Signs & Sympt
Which of the following is a S/S of placenta previa?
-Bleeding with pain
-Abdominal cramps
-Bleeding with no pain
-Vaginal discharge that is yellow in color
Bleeding with no pain
Explain the pathophysiology behind phototherapy in newborns.
Converts bilirubin into structural isomers which are water soluble and can then be excreted out into the urine and bile.
A patient is admitted to the floor postoperatively. After the initial assessment is performed by the RN, what is most important thing you can do to prevent blood clots postoperatively?
-Give the patient water at the bedside
-Elevate legs
-Apply SCD's
-Administer Lovenox as per physicians orders
Apply SCD's
Why is the Tdap immunization important and why?
The Tdap injection provides protection from Tetanus, Diphtheria, and Pretussis. It's important to get this immunization to protect your infant from whooping cough and to protect yourself.
Which medication is routinely given to all newborns shortly after birth to prevent bleeding?
-Glucagon
-Lovenox
-Vitamin K
-Ampicillin
Answer: Vitamin K
Rationale: Newborns have low vitamin K levels at birth, increasing risk for bleeding. Vitamin K prevents hemorrhagic disease of the newborn.
What S/S is exhibited in patient's experiencing appendicitis?
-Left upper quadrant pain
-Right upper quadrant pain
-Left lower quadrant pain
-Right lower quadrant pain
Right lower quadrant pain
A postpartum patient has a hemoglobin level of 7 g/dL. What complication is she at highest risk for?
- Hypovolemic shock
- Hypoxia
- Dehydration
- Bone marrow disorders
Answer: Hypovolemic shock
Rationale: Hgb 7 g/dL is critically low postpartum and may require transfusion.
A patient wants to get up to ambulate postoperatively. What interventions would you perform to prevent patient falls? (Select all that apply)
-Put on appropriate colored socks
-Apply gait belt
-Disconnect IV fluids and let them walk the floor alone
-Have the CNA follow behind you with a wheelchair
-Put on appropriate colored socks
-Apply gait belt
-Have the CNA follow behind you with a wheelchair
Which symptom should a postpartum patient report immediately after discharge?
- Passing clots the size of marbles
- Scant bleeding for 5-6 days
- White/yellow discharge on weeks 4-6
- Bright red bleeding soaking a pad in 1 hour
Answer: Heavy bleeding (soaking a pad in 1 hour)
Rationale: Indicates possible postpartum hemorrhage and requires immediate evaluation.
What medication is administered to stimulate labor contractions?
-Magnesium
-Oxytocin
-Terbutaline
-Nifedipine
Oxytocin
Which of the following is a S/S of pneumonia? (Select all that apply)
-Non-productive coughing
-Chest x-ray displaying white infiltrates
-Body aches
-Fatigue
-Chest pain
-Temp 38.3 C
Answer:
-Chest x-ray displaying white infiltrates
-Fatigue
-Chest pain
-Temp 38.3 C
A newborn has a bilirubin level of 18 mg/dL. What treatment does the nurse anticipate?
-Redrawing labs in 24 hours
-Phototherapy
-Administering iron via IM
-Adding protein to breastmilk/formula
Answer: Phototherapy
Rationale: Bilirubin 18 mg/dL is elevated and may require phototherapy to prevent kernicterus (brain damage from hyperbilirubinemia).
What intervention can you do to prevent postoperative atelectasis in your patient?
-Provide lots of water
-Keep them medicated with pain meds to prevent breakthrough pain
-Encourage the use of incentive spirometer
-Make sure they have enough blankets and pillows
Encourage the use of incentive spirometer
A mother with mastitis asks if she should continue breastfeeding. What is the best response by the nurse?
-Stop breastfeeding until pain goes away
-Apply ice packs
-Continue breastfeeding
-Perform deep vigorous massaging
Answer: Continue breastfeeding
Rationale: Mastitis improves with continued emptying of the breast. Breastfeeding is safe for the infant.
-Prednisone
-Hydrocortisone
-Betamethasone
-Testosterone
A laboring patient has sudden severe abdominal pain, a rigid uterus, and dark vaginal bleeding. What complication is most likely occurring?
-Preeclampsia
-Placental abruption
-PROM (Premature Rupture Of Membranes)
-Fetal insufficiency
Answer: Placental abruption
Rationale: Severe abdominal pain, rigid uterus, and dark bleeding are classic signs of abruption — an obstetric emergency.
A patient who is 32 weeks pregnant is admitted to the antepartum unit with hypertension. The physician has orders for modified bedrest and a 24 hour urine collection. The patient asks you "why is the doctor concerned with my urine and not my heart?" What is an appropriate response?
With hypertension in pregnancy we are concerned with preeclampsia. Preeclampsia can damage the kidneys and liver leading to HELLP syndrome (Hemolysis, Elevated liver enzymes, and Low platelet counts) which interferes with blood clotting.
A patient is admitted to the floor for kidney stones and is pending lithotripsy procedure tomorrow. What intervention is most important for you to do until the patient goes for surgery?
-Administer pain meds
-Encourage ambulation
-Strain the urine
-Encourage use of Incentive Spirometer
Strain the urine
What is the frequency for administering RhoGam to a mother who is Rh-negative and had a baby that was Rh-positive?
- 1st dose: 35 weeks & 2nd dose: 1 week after birth
- 1st dose: 28 weeks & 2nd dose: 72 hours after birth
- 1st dose: 40 weeks & 2nd dose: 2 months after birth
- 1st dose: 12 weeks & 2nd dose: 72 hours after birth
Answer: 1st dose at 28 weeks and 2nd dose within 72 hours after baby is born
Rationale: A mother who is Rh-negative should be administered the RhoGam injection twice (once at 28 weeks and within 72 hours after the baby is born).
Which medication is given to a patient with preeclampsia to prevent seizures?
-Pitocin
-Magnesium sulfate
-Misoprostol
-Zofran
Answer: Magnesium sulfate
Rationale: Magnesium sulfate is given in preeclampsia to prevent seizures (eclampsia). Monitor for toxicity (↓RR, ↓reflexes).
Which of the following patients would you immediately call Rapid Response Team (RRT) for?
-Patient with BP 140/87, R 12, P 67, 02 98%
-Patient with BP 110/80, R 18, P 101, 02 96%
-Patient with BP 118/90, R 24, P 130, 02 88%
-Patient with BP 120/80, R 12, P 70, 02 100%
Patient with BP 118/90, R 24, P 130, 02 88%
Explain the pathophysiology behind administering RhoGam to a mother who is Rh-negative and a baby who is Rh-positive.
Mother and baby share blood through the placenta throughout pregnancy. The Rh protein in the baby (Rh-positive) is recognized as a foreign body causing the mother's immune system to attack it. The RhoGam prevents the mother's body from making the antibody that can attack future babies and prevent pregnancy in future.
A patient had returned to their room after surgery. After the RN does the initial assessment she gives the patient to you. You observe bleeding on the surgical dressing and it's becoming saturated. You page the physician and they're on the way to evaluate the patient. In the meantime, what do you do about the saturated dressing?
-Remove it and replace with dry dressing
-Place a towel or pad under the patient
-Leave it alone so the physician can see how much bleeding there in
-Reinforce the surgical dressing
Reinforce the surgical dressing
A patient is 36 weeks pregnant presents to the L&D Triage with vitals of BP 180/118, R 20, P 118, & O2 96%. The nurse reviews her labs: Creatinine 2.8 mg/dL and Platelets 150,000. What should the nurse anticipate for treating this patient?
-Bed rest and continue monitoring
-Administer antihypertensive IV medication
-Cesarean birth
-Admit to the unit and perform 24 hour urine collection
Answer: Cesarean birth
Rationale: Elevated BP, Creatinine and platelet levels indicate a need for an emergency c-section as the patient has developed preeclampsia and is exhibits signs of severe kidney injury and worsening.
A child presents to the pediatric ED with itching, redness, and difficulty breathing. Which medication should be administered first?
-Diphenhydramine
-Epinephrine
-Topical cortisone cream
-Continue monitoring for worsening
Answer: Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It rapidly reverses airway swelling and hypotension.