ATI RN
ATI RN Maternal Newborn 2023/24 1st Attempt & Retake Questions
Extract:
Question 1 of 5
A nurse is caring for a client who delivered by cesarean birth 6 hr ago. The nurse notes a steady trickle of vaginal bleeding that does not stop with fundal massage. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Administer 500 mL lactated Ringer’s IV bolus. This action is necessary to address the ongoing vaginal bleeding after cesarean birth, which may indicate hypovolemia or postpartum hemorrhage. Administering IV fluids helps to restore circulating volume and maintain adequate perfusion to prevent further complications.
Replacing the surgical dressing (
A) does not address the underlying issue of vaginal bleeding. Evaluating urinary output (
B) is important for assessing renal function but is not the priority in this situation. Applying an ice pack to the incision site (
C) is not appropriate for treating postpartum bleeding. Administering a lactated Ringer’s IV bolus (
D) is the most urgent intervention to manage the ongoing bleeding and prevent further complications.
Question 2 of 5
A nurse is assessing a newborn whose mother had gestational diabetes mellitus. The nurse should monitor for which of the following findings as a manifestation of hypoglycemia?
Correct Answer: D
Rationale: The correct answer is D: Jitteriness. In newborns of mothers with gestational diabetes, they are at risk for hypoglycemia due to the sudden drop in glucose levels after birth. Jitteriness is a common manifestation of hypoglycemia in newborns, indicating neurological impairment. Abdominal distention (
A) is not typically associated with hypoglycemia. Petechiae (
B) are tiny red or purple spots on the skin and are not specific to hypoglycemia. Increased muscle tone (
C) is more commonly seen in conditions like cerebral palsy. Jitteriness (
D) is a typical sign of hypoglycemia in newborns and requires prompt attention to prevent further complications.
Question 3 of 5
A nurse is collecting data from a client who is at 30 weeks of gestation. Which of the following findings should the nurse identify as a manifestation of pyelonephritis?
Correct Answer: B
Rationale: The correct answer is B: Flank pain. Pyelonephritis is an infection of the kidneys commonly characterized by flank pain. At 30 weeks of gestation, the uterus enlarges and can lead to obstruction of the ureters, increasing the risk of urinary stasis and infection. Epigastric discomfort (choice
A) is more indicative of issues like preeclampsia. Temperature elevation (choice
C) can be a sign of infection but is not specific to pyelonephritis. Abdominal cramping (choice
D) is more likely related to uterine contractions or gastrointestinal issues.
Question 4 of 5
A nurse is providing teaching to the parents of a newborn about the Plastibell circumcision technique. Which of the following information should the nurse include?
Correct Answer: D
Rationale:
Correct
Answer: D. Notify the provider if the end of your baby’s penis appears dark red.
Rationale: Dark red appearance at the end of the baby's penis could indicate infection or poor blood flow, requiring immediate medical attention to prevent complications. This information is crucial for parents to recognize potential risks post-circumcision.
Summary of other choices:
A: The Plastibell is usually removed after a few days, not 4 hours. Incorrect.
B: Snug diapers can cause irritation. Not relevant to Plastibell circumcision. Incorrect.
C: Yellow exudate forming in 24 hours is normal post-circumcision. Not concerning. Incorrect.
Question 5 of 5
A nurse is providing discharge teaching to a client following tubal ligation. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D: Ovulation will remain the same. This statement indicates an understanding of tubal ligation, which is a permanent method of contraception that prevents pregnancy by blocking the fallopian tubes. Ovulation, the release of an egg from the ovary, will continue to occur after tubal ligation. This is because tubal ligation does not affect the hormonal process of ovulation.
Choice A is incorrect because premenstrual tension can still occur even after tubal ligation.
Choice B is incorrect as tubal ligation does not affect the duration of menstrual periods.
Choice C is incorrect because hormone replacements are not typically needed after tubal ligation unless there are other underlying medical conditions.