ATI RN
ATI RN Maternal Newborn 2023/24 1st Attempt & Retake Questions
Extract:
A nurse is caring for a newborn who was born at 39 weeks of gestation and is 36 hr old.
Physical Examination:
• Fontanels soft and flat
• Head molded with caput succedaneum
• Eyes symmetric, no discharge, sclera yellow
• Mucous membranes dry
• Abdomen soft and rounded, bowel sounds present x 4 quadrants
Question 1 of 5
Which of the following findings should the nurse report to the provider? (Select all that apply.)
Correct Answer: A,B,C,G
Rationale: The correct answer is A, B, C, and G.
A: Coombs test result is important for assessing for hemolytic anemia.
B: Mucous membrane assessment can indicate hydration status and oxygenation.
C: Intake and output are crucial for assessing fluid balance.
G: Sclera color can indicate liver function or jaundice.
Other choices are incorrect because:
D: Respiratory rate is important, but not typically a priority to report unless abnormal.
E: Head assessment finding is broad and does not specify a critical finding.
F: Heart rate is important, but not as critical as the other choices.
Extract:
Question 2 of 5
A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D: "I will eliminate products that contain dairy from my diet." This is the correct choice because dairy products can exacerbate symptoms of hyperemesis gravidarum due to their high fat content, which can be difficult to digest during pregnancy. By eliminating dairy products, the client can potentially reduce nausea and vomiting.
A: "I will eat foods that taste good instead of balancing my meals." This choice is incorrect because focusing solely on taste without considering nutritional balance may not address the client's specific dietary needs during hyperemesis gravidarum.
B: "I will avoid having a snack before I go to bed each night." This choice is not directly related to managing hyperemesis gravidarum through dietary changes.
C: "I will have a cup of hot tea with each meal." While hot tea can be soothing, it may not address the specific dietary modifications needed for managing hyperemesis gravidarum.
Question 3 of 5
A nurse is assessing a newborn who has neonatal abstinence syndrome. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Excessive crying. Neonatal abstinence syndrome is characterized by withdrawal symptoms in newborns exposed to drugs in utero. Excessive crying is a common manifestation due to irritability and discomfort. Diminished deep tendon reflexes (
A) are not typically associated. Decreased muscle tone (
C) may be present but is not a defining feature. Absent Moro reflex (
D) is not a typical finding in neonatal abstinence syndrome.
Question 4 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 lead to mood changes, including depression, as a known adverse effect. This is due to hormonal fluctuations caused by the medication.
Choice B, polyuria, is excessive urination which is not typically associated with oral contraceptives.
Choice C, hypotension, is low blood pressure and is not a common adverse effect of this medication.
Choice D, urticaria, is hives or skin rash, which is not directly linked to oral contraceptives. In summary, depression is the correct adverse effect to include in teaching as it is a recognized side effect of combined oral contraceptives, while the other choices are not commonly associated with this medication.
Question 5 of 5
A nurse is caring for a client who is at 22 weeks of gestation and is HIV positive. Which of the following actions should the nurse take?
Correct Answer: D
Rationale:
Correct Answer: D - Report the client’s condition to the local health department.
Rationale: Reporting the client's HIV positive status to the local health department is crucial for public health surveillance and monitoring. This action helps to prevent the spread of HIV to others and ensures appropriate follow-up care and support for the client. It also allows for contact tracing and identification of potential exposure risks. Additionally, notifying the health department enables them to provide resources and interventions to support the client's health and well-being.
Incorrect
Choices:
A: Administering penicillin G is not the appropriate action for an HIV-positive client at 22 weeks of gestation. Penicillin G is typically used to treat bacterial infections, not HIV.
B: Instructing the client to schedule an annual pelvic examination is important for general health maintenance but is not directly related to the client's HIV status and gestational age.
C: Waiting to start HIV medication until after delivery is not recommended as timely initiation of antiretrov