ATI LPN
PN ATI Capstone Maternal Newborn
1. A nurse is reviewing the laboratory results of a newborn who is 24 hours old. Which of the following findings should the nurse report to the provider?
- A. Hemoglobin 12 g/dL
- B. Glucose 50 mg/dL
- C. Bilirubin 4 mg/dL
- D. Platelets 200,000/mm³
Correct answer: C
Rationale: The correct answer is C: Bilirubin 4 mg/dL. A bilirubin level of 4 mg/dL is elevated for a newborn and requires monitoring and potential intervention to prevent complications such as jaundice and kernicterus. Elevated bilirubin levels in newborns can lead to serious neurological consequences. Choices A, B, and D are within normal ranges for a newborn and do not require immediate reporting to the provider. Therefore, the nurse should prioritize reporting the elevated bilirubin level to the provider for further evaluation and management.
2. A nurse manager is teaching a group of employees about QSEN. What statement by an employee should the nurse manager identify as quality improvement?
- A. We should track the rate of hospital-acquired infections.
- B. We should evaluate patient satisfaction scores.
- C. We should start tracking how soon patients are discharged after laparoscopic versus open surgery.
- D. We should check the patient's temperature before discharge.
Correct answer: C
Rationale: The correct answer is C. QSEN focuses on quality improvement in healthcare. Tracking how soon patients are discharged after different types of surgeries helps in evaluating the quality of care provided and identifying areas for improvement. Choices A and B focus on monitoring outcomes but do not directly relate to quality improvement initiatives. Choice D is more about a routine assessment before discharge and does not involve a quality improvement process.
3. A healthcare professional is reviewing the health history of an older adult who has a hip fracture. What is a risk factor for developing pressure injuries?
- A. Dehydration
- B. Urinary incontinence
- C. Poor nutrition
- D. Poor tissue perfusion
Correct answer: B
Rationale: Urinary incontinence is a risk factor for developing pressure injuries due to prolonged skin exposure to moisture and irritants. Dehydration (choice A) can contribute to skin dryness but is not a direct risk factor for pressure injuries. Poor nutrition (choice C) can affect wound healing but is not specifically linked to pressure injuries. Poor tissue perfusion (choice D) can increase the risk of tissue damage but is not as directly associated with pressure injuries as urinary incontinence.
4. A nurse is preparing to administer an intramuscular injection to an adult client. At what angle should the nurse administer the medication using the ventrogluteal site?
- A. 90-degree angle
- B. 60-degree angle
- C. 75-degree angle
- D. 45-degree angle
Correct answer: A
Rationale: The correct answer is A: 90-degree angle. The ventrogluteal site is preferred for intramuscular injections because it is away from major nerves and blood vessels. Administering the injection at a 90-degree angle ensures that the medication reaches deep into the muscle tissue, allowing for proper absorption of the drug. Choice B, 60-degree angle, is incorrect as it is not the recommended angle for the ventrogluteal site. Choice C, 75-degree angle, and Choice D, 45-degree angle, are also incorrect as they are not the appropriate angles for administering an intramuscular injection using the ventrogluteal site.
5. A client is receiving IV moderate sedation with midazolam and has a respiratory rate of 9/min. What should the nurse do?
- A. Place the client in a prone position
- B. Implement positive pressure ventilation
- C. Perform nasopharyngeal suctioning
- D. Administer flumazenil
Correct answer: D
Rationale: The correct answer is D: Administer flumazenil. Flumazenil is the reversal agent for midazolam, a benzodiazepine, and should be administered to counteract respiratory depression. Placing the client in a prone position (choice A) could further compromise their breathing. Implementing positive pressure ventilation (choice B) is not indicated as the first step when dealing with respiratory depression due to sedation. Performing nasopharyngeal suctioning (choice C) is not appropriate in this situation where the client is experiencing respiratory depression due to medication sedation.
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