ATI LPN
ATI PN Maternal Newborn 2023 II Questions
Extract:
Vital Signs: Heart rate: 132/min, Axillary temperature: 36° C (96.8° F), Respiratory rate: 72/min, Weight: 4,366 g (9 lb 10 oz). History and Physical: The newborn was delivered via spontaneous vaginal birth at 41 weeks of gestation. The mother is gravida 2 para 2 with a history of syphilis in the first trimester, treated with penicillin, and no reoccurrence during the pregnancy. The mother also reports intermittent cannabis use during pregnancy. Diagnostic Results: Blood type: A+, Venereal Disease Research Laboratory (VDRL): negative, Rapid Plasma Reagin (RPR): negative, Urine drug screen: Positive for marijuana, negative for opiates, cocaine, amphetamines, or barbiturates. Nurses' Notes: The newborn is lying in a bassinet, lightly swaddled. The newborn is noted to be jittery with a weak cry when disturbed. Extremities are mottled with acrocyanosis. Respirations are rapid and unlabored.
Question 1 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct Answer:
Rationale: Hypoglycemia is most likely given the newborn's jitteriness, weak cry, and mottled extremities. Actions: Feed the newborn to increase blood sugar; monitor phototherapy for jaundice. Parameters: Assess skin integrity; monitor bilirubin levels.
Extract:
Vital Signs: Heart rate: 88/min, Temperature: 37.1°C (98.8°F), Respiratory rate: 16/min, Blood pressure: 122/78 mm Hg. History and Physical: The client is gravida 2 para 1, with a previous vaginal delivery. She has a history of hypothyroidism and Herpes simplex virus type 2. She is currently undergoing labor induction at 39 weeks and 3 days of gestation. Assessment: The fetal heart rate is 140/min with moderate variability, and mild uterine irritability is noted. The abdomen is soft and nontender upon palpation. Cervical examination reveals dilation of 1 cm, thickness, and no presenting part palpable. An ultrasound shows a footling breech presentation. There are clusters of lesions noted on the vaginal introitus and labia majora. Laboratory Results: WBC count: 9,500/mm³ (Normal: 5,000 to 15,000/mm³), Hgb: 10.5 mg/dL (Normal: greater than 11 mg/dL), Hct: 31% (Normal: greater than 33%), Platelets: 225,000/mm³ (Normal: 150,000 to 400,000/mm³), Blood Type/Rh: O+. Provider Prescriptions: Levothyroxine 100 mcg PO once daily in PM, Acetaminophen 325 mg PO every 6 hr PRN, Dinoprostone 10 mg intravaginally x one dose now, Terbutaline 2.5 mcg/min intravenous per provider's instructions.
Question 2 of 5
For which of the following findings should the nurse anticipate a provider's prescription to withhold the dinoprostone? Select all that apply.
Correct Answer: A,C,E
Rationale: Breech presentation, abnormal FHR, and lesions (Herpes simplex) are contraindications for dinoprostone due to increased risks of complications and neonatal herpes transmission.
Extract:
A nurse is assisting with the care of a client who is in the latent phase of labor and just had an amniotomy.
Question 3 of 5
Which of the following findings indicates that the fetus is at risk?
Correct Answer: A
Rationale: This finding indicates fetal distress. Recurrent variable decelerations in the fetal heart rate (FHR) can be a sign of umbilical cord compression, which can compromise fetal oxygenation.
Extract:
Vital Signs: Heart rate: 84/min, Temperature: 37.3°C (99.1°F), Blood pressure: 128/82 mm Hg, Respiratory rate: 18/min. Diagnostic Results: Blood glucose: 120 mg/dL (Normal: 74 to 106 mg/dL). Medical History: The client is a 24-year-old female with a history of type 1 diabetes mellitus first diagnosed at 14 years of age. The client is on insulin for diabetes management. No other significant prenatal history is noted. The client is gravida 1 para 1 following a spontaneous vaginal birth at 37 weeks of gestation. The newborn was large for gestational age, weighing 4.1 kg (9 lb). The client has a third-degree laceration that required several stitches. Nurses' Notes: Client was admitted to the postpartum unit 4 hours after delivery. The fundus is firm and midline at the level of the umbilicus. Lochia is moderate. A lunch tray was given. The newborn is sleeping in a bassinet next to the client's bed. The client is diaphoretic, with skin that is clammy. Pulse is rapid, strong, and regular, and respirations are shallow. The client reports a headache, slight nausea, and feeling weak.
Question 4 of 5
Complete the following sentence by using the list of options. The nurse should plan to ___ then ___
Correct Answer: A
Rationale: The nurse should plan to check the client's blood glucose level then implement seizure precautions. Symptoms suggest hypoglycemia, common in diabetic patients, requiring glucose check and seizure precautions.
Extract:
Vital Signs (0900): Temperature: 37° C (98.6° F), Heart rate: 90/min, Blood pressure: 158/100 mm Hg, Respiratory rate: 16/min. (1000): Oxygen saturation: 98% on room air, Heart rate: 95/min, Temperature: 37° C (98.6° F), Blood pressure: 162/110 mm Hg, Respiratory rate: 20/min. Diagnostic Results: Hct: 35% (33 to 47%), Hgb: 10 g/dL (11 to 16 g/dL), Urine: 2+ protein, Platelet count: 95,000/mm³ (150,000 to 400,000/mm³), Aspartate aminotransferase (AST): 200 units/L (0 to 35 units/L), Alanine aminotransferase (ALT): 25 units/L (4 to 36 units/L), Total bilirubin: 1.8 mg/dL (0.3 to 1 mg/dL). Medical History: The client is a 26-year-old primigravida at 28 weeks of gestation. She is obese and has no history of hypertension or diabetes mellitus. She presents with elevated blood pressure, peripheral edema, and headaches. Physical Examination Results: The client is alert and oriented to person, place, and time. Her heart rate is regular, and respirations are even and non-labored. She has 3+ deep tendon reflexes and +2 pitting edema of the bilateral lower extremities. The fetal heart rate (FHR) is 140/min with moderate variability.
Question 5 of 5
Complete the following sentence by using the lists of options. The nurse should first address the client's ___ followed by the client's ___ and ___
Correct Answer: B
Rationale: The nurse should first address the client's blood pressure followed by the client's headache and liver enzymes. High blood pressure indicates preeclampsia, requiring immediate intervention. Headache and elevated liver enzymes (AST 200 units/L) suggest severe preeclampsia complications.