ati case studies
a nurse in a provider's office is assessing a client who is at 35 weeks of gestation. The nurse should identify which of the following findings as the priority to report to the provider? a- increasing intensity of uterine contractions b- bilateral non pitting ankle edema c- report of burning sensation during urination d- shortness of breath upon ambulation
a
a nurse is assisting a postpartum client who had a cesarean birth with breastfeeding her newborn. Which of the following breastfeeding positions should the nurse suggest for this client? a- football hold b- modified cradle c- side-lying d- cradle hold
a
a nurse is caring for a client who is 8 hr postpartum & begins to hemorrhage. Which of the following actions should the nurse take first? a- massage the client's fundus b- evaluate the client's temperature c- insert a urinary catheter d- draw a cbc
a
a nurse is caring for a client who is 8 hr postpartum. The nurse palpates the fundus at two fingerbreadths above the umbilicus & deviated to the right. Which of the following actions should the nurse take first? a- assist the client to void b- administer analgesics c- pour water from a squeeze bottle over the client's perineum d- teach the client relaxation exercises
a
a nurse is caring for a newborn immediately following birth. Which of the following actions should the nurse take first? a- place newborn skin to skin w/ the client b- administer vitamin k c- obtain a new ballard score d- weigh the newborn
a
a nurse is caring for a newborn immediately following birth. which of the following actions should the nurse take first? a- place newborn skin to skin on the mother's chest b- perform Apgar score assessment on newborn c- conduct complete physical assessment of newborn d- administer erythromycin eye ointment to newborn
a
a nurse is discussing Apgar scoring with a newly licensed nurse. the nurse should identify that which of the following factors can affect the Apgar score? a- maternal medications b- gender of newborn c- use of internal fetal monitoring during labor d- maternal age
a
a nurse is discussing breastfeeding with a postpartum client. which of the following statements should the nurse include? a- initiate breastfeeding within 1st hour after birth b- the American academy of pediatrics recommends exclusive breastfeeding for the 1st 2 months c- breastfeeding is contraindicated for clients who have group B strep d- breastfeed your newborn on a strict schedule
a
a nurse is discussing the benefits of breastfeeding with a postpartum client. Which of the followings benefits to the newborn should the nurse include? a- reduces the risk for otitis media b- reduces the risk for UTI c- reduces the risk for bleeding d- reduces the risk for dental caries
a
a nurse is teaching a client who is at 10 weeks of gestation about danger signs of pregnancy. The nurse should identify which of the following client statements as an indication of understanding? a- I should report persistent vomiting that causes weight loss b- I should expect to develop hemorrhoids during my 1st trimester c- I know the breast pain means I have a breast infection. d- I know that diarrhea is expected throughout my pregnancy
a
a nurse is caring for a client who is experiencing postpartum hemorrhage and has a prescription for methylergonovine. Which of the following conditions is a contraindication for this medication? a- gestational diabetes mellitus b- preeclampsia c- asthma d- cholecystitis
b
a nurse is assessing a client who is at 24 weeks of gestation during a routine prenatal visit. Which of the following findings should the nurse identify as a potential danger sign of pregnancy? a- angiomas on the face b- supine hypotension c- glycosuria d- leukorrhea
c
a nurse is assessing a client who is postpartum & has saturated 4 pads in 1 hr. Which of the following findings is a manifestation of hemorrhagic shock? a- polyuria b- bradycardia c- rapid shallow respirations d- capillary refill less than 2 seconds
c
a nurse is conducting an Apgar score assessment on a newborn. which of the following findings should the nurse assess? a- temperature b- blood pressure c- respiratory effort d- gestational age
c
a nurse is discussing Apgar scoring with a newly licensed nurse. which of the following information should the nurse include in the teaching? a- Apgar scoring predicts future neurologic outcomes b- Apgar scoring assesses the gestational age level of the neonate c- Apgar scoring is a rapid assessment of the newborn's transition to extrauterine life d- Apgar scoring should be done at 30 mins following birth
c
a nurse is discussing proper positioning techniques with a postpartum client who is breastfeeding. Which of the following information should the nurse include? a- you should hold your baby so his stomach faces upward b- you should stroke your baby's forehead to encourage release of sucking during the feeding c- your baby's nose, cheeks, and chin should touch your breast during the feeding d- you should swaddle your baby in a blanket throughout the feeding
c
nurse is assessing a newborn who is 5 mins old. The newborn has a slow & weak cry, flaccid tone, pale color, grimace, & heart rate of 120/min. which of the following Apgar scores should the nurse assign the newborn? a- 2 b- 6 c- 4 d- 3
c 2 for HR 1 for respiratory effect (slow & weak cry) 0 for muscle tone (flaccid) 1 for reflex irritability (grimace) 0 for color
a nurse is assessing a client who is at 20 weeks of gestation. Which of following findings should the nurse identify as an indicator of fetal compromise? a- client report of quickening b- fundal height of 22 cm c- fetal heart rate of 110/min d- absence of protein in the client's urine
c While 110 to 160/min is an expected finding for an at-term fetus, the nurse should expect a fetal heart rate (FHR) of about 160 /min for a fetus at 20 weeks of gestation. The nurse should further assess the status of the fetus and report the findings immediately to the provider.
a nurse is assessing a client who is in her 3rd trimester of pregnancy. When assessing for indications of preeclampsia, the nurse should ask the client if she has which of the following manifestations? a- pelvic pressure b- vaginal bleeding c- leg cramps d- blurred vision
d
a nurse is caring for a client who is 2 hr postpartum. Which of the following factors should the nurse identify as a risk factor for postpartum hemorrhage? a- oligohydramnios b- intrauterine growth restriction c- primigravida d- prolonged labor
d