ATI RN Maternal Newborn NGN Proctored Exam with Answers (250 Solved Questions)

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(NGN)ATIRNMATERNALNEWBORNPROCTOREDEXAMTESTBANKACTUALQUESTIONSWITHVERIFIED DETAILEDSOLUTIONS/A+GRADEASSURED1.A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa.Which ofthe followingfindingssupportthisdiagnosis?A.PainlessredvaginalbleedingRationale:Placentapreviaisaconditionofpregnancywhentheplacentaimplantsinthelowerpartoftheuterus, partly or completely obstructing the cervical os (outlet to the vagina). Bright red, painlessvaginal bleedingoccursinthesecondandthirdtrimester.B.Increasingabdominalpainwith anonrelaxed uterusRationale:Abruptioplacentaisseparationoftheplacentafromthesiteofuterineimplantationbeforedelivery of the fetus. When the placenta separates prematurely, there is internal bleeding, whichispainful,and the uterusisnonrelaxedorbecomes rigidastheseparation advances.C.Abdominalpain with scantred vaginalbleedingRationale:Placentapreviainvolvesminimaltoseverebrightredvaginalbleedingintheabsenceofabdominal pain.D.Intermittentabdominal painfollowing passageofbloodymucusRationale:Intermittentabdominalpainfollowingpassageofbloodymucusisadescriptionofnormallabor.Thepassageofbloodymucusrepresentsthelossofthecervicalmucousplug,alsoreferredto

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as the"bloodyshow."2.A nurse is caring for a client who is 1 hr postpartumand observes a large amount of lochia rubra and several smallclotson theclient'sperinealpad.Thefundusismidlineand firmatthe umbilicus.Which ofthe following actionsshouldthenursetake?A.Documentthefindingsand continueto monitorthe client.Rationale:Theseareexpectedfindings.At1hr postpartum,lochiarubrashouldbeintermittentandassociated with uterine contractions. The volume of lochia resembles that of a heavy menstrualperiod.Small clotsarecommon.Thenurseshoulddocumentthefindingsandcontinue tomonitortheclient.B.Notifytheclient‟sprovider.Rationale:Theseareexpectedfindings,sothereisnoneedtonotifytheprovider.C.Increase thefrequencyoffundal massage.Rationale:Theseareexpectedfindingsandthefundusisalreadyfirm.Increasingthefrequency offundalmassageisnotindicatedatthistime.D.Encouragethe clienttoemptyher bladder.Rationale:Theseare expectedfindings,and the fundus isfirmat the midline.If the funduswasdeviated,this would be an indication of a distended bladder and the client should be encouraged to void toprevent uterineatony.A+TestBankPage

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3.A nurse is caring for a newborn immediately following birth. After assuring a patent airway, what isthe prioritynursingaction?A.AdministervitaminK.Rationale:AdministrationofvitaminKisimportant,butitcanbedelayeduntilthenewbornisheldbythemotherandisbreastfed.Thereisanother,moreimportantnursingaction.B.Drytheskin.Rationale:Thenewbornshouldbethoroughlydried,coveredwithawarm blanket,placedonthemother‟sabdomen, and a cap applied to the newborn‟s head to prevent cold stress. The newbornrespondstothecoolerenvironmentbyincreasinghisrespiratoryrate,whichcanleadtorespiratorydistress.BasedonMaslow‟shierarchyofneeds,thisisthemostimportantnursingactionaftersecuringtheairway.C.Administereyeprophylaxis.Rationale:Administrationofeyeprophylaxisshouldoccurwithinthefirsthourafterbirth.Thereisanother,moreimportantnursingaction.D.Placeanidentificationbracelet.Rationale:Correctidentificationof the newbornisimportant,but itcanbe delayed,aslongasitiscompleted prior to the mother and newborn leaving the delivery room. There is another, moreimportantnursingaction.A+TestBankPage 3

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4.Anurseinaprenatalcliniciscaringfor a clientwhoisat7weeksofgestation.Theclient reports urinaryfrequencyandasksifthiswill continueuntildelivery.Whichofthefollowingresponsesshouldthe nursemake?A."It'saminorinconvenience,whichyoushould ignore."Rationale:Thisisanontherapeuticresponsethatdisregardstheclient‟sconcernandoffersunwarrantedreassurance.B."Inmost casesit onlylastsuntilthe12thweek,butitwillcontinueifyou havepoorbladder tone."Rationale:Thepresence orabsenceof bladder tonehas nobearing onurinaryfrequencyduringpregnancy.C."Thereis nowayto predicthowlongitwill lastin each individual client."Rationale:Thisisanontherapeuticresponsethatdoesnotprovideappropriateinformationtotheclient.D."It occursduring thefirst trimesterandneartheendofthepregnancy."Rationale:Urinaryfrequencyisduetoincreasedbladdersensitivityduringthefirsttrimesterandrecursnear theendofthepregnancyasthe enlarginguterusplacespressureonthebladder.A+TestBankPage 4

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Anurseis caring fora clientduringthefirst trimester ofpregnancy.Afterreviewingtheclient'sbloodwork,thenursenotices shedoesnothaveimmunitytorubella.Whichofthefollowing timesshouldthenurseunderstandisrecommendedforrubellaimmunization?E.Shortlyaftergiving birthRationale:Therubellaimmunizationshouldbeofferedtotheclientfollowingbirth, preferablypriortodischarge from the hospital. This prevents the client from contracting rubella during the currentor subsequent pregnancies,whichwouldputherfetusat riskforrubellasyndrome.F.In thethirdtrimesterRationale:Becausetherubellavaccinecontainsalivevirus,immunizingtheclientatthispointinpregnancy wouldputherfetusatriskfordevelopingrubellasyndrome.G.ImmediatelyRationale:Becausetherubellavaccinecontainsalivevirus, immunizingtheclient duringthefirsttrimesterwouldputthefetusatriskfordevelopingaseveremanifestationsofrubella syndrome.H.During her next attempt toget pregnantRationale:Rubellaimmunizationmustbegivenatleast28 days priortopregnancytoassurethat thedeveloping fetusisnot exposed tothevirusandput atriskforrubellasyndrome.5.A nurse is caring for a client who just delivereda newborn. Following the delivery, which nursing action should bedonefirsttocareforthenewborn?A+TestBankPage 5

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A.Cleartherespiratorytract.Rationale:Clearingtheairwayoftheinfantisthefirstactionthenurseshouldtakeimmediatelyfollowingdelivery.B.Drytheinfantoffandcoverthe head.Rationale:Dryingtheinfantandcoveringtheheadshouldbedoneshortlyafterthedelivery,butitisnotthefirstactionthenurseshouldtake.C.Stimulatethe infantto cry.Rationale:Stimulatingtheinfanttocryshouldbedoneshortlyafterthedelivery,butitisnotthefirstactionthe nurseshouldtake.D.Cutthe umbilicalcord.Rationale:Cuttingtheumbilicalcordshouldbedoneshortlyafterthedelivery,butitisnotthefirstactionthe nurseshouldtake.6.Anurseinafamilyplanning clinic is caringfora17-year-oldfemaleclient whois requestingoralcontraceptives.Theclient statesthatshe isnervousbecause shehasnever had apelvic examination.Which ofthe followingresponsesshouldthenursemake?A+TestBankPage 6

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A."What partoftheexammakesyoumostnervous?"Rationale:Thistherapeuticresponserecognizestheclient'sfeelings.Italsousesthetherapeutictechniqueofclarificationtoencouragetheclient totell thenursemoreaboutherconcerns.B."Don'tworry, Iwillbe withyouduring the exam."Rationale:Thisclosed-endednontherapeuticresponsediscountstheclient'sfeelingsanddoesnotencourage furtherdiscussion.C."Allyou needto dois relax."Rationale:Thisclosed-endednontherapeuticresponsedoesnotaddresstheclient'sconcernsanddoesnot encourage furtherdiscussion.Itblockscommunicationbyusingaclichéandfalsereassurance.D."Apelvicexamisrequired ifyouwantbirthcontrol pills."Rationale:Thisstatementfailstoaddresstheclient‟sfeelingsthatshesharedwiththenurse.Itblockscommunicationanddoesnotencouragefurtherdiscussion.7.A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines theumbilicalcord.Which ofthefollowingvesselsshouldthe nurseexpect toobservein theumbilicalcord?A.Two veinsandonearteryRationale:Thisisnotthecorrectcombinationofvessels.A+TestBankPage 7

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B.One arteryandoneveinRationale:Thisisnotthecorrectcombinationofvessels.C.Twoarteriesand oneveinRationale:Theveincarriedtheoxygenated,nutrient-richbloodfromtheplacentatothefetus,andthetwoarteriesreturnedthebloodtotheplacenta.D.Twoarteries and twoveinsRationale:Thisisnotthecorrectcombinationofvessels.8.A nurse is caring for a client who is considering several methods of contraception. Which of the following methodsofcontraceptionshouldthenurseidentifyasbeingmostreliable?A.AmalecondomRationale:Thismethodofcontraceptionhas11to16failuresforevery100users.B.An intrauterine device (IUD)Rationale:AnIUDisfoundtohaveafailurerateoflessthan1in100users,whichmakesitoneofthemostA+TestBankPage 8

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reliablemethodsofcontraception.C.AnoralcontraceptiveRationale:This method of contraception has about 8 failures for every 100 users, due to failure to take pillconsistently anddecreasedefficacywhen takenwithcertainmedications.D.Adiaphragmwithspermicide.Rationale:This method of contraception has about 16 failures for every 100 users during the first year ofuse.9.A nurse is caring for an antepartum client whose laboratory findings indicate a negative rubella titer. Which of thefollowingisthecorrectinterpretationofthisdata?A.Theclientis notexperiencingarubellainfectionatthistime.Rationale:Anegativerubellatiterindicatestheclientissusceptibletotherubellavirus.Itdoesnotindicate thepresenceorabsenceofa rubellainfection.B.Theclientis immunetotherubella virus.Rationale:Anegativerubellatiterindicatestheclientissusceptibletotherubellavirus.C.Theclientrequiresarubella vaccination atthistime.Rationale:Rubellavaccinationduringpregnancyiscontraindicatedbecauseofpossibleinjurytothedevelopingfetus.A+TestBankPage 9

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D.Theclient requiresarubellaimmunizationfollowingdelivery.Rationale:Anegativerubellatiterindicatesthattheclientissusceptibletotherubellavirusandneedsvaccinationfollowingdelivery.Immunizationduringpregnancyiscontraindicatedbecauseofpossible injury to the developing fetus. Following rubella immunization, the client should becautionednottoconceivefor1month.10.Anurseina hospital iscaring for a clientwhoisat38weeksofgestationandhasalarge amountofpainless,bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/minandno uterine contractions. The client'svitalsignsare:bloodpressure 98/52 mmHg, heartrate118/min,respiratoryrate24/min,andtemperature 36.4°C (97.6°F).Which ofthe following istheprioritynursingaction?A.Insertan indwelling urinarycatheter.Rationale:Anindwellingurinarycathetercanbeinsertedinthedeliveryroomjustpriorto delivery.This isnotthepriority nursingaction.B.Initiate IVaccess.Rationale:Insertionofalarge-boreIVcatheteristheprioritynursingaction.Theclientislosingbloodrapidly, has hypotension, and tachycardia. IV access will allow IV fluids and blood to beadministeredquicklyifhypovolemiadevelops.A+TestBankPage 10

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D.Excessive uterineenlargementC.Witnessthesignaturefor informed consentforsurgery.Rationale:RationaleC.Thisisnotthenurse'spriorityactionatthistime.Afamilymembercansigntheconsentformifneeded.D.Prepare theabdominalandperinealareas.Rationale:Skinpreparationcanbedelayeduntiljustpriorto acesareandelivery. Thisisnotheprioritynursingaction.12.AA nurseinaprenatal cliniciscaringforaclientwhoissuspectedofhavingahydatidiformmole.Whichofthe followingfindingsshouldthe nurseexpectto observeinthisclient?A.Rapiddeclineinhumanchorionic gonadotropin(hCG)levelsRationale:AclientwhohasahydatidiformmoleusuallyhasanelevatedserumhCGlevel.B.Profuse,clearvaginaldischargeRationale:A client who has a hydatidiform mole often has vaginal bleeding later in the pregnancy. Thisdischargecanbedarkbrown,brightred,scant,orprofuse.C.Irregular fetalheartrateRationale:When a client has a hydatidiform mole, fetal heart tones arenot heard since there is nodeveloping fetus.A+TestBankPage 11

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Rationale:A hydatidiform mole is a rare tumor that forms inside the uterus at the beginning of a pregnancyand results in the over-production of tissue that would normally develop into the placenta. Thistissueconsistsof fluid-filledvesicles.Arapidlyenlarginguterusisaclassicfinding in clientswho have a molar pregnancy. It is often accompanied by severe nausea and vomiting, elevatedhumanchorionicgonadotropinlevels,signsofhyperthyroidism,and earlyonsetofpreeclampsia.13.AAnurseiscaringforanewmotherwhoisconcernedthathernewborn'seyescross.Whichofthefollowingstatementsisatherapeuticresponsebythenurse?A."I willcallyourprimarycareprovidertoreportyour concerns."Rationale:Thisisaninappropriateresponsebythe nursebecauseitdoesnotaddresstheclient'sfeelingsofconcern.B."Iwilltakeyourbabyto thenurseryfor further examination."Rationale:Itisnotnecessaryforthenurse tocompleteadditionalexaminationof thenewborn.Thisalsodoesnotaddresstheclient‟sconcerns.C."This occurs because newborns lack musclecontroltoregulate eyemovement."Rationale:A+TestBankPage 12

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This addresses the client‟s concerns because it provides information that addresses herconcerns. The eyes of newborns are structurally incomplete and muscle control is not fullydevelopedfor3months.D."This isaconcern,but strabismus is easilytreatedwithpatching."Rationale:Thisisaninappropriatestatementbythenursebecauseitoffersunwarrantedreassurance.Thenurseismaking anassumption thatthat shouldbeaddressedbytheprovider.14.AAnurseiscaringforaclientwhoishavinganonstresstestperformed.Thefetalheartrate(FHR)is130to 150/min, but there has been no fetal movement for 15 min. Which of the following actions should thenurseperform?A.Immediatelyreportthesituation totheclient's providerandpreparetheclient forinductionof labor.Rationale:Thefetusmightnotbemovingbecauseitisasleep,ortheremightbeanotherbenignreason.B.Encouragethe clienttowalkaround without the monitoringunit for 10 min,thenresumemonitoring.Rationale:Havingtheclientwalkisnotlikelytopromotefetalmovement.C.Offer the clientasnackoforange juice and crackers.Rationale:Anonstresstestdependsuponfetalmovement,andthisfetusismostlikelyasleep.Mostfetusesare moreactiveafter meals due totheincrease inthemother's blood sugar. Givingthemotherasnackwillpromotefetalmovement.D.Turn the clientontoher leftside.A+TestBankPage 13

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Rationale:Turningtheclientontoherleftside increasestheplacentalperfusionofoxygentothefetus,butthe FHRof130to150/minisnotindicativeoffetaldistress.15.AAnurseonalaborunit isadmitting aclientwhoreportspainfulcontractions. Thenursedeterminesthatthecontractions haveaduration of1 min anda frequencyof3min. Thenurse obtainsthe followingvital signs: fetalheart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. Which of the followingisthepriority actionforthenursetotake?A.Notifytheprovider ofthe findings.Rationale:Callingtheprovidermaybeappropriate;however,thisisnotthepriorityintervention.B.Positiontheclientwithone hip elevated.Rationale:BasedonMaslow‟shierarchyof needs,the client'sneedforan adequatebloodpressuretoperfuseherselfandher fetusisaphysiologicalneedthatrequires immediateintervention.Supinehypotensionisafrequent causeoflowblood pressure in clientswho arepregnant. Byturningthe client onher sideand retakingher bloodpressure, the nurseisattemptingtocorrectthelowbloodpressureandreassess.C.Askthe clientifsheneeds pain medication.Rationale:A+TestBankPage 14

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Theclient's comfortshould beaddressed;however,this is notthepriorityintervention.D.Have the clientvoid.Rationale:Theclientshouldbeencouragedtoemptyherbladderevery2hrduringlabor;however,thisisnotthepriority intervention.16.AAnurseiscaringforaclientwhoisaprimigravida,atterm,andhavingcontractionsbutisstatingthatsheis"notreallysureifsheisinlaborornot." Whichofthe following shouldthenurserecognize asasignoftruelabor?A.Rupture ofthe membranesRationale:Themembranescanrupturespontaneouslylongbeforetheonsetoflabor.B.Changesin the cervixRationale:Assessmentofprogressivechangesintheeffacementanddilationofthecervixisthemostaccurateindicationoftruelabor.C.Stationofthepresenting partRationale:Aclientwhoisaprimigravidawilltypicallyengagebeforelaborandcanenterlaborat-1,0,oreven+1station.D.Patternof contractionsRationale:Aclientcanhaveregularcontractionsforasignificantperiod of timepriortotheonsetof truelabor.A+TestBankPage 15

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