ATI RN
Introduction to Maternity and Pediatric Nursing Test Bank Questions
Question 1 of 5
Which of the following nursing interventions will help prevent a further increase in ICP?
Correct Answer: C
Rationale: Elevating the head of the bed helps to promote venous drainage from the brain, which can help reduce intracranial pressure (ICP). By positioning the patient with the head of the bed at a 30-45 degree angle, it can facilitate the circulation of cerebrospinal fluid and blood, thus preventing a further increase in ICP. This intervention is a crucial aspect of managing patients with increased ICP and can help improve their overall neurological status.
Question 2 of 5
In which of the ff clients will an MRI scan be contraindicated?
Correct Answer: B
Rationale: An MRI scan uses strong magnetic fields and radio waves to create detailed images of the body's internal structures. Clients with metal implants in their body, such as pacemakers, artificial joints, or other metallic objects, may experience potential risks and complications during an MRI scan. The strong magnetic field can interact with the metal in the body, causing movement, heating, or potential damage to the surrounding tissues. Hence, it is contraindicated to perform an MRI scan on clients with metal implants to avoid harm and ensure their safety.
Question 3 of 5
Which of the ff is a sign of urinary retention in older adults with a neurologic deficit?
Correct Answer: D
Rationale: Urinary retention in older adults with a neurologic deficit can lead to a behavior change. This change may manifest as increased restlessness, agitation, or discomfort. It is important to be vigilant for any sudden alterations in behavior as they may indicate underlying complications such as urinary retention, which can be more challenging to identify in older individuals who may have difficulty communicating their symptoms clearly. Monitoring for behavior changes can help healthcare providers promptly address and manage urinary retention in these individuals.
Question 4 of 5
The nurse is caring for a client in the emergency room diagnosed with Bell's palsy. The client has been taking acetaminophen (Tylenol), and acetaminophen overdose is suspected. The nurse anticipates that the antidote to be prescribed is:
Correct Answer: D
Rationale: Acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol) overdose. If an overdose of acetaminincophen is suspected, acetylcysteine should be administered within 8-10 hours of ingestion to prevent liver damage and failure. Pentostatin, Fludarabine, and Auranofin are not antidotes for acetaminophen overdose and are used for other medical conditions.
Question 5 of 5
During an ophthalmic assessment, which of the ff are the nurses expected to observe carefully? Choose all that apply
Correct Answer: B
Rationale: In an ophthalmic assessment during maternity and pediatric nursing, observing pupil responses is crucial for several reasons. Pupil responses can provide valuable information about the integrity of the cranial nerves, brainstem function, and potential neurological issues. Changes in pupil size, shape, or reactivity can indicate serious conditions like increased intracranial pressure or cranial nerve damage, which are especially important to monitor in pediatric and maternity patients. The other options are important aspects of an ophthalmic assessment but are not as critical as pupil responses in this context. While the level of central vision (option A) is important for overall eye function, it may not provide immediate insights into urgent neurological issues. External eye appearance (option C) and eye movements (option D) are also important for assessing eye health and function but may not be as directly linked to neurological status as pupil responses. Educationally, understanding the significance of pupil responses in an ophthalmic assessment reinforces the connection between ocular health and neurological function. It highlights the importance of thorough assessments in pediatric and maternity patients to detect any subtle changes that may require prompt intervention. By prioritizing pupil responses, nurses can ensure comprehensive care and early detection of potential complications.