ATI LPN
Maternal Newborn ATI Proctored Exam 2023
1. A client is in labor and reports increasing rectal pressure. She is experiencing contractions 2 to 3 minutes apart, each lasting 80 to 90 seconds, and a vaginal examination reveals that her cervix is dilated to 9 cm. The client is in which of the following phases of labor?
- A. Active
- B. Transition
- C. Latent
- D. Descent
Correct answer: B
Rationale: The client is in the transition phase of labor, characterized by cervical dilatation of 8 to 10 cm and contractions every 2 to 3 minutes, each lasting 45 to 90 seconds. In this phase, the cervix is nearly fully dilated, preparing the client for the pushing stage. The active phase of labor typically involves cervical dilatation from 4 to 7 cm, whereas the latent phase is the early phase of labor when the cervix dilates from 0 to 3 cm. Descent is not a phase of labor but rather refers to the movement of the fetus through the birth canal during the second stage of labor.
2. Which of the following is the most prominent feature of public health nursing?
- A. Providing home care to sick people who are not confined in the hospital
- B. Providing free services to people within the catchment area
- C. Functioning as part of a team to provide a public health nursing service
- D. Focusing on preventive, not curative services
Correct answer: D
Rationale: The most prominent feature of public health nursing is its focus on preventive services rather than curative ones. Public health nursing aims to prevent diseases and promote health within the community by implementing interventions that target the population as a whole. This focus distinguishes public health nursing from other types of nursing that primarily provide curative care to individuals. Preventive services play a significant role in improving the overall health outcomes of communities and reducing the burden of disease.
3. What are the risk factors for pressure ulcer development?
- A. Immobility and poor nutrition
- B. Obesity and diabetes
- C. Dehydration and malnutrition
- D. Use of assistive devices and prolonged bedrest
Correct answer: A
Rationale: Corrected Rationale: The correct answer is immobility and poor nutrition. Immobility can lead to constant pressure on certain areas of the body, while poor nutrition can impair tissue repair and regeneration, both contributing to the development of pressure ulcers. Choices B, C, and D are incorrect because while obesity, diabetes, dehydration, malnutrition, use of assistive devices, and prolonged bedrest can impact skin integrity and wound healing, they are not the primary risk factors specifically associated with pressure ulcer development.
4. A patient with a diagnosis of deep vein thrombosis (DVT) is receiving heparin therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of the heparin therapy?
- A. Prothrombin time (PT)
- B. Partial thromboplastin time (PTT)
- C. Bleeding time
- D. Platelet count
Correct answer: B
Rationale: The correct answer is B: Partial thromboplastin time (PTT). Heparin affects the intrinsic pathway of the coagulation cascade, which is reflected by changes in the PTT. Monitoring the PTT helps ensure that the patient's blood is within the desired therapeutic range and prevents complications related to clotting or bleeding. Prothrombin time (PT) primarily assesses the extrinsic pathway and is not as sensitive to heparin therapy. Bleeding time and platelet count are not specific tests for monitoring the effectiveness of heparin therapy in DVT.
5. What is the most appropriate intervention for a patient experiencing severe anxiety?
- A. Encourage the patient to talk about their anxiety.
- B. Teach the patient deep breathing exercises.
- C. Remain with the patient and provide a calm presence.
- D. Suggest the patient engage in physical activity.
Correct answer: C
Rationale: When a patient is experiencing severe anxiety, remaining with the patient and providing a calm presence is the most appropriate intervention. This approach can help the patient feel supported and safe, which can help in reducing their anxiety levels. Encouraging the patient to talk about their anxiety may not be suitable during a severe anxiety episode, as it can potentially escalate their distress. Teaching deep breathing exercises can be helpful, but in cases of severe anxiety, the patient may find it challenging to focus on such techniques. Suggesting physical activity may not be suitable as the patient might not be in a state to engage in such activities when experiencing severe anxiety.
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