Video Library
Rn Hesi Pediatric And Women Health Proctored Exam
Total Questions : 59
Showing 10 questions, Sign in for moreThe nurse is providing discharge instructions to the caregiver of an infant with recurrent otitis media. Which statement made by the caregiver should the nurse recognize as needing additional education about minimizing subsequent infections?
A mother brings her male preschooler to the clinic because he has had diarrhea, vomiting, and high fevers for the past three days. The child begins to cry and cling to his mother when the nurse enters the examination room. Which action should the nurse implement to get the child to cooperate?
38-year-old primiparous client is seen in the outpatient obstetric office 2 weeks postpartum after a spontaneous vaginal birth of a full-term infant after rupture of membranes for 16 hours. The client was discharged on day 2, exclusively breastfeeding.
|
Laboratory Test |
Result |
Reference Range |
|
Hemoglobin, admission |
12 g/dL (12 g/L) |
greater than 11 g/dL (greater than 110 g/L |
|
Hemoglobin, discharge |
9.2 g/dL (92 g/L) |
greater than 11 g/dL (greater than 110 g/L) |
1130
Client informs she is breastfeeding about 7 to 8 times a day, for 10 minutes each feeding. The baby has been fussier for the last two days and wants to "nurse all the time." The client went out shopping yesterday for 5 hours with her sister and their mother watched the baby. The baby was fed pumped breast milk during that time. Client has noticed a red, warm, firm spot on the outer aspect of her right breast that started this morning. She also notes feeling chilled, achy, fatigued, and dizzy. Bleeding is small amount of foul-smelling lochia rubra.
1130
Vital signs
- Temperature 101.2° F (38.4° C)
- Heart rate 105 beats/minute
- Respirations 18 breaths/minute
- Blood pressure 138/72 mm Hg
- Pain rating of 4 on a 0 to 10 scale
The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet.
Select the findings that will help the nurse determine what is causing the client's symptoms.
38-year-old primiparous client is seen in the outpatient obstetric office 2 weeks postpartum after a spontaneous vaginal birth of a full-term infant after rupture of membranes for 16 hours. The client was discharged on day 2, exclusively breastfeeding.
|
Laboratory Test |
Result |
Reference Range |
|
Hemoglobin, admission |
12 g/dL (12 g/L) |
greater than 11 g/dL (greater than 110 g/L |
|
Hemoglobin, discharge |
9.2 g/dL (92 g/L) |
greater than 11 g/dL (greater than 110 g/L) |
1130
Client informs she is breastfeeding about 7 to 8 times a day, for 10 minutes each feeding. The baby has been fussier for the last two days and wants to "nurse all the time." The client went out shopping yesterday for 5 hours with her sister and their mother watched the baby. The baby was fed pumped breast milk during that time. Client has noticed a red, warm, firm spot on the outer aspect of her right breast that started this morning. She also notes feeling chilled, achy, fatigued, and dizzy. Bleeding is small amount of foul-smelling lochia rubra.
1130
Vital signs
- Temperature 101.2° F (38.4° C)
- Heart rate 105 beats/minute
- Respirations 18 breaths/minute
- Blood pressure 138/72 mm Hg
- Pain rating of 4 on a 0 to 10 scale
The nurse reviews the client's history and physical, the nurses notes, and the flow sheet to determine the cause of the client's symptoms.
For each assessment finding, click to indicate whether findings from this client's assessment are generally associated with mastitis, endometritis, or could be a sign of both conditions. Each row must have only one response option selected.
Explanation
- Temperature of 101.2°F (38.4°C):Fever over 100.4°F can occur with either breast or uterine infection as a systemic inflammatory response. Mastitis often produces moderate fever due to bacterial entry through cracked nipples, while endometritis involves uterine lining infection releasing endotoxins that raise temperature.
- Feeling chilled, achy, and fatigued: General malaise and myalgia reflect systemic infection and inflammatory cytokine release. In mastitis, bacterial invasion causes flu-like symptoms, while in endometritis, uterine bacterial toxins similarly trigger body-wide aches and chills.
- Pulse of 105 beats/minute: Tachycardia accompanies fever and infection as the body compensates for increased metabolic demand. Both infections can lead to elevated heart rate due to systemic inflammatory response and mild dehydration from fever.
- Foul-smelling lochia rubra at 2 weeks postpartum: Malodorous discharge beyond 2 weeks postpartum signals infection of the uterine lining. The odor results from necrotic tissue breakdown and bacterial proliferation—typically E. coli or anaerobes—localized to the endometrium.
- Baby fed pumped breast milk: Pumping and prolonged separation from the infant can lead to milk stasis and duct obstruction, predisposing to mastitis. Inefficient emptying increases bacterial growth within the stagnant milk ducts, triggering inflammation.
- Pain rating of 4 on a 0–10 scale: Pain is a generalized symptom. While mastitis causes severe localized breast pain, and endometritis causes pelvic/abdominal pain, the overall pain rating of 4 is non-specific and could be attributed to discomfort from either localized inflammation or systemic infection.
38-year-old primiparous client is seen in the outpatient obstetric office 2 weeks postpartum after a spontaneous vaginal birth of a full-term infant after rupture of membranes for 16 hours. The client was discharged on day 2, exclusively breastfeeding.
|
Laboratory Test |
Result |
Reference Range |
|
Hemoglobin, admission |
12 g/dL (12 g/L) |
greater than 11 g/dL (greater than 110 g/L |
|
Hemoglobin, discharge |
9.2 g/dL (92 g/L) |
greater than 11 g/dL (greater than 110 g/L) |
1130
Client informs she is breastfeeding about 7 to 8 times a day, for 10 minutes each feeding. The baby has been fussier for the last two days and wants to "nurse all the time."The client went out shopping yesterday for 5 hours with her sister and their mother watched the baby. The baby was fed pumped breast milk during that time. Client has noticed a red, warm, firm spot on the outer aspect of her right breast that started this morning. She also notes feeling chilled, achy, fatigued, and dizzy. Bleeding is small amount of foul-smelling lochia rubra.
1200
A breastfeeding session is observed with the newborn asymmetrically latching. Most of the areola is in the infant's mouth, and every few sucks a swallow is heard. The client mentions pain with the initial latch but notes that it subsided after 1 minute of feeding. The client is feeding on the left breast in the cradle position. The nipple post feeding is round with mature milk noted. The lungs are clear to auscultation bilaterally.
1230
The healthcare provider performs an exam on the client and finds a warm tender area on her right breast that is firm to the touch at the 9 o'clock position, nipple intact. On lower abdominal exam the healthcare provider notes no tenderness on palpation. There is no costovertebral tenderness noted. The client last changed her maxi pad more than 24 hours ago.
1130
Vital signs
- Temperature 101.2° F (38.4° C) .
- Heart rate 105 beats/minute
- Respirations 18 breaths/minute
- Blood pressure 138/72 mm Hg
- Pain rating of 4 on a 0 to 10 scale
The nurse determines the need to perform more of an assessment based on the client's symptoms.
Based on the new assessment findings, choose the most likely options for the information missing from the statements by selecting from the lists of options provided.
Based on the assessment findings, the priority diagnosis suspected is
Explanation
Rationale for Correct Choices
- Mastitis: The client presents with a red, warm, firm, and tender area on one breast with systemic symptoms of infection—fever, chills, and malaise—indicating mastitis. The findings are localized to the right breast, consistent with bacterial infection caused by milk stasis or nipple trauma. The intact nipple and localized tenderness at the 9 o’clock position further support the diagnosis of mastitis over uterine or urinary infection.
- Plugged duct: Mastitis commonly develops from milk stasis due to a plugged duct. Incomplete emptying of the breast, skipped feedings, or pressure from tight clothing can cause obstruction. This client’s 5-hour absence from breastfeeding and feeding only pumped milk likely contributed to milk accumulation and duct blockage, predisposing her to mastitis.
Rationale for Incorrect Choices
- Endometritis: Endometritis typically presents with uterine tenderness, foul-smelling lochia, and fever—yet this client’s abdomen is non-tender and her infection is localized to the breast. While lochia odor is present, its significance is minor compared to the breast findings, making uterine infection less likely.
- Urinary tract infection: A UTI would present with dysuria, frequency, urgency, or flank tenderness, none of which are observed. The absence of costovertebral tenderness and normal urination pattern rules out urinary involvement as the primary issue.
- Fever: Fever is a symptom, not a complication or risk factor. It results from the body’s immune response to infection and does not represent a risk outcome of mastitis. The concern is the underlying process (milk stasis/plugged duct) that led to the infection, not the fever itself.
- Pain rated 4 on a scale of 0 to 10: Pain is a symptom reflecting localized inflammation but not the main complication or risk. The risk lies in the persistent duct obstruction leading to abscess formation if untreated, not in the level of pain reported.
38-year-old primiparous client is seen in the outpatient obstetric office 2 weeks postpartum after a spontaneous vaginal birth of a full-term infant after rupture of membranes for 16 hours. The client was discharged on day 2, exclusively breastfeeding.
|
Laboratory Test |
Result |
Reference Range |
|
Hemoglobin, admission |
12 g/dL (12 g/L) |
greater than 11 g/dL (greater than 110 g/L |
|
Hemoglobin, discharge |
9.2 g/dL (92 g/L) |
greater than 11 g/dL (greater than 110 g/L) |
1130
Client informs she is breastfeeding about 7 to 8 times a day, for 10 minutes each feeding. The baby has been fussier for the last two days and wants to "nurse all the time."The client went out shopping yesterday for 5 hours with her sister and their mother watched the baby. The baby was fed pumped breast milk during that time. Client has noticed a red, warm, firm spot on the outer aspect of her right breast that started this morning. She also notes feeling chilled, achy, fatigued, and dizzy. Bleeding is small amount of foul-smelling lochia rubra.
1200
A breastfeeding session is observed with the newborn asymmetrically latching. Most of the areola is in the infant's mouth, and every few sucks a swallow is heard. The client mentions pain with the initial latch but notes that it subsided after 1 minute of feeding. The client is feeding on the left breast in the cradle position. The nipple post feeding is round with mature milk noted. The lungs are clear to auscultation bilaterally.
1230
The healthcare provider performs an exam on the client and finds a warm tender area on her right breast that is firm to the touch at the 9 o'clock position, nipple intact. On lower abdominal exam the healthcare provider notes no tenderness on palpation. There is no costovertebral tenderness noted. The client last changed her maxi pad more than 24 hours ago.
1130
Vital signs
- Temperature 101.2° F (38.4° C) .
- Heart rate 105 beats/minute
- Respirations 18 breaths/minute
- Blood pressure 138/72 mm Hg
- Pain rating of 4 on a 0 to 10 scale
Choose the most likely options for the information missing from the statement by selecting from the list of options provided.
The nurse knows that the mastitis in this scenario is most likely caused by
Explanation
Rationale for Correct Choices
• A plugged duct: Mastitis most commonly results from milk stasis due to a blocked or plugged duct. The client’s history of missing direct breastfeeding for several hours while the baby was bottle-fed increases the risk of ductal obstruction. Stagnant milk allows bacterial growth, leading to localized inflammation and infection.
• The firm red area at the 9 o’clock position: A firm, localized, warm, red area on the breast is a hallmark sign of a plugged duct that has progressed to mastitis. The finding indicates obstruction and subsequent inflammation in a specific ductal region, supporting the diagnosis.
Rationale for Incorrect Choices
• A nipple fissure: A nipple fissure can serve as an entry point for bacteria but is not the primary cause in this case. The client’s nipple was described as intact and round post-feeding, indicating there were no cracks or lesions predisposing her to infection through the skin surface.
• Thrush: Thrush (Candida infection) presents with shiny, red, burning nipples and a white coating in the infant’s mouth, neither of which are reported. There is also no mention of sharp nipple pain during or after feeds, making yeast infection unlikely.
• The nipple being round with mature milk post feeding: A round nipple and mature milk reflect effective latch and milk transfer on the unaffected breast, not an indicator of mastitis. This finding supports healthy breastfeeding mechanics rather than pathology.
• The client being 2 weeks postpartum: While mastitis often develops within the first few postpartum weeks, timing alone does not confirm the cause. The localized firm, red area provides more direct evidence of a plugged duct as the underlying factor.
38-year-old primiparous client is seen in the outpatient obstetric office 2 weeks postpartum after a spontaneous vaginal birth of a full-term infant after rupture of membranes for 16 hours. The client was discharged on day 2, exclusively breastfeeding.
|
Laboratory Test |
Result |
Reference Range |
|
Hemoglobin, admission |
12 g/dL (12 g/L) |
greater than 11 g/dL (greater than 110 g/L |
|
Hemoglobin, discharge |
9.2 g/dL (92 g/L) |
greater than 11 g/dL (greater than 110 g/L) |
1130
Client informs she is breastfeeding about 7 to 8 times a day, for 10 minutes each feeding. The baby has been fussier for the last two days and wants to "nurse all the time. "The client went out shopping yesterday for 5 hours with her sister and their mother watched the baby. The baby was fed pumped breast milk during that time. Client has noticed a red, warm, firm spot on the outer aspect of her right breast that started this morning. She also notes feeling chilled, achy, fatigued, and dizzy. Bleeding is small amount of foul-smelling lochia rubra.
1200
A breastfeeding session is observed with the newborn asymmetrically latching. Most of the areola is in the infant's mouth, and every few sucks a swallow is heard. The client mentions pain with the initial latch but notes that it subsided after 1 minute of feeding. The client is feeding on the left breast in the cradle position. The nipple post feeding is round with mature milk noted. The lungs are clear to auscultation bilaterally.
1230
The healthcare provider performs an exam on the client and finds a warm tender area on her right breast that is firm to the touch at the 9 o'clock position, nipple intact. On lower abdominal exam the healthcare provider notes no tenderness on palpation. There is no costovertebral tenderness noted. The client last changed her maxi pad more than 24 hours ago.
1130
Vital signs
- Temperature 101.2° F (38.4° C) .
- Heart rate 105 beats/minute
- Respirations 18 breaths/minute
- Blood pressure 138/72 mm Hg
- Pain rating of 4 on a 0 to 10 scale
1300
Cephalexin 500 mg PO every 6 hours for 14 days
Which education by the nurse will help resolve the issue for the client? Select all that apply.
38-year-old primiparous client is seen in the outpatient obstetric office 2 weeks postpartum after a spontaneous vaginal birth of a full-term infant after rupture of membranes for 16 hours. The client was discharged on day 2, exclusively breastfeeding.
|
Laboratory Test |
Result |
Reference Range |
|
Hemoglobin, admission |
12 g/dL (12 g/L) |
greater than 11 g/dL (greater than 110 g/L |
|
Hemoglobin, discharge |
9.2 g/dL (92 g/L) |
greater than 11 g/dL (greater than 110 g/L) |
1130
Client informs she is breastfeeding about 7 to 8 times a day, for 10 minutes each feeding. The baby has been fussier for the last two days and wants to "nurse all the time."The client went out shopping yesterday for 5 hours with her sister and their mother watched the baby. The baby was fed pumped breast milk during that time. Client has noticed a red, warm, firm spot on the outer aspect of her right breast that started this morning. She also notes feeling chilled, achy, fatigued, and dizzy. Bleeding is small amount of foul-smelling lochia rubra.
1200
A breastfeeding session is observed with the newborn asymmetrically latching. Most of the areola is in the infant's mouth, and every few sucks a swallow is heard. The client mentions pain with the initial latch but notes that it subsided after 1 minute of feeding. The client is feeding on the left breast in the cradle position. The nipple post feeding is round with mature milk noted. The lungs are clear to auscultation bilaterally.
1230
The healthcare provider performs an exam on the client and finds a warm tender area on her right breast that is firm to the touch at the 9 o'clock position, nipple intact. On lower abdominal exam the healthcare provider notes no tenderness on palpation. There is no costovertebral tenderness noted. The client last changed her maxi pad more than 24 hours ago.
1300
The healthcare provider examines the client and diagnoses right breast mastitis. Prescriptions are received and the client is sent home, to return if symptoms do not resolve.
Day 3
1000
Call placed to the client to follow up on her symptoms and treatment. The client reports that the infant is breastfeeding every 2 to 3 hours for 20 minutes for each feeding using various positions. Reports a pain rating of 2 on a 0 to 10 scale during the first 10 minutes of the feed and reports that after feeding, the nipple is creased. The infant continues to elicit timely feeding cues. The client says that the red area on her right breast is no longer present and she reports that she no longer has any chills, achiness, or dizziness; however, she does feel a little fatigued. She reports her last oral temperature was 99.0° F (37.2° C) yesterday at 1630. She reports that she has been taking the antibiotic as prescribed. The client is also pumping on the right side rather than breast feeding.
1130
Vital signs
- Temperature 101.2° F (38.4° C) .
- Heart rate 105 beats/minute
- Respirations 18 breaths/minute
- Blood pressure 138/72 mm Hg
- Pain rating of 4 on a 0 to 10 scale
1300
Cephalexin 500 mg PO every 6 hours for 14 days
Which description(s) by the client should help confirm that the mastitis has been resolved and breastfeeding/breast health is well maintained? Select all that apply.
An 8-year-old girl with precocious sexual development is being treated medically with injections of luteinizing hormone-releasing hormone (LHRH) to regulate the pituitary gland. Which statement by the parents indicates that they understand the treatment?
The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?
Sign Up or Login to view all the 59 Questions on this Exam
Join over 100,000+ nursing students using Naxlex’s science-backend flashcards, practice tests and expert solutions to improve their grades and reach their goals.
Sign Up Now
