Final Exam Pedi Eves - Greater Lowell Technical School
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Free Final Exam Pedi Eves - Greater Lowell Technical School Questions
A nurse is caring for a pregnant client hospitalized with severe preeclampsia. During assessment, the client suddenly develops generalized seizure activity. Which action should the nurse take first?
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Prepare for the administration of IV magnesium sulfate.
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Administer oxygen by facemask.
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Check the blood pressure and fetal heart tones.
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Clear and maintain an open airway.
Explanation
Correct Answer: (D) Clear and maintain an open airway.
When a client develops a seizure, the immediate priority follows the ABCs of emergency care: Airway, Breathing, and Circulation. During a generalized seizure, the client loses voluntary muscle control, which can compromise the airway through jaw clenching, tongue displacement, or aspiration of secretions. Clearing and maintaining a patent airway is the first and most critical action because without a secure airway, all subsequent interventions including oxygen delivery and medication administration cannot be effective.
Why the other options are incorrect:
A. Prepare for the administration of IV magnesium sulfate — Magnesium sulfate is the drug of choice for treating and preventing further eclamptic seizures and will be administered after the immediate seizure is managed. However, airway security must be established first before any medication preparation.
B. Administer oxygen by facemask — Supplemental oxygen is essential during and after a seizure to address maternal and fetal hypoxia, but it is the second priority after securing the airway. Oxygen cannot be effectively delivered to an obstructed or compromised airway.
C. Check the blood pressure and fetal heart tones — Monitoring maternal blood pressure and fetal status is critically important in severe preeclampsia and eclampsia but represents assessment rather than an immediate life-saving intervention. Airway management takes absolute precedence over assessment during an active seizure.
An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. The nurse understands that this condition is known as:
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Marginal placenta previa
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Partial placenta previa
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Total placenta previa
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Low-lying placenta
Explanation
Correct Answer: (C) Total placenta previa.
Total placenta previa occurs when the placenta completely covers the internal cervical os. This is precisely what the ultrasound finding describes, as the placenta is implanted over the entire cervical opening. This is the most severe and dangerous form of placenta previa because it completely obstructs the birth canal, posing a significant risk of severe hemorrhage and necessitating cesarean delivery.
Why Other Options are Incorrect:
A. Marginal placenta previa — In marginal previa, the edge of the placenta reaches but does not cover the cervical os. This is a partial, not complete, obstruction and does not match the described finding.
B. Partial placenta previa — Partial previa involves the placenta covering only a portion of the cervical os, not the entire opening as described in this scenario.
D. Low-lying placenta — A low-lying placenta is implanted in the lower uterine segment and is close to but does not reach the cervical os. This is the least severe variant and does not match the finding described.
Actions to take pick 2: Instruct client to wash hands only before eating / Instruct the client to avoid changing cat litter / Encourage consumption of rare meats for protein / Teach the client to wear gloves when touching soil
Potential Condition: Cytomegalovirus / Toxoplasmosis / Group B Strep / Hepatitis B
Parameters to Monitor pick 2: Hyperglycemia / Flu-like symptoms (fever, malaise) / Hypertension and proteinuria / Decreased fetal movement
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Instruct client to wash hands only before eating
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Instruct the client to avoid changing cat litter
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Encourage consumption of rare meats for protein
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Teach the client to wear gloves when touching soil
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Cytomegalovirus
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Toxoplasmosis
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Group B Strep
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Hepatitis B
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Hyperglycemia
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Flu-like symptoms (fever, malaise)
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Hypertension and proteinuria
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Decreased fetal movement
Explanation
Correct Answer: Potential Condition — Toxoplasmosis. Actions to Take — Instruct the client to avoid changing cat litter and Teach the client to wear gloves when touching soil. Parameters to Monitor — Flu-like symptoms (fever, malaise) and Decreased fetal movement.
Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii, a protozoan found in cat feces, contaminated soil, and undercooked meat. This client has three significant risk factors: she cleans the cat litter box daily, gardens with her hands in soil, and eats rare steak. During pregnancy, Toxoplasma can cross the placenta and cause serious fetal harm including miscarriage, stillbirth, and congenital toxoplasmosis resulting in hydrocephalus, chorioretinitis, and intellectual disability. The most critical preventive action is instructing the client to stop changing the cat litter entirely, as cat feces are the primary source of oocysts. Teaching her to wear gloves when gardening and touching soil prevents skin contact with contaminated earth. Monitoring for flu-like symptoms such as fever, malaise, and lymphadenopathy is important because maternal toxoplasmosis often presents with mild nonspecific symptoms that can be overlooked. Monitoring for decreased fetal movement alerts the nurse to potential fetal compromise caused by transplacental infection.
Why the other options are incorrect:
Cytomegalovirus is transmitted through contact with infected bodily fluids such as saliva, urine, and blood, not through cat feces or soil. While it is a TORCH infection, it is not the primary risk associated with the behaviors described in this scenario.
Group B Strep is a bacterial colonization of the maternal genitourinary tract that poses risk during labor and delivery, not a condition linked to cat litter, gardening, or dietary habits at 14 weeks gestation.
Hepatitis B is transmitted through blood, sexual contact, and sharing needles. None of the behaviors described by this client represent a risk factor for Hepatitis B transmission.
Instructing the client to wash hands only before eating is insufficient because the risk of toxoplasmosis exposure is constant through litter box contact and gardening, not limited to pre-meal hygiene.
Encouraging consumption of rare meats would actually increase the client's risk of toxoplasmosis, as undercooked meat is a known transmission source. This is directly contraindicated.
Hyperglycemia is monitored in the context of gestational diabetes and is unrelated to the infectious risk presented by this client's exposures.
Hypertension and proteinuria are monitored for preeclampsia and are not relevant parameters in the context of toxoplasmosis risk.
The nurse is assisting with the first prenatal visit. The nurse notes the presence of Chadwick's sign. What will the nurse observe?
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Early fetal movements are palpated.
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A purple color to vulva, vagina, and cervix.
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Breasts have darkened areola and nipple.
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Pigment changes on the patient's face.
Explanation
Correct Answer: (B) A purple color to vulva, vagina, and cervix.
Chadwick's sign is a bluish-purple discoloration of the vulva, vagina, and cervix that occurs as a result of increased vascular congestion in the pelvic region during early pregnancy. It is caused by the increased blood flow and venous engorgement that accompanies the hormonal changes of early pregnancy and is considered a probable sign of pregnancy typically visible around 6 to 8 weeks gestation.
Why Other Options are Incorrect:
A. Early fetal movements are palpated — This describes quickening, which is the mother's perception of fetal movement, typically occurring between 16 and 20 weeks of gestation. It is not related to Chadwick's sign.
C. Breasts have darkened areola and nipple — Darkening of the areola and nipple is a normal change of pregnancy caused by increased melanin stimulation but is not Chadwick's sign. It has no specific clinical sign name associated with cervical or vaginal coloring.
D. Pigment changes on the patient's face — This describes chloasma, also known as the mask of pregnancy, which is a hyperpigmentation pattern on the face caused by hormonal influences. It is entirely separate from Chadwick's sign.
The nurse observes that the infant's anterior fontanel is bulging after the placement of a ventriculoperitoneal shunt. The nurse responds by positioning the infant:
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Supine with the head flat.
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Prone with the head elevated.
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Side-lying on the operative side.
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In semi-Fowler's position.
Explanation
Correct Answer: (A) Supine with the head flat.
Following ventriculoperitoneal shunt placement, a bulging anterior fontanel indicates increased intracranial pressure, which suggests the shunt may not yet be functioning optimally or that cerebrospinal fluid is still accumulating. Positioning the infant supine with the head flat allows for gradual and controlled drainage of cerebrospinal fluid. Elevating the head too quickly following shunt placement can cause CSF to drain too rapidly, leading to a sudden drop in intracranial pressure, subdural hematoma formation, or shunt overdrainage. The flat position promotes slow, controlled decompression while the shunt begins functioning.
Why the other options are incorrect:
B. Prone with the head elevated — Prone positioning after neurosurgical intervention is not standard practice and does not safely manage post-shunt intracranial pressure dynamics. Head elevation in the immediate post-operative period with a bulging fontanel risks rapid overdrainage.
C. Side-lying on the operative side — Positioning the infant directly on the operative side places pressure on the surgical incision and the shunt hardware, which can cause discomfort, wound complications, and potential shunt displacement. The infant should be kept off the operative side.
D. In semi-Fowler's position — Semi-Fowler's positioning elevates the head of bed to 30 to 45 degrees and would cause too-rapid CSF drainage in the immediate post-shunt period when the fontanel is still bulging. This position is appropriate later in recovery once the shunt is functioning properly and intracranial pressure has stabilized.
Keep the baby away from the 5-year-old as much as possible. Have the 5-year-old feed the newborn a bottle unsupervised. Encourage co-sleeping with the 5-year-old and infant. Have the 5-year-old visit in the hospital. Let the 5-year-old help hold the newborn with adult supervision.
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Keep the baby away from the 5-year-old as much as possible.
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Have the 5-year-old feed the newborn a bottle unsupervised.
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Encourage co-sleeping with the 5-year-old and infant.
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Have the 5-year-old visit in the hospital.
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Let the 5-year-old help hold the newborn with adult supervision.
Explanation
Correct Answer: Do Not Encourage — Keep the baby away from the 5-year-old as much as possible. Do Not Encourage — Have the 5-year-old feed the newborn a bottle unsupervised. Do Not Encourage — Encourage co-sleeping with the 5-year-old and infant. Encourage — Have the 5-year-old visit in the hospital. Encourage — Let the 5-year-old help hold the newborn with adult supervision.
Fostering sibling attachment requires intentional inclusion of the older child in age-appropriate, supervised interactions with the newborn. Having the 5-year-old visit in the hospital normalizes the new family dynamic and helps the child feel included rather than replaced. Allowing the child to hold the newborn under adult supervision builds bonding while maintaining safety. Keeping the baby away from the older sibling promotes jealousy and detachment rather than connection. Unsupervised bottle feeding poses a safety risk as a 5-year-old lacks the developmental capacity to safely manage a feeding. Co-sleeping between a young child and a newborn is a significant safety hazard and increases the risk of accidental suffocation or injury to the infant.
A nurse is caring for a newborn receiving phototherapy for a significantly elevated bilirubin level. Which assessment finding requires the highest priority intervention?
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Bronze skin discoloration
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Sunken fontanels
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Conjunctivitis
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T 99.2
Explanation
Sunken or depressed fontanels are a sign of dehydration in a newborn. Phototherapy increases insensible water loss through the skin and requires adequate fluid intake to prevent dehydration. Dehydration in a newborn with elevated bilirubin is particularly dangerous because it concentrates bilirubin in the blood and tissues, raising serum bilirubin levels further and increasing the risk of bilirubin crossing the blood-brain barrier to cause kernicterus and permanent neurological damage. Sunken fontanels therefore represent a compounding emergency requiring immediate intervention to restore hydration and protect the brain.
Why the other options are incorrect:
A. Bronze skin discoloration — Bronze baby syndrome is a recognized complication of phototherapy that occurs when phototherapy is used in infants with elevated direct bilirubin. The skin, serum, and urine take on a grayish-brown discoloration. While this finding indicates a need to reassess phototherapy use, it is not an immediate life-threatening emergency requiring the highest priority intervention compared to active dehydration.
C. Conjunctivitis — Eye irritation or conjunctivitis can occur from the phototherapy eye shields rubbing against the periorbital skin, or from dryness. While this requires attention and shield adjustment, it does not represent an immediate threat to the infant's life or neurological integrity.
D. T 99.2 — A temperature of 99.2°F is only mildly elevated and falls within a range that warrants monitoring and assessment for overheating under the phototherapy lights. However, it is not as immediately dangerous as the dehydration indicated by sunken fontanels, which directly accelerates bilirubin-related neurological injury.
The provider diagnoses chorioamnionitis and orders the immediate initiation of IV antibiotic therapy and oxytocin titration to expedite delivery. Which intervention falls within the appropriate scope of practice for the LPN during this high-risk situation?
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Perform the initial calculation and titrate the IV oxytocin infusion pump based on contraction patterns.
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Discontinue the fetal monitor to allow the patient to use the restroom independently.
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Continuously monitor maternal vital signs and fetal heart rate patterns, report to the RN.
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Perform a sterile digital vaginal exam to determine if the cervix is dilated enough for delivery.
Explanation
Correct Answer: (C) Continuously monitor maternal vital signs and fetal heart rate patterns, report to the RN.
The LPN scope of practice centers on data collection, observation, and reporting findings to the supervising registered nurse or provider. In a high-risk obstetric situation such as chorioamnionitis with oxytocin titration, continuously monitoring maternal vital signs and fetal heart rate patterns and communicating findings to the RN is both within the LPN's competency and critically important to patient safety. This action supports the care team without exceeding the LPN's legal and professional boundaries.
Why the other options are incorrect:
A. Perform the initial calculation and titrate the IV oxytocin infusion pump based on contraction patterns — Oxytocin titration is a high-risk medication management task requiring clinical judgment about uterine response and fetal tolerance. This falls within the RN scope of practice and is beyond the LPN's independent scope, particularly in a high-risk labor situation.
B. Discontinue the fetal monitor to allow the patient to use the restroom independently — In a patient with chorioamnionitis receiving oxytocin, continuous fetal monitoring is essential. Independently discontinuing monitoring without RN direction could put both mother and fetus at risk and is not an appropriate independent LPN decision in this context.
D. Perform a sterile digital vaginal exam to determine if the cervix is dilated enough for delivery — Cervical examination in a patient with ruptured membranes and active infection is a provider or RN-level assessment that requires advanced clinical judgment. Performing a vaginal exam in this context also introduces additional risk of further ascending infection and is outside the LPN's independent scope of practice.
To prevent possible retinopathy in a preterm infant requiring oxygen therapy, what action will the nurse implement?
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Position with the head slightly lower than the body.
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Monitor arterial oxygen levels with a pulse oximeter.
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Keep the infant's eyes covered at all times.
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Administer low concentrations of oxygen.
Explanation
Correct Answer: (B) Monitor arterial oxygen levels with a pulse oximeter.
Retinopathy of prematurity (ROP) is caused by abnormal vascular proliferation in the immature retina, which is directly triggered by excessively high arterial oxygen levels rather than oxygen therapy itself. The key to prevention is maintaining oxygen saturation within a carefully targeted range, typically between 90% and 95% in preterm infants, to avoid both hyperoxia and hypoxia. Continuous pulse oximetry monitoring allows the nurse to detect and correct oxygen levels that exceed the safe range before retinal damage occurs.
Why the other options are incorrect:
A. Position with the head slightly lower than the body — This positioning strategy is used to facilitate secretion drainage or improve cerebral venous return in specific clinical situations and has no relationship to preventing retinopathy of prematurity.
C. Keep the infant's eyes covered at all times — Eye covering does not prevent retinopathy of prematurity, which is a vascular condition caused by oxygen toxicity to retinal vessels, not by light exposure. Phototherapy eye covers are used during bilirubin light treatment, not oxygen therapy.
D. Administer low concentrations of oxygen — Simply using low concentrations of oxygen is not sufficient as a prevention strategy because even low concentrations can produce excessively high arterial oxygen levels in certain clinical situations. The critical factor is not the concentration delivered but the resulting arterial oxygen saturation, which must be continuously monitored and maintained within the targeted safe range.
The LPN is reviewing the medical records of four postpartum clients. Which client should the nurse expect the healthcare provider to order Rho(D) immune globulin (RhoGAM) for?
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An Rh-negative mother who gave birth to an Rh-positive newborn.
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An Rh-positive mother who gave birth to an Rh-negative newborn.
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Rh-positive mother becomes jaundiced.
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Rh-negative infant has a rising bilirubin level.
Explanation
Correct Answer: (A) An Rh-negative mother who gave birth to an Rh-positive newborn.
RhoGAM is indicated specifically when an Rh-negative mother is exposed to Rh-positive fetal blood cells, which occurs most commonly during delivery. In this situation, fetal Rh-positive red blood cells can enter the maternal circulation and trigger the mother's immune system to produce anti-D antibodies. RhoGAM works by binding to and neutralizing any Rh-positive fetal cells before the mother's immune system can form a lasting antibody response, thereby protecting future Rh-positive pregnancies from hemolytic disease of the newborn.
Why the other options are incorrect:
B. An Rh-positive mother who gave birth to an Rh-negative newborn — An Rh-positive mother cannot be sensitized by an Rh-negative infant because the mother already carries the Rh antigen. There is no incompatibility from the mother's immune perspective, and RhoGAM is not indicated.
C. Rh-positive mother becomes jaundiced — Jaundice in an Rh-positive mother is unrelated to Rh incompatibility. RhoGAM has no role in managing maternal jaundice, which would require its own separate clinical evaluation.
D. Rh-negative infant has a rising bilirubin level — Rising bilirubin in a newborn is managed with phototherapy or exchange transfusion depending on severity. RhoGAM is a maternal prophylactic medication and is not administered to the infant for bilirubin management.
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