ATI Capstone Class Exam Week 12 | Nurselytic

Questions 45

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ATI Capstone Class Exam Week 12 Questions

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Question 1 of 5

A nurse is assessing a newborn immediately following a scheduled cesarean delivery. Which of the following assessments is the nurse’s priority?

Correct Answer: B

Rationale: The correct answer is B: Respiratory distress. The nurse's priority is to ensure the newborn's ability to breathe effectively. Respiratory distress is common after cesarean delivery due to fluid in the lungs. Addressing this promptly is critical to prevent complications. Accidental lacerations (
A) are important but not immediately life-threatening. Hypothermia (
C) can be addressed after ensuring the newborn's respiratory status. Acrocyanosis (
D) is a common finding in newborns and not an urgent concern.

Question 2 of 5

A nurse is completing discharge instructions for a new mother and her 2-day-old newborn. The mother asks, “How will I know if my baby gets enough breast milk?” Which of the following responses should the nurse make?

Correct Answer: A

Rationale: The correct answer is A: Your baby should wet 6 to 8 diapers per day. This is because the frequency of wet diapers indicates that the newborn is getting enough breast milk. An adequate amount of wet diapers signifies that the baby is adequately hydrated and receiving sufficient nourishment. It is a concrete and measurable way to monitor the baby's intake.


Choice B is incorrect because the wake cycle after feeding varies among newborns and is not a reliable indicator of milk intake.
Choice C is incorrect as burping after feeding is a normal process but not necessarily an indicator of sufficient milk intake.
Choice D is incorrect because newborns typically need to feed more frequently than every 6 hours.

Question 3 of 5

A nurse on the labor and delivery unit is caring for a newborn immediately following birth. Which of the following actions by the nurse reduces evaporative heat loss by the newborn?

Correct Answer: A

Rationale: The correct answer is A: Drying the newborn's skin thoroughly. When a newborn is born, they are wet and evaporative heat loss occurs as the moisture on their skin evaporates, leading to cooling. Drying the newborn's skin thoroughly helps reduce this heat loss by preventing the moisture from evaporating. Preventing air drafts (
B) and placing the newborn on a warm surface (
C) can help with overall thermal regulation but do not specifically target evaporative heat loss. Maintaining ambient room temperature at 24°C (75.2°F) (
D) is important for thermoregulation but does not directly address evaporative heat loss.

Question 4 of 5

A nurse in a provider’s office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?

Correct Answer: C

Rationale: The correct answer is C: Hypertension. Hypertension is the most common risk factor for placental abruption because it can lead to reduced blood flow to the placenta, increasing the risk of separation. High blood pressure can cause damage to the blood vessels in the placenta, making it more susceptible to detachment. Cocaine use (
A) and cigarette smoking (
D) can also increase the risk of abruption, but they are not as common as hypertension. Blunt force trauma (
B) can directly cause placental abruption but is not as prevalent as hypertension in this context.

Question 5 of 5

A nurse is caring for a client who is in premature labor and is receiving terbutaline. The nurse should monitor the client for which of the following adverse effects that should be reported to the provider?

Correct Answer: A

Rationale: The correct answer is A: Dyspnea. Terbutaline is a beta-adrenergic agonist that can cause pulmonary edema as a serious adverse effect. Dyspnea is a common symptom of pulmonary edema, indicating potential respiratory distress. This adverse effect should be reported promptly to the provider for further evaluation and management to prevent complications.

Incorrect choices:
B: Headaches - Headaches are a common side effect of terbutaline but are not as concerning as respiratory distress.
C: Nervousness - Nervousness is a common side effect of terbutaline and does not typically require immediate reporting unless severe.
D: Tremors - Tremors are a common side effect of terbutaline and are not as concerning as respiratory distress.

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