NR327 ATI Maternal-Newborn Proctored Exam 2024

A nurse is performing a physical assessment of a newborn. Which of the following actions should the nurse take? - Measure the circumference of the newborn's head with a tape measure just above the eyebrows A nurse is caring for a client in active labor who has meconium staining of the amniotic fluid. The nurse notes a reassuring fetal heart rate (FHR) tracing from the external fetal monitor. Which of the following actions should the nurse perform? - Prepare equipment needed for newborn resuscitation A nurse is caring for a client in active labor whose membranes have ruptured. The fetal monitor tracing reveals late decelerations. Which of the following actions should the nurse take first? - Turn the client onto her left side A nurse is caring for a primigravida client who is at 8 weeks gestation with twins. The client states that even though she and her husband planned this pregnancy, she is experiencing ambivalent feelings about it. Which of the following responses should the nurse make? - "These feelings are quite normal at the beginning of pregnancy." A nurse in an antepartum clinic is caring for a client who is at 24 weeks gestation. Which of the following findings should the nurse report to the provider? - Frequent headaches A nurse is providing care to a client who is in labor. A fetal heart tracing shows early decelerations. Which of the following actions should the nurse take? - Continue to monitor the fetal heart tracings A nurse is explaining lactation suppression to a client whose newborn will be bottle-fed. Which of the following client statements indicates an understanding of the teaching? - "I should wear a support bra for a few days." The guardian of a 3-day-old female newborn tells the nurse that he noticed a small amount of blood-tinged mucus discharge on the newborn's labia. Which of the following responses should the nurse make? - "The blood-tinged mucus is a result of pseudomenstruation." A nurse is teaching a client who is at 10 weeks gestation about an abdominal ultrasound in the first trimester. Which of the following pieces of information should the nurse include in the teaching? - "You will need to have a full bladder during the ultrasound." A nurse is providing teaching for a postpartum client who is breastfeeding. Which of the following pieces of information should the nurse include in the teaching? - "Your milk supply will noticeably increase in volume around the third or fourth day after delivery." A nurse is caring for a client who is in labor and received meperidine for pain 1 hr prior to entering the second stage of labor. Which of the following actions should the nurse take? - Assess the newborn for respiratory depression A nurse is teaching a client who has active genital herpes simplex virus, type 2. Which of the following statements should the nurse include in the teaching? - "You will have a cesarean birth prior to the onset of labor." A nurse is assessing a client who reports that she might be pregnant. Which of the following findings should the nurse identify as a presumptive sign of pregnancy? - Nausea in the morning A nurse is caring for a client who is using patterned-paced breathing during the first stage of labor. The client reports a lightheaded feeling and tingling of the fingers. Which of the following actions should the nurse take first? - Have the client breathe into a paper bag. A nurse is caring for a client at 37 weeks gestation who is undergoing a nonstress test. The fetal heart rate (FHR) is 130/min without accelerations for the past 10 min. Which of the following actions should the nurse take? - Use vibroacoustic stimulation on the client's abdomen for 3 sec A nurse is caring for a client who is at 39 weeks gestation and in active labor. Which of the following actions should the nurse include in the plan of care? - Check the cervix prior to analgesic administration A nurse is caring for a newborn who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect and report to the provider? - Tremors A nurse is assisting a client who is 4 hr postpartum to get out of bed for the first time. The client becomes frightened by a gush of dar red blood from her vagina. Which of the following statements should the nurse make in response? - "Blood pools in the vagina when you are lying in bed." A nurse is caring for a preterm infant in the NICU. Which of the following actions by the nurse will promote the infant's optimal development? - Reducing ambient noise and lighting. A nurse in an outpatient setting is providing education for a client who is pregnant. Which of the following statements should the nurse include in the teaching? - "You will probably first notice your baby moving when you are around 20 weeks gestation." A nurse is caring for a newborn who has irregular respirations of 52/min with several periods of apnea lasting approximately 5 sec. The newborn is pink with acrocyanosis. Which of the following actions should the nurse take? - Continue to monitor the newborn routinely A nurse is assessing a client who is in the first stage of labor and has preeclampsia. Which of the following findings should the nurse expect? - Proteinuria A postpartum nurse is providing care for a client who is breastfeeding and has a perineal hematoma. The nurse should recommend that the client use which of the following breastfeeding positions? - Side-lying A nurse is performing a routine prenatal examination of a client who is in the second trimester. The client reports backaches with no other symptoms and refuses medication. Which of the following responses should the nurse make? - "Try pelvic tilt exercises." A nurse is preparing to perform a hell stick on a newborn. Which of the following actions should the nurse take? - Warm the heel with a warm washcloth prior to the procedure A nurse is assessing a client who is 14 hr postpartum and has a third-degree perineal laceration. The client's temperature is 37.8 degrees celsius (100 degrees Fahrenheit), and her fundus is firm and slightly deviated to the right. The client reports a gush of blood when she ambulates and no bowel movement since delivery. Which of the following actions should the nurse take? - Assist the client to empty her bladder A nurse is teaching a client with pre-eclampsia who is scheduled to receive magnesium sulfate via continuous IV infusion about expected adverse effects. Which of the following adverse effects should the nurse include in the teaching? - Feeling of warmth A nurse is talking with a client at 20 weeks of gestation who is scheduled for a sonogram. The client states, "I am here to have my regular prenatal checkup, but I do not want any pictures take of my baby." Which of the following responses should the nurse make? - "I would like to hear more about why you do not want the sonogram, including any cultural reasons." A nurse is obtaining the blood pressure of a client who is pregnant. The client's blood pressure is 142/90 mmHg. Which of the following actions should the nurse take? - Repeat the measurement after allowing the client to sit for 5 to 10 minutes. A nurses assessing a client at 35 weeks gestation who is receiving magnesium sulfate via continuous IV infusion for severe preeclampsia. Which of the following findings should the nurse report to the provider? - Urinary output of 20mL/hr