ATI RN
RN ATI Maternal Newborn 2023 with NGN Questions
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 1 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 2 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.
Question 3 of 5
A nurse in a family planning clinic is caring for a client who requests an oral contraceptive. Which of the following findings in the client's history should the nurse recognize as a contraindication to oral contraceptives? (Select all that apply.)
Correct Answer: A, B, D
Rationale: The correct answer is A, B, D. Cholecystitis is a contraindication due to an increased risk of gallbladder disease with oral contraceptive use. Hypertension is a contraindication because estrogen in oral contraceptives can exacerbate hypertension. Migraine headaches with aura are a contraindication due to an increased risk of stroke. Human papillomavirus and anxiety disorder are not contraindications for oral contraceptives.
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.
Extract:
The nurse is reviewing laboratory results in the adolescent's medical record.
Exhibit 1
Vital Signs
1300: Blood pressure 118/72 mm Hg, Heart rate 100/min ,Respiratory rate 20/min ,Temperature 38.3° C
(101° F)
Exhibit 2:
Provider Prescriptions 1300: Standing prescriptions for clients who present with abdominal pain: Obtain
laboratory tests: Urinalysis Cervical culture C-reactive protein Beta hCG
Exhibit 3:
Nurses' Notes 1300: Admitted adolescent reporting "cramping in my stomach." Reports pain as a 4 on 0
to 10 pain scale and describes pain as constant and dull. Reports nausea and vomiting over past 24
hours. Reports painful urination and pain during sexual intercourse with minimal vaginal itching-
Tenderness with palpation to lower abdomen, guarding abdomen observed. Greenish vaginal discharge
observed. Reports last menstrual period was 3 weeks ago as normal period lasted 4 days. “
Question 5 of 5
Which of the following conditions is the client most likely developing?
| Pelvic inflammatory. |
| Ectopic pregnancy. |
| Pyclonephritis. |
| C-reactive protein. |
| Beta hCG. |
| Urinalysis. |
Correct Answer: A
Rationale: For the correct answer A : (1, 0, 0, 0, 0, 0)
Rationale: Pelvic inflammatory disease (PI
D) is an infection of the female reproductive organs. It typically presents with symptoms like pelvic pain, abnormal vaginal discharge, fever, and painful urination. It is commonly associated with sexually transmitted infections. In this scenario, the client is most likely developing PID due to the presence of symptoms such as pelvic pain and abnormal discharge. Ectopic pregnancy (
B) presents with abdominal pain and vaginal bleeding, not typically associated with PID. Pyelonephritis (
C) is a kidney infection that manifests with fever, flank pain, and urinary symptoms, not specific to PID. C-reactive protein (
D) is a marker of inflammation, not a condition itself. Beta hCG (E) is a hormone indicative of pregnancy, not specific to PID. Urinalysis (F) can help diagnose urinary tract infections but