ATI RN
ATI RN Maternal Newborn Latest Update. 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 appropriate as the client is experiencing postpartum hemorrhage, which can lead to hypovolemic shock. Administering IV fluids helps increase circulating volume and stabilize the client's condition. The other choices are incorrect because:
A) Replacing the surgical dressing does not address the underlying issue of hemorrhage.
B) Evaluating urinary output is important but not the priority when the client is actively bleeding.
C) Applying an ice pack to the incision site is not indicated and may not address the hemorrhage. Overall, choice D is the most crucial intervention to address the immediate concern of postpartum hemorrhage.
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. Infants born to mothers with gestational diabetes are at risk for hypoglycemia due to the abrupt cessation of the maternal glucose supply post-birth. Jitteriness is a common manifestation of hypoglycemia in newborns, indicating the need for prompt intervention to prevent further complications. Abdominal distention (
A) is not typically associated with hypoglycemia. Petechiae (
B) are small red or purple spots on the skin caused by bleeding under the skin and are not directly related to hypoglycemia. Increased muscle tone (
C) is not a typical sign of hypoglycemia in newborns.
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 seen in pregnant women due to physiological changes. Flank pain is a classic symptom due to inflammation of the kidney tissue. Epigastric discomfort (
A) is more indicative of gastrointestinal issues, not typically associated with pyelonephritis. Temperature elevation (
C) is a common sign of infection but not specific to pyelonephritis. Abdominal cramping (
D) is more commonly associated with uterine contractions in pregnancy.
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: The correct answer is D: Notify the provider if the end of your baby’s penis appears dark red. This is important because it could indicate infection or other complications. Dark red color may suggest poor blood flow or infection, requiring immediate medical attention to prevent further complications.
Incorrect answers:
A: The Plastibell is not typically removed after 4 hours, as it usually falls off on its own within a week.
B: Snug diaper can cause discomfort and hinder proper healing.
C: Yellow exudate forming at the site in 24 hours is normal as part of the healing process.
Therefore, option D is the most critical information for the parents to be aware of.
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 the teaching because tubal ligation does not affect ovulation; it only blocks the fallopian tubes to prevent the egg from traveling to the uterus. The client should still ovulate as before, but pregnancy is prevented by blocking the egg's path.
Incorrect choices:
A: Premenstrual tension will no longer be present - This is incorrect because tubal ligation does not affect premenstrual tension.
B: My monthly menstrual period will be shorter - This is incorrect as tubal ligation does not affect the length of menstrual periods.
C: Hormone replacements will be needed following this procedure - This is incorrect as tubal ligation does not typically require hormone replacements.