ATI RN
Complications in Early Pregnancy Questions
Question 1 of 5
The nurse is caring for a client with a suspected hydatidiform mole. Based on the diagnosis, what does the nurse anticipate? Select all that apply.
Correct Answer: B
Rationale: Step-by-step rationale: 1. Hydatidiform mole is a type of gestational trophoblastic disease. 2. It results in the abnormal growth of placental tissue instead of a fetus. 3. As there is no fetus, there won't be any fetal heart tones. 4. Therefore, the nurse anticipates absence of fetal heart tones. Summary: A: Dark brown vaginal bleeding is not specific to hydatidiform mole. C: Fundal height larger than expected is not a typical sign of hydatidiform mole. D: Elevated blood pressure is not directly associated with hydatidiform mole.
Question 2 of 5
A nurse is monitoring a client with type 2 diabetes mellitus. Her blood work reveals a glycosylated hemoglobin (HbA1c) of 10%. The nurse knows this blood work indicates which of the following?
Correct Answer: C
Rationale: Rationale: 1. HbA1c reflects average blood glucose levels over the past 2-3 months. 2. A value of 10% indicates poor blood glucose control. 3. High HbA1c (above 6.5-7%) signifies uncontrolled diabetes. 4. Choice C is correct as it aligns with the interpretation of HbA1c. Summary: - Choice A is incorrect as 10% is not a normal HbA1c value. - Choice B is incorrect as a low value would indicate good control. - Choice D is incorrect as HbA1c is a key marker for diabetes management.
Question 3 of 5
The labor and delivery nurse reviews a client’s prenatal records and notes that the client had a positive GBS culture at 27 weeks gestation. Based on current guidelines, what is the recommended plan?
Correct Answer: B
Rationale: The correct answer is B: Prepare to administer penicillin prophylactically. This is the recommended plan because current guidelines suggest administering intrapartum prophylaxis with penicillin for GBS-positive pregnant women to prevent neonatal GBS disease. Choice A is incorrect because sending a GBS to the laboratory immediately is unnecessary since the previous positive culture result is already known. Choice C is incorrect because follow-up cultures are not routinely recommended at 38 weeks gestation. Choice D is incorrect because determining if the patient received antibiotics for the positive strep does not address the need for intrapartum prophylaxis specifically with penicillin.
Question 4 of 5
The nurse is caring for a client in labor who is HIV positive. Which nursing care should be included?
Correct Answer: A
Rationale: The correct answer is A because administering antiretroviral drugs as ordered helps reduce the risk of vertical transmission of HIV from mother to baby during childbirth. This treatment is essential in managing the client's HIV status and ensuring the safety of the newborn. Choice B is incorrect because using a labor ball does not directly address the HIV status of the client or the transmission risk to the newborn. Choice C is incorrect as wearing gloves when handling the newborn does not replace the need for antiretroviral therapy to prevent transmission. Choice D is incorrect because breastfeeding can transmit HIV from mother to baby, so it is not recommended for HIV-positive mothers to breastfeed.
Question 5 of 5
The nurse is caring for a patient who is receiving magnesium sulfate for pre-eclampsia. Which assessments will be of the highest priority?
Correct Answer: A
Rationale: The correct answer is A: Assessing lung sounds. This is of highest priority because magnesium sulfate can lead to respiratory depression. Assessing lung sounds helps monitor for signs of respiratory distress, such as decreased breath sounds or crackles. Assessing blood sugar level (B) is important but not as urgent as respiratory status. Encouraging fluid intake (C) is important for hydration but not as critical as respiratory assessment. Assessing for pitting edema (D) is relevant for monitoring fluid retention but not as immediate as assessing lung sounds for respiratory compromise.