#1 A 35 year old G1P0 is 20 weeks gestation with a past medical history
of hypertension. Her pregnancy has been uneventful; however, at today's appointment, her blood pressure was 150/100mmHg at first check and 15 minutes later was still 136/90 mmHg. She is also complaining of light-headedness and palpitations.
A. What actions would you take as her nurse?
B. What change should this patient be encouraged to do?
C. What are the expected outcomes?
#2. The patient is a 17 year old female who arrives to the emergency department in active labor with a questionable past of obstetrical history. She indicates that she has had no prenatal care, does not remember her last menstruation period, and is evasive if this is her first pregnancy. Blood work indicates she is Rh negative.
A. What are some concerns you as her nurse should be prepared for?
B. What teaching does this patient need?
C. What are the expected outcomes for this patient?
#3 A 15 year-old female has come to the urgent care complaining about nausea, vomiting, and feeling tired all the time. Her complaints are vague, but the nurse is suspicious she may be pregnant when the girl mentions she is late for her period.
A. What nursing care will you provide to this young lady if she is pregnant.
B. What nursing diagnoses will apply to this situation?
C. What are some expected outcomes?
#4 A woman in labor has been progressing well with minimal difficulties. The nullipara woman has been working with her coach, progressing through the process. The fetal monitor has indicated that the fetus is in stable condition. Suddenly, the monitor alarm goes off and exam reveals a possible prolapsed cord.
A. What steps should you take as her nurse?
B. What care does the mother and infant need?
C. How would you evaluate that your interventions were helpful?
#5 Your patient is a petite 23-year-old G1P0 woman. Prenatal assessment has determined that this woman will need a cesarean birth due to cephalopelvic disproportion.
A. What can this patient and you as the nurse do prenatally to ensure a safe delivery?
B. What potential risks and/or complications should the nurse be aware of and prepare for?
C. What postoperative care will this mother and/or infant need?
#6. The mother of a 10-year-old girl has brought her to the clinic based on concerns expressed by the school nurse. The teacher has noted times when the girl appears to be daydreaming; however, after the nurse witnessed a few of these incidents, she has recommended the child be evaluated for absence seizures. The mother is not totally convinced that is true, however, is willing to find out.
A. How would you respond to this mother?
B. What patient centered care will be appropriate here?
C. What safety measures should the parents be encouraged to follow?
#7. You are assessing a child's vision and notice the child is unable to correctly answer her questions when shown the Ishihara color plates. When questioning the mother, you discover that the child has not understood the colors but the mother has just assumed the child was slow.
A. How would you proceed?
B. What care would you provide in this case?
C. How will you know the nursing care plan was effective for this child?
#8. The parents have brought their 3-year-old son to the clinic for an evaluation. They are concerned something is wrong because he cannot seem to move like he used to and is having difficulty climbing up and down the stairs.
A. How would you respond?
B. What patient-centered care should you develop?
C. You recognize that this patient will need assistance from other departments. Which additional team members will be able to assist this patient and his family?
#9. A mother has brought her 4-year-old daughter to the emergency department. She didn't realize her husband had sprayed the lawn with a pesticide and allowed their daughter to play in the yard. She now comes in with complaints of nausea, vomiting, difficulty breathing, and confusion.
A. How would you respond? What are you initial interventions?
B. How can you help the family?
C. What are some nursing diagnoses that would be appropriate for this situation?
#10. The parents are in denial demanding a second opinion. The physician has just informed them their 2-year-old son has a glioblastoma. Devastated, they ask the nurse, "How can this happen to us?"
A. How would you respond?
B. What are some nursing diagnoses you would identify in this situation (more than 1 please)
C. What are some expected outcomes related to your nursing diagnoses? (should have an outcome for every diagnoses)
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