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Vati PN Comprehensive Predictor Proctored Exam
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Showing 10 questions, Sign in for more37 weeks of gestation
Spontaneous vaginal delivery
Apgar score 1 min at 8; 5 min at 9
Birth weight 3,515 g (7 lb, 12 oz)
Newborn blood type: B Rh positive
Newborn Coombs: negative (negative)
Maternal blood type: O Rh positive
Day 2, 0830:
Newborn alert and active when awake. Mucus membranes and sclera slightly jaundiced. Respirations easy and unlabored. Abdomen soft with active bowel sounds. Cord stump dry. No redness or drainage noted. Anterior fontanel level and soft. Caput succedaneum noted.
Parent reports infant breastfeeding every few hours for 10 to 15 min but falls asleep quickly during feedings. Passed moderate amount of transitional stool. No void noted.
Day 1, 0830:
Transcutaneous bilimeter reading 6.2 gm/dL (1.0 to 12.0 mg/dL; critical value greater than 15 mg/dL)
Day 2, 0830:
Transcutaneous bilimeter reading 15.6 gm/dL (1.0 to 12.0 mg/dL; critical value greater than 15 mg/dL)
Day 2, 1000:
Total bilirubin 16.4 mg/dL (1.0 to 12.0 mg/dL)
Direct bilirubin 0.2 mg/dL (0.1 to 0.3 mg/dL)
Day 2, 0830:
Temperature 37.1° C (98.8° F) Axillary
Heart rate 145/min
Respiratory rate 52/min
Weight 3,285 g (7 lb, 2 oz) 8% weight loss
Day 2, 1030:
Initiate phototherapy.
Obtain total and direct bilirubin every 6 hr.
A nurse is assisting with the care of a newborn.
For each potential nursing intervention, click to specify if the action appropriate, nonessential, or contraindicated for the newborn.
Explanation
- Maintain an opaque mask over the newborn's eyes when under the lights: Phototherapy can damage the retina due to prolonged light exposure. Properly fitted eye shields protect the eyes while allowing maximum skin exposure to the lights. The mask should be removed during feedings to assess the eyes for irritation or drainage.
- Monitor the frequency and consistency of stools: Phototherapy increases bilirubin excretion through stool, often causing loose, greenish stools. Monitoring stool patterns helps evaluate treatment effectiveness and detect dehydration. Increased stool frequency is expected as bilirubin levels decline. Ongoing assessment supports safe fluid balance management.
- Apply a mild, fragrance free lotion to exposed skin BID: Lotions and ointments can absorb heat and increase the risk of burns during phototherapy. Topical products may also block light penetration, reducing treatment effectiveness. The skin should remain clean and dry without barriers. Avoiding lotions ensures optimal bilirubin breakdown.
- Measure the occipital frontal-circumference (OFC) daily: Daily OFC measurement is indicated for concerns related to hydrocephalus or neurological abnormalities. This newborn’s primary issue is hyperbilirubinemia, not intracranial pathology. Caput succedaneum is already noted and does not require daily OFC monitoring unless head growth abnormalities are suspected.
- Offer glucose water supplements between feedings: Supplementing with glucose water can interfere with breastfeeding establishment and does not effectively reduce bilirubin levels. Adequate breast milk intake promotes bilirubin elimination through stool. Water supplementation may contribute to inadequate caloric intake and worsen weight loss
- Reposition the newborn every 2 to 3 hr: Frequent repositioning ensures maximum skin exposure to phototherapy lights and prevents pressure injury. Turning the newborn promotes even bilirubin breakdown across body surfaces. It also reduces the risk of skin irritation and supports comfort. Regular repositioning enhances treatment effectiveness.
1 month ago:
Client presents to the outpatient mental health clinic with reports of pervasive lack of energy, difficulty concentrating, and loss of appetite. Client also reports sleeping 10 to 12 hr per night, napping during the day, yet still feeling tired. Flat affect noted. Provider prescribed fluoxetine and advised to return to the clinic in 1 month for follow up.
Today:
Client presents to the clinic for follow up appointment. Client reports "not feeling right" and experiencing abdominal pain and episodes of diarrhea for the past 2 days. Client noted to be restless and diaphoretic.
1 month ago:
- Blood pressure 118/72 mm Hg
- Heart rate 78/min
- Respiratory rate 18/min
- Temperature 37° C (98.6° F)
Today:
- Blood pressure 138/90 mm Hg
- Heart rate 106/min
- Respiratory rate 20/min
- Temperature 37.9° C (100.2° F)
A nurse is assisting in the care of a client.
For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.
Explanation
- Check deep tendon reflexes: The client exhibits restlessness, diaphoresis, tachycardia, elevated temperature, and gastrointestinal symptoms, which are consistent with serotonin syndrome. Hyperreflexia and clonus are key neuromuscular findings associated with this condition. Assessing deep tendon reflexes helps confirm neuromuscular hyperactivity.
- Discontinue fluoxetine: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels and can precipitate serotonin syndrome. The client’s symptoms developed after initiating this medication, suggesting toxicity. Immediate discontinuation removes the source of excess serotonin.
- Administer citalopram: Citalopram is another SSRI that increases serotonin activity. Administering it while the client is experiencing serotonin toxicity would worsen the condition. Adding another serotonergic agent could intensify hyperthermia, autonomic instability, and neuromuscular symptoms.
- Administer phenelzine: Phenelzine is a monoamine oxidase inhibitor (MAOI) that significantly increases serotonin levels. Combining or switching to an MAOI in the setting of suspected serotonin syndrome is dangerous and can precipitate severe toxicity. MAOIs require a washout period after SSRIs due to fluoxetine’s long half-life.
- Administer propranolol: Propranolol may be used to manage autonomic instability such as tachycardia and hypertension associated with serotonin syndrome. The client’s elevated heart rate and blood pressure support this intervention. Controlling sympathetic overactivity reduces cardiovascular strain.
1730:
Client reports their abdomen started hurting this morning along with cramping in right lower quadrant of abdomen. Reports pain as 7 on a scale of 0 to 10. Bowel sounds hypoactive in all quadrants. Client lacks an appetite and has not eaten all day. Client displays guarding and rebound tenderness of abdomen. Pain medication administered.
1900:
Client reports pain as 9 on a scale of 0 to 10. Has vomited bile x2. Acetaminophen and pain medication administered. WBC count elevated. Provider has prescribed CT of abdomen to be performed.
1730:
- Temperature 37.4° C (99.3° F)
- Blood pressure 128/62 mm Hg
- Heart rate 78/min
- Respiratory rate 22/min
- Oxygen saturation 98% on room air
1900:
- Temperature 38.5° C (101.3° F)
- Blood pressure 146/78 mm Hg
- Heart rate 84/min
- Respiratory rate 24/min
- Oxygen saturation 96% on room air
A nurse in the emergency department is assisting with the care of a client.
For each assessment finding below, click to specify if the finding is consistent with appendicitis, diverticulitis, or celiac disease. Each finding may support more than 1 disease process.
Explanation
- Muscle guarding: Muscle guarding is a classic sign of peritoneal irritation, most commonly seen in acute appendicitis. Rebound tenderness and right lower quadrant pain strongly support inflammation of the appendix. Guarding occurs as the abdominal muscles contract to protect inflamed underlying tissue. It is not typically associated with celiac disease and is less characteristic of uncomplicated diverticulitis.
- Increased temperature: Fever reflects an inflammatory or infectious process and is commonly seen in appendicitis and diverticulitis. Both conditions involve localized infection that can progress if untreated. The client’s rising temperature supports acute abdominal inflammation. Celiac disease is an autoimmune condition and does not usually present with fever.
- Nausea and vomiting: Nausea and vomiting frequently accompany appendicitis due to visceral irritation and inflammation. These symptoms can also occur in diverticulitis as a result of bowel inflammation and decreased motility. In contrast, celiac disease more commonly presents with chronic diarrhea and malabsorption rather than acute vomiting.
- Abdominal pain: Abdominal pain is present in all three conditions but differs in character and location. Appendicitis typically causes right lower quadrant pain, while diverticulitis often presents with left lower quadrant pain. Celiac disease can cause diffuse abdominal discomfort related to gluten exposure and malabsorption.
- Elevated WBC count: An elevated white blood cell count indicates an acute inflammatory or infectious process, which is characteristic of appendicitis and diverticulitis. Leukocytosis reflects the body’s immune response to bacterial infection or tissue inflammation. Celiac disease does not typically cause leukocytosis because it is a chronic autoimmune condition rather than an acute infection.
1000:
Infant presented to the ED. Parents report infant has had a runny nose and low-grade fever for several days. Parents report worsening manifestations and poor breastfeeding in the past 24 hr.
Infant appears irritable in parent's arms with frequent coughing and audible expiratory wheeze. Large amount of thick nasal discharge present. Mild subcostal and intercostal retractions present. Crackles auscultated with diminished breath sounds noted in the lung bases.
Mucus membranes slightly dry. Skin turgor demonstrates rapid recoil. Anterior fontanel level and soft. Small amount of dark yellow urine noted in diaper.
Admission weight 7.3 kg (16 lb)
1000:
- Axillary temperature 38.1° С (100.6° F)
- Apical heart rate 152/min
- Respiratory rate 48/min
- Pulse oximeter 94%
1200:
- Axillary temperature 38.7° C (101.6° F)
- Apical heart rate 168/min
- Respiratory rate 70/min
- Pulse oximeter 92%
1130:
Admit to acute care facility.
Diagnosis: Bronchiolitis
Instill normal saline nose drops and aspirate external nares every 4 hr and PRN.
Offer sips of fluids as tolerated if respiratory rate less than 60/min.
Administer oxygen to maintain saturations greater than 90%.
Continuous pulse oximeter
Acetaminophen 80 mg PO every 6 hr PRN for temperature greater than 38.2° C (100.8° F)
Dextrose 5% in 0.45% sodium chloride 500 mL at 30 mL/hr by continuous IV infusion
Urine specimen for culture
Blood cultures x1
A nurse is assisting in the care of an 8-month-old infant in the emergency department (ED).
Select the 3 priority actions the nurse should take.
A nurse is assisting in the care of a client on the medical-surgical unit.
Which of the following client findings suggest that the nurse should hold the tube feeding and notify the provider? Select all that apply.
A charge nurse is supervising a newly licensed nurse who is caring for a client who is experiencing auditory hallucinations and is refusing medication. The newly licensed nurse suggests placing the medication in the client's food to the charge nurse. Which of the following actions should the charge nurse take?
A nurse from a medical-surgical unit is floating to a postpartum unit. Which of the following clients is an appropriate assignment for the nurse to accept?
A nurse is applying a condom catheter to a male client who is incontinent. Which of the following is an appropriate technique to use?
A nurse is reviewing the list of medications for a client who has a new prescription for fluoxetine. The nurse should identify that which of the following medications is contraindicated with fluoxetine?
A nurse is preparing to administer purified protein derivative (PPD) to a client. The nurse should use which of the following routes?
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