Maternity and Peds Hesi Review 3 2022

• Mother of a preschool-aged child calls school RN to report her child was bitten by a tick while on a school outing last wk. Mother tells RN she removed tick & flushed it down toilet. What action should school RN take? Schedule test for Lyme disease if rash appears. • Dr. prescribes phenytoin (Dilantin) for school-aged child diagnosed with tonic-clonic epilepsy. Which info should RN provide parents when teaching about seizure management with phenytoin? Monitor child’s serum phenytoin levels routinely while taking Dilantin. • During newborn admission assessment, RN palpates newborn’s scrotum & does not feel the testicles. Which assessment technique should RN perform next to verify absence of testes: Perform transillumination of scrotal sac to visualize shadows of testes. • The parents of a 14-month-old-child who is hospitalized due to febrile seizures tell RN that they fear their child will have lifelong seizures. What info should RN convey to these parents? Reassure the parents that febrile seizures decrease as child grows older. • In determining the one min Apgar score of a male infant, RN assesses a heart rate of 120 beats per min & 44 respirations per min. He has a loud cry with stimulation, good muscle tone, & his color is acrocyanotic. What Apgar score should RN assign? 9 • School-aged child with otitis media receives prescription for azithromycin (Zithromax) 100 mg once, then 50 mg daily for 4 days. Med available in solution containing 200 mg/5 ml. How many ml should RN give on first day? 2.5 • 39-wk-gestational multigravida is admitted to L & D with spontaneous rupture of membranes (SROM) & contractions occurring every 2-3 mins. A vaginal exam indicates that cervix is dilated 6 cm, 90% effaced, & the fetus is at a +2 station. During last 45 mins FHR has ranged between 170 & 180 beats/min. What action should RN implement? Take oral maternal temp. • During admission of newborn, RN identifies localized swelling that does not cross suture line on the posterior area of the parietal bone. What action should RN implement? Notify Dr of cephalhematoma. • Mother of 6 y/o girl is concerned about her child’s obesity. The child’s weight plots at 75 percentile, & the height at the 25 percentile. The child’s BMI is at 85 percentile for age & gender. Which interventions should RN implement? SATA: Determine child’s usual physical activity pattern, Ask if school has PE program, Obtain child’s 3-day diet history based on mother’s input. • Woman 36-wks & Rh negative admitted to L & D with abdominal cramping. She is placed on strict bedrest & FHR & contraction pattern are monitored with external fetal monitor. Two hrs later, RN notes large amount of bright red vaginal bleeding. Highest priority nursing action? Assess FHR & Pt’s contraction pattern. • Nutritional info RN should give mother of 6-mo-old on introducing solid foods? Introduce foods one at a time, at 4-7 day intervals. • Digoxin is prescribed to 3-month-old with congenital heart disease. RN should teach parents to do what if they miss giving a dose of this med? If less than four hrs 2 2 1 have elapsed, give the missed dose. • A 10 y/o boy has been seen frequently by the school RN over the past three wks after school begins in the fall. He reports headaches, stomach aches, & difficulty sleeping. What intervention should RN implement? a. Ask the boy to describe a typical day at school. 3 3 • Pt who had her first baby three months ago & is breastfeeding tells RN that she is currently using the same diaphragm that she used before becoming pregnant. What info should RN provide this Pt? Use other form of conception until new diaphragm obtained. • In assessing child with suspected bacterial meningitis, RN should anticipate a recent history of which problem? a. Ear ache • Following the vaginal delivery of a 10-pound infant, RN assesses a new mother’s vaginal bleeding & finds that she has saturated two pads in 30 mins & has a boggy uterus. What action should RN implement first? a. Perform fundal massage until firm. • Mother brings her 3 y/o son to ER & tells RN he has had an upper respiratory infection for past two days. Assessment of child reveals rectal temp of 102 F. He is drooling & becoming increasingly more restless. First RN acton? d. Notify Dr & obtain a tracheostomy tray. • Mother brings 3-month-old to clinic because baby does not sleep through the night. Which finding is most significant in planning care for this family? diaper area shows severe skin breakdown. • Pt 18-wks was informed this morning that she has elevated alpha-fetoprotein (AFP) level. After Dr. leaves room, Pt asks what she should do next. What info should RN provide? Explain sonogram should be scheduled for definitive results. • A 4 y/o boy was recently diagnosed with Duchenne muscular dystrophy (DMD). Which characteristic of the disease is most important for RN to focus on during the initial teaching? c. Lower legs become progressively weaker, causing a waddling, unsteady gait. • While caring for laboring Pt on continuous fetal monitoring, RN notes FHR pattern that falls & rises abruptly with “V” shaped appearance. First RN action? Change maternal position. • Woman returns to clinic for 2-wk postpartum checkup & has signs of left breast mastitis. Which instructions should RN suggest Pt follow at home? SATA: Wear bra with good breast support, Take antibitotics at regular intervals, Apply warm compress to left breast. • A one-month old male infant is brought to clinic by his mother who states son has been vomiting forcefully after each meal for last three days. Infant is afebrile, dehydrated, & pyloric stenosis is suspected. What other findings should RN identify that are consistent with pyloric stenosis? olive-shaped mass in abdominal area • Babysitter of 7 y/o with type 1 diabetes calls clinic to report that child is very irritable, perspiring, & shaking. Which instructions should RN provide to the babysitter? Give child 8oz glass of milk. • Pt in preterm labor has had infusion of mag sulfate running for 8 hrs. Current findings: RR 14 breaths/min; urine output 25 ml/hr; DTRs 1+; serum mag level 8 mEq/L. Based on these findings, what conclusion should RN reach? c. Findings indicate potential toxicity to magnesium sulfate & close follow-up is indicated. • Teen with pelvic inflammatory disease (PID) is admitted to hospital after 14 days of taking levofloxacin (Levaquin) 500 mg orally once daily & metronidazole (Flagyl) 500 mg twice daily. She asks RN, “Why do I have to be in hospital? Why can’t I get my Tx at home?” Which purpose should RN provide that supports effective outcome? Administration of a supervised parenteral antibiotic protocol. 4 • A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) & high levels of thyroid stimulating hormone (TSH). Best explanation for this finding? TSH is high because of the low production of T4 by the thyroid • During well-baby visit, parents explain a soft bulge appears in groin of 4-month-old son when he cries or strains during stooling. Infant is scheduled for surgical repair of inguinal hernia in 2 wks. Parents should be instructed to do what if hernia becomes incarcerated prior to surgery? Gently manipulate hernia for reduction. • 6 y/o child diagnosed with rheumatic fever & demonstrates associated chorea (Sudden aimless movements of arms & legs). Which info should RN give pare