ATI Custom- NUR 2721 Final Exam-PPD-PPH-NB SP26
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Free ATI Custom- NUR 2721 Final Exam-PPD-PPH-NB SP26 Questions
1. A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?
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"It halts cervical dilation."
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"It is used to stop preterm labor contractions."
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"It increases the fetal heart rate."
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"It promotes fetal lung maturity."
Explanation
Explanation
Correct Answer: (D) "It promotes fetal lung maturity."
Betamethasone is a corticosteroid administered to clients in preterm labor to accelerate fetal lung development and surfactant production, reducing the risk and severity of respiratory distress syndrome if the newborn is born prematurely.
Why Other Options are Incorrect:
A. "It halts cervical dilation." — Betamethasone has no direct effect on cervical dilation.
B. "It is used to stop preterm labor contractions." — This is the role of tocolytic medications, such as terbutaline or nifedipine, not betamethasone, which does not suppress uterine contractions.
C. "It increases the fetal heart rate." — Betamethasone does not have a direct effect on fetal heart rate.
Correct Answer: (D) "It promotes fetal lung maturity."
Betamethasone is a corticosteroid administered to clients in preterm labor to accelerate fetal lung development and surfactant production, reducing the risk and severity of respiratory distress syndrome if the newborn is born prematurely.
Why Other Options are Incorrect:
A. "It halts cervical dilation." — Betamethasone has no direct effect on cervical dilation.
B. "It is used to stop preterm labor contractions." — This is the role of tocolytic medications, such as terbutaline or nifedipine, not betamethasone, which does not suppress uterine contractions.
C. "It increases the fetal heart rate." — Betamethasone does not have a direct effect on fetal heart rate.
2. Maria is suspected to be suffering from postpartum psychosis. Choose whether an assessment finding would be expected or unexpected for this diagnosis.
Explanation
Explanation
Correct Answer: Strong desire to care properly for her baby in a safe manner — Unexpected; Depressed or elated moods — Expected; Paranoia, grandiose, or bizarre delusions — Expected; Strange beliefs that she or the baby must die — Expected
Postpartum psychosis is a severe psychiatric emergency characterized by a break from reality. Expected findings include depressed or elated moods reflecting extreme mood disturbances, paranoia, grandiosity, or bizarre delusions reflecting impaired reality testing, and strange beliefs that she or the baby must die, which reflects dangerous delusional thinking that places the mother and infant at risk of harm. A strong desire to care properly for her baby in a safe manner would be unexpected, since impaired judgment and potentially harmful delusions compromise the mother's ability to safely care for her infant.
Correct Answer: Strong desire to care properly for her baby in a safe manner — Unexpected; Depressed or elated moods — Expected; Paranoia, grandiose, or bizarre delusions — Expected; Strange beliefs that she or the baby must die — Expected
Postpartum psychosis is a severe psychiatric emergency characterized by a break from reality. Expected findings include depressed or elated moods reflecting extreme mood disturbances, paranoia, grandiosity, or bizarre delusions reflecting impaired reality testing, and strange beliefs that she or the baby must die, which reflects dangerous delusional thinking that places the mother and infant at risk of harm. A strong desire to care properly for her baby in a safe manner would be unexpected, since impaired judgment and potentially harmful delusions compromise the mother's ability to safely care for her infant.
3. A nurse is assessing a client who is pregnant for preeclampsia. Which of the following findings should indicate to the nurse that the client requires further evaluation for this disorder?
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Elevated blood pressure
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Vaginal discharge
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Joint pain
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Increased urine output
Explanation
Explanation
Elevated blood pressure is a hallmark diagnostic criterion for preeclampsia, resulting from widespread vasospasm and endothelial dysfunction. A finding of elevated blood pressure in a pregnant client should prompt the nurse to further evaluate for other signs of preeclampsia, such as proteinuria and edema.
Why Other Options are Incorrect:
B. Vaginal discharge — This finding is not associated with preeclampsia and would more likely suggest an infection.
C. Joint pain — Joint pain is not a characteristic finding of preeclampsia.
D. Increased urine output — Preeclampsia is associated with decreased urine output due to renal involvement and fluid retention, not increased output.
Elevated blood pressure is a hallmark diagnostic criterion for preeclampsia, resulting from widespread vasospasm and endothelial dysfunction. A finding of elevated blood pressure in a pregnant client should prompt the nurse to further evaluate for other signs of preeclampsia, such as proteinuria and edema.
Why Other Options are Incorrect:
B. Vaginal discharge — This finding is not associated with preeclampsia and would more likely suggest an infection.
C. Joint pain — Joint pain is not a characteristic finding of preeclampsia.
D. Increased urine output — Preeclampsia is associated with decreased urine output due to renal involvement and fluid retention, not increased output.
4. Emily is being treated for gonorrhea. The physician has ordered ceftriaxone 250 mg IM once. The vial of ceftriaxone has a concentration of 500 mg/2 mL. How many mL will be administered for this dose?
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1 mL
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3 mL
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0.5 mL
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2 mL
Explanation
Explanation
Correct Answer: (A) 1 mL
To calculate the correct dose, use the formula: (Desired dose ÷ Concentration on hand) × Volume. Here, (250 mg ÷ 500 mg) × 2 mL = 1 mL. This means the nurse should administer 1 mL to deliver the prescribed 250 mg dose of ceftriaxone.
Correct Answer: (A) 1 mL
To calculate the correct dose, use the formula: (Desired dose ÷ Concentration on hand) × Volume. Here, (250 mg ÷ 500 mg) × 2 mL = 1 mL. This means the nurse should administer 1 mL to deliver the prescribed 250 mg dose of ceftriaxone.
5. A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?
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Place the client in knee-chest position.
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Prepare the client for an immediate birth.
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Cover the cord with a sterile, moist saline dressing.
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Insert a gloved hand into the vagina to relieve pressure on the cord.
Explanation
Explanation
Umbilical cord prolapse is an obstetric emergency in which the cord becomes compressed between the fetal presenting part and the maternal pelvis, cutting off fetal oxygen supply. The nurse's first action should be to insert a gloved hand into the vagina and manually elevate the presenting part off the cord to relieve compression while awaiting further intervention.
Why Other Options are Incorrect:
A. Place the client in knee-chest position — This position helps relieve pressure on the cord using gravity, but it is a subsequent action performed after the nurse has manually relieved pressure with a gloved hand.
B. Prepare the client for an immediate birth — While an emergency cesarean birth is often required, this action follows the immediate relief of cord compression, which is the priority.
C. Cover the cord with a sterile, moist saline dressing — Keeping the cord moist is important to prevent drying and vasospasm, but this is not the priority action when the fetus is at immediate risk from cord compression.
Umbilical cord prolapse is an obstetric emergency in which the cord becomes compressed between the fetal presenting part and the maternal pelvis, cutting off fetal oxygen supply. The nurse's first action should be to insert a gloved hand into the vagina and manually elevate the presenting part off the cord to relieve compression while awaiting further intervention.
Why Other Options are Incorrect:
A. Place the client in knee-chest position — This position helps relieve pressure on the cord using gravity, but it is a subsequent action performed after the nurse has manually relieved pressure with a gloved hand.
B. Prepare the client for an immediate birth — While an emergency cesarean birth is often required, this action follows the immediate relief of cord compression, which is the priority.
C. Cover the cord with a sterile, moist saline dressing — Keeping the cord moist is important to prevent drying and vasospasm, but this is not the priority action when the fetus is at immediate risk from cord compression.
6. A nurse is caring for a client during a nonstress test (NST). At the end of a 30-min period of observation, the nurse notes the following findings: The fetal heart rate baseline is 120/min with minimal variability and no accelerations. There are two decelerations of 15/min in the fetal heart rate during a period of fetal movement, each lasting 20 seconds. Which of the following interpretations of these findings should the nurse make?
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A reactive test
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A nonreactive test
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A positive test
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A negative test
Explanation
Explanation
Correct Answer: (B) A nonreactive test
A nonstress test is interpreted as nonreactive when there are no accelerations meeting the required criteria within the observation period. In this case, the absence of accelerations, along with minimal variability, indicates a nonreactive test, which requires further evaluation of fetal well-being.
Why Other Options are Incorrect:
A. A reactive test — A reactive test requires at least two accelerations of adequate amplitude and duration within a 20-minute period, which did not occur here.
C. A positive test — This terminology applies to contraction stress test results indicating late decelerations with a majority of contractions, not to NST findings.
D. A negative test — This terminology also applies to contraction stress test interpretation, not to NST results.
Correct Answer: (B) A nonreactive test
A nonstress test is interpreted as nonreactive when there are no accelerations meeting the required criteria within the observation period. In this case, the absence of accelerations, along with minimal variability, indicates a nonreactive test, which requires further evaluation of fetal well-being.
Why Other Options are Incorrect:
A. A reactive test — A reactive test requires at least two accelerations of adequate amplitude and duration within a 20-minute period, which did not occur here.
C. A positive test — This terminology applies to contraction stress test results indicating late decelerations with a majority of contractions, not to NST findings.
D. A negative test — This terminology also applies to contraction stress test interpretation, not to NST results.
7. A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?
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Irregular fetal heart rate
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Excessive uterine enlargement
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Rapid decline in human chorionic gonadotropin (hCG) levels
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Profuse, clear vaginal discharge
Explanation
Explanation
Correct Answer: (B) Excessive uterine enlargement
A hydatidiform mole is a gestational trophoblastic disease in which abnormal proliferation of trophoblastic tissue occurs, causing the uterus to grow much larger than expected for the client's gestational age. This excessive uterine enlargement, disproportionate to gestational dating, is a classic finding of this condition.
Why the other options are incorrect:
A. Irregular fetal heart rate — In a complete hydatidiform mole, there is no viable fetus present, so a fetal heart rate would not be detected at all.
C. Rapid decline in human chorionic gonadotropin (hCG) levels — A hydatidiform mole is associated with markedly elevated hCG levels, not a decline, due to excessive trophoblastic tissue proliferation.
D. Profuse, clear vaginal discharge — Hydatidiform mole is more commonly associated with dark brown or bloody vaginal discharge, sometimes containing grape-like vesicles, rather than a clear discharge.
Correct Answer: (B) Excessive uterine enlargement
A hydatidiform mole is a gestational trophoblastic disease in which abnormal proliferation of trophoblastic tissue occurs, causing the uterus to grow much larger than expected for the client's gestational age. This excessive uterine enlargement, disproportionate to gestational dating, is a classic finding of this condition.
Why the other options are incorrect:
A. Irregular fetal heart rate — In a complete hydatidiform mole, there is no viable fetus present, so a fetal heart rate would not be detected at all.
C. Rapid decline in human chorionic gonadotropin (hCG) levels — A hydatidiform mole is associated with markedly elevated hCG levels, not a decline, due to excessive trophoblastic tissue proliferation.
D. Profuse, clear vaginal discharge — Hydatidiform mole is more commonly associated with dark brown or bloody vaginal discharge, sometimes containing grape-like vesicles, rather than a clear discharge.
8. Martha is experiencing the common aches and pains of pregnancy and calls her physician for advisement on what she can take for pain relief. The physician states to take Tylenol 650 mg orally every 6 hours as needed for pain. Martha has a bottle of Tylenol in her medicine cabinet that has 325 mg tablets. How many tablets should Martha take per dose?
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1.5 tablets
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2 tablets
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0.5 tablet
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1 tablet
Explanation
Explanation
Correct Answer: (B) 2 tablets
To calculate the correct dose, use the formula: Desired dose ÷ Dose on hand = Number of tablets. Here, 650 mg ÷ 325 mg = 2 tablets. Martha should take 2 tablets of 325 mg Tylenol to achieve the prescribed 650 mg dose.
Correct Answer: (B) 2 tablets
To calculate the correct dose, use the formula: Desired dose ÷ Dose on hand = Number of tablets. Here, 650 mg ÷ 325 mg = 2 tablets. Martha should take 2 tablets of 325 mg Tylenol to achieve the prescribed 650 mg dose.
9. A nurse is assessing a client in labor who has had epidural anesthesia for pain relief. Which of the following findings should the nurse identify as a complication from the epidural block?
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Hypotension
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Vomiting
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Tachycardia
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Respiratory depression
Explanation
Explanation
Correct Answer: (A) Hypotension
Epidural anesthesia causes sympathetic nervous system blockade, which leads to vasodilation and a resulting drop in blood pressure. Maternal hypotension is a common and significant complication of epidural placement that can also compromise placental blood flow and fetal oxygenation if not promptly treated.
Why Other Options are Incorrect:
B. Vomiting — Vomiting is not a typical direct complication of epidural anesthesia.
C. Tachycardia — Epidural anesthesia is more likely to cause bradycardia as a reflexive response to hypotension, not tachycardia.
D. Respiratory depression — This is more commonly associated with systemic opioid administration rather than epidural regional anesthesia, which primarily affects the lower body.
Correct Answer: (A) Hypotension
Epidural anesthesia causes sympathetic nervous system blockade, which leads to vasodilation and a resulting drop in blood pressure. Maternal hypotension is a common and significant complication of epidural placement that can also compromise placental blood flow and fetal oxygenation if not promptly treated.
Why Other Options are Incorrect:
B. Vomiting — Vomiting is not a typical direct complication of epidural anesthesia.
C. Tachycardia — Epidural anesthesia is more likely to cause bradycardia as a reflexive response to hypotension, not tachycardia.
D. Respiratory depression — This is more commonly associated with systemic opioid administration rather than epidural regional anesthesia, which primarily affects the lower body.
10. A nurse is creating the plan of care for a client who is at 39 weeks of gestation and in active labor. Which of the following actions should the nurse include in the plan of care?
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Insert an indwelling urinary catheter.
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Monitor the fetal heart rate (FHR) every hour.
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Check the cervix prior to analgesic administration.
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Keep four side rails up while the client is in bed.
Explanation
Explanation
Correct Answer: (C) Check the cervix prior to analgesic administration.
Assessing cervical dilation before administering analgesics is essential to avoid giving medication too close to delivery, which could cause respiratory depression in the newborn. This assessment helps the nurse determine the appropriate timing and type of pain relief for the client.
Why Other Options are Incorrect:
A. Insert an indwelling urinary catheter — This is not a routine action for a client in active labor unless clinically indicated, such as prior to epidural placement or for bladder distention.
B. Monitor the fetal heart rate (FHR) every hour — During active labor, FHR should be monitored more frequently than every hour, typically every 15 to 30 minutes for a low-risk client, to detect signs of fetal distress promptly.
D. Keep four side rails up while the client is in bed — Raising all four side rails is considered a restraint and is not an appropriate standard action for a laboring client; typically only two rails are raised for safety.
Correct Answer: (C) Check the cervix prior to analgesic administration.
Assessing cervical dilation before administering analgesics is essential to avoid giving medication too close to delivery, which could cause respiratory depression in the newborn. This assessment helps the nurse determine the appropriate timing and type of pain relief for the client.
Why Other Options are Incorrect:
A. Insert an indwelling urinary catheter — This is not a routine action for a client in active labor unless clinically indicated, such as prior to epidural placement or for bladder distention.
B. Monitor the fetal heart rate (FHR) every hour — During active labor, FHR should be monitored more frequently than every hour, typically every 15 to 30 minutes for a low-risk client, to detect signs of fetal distress promptly.
D. Keep four side rails up while the client is in bed — Raising all four side rails is considered a restraint and is not an appropriate standard action for a laboring client; typically only two rails are raised for safety.
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