ATI Proctored Exam Maternal Newborn

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ATI Proctored Exam Maternal Newborn A nurse is caring for a client who is 2 weeks postpartum following a cesarean birth. Which of the following clinical fndings should the nurse identify as an indi... cation of postpartum infection? a. Unilateral breast pain b. Persistent abdominal striae c. Lochia alba d. WBC count 12,000/mm3 - a. Unilateral breast pain A nurse is assessing client who has preeclampsia during a prenatal visit. Which of the following findings should the nurse report to the provider? a. Blood glucose 110 mg/dL b. Deep tendon reRexes of 2+ c. Urine protein of 3+ d. Hemoglobin 13 g/dL - c. Urine protein of 3+ A nurse is providing teaching about the expected effects of magnesium sulfate to a client who is at 28 weeks of gestation and has preeclampsia. Which of the following responses by the nurse is appropriate? a. "This medication improves tissue perfusion." b. "This medication increases cardiac output." c. "This medication stabilizes the fetal heart rate." d. "This medication prevents seizures." - d. "This medication prevents seizures." A nurse is teaching a prenatal class regarding false labor. Which of the following information should the nurse include? a. "You will have dilation and effacement of the cervix." b. "Your contractions will become temporarily regular." c. "You will have bloody show." d. "Your contractions will become more intense when walking." - b. "Your contractions will become temporarily regular." A nurse manager is revising a maternal unit policy to ensure proper identification of newborns. Which of the following should the nurse include in the policy? a. Check the newborn's identification using the crib card. b. Replace the infant's identification band after his name has been recorded. c. Require visitors to wear an identification band. d. Obtain an imprint of the infant's feet prior to taking him to the nursery. - d. Obtain an imprint of the infant's feet prior to taking him to the nursery. A nurse is caring for a client who delivered by cesarean birth 6 hr ago. The nurse notes a steady trickle of vaginal bleeding that does not stop with fundal massage. Which of the following actions should the nurse take? a. Apply an ice pack to the incision site. b. Replace the surgical dressing. c. Administer 500 mL lactated Ringer's IV bolus. d. Evaluate urinary output. - d. Evaluate urinary output. . A nurse is providing discharge instructions to a client who is postpartum and has engorged breasts. Which of the following nonpharmacological comfort measures should the nurse include in the teaching? a. Wear nipple shields during the feeding. b. Use a breast binder for 2 days. c. Use plastic-lined breast pads. d. Apply cabbage leaves a^er feedings - d. Apply cabbage leaves a^er feedings A nurse is calculating estimated date of birth using Naegele's rule for a client who is pregnant and whose last menstrual cycle started June 21. Which of the following is the estimated delivery in the next year? a. March 14 b. March 21 c. March 28 d. April 4 - c. March 28 A nurse is caring for a client immediately following the delivery of a stillborn fetus. Which of the following actions should the nurse take? a. Inform the client that the law requires her to name the fetus. b. Limit the amount of time the fetus is in the client's room. c. Instruct the client that an autopsy should be performed within 24 hr. d. prepare the client for what to expect the fetus to look like - d. prepare the client for what to expect the fetus to look like A nurse is observing an adolescent client who is offering her newborn a bottle while he is lying in the bassinet. When the nurse offers to pick the newborn up and place him in the client's arms, the mother states, "No, the baby is too tired to be held." Which of the following actions should the nurse take? a. Demonstrate how to hold the newborn and allow client to practice. b. Persuade the client to breasfeed the newborn to promote bonding. c. Offer to take the newborn to the nursery to finish his feeding. d. Insist that the mother pick up the newborn to feed him. - a. Demonstrate how to hold the newborn and allow client to practice. . A nurse is caring for a client who is in labor. Which of the following findings should prompt the nurse to reassess the client? a. Intense contractions lasting 45 to 60 seconds b. An urge to have a bowel movement during contractions c. A sense of excitement and warm, flushed skin d. Progressive sacral discomfort during contractions - b. An urge to have a bowel movement during contractions . A nurse is assessing a client who is at 27 weeks of gestation and has preeclampsia. Which of the following findings should the nurse report to the provider? a. Hemoglobin 14.8 g/dL b. Urine protein concentration 200 mg/24 hr c. Creatinine 0.8 mg/dL i. normal d. Platelet count 60,000/mm3 - d. Platelet count 60,000/mm3 A nurse in a clinic is preparing to measure the fundal height of a client who is pregnant. Which of the following actions should the nurse take? a. Lay the tape measure horizontally over the middle of the client's abdomen. b. Place the client in a left-lateral position to obtain the measurement. c. Ensure that the client has a full bladder before taking the measurement. d. Measure from the upper border of the pubis to the upper border of the fundus. - d. Measure from the upper border of the pubis to the upper border of the fundus. A nurse is caring for a client who is at 20 weeks of gestation and reports constipation. Which of the following recommendations should the nurse make to help retrieve this common discomfort of pregnancy? a. Include 18 g of fiber in the diet each day. b. Drink 2 to 3 L of water each day. . c. Add 30 mL of mineral oil to each meal. d. Tale 60 mL of magnesium hydroxide once daily. - b. Drink 2 to 3 L of water each day A nurse is assessing the fetal heart rate for a client who is at 38 weeks of gestation. When using an ultrasound device, the nurse hears blood rushing through the umbilical vessels in synchronization with the fetal heart beat. Which of the following terms should the nurse use to document this finding? a. Goodell's sign b. Funic souffle c. Quickening d. Hegar's sign - b. Funic souffle . A nurse manager in a newborn nursery is reviewing infection control procedures with a group of newly hired nurses. Which of the following instructions should the nurse manager include in the teaching? a. Allow parents to enter the nursery if they are wearing a mask b. Place newborn bassinets at least 3 feet apart. c. Place the newborn's foot on a sterile field during a heel stick. d. Maintain airborne precautions in the nursery. - b. Place newborn bassinets at least 3 feet apart. A nurse is caring for a client who is receiving magnesium sulfate by continuous IV infusion. The nurse notes a respiratory rate of 8/min and absent deep-tendon reflexes. Which of the following medications should the nurse administer? a. Phytonadione b. Acetylcysteine c. Protamine sulfate d. Calcium gluconate - d. Calcium gluconate A nurse is caring for a client who is 8 hr postpartum following vaginal delivery and is unable to void. Which of the following interventions should the nurse use to promote voiding? a. Apply supra pubic pressure. b. Administer a diuretic to the client. c. Insert an indwelling urinary catheter. d. Encourage the client to void in the shower. - d. Encourage the client to void in the shower. . A nurse manager on the labor and delivery unit is teaching a group of newly licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching? a. "Mothers will receive prophylactic treatment with acyclovir prior to delivery." b. "Transmission can occur via the saliva and urine of the newborn." c. "This infection requires airborne precautions are initiated for the newborn." d. "Lesions are visible on the mother's genitalia." - b. "Transmission can occur via the saliva and urine of the newborn." A nurse in a prenatal clinic is caring for a client who has hyperemesis gravidarum. Which of the following is the initial laboratory testused to evaluate this condition? a. Liver enzymes b. Complete blood count c. Urine ketones d. Thyroid levels - c. Urine ketones A nurse in a prenatal clinic is reviewing the laboratory results for a client who is at 12 weeks gestation. Which of the following actions should the nurse take? (Click in the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.) a. Administer ceftriaxone IM. b. Administer rubella vaccine. c. Obtain a maternal serum alpha-fetoprotein specimen. d. Obtain a blood culture. - a. Administer ceftriaxone IM. A nurse is teaching a client about the basal body temperature method of contraception. Which of the following statements should the nurse include in the teaching? (pg 4) a. "Your risk of pregnancy is greatest on days 21 to 28 of your cycle." b. "You should take your temperature before getting up for the day." c. "You should abstain from intercourse when your temperature is above 100 F." d. "Your temperature may increase slightly immediately prior to ovulation." - b. "You should take your temperature before getting up for the day." A nurse is providing education to a client who is to receive misoprostol for induction of labor. Which of the following instructions should the nurse include in the teaching? a. "You will lie on your side for 40 minutes after I administer the medication." b. "I will begin an oxytocin infusion within 2 hours of your last dose of medication." c. "You will receive an antacid containing magnesium before the medication." d. "I will insert a urinary catheter before I administer the medication." - a. "You will lie on your side for 40 minutes after I administer the medication." A nurse is planning care for a client in the postpartum unit. Which of the following goals should the nurse identify for the client to accomplish during the taking-in phase of postpartum adjustment? a. The client will identify individual family member roles. b. The client will have adequate nutritional intake. c. The client will verbalize appropriate car seat safety. d. The client will demonstrate proper bathing of the infant. - b. The client will have adequate nutritional intake. . A nurse in the antepartum clinic is teaching a client who is at 28 weeks of gestation and has preeclampsia. Which of the following instructions should the nurse include in the teaching? a. "Limit your fluid intake to four 8-ounce glasses per day." b. "Count your baby's movements daily." c. "Reduce your calcium intake to less than 1 gram per day." d. "Alternate arms each time you check your blood pressure." - b. "Count your baby's movements daily." A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client ismultigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse? a. "We need to know if you are positive for GBS at the time of delivery." b. "There was no indication of GBS in your earlier prenatal testing." c. "You didn't report any symptoms of GBS during your pregnancy." d. "Your previous deliveries were all negative for GBS." - a. "We need to know if you are positive for GBS at the time of delivery." A nurse is assessing a full-term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider? a. Single palmar creases b. Transient circumoral cyanosis c. Rust-stained urine d. Subconjunctival hemorrhage - b. Transient circumoral cyanosis A nurse is caring for a client who is postpartum and experiencing hypovolemic shock. Which of the following findings should the nurse expect? a. Respiratory rate 18/min b. Cool, clammy skin c. Urinary output 30 mL/hr d. Bounding pulses - b. Cool, clammy skin A nurse is teaching a client who [Show More]

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