ATI RN
ATI Maternal Newborn Proctored Exam Latest Update Questions
Extract:
Question 1 of 5
A client is admitted to the hospital with severe pregnancy-induced hypertension (PIH). The physician orders magnesium sulfate. Which nursing intervention is important when administering this drug?
Correct Answer: A
Rationale: The correct answer is A: Assess blood pressure and respiratory rate every fifteen minutes when administering magnesium sulfate to a client with severe PIH. This is crucial because magnesium sulfate is a potent medication that can cause respiratory depression and hypotension as side effects. Monitoring these parameters frequently allows early detection of any adverse reactions, enabling prompt intervention. Option B is incorrect as monitoring blood glucose levels is not directly related to magnesium sulfate administration. Option C is incorrect as orthostatic hypotension is not a common side effect of magnesium sulfate. Option D is incorrect as observing for premature labor is not relevant to the administration of magnesium sulfate for PIH.
Question 2 of 5
A nurse is caring for a 14-year-old child with appendicitis who has a pain rating of 8 on a scale of 1 to 10. The child has just returned to the unit after a computed tomography (CT) scan of the abdomen and tells the nurse the pain just stopped. Which of the following should the nurse do first?
Correct Answer: A
Rationale: The correct answer is A. The nurse should first address fluid balance because the child's sudden relief of pain can indicate a ruptured appendix, leading to potential fluid loss and dehydration. Monitoring fluid balance is crucial in this case to prevent complications.
Choice B is incorrect as it discusses exercise and insulin, which are not immediate priorities in this scenario.
Choice C mentions urine glucose monitoring, which is not directly related to the child's current condition.
Choice D focuses on diet modification, which is not the primary concern when the child may be experiencing a medical emergency. The priority is to assess and address the potential fluid imbalance due to the possibility of a ruptured appendix.
Question 3 of 5
Two days after delivery, a postpartum client prepares for discharge. What should the nurse teach her about lochia flow?
Correct Answer: D
Rationale: The correct answer is D because it accurately describes the progression of lochia flow after delivery. Lochia starts as bright red (lochia rubra) on days 1-3, transitions to pinkish brown (lochia serosa) on days 4-9, and finally becomes creamy white (lochia alba) from days 10-21. This information is crucial for the postpartum client to understand what is normal regarding lochia color and duration.
Choice A is incorrect as it does not provide the correct timeline of color changes.
Choices B and C are incorrect because they focus on abnormal findings rather than the normal progression of lochia.
Question 4 of 5
A nurse is caring for a child with Wilms' tumor. The parents ask why the sign 'Do not palpate the abdomen' has to be placed on their child's bed. Which of the following is the correct response by the nurse?
Correct Answer: C
Rationale: The correct response is C: Palpation of the abdomen could result in some of the tumor cells breaking loose, causing it to spread. Palpating the abdomen in a child with Wilms' tumor can potentially lead to the dissemination of tumor cells into surrounding tissues and blood vessels, increasing the risk of metastasis. This precaution is crucial to prevent the spread of cancer cells and to contain the tumor within the kidney.
Choices A, B, and D are incorrect as they do not address the specific risk associated with manipulating the abdomen in a child with Wilms' tumor. Option A focuses solely on pain, which is not the primary concern in this case. Option B is inaccurate as palpation does not cause tumor growth. Option D is irrelevant to the potential consequences of abdominal manipulation in this context.
Question 5 of 5
During an outpatient clinic visit, a 13-year-old client is diagnosed with infectious mononucleosis. The nurse should expect which of the following to be included in the client's plan of care?
Correct Answer: B
Rationale: The correct answer is B: Encourage gargling with warm water to alleviate pain. Gargling with warm water can help soothe a sore throat, a common symptom of infectious mononucleosis. Acetaminophen with codeine (
A) is not typically recommended for mononucleosis pain management in children due to the risk of respiratory depression. Starting a short course of ampicillin (
C) is contraindicated in mononucleosis as it can cause a rash. Encouraging social activity (
D) may not be appropriate as the client may need rest to recover.