Review ATI NUR 209 Maternal newborn exam

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ATI NUR 209 Maternal newborn exam

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Total Questions : 45

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Question 1:

A nurse is caring for a client with the nursing diagnosis of acute pain related to breast engorgement.
Which interventions should the nurse include in the plan of care?

A. Apply warm compresses to the breasts before breastfeeding. B. Advise the client to limit fluid intake to reduce milk production. C. Apply cold compresses to the breasts after breastfeeding. D. Instruct the client to breastfeed frequently or pump milk regularly. E. Encourage the client to wear a tight-fitting bra throughout the day.

Answer and Explanation

Choice A:

Applying warm compresses before breastfeeding promotes vasodilation, increasing blood flow to the breast tissue. This facilitates milk let-down by relaxing the smooth muscles around the alveoli and ducts, making it easier for the infant to latch and nurse effectively, thereby relieving engorgement and associated pain.

Choice B:

Limiting fluid intake is contraindicated for breast engorgement. Adequate hydration is essential for maintaining milk production. Reducing fluids can lead to dehydration and potentially decrease milk supply, exacerbating engorgement and discomfort rather than alleviating it.

Choice C:

Applying cold compresses after breastfeeding helps to reduce inflammation and swelling in the breast tissue. The cold temperature causes vasoconstriction, which decreases blood flow and can minimize discomfort and engorgement by reducing tissue edema.

Choice D:

Frequent breastfeeding or regular pumping helps to remove milk from the breasts, which is the primary intervention for relieving engorgement. Regular emptying prevents milk from accumulating in the ducts and alveoli, reducing pressure and pain. This also helps establish and maintain milk supply.

Choice E:

Wearing a tight-fitting bra can restrict milk flow and increase pressure on the breast tissue, potentially worsening engorgement and causing discomfort. A supportive but not restrictive bra is recommended to provide comfort without impeding circulation or milk ducts.

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Question 2:

A nurse is reviewing the differences between placenta previa and abruptio placentae with a group of nursing students.
Which of the following statements accurately differentiates placenta previa from abruptio placentae?

A. Placenta previa is characterized by sudden onset of severe abdominal pain and uterine tenderness, while abruptio placentae is associated with painless bleeding. B. Placenta previa typically presents with severe pain and contractions, whereas abruptio placentae involves painless bleeding without contractions. C. Placenta previa involves the placenta partially or completely covering the cervix, whereas abruptio placentae involves the premature separation of the placenta from the uterine wall. D. Placenta previa usually results in a higher risk of maternal hypertension, while abruptio placentae is commonly associated with a low-risk pregnancy.

Answer and Explanation

Choice A:

Placenta previa is typically characterized by painless vaginal bleeding, often bright red, especially in the later trimesters as the cervix begins to efface and dilate. Abruptio placentae, on the other hand, often presents with sudden onset of abdominal pain, uterine tenderness, and possible vaginal bleeding, which may be dark red.

Choice B:

Placenta previa is not typically associated with severe pain or regular contractions, although contractions may occur if labor begins. Abruptio placentae is characterized by uterine tenderness and abdominal pain, which may be accompanied by contractions, and bleeding may or may not be visible externally.

Choice C:

Placenta previa occurs when the placenta implants in the lower uterine segment, partially or completely covering the internal cervical os. Abruptio placentae involves the premature separation of a normally implanted placenta from the uterine wall before delivery of the fetus, leading to bleeding and potential fetal compromise.

Choice D:

Placenta previa itself does not inherently increase the risk of maternal hypertension. Abruptio placentae, however, is more commonly associated with pre-existing or pregnancy-induced hypertension due to underlying vascular issues that can contribute to placental separation.

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Question 3:

A G1P1 patient at 37 weeks' gestation is scheduled for a nonstress test (NST). The nurse's greatest concern is the client's risk of developing related to

and .

Answer and Explanation

Explanation

The nurse should be most concerned about preeclampsia, which is a hypertensive disorder of pregnancy that typically occurs after 20 weeks' gestation. Primigravida status (first pregnancy) and being at or near term (like 37 weeks) are known risk factors. Monitoring through a nonstress test is part of evaluating fetal well-being in at-risk pregnancies.

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Question 4:

The client arrives at the emergency room following a sexual trafficking incident.

She is experiencing significant pain but has difficulty swallowing pills.

The provider prescribes 15 mL of Codeine with acetaminophen oral elixir to be taken by mouth once.

Pharmacy Formulary

Codeine with acetaminophen oral elixir available: 2 mg/mL of codeine 24 mg/mL of acetaminophen.

The client is prescribed elixir.

She will receive of ______ acetaminophen based on the formulary concentration.

Answer and Explanation

Correct Answer: "360" mg

Explanation

Step 1 is: Determine the concentration of acetaminophen in the elixir. The formulary states that the elixir contains 24 mg of acetaminophen per 1 mL.

Step 2 is: Calculate the amount of acetaminophen in the prescribed dose. The prescribed dose is 15 mL.

Step 3 is: Multiply the prescribed volume by the concentration: 15 mL × 24 mg/mL = 360 mg. The client will receive 360 mg of acetaminophen.

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Question 5:

The nurse is reviewing fetal and maternal circulation with a group of nursing students.
Which statement by a student demonstrates a need for further clarification?

A. "The fetal heart pumps blood to both the placenta and the developing organs.”. B. "Maternal and fetal blood mix to allow for nutrient and oxygen exchange.”. C. "The placenta is the site of gas exchange for the fetus.”. D. "The umbilical arteries carry deoxygenated blood from the fetus to the placenta.”.

Answer and Explanation

Choice A:

The fetal heart indeed pumps blood to both the placenta, where oxygen and nutrients are obtained, and to the developing organs, which require these substances for growth and function. This dual circulation is essential for fetal development. The normal circulatory pattern ensures that oxygenated blood returns from the placenta to nourish the fetal tissues, while deoxygenated blood is transported back to the placenta for gas exchange.

Choice B:

Maternal and fetal blood do not mix under normal physiological conditions. The exchange of gases, nutrients, and waste products occurs across the placental barrier, which consists of fetal and maternal tissues but keeps their bloodstreams separate. This separation prevents potential immune reactions and maintains distinct circulatory systems for the mother and the fetus.

Choice C:

The placenta serves as the vital site for gas exchange in the fetus. Oxygen and carbon dioxide are exchanged between the maternal and fetal blood across the placental membranes via diffusion. Oxygen-rich blood from the mother is delivered to the fetus, while carbon dioxide, a waste product of fetal metabolism, moves from the fetus to the mother for elimination.

Choice D:

The umbilical arteries are responsible for carrying deoxygenated blood and waste products from the fetus to the placenta. This deoxygenated blood is then oxygenated and cleared of waste at the placenta before returning to the fetus via the umbilical vein. This flow pattern is crucial for maintaining the fetal environment and supporting its development.

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Question 6:

A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception.
Which of the following statements made by the client indicates a need for further teaching?

A. "I can use the morning-after pill as a regular form of birth control.”. B. "I should take the morning-after pill as soon as possible after unprotected intercourse.”. C. "The morning-after pill does not protect against sexually transmitted infections.”. D. "The morning-after pill can be less effective if I take it more than 72 hours after unprotected sex.”. . . .

Answer and Explanation

Choice A:

The morning-after pill, containing levonorgestrel, is intended for emergency contraception and should not be used as a regular method of birth control. Frequent use can disrupt the menstrual cycle and may be less effective over time compared to consistent contraception methods like oral contraceptives, IUDs, or barrier methods. These regular methods provide continuous protection against pregnancy.

Choice B:

The morning-after pill is most effective when taken as soon as possible after unprotected intercourse. Its efficacy decreases with time, and it is significantly less effective after 72 hours. The medication works primarily by delaying or preventing ovulation, and its effectiveness is highest when administered before ovulation occurs.

Choice C:

The morning-after pill does not provide any protection against sexually transmitted infections (STIs). It only reduces the risk of pregnancy. Individuals should use barrier methods like condoms during sexual activity to protect themselves and their partners from STIs. Emergency contraception addresses pregnancy risk, not STI transmission.

Choice D:

The efficacy of the morning-after pill declines significantly if taken more than 72 hours after unprotected sex. While it may still offer some protection up to 120 hours, its effectiveness is considerably reduced compared to when taken within the first 72 hours. Prompt use is crucial for maximizing its contraceptive effect. .

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Question 7:

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor.
The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication.
The nurse should provide which of the following explanations?

A. "It increases the fetal heart rate.”. B. "It promotes fetal lung maturity.”. C. "It halts cervical dilation.”. D. "It is used to stop preterm labor contractions.”.

Answer and Explanation

Choice A:

Betamethasone does not directly increase the fetal heart rate. Factors influencing fetal heart rate include fetal oxygenation, maternal hydration, and medications affecting the maternal or fetal autonomic nervous system. Normal fetal heart rate ranges from 110 to 160 beats per minute.

Choice B:

Betamethasone is a corticosteroid administered to pregnant women at risk of preterm delivery to accelerate fetal lung maturity. It stimulates the production of surfactant, a lipoprotein that reduces surface tension in the alveoli, preventing collapse upon expiration and improving the neonate's ability to breathe independently.

Choice C:

Betamethasone does not halt cervical dilation. Cervical dilation is primarily influenced by uterine contractions and the presenting fetal part. Medications like tocolytics, such as terbutaline or magnesium sulfate, are used to inhibit uterine contractions in preterm labor.

Choice D:

Betamethasone is not used to stop preterm labor contractions. Its primary purpose is to enhance fetal lung maturation. Tocolytic medications are the class of drugs used to attempt to delay or stop preterm labor contractions, allowing time for corticosteroids to be administered.

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Question 8:

A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia.
The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

A. "We will check for a reduction in swelling and fluid retention.”. B. "You should feel less pain and have fewer headaches.”. C. "We will monitor your blood pressure to see if it decreases.”. D. "We will assess for a decrease in seizure activity and improved reflexes.”.

Answer and Explanation

Choice A:

While magnesium sulfate can sometimes lead to a mild diuresis, its primary therapeutic effect in severe preeclampsia is not a direct reduction in swelling and fluid retention. These symptoms are more effectively managed by addressing the underlying hypertension and potential fluid overload through other interventions.

Choice B:

Magnesium sulfate is primarily used as an anticonvulsant and to lower blood pressure in severe preeclampsia. While it might indirectly alleviate some discomfort associated with preeclampsia, a direct reduction in pain and headaches is not the primary indicator of its therapeutic effectiveness.

Choice C:

Magnesium sulfate does have antihypertensive properties and can help lower blood pressure in severe preeclampsia. However, its most critical role is in preventing seizures. Therefore, monitoring blood pressure alone is not the most appropriate way to determine if the medication is working effectively in preventing seizures. Normal blood pressure is typically less than 120/80 mmHg.

Choice D:

Magnesium sulfate is administered in severe preeclampsia primarily to prevent seizures and may also have a relaxing effect on smooth muscles, which can improve hyperreflexia. A decrease in seizure activity and the normalization of deep tendon reflexes (normal range is 2+) are key indicators that the magnesium sulfate is achieving its therapeutic goals.

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Question 9:

Which interventions should be immediately initiated when caring for a patient at 32 weeks' gestation who presents with a moderate amount of painless bright red vaginal bleeding?

A. Monitor vital signs. B. Administer oxygen at 10L via non-rebreather face mask. C. Perform a digital vaginal examination to assess cervical dilation. D. Initiate intravenous (IV) Lactated Ringers for fluid replacement. E. Assess client for incidence of domestic violence.

Answer and Explanation

Choice A:

Monitoring vital signs (blood pressure, heart rate, respiratory rate, temperature) is a crucial immediate intervention to assess the client's hemodynamic stability in the presence of vaginal bleeding. Bright red bleeding may indicate active bleeding that could compromise maternal and fetal well-being.

Choice B:

While oxygen administration might be considered if there are signs of fetal distress or maternal hypoxemia, applying oxygen at 10L via non-rebreather face mask is not the immediate first-line intervention for painless bright red vaginal bleeding at 32 weeks gestation without further assessment. The need for oxygen depends on the overall clinical picture.

Choice C:

A digital vaginal examination is contraindicated in the presence of unexplained vaginal bleeding in the third trimester, especially if placenta previa is suspected. Palpation of the placenta could cause severe hemorrhage. An ultrasound should be performed first to determine the cause of the bleeding.

Choice D:

Initiating intravenous (IV) Lactated Ringers for fluid replacement is an important immediate intervention to maintain intravascular volume and prevent hypovolemia, especially if the vaginal bleeding is significant. This helps to support maternal circulation and fetal perfusion.

Choice E:

While assessing for domestic violence is important for the overall well-being of the pregnant client, it is not an immediate intervention in the acute presentation of painless bright red vaginal bleeding at 32 weeks gestation. The immediate focus should be on assessing and managing the bleeding and maternal-fetal status.

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Question 10:

A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

A. Observe an area of redness on the breast of a client who is 1 day postpartum. B. Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum. C. Monitor vital signs during admission of a client who has gestational hypertension. D. Change the initial perineal pad of a client who just transferred from labor and delivery.

Answer and Explanation

Choice A:

Observing an area of redness on the breast of a client who is 1 day postpartum requires the assessment and clinical judgment of a registered nurse. This observation could indicate mastitis or other complications that need professional evaluation.

Choice B:

Providing a sitz bath to a stable postpartum client with a fourth-degree laceration is a comfort measure that can be safely delegated to assistive personnel. The procedure is routine and does not require the specialized assessment skills of a registered nurse.

Choice C:

Monitoring vital signs during the admission of a client with gestational hypertension requires the assessment skills of a registered nurse. Baseline vital signs and the client's overall condition need to be evaluated by the nurse upon admission, especially in a client with a potentially unstable condition like gestational hypertension. Normal blood pressure is typically less than 140/90 mmHg in gestational hypertension, but admission monitoring requires professional nursing judgment.

Choice D:

Changing the initial perineal pad of a client who just transferred from labor and delivery involves assessing the amount and type of bleeding, which is a nursing assessment. This initial assessment is crucial to monitor for postpartum hemorrhage and should be performed by the registered nurse. .

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ATI NUR 209 Maternal newborn exam

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