ATI RN
ATI Custom PNU Maternity Fall 2023 Questions
Extract:
A nurse is assisting in the care of a client who is to undergo an amniotomy.
Question 1 of 5
Which of the following is the priority nursing action following this procedure?
Correct Answer: A
Rationale: The correct answer is A: Check the fetal heart rate pattern. This is the priority nursing action because it assesses the well-being of the fetus immediately after a procedure that may impact fetal distress. Monitoring the fetal heart rate helps identify any potential complications and guides further interventions. Evaluating for signs of infection (
B) is important but not the immediate priority post-procedure. Taking the client's temperature (
C) and observing amniotic fluid (
D) are important assessments but do not directly address fetal well-being.
Extract:
A nurse is reinforcing teaching about nutrition with a client who is pregnant and has hyperemesis gravidarum at home.
Question 2 of 5
Which of the following statements indicates that the client understands the teaching?
Correct Answer: D
Rationale: The correct answer is D: "I will eat crackers before I get out of bed in the morning." This statement indicates understanding as it demonstrates compliance with a specific teaching instruction. Eating crackers before getting out of bed is a common recommendation for managing morning sickness or low blood sugar levels upon waking.
Choices A, B, and C are incorrect because they do not directly address a specific teaching point or demonstrate understanding of the instruction given.
Choice A focuses on timing rather than the actual instruction.
Choice B mentions water consumption, which is not necessarily related to the teaching.
Choice C talks about limiting protein intake, which may or may not be relevant to the teaching provided.
Extract:
A nurse is caring for a client who is 1 day postpartum following a cesarean birth.
Question 3 of 5
To prevent thrombophlebitis, the nurse should contribute which of the following interventions to the client's plan of care?
Correct Answer: A
Rationale: The correct answer is A: Place pillows under the client's knees while she is resting in bed. Elevating the client's legs with pillows promotes venous return, reducing the risk of thrombophlebitis. It helps prevent blood pooling in the lower extremities, decreasing the chances of blood clots forming. This intervention also improves circulation and reduces venous stasis.
Choices B and D are incorrect as applying hot moist soaks or keeping the client on bed rest do not directly address venous return or clot prevention.
Choice C, assisting the client to ambulate, is beneficial for circulation but may not be as effective as elevating the legs.
Extract:
Vital Signs: 0800: Temperature 36.6°C (97.9°F), Pulse 88/min, Respirations 20/min, BP 179/99 mm Hg. 0815: Pulse 82/min, Respirations 16/min, BP 168/104 mm Hg. 0830: Pulse 81/min, Respirations 16/min, BP 170/101 mm Hg. Medical History: Gravida 3 Para 2, 32 weeks gestation, Allergies: Penicillin, Height 5'4, Weight 80.7 kg (178 lb), BMI 30.6, 6 lb weight gain in 2 weeks. Client reports 5-day headache, blurred vision, dizziness, unrelieved by Tylenol, swelling of feet/fingers, 2+ pitting edema, DTR 3+, FHT 148.
Question 4 of 5
Which of the following findings should the nurse report to the provider?
Correct Answer: C,D,E
Rationale: The nurse should report weight, visual disturbances, and blood pressure to the provider as they indicate potential health issues. Weight changes can signal fluid retention or malnutrition. Visual disturbances may signify neurological or ocular problems. Abnormal blood pressure levels can indicate cardiovascular issues or preeclampsia. Respirations, fetal heart rate, and deep tendon reflexes are typically monitored during routine assessments and don't necessarily require immediate reporting unless significantly abnormal.
Extract:
A nurse is reinforcing teaching with a newly licensed nurse about the complications associated with maternal gestational diabetes.
Question 5 of 5
Which of the following complications should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Newborn hypoglycemia. This complication should be included because infants born to mothers with gestational diabetes are at risk for hypoglycemia due to the abrupt decrease in glucose supply after birth. The other options are not directly related to gestational diabetes. A (Small for gestational age) is a condition where the baby is smaller than expected, not necessarily due to gestational diabetes. B (Oligohydramnios) is a low level of amniotic fluid, which is not typically a complication of gestational diabetes. D (Placenta previa) is a condition where the placenta partially or completely covers the cervix, unrelated to gestational diabetes.