ATI RN
ATI Capstone Week 11 Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a child who has influenza. The nurse should identify which of the following statements by the parent indicates the child has an increased risk for Reye syndrome?
Correct Answer: A
Rationale: The correct answer is A: "I give my child aspirin to reduce his fever." This statement indicates an increased risk for Reye syndrome because aspirin use in children with influenza can lead to Reye syndrome, a rare but serious condition that affects the brain and liver. Reye syndrome is associated with aspirin use in children recovering from viral infections like influenza. Aspirin should be avoided in children with viral illnesses like influenza. The other choices are incorrect because ibuprofen is an appropriate medication for muscle aches, a humidifier can help with congestion, and grapefruit juice does not pose a risk for Reye syndrome.
Question 2 of 5
A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor for complications in response to this diagnosis?
Correct Answer: B
Rationale: The correct answer is B: Cardiovascular. Kawasaki disease primarily affects the blood vessels, particularly the coronary arteries, leading to potential complications such as coronary artery aneurysms and myocarditis. Monitoring the cardiovascular system is crucial to detect any signs of these serious complications early on.
Choice A: Respiratory is incorrect as Kawasaki disease does not primarily affect the respiratory system.
Choice C: Integumentary is incorrect as this disease does not typically cause significant skin issues.
Choice D: Gastrointestinal is incorrect as gastrointestinal complications are not commonly associated with Kawasaki disease.
In summary, monitoring the cardiovascular system is essential in Kawasaki disease due to its potential impact on coronary arteries, while the other systems are less likely to be affected.
Question 3 of 5
A nurse is providing teaching about Kegel exercises to a group of clients who are in the third trimester of pregnancy. Which of the following statements by a client indicates understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D because Kegel exercises help strengthen the pelvic floor muscles, which are important for supporting the uterus, bladder, and bowel. Strong pelvic muscles can facilitate the birthing process by providing better control during labor and delivery. Additionally, these exercises can help prevent urinary incontinence postpartum. The other options are incorrect as Kegel exercises do not directly impact stretch marks, back aches, or constipation. Stretch marks are related to skin elasticity, back aches may be relieved through proper posture and exercises targeting back muscles, and constipation is more influenced by dietary factors and hydration.
Question 4 of 5
A nurse is caring for a client who is having a nonstress test performed. The fetal heart rate (FHR) is 130 to 150/min, but there has been no fetal movement for 15 min. Which of the following actions should the nurse perform?
Correct Answer: B
Rationale: The correct answer is B: Offering the client a snack of orange juice and crackers. This action is appropriate because it can help stimulate fetal movement due to the natural increase in blood sugar levels from consuming the snack. This may lead to an increase in fetal activity, which is a positive sign during a nonstress test. Encouraging the client to consume a snack is a non-invasive intervention that can potentially improve the test results without causing harm to the client or the fetus. It is important to address the lack of fetal movement promptly, and offering a snack is a safe and effective way to do so.
Incorrect choices:
A: Encouraging the client to walk around without the monitoring unit could potentially disrupt the monitoring process and may not necessarily stimulate fetal movement.
C: Induction of labor is not warranted based solely on the absence of fetal movement for 15 minutes during a nonstress test.
D: Turning the client onto her left side is a common intervention to optimize fetal oxygenation but may
Question 5 of 5
A nurse is caring for a client during the first trimester of pregnancy. After reviewing the client's blood work, the nurse notices she does not have immunity to rubella. Which of the following times should the nurse understand is recommended for rubella immunization?
Correct Answer: B
Rationale: The correct answer is B: Shortly after giving birth. Rubella vaccine is contraindicated during pregnancy to avoid any potential harm to the fetus. Postpartum vaccination ensures the client is protected before her next pregnancy. Option A is incorrect as it is contraindicated during the third trimester. Option C is incorrect because immediate vaccination during pregnancy is not recommended. Option D is incorrect as it is essential to vaccinate postpartum, not during the next attempt to get pregnant to prevent rubella infection during pregnancy.