ATI RN
RN ATI Maternal Newborn 2023 with NGN Questions
Extract:
Question 1 of 5
A nurse is assessing a client who gave birth vaginally 12 hr ago and palpates their uterus to the right above the umbilicus. Which of the following interventions should the nurse perform?
Correct Answer: C
Rationale: The correct answer is C: Assist the client to empty their bladder. After giving birth vaginally, the uterus should be midline and firm. Palpating it above the umbilicus and to the right indicates a full bladder displacing the uterus. Emptying the bladder will allow the uterus to return to its normal position. A: Reassessing in 2 hours is unnecessary as the issue is a full bladder. B: Administering simethicone is for gas relief and not relevant in this situation. D: Instructing the client to lie on their right side does not address the underlying issue of the full bladder.
Question 2 of 5
A nurse is caring for a client who is at 38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring?
Correct Answer: B
Rationale: The correct answer is B: Perform Leopold maneuvers. Prior to applying an external transducer for fetal monitoring, the nurse should perform Leopold maneuvers to assess the fetal position, presentation, lie, and engagement. This helps in determining the optimal placement of the transducer for accurate monitoring of the fetal heart rate. It allows the nurse to locate the fetal back and position the transducer over the fetal heart for the best signal quality.
Choices A, C, and D are incorrect:
A: Determining progression of dilatation and effacement is not necessary before applying the external transducer.
C: Completing a sterile speculum exam is not needed for fetal monitoring.
D: Preparing a Nitrazine paper test is unrelated to applying an external transducer.
Question 3 of 5
A nurse is assessing a newborn following a circumcision. Which of the following findings should the nurse identify as an indication that the newborn is experiencing pain?
Correct Answer: B
Rationale: The correct answer is B: Chin quivering. Pain assessment in newborns can be challenging due to their limited ability to communicate. Chin quivering is a common behavioral indicator of pain in newborns. It is a subtle sign of distress and discomfort. Other choices such as decreased heart rate (
A), pinpoint pupils (
C), and slowed respirations (
D) are not reliable indicators of pain in newborns. Decreased heart rate can indicate relaxation, pinpoint pupils are more indicative of opioid use, and slowed respirations might be a sign of sleepiness or relaxation rather than pain.
Question 4 of 5
A nurse is assessing a newborn 12 hr after birth. Which of the following manifestations should the nurse report to the provider?
Correct Answer: C
Rationale: The correct answer is C: Jaundice. Jaundice in a newborn within the first 24 hours can indicate pathological conditions like hemolytic disease or liver dysfunction, requiring immediate attention. Acrocyanosis (
A) and caput succedaneum (
D) are common benign conditions in newborns. Transient strabismus (
B) is a temporary eye misalignment that often resolves on its own. Other choices are not provided.
Extract:
The nurse is reviewing laboratory results in the adolescent's medical record.
Exhibit 1
Vital Signs
1300: Blood pressure 118/72 mm Hg, Heart rate 100/min ,Respiratory rate 20/min ,Temperature 38.3° C
(101° F)
Exhibit 2:
Provider Prescriptions 1300: Standing prescriptions for clients who present with abdominal pain: Obtain
laboratory tests: Urinalysis Cervical culture C-reactive protein Beta hCG
Exhibit 3:
Nurses' Notes 1300: Admitted adolescent reporting "cramping in my stomach." Reports pain as a 4 on 0
to 10 pain scale and describes pain as constant and dull. Reports nausea and vomiting over past 24
hours. Reports painful urination and pain during sexual intercourse with minimal vaginal itching-
Tenderness with palpation to lower abdomen, guarding abdomen observed. Greenish vaginal discharge
observed. Reports last menstrual period was 3 weeks ago as normal period lasted 4 days. “
Question 5 of 5
Which of the following conditions is the client most likely developing?
| Pelvic inflammatory. |
| Ectopic pregnancy. |
| Pyclonephritis. |
| C-reactive protein. |
| Beta hCG. |
| Urinalysis. |
Correct Answer: A
Rationale: [1, 0, 0, 0, 0, 0]
The correct answer is A: Pelvic inflammatory. Pelvic inflammatory disease is an infection of the female reproductive organs, often caused by sexually transmitted infections. It presents with symptoms like pelvic pain, abnormal vaginal discharge, and fever. Ectopic pregnancy (
B) is the implantation of a fertilized egg outside the uterus and presents with abdominal pain and vaginal bleeding. Pyelonephritis (
C) is a kidney infection, typically causing fever and flank pain. C-reactive protein (
D) is a marker for inflammation and infection, not a specific condition. Beta hCG (E) is a hormone produced in pregnancy. Urinalysis (F) is a test to analyze urine composition, not a condition.