ATI RN Maternal Newborn 2023 IV

Extract:

A nurse is planning care for a client who is 12 hr postpartum and has a third-degree perineal laceration.

Question 1 of 5

Which of the following interventions should the nurse include in the plan?

A. Encourage the client to apply a warm pack to the perineum for discomfort. B. Prepare the client for a pudendal nerve block. C. Apply hydrogel pads to the perineum every 4 hr. D. Place a witch hazel pad on the client's perineal pad after each voiding.

Correct Answer: D

Rationale: Witch hazel pads reduce swelling and discomfort, aiding healing in third-degree lacerations. Warm packs may worsen swelling, and nerve blocks or hydrogels are not routine.

Extract:

A nurse is caring for a client. Nurses' Notes: Initial visit, 1340: 29-year-old G2P0, positive hCG 2 weeks ago, LMP 7 weeks ago, vomiting daily for 2 weeks, vegetarian, poor protein intake, decreased skin turgor, moist mucous membranes, weight 79.4 kg. Vital Signs: HR 110/min, RR 18/min, BP 104/66 mmHg, Temp 36.6Â°C, SpO2 99%. Labs: WBC 7,500/mmÂ³, Hgb 10.2 g/dL, Hct 45%, Platelets 360,000/mmÂ³, Na 136 mEq/L, K 3.3 mEq/L, BUN 28 mg/dL, UA: dark amber, SG 1.045.

Question 2 of 5

Click to highlight the findings that require follow-up.

A. Vomiting several times a day B. Decreased skin turgor C. Hgb 10.2 g/dL D. Potassium 3.3 mEq/L E. BUN 28 mg/dL F. Color dark amber, SG 1.045 G. Heart rate 110/min

Correct Answer: A, B, C, D, E, F

Rationale: Vomiting (
A), decreased turgor (
B), low Hgb (
C), low potassium (
D), high BUN (E), and dark amber urine with high SG (F) indicate dehydration, anemia, and electrolyte imbalance needing follow-up.

Extract:

A nurse is preparing to administer phytonadione 0.5 mg to a newborn.

Question 3 of 5

Which of the following routes should the nurse choose for administration of the medication?

A. IM in right deltoid B. Subcutaneous in the right deltoid C. IM in left vastus lateralis D. Subcutaneous in the left vastus lateralis

Correct Answer: C

Rationale: The vastus lateralis muscle in the thigh is the preferred site for IM injections in newborns due to its size and accessibility. Phytonadione (Vitamin K) is administered IM, not subcutaneously, and the deltoid is not used in newborns.

Extract:

A nurse is assessing the results of a nonstress test for an antepartal client at 35 weeks of gestation.

Question 4 of 5

Which of the following findings should indicate to the nurse the need for further diagnostic testing?

A. Irregular contractions of 10 to 20 seconds in duration that are not felt by the client B. An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40-min testing period C. No late decelerations in the fetal heart rate noted with three uterine contractions of 60 seconds in duration within a 10-min testing period D. Three fetal movements perceived by the client in a 20-min testing period

Correct Answer: A

Rationale: Irregular contractions not felt by the client may indicate decreased fetal movement, warranting further evaluation. The other findings (reactive NST, no late decelerations, fetal movements) are reassuring.

Extract:

A nurse is caring for a client who is at 28 weeks of gestation and received no immunizations during childhood.

Question 5 of 5

Which of the following vaccines should the nurse plan to administer?

A. Human papillomavirus B. Rubella C. Varicella D. Tetanus

Correct Answer: D

Rationale: Tetanus vaccination (Tdap) is safe and recommended during pregnancy to prevent maternal and neonatal tetanus. HPV, rubella, and varicella vaccines are contraindicated due to lack of safety data or live virus content.

ATI RN Maternal Newborn 2023 IV | Nurselytic

Nurselytic

ATI RN

ATI RN