Introduction to Maternity and Pediatric Nursing Final

Introduction to Maternity and Pediatric Nursing Final What is the correct nursing response to a mother who asks, "How can I get rid of the baby's cradle cap?" Ans- "Rub baby oil on the infant's head and brush the hair out carefully." What would the nurse teach parents to do in order to avoid diaper rash? (Select all that apply.) Ans- - Use disposable diapers. Avoid plastic bloomer or pants. Change diapers frequently. What should the nurse stress to the mother of a child with impetigo? Ans- Small cuts and bites should be treated promptly. What risk is increased with children who have been diagnosed with infantile eczema? Ans- -Asthma What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace? Ans- Wear the brace over a T-shirt 23 hours a day. What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis? Ans- Ask the child to bend forward at the waist and observe the child's back for asymmetry. The nurse is performing a neurovascular check on a limb in traction. Which findings would be indicative of altered circulation? (Select all the apply.) Ans- -Limb is cool to the touch Capillary refill is 5 seconds What characteristic manifestation would the nurse assessing a child with Duchenne's Muscular Dystrophy document? Ans- Falls frequently and is clumsy Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis? Ans- Applying moist heat packs upon awakening What would the nurse include in planning teaching to parents of a child with Legg-Calve-Perthes disease about the long-term effects of this disease? Ans- Degenerative arthritis may develop later in life. What might the nurse explain as a common treatment for amblyopia? Ans- Patching the good eye to force the brain to use the affected eye What would the nurse instruct the parents of a child who takes dilantin? Ans- Give meticulous oral hygiene. What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic seizure? Ans- Move objects out of the child's immediate area. The nurse is planning to teach parents about prevention of Reye's syndrome. What information would the nurse include in this teaching? Ans- Aviod giving salicylate-containing medications to a child who has viral symptoms. What is the best way for the nurse to communicate with a 10-year-old child who has a hearing impairment? Ans- Face the child and speak clearly in short sentences. The nurse urges the mother of a 6-month-old child to get her child inoculated with Haemophillus influenzae type B. What does this immunization protect against? Ans- Bacterial meningitis The nurse is caring for a preschooler with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)? Ans- Increase in blood pressure with a decrease in pulse What will the nurse teach parents when giving instructions for acute conjunctivitis? Ans- Clear the drainage from the inner to the outer aspect of the eye. Which assessments would cause the pediatric nurse to suspect the probability of an ear infection in a 15-month-old child. (Select all that apply.) Ans- Pulling at ears Irritability Rolls head from side to side Temperature of 39.4 C (103 F) Which assessment finding in a child with meningitis should be reported immediately? Ans- Irregular respirations What assessment made by the school nurse would lead to the suspicion of strabismus? Ans- Child covers one eye to read the chalkboard What does the nurse explain to parents of a child who experienced a febrile seizure? Ans- They occur when the temperature rises quickly. A child is brought to the emergency department after he fell and hit his head on the ground. Which nursing assessment suggests the child has a concussion? Ans- Cannot remember what happened to him A parent reports that her child has begun to do poorly at school and experiences episodes where he appears to be staring into space. Of which type of seizure is this behavior a characteristic? Ans- Absence Which situation would cause the nurse to suspect a hearing impairment? Ans- 24-month-old toddler who communicates by pointing What would the nurse include when planning postoperative teaching for a child who has had a tympanostomy with insertion of tubes? Ans- Avoiding getting water in the ears What is the best way to give an oral medication to an infant? Ans- Per a small oral syringe What is the best pulse location for the nurse to use when assessing the pulse rate on a 10-month-old infant? Ans- Apical Gentamicin ear drops are prescribed for a 4-year-old child. How would the nurse position the auricle when administering the ear drops? Ans- Up and back A 9-year-old child is being prepared for lumbar puncture. What position will the nurse explain to the child for this procedure? Ans- -"On your side with the knees bent and the head close to the knees." What factor affects the infant's physiological response to medications? Ans- Immature liver function The nurse preparing to administer medication to a 2-month-old infant discovers there is no ID bracelet on the child. What should be the next action by the nurse? Ans- Confirm the identity with the charge nurse, make a new bracelet, and give the medicine Informed consent for a minor means that the parent or legal guardian understands what aspect(s) of a procedure? (Select all that apply) Ans- -Purpose of the procedure Risks associated with the procedure That the document must be signed and witnessed That information was given Which of the following are safety measures for children who are hospitalized? (Select all that apply) AnsHard plastic top on crib for toddlers Inspect toys for sharp edges Side rails up and locked What is the biggest fear of a preschooler who is having a procedure performed? Ans- Threatened body integrity Toddlers react to illness and hospitalization in a way that corresponds with their developmental stage. Which of the following statements represents a toddler's response towards illness or hospitalization? Ans- Believes he/she is being punished The mother of a 3-year-old child tells the nurse that she will be in to visit tomorrow around 12:00 PM. The next morning, the child asks the nurse, "When is my mommy coming?" What is the nurse's best response? Ans- -"Your mommy will be here when you have lunch." The nurse is preparing to start an IV on an infant admitted to the pediatric unit. Which nursing intervention would be appropriate? Ans- Involve the parents. Which statement by the parent of a hospitalized toddler shows understanding of the toddler's need for transitional objects? Ans- -"This stuffed animal makes him feel secure." Which statement best represents the characteristic thinking of a preschooler's understanding of why he/she is sick or hospitalized? Ans- -"I got sick because I was mad at my mother." A nurse encourages a school-age child to be involved with his/her care. Why is this important? AnsGives some sense of control Nursing interventions for a hospitalized toddler would be: (Select all that apply) Ans- -Encourage a parent to be with the child. Reinforce mother/parent relationship. Identity events per child's routine Which child would have the most difficulty in coping with separation from parents because of hospitalization? Ans- 16-month-old child A hospitalized toddler was drinking from a cup at home but now refuses to drink from anything except his favorite bottle. What is the most likely reason for this behavior? Ans- He is dealing with the anxiety of hospitalization by regressing. The school nurse is discussing challenges of the adolescent years with a group of high school students in health class. What challenges toward adolescent development will the nurse include? (Select all that apply) Ans- -Developing intimacy Searching for identity Adjusting to body changes Establishing future goals According to Piaget, what characteristics of thinking does the adolescent exhibit? (Select all that apply) Ans- -Abstract thinking Logic Problem solving A 13 year old boy states, "The girls in my class tower over me." What would be the nurse's most appropriate response? Ans- -"It may seem that way because girls have a growth spurt 2 years earlier than boys." Assessment of secondary sex development of boys and girls is compared to what? Ans- Tanner scale The nurse is planning care of an adolescent. What psychosocial task does the nurse understand is important for the adolescent to develop? Ans- A sense of identity A 13 year old girl tells the nurse she is concerned because she has not had her first menstrual period. What is the best initial response from the nurse? Ans- -"Age of first menstrual cycle varies." A woman on the labor and delivery unit had her membranes artificially ruptured. What are the risks post this procedure? Select all that apply Ans- Umbilical cord compression Abrupto placentae Infection The main goal of controlling a woman is diabetes mellitus is to prevent what? Ans- Hydramnios A 33 week pregnant woman is admitted to the antenatal unit with gestational hypertension. What evaluative finding would indicate that her condition advanced to pre-eclampsia. Ans- Proteinuria A pregnant woman is at her 28 week prenatal visit. The nurse gives her a sugar drink for what reason? Ans- Test for diabetes How should the nurse intervene to relieve perineal bruising and edema following delivery? Ans- Place an ince pack on the area for 12 hours. What is the nurse's primarily intervention in the initial care of the newborn? Ans- Thermoregulation One hour post delivery the nurse notes the new mother has saturated three perineal pads. What is the most appropriate nursing action? Ans- Check the fundus for position and firmness. What does meconium-stained amniotic fluid indicate when the infant is in a vertex presentation? AnsFetal distress The nurse tells the laboring woman that the baby is at minus 1 station. This means: Ans- "Fetal head is above the ischial spines." Vaginal examination reveals the presenting part is the infant's head, which is well flexed on the chest. What is this presentation? Ans- Vertex While discussing labor and delivery during a prenatal visit, a primigravida asks the nurse when she should go to the hospital. What is the nurse's most informative response? Ans- When membranes have ruptured" A pregnant woman arrives at the emergency department (ED) and reports she is in labor. After a thorough examination and diagnostic testing, it is determined to be false labor. What signs and symptoms would lead the nurse to suspect false labor? (Select all that apply.) Ans- Positive Ballorment Painless tightening of abdominal muscles Cervix thick and not effaced Why should the nurse encourage the mother to void during the fourth stage of labor? Ans- A full bladder could predispose the mother to uterine hemorrhage. The nurse is caring for woman in the first stage of labor. What will the nurse remind the patient about contractions during this stage of labor? Ans- They dialate and efface the cervix. What is the most important nursing intervention during the forth stage of labor? Ans- Assess for hemorrhage. What does the nurse note when measuring the frequency of a laboring woman's contractions? Ans- The time between the beginning of one contraction and the beginning of the next The nurse is caring for a patient who is not certain if she is in true labor. How might the nurse attempt to stimulate cervical effacement and intensify contractions in the patient? Ans- By helping the patient to ambulate in the room A newborn's Apgar score is a 9 at 1 and 5 minutes. What does the nurse understand regarding the score of 9? Ans- The newborn is in stable condition.