ATI RN
RN ATI Maternal Newborn 2023 with NGN Questions
Extract:
Question 1 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.
Extract:
A nurse is caring for a newborn.
Exhibit1
Vital Signs
8 hr of age:
Temperature: 37.1° C (98.8° F) Axillary
Pulse rate: 132/min
Respiratory rate: 52/min
36 hr of age:
Temperature: 36.1° C (97" F) Axillary
Pulse rate: 160/min
Respiratory rate: 78/min”
Question 2 of 5
For each assessment finding, click to specify if the finding is consistent with hypoglycemia, hyperbilirubinemia, or sepsis.
| Assessment Findings | Hypoglycemia | Hyperbilirubinemia | Sepsis | |
|---|---|---|---|---|
| Ecchymotic caput Succedaneum. | ||||
| Decreased temperature. | ||||
| Lethargy. | ||||
| Poor feeding. | ||||
| Respiratory distress. | ||||
| Yellow sclera and oral mucosa. |
Correct Answer: B, C, D, E, F
Rationale:
To determine if the assessment findings are consistent with hypoglycemia, hyperbilirubinemia, or sepsis, we analyze each choice.
B: Decreased temperature - Can be seen in hypoglycemia, sepsis, but not hyperbilirubinemia.
C: Lethargy - Common in hypoglycemia, sepsis, less in hyperbilirubinemia.
D: Poor feeding - Indicative of hypoglycemia, sepsis, not hyperbilirubinemia.
E: Respiratory distress - Present in sepsis, less likely in hypoglycemia or hyperbilirubinemia.
F: Yellow sclera and oral mucosa - Suggestive of hyperbilirubinemia.
Therefore, choices B, C, D, E, F are consistent with a range of hypoglycemia, sepsis, and hyperbilirubin
Extract:
Question 3 of 5
A nurse is admitting a client to the labor and delivery unit when the client states, 'My water just broke.' Which of the following interventions is the nurse's priority?
Correct Answer: D
Rationale: The correct answer is D: Begin FHR monitoring. Monitoring fetal heart rate (FHR) is the priority as it assesses the well-being of the baby after the water breaking. A sudden gush of fluid can indicate potential stress on the baby, so immediate monitoring is crucial. Performing Nitrazine testing (choice
A) or assessing the fluid (choice
B) can be done after ensuring the baby's safety. Checking cervical dilation (choice
C) is important but not as urgent as monitoring the FHR.
Question 4 of 5
A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: A
Rationale: The correct answer is A. By stating "I will eat foods that taste good instead of balancing my meals," the client shows an understanding of the importance of listening to their body's cravings and preferences while still maintaining a balanced diet to manage hyperemesis gravidarum. This response acknowledges the need to prioritize enjoyment of food while ensuring adequate nutrition.
Incorrect choices:
B: Avoiding a snack before bed may not address the issue of balancing meals throughout the day.
C: Having a cup of hot tea with each meal is unrelated to the principles of balancing meals or addressing hyperemesis gravidarum.
D: Eliminating dairy products may lead to nutrient deficiencies unless alternative sources of calcium and other essential nutrients are included in the diet.
Question 5 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.