a nurse is completing the admission assessment of a newborn which of the following anatomical landmarks should the nurse use when measuring the newbor
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ATI Maternal Newborn Proctored

1. During the admission assessment of a newborn, which anatomical landmark should be used for measuring the newborn's chest circumference?

Correct answer: B

Rationale: When measuring a newborn's chest circumference, the appropriate anatomical landmark to use is the nipple line. This point is consistent and allows for accurate and standardized measurements across all newborn assessments. The sternal notch is not typically used for chest circumference measurements in newborns. The xiphoid process is located at the lower end of the sternum and is not an appropriate landmark for chest circumference measurement. The fifth intercostal space is typically used for locating the point of maximal impulse (PMI) during cardiac assessments, not for measuring chest circumference.

2. A nurse on the labor and delivery unit is caring for a client who is having a difficult, prolonged labor with severe backache. Which of the following contributing causes should the nurse identify?

Correct answer: D

Rationale: The correct answer is D. In a persistent occiput posterior position, the baby's head presses against the mother's spine, causing prolonged labor and severe backache. This position can lead to difficulties in labor progress and increase discomfort for the mother. Choices A, B, and C are incorrect as they do not directly relate to the client's difficult, prolonged labor with severe backache. Fetal attitude, fetal lie, and maternal pelvis type may affect labor, but in this scenario, the persistent occiput posterior fetal position is the primary contributing cause for the client's symptoms.

3. Which of the following medications should the provider prescribe for a client with gonorrhea?

Correct answer: A

Rationale: Ceftriaxone is the preferred medication to treat gonorrhea, a bacterial infection. It is essential to promptly treat gonorrhea to prevent complications such as pelvic inflammatory disease, infertility, and the spread of the infection to others. Fluconazole is used for fungal infections, Metronidazole treats certain bacterial and parasitic infections, and Zidovudine is an antiretroviral medication used in HIV treatment; none of these are appropriate for gonorrhea.

4. A client who is pregnant and has phenylketonuria (PKU) is receiving teaching from a nurse. Which of the following foods should the nurse instruct the client to eliminate from her diet?

Correct answer: A

Rationale: Individuals with phenylketonuria (PKU) have difficulty breaking down phenylalanine, an amino acid found in protein-rich foods like peanut butter. Therefore, clients with PKU should avoid foods high in phenylalanine, such as peanut butter, to prevent adverse effects on their health. Choices B, C, and D are not typically high in phenylalanine and do not pose the same risk to individuals with PKU as peanut butter.

5. A client at 36 weeks of gestation is suspected of having placenta previa. Which of the following findings support this diagnosis?

Correct answer: A

Rationale: Painless red vaginal bleeding is a hallmark sign of placenta previa. In this condition, the placenta partially or completely covers the cervical opening, leading to painless, bright red bleeding due to the separation of the placenta from the uterine wall. Other types of bleeding, such as those associated with abdominal pain or mucus passage, are more indicative of conditions like placental abruption rather than placenta previa. Therefore, choices B, C, and D are incorrect as they describe findings more consistent with placental abruption rather than placenta previa.

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