ATI RN
RN ATI Maternal Newborn 2023 with NGN Questions
Extract:
Question 1 of 5
A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan?
Correct Answer: C
Rationale: The correct answer is C: Remove all clothing from the newborn except the diaper. This is important during phototherapy as it maximizes the skin surface exposed to the light, aiding in bilirubin breakdown.
Choice A is incorrect as water feeds are unnecessary and may interfere with breastfeeding.
Choice B is incorrect as lotions can interfere with the effectiveness of phototherapy.
Choice D is incorrect as a rash is a common side effect of phototherapy and does not warrant discontinuation of the therapy.
Question 2 of 5
A nurse is reviewing the medical record of a newly admitted client who is at 32 weeks of gestation. Which of the following conditions is an indication for fetal assessment using electronic fetal monitoring?
Correct Answer: A
Rationale: The correct answer is A: Oligohydramnios. Electronic fetal monitoring is used to assess fetal well-being in high-risk pregnancies, including conditions that may affect fetal oxygenation like oligohydramnios. Oligohydramnios refers to a decreased level of amniotic fluid, which can lead to fetal compromise and requires close monitoring. Hyperemesis gravidarum (
B) is severe nausea and vomiting in pregnancy, not directly related to fetal well-being. Leukorrhea (
C) is normal vaginal discharge during pregnancy. Periodic tingling of the fingers (
D) is unrelated to fetal assessment.
Question 3 of 5
A nurse is assessing a client who is postpartum and has idiopathic thrombocytopenia purpura (ITP). Which of the following findings should the nurse expect?
Correct Answer: A
Rationale:
Correct Answer: A - Decreased platelet count.
Rationale: In idiopathic thrombocytopenia purpura (ITP), there is a decreased platelet count due to immune-mediated destruction of platelets. This leads to an increased risk of bleeding and bruising. The nurse should expect thrombocytopenia in a client with ITP.
Summary of other choices:
B: Increased ESR - ESR is not typically affected in ITP.
C: Decreased megakaryocytes - Megakaryocytes are usually increased in ITP as the bone marrow tries to compensate for the decreased platelet count.
D: Increased WBC - WBC count is not typically affected in ITP.
Question 4 of 5
A nurse is planning care for a client who is in labor and is to have an amniotomy. Which of the following assessments should the nurse identify as the priority?
Correct Answer: B
Rationale: The correct answer is B: Temperature. Amniotomy involves breaking the amniotic sac, increasing the risk of infection. Monitoring the client's temperature is crucial to detect early signs of infection, such as fever. Maintaining a normal temperature is essential to prevent maternal and fetal complications. O2 saturation, blood pressure, and urinary output are important assessments but do not take priority over monitoring the client's temperature post-amniotomy.
Question 5 of 5
A nurse in a prenatal clinic is assessing a group of clients. Which of the following clients should the nurse see first?
Correct Answer: A
Rationale: The correct answer is A: A client who is at 11 weeks of gestation and reports abdominal cramping. Abdominal cramping in early pregnancy could indicate ectopic pregnancy, miscarriage, or other serious complications. The nurse should see this client first to assess the severity of the cramping, check for any signs of bleeding, and determine if urgent intervention is needed to protect the client and the pregnancy.
Choices B, C, and D do not present immediate, potentially life-threatening concerns like the possibility of a miscarriage or ectopic pregnancy. Tingling and numbness in the hand (
B) may be related to carpal tunnel syndrome common in pregnancy, constipation (
C) can usually be managed with dietary changes, and occasional bloody noses (
D) are not uncommon in pregnancy.