ATI LPN
ATI PN Maternal Newborn 2023 II Questions
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 1 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: 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:
Vital Signs: Heart rate: 80/min, Temperature: 37.2°C (99°F), Blood pressure: 120/80 mm Hg, Respiratory rate: 18/min. Diagnostic Results: January 8 / 0900: Oral Glucose Tolerance Test with 75-g glucose load - 190 mg/dL (Normal: less than 180 mg/dL). February 8 / 0900: Fasting: 110 mg/dL (Normal: less than 110 mg/dL), 1000: 220 mg/dL (Normal: less than 180 mg/dL), 1100: 165 mg/dL (Normal: less than 140 mg/dL), 1200: 142 mg/dL (Normal: 70 to 115 mg/dL). Nurses' Notes: On January 8 at 0900, the fundal height was measured at 22 cm and fetal heart tones were 150/min. On February 8 at 0900, the fundal height was measured at 27 cm and fetal heart tones were 145/min. The client reports positive fetal movement, denies abdominal cramping, vaginal bleeding, and leaking of fluids. The client also denies headaches, visual disturbances, and epigastric pain. History and Physical: The client is a 32-year-old female, gravida 2 para 1, with a history of gestational diabetes mellitus (GDM) during her previous pregnancy. She is currently at 28 weeks of gestation. The client reports no other significant medical history. She is adhering to a diabetic diet and taking insulin as prescribed.
Question 3 of 5
Complete the following sentence by using the lists of options. The nurse should prepare to reinforce teaching with the client about a ___ with a prescription of ___
Correct Answer: A
Rationale: The nurse should prepare to reinforce teaching with the client about a diabetic diet with a prescription of insulin therapy. Elevated glucose levels indicate the need for continued dietary and insulin management.
Extract:
Vital Signs: Heart rate: 80/min (January 8), Temperature: 36°C (96.8°F) (January 8), Respiratory rate: 12/min (January 8), Pulse oximetry: 99% (January 8), Blood pressure: 132/82 mm Hg (January 8), Heart rate: 90/min (February 8), Temperature: 36°C (96.8°F) (February 8), Respiratory rate: 16/min (February 8), Pulse oximetry: 99% (February 8), Blood pressure: 140/88 mm Hg (February 8). History and Physical: The client is a 24-year-old gravida 2 para 1 who is at 21 weeks of gestation. The client has a history of obesity and hypertension. She is 62 inches tall and weighs 93 kg (205 lb), with a BMI of 37.5. Her prepregnancy weight was 90.7 kg (200 lb) and BMI was 36.6. Scheduled return visit for follow-up in 4 weeks. Provider Prescriptions: Nifedipine 30 mg PO once daily.
Question 4 of 5
Complete the following sentence by using the lists of options. The nurse should prepare to reinforce teaching with the client about a ___ with a prescription of ___
Correct Answer: A
Rationale: The nurse should prepare to reinforce teaching with the client about a low-sodium diet with a prescription of nifedipine. Hypertension management requires dietary sodium reduction and nifedipine.
Extract:
Vital Signs: Temperature: 38.4°C (101.1°F), Heart rate: 108/min, Respiratory rate: 20/min, Blood pressure: 118/72 mm Hg. History and Physical: The client is gravida 1 para 1, at 41 weeks of gestation. The client gave birth via cesarean following prolonged rupture of membranes and cephalopelvic disproportion. Assessment: The client's breasts are starting to feel firmer and heavier, and she denies nipple discomfort. The client is bottle-feeding. The uterus is boggy and tender to palpation, with the fundus at the umbilicus. The lochia discharge is moderate, dark brown, and foul-smelling. The client reports frequent voiding without difficulty. Bilateral edema is noted in the lower extremities, without pain, warmth, or tenderness.
Question 5 of 5
Complete the diagram by selecting 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.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer: A
Rationale: Endometritis is indicated by fever, tender boggy uterus, and foul-smelling lochia. Actions: Administer antibiotics; monitor oxytocic medication. Parameters: Monitor temperature and lochia.