Custom ATI Maternity Final 2023 | Nurselytic

Questions 53

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Custom ATI Maternity Final 2023 Questions

Extract:

A client in the immediate postoperative period following removal of an ectopic pregnancy via salpingostomy.


Question 1 of 5

For which of the following indications should the nurse administer Rho(D) Immune globulin?

Correct Answer: C

Rationale: The correct answer is C because Rho(
D) Immune globulin is administered to Rh-negative individuals to prevent sensitization to Rh-positive blood. This is crucial in preventing hemolytic disease of the newborn in future pregnancies.
Choice A is incorrect as the desire to conceive does not warrant the administration of Rho(
D) Immune globulin.
Choice B is incorrect because having previously given birth to an Rh-negative infant does not necessitate the administration of Rho(
D) Immune globulin.
Choice D is incorrect as significant blood loss during a procedure does not directly relate to the need for Rho(
D) Immune globulin.

Extract:

A newborn who is 48 hours old.


Question 2 of 5

Which of the following findings should the nurse report to the provider?

Correct Answer: B

Rationale: The correct answer is B: Jaundiced skin and yellow tinge to the sclera. This finding indicates elevated bilirubin levels, which could be a sign of liver dysfunction or hemolysis. It needs immediate medical attention to prevent complications like kernicterus.
A: Erythema toxicum is a common benign rash in newborns, not requiring immediate reporting.
C: Mongolian spot is a harmless birthmark common in infants of certain ethnicities, not requiring urgent reporting.
D: Telangiectatic nevi are small, benign blood vessels on the skin, not needing immediate reporting.

Extract:

A client is concerned that her newborn has "crossed eyes."


Question 3 of 5

Which of the following statements is a therapeutic response by the nurse?

Correct Answer: C

Rationale: The correct answer is C: Newborns lack the necessary muscle control to regulate eye movement. This is a therapeutic response because it provides accurate and helpful information to the parent regarding their baby's eye movement. It demonstrates the nurse's knowledge and reassures the parent that their baby's condition is normal. This response also shows empathy and understanding towards the parent's concerns.


Choices A, B, and D are incorrect:
A: I will call your provider and report your concerns - This response does not provide direct information or reassurance to the parent about their baby's condition.
B: I will take your baby back to the nursery for an examination - This response does not address the parent's concerns or provide information about the baby's eye movement.
D: This condition is easily treated by patching your baby's eyes - This response is presumptive and may cause unnecessary worry or confusion for the parent.

Extract:

A newborn immediately after birth. At 5 min after birth, the newborn has acrocyanosis, flexed extremities, a grimace when suctioned, a heart rate of 130/min, and a lusty cry with tactile stimulation.


Question 4 of 5

What should the nurse document as the newborn's 5 min Apgar score?

Correct Answer: C

Rationale: The correct answer is C (9) for the newborn's 5 min Apgar score. The Apgar score assesses the newborn's health at 1 and 5 minutes after birth based on appearance, pulse, grimace, activity, and respiration. A score of 9 indicates the newborn is in good health with minor signs of distress, such as a slightly pale body color or weak cry. A score of 10 would be rare and signifies excellent health.

Choices A (5) and B (7) indicate a lower score, which would suggest more significant signs of distress.
Therefore, choice C (9) is the most appropriate score based on the guidelines for assessing newborn health.

Extract:

A client who is postpartum.


Question 5 of 5

Which of the following instructions should the nurse include?

Correct Answer: D

Rationale: The correct answer is D. Immersing the newborn's abdomen in water before the cord is dry can lead to infection. It is crucial to keep the cord dry until it naturally falls off.
Choice A is incorrect because baby oil can trap moisture, leading to infection.
Choice B is incorrect as covering the cord can also trap moisture.
Choice C is incorrect as the stump may fall off earlier or later.

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