maternity
A 39 week pregnant woman arrives to labor triage. The patient’s prenatal history includes gravidity 3, parity 2. What signs and symptoms below indicate the patient is experiencing true labor? Select all that apply:
A:The patient states the contractions are located above the umbilicus.
B. Changing positions and walking does not decrease discomfort.
C. The contractions are regular.
D. The cervix is 90% effaced and dilated to 4 cm.
B. Changing positions and walking does not decrease discomfort.
C. The contractions are regular.
D. The cervix is 90% effaced and dilated to 4 cm.
A 2-year-old weighed 7 lbs. at birth. How much should the child weigh now?
A. 14 lbs.
B. 28 lbs.
C. 21 lbs.
D. 36 lbs.
B. 28lbs. they should be 4x their birth weight at 2 years old.
A. stridor
ype 1 diabetics typically have the following clinical characteristics:
A. Thin, young with ketones present in the urine
B. Overweight, young with no ketones present in the urine
C. Thin, older adult with glycosuria
D. Overweight, adult-aged with ketones present in the urine
A. Thin, young with ketones present in the urine
A patient is admitted with uncontrolled atrial fibrillation. The patient’s medication history includes vitamin D supplements and calcium. What type of stroke is this patient at MOST risk for?
A. Ischemic thrombosis
B. Ischemic embolism
C. Hemorrhagic
D. Ischemic stenosis
B. If a patient is in uncontrolled a-fib they are at risk for clot formation within the heart chambers. This clot can leave the heart and travel to the brain. Hence, an ischemic embolism type stroke can occur. An ischemic thrombosis type stroke is where a clot forms within the artery wall of the neck or brain.
TRUE OR FALSE Labor: A 37 week pregnant patient is having consistent contractions, the cervix is 90% effaced, and cervix is 6 cm dilated. The fetal station is +1.
A. True labor
B. False labor
A: true labor
A 4 year old is scheduled for routine immunizations. As the nurse you know the physician will most likely order what vaccinations?
A. DTaP (diphtheria, Tetanus, Pertussis)
B. Polio
C. Hepatitis B
D. RV (Rotavirus)
E. MMR (Measles, Mumps, Rubella)
F. Hib (Haempophilus Influenzae Type B)
G. Varicella
A, B, E, and G. The immunizations ordered at 4-6 years of age include: DTaP, Polio, MMR, and Varicella.
In which of the following conditions below do the alveolar sacs lose elasticity which can lead to “air-trapping”:
A. Chronic Bronchitis
B. Emphysema
B. emphysema
The _____ ______ secrete insulin which are located in the _______.
A. Alpha cells, liver
B. Alpha cells, pancreas
C. Beta cells, liver
D. Beta cells, pancreas
D. Beta cells, pancreas
While conversing with a patient who had a stroke six months ago, you note their speech is hard to understand and slurred. This is known as:
A. Dysarthria
B. Apraxia
C. Alexia
D. Dysphagia
A. Dysarthria
The nurse knows that preeclampsia tends to occur during what time in a pregnancy?
A. before 20 weeks
B. in the third trimester and postpartum
C. after 20 weeks
D. in the first and second trimester
C. Preeclampsia tends to occur AFTER 20 weeks gestation.
When the Moro Reflex is stimulated in an infant, the infant will _____________the arms with the palms of the hands turned ___________ and then move the arms ___________ the body.
A. flex, upward, away from
B. extend, upward, back to
C. flex, downward, back to
D. extend, downward, away from
B. When the Moro Reflex is stimulated in an infant, the infant will EXTEND the arms with the palms of the hand turned UPWARD and then move the arms BACK TO the body.
You’re assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient’s lung fields and note expiratory wheezes. The patient’s peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack?
A. Theophylline
B. Tiotropium
C. Albuterol
D. Cromolyn
C. During an asthma attack, the patient needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators, such as Albuterol, short-acting beta agonists. Another type of short-acting bronchodilator is an anticholinergic bronchodilator called Ipratropium (this is given if a patient can’t tolerated short-acting beta agonists like Albuterol). Theophylline is a bronchodilator but given orally and is NOT for quick relief. Tiotropium is a bronchodilator, as well, but is a LONG-ACTING anticholinergic bronchodilator. Cromolyn is an inhaled nonsteroidal anti-allergy medication that doesn’t provide quick relief.
A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to:
A. Administer Dextrose 50% IV per protocol
B. Continue to monitor the glucose
C. Give the patient 4 oz of fruit juice
D. None, this is a normal blood glucose reading
A. administer dextrose 50% IV per protocol
This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level.
A patient with Parkinson’s Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has:
A. Akinesia
B. “Freeze up” tremors
C. Bradykinesia
D. Pill-rolling
C. Bradykinesia
A newborn baby, who is diagnosed with transposition of the great arteries, is ordered by the physician to be started on an infusion of prostaglandin E (alprostadil). The purpose of this medication is to:
A. Prevent the closure of the foramen ovale.
B. Allow a continued connection between the aorta and pulmonary artery via the ductus arteriosus.
C. Prevent the closure of the ductus venosus.
D. Increase the blood flow to the pulmonary vein, which will increase oxygen levels.
B. Prostaglandin E (alprostadil) is an infusion that can be given to a baby with TGA. This will provide temporary relief from the TGA by keeping the ductus arteriosus open (normally this structure will close after birth). The ductus arteriosus will keep the connection between the aorta and pulmonary artery open, which will allow unoxygenated and oxygenated blood to mix and enter circulation. In TGA, oxygenated blood is not able to enter the systemic circulation, but if this structure is kept open it will allow this to occur. This infusion is only temporary until a balloon atrial septostomy or arterial switch procedure can be performed.
Select all the correct options that represent the pathophysiology of an asthma attack.
A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation.
B. The mucosa lining experiences severe inflammation.
C. The goblet cells within the mucosa lining produce excessive amounts of mucous.
D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis.
B and C. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop….hence acidosis. Remember CO2 is acidic.
A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially?
A. Diet and exercise regime
B. Metformin BID by mouth
C. Regular insulin subcutaneous
D. None, monitoring at this time is sufficient enough
A. Diet and exercise regime
Select the drugs below that are considered anticholinergic drugs (also called parasympatholytic):
A. Pyridostigmine
B. Atropine
C. Ipratropium
D. Propranolol
B. Atropine and C. Ipratropium
Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient’s lab results correlate with HELLP Syndrome?
A. Hemoglobin 12 g/dL
B. Platelets 90,000 μL
C. ALT 100 IU/L
D. AST 90 IU/L
E. Glucose 350 mg/dL
F. Abnormal RBC peripheral smear
B, C, D, and F. HELLP Syndrome causes of Hemolysis of RBCs (abnormal RBC peripheral smear), Elevated Liver enzymes (>70 IU/L for AST or ALT), Low Platelets (<100,000 μL ).
You are assessing the heart sounds of a patient with a severe case of Tetralogy of Fallot. You would expect to hear a __________ murmur at the _______ of the sternal border?
A. diastolic; right
B. systolic; left
C. diastolic; left
D. systolic; right
B. The patient will have a harsh systolic murmur due to pulmonary stenosis, which would lead you to find the murmur at the LEFT of the sternal border (the sound location of the pulmonary valve).
A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient’s symptoms, you suspect the patient suffers from what type of COPD?
A. Emphysema
B. Pneumonia
C. Chronic bronchitis
D. Pneumothorax
C. chronic bronchitis
A patient undergoing treatment for Hyperglycemic Hyperosmolar Nonketotic Syndrome has a blood glucose of 799. The doctor has ordered intravenous fluids and intravenous Regular insulin therapy. Which of the following findings causes concern before starting insulin therapy?
A. Regular insulin cannot be given intravenously; therefore, the nurse needs to clarify the doctor’s order.
B. The patient’s potassium level is 3.1.
C. The patient is complaining of severe thirst and has dry mucous membranes.
D. The patient is confused and drowsy.
B. The patient’s potassium level is 3.1.
Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.
A. metabotropic; muscle weakness
B. nicotinic acetylcholine; muscle weakness
C. dopaminergic adrenergic; muscle contraction
D. nicotinic adrenergic; muscle contraction
B. nicotinic acetylcholine; muscle weakness