ATI LPN
PN ATI Capstone Maternal Newborn
1. A client tells the nurse that she suspects she is pregnant because she is able to feel the baby move. The nurse knows that this is a:
- A. Presumptive sign of pregnancy
- B. Probable sign of pregnancy
- C. Positive sign of pregnancy
- D. Possible sign of pregnancy
Correct answer: A
Rationale: The correct answer is A: Presumptive sign of pregnancy. Quickening, or the sensation of fetal movement, is considered a presumptive sign of pregnancy. It is not definitive because other conditions, such as gas or intestinal movement, can mimic the feeling of fetal movement. Choice B, Probable sign of pregnancy, refers to signs that make the nurse reasonably certain that a woman is pregnant, such as a positive pregnancy test. Choice C, Positive sign of pregnancy, includes signs like hearing fetal heart tones or visualizing the fetus on ultrasound, which definitively confirm pregnancy. Choice D, Possible sign of pregnancy, is a vague term and does not specifically relate to any pregnancy sign.
2. What is the most appropriate response when a client with chronic kidney disease asks about fluid restrictions?
- A. Fluid restrictions are not needed for all clients with chronic kidney disease.
- B. You may need to limit fluid intake to prevent fluid overload.
- C. Fluid restrictions are based on your lab results and daily weights.
- D. Restricting fluids is only necessary during dialysis.
Correct answer: B
Rationale: The most appropriate response when a client with chronic kidney disease asks about fluid restrictions is to inform them that limiting fluid intake may be necessary to prevent fluid overload. This is crucial in managing the condition and preventing complications such as edema and electrolyte imbalances. Choice A is incorrect as fluid restrictions are commonly advised for clients with chronic kidney disease. Choice C is partially correct as fluid restrictions are indeed based on lab results and daily weights, but the primary goal is to prevent fluid overload. Choice D is incorrect because fluid restrictions are not limited to just during dialysis; they are often recommended throughout the day to manage the condition.
3. A nurse is teaching a client who has diabetes mellitus about foot care. Which of the following instructions should the nurse include?
- A. Soak feet in hot water daily
- B. Use a heating pad on the feet daily
- C. Cut toenails straight across
- D. Massage feet with lotion daily
Correct answer: C
Rationale: The correct answer is C: 'Cut toenails straight across.' This instruction is crucial for clients with diabetes to prevent ingrown toenails and potential foot complications. Soaking feet in hot water daily (Choice A) can lead to skin damage and is not recommended for diabetic individuals. Using a heating pad on the feet daily (Choice B) can cause burns or injuries due to reduced sensation in the feet that often accompanies diabetes. Massaging feet with lotion daily (Choice D) is generally safe but may not address the specific preventive measure of cutting toenails correctly.
4. What are the side effects of chemotherapy, and how should they be managed?
- A. Nausea, vomiting; manage with antiemetics
- B. Hair loss and anemia; manage with blood transfusions
- C. Diarrhea and fatigue; manage with hydration
- D. Weight gain and high blood pressure; manage with diuretics
Correct answer: A
Rationale: The correct side effects of chemotherapy mentioned in this question are nausea and vomiting. These side effects are commonly managed with antiemetics to improve the quality of life for patients undergoing chemotherapy. Choice B (Hair loss and anemia) is incorrect as hair loss and anemia are potential side effects of chemotherapy but are not addressed in this question. Choice C (Diarrhea and fatigue) is also incorrect as it does not match the side effects provided. Choice D (Weight gain and high blood pressure) is inaccurate as these are not typical side effects of chemotherapy.
5. How is resistant starch digested in the colon?
- A. bacterial fermentation.
- B. pancreatic amylase.
- C. hydrochloric acid.
- D. villi and microvilli.
Correct answer: A
Rationale: In the colon, resistant starch is digested by bacterial fermentation. The correct answer is A. During this process, short-chain fatty acids are produced. Pancreatic amylase, as mentioned in choice B, is responsible for breaking down starch in the small intestine, not in the colon. Choice C, hydrochloric acid, functions in the stomach to aid in the digestion of proteins, not starch. Villi and microvilli, as stated in choice D, are structures in the small intestine that absorb nutrients; they do not participate in the digestion of resistant starch in the colon.
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