The mother of a neonate with Down

The mother of a neonate with Down syndrome visits the clinic 1 week after delivery with concerns of problems feeding her baby. Which is the probable cause of these feeding difficulties? 1 Receding jaw 2 Brain damage 3 Tongue thrust 4 Nasal congestion 3. A new mother is concerned about a lump on the right side of her infant’s head that wasn’t there at birth 36 hours ago. After assessment of the infant, which response by the nurse is appropriate? 1 “Your baby’s head is just slightly elongated, and that’s nothing to be concerned about.” 2 “Your baby will be examined again by the pediatrician before you leave later today, so there’s no need to worry right now.” 3 “Your baby may have a condition called cephalhematoma. It’s common; however, I’ll make a note to have the pediatrician assess it.” 4 “Your baby may have a condition called caput succedaneum, which is common. I’ll make a note to have the pediatrician assess it.” 4. The nurse is performing an assessment of a 1-hour-old newborn, which reveals that the newborn’s hands and feet are cyanotic, and there is circumoral pallor when the infant cries or feeds. Which action would the nurse perform based on these findings? 1 Notify the practitioner, because circumoral pallor may indicate cardiac problems. 2 Notify the practitioner, because both signs are indicative of increased intracranial pressure. 3 Take no specific action, because both signs are expected in a newborn until 2 weeks of age. 4 Take no specific action, because circumoral pallor is an expected finding during feedings and periods of crying. 5. The nurse is assessing a newborn with suspected retention of a fetal structure that will result in a congenital heart defect. Which fetal structures should undergo change after birth? Select all that apply. One, some, or all responses may be correct. 1 Mitral valve 2 Foramen ovale 3 Pulmonary veins 4 Ductus arteriosus 5 Pulmonary arteries 6. Once identification bands have been applied and vital signs have been taken, which is the initial intervention the nurse would make to a newborn? 1 Taking and recording weight and height 2 Assisting the new mother with breast-feeding 3 Performing a head-to-toe physical examination 4 Placing the infant under a warmer and attaching a sensor probe 7. Which component of nursing care is most important for a newborn with respiratory distress syndrome (RDS)? 1 Keeping the infant in a warm environment 2 Turning the infant frequently to prevent apnea 3 Tapping the infant’s toes to stimulate deep breathing 4 Maintaining the infant’s oxygen administration level at the same rate 8. As the nurse is conducting the discharge assessment, the 2-day-old neonate expels a large amount of meconium. Which would the nurse conclude regarding this occurrence? 1 It is the precursor of newborn diarrhea. 2 It is a common finding in a 2-day-old neonate. 3 It is a pathological condition of the digestive system. 4 It reflects immaturity of the autonomic nervous system. 9. At 1 minute after birth the nurse determines that an infant is crying, has a heart rate of 140 beats/min, has blue hands and feet, resists the suction catheter, and keeps the legs flexed and the arms extended. Which Apgar score would the nurse assign? 6 7 8 9 10. A small-for-gestational-age (SGA) newborn has just been admitted to the nursery. Nursing assessment reveals a high-pitched cry, jitteriness, and irregular respirations. Which condition is the nurse concerned with regarding these manifestations? 1 Hypervolemia 2 Hypoglycemia 3 Hypercalcemia 4 Hypothyroidism 11. The nurse is assessing a newborn whose mother had a precipitate birth at home. For which complication would the nurse assess the newborn? 1 Facial palsy 2 Dislocated hip 3 Fractured clavicle 4 Intracranial hemorrhage 12. A newborn weighing 9 lb 14 oz (4479 g) is delivered by cesarean because of cephalopelvic disproportion. The Apgar scores are 7 at 1 minute and 9 at 5 minutes. Which priority nursing action would be taken after the initial physical assessment? 1 Administer oxygen by hood. 2 Determine the blood glucose level. 3 Insert a gavage tube for a formula feeding. 4 Transfer the newborn to the neonatal intensive care unit. 13. A nurse is assessing a newborn with a myelomeningocele. Which clinical findings prompt the nurse to suspect hydrocephalus? Select all that apply. One, some, or all responses may be correct. 1 Bulging fontanels 2 High-pitched crying 3 Apgar score of less than 5 4 A defect in the lumbosacral area 5 Head circumference 2 cm greater than the chest circumference 14. A newborn with respiratory distress syndrome (RDS) is receiving continuous positive airway pressure (CPAP) therapy by way of an endotracheal tube. The nurse determines that the infant’s breath sounds on the right side are diminished and that the point of maximum impulse (PMI) of the heartbeat is in the left axillary line. Which is the interpretation of these assessment data and the appropriate nursing action? 1 Inspiratory pressure on the ventilator is probably too low and should be increased for adequate ventilation. 2 Infants with RDS often have some degree of atelectasis, and there should be no change in treatment. 3 The endotracheal tube has slipped into the left main stem bronchus and should be pulled back to ventilate both lungs. 4 The infant may have a pneumothorax, and the health care provider should be called so that corrective therapy can be started immediately. 15. After a newborn has skin-to-skin contact with the mother, the nurse places the newborn under a radiant warmer. Which complication is the nurse attempting to prevent? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis 16. Which information would the nurse include in the teaching session for a couple about the assisted reproductive technique of in vitro fertilization (IVF)? 1 The sperm will need to come from an unknown donor. 2 Supplemental progesterone is given in early pregnancy. 3 The fertilized ova are implanted in the woman’s fallopian tube. 4 After implantation, a sign that pregnancy has occurred is an absence of a menstrual period. 17. After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. Which response would the nurse give? 1 “It’s best to wait until a few months after surgery because you may not have any symptoms.” 2 “Hormone replacement therapy has been associated with increased risk of breast cancer, so it would not be recommended.” 3 “You have to wait until symptoms are severe; otherwise the hormones will have no effect.” 4 “There are pros and cons to hormone replacement therapy. I will let your primary health care provider know you would like to discuss this.” 18. Which instruction would the nurse include in discharge teaching for a client who has had an anteriorposterior colporrhaphy? 1 Eating a high-fiber diet 2 Limiting daily activities 3 Reporting signs of urine retention 4 Being alert to signs of a rectovaginal fistula 19. Which alternative remedy would the nurse suggest to a client with dysmenorrhea who is interested in treating the condition with herbal therapies? Select all that apply. One, some, or all responses may be correct. 1 Ginger 2 Fennel 3 Valerian 4 Wild yam 5 Black haw 20. After a client gives birth she has the following vital signs: temperature 99.4°F (37.4°C); pulse rate 80 beats/min and regular; respiratory rate of 16 breaths/min, with even respirations; and blood pressure of 148/92 mm Hg. Which vital sign would the nurse continue to monitor closely? 1 Pulse rate 2 Temperature 3 Blood pressure 4 Respiratory rate 21. Which technique for nipple cleansing would the nurse recommend to the breast-feeding client? 1 Wash the breasts and nipples with water when bathing. 2 Wipe the nipples with sterile water before each feeding. 3 Swab the nipples with an alcohol sponge after each feeding. 4 Rub the breasts and nipples with soapy water when showering. 22, Which weight change in the obese prenatal client during the 6th month of pregnancy would indicate to the nurse that the client is successfully managing her weight gain? 1 Weight loss of 1 lb (0.45 kg) 2 Weight gain of 2 lb (0.91 kg) 3 Weight gain of 5 lb (2.26 kg) 4 The client’s statement that she lost weight last week 23. The nurse explains to the pregnant client that the serum alpha-fetoprotein test screens for which condition? 1 Trisomy 21 2 Turner syndrome 3 Open neural tube defects 4 Chromosomal aberrations 24. During a routine prenatal office visit at 26 weeks’ gestation, a client states that she is getting fat all over and that she even needed to buy bigger shoes. Which is the next nursing action? 1 Obtaining the client’s weight and blood pressure 2 Reassuring the client that weight gain is expected 3 Supporting the client’s decision to buy comfortable shoes 4 Teaching the client about the importance of limiting fatty foods and sweets Which response would the nurse provide to a client who has been diagnosed with genital herpes at her annual examination and asks how the health care provider knew that she had herpes? 1 “There’s a sore in your vagina.” 2 “There’s a rash near your vagina.” 3 “You have a typical discharge from your vagina.” 4 “You have blisters on the skin around your vagina.” 25. Which condition would the nurse anticipate as a diagnosis for the female client complaining of swelling of the labia and throbbing pain in the labial area after sexual intercourse? 1 Urethritis 2 Bartholinitis 3 Vaginal hematoma 4 Inflamed Skene glands 27. The nurse admits a client to the birthing unit at 40 weeks’ gestation and determines that her contractions are 10 minutes apart and her cervix is dilated 2 cm. Which stage of labor is the client in? 1 Second stage 2 Latent first stage 3 Active first stage 4 Transition stage 28. A new mother who has begun breast-feeding asks for assistance removing the baby from her breast. Which instruction is most appropriate for the nurse to provide? 1 “Pinch the baby’s nostrils gently to help release the nipple.” 2 “Let the baby nurse as long as desired without interruption.” 3 “Pull your nipple out of the baby’s mouth when the baby falls asleep.” 4 “Insert your finger in the corner of the baby’s mouth to break the suction.” 29. The nurse is preparing a pregnant 39-year-old client for an amniocentesis. Which factor increases the risk of problems after an amniocentesis? 1 The client’s blood type is known to be Rh positive. 2 Ultrasonography is done before the amniocentesis. 3 The procedure is done at the 22nd week of gestation. 4 Several punctures are needed to obtain amniotic fluid. 30. When checking the cervical dilation of a client in labor, the nurse notes that the umbilical cord has prolapsed. Which action would the nurse take in response to this finding? 1 Check the fetal heart rate. 2 Turn the client on her side. 3 Cover the cord with a sterile saline-soaked cloth. 4 Assist the client into the Trendelenburg position. 31. Which method would the nurse use to assess blood loss in a client with placenta previa? 1 Count or weigh perineal pads. 2 Monitor pulse and blood pressure. 3 Check hemoglobin and hematocrit values. 4 Measure or estimate the height of the fundus. 32. Which is the priority nursing intervention for a client with severe preeclampsia? 1 Isolating her in a dark room 2 Maintaining her in a supine position 3 Encouraging her to drink clear fluids 4 Protecting her against extraneous stimuli 33. Which action would the nurse take based on receiving a laboratory report stating that a client receiving magnesium sulfate 2 g/h IV for preeclampsia has a magnesium level of 6.4 mEq/L (0.30 mmol/L)? 1 Stop the infusion. 2 Assess the client’s deep tendon reflexes. 3 Assess the client’s level of consciousness. 4 Document the level on the fetal monitoring strip. 34. Which sign would indicate possible heart failure in a client with heart disease in the immediate postpartum period? 1 Bradycardia 2 Tachypnea 3 Hypotension 4 Increased vaginal bleeding 35. Which inference would the nurse draw when crackles are heard while auscultating the lungs of a client admitted with severe preeclampsia? 1 Seizure activity is imminent. 2 Pulmonary edema may have developed. 3 Diaphragmatic function is being impaired by the enlarged uterus. 4 Bronchial constriction was precipitated by the stress of pregnancy. 36. Which conclusion is indicated by a positive contraction stress test (CST)? 1 A nonstress test is needed. 2 An immediate cesarean birth is needed. 3 The fetal heart rate is within the expected limits for the average fetus. 4 Late decelerations of the fetal heart rate are occurring with each contraction. 37. Which test is used to confirm cephalopelvic disproportion? 1 Ultrasound 2 Fetal scalp pH 3 Amniocentesis 4 Digital pelvimetry 37. After 8 hours postpartum the nurse determines that a client’s fundus is 3 cm above the umbilicus and displaced to the right. Which statement is most significant in confirming the reason for the location of the uterus? 1 “I’ve been so thirsty the past few hours.” 2 “I went to the bathroom, but I can’t seem to urinate.” 3 “I’ve changed my pad once since I got to my room.” 4 “I’ve had a lot of contractions, especially while I was nursing.” 38. Which symptom in a pregnant client lying on her back indicates the need for emergency intervention? Select all that apply. One, some, or all responses may be correct. 1 Pallor 2 Eupnea 3 Bradycardia 4 Increased blood pressure 5 Decreased oral temperature 39. When caring for a woman with a probable ruptured tubal pregnancy, which clinical manifestation requires immediate intervention? 1 Abdominal distention 2 Intermittent abdominal contractions 3 Dull, continuous upper-quadrant abdominal pain 4 Sudden onset of knifelike pain in one of the lower quadrants 40. A pregnant client is admitted to the high-risk unit with abdominal pain and heavy vaginal bleeding. Which is the nurse’s priority intervention? 1 Starting oxygen therapy 2 Administering an opioid 3 Elevating the head of the bed 4 Drawing blood for laboratory tests 41. A client comes to the emergency room reporting severe abdominal cramping and heavy bleeding at 10 weeks’ gestation. Cervical examination reveals heavy bleeding; the cervical os is open and tissue is present. Which type of abortion is the client experiencing? 1 Missed 2 Complete 3 Inevitable 4 Threatened 42. Which precaution would the nurse institute for a client with a diagnosis of severe preeclampsia? 1 Padding the side rails on the bed 2 Placing the call button next to the client 3 Having oxygen and a face mask available 4 Assigning a nursing assistant to stay with the client 43. A client with mild preeclampsia is instructed to rest at home. She asks the nurse, “What do you mean by rest?” Which is the most appropriate response? 1 “Tell me what you consider rest.” 2 “Take three or four naps a day.” 3 “Stay off your feet as much as possible.” 4 “Would you like to know what I think it means?” SCIENCE HEALTH SCIENCE NURSING NUR 3290

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