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
Molly is a 21-year-old pregnant patient at the clinic today for her prenatal appointment. She is addicted to marijuana. Which of the following would be most characteristic of her vital signs during this appointment?
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BP - 160/110, Pulse - 65
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BP - 101/76, Pulse - 110
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BP - 140/90, Pulse - 98
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BP - 135/88, Pulse - 82
Explanation
Correct Answer: (B) BP - 101/76, Pulse - 110
Marijuana use is associated with tachycardia due to its stimulant effect on the cardiovascular system, along with mild hypotension, particularly orthostatic hypotension, from peripheral vasodilation. This combination of a lower blood pressure and an elevated heart rate is most characteristic of marijuana intoxication.
Why Other Options are Incorrect:
A. BP - 160/110, Pulse - 65 — This reflects severe hypertension with bradycardia, a pattern more consistent with conditions like preeclampsia, not marijuana use.
C. BP - 140/90, Pulse - 98 — This shows mild hypertension, which is not characteristic of marijuana's vasodilatory effect on blood pressure.
D. BP - 135/88, Pulse - 82 — This reflects borderline elevated blood pressure with a normal pulse, which does not reflect the tachycardia typically seen with marijuana use.
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
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.
The RN is assessing a 22-year-old female patient who arrives at the family clinic. The patient has finished her prescription for a urinary tract infection and now reports a milky discharge from her vagina and a fishy odor. After microscopic examination of the vaginal discharge, the physician prescribes metronidazole gel to be inserted vaginally. What is the suspected medical diagnosis for this patient?
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The patient has candida vaginitis due to recent disruption of normal flora
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The patient has gonorrhea due to lowered immunity after antibiotic therapy
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The patient has bacterial vaginosis due to recent disruption of normal vaginal flora
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The patient has genital condylomas due to the recent UTI treatment
Explanation
Bacterial vaginosis results from an imbalance in normal vaginal flora, often triggered by antibiotic use, which disrupts the protective lactobacilli and allows anaerobic bacteria to overgrow. Classic signs include a thin, milky-white discharge with a distinct fishy odor. Metronidazole gel is the standard treatment for bacterial vaginosis, confirming this diagnosis.
Why the other options are incorrect:
A. Candida vaginitis due to recent disruption of normal flora — Candida vaginitis typically presents with thick, white, cottage cheese-like discharge and itching, not a fishy odor, and is treated with antifungals rather than metronidazole.
B. Gonorrhea due to lowered immunity after antibiotic therapy — Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae and is not related to antibiotic-induced flora disruption; it also does not present with a fishy-odor discharge.
D. Genital condylomas due to the recent UTI treatment — Genital condylomas (warts) are caused by HPV and present as growths, not a discharge with odor, and are unrelated to antibiotic use.
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
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.
A nurse is caring for a client who is 3 days postpartum and is attempting to breastfeed. Which of the following findings indicate mastitis?
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A white patch on a nipple
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Red and painful area in one breast
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Swelling in both breasts
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Cracked and bleeding nipples
Explanation
Correct Answer: (B) Red and painful area in one breast
Mastitis is an infection of the breast tissue that typically presents unilaterally with localized redness, warmth, and pain, often accompanied by a firm or wedge-shaped area of tenderness. This is a classic finding that distinguishes mastitis from other benign breastfeeding-related conditions.
Why the other options are incorrect:
A. A white patch on a nipple — This finding is more consistent with a Candida (yeast) infection of the nipple, not mastitis.
C. Swelling in both breasts — Bilateral swelling and fullness are more consistent with normal engorgement rather than mastitis, which is typically a unilateral, localized infection.
D. Cracked and bleeding nipples — This finding is associated with improper latch or breastfeeding technique and can be a risk factor for developing mastitis, but it is not a defining sign of the infection itself.
Emily has just delivered her first baby at 36 weeks gestation. Upon physical exam, it is noted that this baby has a low birth weight, small eyes, a thin upper lip, a flat philtrum, a short nose, and a shortened right forearm when compared to the left. What substance was Emily addicted to during pregnancy that resulted in these effects to her baby?
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Inhalants
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Alcohol
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Marijuana
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Cocaine
Explanation
This infant's presentation is consistent with Fetal Alcohol Syndrome (FAS), a condition caused by maternal alcohol consumption during pregnancy. The classic features include low birth weight, small eye openings (palpebral fissures), a thin upper lip, a smooth or flattened philtrum, and a short, upturned nose. Alcohol is a teratogen that crosses the placenta and can also cause limb and skeletal abnormalities, such as the shortened forearm seen in this baby, along with intellectual and developmental delays later in life.
Why the other options are incorrect:
A. Inhalants — Inhalant exposure during pregnancy can cause growth restriction and developmental issues, but it does not produce the classic facial dysmorphology (thin upper lip, flat philtrum, small eyes) described here.
C. Marijuana — Prenatal marijuana exposure has been associated with low birth weight and neurodevelopmental effects, but it does not cause the distinct craniofacial features or limb defects seen in this infant.
D. Cocaine — Cocaine exposure in utero is more commonly linked to vascular disruptions, such as placental abruption, preterm birth, and limb reduction defects from vascular events, but it does not cause the specific facial features characteristic of Fetal Alcohol Syndrome.
A nurse in a provider's office is caring for a client who is at 36 weeks of gestation and scheduled for an amniocentesis. The client asks why she is having an ultrasound prior to the procedure. Which of the following is an appropriate response by the nurse?
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"This is a screening tool for spina bifida."
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"It is useful for estimating fetal age."
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"It assists in identifying the location of the placenta and fetus."
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"This will determine if there is more than one fetus."
Explanation
Correct Answer: (C) "It assists in identifying the location of the placenta and fetus."
An ultrasound performed immediately prior to an amniocentesis is used to identify the location of the placenta and fetus so the provider can select a safe insertion site for the needle. This helps avoid injury to the fetus, umbilical cord, or placenta during the procedure.
Why Other Options are Incorrect:
A. "This is a screening tool for spina bifida." — Screening for neural tube defects such as spina bifida is typically done through maternal serum alpha-fetoprotein testing or detailed anatomy ultrasounds earlier in pregnancy, not as the specific purpose of this pre-procedure ultrasound.
B. "It is useful for estimating fetal age." — At 36 weeks of gestation, fetal age has already been established; this is not the purpose of the ultrasound performed immediately before amniocentesis.
D. "This will determine if there is more than one fetus." — Multiple gestation would have already been identified earlier in the pregnancy through prior ultrasounds, not newly determined at this late gestational stage.
History and Physical 1100: 38-year-old Gravida 3 Para 2 who is at 42 weeks of gestation and is being induced after a nonreactive nonstress test, positive contraction stress test, and biophysical profile (BPP) score of 6. Previous pregnancy was complicated by gestational diabetes mellitus (GDM) and gonorrhea; current pregnancy is uncomplicated. Client has refused induction of labor before today, stating, "I want nature to have a chance to work." Upon examination, client's cervix is dilated 1 cm and 40% effaced, -1 station, soft and anterior. Will induce using oxytocin.
Body System: Cardiovascular
Body System: Respiratory
Body System: Neurologic
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Heart rate 120/min, acrocyanosis observed
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Heart rate 80/min, acrocyanosis observed
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Heart rate 60/min, acrocyanosis observed
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Strong cry
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Weak cry
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No cry
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Minimal flexion of extremities, grimaces when stimulated
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Minimal flexion of extremities, cries when stimulated
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Minimal flexion of extremities, no response to stimulation
Explanation
Correct Answer:
Cardiovascular — (A) Heart rate 120/min, acrocyanosis observed; Respiratory — (A) Strong cry; Neurologic — (A) Minimal flexion of extremities, grimaces when stimulated
By 5 minutes of life, this newborn shows significant improvement from the initial 1-minute Apgar findings (heart rate 80, minimal tone, diminished response), consistent with effective resuscitation efforts. A heart rate of 120/min reflects a normal newborn heart rate, indicating successful stabilization of cardiovascular status, though acrocyanosis (bluish discoloration of the hands and feet) commonly persists briefly after birth and does not indicate ongoing compromise. A strong cry demonstrates improved respiratory effort and lung expansion following initial resuscitation. Grimacing when stimulated reflects improved reflex irritability compared to the diminished response noted at 1 minute, showing a positive neurologic response to stimulation as resuscitation efforts take effect.
Why the other options are incorrect:
Heart rate 80/min or 60/min, acrocyanosis observed — These lower heart rates would indicate the newborn remains in significant distress and has not responded to resuscitation, which would be inconsistent with an improving clinical picture at 5 minutes.
Weak cry or No cry — These findings would indicate persistent respiratory compromise, requiring continued aggressive intervention rather than reflecting expected improvement by 5 minutes.
Minimal flexion of extremities, cries when stimulated or no response to stimulation — A cry response reflects vocal/respiratory effort rather than the specific reflex irritability component being assessed, while no response would indicate the newborn has not improved neurologically, which is less consistent with a successfully resuscitated newborn at 5 minutes.
A nurse is preparing to administer methylergonovine IM to a client who experienced a vaginal delivery. The nurse should explain to the client that the purpose of this medication is to prevent which of the following conditions?
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Postpartum hemorrhage
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Hypertension
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Thromboembolic events
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Postpartum infection
Explanation
Correct Answer: (A) Postpartum hemorrhage
Methylergonovine is a uterotonic medication that causes sustained uterine contraction, which helps prevent postpartum hemorrhage by reducing bleeding from the placental implantation site after delivery.
Why Other Options are Incorrect:
B. Hypertension — Methylergonovine can actually cause hypertension as an adverse effect and is contraindicated in clients with preexisting hypertension; it is not used to prevent this condition.
C. Thromboembolic events — This medication does not have anticoagulant or antithrombotic properties and does not prevent clot formation.
D. Postpartum infection — Methylergonovine acts on uterine muscle tone and does not have antimicrobial properties to prevent infection.
A nurse is caring for a client who is in preterm labor with a current L/S ratio of 1:1. Which of the following actions should the nurse take?
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Prepare the client for immediate delivery.
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Administer betamethasone 12 mg IM.
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Administer hydralazine 25 mg IV.
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Infuse a bolus of IV fluid.
Explanation
An L/S (lecithin/sphingomyelin) ratio of 1:1 indicates fetal lung immaturity, as a mature ratio is typically 2:1 or greater. Betamethasone is a corticosteroid administered to accelerate fetal lung maturation by stimulating surfactant production, reducing the risk of respiratory distress syndrome in the preterm newborn.
Why Other Options are Incorrect:
A. Prepare the client for immediate delivery — Immediate delivery is not indicated based on this finding alone; the priority is to delay delivery, if possible, to allow time for corticosteroid administration to be effective.
C. Administer hydralazine 25 mg IV — This antihypertensive medication is used to treat severe hypertension and is not indicated based on the information given about fetal lung immaturity.
D. Infuse a bolus of IV fluid — There is no indication for fluid resuscitation based on this finding.
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