ATI RN
ATI RN Maternal Newborn level 3 Final Exam 2023 Questions
Extract:
Question 1 of 5
A nurse is assessing a client who is in preterm labor and has a new prescription or terbutaline 0.25 mg subcutaneous. For which of the following findings should the nurse Withhold the medication and Report to the provider?
Correct Answer: B
Rationale: The correct answer is B: Blood pressure 88/58 mmHg. Terbutaline is a tocolytic medication used to stop preterm contractions. A low blood pressure reading of 88/58 mmHg may indicate hypotension, a potential side effect of terbutaline. Hypotension can lead to decreased placental perfusion, putting the fetus at risk. The nurse should withhold the medication and report this finding to the provider for further assessment and intervention.
A: Fasting blood glucose of 75 mg/dL is within normal range and does not require withholding the medication.
C: Urinary output of 40 ml/hr is adequate and does not indicate a need to withhold the medication.
D: Fetal heart rate of 120/min is within the normal range for a fetus and does not require withholding the medication.
Question 2 of 5
A nurse is providing teaching to the parents of a newborn about the plastibell circumcision technique. Which of the following? - p170-171 - postprocedure bottom of 170 and goes into top of 171.
Correct Answer: D
Rationale: The correct answer is D. Yellow exudate forming at the surgical site in 24 hours is expected after plastibell circumcision due to the healing process. This exudate consists of dead cells and is a normal part of wound healing. It is important for the parents to be aware of this so they do not mistake it for an infection or abnormality.
Explanation for other choices:
A: The plastibell is not removed after 4 hours; it falls off on its own in about 5-10 days.
B: Dark red appearance at the end of the penis could indicate a potential issue, but immediate notification of the provider is not necessary.
C: Ensuring the newborn's diaper is snug is unrelated to the circumcision technique.
E, F, G: No information provided.
Question 3 of 5
A nurse is planning care immediately following birth for a newborn who has Myelomeningocele that is cerebrospinal fluid. Which of the following actions should the nurse include in the plan of care?
Correct Answer: A
Rationale: The correct answer is A: Administer broad-spectrum antibiotics. This is crucial in preventing infection in a newborn with myelomeningocele where the spinal cord is exposed. Infection can lead to serious complications. Administering broad-spectrum antibiotics helps to reduce the risk of infection. Cleansing the site with Povidone iodine (choice
B) is important, but antibiotics are necessary for prophylaxis. Monitoring rectal temperature (choice
C) is not directly related to preventing infection. Surgical closure (choice
D) after 72 hours is important, but antibiotics are essential immediately post-birth to prevent infection.
Question 4 of 5
A nurse is caring for a newborn Boys 6 hours old and has a bedside glucose meter reading of 65 mg / DL. The New Orleans mother has Type 2 diabetes mellitus. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Feed the newborn immediately. In this scenario, the newborn's blood glucose level is 65 mg/dL, which is considered low. Given that the mother has Type 2 diabetes, the baby is at risk for hypoglycemia due to maternal hyperglycemia during pregnancy. Feeding the newborn immediately will help increase their blood glucose levels. IV dextrose solution administration (choice
A) is not necessary at this time as the baby can be orally fed. Obtaining a blood sample for serum glucose level (choice
B) can be done later after feeding to confirm improvement. Reassessing blood glucose prior to the next feeding (choice
C) delays necessary intervention. The baby must be fed promptly to prevent further hypoglycemia.
Question 5 of 5
A nurse is caring for four enter-partum clients. Which of the following clients should the nurse assess first?
Correct Answer: B
Rationale: The correct answer is B. The nurse should assess the client at 32 weeks of gestation reporting seeing floating spots first because it could indicate a serious condition called preeclampsia, characterized by high blood pressure and organ damage. This client's symptom is a sign of visual disturbances, a classic symptom of preeclampsia. Immediate assessment is necessary to prevent complications such as seizures and stroke. The other clients' symptoms, urinary frequency, leg cramps, and periodic numbness in fingers, are common discomforts in pregnancy but do not suggest immediate serious complications like preeclampsia.