ATI RN
RN ATI Maternal Newborn 2023 with NGN Questions
Extract:
Question 1 of 5
A nurse is planning care for a client who is in labor and is requesting epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care?
Correct Answer: C
Rationale: The correct answer is C: Monitor the client's blood pressure every 5 min following the first dose of anesthetic solution. This is crucial to assess for any potential hypotension, a common side effect of epidural anesthesia. Close monitoring allows for prompt intervention if hypotension occurs, ensuring the client's safety.
Choice A is incorrect because placing the client in a supine position following epidural anesthesia can lead to hypotension.
Choice B is incorrect as administering dextrose solution is not necessary for epidural anesthesia.
Choice D is incorrect as NPO status is not required for epidural anesthesia administration.
Question 2 of 5
A nurse is assessing the newborn of a client who took a selective serotonin reuptake inhibitor (SSRI) during pregnancy. Which of the following manifestations should the nurse identify as an indication of withdrawal from an SSRI?
Correct Answer: D
Rationale: The correct answer is D: Vomiting. Neonatal withdrawal from SSRIs can present with symptoms such as jitteriness, irritability, poor feeding, and gastrointestinal symptoms like vomiting. This is due to the sudden cessation of the drug after birth, leading to withdrawal symptoms. The other choices are incorrect because large for gestational age (
A) is not typically associated with SSRI withdrawal; hyperglycemia (
B) is not a common withdrawal symptom; bradypnea (
C) is not a typical manifestation of SSRI withdrawal.
Question 3 of 5
A nurse is caring for a postpartum client who is receiving heparin via a continuous IV infusion for thrombophlebitis in their left calf. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Maintain the client on bed rest. This is important to prevent dislodgement of the clot and further complications associated with thrombophlebitis. Moving the client around can increase the risk of clot migration. Administering aspirin for pain (choice
A) is not appropriate as it can increase the risk of bleeding with heparin therapy. Massaging the affected leg every 12 hours (choice
C) can also dislodge the clot and is contraindicated. Applying cold compresses to the affected calf (choice
D) can also increase the risk of clot dislodgement.
Therefore, the best action is to maintain the client on bed rest to minimize the risk of complications.
Question 4 of 5
A nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. Which of the following findings should the nurse report to the provider?
Correct Answer: C
Rationale: The correct answer is C: Urine output of 280 mL within 8 hr. In hyperemesis gravidarum, a low urine output may indicate dehydration despite IV fluid replacement. This finding is critical as it suggests inadequate renal perfusion. A reduced urine output can lead to electrolyte imbalances and compromised fetal well-being. Reporting this to the provider is essential for prompt intervention.
Choices A, B, and D are within normal limits for a client with hyperemesis gravidarum. A blood pressure of 105/64 mm Hg and heart rate of 98/min can be expected due to dehydration. Urine negative for ketones is a positive finding, indicating improved hydration and reduced risk of metabolic complications.
Question 5 of 5
A nurse is providing teaching for a client who has a new prescription for combined oral contraceptives. Which of the following findings should the nurse include as an adverse effect of this medication?
Correct Answer: A
Rationale: The correct answer is A: Depression. Combined oral contraceptives can cause mood changes, including depression, as an adverse effect. Estrogen in the medication can affect neurotransmitters in the brain, leading to mood alterations. Polyuria (
B) is excessive urination, not typically associated with oral contraceptives. Hypotension (
C) is low blood pressure, not a common side effect of oral contraceptives. Urticaria (
D) is hives, which is not a typical adverse effect of this medication. It is essential for the nurse to educate the client about potential adverse effects to monitor and report any concerning symptoms.