ATI LPN
PN ATI Capstone Maternal Newborn
1. A client who is 32 weeks pregnant and has a diagnosis of placenta previa is receiving teaching from a nurse. Which of the following instructions should the nurse include?
- A. Limit physical activity
- B. Monitor fetal movements daily
- C. Call the healthcare provider if contractions begin
- D. All of the above
Correct answer: D
Rationale: Clients diagnosed with placenta previa are at an increased risk of bleeding and preterm labor. Therefore, it is essential for them to limit physical activity to prevent complications. Monitoring fetal movements daily helps in assessing the well-being of the fetus. Additionally, notifying the healthcare provider if contractions begin is crucial as it could be a sign of preterm labor. Therefore, all of the instructions (limiting physical activity, monitoring fetal movements, and calling the healthcare provider if contractions begin) are necessary for managing placenta previa effectively. Choices A, B, and C are all correct instructions for a client with placenta previa.
2. A client is experiencing dysphagia. Which of the following actions should the nurse take?
- A. Provide small food pieces.
- B. Offer thickened liquids.
- C. Encourage the client to sit upright after meals.
- D. Place food on the unaffected side of the mouth.
Correct answer: D
Rationale: When caring for a client with dysphagia, placing food on the unaffected side of the mouth can help them chew and swallow more effectively. This technique can assist in minimizing the risk of aspiration and improve the client's ability to manage food safely. Providing small food pieces, offering thickened liquids, and encouraging the client to sit upright after meals are also important interventions in managing dysphagia, but placing food on the unaffected side of the mouth is a specific technique that directly addresses the swallowing difficulty associated with dysphagia.
3. In a patient with chronic kidney disease (CKD) receiving erythropoietin therapy, what laboratory result should the nurse monitor to evaluate the effectiveness of this therapy?
- A. Serum creatinine
- B. White blood cell count
- C. Hemoglobin level
- D. Serum potassium
Correct answer: C
Rationale: The correct answer is C: Hemoglobin level. Erythropoietin therapy is used to stimulate red blood cell production in patients with chronic kidney disease who often develop anemia due to reduced erythropoietin production by the kidneys. Monitoring the hemoglobin level is essential to evaluate the effectiveness of erythropoietin therapy as an increase in hemoglobin indicates improved red blood cell production and better management of anemia in these patients. Serum creatinine, white blood cell count, and serum potassium levels are important parameters to monitor in CKD patients but are not specific indicators of the effectiveness of erythropoietin therapy for managing anemia.
4. A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?
- A. Administer acetaminophen (Tylenol).
- B. Apply lotion to the skin.
- C. Encourage a high-protein diet.
- D. Provide a warm bath.
Correct answer: B
Rationale: Pruritus is a common symptom in clients with cirrhosis due to bile salts accumulating in the skin. Applying lotion to the skin helps soothe the itching and can prevent skin breakdown. Acetaminophen can worsen liver damage in clients with cirrhosis as it is metabolized in the liver. Encouraging a high-protein diet is not directly related to relieving pruritus. Providing a warm bath may further dry the skin, exacerbating the itching. Therefore, the most appropriate intervention to help relieve pruritus in a client with cirrhosis is to apply lotion to the skin.
5. Which of the following is a common symptom of borderline personality disorder?
- A. Obsessive-compulsive behaviors
- B. Fear of social situations
- C. Grandiose sense of self-importance
- D. Impulsive and self-destructive behaviors
Correct answer: D
Rationale: Individuals with borderline personality disorder often exhibit impulsive and self-destructive behaviors. These behaviors can include reckless driving, substance abuse, self-harm, and suicidal gestures. These actions are often attempts to cope with intense emotional pain or to avoid feelings of emptiness and abandonment. It is crucial for healthcare professionals to recognize and address these symptoms when diagnosing and treating borderline personality disorder.
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