ATI RN
ATI Capstone Maternal Newborn Assessment Quizlet
1. A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following actions should the nurse take?
- A. Swaddle the newborn tightly
- B. Provide frequent tactile stimulation
- C. Position the newborn in a prone position
- D. Offer large feedings every 4 hours
Correct answer: A
Rationale: The correct action for the nurse to take when caring for a newborn with neonatal abstinence syndrome is to swaddle the newborn tightly. Swaddling helps to provide comfort and reduce irritability in these newborns. Choice B, providing frequent tactile stimulation, may exacerbate the symptoms of neonatal abstinence syndrome by overstimulating the newborn. Choice C, positioning the newborn in a prone position, is not recommended as it increases the risk of sudden infant death syndrome (SIDS). Choice D, offering large feedings every 4 hours, is not appropriate as newborns with neonatal abstinence syndrome may have feeding difficulties and need smaller, more frequent feedings.
2. The most energy-rich nutrient is:
- A. carb
- B. fat
- C. protein
- D. water
Correct answer: B
Rationale: Fat provides 9 kcal per gram, making it the most energy-rich nutrient compared to carbohydrates and proteins, which provide 4 kcal per gram.
3. Which are included in the evaluation step of the nursing process? (Select all that apply.)
- A. All below
- B. Ascertaining if the plan requires modification
- C. Determination if the outcome has been met
- D. Selecting alternative interventions if the outcome has not been met
Correct answer: A
Rationale: The evaluation step involves determining if outcomes are met, modifying the plan if needed, and selecting alternative interventions if goals are not achieved.
4. A client with a new tracheostomy is being seen in the oncology clinic. What finding by the nurse best indicates that goals for the nursing diagnosis Impaired Self-Esteem are being met?
- A. The client demonstrates a good understanding of stoma care.
- B. The client has joined a book club that meets at the library.
- C. Family members take turns assisting with stoma care.
- D. Skin around the stoma is intact without signs of infection.
Correct answer: B
Rationale: The client joining a book club that meets outside the home and requires him or her to go out in public is the best indicator that goals for Impaired Self-Esteem are being met. This social activity indicates an improvement in self-confidence and willingness to engage with others, which are essential aspects of self-esteem. The other choices, while positive, do not directly address self-esteem concerns related to social interaction and confidence.
5. What is a potential implication of multiple dark bands on the nails?
- A. They are considered a normal variant.
- B. They can be associated with malignant melanoma.
- C. They are indicative of a nail fungus.
- D. They are associated with aging.
Correct answer: B
Rationale: Multiple dark bands on the nails can be a concerning sign of malignant melanoma, a type of skin cancer that can affect the nails. While some nail changes are considered normal variants, dark bands should not be dismissed lightly as they can indicate a serious condition like melanoma. Nail fungus typically presents differently, causing discoloration, thickening, or distortion of the nail without distinct dark bands. Additionally, aging can lead to various nail changes, but dark bands alone are not a common feature of normal aging.
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