“Obstetric Nursing Practice Test” plus 3 more nursing article(s): NursingCrib.com Updates

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• Obstetric Nursing Practice Test
• Bipolar Disorder Signs and Symptoms
• Physiology of Breast Milk Production
• Electroconvulsive Therapy (ECT)

Obstetric Nursing Practice Test Posted: 18 Nov 2010 02:12 AM PST December 2010 Nursing Board Exam Review Questions on Obstetric and Gynecology Nursing. Mark the letter of your choice then click on the next button. Your score will be posted as soon as the you are done with the quiz. We will be posting more of this soon. If you want a simulated Nursing Board Exam, get a copy of our Nursing Board Exam Reviewer v1.0 and v2 now. 1. The fetal accessory ductus venosus closes due to which of the following? a. Increase pressure of the right side of the heart b. Clamping of the cord c. Increase pressure of left side of the heart d. Increase prostaglandin levels 2. The fetal accessory that is located in between the two atria is called: a. Foramen ovale b. Ductus venosus c. Ductus arteriosus d. Pulmonary arteries 3. Presence of what hormone causes the ductus arteriosus to open? a. Estrogen b. Progesterone c. Human Chorionic Gonadrotopin d. Prostaglandin 4. Inborn errors of metabolism are discussed in a nursing lecture. Absence of liver enzyme phenylalanine hydroxylase directly causes the absence of which of the following? a. Thyroxine b. Melanin c. Epinephrine d. Tyrosine 5. An infant with phenylketonuria (PKU) has a mousy odor of urine. Which of the following causes this indifferent odor? a. Phenylpyruvic acid b. Lactic Acid c. Galactic acid d. Insulin 6. A child diagnosed with PKU should be managed by giving which soy-based milk formula? a. Nutraminogen b. Similac c. Lofenalac d. Sustagen 7. A mother comes in a clinic asking about the normal development of her child. The nurse, told her that DDST (Denver Developmental Screening Test) is done for children to assess their developmental processes. When is DDST first done? a. 3 months b. 10 months c. 3-4 years d. 5 years 8. The child was admitted in the ER with the presenting symptoms of sitting in a leaning position, with the tongue protruding, drooling and muffled cough. The nurse should prepare what equipment at the bedside? a. Tongue depressor b. Intubation set c. Sterile gauze d. Clamp 9. As the nurse is assessing a 3-year old child, the toddler appears good. However the child's mother told the nurse that her child usually appears ill at nighttime. The cough is barking and inspiratory stridor is noted. The nurse interprets this as: a. Laryngotracheobronchitis b. Epiglotitis c. Pneumonia d. Bronchitis 10. A preschool child has been admitted for rheumatic fever. In the diagnosis of the disease which of the following meets the Jone's criteria? a. Increase ESR, arthralgia, fever b. Leukocytosis, carditis, fever c. Arthralgia, fever, leukocytosis d. Leukocytosis, increase ESR, history of Rheumatic fever 11. To manage the chorea in rheumatic fever which of the following is administered? a. Ampicillin b. Erythromycin c. Diazepam d. Mannitol 12. A 3 year old child is admitted in the hospital. The mother asks what developmental milestone is expected for this child to accomplish. The nurse correctly responds by pinpointing which of the following? a. Bowel control achieved b. Riding a tricycle c. Sitting without support d. Tying shoelaces 13. The statements are true about communicating hydrocephalus apart from: a. It is also known as non-obstructive hydrocephalus. b. It is due to the functional impairment of arachnoid granulations. c. It is caused by a CSF-flow obstruction ultimately preventing the CSF from flowing into the subarachnoid spaces. d. It can be caused by diffuse ventricular dilatation from scarring and fibrosis of subarachnoid space following infectious, inflammatory and hemorrhagic events preventing the flow of CSF. 14. A child is diagnosed with Kawasaki Disease. Which of the following manifestations is seen during the subacute phase of the disease? a. Fever b. Conjunctivitis c. Strawberry tongue d. Desquamation of palms and soles 15. The platelet receptor inhibitor specific for Kawasaki Disease is prescribed by the physician. Which of the following drugs will you expect in the doctor's order? a. Ibuprofen b. Abciximab c. Succimer d. Dimercaprol 16. Health teaching is important in successful management of a certain disease. In Kawasaki disease, what is the main reason why steroids are not administered to clients with Kawasaki disease? a. It can cause aneurysms. b. It can cause increase body temperature. c. It decreases WBC count and increases ESR. d. It causes more rashes in children. 17. Angelo, 1 year old has been tested for lead levels in the blood. Result shows that his blood lead level is 28 microgram pre deciliter. Which of the following management would be appropriate for Angelo? a. Rescreen the child to confirm level every year for 6 years b. Administer oral Succimer c. Hospitalization and administer Edetate Calcium Disodium (EDTA) intramuscularly d. Assess kidney function 18. The following observations are noted in a child under the acute phase of Kawasaki disease except: a. Fever b. Increase platelet count c. Conjunctivitis d. Increase WBC count 19. A 2 year old child is diagnosed with Plumbism. Edetate Calcium Disodium (EDTA) is ordered to be administered intramuscularly. In the preparation of the medication, what should the nurse do? a. Hold the syringe by the plunger. b. Prepare calcium to be administered after EDTA is given c. Add 0.5 ml of procaine in the medication d. Add 10 ml of procaine 20. Clamping of the cord causes the closure of what fetal accessory structure? a. Ductus arteriosus b. Foramen ovale c. Pulmonary blood vessels d. Ductus Venosus 21. Understanding a clubfoot disorder means knowing the normal anatomy and physiology of a skeletal foot. The weight of the body is carried by the largest tarsal bones of the foot which are: A. Cuneiform B. Talus C. Navicular D. Calcaneus E. Cuboid a. A and D b. B and D c. A and E d. C and E 22. A diagnosis of hydrocephalus is confirmed. The mother of a 2 year old patient is asking about the types of hydrocephalus. Which of the following correctly defines non-communicating hydrocephalus? a. It is also known as non-obstructive hydrocephalus. b. It is characterized by enlarged cerebral ventricles, with only intermittently elevated cerebrospinal fluid pressure. c. It is due to the functional impairment of arachnoid granulations. d. It is caused by a CSF-flow obstruction ultimately preventing the CSF from flowing into the subarachnoid spaces. 23. The surgical management for atrial septal defect (ASD) and ventricular septal defect (VSD) is which of the following? a. Dacron or Silastic patch placement b. Ductal ligation c. Fontan procedure d. Brock Procedure 24. Which of the following accurately describes the treatment of a Pseudo talipes? a. Pseudo-talipes does not need a surgical procedure, however ilizarov frames can be used at nighttime b. Pseudo-talipes only requires tendon replacement c. No procedures are done with pseudo-talipes, however passive foot exercises would be fine d. A cast above the knee is required for alignment; if the procedure poses no effect surgical procedures can be done 25. Phalanges form the toes and are composed of 14 bones. The big toe is made up of how many phalanges? a. 2 b. 3 c. 1 d. 5 Related posts: Nursing Board Review: Fundamentals of Nursing Practice Test Part 2 Nursing Board Review: Maternal and Child Health Nursing Practice Test Part 2 Nursing Board Review: Maternal and Child Health Nursing Practice Test Part 1

Bipolar Disorder Signs and Symptoms Posted: 17 Nov 2010 07:02 PM PST A mood disorder, formerly known as manic depression is characterized by recurrent episodes of depression and mania. Either phase may be predominant at any given time or elements of both phases may be present simultaneously. Risk Factors Biochemical imbalances Family genetics – one parent, child has 25% risk; two parents, 50-75% risk. Environmental factors such as stress, losses, poverty, social isolation. Psychological influences – inadequate coping, denial of disordered behavior. Specific Biological Factors Possible excess of norepinephrine, serotonin, and dopamine. Increased intracellular sodium and calcium Neurotransmitters supersensitive to transmission of impulses Defective feedback mechanism in limbic system. Signs and Symptoms Risk for self or others Impaired social interactions Mania Persistent elevated or irritable mood Poor judgment Increase in talking and activities, grandiose view of self and abilities. Impulsivity such as spending money, giving away money or possessions. Impairment in social and occupational functioning Decreased sleep Distractibility Delusions, paranoia, and hallucinations Dislike of interference or intolerance of criticism Denial of illness Agitation Attention seeking behavior Depression Nursing Diagnoses High risk for violence, directed at self or others Impaired verbal communication Anxiety Individual coping, ineffective Disturbance of self-esteem Alteration in though processes Alteration in sensory perceptions Self-care deficits Sleep pattern disturbances Alteration in nutrition Therapeutic Nursing Management Environment Psychological treatment Individual Psychotherapy – may be used to identify stressors and pattern of behavior. Group therapy – establishes a supportive environment and redirect inappropriate behavior. Family therapy – verbalizes family frustration and establishes a treatment plan for outpatient use. Somatic and Psychopharmacologic treatments electroconvulsive therapy Psychopharmacology Nursing Interventions Assess client's suicidal feelings and intentions and escalating behavior regularly. Set consistent limits on inappropriate behavior to help the client de-escalate. Establish a calm environment for the client. Reinforce and focus on reality. Provide outlets for physical activity but prevent client for escalating. Client may be very likable during "high periods". Staff members need to avoid participating in this behavior, at other times, client may be very irritable and staff members should approach client quietly and with limits, if necessary. If the client cannot control self and other methods are not successful, staff may need to provide client protection if a threat of a self-harm or injury to other exist. Monitor client's nutrition, fluid intake and sleep. Discuss with the client and family the possible environment or situational causes, contributing factors and triggers for a mood disorder with recurrent episodes of depression and mania. Related posts: Glossary of Key Terms in Pharmacology, Clinical Conditions, and Associated Signs and Symptoms Pharmacology Terms & Definitions, Clinical Conditions, and Associated Signs and Symptoms Electroconvulsive Therapy (ECT)

Physiology of Breast Milk Production Posted: 17 Nov 2010 07:01 PM PST Physiology of Breast Milk Production Regardless of the mother's physical condition, method of delivery (Cesarean section or vaginal delivery) or breast size, milk will be produced. Increase levels of estrogen and progesterone during pregnancy suppresses lactation as increase in the level of these hormones inhibits prolactin production. However, increase levels of these hormones early in pregnancy stimulate the growth of milk glands in preparation for lactation. This is the main reason why pregnant women's breasts tend to increase in size due to larger glands that result to more fluid accumulation and formation of some extra adipose tissue. Estrogen and progesterone levels drop after delivery that stimulates the production of prolactin. Prolactin is responsible for breast milk production. If the mother wants to suppress lactation, lactation suppressing agents should be given immediately after placental delivery to be effective. The milk ducts become distended when breast milk begins to form. The woman's breasts become fuller, larger and firmer. For some this is accompanied by a throbbing pain or feeling of heat in the breasts. The feeling of tension in the breast that most likely occurs by the third or fourth pospartal day is called engorgement. Relief is achieved when the neonate starts to effectively suck the breasts or for those who have no plans of breastfeeding using a breast pump would be provide immediate alleviation. The infant has to effectively suck the milk for relief to occur. Effective sucking means the infant is actually receiving milk. A baby can suck the breast without actually swallowing milk but rather swallowing air. One criteria of knowing that effective sucking is done by the baby is when the mother hears a soft "ka" or "ah" sound during feeding. This indicates that the infant is swallowing the colostrum or milk. Let-down reflex is the one responsible for pushing the milk outside the breast. This reflex is stimulated by the release of oxytocin. Oxytocin on the other hand, is released when an infant sucks the breast or the mother uses a breast pump. The following sequential pattern occurs during breast milk production: Levels of estrogen and progesterone drops after the delivery of the baby. Decreasing amounts of these hormones stimulates the anterior pituitary glands (APG) to produce prolactin. Prolactin stimulates the foremilk production in the glandular tissues of the breasts. Foremilk is stored in the collecting tubules of the breasts, ready for infant feeding. When the infant sucks the breast or a breast pump is used by a woman, the posterior pituitary gland (PPG) is stimulated to produce oxytocin. Oxytocin causes contraction of the smooth muscles or the collecting tubules. (this is the reason why afterpains are felt by women who breast feed their babies) 7. Contraction causes the ejection of the milk forward and outside the breasts – Let-down or Milk Ejection Reflex. Hindmilk is produced. Related posts: Physiology of Menstruation How to Perform a Self-Breast Examination Head-To-Toe Assessment (Q. Breast)

Electroconvulsive Therapy (ECT) Posted: 17 Nov 2010 06:51 PM PST Definition Electroconvulsive therapy or the shock treatment is used to treat depression in clients who do not respond to antidepressants or those patients who have intolerable adverse reactions at administered therapeutic doses. Despite the controversy about the therapy, it is proven to be effective for certain patients. Many depressed (major) clients, particularly those with psychotic symptoms, don't respond to medications but do respond to ECT. Indications Nowadays, ECT is not only used for major depression, but also for the treatment of: mania (in bipolar disorder) catatonia quick relief for self-destructive behavior (suicide attempts) ECT may only be indicated for the treatment of severely depressed clients that needs fast relief. Suicidal clients may be given ECT. Giving antidepressant medication may take weeks before the full effects to occur. That is an enough time for a self-destructive client to harm himself. Can pregnant women undergo ECT? Pregnant clients can also undergo an electroconvulsive therapy. The treatment poses no harm or injury to the fetus. Thus, pregnant self-destructive women may undergo ECT to provide quick relief of depression and self-directed violence. This prevents a fetus from suffering if an untreated the mother tries to hurt herself while waiting for the medication to take full effect. Contraindications and precautions ECT stimulates a seizure episode to occur, however it does not cause a seizure disorder and patient with a seizure disorder may undergo the therapy. No absolute contraindications are noted with ECT but a few conditions have been associated with morbidity and mortality rate which includes the following: recent myocardial infraction stroke sever hypertension presence of intracerebral mass Mechanism of action The therapy induces a therapeutic tonic seizure (a seizure where the person loses consciousness and has convulsions) which lasts for about 15 seconds. To do this, electrodes are applied to the head of the client which will deliver an electrical impulse in the brain that causes a seizure. It is believed that the shock intensifies brain chemistry to correct the chemical imbalance in depression (decrease serotonin and norepinephrine). Frequency of treatment A series of about 6-15 treatments are scheduled three times a week. Six treatments are needed to observe a sustained improvement of depressive symptoms. Maximum effect or benefit is achieved in 12 to 15 treatments. Side Effects Confusion or Disorientation Fatigue Headache Short-term memory impairment (temporary) Nursing Interventions Before ECT Informed consent should be signed. NPO post midnight. Remove fingernail polish. IV line initiation. Administration of short-acting anesthetic. Administration of a sedative or muscle relaxant (succinylcholine).  Atropine is also given to decrease bronchial secretions which could block the airways during seizures. Let the client void before the procedure. During ECT Place electrodes on the client's head on one side (unilateral) or both (bilateral). Brain monitoring through electroencephalogram (EEG). Oxygen administration with an Ambu-bag. After ECT When the client is awake, reorient the client. Obtain vital signs. Assess client for the return of gag reflex. Allow the client to eat (with a positive gag reflex). image from depressionstress.info Related posts: Therapeutic Community or Milieu Therapy Nursing Care Plan – Seizure Oxygen Therapy

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