ATI MATERNAL NEWBORN PROCTORED 2019
(All Questions & Answers 100% Correct)
A nurse is caring for a client who is 2 weeks postpartum following a
... [Show More] cesarean birth. Which of the following clinical findings should the nurse identify as an indication of postpartum infection?
Unilateral breast pain
A nurse is assessing a client who has preeclampsia during a prenatal visit. Which of the following findings should the nurse report to the provider?
Urine protein of 3+
A nurse is providing teaching about the expected effects of magnesium sulfate to a client who is at 28 weeks gestation and has preeclampsia. Which of the following responses by the nurses is appropriate?
“This medication prevents seizures.”
A nurse is teaching a prenatal class regarding false labor. Which of the following information should the nurse include?
“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?
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 hrs. 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?
Administer 500 mL lactated ringer’s IV bolus
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?
Apply cabbage leaves after feedings
A nurse is calculating the estimated date of birth using Nagele’s rule for a client who is pregnant and whose last menstrual cycle started June 21. Which of the following is the estimated date of delivery in the next year?
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?
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?
Demonstrate how to hold the newborn and allow the 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.
Progressive sacral discomfort 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?
Platelet count 60,000/mm
HELLP Syndrome
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?
Measure from the upper border of the symphysis 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 relieve this common discomfort of pregnancy?
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 heartbeat. Which of the following terms should the nurse use to document this finding?
Funic soufflé
Funic soufflé
Swishing of blood sound through umbilical cord (fetus)
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?
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 DTR’s. Which of the following medications should the nurse administer?
Calcium gluconate
A nurse is caring for a client who is 8 hrs. postpartum following vaginal delivery and is unable to void. Which of the following interventions should the nurse use to promote voiding?
Insert an indwelling urinary catheter
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?
Transmission can occur via the saliva and urine of the newborn cytomegalovirus a herpes type virus that usually causes disease when the immune system is compromised
A nurse in a prenatal clinic is caring for a client who has hyperemesis gravidarum. Which of the following is the initial laboratory test used to evaluate this condition?
Urine ketones
A nurse in a prenatal clinic is reviewing the lab results for a client who is at 12 weeks of gestation. Which of the following actions should the nurse take (EXHIBIT QUESTION)
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?
“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?
“You will lie on your side for 40 minutes after I administer the medication
Misoprostol
Cytotec
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?
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?
“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-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?
“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
Transient circumoral cyanosis
Circumoral Cyanosis
Blue around mouth due to inadequate oxygenation
A nurse is caring for a client who is postpartum and experiencing hypovolemic shock. Which of the following findings should the nurse expect?
Cool, clammy skin
A nurse is teaching a client who is at 8 weeks of gestation about self-care during pregnancy. Which of the following statements should the nurse make?
“You should take 600 micrograms of folic acid per day.”
A nurse is planning care for a client who is receiving oxytocin by continuous IV infusion for labor induction. Which of the following interventions should the nurse include in the plan?
Increase the infusion rate every 30-60 min
A nurse is providing teaching about expected changes during pregnancy to a client who is at 24 weeks of gestation. Which of the following information should the nurse include?
“You should expect your uterus to double in size.”
A nurse is assisting the provider to administer a dinoprostone insert to induce labor for a client. Which of the following actions should the nurse take?
Verify that the informed consent is obtained prior to administration
Dinoprostone
PGE2 analog causing cervical dilation and uterine contraction, inducing labor
A nurse is preparing to administer metronidazole 2 g PO to a client who has pelvic inflammatory disease. Available is metronidazole 500 mg tablets. How many tablets should the nurse administer? (Round to nearest whole number)
2000 mg/500 mg = 4 tabs
A nurse in a prenatal clinic is caring for a group of clients. Which of the following clients should the nurse recommend for an interdisciplinary care conference?
A client who is at 35 weeks of gestation and has a biophysical profile of 6
A nurse is planning to teach a group of clients who are pregnant about breastfeeding after returning to work. Which of the following information should the nurse include in the teaching?
“Breast milk can be stored in a deep freezer for 12 months.”
A nurse is performing an initial assessment of a newborn who was delivered with a nuchal cord. Which of the following clinical findings should the nurse expect?
Telangiectatic nevi
Nuchal Cord
An umbilical cord that is wrapped around the infants neck
A nurse is assessing a newborn upon admission to the nursery. Which of the following findings should the nurse expect?
Chest circumference 2 cm (0.8 in) smaller than the head circumference
A nurse is assisting with precipitous delivery of a term newborn. After the head emerges, the nurse palpates the cord around the newborn’s neck. Which of the following actions should the nurse take?
Slip the cord over the newborn’s head
A nurse is planning care for a newborn who is to undergo a circumcision using a plastic bell device. Which of the following interventions should the nurse include in the plan of care?
Monitor for bleeding every 15 min for the first hour
A nurse is providing discharge instructions to a client who is 24 hrs. postpartum and has decided not to breastfeed. Which of the following instructions should the nurse include in the teaching?
“Apply ice packs to your breasts using a 15 minute on, 45 minutes off schedule.”
A nurse is preparing to administer methylergonovine 0.2 mg orally to a client who is 2 hours postpartum and has a boggy uterus. For which of the following assessment findings should the nurse withhold the medication?
Blood pressure 142/92 mm Hg
Do not administer to client with HTN
A nurse is caring for four newborns. Which of the following findings should the nurse report to the provider?
A newborn who has a high-pitched cry with exaggerated Moro reflex
A nurse in a provider’s office is caring for a 20-year old client who is at 12 weeks of gestation and requests an amniocentesis to determine the gender of the fetus. Which of the following responses should the nurse make?
“This procedure determines if your baby has genetic or congenital disorders.” [Show Less]