Review ATI RN MATERNAL NEWBORN 2023

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ATI RN MATERNAL NEWBORN 2023

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Total Questions : 62

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Question 1:

A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take?

A. Place the infant on his back with legs extended. B. Provide a stimulating environment. C. Monitor blood glucose level every hr. D. Initiate seizure precautions.

Answer and Explanation

Choice A:

Placing the infant on his back with legs extended is a recommended sleeping position for infants to reduce the risk of sudden infant death syndrome (SIDS). However, it is not directly related to managing neonatal abstinence syndrome.

Choice B:

Providing a stimulating environment would not be appropriate for an infant with NAS, as excessive stimulation can exacerbate symptoms such as irritability and tremors. A calm and quiet environment is preferable.

Choice C:

Monitoring blood glucose levels every hour is not a routine practice for managing neonatal abstinence syndrome. While NAS can cause feeding difficulties, hypoglycemia is not typically a primary concern unless the infant is exhibiting specific symptoms.

Choice D:

Initiating seizure precautions is important when caring for an infant with NAS because seizures can be a complication of withdrawal. Seizure precautions may include padding the crib, ensuring a safe environment, and being vigilant for signs of seizure activity.

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Question 2:

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 is multigravida 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. "You didn't report any symptoms of GBS during your pregnancy." B. "Your previous deliveries were all negative for GBS." C. "There was no indication of GBS in your earlier prenatal testing." D. "We need to know if you are positive for GBS at the time of delivery."

Answer and Explanation

Choice A:

"You didn't report any symptoms of GBS during your pregnancy." This response is incorrect because GBS infection in pregnant women often does not present with noticeable symptoms. Additionally, GBS screening is not based on symptoms but rather on the presence of the bacteria in the genital or gastrointestinal tract.

Choice B:

"Your previous deliveries were all negative for GBS." This response is incorrect because GBS status can change between pregnancies. A negative result in previous pregnancies does not guarantee a negative result in subsequent pregnancies. Screening closer to the delivery date is necessary to determine the current GBS status.

Choice C:

"There was no indication of GBS in your earlier prenatal testing." This response is incorrect because routine prenatal testing typically does not include GBS screening unless there are specific risk factors or symptoms present. GBS screening is specifically done closer to delivery to determine colonization status at that time.

Choice D:

"We need to know if you are positive for GBS at the time of delivery." This response is appropriate. Group B streptococcus (GBS) screening is typically performed around the 35th to 37th week of pregnancy because colonization status can change over time. A negative result earlier in the pregnancy does not necessarily mean that the client will remain negative at the time of delivery. Therefore, it is essential to screen closer to delivery to determine if the client is colonized with GBS and if prophylactic measures are needed to reduce the risk of transmission to the newborn during labor and delivery.

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Question 3:

A nurse is caring for a client who is at 20 weeks of gestation and has trichomoniasis. Which of the following findings should the nurse expect?

A. Vulva lesions B. Malodorous discharge C. Urinary frequency D. Thick, white vaginal discharge

Answer and Explanation

Choice A:

Vulva lesions are not typically associated with trichomoniasis. Trichomoniasis primarily affects the vagina and cervix rather than the vulva.

Choice B:

Malodorous discharge is a common symptom of trichomoniasis. The discharge may have a strong, unpleasant odor.

Choice C:

Urinary frequency is not a typical symptom of trichomoniasis. However, some individuals may experience mild urinary symptoms such as burning or discomfort during urination.

Choice D:

Thick, white vaginal discharge is more indicative of a yeast infection (such as candidiasis) rather than trichomoniasis. Trichomoniasis typically presents with a frothy, yellow-green, or gray vaginal discharge.

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Question 4:

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. Provide the client with photos of the fetus. B. Inform the client that the law requires them to name the fetus. C. Limit the amount of time the fetus is in the client's room. D. Instruct the client that an autopsy should be performed within 24 hr.

Answer and Explanation

Choice A:

Providing photos of the stillborn fetus is a sensitive gesture that allows the parents to have tangible memories of their child. However, it should be done with sensitivity and only if the parents express a desire for them.

Choice B:

Informing the client that the law requires them to name the fetus is incorrect. There is no legal requirement to name a stillborn fetus. Naming the fetus is a personal decision that should be left to the parents. Pressuring them to name the fetus may cause additional distress.

Choice C:

Limit the amount of time the fetus is in the client's room. This is not an appropriate action. Allowing the parents time to grieve and bond with their stillborn child is important for their emotional healing process. They should be given the opportunity to spend time with the baby if they desire.

Choice D:

Instructing the client that an autopsy should be performed within 24 hours is incorrect. While autopsies can sometimes provide valuable information about the cause of stillbirth, it is not necessary to perform one within 24 hours. The decision to have an autopsy should be discussed with the parents, and the timing can vary depending on their wishes and circumstances.

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Question 5:

A nurse is caring for a client who is at 36 weeks of gestation and has methicillin-resistant Staphylococcus aureus. Which of the following types of isolation precautions should the nurse initiate?

A. Droplet B. Protective environment C. Airborne D. Contact

Answer and Explanation

Choice A:

Droplet precautions are used for infectious agents that are transmitted through respiratory droplets. These droplets are generated when an infected person coughs, sneezes, or talks. Examples of diseases requiring droplet precautions include influenza, pertussis (whooping cough), and bacterial meningitis. Methicillin-resistant Staphylococcus aureus (MRSA) is not primarily transmitted through respiratory droplets but rather through direct or indirect contact with infected skin or wounds.

Choice B:

Protective environment precautions, also known as reverse isolation, are used to protect immunocompromised clients from acquiring infections from others. This includes clients who have undergone organ transplantation or chemotherapy. MRSA is not an indication for protective environment precautions because it is not typically transmitted via the air or by casual contact.

Choice C:

Airborne precautions are used for infectious agents that remain infectious over long distances when suspended in the air. Diseases requiring airborne precautions include tuberculosis, measles, and chickenpox. MRSA is not transmitted through the airborne route but rather through direct or indirect contact with contaminated surfaces or skin.

Choice D:

Contact precautions are used for infectious agents that are transmitted by direct or indirect contact with the client or their environment. MRSA is primarily transmitted through direct contact with infected skin or wounds, making contact precautions the appropriate choice. These precautions include wearing gloves and gowns when entering the client's room, performing proper hand hygiene, and ensuring that contaminated items and surfaces are cleaned and disinfected appropriately to prevent the spread of infection to others.

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Question 6:

A nurse is caring for a newborn immediately following birth. For which of the following reasons should the nurse delay the instillation of antibiotic ophthalmic ointment?

A. The newborn weighs less than 2.5 kg (5.5 lb) B. To facilitate bonding between the newborn and parent C. To allow manifestations of infection to be identified D. The newborn was delivered via cesarean birth

Answer and Explanation

Choice A:

The newborn weighs less than 2.5 kg (5.5 lb). This is not a valid reason to delay the instillation of antibiotic ophthalmic ointment. Birth weight alone does not affect the timing of ointment administration.

Choice B:

Instillation of eye medication can be delayed for
1 hour after birth to facilitate eye contact and parentnewborn attachment and bonding.

Choice C:

Delaying treatment to wait for signs of infection could worsen the condition if present. Early intervention is crucial for preventing ophthalmia neonatorum.

Choice D:

The newborn was delivered via cesarean birth. Delivery via cesarean section is not typically a reason to delay the instillation of antibiotic ophthalmic ointment. The risk of neonatal conjunctivitis from maternal infection remains, regardless of the mode of delivery.

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Question 7:

A nurse at an antepartum clinic is caring for four clients. Which of the following clients should the nurse assess first?

A. A client who is at 24 weeks of gestation and reports periodic tingling of the fingers B. A client who is at 36 weeks of gestation and reports back pain following intercourse C. A client who is at 8 weeks of gestation and reports severe vomiting D. A client who is at 10 weeks of gestation and reports frequent urination

Answer and Explanation

Choice A:

A client who is at 24 weeks of gestation and reports periodic tingling of the fingers is correct. Tingling of the fingers can be a symptom of preeclampsia, a serious condition characterized by high blood pressure and proteinuria. Preeclampsia can lead to complications for both the mother and baby if left untreated. Therefore, this client should be assessed promptly to rule out preeclampsia.

Choice B:

A client who is at 36 weeks of gestation and reports back pain following intercourse is incorrect. While back pain following intercourse can be uncomfortable, it is not typically considered an urgent or severe symptom. This client's assessment can be prioritized after addressing more urgent concerns.

Choice C:

A client who is at 8 weeks of gestation and reports severe vomiting is incorrect. Severe vomiting in early pregnancy can be indicative of hyperemesis gravidarum, a condition characterized by excessive nausea and vomiting that can lead to dehydration and electrolyte imbalances. While this is a concerning symptom, it is not typically as urgent as potential symptoms of preeclampsia.

Choice D:

A client who is at 10 weeks of gestation and reports frequent urination. Frequent urination is a common symptom in early pregnancy and is not typically indicative of an urgent or severe condition.

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Question 8:

A nurse is caring for a client who reports spontaneous rupture of membranes. The nurse observes fetal bradycardia on the FHR tracing and notices that the umbilical cord is protruding. After calling for assistance and notifying the provider, which of the following actions should the nurse take next?

A. Cover the umbilical cord with a sterile saline saturated towel. B. Administer oxygen via nonrebreather mask at 8 L/min. C. Perform a vaginal examination by applying upward pressure on the presenting part. D. Initiate an infusion of IV fluids for the client.

Answer and Explanation

Choice A:

Covering the exposed umbilical cord with a sterile saline-saturated towel is an appropriate intervention to prevent the cord from drying out and to reduce the risk of infection. However, this is not the most immediate action that should be taken. The priority is to relieve pressure on the umbilical cord to restore blood flow to the fetus, which is more urgent than covering the cord.

Choice B:

Administering oxygen can help improve maternal oxygenation, which in turn can benefit the fetus. However, in this situation, the immediate priority is to relieve the pressure on the umbilical cord to prevent fetal hypoxia. Administering oxygen is important but secondary to the mechanical relief of cord compression.

Choice C:

This is the most critical and immediate action. Applying upward pressure on the presenting part (e.g., the fetal head) can relieve pressure on the umbilical cord, which is crucial to restore blood flow to the fetus and prevent fetal hypoxia and bradycardia. This action directly addresses the life-threatening situation posed by a prolapsed umbilical cord.

Choice D:

Initiating IV fluids can help maintain maternal blood pressure and support fetal circulation. However, this intervention is not as immediate or directly life-saving as relieving the pressure on the umbilical cord. It can be done after the more urgent interventions are initiated.

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Question 9:

A nurse is caring for a client who is in active labor with a fetus in the occipitoposterior position. The nurse assists the client into a hands-and- knees position. Which of the following questions should the nurse ask to evaluate the effectiveness of this intervention?

A. "Do your contractions feel further apart?" B. "Are you feeling relief from your pelvic pressure?" C. "Has your back labor improved?" D. "Does that lessen your suprapubic pain?"

Answer and Explanation

Choice A:

"Do your contractions feel further apart?" This question does not directly assess the effectiveness of the hands-and-knees position in rotating the baby or relieving discomfort associated with occipitoposterior position. It focuses on the timing of contractions rather than the impact of the position change.

Choice B:

"Are you feeling relief from your pelvic pressure?" This question is relevant to assessing the effectiveness of the hands-and-knees position. Occipitoposterior position can cause increased pressure on the pelvic area, and relieving this pressure is one of the goals of positioning maneuvers. Therefore, this is a suitable question to evaluate the intervention.

Choice C:

"Has your back labor improved?" Occipitoposterior position often results in increased back pain during labor (back labor). While improving back pain is an important aspect of care, it may not directly indicate the effectiveness of the hands-and-knees position in rotating the baby. This question is somewhat relevant but does not directly address the intervention.

Choice D:

"Does that lessen your suprapubic pain?" Suprapubic pain may occur due to pressure on the bladder or pelvic structures during labor. While relieving suprapubic pain is a valid concern, it may not directly indicate the effectiveness of the hands-and-knees position in rotating the baby. This question is somewhat relevant but does not directly address the intervention.

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Question 10:

A nurse is planning care for a client who is 1 hr postpartum and has peripartum cardiomyopathy. Which of the following actions should the nurse plan to take?

A. Restrict daily oral fluid intake. B. Administer an IV bolus of lactated Ringer's. C. Assess blood pressure twice daily. D. Obtain a prescription for misoprostol.

Answer and Explanation

Choice A:

Peripartum cardiomyopathy is a form of heart failure that occurs during the last month of pregnancy or the first few months postpartum. Fluid restriction is often necessary to prevent fluid overload, which can exacerbate heart failure symptoms. By restricting fluid intake, the nurse helps manage the client's fluid balance and reduces the risk of worsening heart failure.

Choice B:

Administering an IV bolus of fluids, such as lactated Ringer's, can increase the client's fluid volume, which is contraindicated in clients with heart failure, including peripartum cardiomyopathy. This could worsen the condition by increasing the workload on the already compromised heart.

Choice C:

Assessing blood pressure is important in monitoring the client's cardiovascular status, but assessing it twice daily may not be sufficient for a client with peripartum cardiomyopathy, especially in the acute postpartum period. Blood pressure should be monitored more frequently, and any significant changes should be promptly addressed.

Choice D:

Obtaining a prescription for misoprostol is incorrect. Misoprostol is a medication used for various purposes, including the prevention and treatment of postpartum hemorrhage. However, it is not a specific treatment for peripartum cardiomyopathy. The focus in peripartum cardiomyopathy management is on cardiac support and stabilization.

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Aesha Shah: Restricting daily oral fluid intake is the correct answer. ~ 1mo ago

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Total Questions : 62

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ATI RN MATERNAL NEWBORN 2023

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