OBSTETRICS AND GYNECOLOGICAL NURSING PEDIATRICS NURSING CRITICAL EXAMINATIONS Prepared by: Bryan Alvin B.

Bautista, RN, BSN Part I

1. While caring for a newly delivered female term neonate, the nurse observesthat the neonates clitoris is enlarged and there is some fusion of the posterior labia majora. The nurse should notify the pediatrician, because these findings are associated with which of the following? a. b. c. d. Renal disorders Potters syndrome Ambiguous genitalia Turners syndrome

2. On the first postpartum day, a primiparous client asks the nurse, Why are my babys breast so swollen? The nurse explains that breast enlargement in neonates is caused by which of the following transferred from the mother? a. b. c. d. Prolactin Estrogen Progesterone Growth hormone

3. When developing the teaching plan for a primiparous client and her term neonate on the first postpartum day, the nurse expects to discuss neonatal reflexes. After describing the rooting reflex, which of the following, if stated by the mother as the age at which the reflex disappears, indicates effective teaching? a. b. c. d. 2 weeks to 1 month 6 weeks to 2 months 3 to 4 months 5 to 6 months

4. The nurse is assigned to care for a newly delivered primiparous client and her term neonate 1 hour after a vaginal delivery the nurse observes that the neonates Apgar score at 5 minutes was 9. The nurse interprets this is indicating which of the following about the neonate? a. b. c. d. Vigorous resuscitation was needed The neonate was cyanotic at birth Oxygen administration was necessary at birth The neonate is in stable condition

5. When performing Ortolanis maneuver to asses a 1- day- old term neonate for congenital hip dysplasia, which of the following would the nurse do? a. Compare the symmetry of the gluteal folds on the right and left legs with the neonate prone b. Measure the legs to determine whether one leg is longer than the other with the neonate supine c. Flex both of the knees and adduct the legs until the examiners thumb touch one another d. Flex the knees while holding the thumbs at midnight and the fingers over the greater trochanters

6. A newly immigrated multuiparous client from Africa who delivered a term neonate a short time ago requests that a
special bracelet be placed on the babys wrist. Which of the following would be the nurses most appropriate action? a. b. c. d. Tell the mother that the bracelet is not recommended for cleanliness reasons Apply the bracelet on the neonates wrist as the mothers requests Place the bracelet on the neonate, limiting its use to when the neonate is with the mother Recommend the mother wait until she is discharged to apply the bracelet

7. On the first postpartum day, the nurse instructs a primipara who has delivered a term neonate about the neonates sense. Which of the following statements by the mother indicates successful teaching?

a. b. c. d.

My baby will not be able to hear very well for a few weeks: My baby has very good peripheral vision and can see shapes My babys eye color will be established by 1 month of age My baby can distinguish the color red from the color blue

8. When teaching a primiparous client who delivered a term male neonate 1 hour ago about the characteristics of her neonate, which of the following would the nurse include? a. b. c. d. Obligatory nose breather Testes probably undescended Kidney typically nonpalpable Oozing at the cord insertion site

9. A primipara calls the birthing unit 3 days after a vaginal delivery. She tells the nurse that she is bottle- feeding and her breasts are swollen and painful. Which of the following instructions would be most appropriate? a. b. c. d. Wear a tight breast binder for the next 24 hours Avoid wearing a bra to allow the engorgement to subside Refrain from talking shower with the water on the breasts Apply ice pack

10. On the first postpartum day, a neonate diagnosed with an ABO incompatibility has a bilirubin level of 10 mg/dL. After teaching the parents about this condition, which of the following statements by the parents about the neonate indicates the need for additional teaching? a. Photocopy causes the babys stools to be bright green. b. Breast feeding may need to be stopped temporarily. c. The baby will need an exchange transfusion with Type A blood. d. The baby may become anemic over the next 2 weeks.

11. When assessing a neonate 1 hour after birth, the nurse observes that the neonate exhibits slight cyanosis when
quiet but becomes pink when crying. The nurse is unable to pass a catheter through the left nostril. The nurse notifies the pediatrician because the neonate most likely is exhibiting symptoms of which of the following? a. b. c. d. Esophageal reflux disorder Unilateral choanal atresia Respiratory distress syndrome Tracheoesophageal fistula

12. After delivery a male neonate at 38 weeks gestation, the nurse dries the neonate and place him under the radiant warmer. The nurse performs this action based on the understanding that one neonatal response to cold stress involves which of the following? a. b. c. d. Metabolism of brown adipose tissue Decreased utilization of glycogen stores Decreased utilization of calorie stores Increased shivering to keep warm

13. When developing the teaching plan for a primipara who is bottle- feeding her term neonate for the first feeding, which of the following instructions would the nurse expect to include? a. b. c. d. Fill the entire nipple of the bottle with formula All term babies have well developed sucking skills Bubble the baby after 2 ounces of formula have been taken Propping of the bottle results in too much air being taken in by the baby

14. A primiparous client at 4 hours after a vaginal delivery and manual removal of the placenta voids for the first time.
The nurse palpates the fundus, noting it to be 1 cm above the umbilicus, slightly firm, and deviated to the left side and notes a moderate amount of lochia rubra. The nurse notifies the physician based on the interpretation that the assessment indicates which of the following?

a. b. c. d.

Perineal lacerations Retained placental fragments Cervical lacerations Urinary retention

15. While performing a gestational age assessment for a newly delivered male neonate who was delivered vaginally at 37 weeks gestation, which of the following would the nurse expect to find? a. b. c. d. An anterior transverse crease on the soles Extensive rugae on the scorum Some cartilage in the ear lobes Coarse and silky scalp hair

16. A neonate of primipara client delivered at 36 weeks gestation in a small, rural hospital is to be transferred by ambulance to a level III nursery. To prepare the parents for the transfer, which of the following would the nurse include in the plan of care? a. b. c. d. Instruct the parents that the neonate is in critical condition Obtain the mothers consent for the neonates transfer Allow the parents to touch the neonate before transfer Ask the father if he desires to ride in the ambulance during the transfer

17. A multiparous client delivers a neonate at 24 weeks gestation. After 12 hours, the neonates condition deteriorates, and death appears likely within the next few minutes. The parents are Roman Catholic, and they request that the neonate be baptized. Which of the following actions would be most appropriate? a. b. c. d. Contact the hospital chaplain to perform the baptism Alert the hospitals director that a neonatal death is imminent Find a health care provider who is Roman Catholic to perform the baptism Baptize the neonate, regardless of the nurses own religious beliefs

18. The nurse on the postpartum unit has delegated the care of a multiparous client and her term neonate at 4 hours postpartum to the licensed practical nurse. Which of the following assessments should the licensed practical nurse report to the nurse immediately? a. b. c. d. Neonatal regurgitation of 1 tablespoon after feeding Maternal pulse rate of 100 bpm at rest Neonatal heart rate of 140 bpm while at rest Increased maternal lochia rubra with initial ambulation

19. A multiparous client and her neonate, who has been cared for in the intensive care nursery for the past 3 days because of being small for gestational age, are to be discharged. Before their release, the mother tells the nurse, Ive been living in my car for the past 2 weeks. Which of the following would the nurse do next? a. b. c. d. Notify the director of the birthing unit Contact the hospitals social worker Contact the clients physician Notify any of the clients family members

20. A multiparous client at 16 weeks gestation is diagnosed as having a fetus with probable anecephaly. The client is
devout Baptist and has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate. Which of the following actions would be most appropriate? a. b. c. d. Explore the nurses own feelings about the issues of anecephaly and organ donation Contact the clients minister to discuss the clients options related to the pregnancy Advise the client that the prolonged neonatal death will be very painful to her Ask the client if she has discussed this with her family members

21. Assessment of a primigravid client in active labor reveals cervical dilation at 9 cm with complete effacement and the fetus at +1 station. Which of the following would the nurse do when the physician orders meperidine (Demerol) 50 mg IM for the client?

a. b. c. d.

Administer the medication in the left ventrogluteal muscle Be certain that naloxone (Narcan) is at the clients bedside Ask the physician to validate the dosage of the drug Refuse to administer the medication to the client

22. A 17- year- old unmarried primigravida client at 10 weeks gestation tells the nurse that her family doesnt have
much money and her dad just got laid off from his job. Which of the following would be the nurses most appropriate action? a. b. c. d. Instruct the client in methods for low-cost, highly nutritious meals preparation Determine whether the client qualifies for state assistance programs Refer the client to a social worker for enrollment in the Women, Infants, and Children (WIC) program Ask the client if she has a job and the amount of income earned.

23. The nurse has been assigned to care for several postpartum clients and their neonates on a birthing unit. Which of the following clients would the nurse assess first? a. b. c. d. A mulipara at 48 hours postpartum who is being discharged A primipara at 2 hours postpartum who delivered a term neonate vaginally A multipara at 24 hours postpartum whose infant is in the special care surgery A primipara at 48 hours after cesarean delivery of a term neonate

24. A 16- year- old primipara has decided to place her baby for adoption. The adoptive parents are on their way to the
hospital when the mother says, I want to see the baby one last time. Which of the following would the nurse do? a. b. c. d. Tell the client that it would be best if she didnt see the baby Allow the client to see the baby through the nursery window Contact the physician for advise related to the clients visitation Allow the client to see and hold the baby for as long as she desires

25. Assessment of primigravid client in active labor reveals a cervix dilated to 5 cm and completely affected, with the fetus at -1 station. The client has indicated that she wants a natural childbirth with no analgesia or anesthesia. The clients husband has been present since their arrival at the birthing unit. The physician enters the room and tells the client that it is time for an epidural anesthetic. Which of the following would be the nurses best action at this time? a. b. c. d. Ask the client if she desires an epidural anesthetic Tell the physician that the client desires a natural childbirth Tell the client that her labor will be more comfortable with an anesthetic Ask the client to discuss this with her husband and then make a decision

26. The nurse is working on a hospitals birthing unit when a primigaravid client in active labor is ordered to receive meperidine (Demerol) 75 mg IM. As the slipping a vial of morphine into the side pocket of her uniform. Which of the following actions would be most appropriate? a. b. c. d. Contact the hospitals security chief Notify the supervisor of the unit Tell the coworker of the incident Notify the federal drug agents about the incident

27. The nurse is working on a birthing unit has several unlicensed assistive personnel (UAP). The nurse expects the UAP assigned to several clients in labor to notify the nurse if the UAP notes which of the following bout one of the clients? a. b. c. d. An episode of the nausea after administration of an epidural anesthetic Contractions 3 minutes apart and lasting 40 seconds Evidence of spontaneous rupture of the membranes Sleeping after administration of intravenous nalbuphine (Nubain)

28. Two hours after a vaginal delivery, the nurse has transferred a primiparous client and her term neonate to the mother- baby unit. Which of the following observations by the nurse is a priority assessment to be related to the nurse receiving the client on the mother- baby unit? a. Firm fundus when gentle massage is used b. Evidence of bonding well with the neonate c. Labor that lasted 12 hours with a 1- hour second stage d. Temperature of 99oF (37.4oC) and pulse rate of 80 bpm

29. The nurse id working in a newborn nursery and caring for several neonates. Precautions that should be taken to
prevent an infant abduction include which of the following? a. b. c. d. Notifying the hospitals security staff about anyone who appears unusual Taking several neonates to their mothers at the same time Placing the infant near the doorway of the mothers room Contacting the hospitals security staff if an exit alarm is triggered

30. The nurse has provided an in- service presentation to ancillary staff about standard precautions on the birthing unit. The nurse determines that one of the staff members needs further instructions when the nurse observes which of the following? a. Use of protective goggles during a cesarean delivery b. Placement of bloody sheets in a container designated for contaminated linens c. Wearing of sterile gloves to bathe a newly delivered neonate at 1 hour of age d. Disposal of used scalpel blades in a puncture resistant container 31. A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the clients history, which of the following would alert the nurse to a possible contradiction to using these agents? a. b. c. d. Thrombophlebitis Urinary tract infection Ulcerative colitis Menorrhagia

32. A 30-year-old multipara has been prescribed oral contraceptives as a method of birth control. The nurse instructs
the client that decreased effectiveness may occur if the client is prescribed which of the following? a. b. c. d. Indomethacin (Indocin) Amitriptyline (Elavil) Ampicilin Omeprazole (Prilosec)

33. A primigravid client in active labor has just received an epidural block for pain. After administration of the epidural block, for which of the following would the nurse frequently assess the client? a. b. c. d. Spinal headache Hypotension Hyperreflexia Uterine relaxation

34. One hour after receiving intravenous meperidine (Demerol) for pain during labor, a primigravid client delivers a
full-term neonate with symptoms of respiratory depression. The nurse anticipates that the neonate will require the administration of which of the following? a. b. c. d. Betamethasone (Celestone) Naltrexone (Trexan) Promethaine (Phenergan) Naloxone (Narcan)

35. A physician has ordered nalbuphine hydrochloride (Nubain) 10mg IV for a client active labor. The pharmacy
supplied a vial labeled as 50 mg in one 5 mL vial. Which of the following amounts would the nurse administer?

a. 0.5 mL
b. 1.0 mL c. 1.5 mL d. 2.0 mL 36. After several hours of induction with IV oxytocin administered along with a primary IV solution of lactated Ringers solution assessment of a primigravid client at 42 weeks gestation reveals a fetal heart rate near the baseline at 120 bmp and strong contractions occurring every 2 to 2.5 minutes and lasting 90 to 100 seconds. Which of the following would the nurse do first? a. b. c. d. Position the client in a supine position Contact the physician for further orders Stop the IV flow of oxytocin Administer oxygen at a rate of 5 L\min

37. During the immediate postpartum period, the nurse is caring for a primipara who delivered a post-term neonate after oxytocin induction. When developing the clients plan of care, which of the following would the nurse expect to assess frequently? a. b. c. d. Respiratory depression Increased pulse rate Hypertension Uterine atony

38. The nurse is preparing to administer a rubella vaccine to a postpartum client before discharge. Which of the
following would the nurse caution the client to avoid? a. b. c. d. Breast feeding the newborn for at least 2 weeks Becoming pregnant for at least 3 months Taking prescription oral contraceptives for at least 1 month Using anti- inflammatory medications for at least 6 weeks

39. Twenty- four hours after delivery of a term neonate, a primiparous client receives acetaminophen with codeine (Tylenol with Codeine) for complaints of perineal pain. One hour after administering, the medication, observation, of which of the following would alert the nurse to the development of a possible side effect? a. b. c. d. Dizziness Hypertension Diarrhea Urinary frequency

40. a prinigravida client in active labor has been diagnosed with severe pregnancy- induced hypertension. The client has been receiving IV magnesium sulfate for several hours. Which of the following assessments would lead the nurse to notify the physician? a. b. c. d. Urinary output of 45 ml/ hour Respiratory rate of 14 breaths/min Fetal heart rate of 126 bpm Serum magnesium level of 9 mg/dL

41. A primigravida at 32 weeks gestation with ruptured membranes is ordered to receive betamethasone (Celestone) 12 mg IM for two doses 24 hours apart. When teaching the client about the medication, which of the following would the nurse include as the purpose of this drug? a. b. c. d. To prevent potential infection To accelerate fetal lung maturity To reduce contraction frequency To improve the fetal heart rate pattern

42. The nurse is preparing to administer vitamin K (aquaMEPHYTON) IM to a term neonate of a primipara who has just delivered. After explaining the purpose of the drug to the mother, which of the following statements by the mother indicates effective teaching? a. b. c. d. Vitamin K will help my baby to breathe easier. Vitamin K will prevent my baby from becoming jaundiced. Vitamin K will help my babys blood to slot properly. Vitamin K will prevent my baby from developing an infection.

43. The nurse is preparing to administer erythromycin ophthalmic ointment to a neonate soon after delivery. The nurse would explain to the parents that this medication, in addition to preventing blindness caused by gonoccocal organisms, also prevents neonatal blindness caused by which of the following? a. b. c. d. B- Hemolytic streptococcus Escherichia coli Chlamydia trachomatis Staphylococcus aureua

44. The physician orders oral terbutaline (Brethine) for primigravida client with symptoms of pre-term labor at 35
weeks geatation after her contractions have stopped. After administering the first dose, for which of the following would the nurse assess the client? a. b. c. d. Tachycardia Hypertension Hyperkalemia Facial edema

45. While caring for a post- term multigravida client who is being induced with IV oxytocin (Pitocin) solution, which of the following maternal assessments would the nurse interpret as indicative of a possible complication? a. b. c. d. Convulsions Jaundice Depressed deep tendon reflexes Hypotension

46. The process of cell division whereby the number of chromosomes in the mature ova and sperm decreases by half is known as: a. Meiosis b. Mitosis c. Cleavage d. Gametogenesis 47. Mrs. Gonzales is planning to undergo tubal fulguration and asks the nurse, What part of my fallopian tubes will they operate on to do this procedure? The nurses correct response is the: a. b. c. d. Ampulla Infundibulum Isthmus Fimbriae

48. The nurse is describing fetal circulation to a group of expectant couples attending a prenatal class. The nurse accurately explains that the umbilical veins carries the blood to the inferior vena cava through the: a. b. c. d. Foramen ovale Ductus arteriosus Pulmonary artery Ductus venosus

49. Baby girl Cruz born with bilateral cleft lip and palate. Mrs. Cruz realizes that something is wrong. She starts crying and asking, Whats wrong with my baby? the nurses beast response would be to: a. Say nothing and take the baby to the nursery immediately

b. Tell the mother that she shouldnt worry and that pediatrician will talk to her later c. Tell the mother not to worry and take the baby to the nursery d. Explain cleft lip and palate to the mother and show her the baby

50. The nurse is assessing a newborn for evidence of intrauterine infection. Which of the following laboratory findings would suggest that the newborn has been exposed to an intrauterine infection? a. b. c. d. White blood cell (WBC) count of 25,000/ul Hemoglobin level of 16 mg/dL Presence of no bands in the WBC count Serum immunoglobin M (IgM) level of 30 mg/dL

Aim for success, not perfection. Never give up your right to be wrong, because then you will lose the ability to learn new things and move forward with your life.