OB Final

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OB Final
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2013-12-09 22:38:00
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OB Final
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  1. Children with congenital heart disease are often able to adapt positively to frustrating situations. Which provides the best explanation for their behavior?
    a)They have usually been spoiled by their parents.
    b)They have had fewer opportunities to learn to deal with frustrations.
    c)They can manipulate others by their reactions.
    d)They are developmentally delayed in their socialization.
    B- They have had fewer opportunities to learn to deal with frustration.
  2. Administration of which drug is most important in treating an infant with transposition of the great vessels?
    a)Digoxin
    b)Antibiotics
    c)Prostaglandin E
    d)Diuretics
    C- Prostaglandin E
  3. A 2 yr old was brought by his parents to the ER, because of respiratory distress, elevated temp, & nasal congestion. A loud systolic murmur was noted over his left sternal border. His diagnosis was a large ventricular septal defect. Which abnormal condition results from this defect?
    a)Peripheral hypoxia.
    b)Elevated hemoglobin and hematocrit.
    c)Volume overload in the lungs.
    d)Decreased blood pressure.
    C- Volume Overload in the lungs
  4. The RN is teaching a nursing student about cyanotic and acyanotic heart defects. Which statement made by student would show they had the correct understanding of this concept?
    a) In cyanotic defects, pressure on the right side of the heart is higher than on the left.
    b)In cyanotic defects, there is no mixing of oxygenated and unoxygenated blood in systemic circulation.
    c)In cyanotic defects, blood is shunted from the left side of the heart to the right.
    d)Acyanotic defects are usually much more complex than cyanotic defects.
    A- in cyanotic defects, pressure on the right side of the heart is higher than on the left.
  5. A 6 yr old boy has undergone successful surgical repair of the coarctation of the aorta. During the convalescent period, the boy's family will probably need special counseling about??
    a)Becoming less protective.
    b)Planning the child's educational goals.
    c)Learning to avoid physical complaints that can occur with childhood diseases.
    d)Maintaining & supporting the child's restricted life-style.
    D- Maintaining & supporting the child's restricted life-style.
  6. The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on what?
    a)It is a very safe, frequently used drug
    b)It is difficult to either overmedicate or undermedicate with digoxin
    c)Parents lack the expertise necessary to administer digoxin.
    d)Parents must learn specific, important guidelines for administration of digoxin.
    D- parents must learn specific, important guidelines for administering digoxin
  7. The nurse is teaching a family about the surgery their infant will have to close the ductus arteriosus. The nurse would explain that by doing this surgery which outcome would occur?
    a)Stop the loss of unoxygenated blood to the systemic circulation
    b)Decrease the edema in legs and feet
    c)Increase the oxygenation of blood
    d)Prevent the return of oxygenated blood to the lungs
    D- prevent the return of oxygenated blood to the lungs
  8. The RN is teaching a nursing student about increased pulmonary blood flow. Which defect results in increase pulmonary blood flow?
    a)Pulmonic stenosis
    b)Tricuspid atresia
    c)Atrial septal defect
    d)Transposition of the great arteries
    C- Atrial septal defect
  9. A preterm neonate is admitted to the hospital. The physician orders indomethacin. The nurse informs the parents that the medication is given for which reason?
    a)To encourage ductal closure.
    b)To prevent hypertension.
    c)To promote release of surfactant.
    d)To protect the immature liver
    a- To encourage ductal closure
  10. The nurse is assessing for cyanosis in an infant with cardiovascular disease. Which location on the infant would be the best to assess for this?
    a)the child's toes for color.
    b)the child's tongue and buccal membrane.
    c)the child's lips and the circumoral area.
    d)the child's fingertips for color and blanching.
    b- the child's tongue & buccal membrane
  11. An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care should include which of the following?
    A) Maintain trendalenburg position to decrease pressure on the shunt
    B)pump the shunt to reservoir to maintain patency
    C) monitor closely for signs of infection
    D) Administer sedation to decrease irritability
    C) Monitor closely for signs of infection
    (this multiple choice question has been scrambled)
  12. A major nursing intervention for an infant born with myelomeningocele is to:
    A) Protect the sac from injury
  13. An infant is diagnosed with pyloric stenosis. During the assessment of this child, what would the nurse expect to find?
    A)Visible peristaltic waves passing from left to right over the epigastric area, dehydration, and weight loss.
    B)Signs of metabolic acidosis, a palpable olive-shaped mass in the epigastric area, and scanty urination.
    C)Liquid green stools, dehydration, and signs of metabolic acidosis.
    D)A palpable sausage-shaped mass in the left upper quadrant, weight loss, and signs of metabolic alkalosis.
    A)Visible peristaltic waves passing from left to right over the epigastric area, dehydration, and weight loss.
    (this multiple choice question has been scrambled)
  14. A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that:
    A)Traction is tried first.
    B)Frequent, serial casting is tried first.
    C)Surgical intervention is needed
    D)Children outgrow this condition when they learn to walk
    B)Frequent, serial casting is tried first
    (this multiple choice question has been scrambled)
  15. Which of the following refers to a hernia protrusion of a saclike cyst of meninges, spinal fluid, & a portion of the spinal cord with its nerves through a defect in the vertebral column?
    A) Myelomeningocele
    B) Meningocele
    C) Rachishisis
    D) Encephalocele
    A)Myelomeningocele
    (this multiple choice question has been scrambled)
  16. When teaching a patient about what to expect when she wears a Milwaukee brace for scoliosis, the nurse should explain that:
    A)A tight fit is necessary, regardless of the discomfort.
    B)Frequent adjustments of the brace will be needed, because of rapid growth rates during adolescence.
    C)The brace is worn only at night.
    D)Treatment of scoliosis is short-term; the brace will be required for only a few months.
    B)Frequent adjustments of the brace will be needed, because of rapid growth rates during adolescence
    (this multiple choice question has been scrambled)
  17. Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child?
    A) Psychogenic factors that cause enuresis persist into adulthood
    B) It is not inherited nor has familial tendency
    C) Organic causes that may be related to enuresis should be considered first
    D) It is more common in girls than boys
    C)Organic causes that may be related to enuresis should be considered first
    (this multiple choice question has been scrambled)
  18. What clinical manifestation would suggest hydrocephalus in a neonate?
    A) Constant low pitch cry, restlessness
    B) Depressed fontanel, decreased blood pressure
    C) bulging fontanel, dilated scalp veins
    D) Closed fontanel, high pitched cry
    C) bulging fontanel, dilated scalp veins
    (this multiple choice question has been scrambled)
  19. Which clinical manifestation of developmental dysplasia of the hip would be seen in the newborn?
    A) Telescoping of the affected limb
    B) Lordosis
    C) Trendelenburg sign
    D) Positive Ortolani click
    D)Positive Ortolani click
    (this multiple choice question has been scrambled)
  20. The nurse can expect which test result to be elevated with glomerulonephritis?
    A)Serum albumin.
    B)Antistreptolysin in O liter (ASO).
    C)Liver enzymes.
    D)Serum ADH.
    B)Antistreptolysin in O liter (ASO).
    (this multiple choice question has been scrambled)
  21. The priority nursing diagnosis for a newborn diagnosed with a diaphragmatic hernia would be:
    A)Imbalanced nutrition: less than body requirements.
    B)Impaired gas exchange.
    C)Risk for impaired parent-infant attachment.
    D)Risk for infection
    B)Impaired gas exchange.
    (this multiple choice question has been scrambled)
  22. The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which of the following should be included?
    A)Necessity to return to clinic every 1 to 2 weeks.
    B)Remove harness several times a day to prevent contractures.
    C)Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.
    D)Apply lotion or powder to minimize skin irritation.
    A)Necessity to return to clinic every 1 to 2 weeks.
    (this multiple choice question has been scrambled)
  23. A 7-year-old boy was admitted yesterday with acute glomerulonephritis and hematuria. He has orders for bed rest, intake and output, blood pressure q2h, a sodium-restricted diet, and daily weights. What additional clinical sign would the nurse expect this child to exhibit?
    A)Severe, generalized edema.
    B)Elevated blood pressure.
    C)Weight loss.
    D)Markedly decreased serum protein.
    B)Elevated blood pressure.
    (this multiple choice question has been scrambled)
  24. An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately following the procedure, which nursing action would best prevent decompression from excessive CSF flow?
    A)Keeping the head of the infant level with the body.
    B)Positioning the infant with the head dependent to the body.
    C)Elevating the infant's head 60 degrees.
    D)Avoiding exercising the upper extremities during bathing.
    A)Keeping the head of the infant level with the body.
    (this multiple choice question has been scrambled)
  25. Which of the following problems is most often associated with myelomeningocele?
    A)Biliary atresia
    B)Craniosynostosis
    C)Hydrocephalus
    D)Esophageal atresia
    C)Hydrocephalus
    (this multiple choice question has been scrambled)
  26. To prevent an infant from damaging the surgical repair of a cleft palate, the nurse would apply,
    A)Elbow restraints.
    B)Gauze wrapping on his hands
    C)A Logan bow to his mouth.
    D)Wrist restraints.
    A)Elbow restraints.
    (this multiple choice question has been scrambled)
  27. An 18-month-old child has a ventricular septal defect that will be repaired when he is 3 years old. Until then, which instructions to his parents would be most realistic?
    A)The child can set his own limits on exercise and activities
    B)Diet should emphasize iron-rich meats and vitamins.
    C)The child's contacts should be limited to healthy adults.
    D)No restrictions or limits are needed.
    A)The child can set his own limits on exercise and activities
    (this multiple choice question has been scrambled)
  28. A preterm neonate is admitted to the hospital. The physician orders indomethacin. The nurse informs the parents that the medication is given for which reason?
    A)To encourage ductal closure.
    B)To prevent hypertension.
    C)To promote release of surfactant.
    D)To protect the immature liver.
    A)To encourage ductal closure.
    (this multiple choice question has been scrambled)
  29. Normally, pressure on the ___ side of the heart is greater than on the ___ side?
    • Left
    • right
  30. If there is an abnormal opening in the heart, oxygenated blood will be shunted from the ____  to the ____, where it will be re-circulated to the ____?
    • left
    • right
    • lungs
  31. What shunt occurs when there is excessive resistance to blood flow in the pulmonary artery or lungs?
    Right > Left shunts
  32. This shunt results in oxygenated blood being circulated out of the body?
    right > left shunts
  33. In this shunt, tissues become oxygenated deprived, the heart must work harder, and thrombi are more common?
    Right > Left Shunt
  34. Patent Ductus Arteriosus,Atrial Septal Defect, Ventricular Septal Defect, what types of blood flow defect are these?
    increased pulmonary blood flow defect
  35. List the clinical manifestations of Increased Pulmonary blood flow....
    • Tachypnea
    • Dyspnea
    • tachycardia
    • Murmur
    • poor weight gain
    • diaphoresis
    • Periorbital edema
    • freq respiratory infection
    • Normal Pulse Ox
  36. Patent Ductus Arteriosis (PDA)- clinical manifestations?
    • Dyspnea
    • tachypnea
    • tachycardia
    • full bounding pulse
    • normal pulse ox
    • high risk for respiratory infections
  37. What is the treatment for PDA?
    Indomethecin
  38. What is indomethacin used for?
    treatment of PDA (Patent Ductus Arteriosis)
  39. Tetralogy of fallot is a type of what defect?
    decreased pulmonary blood flow defect
  40. What type is associated with decreased pulmonary blood flow defect?
    tetralogy of fallot
  41. manifestations of heart with tetralogy of fallot is...
    • hypoxia & cyanosis
    • polycythemia
    • hypoxic spells
    • metabolic acidosis
    • poor growth
    • clubbing
    • exercise intolerance
    • toddlers with uncorrected may squat
    • LOW Pulse Ox
  42. types of mixed defects?
    transposition of the great vessels
  43. clinical manifestations of the transposition of the great vessels?
    • cyanosis soon after birth
    • tachypnea without retraction
    • poor feeding
    • CHF can occur immediately
    • PGE to maintain the PDA
    • LOW pulse OX
  44. Types of obstruction to systemic blood flow?
    • Coarctation of the aorta
    • hypoplastic left heart
  45. clinical manifestations of obstruction to systemic blood flow?
    • diminished pulses
    • poor color
    • delayed capillary refill time
    • decreased urine output
    • CHF with pulmonary edema
  46. Failure of single ventricle occurs over time & these children may need a heart transplant as adolescence?
    Hypoplastic Left Heart
  47. Clinical manifestations of coarctation of the aorta?
    • Always: BP is lower in legs than in arms, brachial and radial pulses are bounding, femoral pulses are weak or absent
    • Severe Obstruction: Cyanosis, heart failure, & shock as PDA closes
    • Moderate Obstruction:poor feeding, failure to thrive, increased respiratory effort, & CHF
    • Mild Obstruction: can be asymptomatic
  48. This causes enlarged liver & spleen, and sometimes edema and heart unable to pump blood to pulmonary artery?
    Right sided heart failure
  49. this causes congestion in the lungs, with increased pulmonary pressure & edema. also unable to pump blood into systemic circulation?
    Left sided heart failure
  50. Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart diagnosis?
    A- Susceptibility to respiratory infection
    B- Frequent V/D
    C- Bleeding tendencies
    D- Seizure disorder
    A- Susceptibility to respiratory infection
  51. A 22 month old, has been diagnosed with Kawasaki Disease, what is priority nursing diagnosis?
    A- frequent assessment for bleeding & GI upset
    B- Passive range of motion to facilitate joint movement
    C- Use warming blankets
    D- Lubricate child lips
    A- frequent assessment for bleeding & GI upset
  52. Child diagnosed with TOF becomes upset, crying & thrashing around while a blood specimen is obtained. The child becomes blue & RR increases to 44. What should nurse do first?
    A- Obtain order for sedation of child
    B- Assess an irregular heart rate & rhythm
    C- Explain to child it will only hurt for a short time
    D- Place child in knee-to-chest position
    D- Place child in knee-to-chest position
  53. What would cause the closure of the foramen ovale after the baby has been delivered?
    Decreased blood flow
  54. The nurse is scheduled to administer digoxin elixir to a 6 month old with congenital heart defect. The nurse auscultates an apical pulse rate of 100, what should the nurse do?
    administer digoxin and recheck HR in 30 min
  55. Due to poor sucking with cleft lip & palate, what is used for feeding?
    Breck feeder or Haberman feeder
  56. what are cleft palate children prone to?
    ear infections & oral health problems
  57. this is failure of the esophagus to develop as a continuous tube and associated with maternal history of polyhydraminos?
    Esophageal atreasia
  58. These children have excessive drooling, cyanosis, choking, coughing, sneezing, during feedings, returns fluids through nose & mouth, high risk for aspiration?
    esophageal atresis
  59. What is diagnosis for esophageal atresia?
    by attempting to pass NG tube into stomach
  60. Attempting to pass NG tube into stomach is a diagnosis for what?
    esophageal atresia
  61. This is associated with projectile vomiting, with hyperplasia or hypertrophy of the muscle surrounding the sphincter of the stomach...
    Pyloric stenosis
  62. What is a major concern for pyloric stenosis?
    Dehydration
  63. This is a protrusion of abdominal contents thru abd wall at the junction of umbilical cord & abdomen, usually covered by transparent layer of peritoneum?
    Omphalocele
  64. This is a protrusion of bowel through a defect of the abdomen wall, usually to the right of umbilical cord, with NO membrane covering exposed portion?
    Gastroschisis
  65. late sign of this is Jelly stools, and this is considered a medical emergency?
    Intussusception
  66. what is the size/ capacity of childs bladder?
    add 2 to their age, so 4yrs would be 6 oz bladder capacity
  67. What do you want to avoid in a child post op bladder exstrophy surgery?
    avoid abduction in the legs
  68. child with Kawasaki disease is irritable, refuses to eat, & exhibits red skin of the hands & feet. What action would the nurse interpret as the priority?
    A- apply lotions to hands & feet
    B- Offer foods toddler likes
    C- Place toddler in quiet environment
    D- Encourage parents to get rest
    C- Place toddler in quiet environment
  69. in a child with suspected coarctation of the aorta, the nurse would expect to find:
    A- strong pedal pulses
    B- diminishing carotid pulses
    C- normal femoral pulses
    D- Bounding pulses in the arms
    D- Bounding pulses in the arms
  70. Kawasaki Disease is characterized by which symptoms?
    a- high temp for 5 days or longer
    b- strawberry tongue
    c- red, dry lips
    d- abd discomfort
    e- splenic dysfunction
    f- edema of the hands
    g- rash on soles or palms
    h- hyperemic conjunctivae
    • a- high temp for 5 days or longer
    • b- strawberry tongue
    • c- red, dry lips
    • f- edema of the hands
    • h- hyperemic conjunctivae
  71. Infants with congenital heart defects are at increased risk for ____ ____?
    heart failure
  72. Infants with congenital heart defects should be given ____ feedings that are more spread out?
    shorter
  73. failure to thrive is usually associated with heart defects? True or False?
    True
  74. what should the nurse do first, before administering digoxin to an infant?
    take apical pulse for 1 full minute
  75. _____ ______ is when the four chambers dilate & systolic contraction is weakened?
    dilated cardiomyopathy
  76. hypertension is a clinical manifestation of what?
    Acute glomerulonephritis
  77. Acute renal failure would show a rapid increase in what lab value?
    BUN
  78. Diet for Acute renal failure, might be...
    cannot handle large amounts of protein, and sodium, potassium, and phosphorus might be restricted as well.
  79. Large amounts of protein should be avoided in what type of patient?
    Acute renal failure
  80. cerebral edema, hypoglycemia, & fatty changes in the liver, are all manifestations of what??
    Reye syndrome
  81. Positive Gower's sign is a clinical manifestation of what?
    MD
  82. MD is a ____ linked disorder, only seen in ____?
    X linked, only seen in males
  83. A positive Kernig & Brudzinski sign is a common manifestation of what?
    meningitis
  84. a ventriculoperitoneal shunt is placed for ____, which is an imbalanced production & absorption of CSF?
    hydrocephalus

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