Capstone Pre-Assessment maternal child 7th edition Questions and Answers.docx

  A nurse is reinforcing teaching with the parents of an adolescent about expected development. Which of the following development tasks should the nurse instruct the parent to expect the adolescent to achieve? -Correct Answers: Identity The adolescent should achieve the development task of establishing an identity. A nurse in an urgent care center is caring for a child who has a forearm fracture. The parent tells the nurse that the provider said it was a greenstick fracture and asks what that means. Which of the following description should the nurse provide? -Correct Answers: "The bone cracked lengthwise but didn't break all the way through" This statement describes a greenstick fracture, which is a common fracture in children. A nurse is reinforcing teaching with a 55-year old client who is experiencing menopause and is prescribed estrogen/progestin therapy (EPT). The nurse should tell the client that which of the following is a benefit of estrogen/progestin therapy in women who are postmenopausal? -Correct Answers: Estrogen prevents fractures from osteoporosis. EPT and estrogen therapy both delay the occurrence of osteoporosis and prevent fractures in women who are postmenopausal. Other benefits include prevent of hot flashes and urethral atrophy, which causes urinary incontinence. A nurse is assisting with the discharge of a child who has sickle cell anemia and is recovering from an acute sickle cell crisis. Which of the following instructions should the nurse reinforce with the child's parents? -Correct Answers: Encourage the child to increases his fluids intake. Preventing dehydration is an important step in preventing a sickle cell crisis. The nurse should recommend a specific amount of daily fluid, based on the child's age and weight, to keep the child hydrated. A nurse is assisting with the admission of a 9-year old child who has acute rheumatic fever. When obtaining the client's history, it is appropriate for the nurse to ask the parent which of the following questions? -Correct Answers: "Has your son has a sore throat recently?" Rheumatic fever typically develops 2 to 6 weeks after an untreated or ineffectively treated streptococcal infection of the respiratory tract. It is appropriate to determine whether or not the child previously has a sore throat. A nurse in a provider's office is reinforcing teaching with a parent of a school-age child who has pediculosis capitis. Which of the following instructions should the nurse include in the teaching? -Correct Answers: Wash all bed linens and dry them in a dryer for at least 20 min. pediculosis wapitis, or head lice, can be transferred via bed linens. All linens must be washed in hot water and dried in a hot dryer for at least 20 min to destroy lice and their eggs. A nurse is assisting a client with breastfeeding her newborn. The nurse should explain that which of the following reflexes will initiate sucking? -Correct Answers: Rooting The nurse elicits the rooting reflex by stroking the newborn's cheek. The newborn will turn his head while making sucking motions with his mouth. A nurse is reinforcing teaching with a client who is at 23 weeks of gestation and will return to the facility the following week for an amniocentesis. Which of the following instructions should the nurse include? -Correct Answers: Empty her bladder immediately prior to the procedure. Emptying her bladder before amniocentesis prevent possible puncture of the bladder and displacement of the uterus and fetus. A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and is to start taking ferrous sulfate syrup. Which of the following instructions should the nurse give the parent? -Correct Answers: Offer the medication through a straw. The parent should have the child drink the medication through a straw to prevent staining of the teeth and to mask the taste. A nurse is reinforcing teaching with the parents of a school-age child who has cystic fibrosis. Which of the following statements should the nurse make? -Correct Answers: "Engage the child in daily aerobic exercise." Engaging the child in daily aerobic exercise stimulates mucous excretion, enhances self-esteem, and is recommended as a daily adjunct to chest percussion therapy . A nurse us assisting with the care of a client who is multigravida and in active labor with 7 cm of cervical dilation and 100% effacement. The fetus is at 1+ station, and the client's amniotic membrane are intact. The client suddenly states that she needs to push. Which of the following is the appropriate nursing response? -Correct Answers: Have the client pant during the next few contractions. Panting is fast, continuous, shallow breathing. It helps a client in labor refrain from pushing before her cervix reaches full dilation. A nurse is monitoring a child who is postoperative following a tonsillectomy for signs for hemorrhage. Which of the following is a sign of this postoperative complication? -Correct Answers: Frequent swallowing Frequent swallowing and throat clearing are signs of hemorrhage after a tonsillectomy . A nurse is reinforcing teaching to a client who has endometriosis. Which of the following statements should the nurse include in the teaching? -Correct Answers: "Endometriosis may be associated with painful bowel movement" The nurse should reinforce to the client that, due to the spread of endometrial tissue beyond the uterus, pain on defecation may occur. A nurse is reinforcing teaching with a client who is in her second trimester and has a new diagnosis of gestation diabetes. Which of the following statements by the client indicates a need for further teaching? -Correct Answers: "I will reduce my exercise schedule to 3 days a week." Increased exercise benefits the client and can result in improved management of gestational diabetes. A nurse is reinforcing teaching with the mother of a toddler who has acute nephrotic syndrome. The nurse should emphasize the need to report which of the following manifestations to the provider? -Correct Answers: Yellow nasal discharge Yellow or green nasal discharge is a sign of an upper respiratory infection. Children who have nephrotic syndrome are at constant risk for infection, so the mother should report this manifestation to the provider who can prescribe appropriate and prompt treatment. A nurse is assisting with the admission of a client who is at 38 weeks of gestation and has severe preeclampsia. When collecting data from the client, the nurse should expect which of the following findings? -Correct Answers: Headache Severe preeclampsia causes headache, blurred vision, irritability, nausea, vomiting hypertension, proteinuria, and edema. A nurse is caring for a client who is 1 day postpartum following a cesarean birth. To prevent thrombophlebitis, the nurse should contribute which of the following interventions to the client's plan of care? -Correct Answers: Have the client ambulate frequently in the hallway. Venous statuses is a major cause of thrombophlebitis . To help prevent it, the nurse should plan to have the client get out of bed and walk as soon as possible after delivery and as often as she can. A nurse is reviewing contraception options for four client. The nurse should identify which of the following clients as having a contraindication to oral contraceptives? -Correct Answers: A client who has a blood pressure of 140/90 mm Hg Oral contraceptives are contraindicated for individuals who have hypertension, especially if it is not controlled by medications. High doses of estrogen and progestin in oral contraceptives are associated with risk for stroke, myocardial infarction, hypertension, and thromboembolism. Client who have hypertension are already at an increased risk for a thromboembolic event. A nurse is collecting data from an infant who has otitis media. The nurse should expect which of the following findings? -Correct Answers: Tugging on the affected lobe Otitis media is a middle ear infections that causes fever and pain and can be indicated by the infant tugging at the affected ear. A nurse is preparing to being cardiopulmonary resuscitation on an infant. Which of the following actions should the nurse take? -Correct Answers: Deliver compressions at a depth of 4 cm (1.5 in). The proper depth of chest compressions for an infant is 1/3 the depth of the chest or at a depth of 4 cm (1.5 in) A nurse is caring for a client in the prenatal client who has a possible ectopic pregnancy at 8 weeks of gestation. Which of the following findings should the nurse expect? -Correct Answers: Pelvic pain The client will experience a dull to colicky pain at the beginning, progressing to a sharp, stabbing pain as the tube stretches. A nurse is assisting in the care of a client who is in active labor. The nurse notes late deceleration on the fetal monitoring tracing. Which of the following actions should the nurse take first? -Correct Answers: Late decelerations are caused by uteroplacental insufficient. A position change should increase perfusion to, or decrease compression, the placenta, and is the first intervention the nurse should try. A nurse at a pediatric hotline receives a call from a mother who plans to administer aspirin to a toddler for a fever and wants to know the dosage. Which of the following statements by the nurse is an appropriate response? -Correct Answers: "Give her acetaminophen, not aspirin." Administering aspirin to the toddler can cause Reye Syndrome, an acute encephalopathy condition. A pregnant client reports that she has a 4- year- old child at home who was born at term, had a miscarriage at 9 weeks gestation two years ago, and an abortion when she was 16 years of age. What should the nurse document for the client's rental record? -Correct Answers: Gravida 4, para 1 Gravida is the number of pregnancies. Para is the number of pregnancies in which the fetus reach viability (approx 20- 14 weeks or fetal weight of more than 500g [2 lbs]. A nurse has accepted a position on a pediatric unit and is learning more about Psychological development. Identify the order of Erikson's stages of Psychological development from birth through 18 years. -Correct Answers: 1. Trust vs. mistrust 2. Autonomy vs. shame and doubt 3. Initiative vs. guilt 4. Industry vs. inferiority 5. Identity vs. role Confusion A nurse administers subcutaneous NPH insulin at 0700 to a child who has diabetes. At which of the following times should the nurse observe for hypoglycemia caused by the onset of the medication? -Correct Answers: 0900 NPH insulin is an intermediate-acting insulin, and has an expected onset of 1 1/2 to 4 hr with a peak of 4 to 12 hr. Therefore, the nurse should observe for hypoglycemia caused by the onset of the medication beginning at 0900. A nurse is collecting data from a client who is 12 hr postpartum following a spontaneous vaginal delivery. The nurse should expect to find the uterine fundus at which of the following positions on the client's abdomen? -Correct Answers: At the level of the umbilicus Within 12 hr, the fundus should rise to the level of the umbilicus and then recede 1 to 2 cm each day. A nurse is reinforcing teaching with the parent of a school-age client who has asthma about the use of a peak flow meter. Which of the following statements about the yellow zone should the nurse include in the teaching? SATA. -Correct Answers: - The child should increase his routine medications. - The child is having an exacerbation of the asthma. - The child can participate in strenuous physical activity. A nurse is planning a menu for a client who has folic acid deficiency anemia and is selecting food high in folic acid. Which of the following should the nurse include? -Correct Answers: Asparagus Half a cup of cooked asparagus contains 134 mcg of folic acid per serving, 34% of the daily recommended requirement of 400 mcg. A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to a 15-mounth-old child. Which of the following findings should the nurse identify as a contraindication for this immunization? -Correct Answers: The child has a congenital immunodeficiency A congenital immunodeficiency is a severe illness, which is contraindication for receiving the MMR vaccine.