ATI Maternal Newborn/Care of Children
A client who is pregnant arrives at the labor and delivery unit reporting leakage of fluid from the
vagina. The nurse determines that the client has probable rupture of membranes when the
assessment reveals what? - ANS-A ferning test is positive when membranes rupture. This test
is deemed positive when a drop of vaginal fluid, allowed to dry on a glass slide, creates a
fern-like pattern.
\A nurse is assessing a client who is 24 hours postpartum following a vaginal delivery. Which of
the following lab findings indicates a postpartum infection?
1. Platelets 300,000
2. WBC 9,000
3. Erythocyte Sed. Rate 26mm/hr
4. C-reactive Protein 0.8 mg/dL - ANS-C-Reactive Protein value exceeds the expected
reference range and indicates an infection.
\A nurse is assessing a newborn who was born 12 hours ago. Which of the following findings
requires an intervention by the nurse? 1. Acrocyanosis 2. Audible Murmur over base 3.
Substernal retractions 4. Positive Babinski reflex - ANS-Substernal Retractions are a sign of
respiratory distress in the newborn and require a nursing intervention.
\A nurse is caring for a client that is 26 weeks gestation. Which of the following findings should
the nurse report to the provider?
1.Leukorrhea
2. Supine Hypotension
3. Periodic numbness in the fingers.
4. Pitting edema in the ankles. - ANS-Pitting edema in the ankles is a clinical manifestation of
preeclampsia and should be reported to the provider.
\A nurse is caring for a client who is 40 weeks gestation and is receiving a non-stress test. The
monitor tracing shows a 15/min increase above baseline, lasting at least 15 seconds, in
response to fetal movement two times in a 20 minute period. Is this a normal finding? -
ANS-Two or more accelerations in a 20 minute period indicates a reassuring non-stress test.
\A nurse is caring for a client who is at 27 weeks of gestation and has an elevated 1 hour, 50g
glucose screening result. The nurse should plan to initiate which of the following for managing
this clients care?
1. Begin diabetes dietary teaching 2. Instruct the client to obtain serial blood glucose levels for
24 hours. 3. Request a prescription for a 3 hour glucose tolerance test (gtt) 4. Inform the client
the test will need to be repeated. - ANS-3. Request a prescription for a 3 hour glucose tolerance
test. (GTT)
\Artificial Active - ANS-A shot that elicits active antibody formation in the body.
\Artificial Passive - ANS-This is acquired via antibody transfer.
\Autonomy vs. Shame - ANS-Developmental task for a toddler. (1-3 years)
\Biots respirations - ANS-Periods of apnea alternating with two or three shallow breaths
\Cheyne-Strokes - ANS-Periods of apnea alternating with periods of hyperventilation
\Chlordiazepoxide hydrochloride - ANS-Used to treat alcohol withdrawal symptoms.
A client who is pregnant arrives at the labor and delivery unit reporting leakage of fluid from the
vagina. The nurse determines that the client has probable rupture of membranes when the
assessment reveals what? - ANS-A ferning test is positive when membranes rupture. This test
is deemed positive when a drop of vaginal fluid, allowed to dry on a glass slide, creates a
fern-like pattern.
\A nurse is assessing a client who is 24 hours postpartum following a vaginal delivery. Which of
the following lab findings indicates a postpartum infection?
1. Platelets 300,000
2. WBC 9,000
3. Erythocyte Sed. Rate 26mm/hr
4. C-reactive Protein 0.8 mg/dL - ANS-C-Reactive Protein value exceeds the expected
reference range and indicates an infection.
\A nurse is assessing a newborn who was born 12 hours ago. Which of the following findings
requires an intervention by the nurse? 1. Acrocyanosis 2. Audible Murmur over base 3.
Substernal retractions 4. Positive Babinski reflex - ANS-Substernal Retractions are a sign of
respiratory distress in the newborn and require a nursing intervention.
\A nurse is caring for a client that is 26 weeks gestation. Which of the following findings should
the nurse report to the provider?
1.Leukorrhea
2. Supine Hypotension
3. Periodic numbness in the fingers.
4. Pitting edema in the ankles. - ANS-Pitting edema in the ankles is a clinical manifestation of
preeclampsia and should be reported to the provider.
\A nurse is caring for a client who is 40 weeks gestation and is receiving a non-stress test. The
monitor tracing shows a 15/min increase above baseline, lasting at least 15 seconds, in
response to fetal movement two times in a 20 minute period. Is this a normal finding? -
ANS-Two or more accelerations in a 20 minute period indicates a reassuring non-stress test.
\A nurse is caring for a client who is at 27 weeks of gestation and has an elevated 1 hour, 50g
glucose screening result. The nurse should plan to initiate which of the following for managing
this clients care?
1. Begin diabetes dietary teaching 2. Instruct the client to obtain serial blood glucose levels for
24 hours. 3. Request a prescription for a 3 hour glucose tolerance test (gtt) 4. Inform the client
the test will need to be repeated. - ANS-3. Request a prescription for a 3 hour glucose tolerance
test. (GTT)
\Artificial Active - ANS-A shot that elicits active antibody formation in the body.
\Artificial Passive - ANS-This is acquired via antibody transfer.
\Autonomy vs. Shame - ANS-Developmental task for a toddler. (1-3 years)
\Biots respirations - ANS-Periods of apnea alternating with two or three shallow breaths
\Cheyne-Strokes - ANS-Periods of apnea alternating with periods of hyperventilation
\Chlordiazepoxide hydrochloride - ANS-Used to treat alcohol withdrawal symptoms.
