ATI LPN
ATI Maternal Newborn Proctored
1. A client who underwent an amniotomy is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?
- A. Maintain the client in the lithotomy position.
- B. Perform vaginal examinations frequently.
- C. Remind the client to bear down with each contraction.
- D. Encourage the client to empty her bladder every 2 hours.
Correct answer: D
Rationale: Encouraging the client to empty her bladder every 2 hours is essential during labor to prevent bladder distention, which can hinder labor progress and cause discomfort. A distended bladder can also lead to potential complications such as uterine atony or increased risk of infection. Choice A is incorrect as maintaining the client in the lithotomy position is not necessary during the active phase of the first stage of labor and may not be comfortable for the client. Choice B is incorrect because performing vaginal examinations frequently can increase the risk of introducing infection and disrupt the natural progress of labor. Choice C is incorrect as bearing down with each contraction is typically reserved for the second stage of labor when the cervix is fully dilated, not during the active phase of the first stage.
2. A nurse is reviewing laboratory results for a client receiving chemotherapy. Which result should the nurse report to the provider?
- A. WBC 3,000/mm³
- B. Hemoglobin 12 g/dL
- C. Platelet count 250,000/mm³
- D. Serum sodium 140 mEq/L
Correct answer: A
Rationale: The correct answer is A: WBC 3,000/mm³. A WBC count of 3,000/mm³ indicates neutropenia, which is a condition characterized by a low level of white blood cells, specifically neutrophils. Neutropenia increases the risk of infection and requires immediate medical attention, especially in clients undergoing chemotherapy. Reporting this result to the provider promptly is crucial for further evaluation and intervention. Choices B, C, and D are within normal ranges and do not pose an immediate risk to the client's health. Hemoglobin of 12 g/dL, platelet count of 250,000/mm³, and serum sodium of 140 mEq/L are all normal values and would not typically require immediate reporting unless there are specific concerns related to the individual client's condition.
3. What are the signs and symptoms of hyperkalemia and how should it be managed?
- A. Muscle weakness and cardiac arrhythmias; administer calcium gluconate
- B. Confusion and bradycardia; administer insulin and glucose
- C. Fatigue and irregular heart rate; administer diuretics
- D. Nausea and vomiting; administer sodium bicarbonate
Correct answer: A
Rationale: The signs and symptoms of hyperkalemia include muscle weakness and cardiac arrhythmias, making choice A correct. Hyperkalemia can lead to dangerous cardiac effects, and calcium gluconate is used to stabilize the heart by antagonizing the effects of potassium. Choices B, C, and D describe symptoms and interventions that are not typically associated with hyperkalemia. Confusion and bradycardia are not common in hyperkalemia, and insulin and glucose are used in hyperkalemia only under specific circumstances. Fatigue and irregular heart rate are vague symptoms, and diuretics are not the primary treatment for hyperkalemia. Nausea and vomiting are nonspecific symptoms and sodium bicarbonate is not indicated for the management of hyperkalemia.
4. Mucus is produced by the salivary glands and the:
- A. intestinal glands.
- B. esophageal glands.
- C. pineal gland.
- D. islets of Langerhans.
Correct answer: A
Rationale: Mucus is produced by the salivary glands to moisten food and aid in swallowing. Additionally, the intestinal glands secrete mucus to protect the lining of the intestines. The other choices, esophageal glands, pineal gland, and islets of Langerhans, are not involved in the production of mucus in the digestive system.
5. Prior to elective surgery, a patient taking warfarin should receive which instruction regarding warfarin therapy?
- A. Continue taking warfarin until the day of surgery.
- B. Stop taking warfarin three days before surgery.
- C. Switch to aspirin before surgery.
- D. Stop taking warfarin one week before surgery.
Correct answer: D
Rationale: Prior to elective surgery, a patient taking warfarin should be instructed to stop taking warfarin around one week before the procedure. This timeframe allows for the effects of warfarin to diminish, lowering the risk of excessive bleeding during surgery. Continuing warfarin until the day of surgery (Choice A) increases the risk of bleeding complications. Stopping warfarin three days before surgery (Choice B) may not provide enough time for the anticoagulant effects to subside. Switching to aspirin before surgery (Choice C) is not recommended as a substitute for warfarin in this context.
Similar Questions
Access More Features
ATI Basic
- 50,000 Questions with answers
- All ATI courses Coverage
- 30 days access @ $69.99
ATI Basic
- 50,000 Questions with answers
- All ATI courses Coverage
- 90 days access @ $149.99