ATI LPN
PN ATI Capstone Maternal Newborn
1. A postpartum client's fundus is firm, 3 cm above the umbilicus, and displaced to the right. Which of the following interventions should the nurse take?
- A. Massage the fundus
- B. Administer oxytocin
- C. Assist the client to void then reassess the fundus
- D. Notify the healthcare provider
Correct answer: C
Rationale: The correct intervention for a postpartum client with a firm, displaced fundus is to assist the client to void then reassess the fundus. Displacement of the uterus to the right is often a sign of bladder distention, which can prevent the uterus from contracting properly and increase the risk of postpartum hemorrhage. By helping the client to void, the nurse can alleviate the bladder distention, allowing the uterus to contract effectively. Massaging the fundus (Choice A) may not address the underlying issue of bladder distention. Administering oxytocin (Choice B) is not indicated without assessing and addressing the cause of the displacement. Notifying the healthcare provider (Choice D) is premature before implementing initial nursing interventions to address the potential cause of the displaced fundus.
2. When resolving a conflict, which statement made by the charge nurse is an example of smoothing?
- A. You have been a nurse a long time, so I’m sure you’re capable of the tasks.
- B. If you prefer, I can take over your assignment.
- C. We can switch your assignment with someone else.
- D. Let’s discuss your concerns in a private setting.
Correct answer: A
Rationale: The correct answer is A because it exemplifies smoothing, a conflict resolution strategy where the charge nurse reassures the staff nurse of their capabilities. Choice B offers to take over the assignment, which is more of a compromising strategy. Choice C suggests switching assignments, which aligns with compromising rather than smoothing. Choice D proposes a discussion in a private setting, indicating a collaborating approach rather than smoothing.
3. Public health services are given free of charge. Is this statement true or false?
- A. The statement is true; it is the responsibility of government to provide these services
- B. The statement is false; people pay indirectly for public health services
- C. The statement may be true or false; depending on the Specific service required
- D. The statement may be true or false; depending on policies of the government concerned.
Correct answer: B
Rationale: Community health services, including public health services, are prepaid paid services, through taxation, for example.
4. A healthcare professional is assessing a client with deep vein thrombosis (DVT). Which of the following interventions should the healthcare professional include in the plan of care?
- A. Apply ice packs to the affected extremity.
- B. Encourage ambulation every hour.
- C. Elevate the affected leg when in bed.
- D. Massage the affected area to improve circulation.
Correct answer: C
Rationale: Elevating the affected leg is a crucial intervention in the care of a client with deep vein thrombosis (DVT). This position helps reduce swelling and promotes venous return, which can alleviate symptoms associated with DVT. Applying ice packs (Choice A) may worsen the condition by causing vasoconstriction. Encouraging ambulation (Choice B) can dislodge the clot and lead to fatal complications. Massaging the affected area (Choice D) can also dislodge the clot and is contraindicated in DVT.
5. A client has just completed an information session about measures to minimize the progression of coronary artery disease (CAD). Which statement indicates an initial understanding of lifestyle alterations?
- A. I should take daily medication for life.
- B. I should eat a diet that is low in fat and cholesterol.
- C. I should continue to smoke to keep the metabolic rate high.
- D. I should begin to exercise if the diet is not sufficient to achieve weight loss.
Correct answer: B
Rationale: Choosing a diet that is low in fat and cholesterol is crucial for managing and preventing the progression of coronary artery disease (CAD). This dietary change can help reduce the risk of further complications associated with CAD, such as plaque buildup in the arteries. It is a fundamental lifestyle alteration that can positively impact the client's heart health. Option A is incorrect as relying solely on medication without lifestyle changes may not address the root cause of CAD. Option C is incorrect as smoking is harmful and worsens CAD. Option D is incorrect because exercise is a crucial part of a healthy lifestyle, but dietary changes should come first in managing CAD.
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