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exam 2 PEDI/OB

Terms in this set (112)

BUN level for children
5-18 mg/dL
creatinine level for children
0.2-1.0 mg/dL
cast
red blood cells squeezed/passed through kidneys found in urine
urine PH
5-9
Urine Specific Gravity
1.010-1.030
acute glomerulonephritis
An autoimmune immune complex disorder occurring 1-3 weeks after a Group A beta hemolytic streptococcal. Typically 10-21 days after infection
nephrotic syndrome
loss of large amounts of plasma protein, usually albumin, through urine due to an increased permeability of the glomerular membrane
positive ASO titer
indicative of acute glomerulonephritis
low albumin levels
indicative of
The most important nursing activity in managing a young child diagnosed with urinary tract infection (UTI) is to:
Administer ordered antibiotics on schedule.
When reviewing a urinalysis report of a client with acute glomerulonephritis, the nurse would expect to note:
Proteinuria
While a child is receiving prednisone for treatment of nephrotic syndrome, it is important for the nurse to assess the child for:
Infection
Which of the following interventions will help obtain accurate urinalysis data?
Provide client/parent education for specimen collection before the specimen is obtained.
The parents of a child diagnosed with upper urinary tract infection (UTI) ask the nurse why the child needs a daily weight.

In formulating a response, the nurse includes that it is important because a daily weight will:
Keep track of possible loss or gain of fluid retained in body tissues.
A child has been diagnosed with acute renal failure secondary to an infectious organism.

The nurse would questionthe medical order for:
Gentamicin (Garamycin)

•Gentamicin is an aminoglycoside antibiotic that is nephrotoxic.
The newborn has been diagnosed with cryptorchidism. The nurse practitioner has ordered human chorionic gonadotropin (HCG) to be administered to the baby.

The mother asks the nurse why the baby is receiving this drug. The nurse's best explanation would be the drug will:
Promote descent of the testes
The nurse admits children with the following diseases to the unit.

Which disease places the child at risk for the development of acute renal failure (ARF)?
Nephrotic syndrome.
A child has recurrent nephrotic syndrome. The mother reports to the nurse that she is overwhelmed with the care of her child.

After the nurse discusses options with the mother, which statement by the mother indicates continued coping difficulties?
"We're going to skip his dietary restrictions one day a week to allow us both some relaxation."
A child returning to the unit after an intravenous pyelogram (IVP) has an order to drink extra fluids.

When the mother asks the purpose of these fluids, the nurse responds that increased fluid intake will:
Flush any remaining dye from the urinary tract.
A 4-year-old child has been diagnosed with renal failure.

The nurse would ensure that the diet for this child would contain:
Adequate calories to optimize growth.
The priority concern for the nurse in assessing a child with acute renal failure (ARF) should be to look for which electrolyte imbalance?
Potassium
An appropriate nursing diagnosis for a child receiving peritoneal dialysis is:
risk for infection related to invasive procedures and diminished immune functioning.
A child is admitted to the nursing unit with acute renal failure (ARF). When reviewing the nursing history, the nurse notes a history of all of the following diseases.

Which is most likely to have precipitated the onset of ARF?
Dehydration
A child has been admitted in renal failure. The nurse would expect to find:
Azotemia and oliguria.
A teenager in acute renal failure has an order for fluid restriction.

What assessment criteria would indicate that insufficient fluids are being administered to this child?
Hypernatremia with weight loss.
An infant has been admitted for treatment of hypospadias. Nursing management of the child and family includes:
Addressing parental anxiety related to functioning and appearance of the penis.
Shortly after birth, the newborn was found to have epispadias. Prior to delivery, the mother had signed permission for a circumcision. The obstetrician is planning to perform the circumcision immediately after delivery.

The nurse explains to the mother that the circumcision will not be done at this time because:
The prepuce will be used for the surgical correction
A baby is born 6 weeks prematurely. On admission to the nursery, the nurse is unable to locate any testicles in the scrotum. The nurse should:
Note the findings in the child's record and take no further action at this time
You are assessing a neonate at 1 minute of life. He has a heart rate of 160, has a strong cry, has acrocyanosis, and his extremities are moving all over. What APGAR score will you assign him?
9
When would be a good time to initiate breast feeding?
After the 2nd Apgar Score, at 5 minutes post delivery
Where should the fundus be immediately after delivery?
2-3 fingers below umbilics but then sizes to level of umbilicus
Metritis/Endometritis
inflammation of the uterine musculature
The nurse should notify the health care provider immediately of what assessment finding?
Firm uterus with steady trickle of blood 2 hours after delivery
What interventions should be included in the care plan when caring for the patient who has a midline episiotomy with a 3rd degree laceration? Select all that apply
-Administer an oral stool softener

-Increase fiber in diet

-Increase fluid intake
Cystocele
hernia of the urinary bladder
Rectocele
hernia of the rectum
The nurse is performing a newborn assessment. The finding that is most indicative of a cardiac issue is
The baby turns blue when crying
Digoxin therapeutic range
0.8-2.0 mg/mL
A toddler has been diagnosed with an acyanotic cardiac defect.

Which assessment data would most likely indicate congestive heart failure?
Cardiac volume overload.
An infant who has a congenital heart defect comes into the clinic with complaints of irritability, pallor, and increased cyanosis that began quickly over the last 30 minutes. As the nurse assesses the infant, the parent asks why the child's color is bluish.

The best response by the nurse is, "Skin color is
Unrelated to your child's condition."
A client is admitted with a diagnosis of "rule out rheumatic fever."

Based on Jones criteria, the nurse assesses for:
Erythema, polyarthritis, and elevated antistreptolysin-O (ASO) titer.
A toddler with Kawasaki's disease is ordered to receive aspirin therapy.

Typical administration of aspirin for Kawasaki's disease would include which of the following principles?
Length of aspirin therapy is related to child's response.
A newborn with possible hypoplastic left heart disease is to be admitted to the nursing unit.

Which drug should be available for use?
Prostaglandin E1 (Prostin VR).
A 2-year-old child is being discharged home and will have palliative surgery for tetralogy of Fallot at a later date. The mother wants to know about how much physical activity she can allow for the child.

The nurse's best answer is:
"Allow the child to regulate her activity."
After a pediatric client has a cardiac catheterization, which intervention would have the highest priority in the immediate postoperative period?
Apply direct pressure to entry site for 15 minutes.
A child is being seen in the ambulatory clinic for a sore throat diagnosed as caused by group A beta hemolytic streptococcus.

The nurse provides care with the understanding that the risk of developing rheumatic fever is greatest:
Two weeks later.
Which evaluation would indicate a toxic dose of digoxin?
Bradycardia and nausea and vomiting.
The nurse is developing a discharge teaching plan for the family of a child with Kawasaki's disease.

Which of the following is the first priority?
Teaching parents to administer aspirin and watch for side effects.
Which assessment data will be most indicative of a potential complication of Kawasaki's disease?
Change in blood pressure, pulse, skin color.
A school-age child is admitted with a suspected acyanotic heart disease. After learning that the heart defect is a congenital disorder, the parents ask the nurse how they could have missed the problem all these years.

The nurse's response should include the information that:
Acyanotic heart disease may be asymptomatic.
The laboratory finding that would be seen in the cyanotic heart disease client but not in the acyanotic heart disease client would be a(an):
Elevated hemoglobin.
The mother asks the purpose of aspirin therapy in a child with rheumatic fever.

The nurse explains that the purpose is to:
Provide comfort and reduce temperature.
The nurse is developing a discharge plan for a family with a toddler who has undergone a successful repair of a ventricular septal defect (VSD). The parents question why the child is being sent home on antibiotics when no infection is present.

The nurse would explain to the parents this is prophylactic to prevent the complication of:
Infective endocarditis.
In assessing children with congenital heart defects, the nurse would expect to see clubbing of the fingers and toes in the child diagnosed with:
Transposition of the great vessels.
A 7-year-old client is diagnosed with rheumatic fever. The physician orders throat cultures of all family members.

The nurse explains that:
"Family members can carry streptococcus and be asymptomatic."
A 3-month-old child was diagnosed with transposition of the great vessels. The mother cannot stop sobbing and tells the nurse she feels guilty about her child's condition.

The nurse's best response is to:
Use therapeutic listening and support.
A client is diagnosed with rheumatic fever and receiving salicylate therapy.

Which evaluation would indicate a therapeutic response to this treatment?
Alleviation of elevated temperature and arthralgia.
A child has been diagnosed with tetralogy of Fallot and is taking Prostaglandin 1 (Alprostadil). The child is very cyanotic, weak, and has moist respirations.

Which evaluation would indicate a therapeutic response to this drug?
Cyanosis does not increase.
An infant is admitted with an acyanotic heart defect.

Which assessment finding should be discussed with the physician?
Dyspnea
The nurse is caring for an infant with a cyanotic heart defect. Symptoms that would indicate risk for congestive heart failure include which of the following?

Select all that apply.
-Respiratory crackles and frothy secretions
-Hepatomegaly
-Rapid weight gain
A child admitted with a diagnosis of "rule out rheumatic fever" has all of the following laboratory findings.

Which finding supports the diagnosis of rheumatic fever?
Elevated antitreptolysin-O (ASO)
A child is admitted with possible coarctation of the aorta.

The nurse reviews the medical orders for the child and should question which of the following orders?
Vital signs on admission, then daily
A child with tetralogy of Fallot becomes acutely ill with an increase in cyanosis, tachycardia, and tachypnea.

To relieve the cardiac load, the nurse will do which of the following?
Place the child in knee-chest position.
•A child with cyanotic heart defect is being discharged home to await surgical repair.

•In the discharge teaching, the nurse instructs the parents to do which of the following?
Obtain training in cardio-pulmonary resuscitation.
A child with rheumatic fever is admitted to the nursing unit.

The nurse's most important interventions at this time is to do which of the following?
Provide comfort measures for arthralgia.
A child with Kawasaki's disease is admitted to the pediatric unit.

To promote comfort, the nurse should do which of the following?
Administer aspirin and immunoglobulins as ordered.
A pediatric patient is discharged after an acute phase of rheumatic fever.

The priority discharge instruction given by the nurse is that the child can be expected to do which of the following?
Take antibiotics as ordered.
An infant who has congenital heart defect comes into the clinic with irritability, pallor, and increased cyanosis that began quickly over the last 30 minutes. As the nurse assesses the infant, the parents ask why the child's color is bluish.

What should the nurse explain related to the infant's skin color?
It is related to hemoglobin level and oxygen saturation.
Foramen Ovale
a fetal structure that allows blood to flow between the atrias
VSD
an opening between the left and right ventricles
kawasaki syndrome
an acquired heart disease whose greatest risk is cardiac aneurysm
Pulm Stenosis
Coarc of the Aorta
Aortic Stenosis
those acyanotic cardiac defects caused by a stricture that causes pressure and hypertrophy in the closest ventricle.
Tetrology of Fallot
accompanied by hypoxic spells that require a knee-to-chest position to decrease venous return.
Prostaglandin
a medication used to keep the PDA open
Indomethacin
a medication used to close the PDA
PDA
AV Canal
ASD
VSD
acyanotic cardiac defects manifested by an opening
AV Canal
cardiac defect which involves complete or partial ASD and VSD
Transposition of the great vessels
cardiac defect in which the Aorta and Pulmonary arteries switch positions
Rheumatic Fever
an aquired heart disease which is an inflammatory connective tissue disorder that follows a strept infection.
SVT
abrupt onset of rapid heart rate that exceeds 200 bpm
SBE prophyllaxis
prophyllactic treatment with penicillin to prevent bacterial vegetation on irregular cardiac surfaces.
Aortic Stenosis
an inherited genetic disorder that puts the child at risk for sudden death from ventricular fibrillation.
a medication used for congestive heart failure to improve contractility of the heart
Digoxin
a medication used in congestive heart failure and hypertension that decreases fluid overload
Lasix
Presumptive Signs of Pregnancy
uFatigue
uBreast tenderness
uBreast enlargement
uNausea and vomiting
uAmenorrhea
uUterine enlargement
uUrinary frequency
uHyperpigmentation of the skin
Fetal movements (quickening)
Probable signs of pregnancy
uBraxton Hicks contractions
uPositive pregnancy test
uAbdominal enlargement
uBallottement
uGoodell sign
uChadwick's sign- blue cervix
Hegar sign -softening bottom cervix
Positive Signs of Pregnancy
uUltrasound verification of embryo or fetus
uFetal movement felt by experienced clinician
Auscultation of fetal heart tones via Doppler
You are taking an intake history of a prenatal client. Which of the following would indicate a positive sign of pregnancy?
Fetal heartbeat audible with doppler at 11 weeks' gestation
Calculate the EDB using Nageles' Rule for the women whose last LNMP occurred on 9/5/18 and ended on 9/10/18
6/12/19
During a prenatal class a nurse teaches a group of newly diagnosed pregnant women about their emotional reactions during pregnancy. What topics should the nurse discuss with the women? SELECT ALL THAT APPLY
-Sexual desire usually increases during the second trimester
-A referral for counseling should be sought if a woman experiences conflicting feelings about her pregnancy in the first trimester
-A woman's own mother is her greatest source of emotional support during pregnancy
Concerning the use and abuse of legal drugs or substances, nurses should be aware that
A.Coffee is a stimulant that can interrupt body functions and has been related to birth defects.
Chadwick sign
Bluish color of cervix, vagina, and vulva (8-12 weeks)
Hegar sign
softening of the lower uterine segment
Goodell sign
softening of the cervix
chloasma
mask of pregnancy
linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
palmar erythema
unusual redness of the palms of the hands
Striae Gravidarum
stretch marks
Which type of pelvis do you think would be least conducive to a vaginal delivery and would likely necessitate a cesarean delivery?
Anthropoid
A 25-year-old client at 18 weeks' gestation has returned to the clinic for her second prenatal visit. Her initial blood pressure was 122/82. Which of the following blood pressure readings would expect at this visit?
A.118/78
HELLP syndrome
Laboratory diagnostic variant of severe preeclampsia involves hepatic dysfunction, characterized by

hemolysis, elevated liver enzymes, low platelets
A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?
A dipstick value of 3+ for protein in her urine.
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:
Intense abdominal pain.
In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states
I will need to increase my insulin dosage during the first 3 months of pregnancy
During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. The nurse evaluates that teaching has been effective when the woman states:
Diet and insulin needs change during pregnancy
Terbutiline/Magsulfate
stop uterine contractions
Tocolytics
drugs used to stop preterm labor
cerclage
suturing of the cervix to prevent it from dilating prematurely during pregnancy, thus decreasing the chance of a spontaneous abortion
A pregnant woman is being discharged from the hospital after placement of cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that
The presence of any uterine cramping or low backache may indicate preterm labor and should be reported
Which client would be an appropriate referral for a contraction stress test (CST)
The one whose fetus has IUGR
You are teaching a client about chorionic villi sampling (CVS). You know that the client has correctly understood the information when the client states:
With CVS, we can get genetic information as early as 10-12 weeks
IUGR (intrauterine growth restriction)
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