ATI RN
ATI RN Maternal Newborn 2023/24 1st Attempt & Retake Questions
Extract:
A nurse in a clinic is caring for a 16-year-old adolescent.
Provider Prescriptions
1300:
Standing prescriptions for clients who present with abdominal pain:
Obtain laboratory tests:
Urinalysis
Cervical culture
C-reactive protein
Beta hCG
Question 1 of 5
Which of the following findings should the nurse report to the provider? (Select all that apply.)
Correct Answer: A,B,D,E,F
Rationale: The correct findings to report to the provider are A, B, D, E, and F. A nurse should report abnormalities in abdominal assessment (
A) as it can indicate various health issues. Vaginal discharge (
B) can be a sign of infection or other conditions, warranting attention. Temperature (
D) is a vital sign that can indicate infection or illness. Dyspareunia (E) is a symptom of possible gynecological issues that require evaluation. Condom usage (F) is important for assessing safe sex practices and potential risk factors. Heart rate (
C) is a routine vital sign and not typically a finding that requires immediate reporting unless it is significantly abnormal.
Extract:
Question 2 of 5
A nurse is teaching about clomiphene citrate to a client who is experiencing infertility. Which of the following adverse effects should the nurse include?
Correct Answer: A
Rationale: The correct answer is A: Breast tenderness. Clomiphene citrate is a medication commonly used to treat infertility by inducing ovulation. Breast tenderness is a common side effect due to the hormonal changes caused by the medication. This occurs because clomiphene citrate can increase estrogen levels, leading to breast discomfort. Tinnitus (
B), urinary frequency (
C), and chills (
D) are not typically associated with clomiphene citrate use. Tinnitus is more commonly linked to ototoxic medications, urinary frequency may be seen with diuretics, and chills are often indicative of an infection or allergic reaction.
Therefore, breast tenderness is the most relevant adverse effect to include in the teaching for a client experiencing infertility and taking clomiphene citrate.
Question 3 of 5
A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hr ago. Which of the following findings place the client at risk for postpartum hemorrhage? (Select all that apply.)
Correct Answer: A,C,D
Rationale: The correct answer choices, A, C, and D, all contribute to an increased risk of postpartum hemorrhage. A, labor induction with oxytocin, can lead to uterine hyperstimulation, increasing the risk of postpartum hemorrhage. C, vacuum-assisted delivery, may cause trauma to the birth canal, leading to increased bleeding. D, history of uterine atony, indicates a previous inability of the uterus to contract effectively, which is a major risk factor for postpartum hemorrhage.
Therefore, these factors collectively place the client at a higher risk for postpartum hemorrhage.
Choices B and E are incorrect as they do not directly relate to the risk of postpartum hemorrhage.
Question 4 of 5
A nurse is assessing a client who is postpartum and has idiopathic thrombocytopenia purpura (ITP). Which of the following findings should the nurse expect?
Correct Answer: A
Rationale: The correct answer is A: Decreased platelet count. In ITP, the immune system attacks and destroys platelets, leading to a low platelet count (thrombocytopenia). This can result in increased bleeding tendencies.
B: Increased ESR is not typically associated with ITP.
C: Decreased megakaryocytes is not expected in ITP as these are the precursors of platelets.
D: Increased WBC is not a characteristic finding in ITP.
Therefore, the nurse should expect a decreased platelet count in a client with postpartum ITP.
Question 5 of 5
A nurse is planning care for a client who is to undergo a nonstress test. Which of the following actions should the nurse include in the plan of care?
Correct Answer: D
Rationale: The correct answer is D: Instruct the client to press the provided button each time fetal movement is detected. This action is crucial during a nonstress test, as pressing the button when fetal movement is felt helps to correlate fetal heart rate changes with fetal movement, providing valuable information about the baby's well-being. This allows healthcare providers to assess the baby's response to movement and determine if the fetal heart rate is within normal parameters.
Maintaining the client NPO (
Choice
A) is not necessary for a nonstress test. Placing the client in a supine position (
Choice
B) can decrease blood flow to the fetus and is contraindicated during pregnancy. Instructing the client to massage the abdomen (
Choice
C) may not be appropriate as it could potentially interfere with the test results by causing fetal movement that is not spontaneous.