ATI RN
ATI Custom PNU Maternity Fall 2023 Questions
Extract:
A nurse is assisting with monitoring a client who has preeclampsia and is receiving magnesium sulfate. The client's respiratory rate is 8 breaths/min and the nurse suspects toxic levels of magnesium.
Question 1 of 5
Which of the following should the nurse administer?
Correct Answer: A
Rationale: The correct answer is A: Calcium gluconate. In cases of calcium channel blocker toxicity, calcium gluconate is administered to counteract the effects of the overdose by increasing calcium levels and improving cardiac contractility. Flumazenil (
B) is used for benzodiazepine overdose, naloxone (
C) for opioid overdose, and protamine sulfate (
D) for heparin overdose. Calcium gluconate is the appropriate choice in this scenario due to the indication of calcium channel blocker toxicity.
Extract:
A nurse is caring for a client who is 1 day postpartum following a cesarean birth.
Question 2 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:
A nurse is reinforcing teaching about reducing the risk of perineal infection with a client who had a vaginal birth.
Question 3 of 5
Which of the following information should the nurse include in the teaching? (Select all that apply.)
Correct Answer: A,D,E
Rationale:
Correct
Answer: A, D, E
Rationale:
A: Blotting the perineal area dry after voiding helps prevent infection and irritation.
D: Cleaning the perineal area from front to back reduces the risk of introducing bacteria into the urinary tract.
E: Performing hand hygiene before and after voiding helps prevent the spread of infection.
Incorrect
Choices:
B: Applying ice packs to the perineal area can decrease blood flow and slow healing.
C: Sitting on an inflatable donut can increase pressure on the perineum and delay healing.
Extract:
A nurse is reinforcing nutritional teaching with a client who is at 8 weeks of gestation.
Question 4 of 5
Which of the following statements should the nurse include?
Correct Answer: B
Rationale: The correct answer is B: "You should increase your folic acid intake during your pregnancy." This is because folic acid is crucial for preventing neural tube defects in the developing fetus. It is recommended that pregnant women increase their intake of folic acid to at least 600 micrograms per day. Adequate folic acid intake is essential during pregnancy to support the baby's brain and spinal cord development.
Explanation for incorrect choices:
A: Incorrect. Nausea is a common symptom during pregnancy, but stopping prenatal vitamins can deprive the mother and baby of essential nutrients.
C: Incorrect. Iron intake is important during pregnancy to prevent anemia, especially in the first trimester when blood volume increases.
D: Incorrect. While calorie needs increase during pregnancy, the general recommendation is an additional 300-500 calories per day, not 750.
Extract:
A nurse is reinforcing teaching with a client who is pregnant and whose routine diagnostic testing reveals a negative rubella titer.
Question 5 of 5
Which of the following statements should the nurse tell the client?
Correct Answer: D
Rationale: The correct answer is D: "You will need an immunization following delivery." This statement is correct because rubella immunity acquired from a previous infection or vaccination can decrease over time, especially during pregnancy. Postpartum rubella vaccination can boost immunity to protect both the mother and future pregnancies.
A: Incorrect - Past infection does not guarantee current immunity.
B: Incorrect - Administering the vaccine during pregnancy is contraindicated.
C: Incorrect - Immunity status should be confirmed through blood tests.
D: Correct - Postpartum immunization is recommended to ensure protection.
E, F, G: N/A