liz is 36 weeks pregnant a rise in her babys heart rate is probably followed within five seconds by liz is 36 weeks pregnant a rise in her babys heart rate is probably followed within five seconds by
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Nursing Elites

ATI RN

Human Growth and Development Exam Questions

1. Liz is 36 weeks pregnant. A rise in her baby's heart rate is probably followed within five seconds by __________.

Correct answer: A

Rationale: A rise in the baby's heart rate during pregnancy is usually followed within five seconds by a burst of motor activity. This indicates that the baby is responding to stimuli and is an important sign of healthy fetal development. A period of sleep, a rise in Liz's heart rate, or a drop in Liz's body temperature are not typically immediate responses to changes in the baby's heart rate. Sleep is less likely to be a direct response to changes in heart rate, Liz's heart rate is independent of the baby's heart rate changes, and a drop in Liz's body temperature is not a common immediate response to fetal heart rate changes.

2. In a routine sputum analysis, which of the following indicates proper nursing action before sputum collection?

Correct answer: A

Rationale: Corrected Rationale: Before sputum collection, it is crucial to use a clean container to prevent specimen contamination. This step is essential to ensure accurate test results and to avoid introducing external particles or bacteria into the sample. Choice B is incorrect because discarding the container if the outside becomes soiled is not a standard practice before collection. Choice C is incorrect as rinsing the client's mouth with Listerine after collection can introduce unnecessary substances into the specimen. Choice D is incorrect as the amount of sputum needed should be determined by the healthcare provider, not the client.

3. A nurse is teaching a patient with chronic lymphocytic leukemia (CLL) about potential complications. Which complication should the nurse emphasize?

Correct answer: A

Rationale: The correct answer is A: Infection. Patients with chronic lymphocytic leukemia (CLL) are at a significant risk of infection due to their compromised immune system. Emphasizing the importance of infection prevention and prompt treatment is crucial in the care of these patients. Choice B, Hemorrhage, is less common in CLL compared to other types of leukemia. Choice C, Fatigue, is a common symptom but not a complication that poses immediate risks. Choice D, Splenomegaly, is a common finding in CLL but not the most critical complication to emphasize regarding patient education.

4. A patient is 1 day postoperative following a hip arthroplasty. Which of the following actions should the nurse take to prevent dislocation of the hip?

Correct answer: B

Rationale: Placing a pillow between the patient's legs is the correct action to prevent dislocation of the hip following arthroplasty. This technique helps maintain proper alignment and stability of the hip joint. Keeping the patient in a side-lying position may not provide the necessary support to prevent hip dislocation. Instructing the patient to avoid sitting for long periods is important for preventing complications like deep vein thrombosis but does not directly prevent hip dislocation. Elevating the head of the bed to 90 degrees is not relevant to preventing hip dislocation in a postoperative hip arthroplasty patient.

5. A nurse is caring for a client with a newly inserted pacemaker. What is the most important nursing action post-procedure?

Correct answer: A

Rationale: Post-procedure, monitoring the insertion site for signs of infection is crucial because it helps in early detection of any potential complications such as infection. While educating the client about activity restrictions, monitoring the client's heart rate and rhythm, and assessing lung sounds for signs of fluid overload are important aspects of care, the immediate priority post-procedure is to prevent infection at the insertion site, which could lead to serious complications.

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