ATI RN
Maternal Disorders Questions
Question 1 of 5
The client receives zidovudine (Retrovir) for treatment of HIV infection. Which assessment data indicates an adverse reaction to the drug?
Correct Answer: C
Rationale: The correct answer is C: Decreased WBC count. Zidovudine is known to cause bone marrow suppression which can lead to a decrease in white blood cell count. This is an adverse reaction as it increases the risk of infections. A: Cough is not a common adverse reaction to zidovudine. B: Enlarged lymph nodes are not directly associated with zidovudine adverse reactions. D: Fever is a non-specific symptom and can occur due to various reasons, not specifically related to zidovudine. Therefore, the most concerning and relevant assessment data indicating an adverse reaction to zidovudine is a decreased white blood cell count.
Question 2 of 5
Reduction in congenital rubella is best accomplished by:
Correct Answer: D
Rationale: The correct answer is D because immunizing susceptible women at least 28 days before they become pregnant ensures protection against rubella during pregnancy, reducing the risk of congenital rubella syndrome in the fetus. This timing allows for the development of immunity before conception. Avoiding contact with young children (A) does not directly prevent rubella transmission to pregnant women. Taking prophylactic antibiotics during pregnancy (B) is not recommended for rubella prevention. Testing rubella titer at the first prenatal visit (C) only assesses current immunity status but does not actively prevent congenital rubella.
Question 3 of 5
The correct injection technique for infants of mothers who are known carriers of hepatitis B virus is to:
Correct Answer: A
Rationale: The correct answer is A because infants born to mothers who are known carriers of hepatitis B virus should receive the hepatitis B vaccine within 12 hours of birth. Delaying intramuscular injections until 1 month of age increases the risk of vertical transmission of the virus. Choice B is incorrect because diluting injections with normal saline is unnecessary and may compromise the effectiveness of the vaccine. Choice C is incorrect as mixing all injections in a single syringe can lead to contamination and inaccurate dosing. Choice D is incorrect as bathing the injection site does not prevent vertical transmission of the virus.
Question 4 of 5
A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first?
Correct Answer: A
Rationale: The correct answer is A: Assess deep tendon reflexes. This is the priority because preeclampsia can progress to eclampsia, a life-threatening condition characterized by seizures. Assessing deep tendon reflexes helps in identifying signs of impending eclampsia. Obtaining a complete blood count (option B) and routine urinalysis (option D) are important in monitoring for complications of preeclampsia but do not address the immediate risk of seizures. Assessing baseline weight (option C) is also important but does not take precedence over assessing deep tendon reflexes in this scenario.
Question 5 of 5
A 32-week-gestation client was last seen in the prenatal clinic at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife?
Correct Answer: A
Rationale: The correct answer is A because a weight gain of 10 pounds in 4 weeks for a 32-week-gestation client is excessive and may indicate a potential issue such as gestational diabetes or preeclampsia. B: The pulse rate change is within a normal range for pregnancy. C: The blood pressure change is minimal and still within normal limits. D: The respiratory rate change is also within normal limits for pregnancy.