 36wks Mother has 8 1/2 lb baby what do you assess in her? Fetal lung status  Muscle dystrophy X linked recessive  Teen has Pelvic inflammatory disease & finished with a 14 day antibiotics & flagyl orally. She wants to know if she can be treated at home. Why not? Monitor parental antibiotics IV  The girl has a fractured ulnar & her wrist is in splints. What do you do next Check wrist pulses  Digoxin: Can administer a first missed dose within 4 hours  A child has liver disease & the parents are aware that they are dying.  What is the priority for the nurse? Reassure the parents  5 day old newborn yellow sticky poop that smells like sour milkThis was normal  What to do for cryptochism Ask parent if they felt it before?  Dosage Calculation: 2.5  Dosage Calculation: 25  Kid is drooling Notify HCP & trach kit by bedside  Lyme Disease/tetracycline Don’t take with milk or antacids  The point of an ultrasound Growth & age  What’s the intervention when the kid has puss filled vesicles Prevent transmission  The kid has a tonsillectomy & is swallowing a lot. What do you do first? Look in their throat with a flashlight  Afebrile Seizures The kid will grow out of them MP Hesi 2016 3 MP Hesi Review – EVERYTHING 4 MP Hesi Review – EVERYTHING  Rubella Vaccine Teaching, wait 1 month before having sex  Esophageal atresia (check body temp)  2 year speech  Tremors in a newborn suspect cocaine addiction  5 months pregnant mothers which assessment info is the most vital (dribbling urine or blood.  betamethasone (30 weeks)  Tetracycline don’t take with milk/antacids  Boggy fundus 10lb baby and has 2 soaked pad in 30 mins do what next Massage her fundus Check the perineum  Yellow sticky stool  Hypospadias post circumcision no physical sports  Nephrotic syndrome treatment evaluation the edema is reducing  Blinds 5 years fracture leg and in traction what does the nurse do next Teach the family, Familiarize pt with her surrounding  4 month old baby with hypothyroidism how do u=you evaluate treatment The baby can pick up his head, The baby laughs and turns it self from his back to his stomach  Digoxin the HR was WNL give the treatment  Sickle cell crisis what’s the manifestation pain  Soccer player with a type 1 DM, ask child to go and play  Scoliosis demographic 10-14 y/o girls  Play (game. for 10y/o on bed rest: checkers  Croup under a Mist tent the parent brings child a stuff animal what do you do  Moro reflex in child of 6 months Moro reflex is gone by 3-4 mos  Mother is schedule for C-SECTION stated to the nurse that she drank a cup of coffee before coming in what should the nurse do Inform the pt doctor, Informed the anesthesiologist  Grandfather molesting child (call social work/report)  Coarctation or aorta Lumen obstruction  MMR is given at 12-15 months  Open heart surgery  What drug not for child under 9: Tetracycline, Aminoglycoside HESI 2015  What is the probable sign of pregnancy? Hegar’s Sign  Taner’s Sign ans: II  Jewish Lady & genetic disorder Tay-Sachs gene  Tetracyclines Do not give with Milk and antacids  Child with 95th percentile BMI Exercise, eat fruits & vegetables  Young girl with UTI Girl must come back for urine test  Mom states she can’t stop crying but so happy she had baby It is normal because Milk is coming and hormonal level change  How to encourage newborn bonding? Provide for mother’s needs and demonstrate warmth for infant  Left breast Mastitis SATA. Warm compress, Wear supportive bra, Continue breastfeeding while on antibiotics  Ear infection with exudate SATA. Remove exudate from ear before putting med in, Tylenol, q4hrs, Don’t use tongue blade, Don’t pick palpate around ear, Don’t use sterile water to ear  Patient had eclampsia Keep airway at bedside  Boggy uterus- what priority do you do? Massage uterus  Crackling in the temporal after getting hit by a swing Refer to PCP for further evaluation  Patient wanted to use oral contraceptives, what is a contradiction? Family history of stroke  Patient complaining of sore nipple, what to do? Assess breastfeeding positioning  Patient had preeclampsia Lift foot of the bed  Pregnant lady fell, what do you assess first? Dribbling urine  Infant being treated for hypothyroidism, how do you know tx is working? Infant is laughing & moving from back to side  Nurse held solid food for pregnant lady while in labor-why? Can aspirate food in case general anesthesia is used  Increased levels of APF - Do sonogram to confirm  Infant has RR of 35, axillary temperature of 96.85, HR 165, what do you do Gradually warm baby in heat source (radiant warmer)  Dosage calculation-8.6  Dosage calculation-12.5  Infant was oozing blood from incision, experiencing muscle irritability, what do you assess? Calcium  Infant boy experiencing circumcision, what do you teach parents? Apply prescribed ointment at every diaper change  Pt had ulnar fraction with splint, what do you check? wrist pulse  Four patients came in, who do you assess first? Patient having 3 minute contractions.  Herpes mom delivered child Isolate baby from others in nursery  Salt wasting: assess perineal edema  Does not cross suture lines: cephalohematoma  weight loss of baby, 7.5 yesterday and today 7lbs It is normal  The woman had 20wks gestation and gained 20 pounds The gestational weight gain is not normal  6months old, abnormal finding Startle/ moro reflex  Last miscarriage and pregnant again Increase minerals & vitamins  Woman on bedrest not to move because Homan’s signs  Child has shakiness, baby sitter call, what to do Give 8oz of milk  Osteomyelitis Reoccurrence of recent infection  Rheumatic fever Chorea is temporary, it would go away  The baby in the tent Allow the child play with the Stuffed toy  Head circumference increased by 5cm Bulging fontannel 4 MP Hesi Review – EVERYTHING 5 MP Hesi Review – EVERYTHING  Child have fever or explosive diarrhea Large bore IV  Child has respiratory distress Nasal flaring  Child is always goes to the nurse for past three weeks What is your typical day at school  Child holding abdomen/complaining of pain Describe pain level  Pregnant, what pet not to have Cat  Two sex ambiguous Offer information on sonogram  Child suck thumb It is normal  You have sore nipple Check infant position  Two pad saturation within 30minute Massage the uterus  36 weeks pregnant and bleeding Stay with pt & Call Dr  Inguinal hernia visible the child cry Persistent diarrhea  Congenital heart defect. (coartation of aorta. Lumen obstruction  Hirschsprungs syndrome Ribbon-like stools  Non-Reactive test Fetal late deceleration  After the epidural Check FHR. Maternity & Peds 1 Drug reference states Ampicillin should be infused over 30 mins. Nurse adds antibiotic to Pt's soluset chamber that contains 25 mL of IV solution & IV tubing used delivers 60 drops/mL Nurse should set IV pump at _ mL/hour? 25ml/30 min=50 ml/1 hr 2 Nurse is caring for a child with Nephroblastoma (Wilm's tumor. should include which one of the following interventions in the child's plan of care? Wilm’s tumor- altered nutrition or Do not palpate the abdomen 3 Parents of a toddler with sickle cell ask if they will have other children with this illness. How should Nurse respond? Possible that future kids will have it, refer for genetic counseling 4 Dr. orders IV infusion of D5% 1/2 normal saline to infuse at rate of 75 mL/hr via microdrip tubing for child. Nurse hangs 500mL bag at 6:00AM. At what time should a new IV bag be hung? D/H x V D: 75 mL/hr H: 500 mL Hung bag: 6:00 AM500mL/1=1hr/75Ml - 6.6 hours ≈ 6 hours and 30 min - This how long bag is hung for, so if she hung it at 6:00 AM, next time she change it is: 12:30pm -- Another person said: Left In Bag→ 1pm----So anywhere from 12:30pm to 1:00 pm 5 Which one of the following statements by the parents indicates understanding of colostomy care for their infant child? 6 Which one of the following nursing diagnoses would be appropriate for a child with nephritis Fluid Volume Excess r/t decreased plasma infiltration, Risk for Imbalanced Fluid Volume related to retention of sodium and fluid and dietary fluid restriction. ii. Risk for Activity Intolerance related to fatigue. iii. Risk for Impaired Skin Integrity r/to edema and decreased activity iv. Anxiety r/to insufficient knowledge about disease process or hospitalization 7 Which statement by mom w/ kid on oral Predisone for Nephrosis means understanding of med regime? Take with meals 8 In order to properly measure the abdominal girth of a 2 year old child which techniue should Nurse use? Measure abdominal girth above umbilicus, measure at same area each time 9 As a nurse you are required to report your suspicion of child abuse under which one of the following circumstances? Mother said child doesn’t like her 10 Dr. orders Ampicillin 200mg IV Q6 hrs to infuse over 30 mins. In order for med to infuse as ordered, Nurse adds 25mL of IV solution to soluset chamber & sets the IV pump at a rate of __ mL/hr using microdrip tubing. 25ml/30 min - 50 ml/1 hr 11 A child with hemophilia has been accidentally hit on knee with a bat during recess. What action should school nurse do? Apply Ice - RICE: rest, ice, compression, elevate 12 Nurse caring for a child with sickle cell disease would expect which abnormal laboratory finding? Hemoglobin (hgb): 8.5 (Low hgb: less than 9.5) 13 Indomethacin (Indocin) may sometimes be used to treat which congenital heart defects prior to any surgical correction. Closes PDA (patent ductus arteriosus) 14 A 9-year old child with a recent diagnosis of rheumatic fever is being seen in the pediatric clinic. In order to evaluate family's compliance with the plan of care Nurse should: Make sure they taking full course of antibiotics 15 An 8-year old child with a diagnosis of glomerulonephritis is complaining of a headache and a blurred view of the television in his room. What action should Nurse take next? Assess BP, Comfort, allow child to rest (seizure precaution), Give vasodilators for hypertension 16 The priority nursing action for a toddler 2-hours post cardiac catheterization is to: Assess both pedal pulses 17 Nurse is teaching family of a toddler w/ hemophilia about disease. Which statement by parents requires additional teaching? Something regarding - Blood transfusion 18 Which diagnosis would be appropriate for infant with ventricular septal defect? Impaired Gas Exchange??? Other choices: Decreased cardiac output, Decreased tissue perfusion, Activity Intolerance, Delayed growth & development 19 Suspected cases of child abuse can be reported by:(SATA. Physicians, nurses, physician assistants, family members 20 Parents of a child with Sickle Cell Disease ask why child is receiving daily doses of oral folic acid. How should Nurse respond? To stimulate RBC production 5