Rasmussen University – Maternal Child Health Nursing (NUR 2633) Final Exam Study Guide 202, Exams of Nursing

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RASMUSSEN UNIVERSITY MATERNAL CHILD HEALTH

NURSING (NUR 2633) FINAL EXAM SG 2025 |

QUESTIONS WITH ACCURATE SOLUTIONS

125 questions

Chapter 40 - Respiratory Disorders

Asthma ● s/s chronic nonproductive cough, diffuse wheezing on expiration , retractions, tachypnea ● Tx: nebulizer via mask = for 10-15 min

Bronchiolitis - caused by RSV

● Inflammation and swelling of bronchioles → may cause bronchospasms ● S/S: upper airway congestion and wheezing, intermittent fever, and apneic spells ○ Wheezing NOT reversed with albuterol ○ First 3 days are critical = peaks day 5, cough for 2-4 weeks ● Elevate HOB ● Humidified oxygen air to get O2 sat > 90% + steamy shower or cool mist ● Clear liquids PO ● Suction the nasopharynx as needed Pneumonia ● s/s *** Productive harsh cough, fine crackles (rales), fever , diminished breath sounds ● Tx: small, frequent meals, clear liquids = avoid dairy

Croup - swelling of vocal cords

● s/s Barking cough, stridor , dyspnea, URI symptoms ● Stridor at rest = Racemic Epinephrine nebulizer therapy ○ Cool air + dexamethasone (0.6 mg/kg) to reduce inflammation ● NO cough medications - it dries out and thickens secretions ● Tx: elevate HOB, humidified O2, corticosteroids (dexamethasone) unless bacterial

Cystic Fibrosis - causes pancreatic insufficiency = can’t digest and absorb

nutrients

• s/s: thick tenacious mucus, steatorrhea, wheezing, barrel chest, finger clubbing
• Chronic hypoxemia, frequent respiratory infections
• Diabetes mellitus = monitor BG
• Sweat chloride test = confirms dx
• Tx: tobramycin, albuterol, dornase alfa, fat-soluble vit (A,D,E,K)
• Give pancrelipase with meals/snacks and high-protein diet
• May interfere with iron absorption = risk for anemia
• Chest physiotherapy (CPT) - give albuterol before
• Goal = increased expectoration

○ Upright position ○ Humidified O ○ Monitor continuous O2 sat ○ Droplet precautions for first 24 hours after IV abx

Chest Tube

● Keep the system closed and below chest level ● Monitor for bubbles in water seal chamber = LEAK ● Watch for frank blood with clots ○ ONLY CLAMP IF TUBES BECOME DISCONNECTED ● Removal = give analgesics prior ○ Petroleum gauze, airtight dressing

Tonsillectomy

● Post-op = side-lying position until awake ● Observe for frequent swallowing ● Clear fluids after gag reflex has returned = ice chips ○ No citrus juices or milk products ● Administer an analgesic on a scheduled basis ● Discourage from coughing, straws, nose blowing ● There can be clots or blood-tinged mucus in vomitus Bronchoscopy - direct visualization of the larynx, trachea, and bronchi ● Complications: Compromise of airway, Hemorrhage, Pneumothorax, Airway edema ● Post-procedure: Bronchospasm, Stridor, Desaturation, Respiratory distress Chapter 41 - Cardiovascular Disorders Heart Failure (HF) - inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures ● s/s tachycardia, tachypnea, cool extremities with weak pulse, nasal flaring, wheezing, hepatomegaly, edema ○ Systemic venous congestion = peripheral edema ● Left-sided = nocturia, pulmonary congestion, cyanosis ● Right-sided = edema, enlarged liver & spleen, ascites, DJV ● Tx: Digoxin = to slow and strengthen the heartbeat ○ For infant = hold if HR < 90 ○ For child = hold if HR < 70 ○ Toxicity = vomiting , bradycardia, anorexia, dysrhythmias ● Nutritional needs: increase caloric density of baby formula ○ add polycose to each of my baby’s bottles. ○ Provide small, frequent meals = every 3hrs.

○ Avoid allowing infant to cry due to stress and fatigue that can burn more calories

○ Systolic murmur in precordium or upper back ○ Assess femoral and radial pulses simultaneously ○ Tx: balloon angioplasty Infective Endocarditis - caused by Strep. Viridans

● s/s Osler nodes = red, painful, intradermal nodes found on pads of the phalanges ○ Janeway lesions = painless hemorrhagic areas on palms and soles ● Tx: High-dose abx for 2-8 weeks ○ Abx prior dental and sx procedures

Rheumatic Fever - inflammation of heart, blood vessels, and joints

● Caused by strep throat (GABHS) 2-6 weeks after untreated or partially treated strep ● Complication = cardiac valve damage ● Dx: Increased ASO titer , CRP and ESR ● Major s/s: JONES = Requires 2 major or 1 major + 2 minor s/s to dx ○ Joints = polyarthritis ○ Carditis ○ Nodules = subcutaneous ○ Erythema marginatum = rash ○ Sydenham’s Chorea = irregular movements of the extremities ● Minor s/s: fever, arthralgia ● Maintain bedrest to prevent cardiac damage ● Rheumatic heart disease = pancarditis → damaged heart valves ○ Endocarditis = mitral + aortic valve ○ Myocarditis = can’t contract ○ Pericarditis = friction rub ○ Tachycardia and cardiac murmur

Kawasaki Disease - generalized vasculitis = resolves in < 8 weeks

● s/s high resistant fever ○ Xerophthalmia ○ Enlarged lymph nodes (unilateral) ○ Strawberry tongue , bright red chapped lips ○ Edema on hands and feet w/ eventual peeling of skin ● Dx: CRP, ESR, albumin, high ALT ● Tx: IV gamma globulin + aspirin ● Avoid live immunizations for 11 months after onset Complications: ● Anaphylactic shock ○ 1. Establish an airway ○ 2. Obtain vascular access ○ 3. Epinephrine IM ○ Apply a medical alert bracelet

● Septic shock = increased cardiac output, vasodilation, warm, flushed skin, fever ● Toxic shock syndrome = erythematous macular rash, hypotension, fever

Dehydration = tachycardia, sunken fontanelles, low UO, low BP

● Severe → tachypnea = ** IV fluids Diagnostics: ● Chest radiograph - permanent record of heart size and configuration ● Electrocardiogram (ECG) - electrical potential generated from heart muscle ● Echocardiogram - heart vessels and tissues by using sound waves ○ Indications = new heart murmur ○ Must lie quietly, sometimes a mild sedative is given prior Procedures: Heart transplant - rejection is the leading cause of death

Cardiac Catheterization

● Children will be sedated for this. ● Pre = NPO 4-6 hrs prior , inject contrast medium (iodine) ○ Check for iodine or shellfish allergies ○ Assess pedal pulse ● Post-op = wait 3 days before taking a tub bath ○ Flat position for 4-8 hours ○ Report weak pedal pulse distal to site ● Priority = assess extremity distal to the insertion site for temperature and color ○ Monitor distal pulses ○ Assess for cardiac arrhythmias ○ Bleeding = apply *** direct pressure above catheterization site

Blood transfusion

● Start within 30 min after blood has left the blood bank ● Max infusion time is 4 hours ● Start slowly for first 15 min = remain with pt ● Save transfusion bag for at least 1 hour after transfusion has ended ● Only NS

Chapter 42 - Immune Disorders

Atopic Dermatitis (Eczema) - chronic inflammatory skin disease d/t allergic disease ● Daily bath = NO soap, fragrance, alcohol ● Topical steroids and antihistamines ● Avoid allergic triggers ● Monitor for s/s of infection

Varicella = chicken pox ● s/s red papules vesicles and crusted lesions , low grade fever

Chapters 47 - Reproductive Disorders

Dysmenorrhea - painful/heavy periods

● Tx: NSAIDs = ibuprofen ○ Naproxen ○ Block prostaglandins that cause dysmenorrhea

Chapters 48 - Endocrine or Metabolic Disorders

Type 1 DM → destruction of beta cells → insulin deficiency ● #1 s/s weight loss ● Short acting draw up FIRST ● Lispro = immediate onset ● Aspart = 15 min onset → peak at 30 min => 3-5 hrs ● Regular = 0.5-1 hr onset → peak at 2-4 hr => 5-7 hrs ○ The ONLY IV insulin ● Lantus = 1 hr onset → peak at 5 hr => 24 hrs Type 2 DM → insulin resistance ● Can be caused by PKU Hypoglycemia ● Newborn = BG < 40, jitteriness , lethargy and seizures, resp distress

Growth hormone deficiency (GHD) - well proportioned but < average on growth chart

● Due to tumor, pressure on pituitary, or increased ICP ● IM Recombinant Human GH (rhGH) = given daily at bedtime Salt Losing Congenital adrenal hyperplasia (SLCAH) - total blockage of cortisol formation ● Deficient aldosterone production → salt is not retained → fluid is not retained ● Complication → dehydration Cushing’s syndrome - overproduction of cortisol ● Pituitary or adrenal cortex tumor → increased ACTH ● s/s moon face, hirsutism, red cheeks, weight gain, pendulous abdomen, abdominal striae (purple), easy bruising, slow wound healing

Chapters 49 - Neurologic Disorders

Seizures

● Causes → febrile, hyponatremia, hypoglycemia, increased ICP ● Protect airway = Position in a side-lying position ● Dx: Electroencephalogram (EEG) ● Absence seizures = loss of awareness, spacing out, new onset enuresis ● Tx: Valproic acid ○ Take some form of birth control to prevent becoming pregnant. ○ Do not stop medication abruptly ○ Be aware of N/V ○ Assess for thrombocytopenia while taking

PTSD

● s/s sleep disturbances, hypervigilance, flashbacks, withdrawal from family

Chapters 50 - Vision and Hearing Disorders

Acute Otitis Media ● s/s fever 104 F, restlessness and irritability, refusal to eat, TUGGING AT EARS ○ Dress the toddler in minimal clothing ● Myringotomy tubes → tympanic membrane to relieve chronic fluid in middle ear ○ Allows direct tx via instillation of abx otic drops ○ Hearing will not be affected ● Ear drops ○ < 3 years → pinna down and back ○ > 3 years → pinna up and back Strabismus = “lazy eye” ● Exotropia - eye turns OUT = away from the nose ● ****Esotropia** - eye turns IN = deviates medially ● Hypertropia - eye turns UP Hyperopia = farsighted → blurry at close range and clear at far range ● Diminish ~ age 5 ● Dizziness or headaches = referral and eye exam Myopia = nearsighted → light rays focus on retina anterior = blurry at far range ● Develops ~ age 8 then progresses Astigmatism - irregular curvature of cornea ● May report headache or vertigo after doing close work ● Corrective lenses = restore functional vision ● Contact lenses = smooth out cornea curvature

Chapters 51 - Musculoskeletal Disorders

Scoliosis ● A molded brace will be worn 23 hours per day except when the child needs to shower. Cerebral Palsy (CP) ● Spastic = strong moro reflex beyond 4 months of age ○ Hypertonia (Spasticity) - abnormal clonus, exaggeration of DTRs, positive Babinski reflex ○ Continuation of neonatal reflexes, such as the tonic neck reflex and scissors gait Legg-calve-perthes disease - avascular necrosis of femoral head

● s/s hip stiffness, limited ROM, limp with walking ● Dx: radiograph of hip and pelvis ● s/s: limp, guarding of hip while moving it ● THE CHILD WILL HAVE A NON-WEIGHT BEARING PERIOD

● Stabilize the extremity , ice, elevate ● Assess neurovascular status

● No ROM !!! ● Cast care ○ Neurovascular checks Q 4 hours ○ Cover the cast with a plastic bag to bathe ○ Nothing is to be put inside the cast ○ Use the cool setting on a hair dryer to ease itchy skin ○ Remain as active as possible with appropriate modifications ● Post-op infection = lethargy, tachycardia, fever Compartment syndrome = compression of nerves, BV in closed fractures within 24 hrs ● s/s intense pain, numbness, pallor, cool, pulselessness ● Pale, nonpalpable pedal pulse = immediately notify the physician ● Check neurovascular status and teach family ● Do NOT get it wet ● Fasciotomy - cutting into muscle to decompress and restore blood flow Osteomyelitis = post-op infection of the bone in open/compound fractures ● s/s fever, pain, tachycardia, edema, ESR 18 mm/hr (<10) ● Dx: bone biopsy ● Tx: antibiotics for at least 4 weeks = maintain patent IV

Burns

● 1st-degree = Superficial → epidermis ○ Erythema = sunburn ○ Priority = MAINTAIN ADEQUATE CIRCULATORY FUNCTION ● 2nd-degree = Partial-thickness → epidermis + part of dermis ○ Very painful, blisters , bleeds easily = scarring will occur ● 3rd-degree = Deep-partial thickness → epidermis + full dermis ○ White/pale color , huge blisters, extreme pain ● 4th-degree = Full-thickness ○ Eschar visible, nerve damage = NO pain ● Interventions ○ Protect airway ○ Fluid replacement ○ **Daily debridement = to prevent infection***** ○ Pain management Head injuries ● Head injury - assess LOC, Seizures, Vomiting, Irritability when regaining consciousness, Crying (fright or pain) ○ Halo test ● Increased ICP = irritability, restlessness, decreased LOC , vomiting, fatigue, bulging fontanelles, bradypnea, bradycardia