ATI LPN
ATI PN Maternal Newborn 2023 II Questions
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 1 of 4
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 2 of 4
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 3 of 4
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 4 of 4
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.
Extract:
Nurses' Notes: At 0625, the client is alert and oriented, at 38 weeks of gestation, presenting to the labor and delivery unit for evaluation of fluid leaking from the vagina. The client states they felt a small gush of fluid and thinks their membranes have ruptured. At 0830, mild contractions are occurring 20 minutes apart, irregular, lasting 40 seconds. The client rates the pain as a 3 on a scale of 0 to 10. An electronic fetal monitor is applied. The client voided 50 mL of clear yellow urine in a bedpan. Mild contractions are now 15 minutes apart, irregular, lasting 30 seconds. The cervix is 2 cm dilated with 20% effacement. The client rates pain as a 4 on a scale of 0 to 10. The fetal heart rate (FHR) is 132/min with moderate variability.
Question 5 of 4
The nurse is assisting with planning care for the client. After review of the client's electronic medical record (EMR), which of the following interventions should the nurse recommend as anticipated, nonessential, or contraindicated?
| Options | Indicated | Non-Essential | Contraindicated |
|---|---|---|---|
| Encourage frequent ambulation | |||
| Ensure the client maintains a supine position while in bed | |||
| Check FHR every 30 min | |||
| Perform a Nitrazine test | |||
| Prepare the client for catheterization | |||
| Obtain CBC blood sample | |||
| Check the client's temperature every hour |
Correct Answer: A: Anticipated, B: Contraindicated, C: Anticipated, D: Anticipated, E: Nonessential, F: Nonessential, G: Anticipated
Rationale: A: Encourages labor progression. B: Can impede labor and fetal oxygenation. C: Ensures fetal well-being. D: Confirms rupture of membranes. E: Not needed with spontaneous voiding. F: No signs of infection. G: Monitors for infection post-rupture.