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
A nurse is caring for a client who is at 28 weeks of gestation and received terbutaline. Which of the following findings should the nurse expect?
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Weakened uterine contractions
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Maternal blood glucose 63 mg/dL
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Enhanced production of fetal lung surfactant
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Fetal heart rate 100/min
Explanation
Terbutaline is a beta-adrenergic agonist used as a tocolytic to suppress uterine contractions and delay preterm labor. Its intended therapeutic effect is to relax uterine smooth muscle, resulting in weakened or decreased uterine contractions.
Why Other Options are Incorrect:
B. Maternal blood glucose 63 mg/dL — Terbutaline typically causes hyperglycemia, not hypoglycemia, due to its beta-adrenergic effects on glycogenolysis; a blood glucose of 63 mg/dL would be an unexpected finding.
C. Enhanced production of fetal lung surfactant — This effect is associated with corticosteroids, such as betamethasone, not terbutaline.
D. Fetal heart rate 100/min — Terbutaline commonly causes maternal and fetal tachycardia as a beta-adrenergic effect, so a fetal heart rate of 100/min (which is on the low end of normal) would not be an expected finding; fetal tachycardia would be expected instead.
What is the term for a group of signs and neurological behaviors exhibited by neonates resulting from the abrupt discontinuation of intrauterine exposure to substances such as heroin, nicotine, alcohol, cannabis, opiates, cocaine, and methamphetamines?
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Digoxin Toxicity
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Neonatal Abstinence Syndrome (NAS)
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Magnesium Toxicity
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Newborn Addiction
Explanation
Correct Answer: (B) Neonatal Abstinence Syndrome (NAS)
Neonatal Abstinence Syndrome (NAS) describes the group of signs and neurological behaviors that occur in newborns following the abrupt discontinuation of substances they were exposed to in utero. Symptoms can include irritability, tremors, feeding difficulties, high-pitched crying, and disrupted sleep patterns, resulting from the newborn's withdrawal from the maternal substance exposure.
Why Other Options are Incorrect:
A. Digoxin Toxicity — This refers to adverse effects from excessive digoxin levels, unrelated to intrauterine substance exposure or withdrawal.
C. Magnesium Toxicity — This describes an adverse reaction to elevated magnesium levels, often related to magnesium sulfate therapy, not substance withdrawal in neonates.
D. Newborn Addiction — This is not a recognized clinical term; the correct clinical terminology for this condition is Neonatal Abstinence Syndrome.
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
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.
Which of the following are risk factors for postpartum depression? (Select all that apply.)
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Inadequate social support
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Life and child care stressors
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Complications with pregnancy and/or childbirth
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Healthy pregnancy with supportive partner
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History of postpartum depression
Explanation
Correct Answer: (A) Inadequate social support, (B) Life and child care stressors, (C) Complications with pregnancy and/or childbirth, (E) History of postpartum depression
Postpartum depression risk increases with factors that create emotional and physical strain on the new mother. Inadequate social support leaves the client without adequate help managing the demands of new motherhood. Life and child care stressors add to overall burden and fatigue. Complications with pregnancy and/or childbirth can contribute to physical recovery challenges and emotional distress. A prior history of postpartum depression significantly increases the risk of recurrence with subsequent pregnancies.
Why the Other Option is Incorrect:
D. Healthy pregnancy with supportive partner — This describes protective factors, not risk factors, as a supportive partner and uncomplicated pregnancy reduce the likelihood of postpartum depression.
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.
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.
Nurses' Notes 1600: Newborn transferred to radiant warmer immediately post-delivery. Initiated drying, tactile stimulation, and suctioning of oral and nasal passages to clear secretions. 1601: Observed newborn presenting with cyanosis and gasping respirations. Heart rate measured at 80 beats per minute. Noted minimal muscle tone and diminished response to stimuli. Assigned an Apgar score of 4 at 1 minute. 1606: Apgar Score: 5 minutes — Heart rate 2, Respiratory effort 2, Muscle tone 1, Reflex irritability 1, Color 1, Total 7.
Progress Report 1700: Primary cesarean birth performed at 1600 due to nonreassuring fetal status. Newborn delivered. Newborn transferred to neonatal intensive care unit for observation. Birthing client in stable condition.
Physical Examination 2200: Apical heart rate 130/min. Respiratory rate 46/min, irregular. Intercostal retractions observed. Oxygen saturation 98% on O2 at 24% via nasal cannula. Acrocyanosis observed. Extremities flexed. Abdomen soft, umbilical cord clamped and dry. Mucous membranes moist and yellow.
Select the 5 findings that indicate the newborn is progressing as expected.
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Respiratory rate
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Oxygen saturation
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Heart rate
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Skin tone
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Chest assessment
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Extremities
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Mucous membranes
Explanation
Correct Answer: (A) Respiratory rate, (B) Oxygen saturation, (C) Heart rate, (D) Skin tone, (F) Extremities
A. Respiratory rate — Expected. A respiratory rate of 46/min falls within the normal newborn range of 30 to 60/min, and irregular, periodic breathing patterns are a normal finding in newborns.
B. Oxygen saturation — Expected. An oxygen saturation of 98% reflects adequate oxygenation and falls within the acceptable target range for a newborn.
C. Heart rate — Expected. An apical heart rate of 130/min is within the normal newborn range of 110 to 160/min.
D. Skin tone — Expected. Acrocyanosis, or bluish discoloration of the hands and feet, is a normal finding in newborns and typically resolves within the first 24 to 48 hours of life.
F. Extremities — Expected. Flexed extremities reflect normal newborn muscle tone and positioning.
Why Other Findings Are Not Expected:
E. Chest assessment — Intercostal retractions indicate increased work of breathing and respiratory distress, which is not an expected finding and requires ongoing monitoring and intervention.
G. Mucous membranes — Yellow discoloration of the mucous membranes suggests jaundice; since this newborn is only a few hours old, jaundice appearing this early is pathologic rather than physiologic and is not an expected finding.
A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?
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Changes in the cervix
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Pattern of contractions
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Station of the presenting part
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Rupture of the membranes
Explanation
Correct Answer: (A) Changes in the cervix
Progressive cervical dilation and effacement are the definitive signs of true labor. True labor contractions cause the cervix to change over time, whereas false labor (Braxton Hicks) contractions do not produce cervical change regardless of contraction intensity.
Why Other Options are Incorrect:
B. Pattern of contractions — While true labor contractions typically occur at regular intervals and increase in frequency and intensity, contraction patterns alone can be inconsistent and are not as definitive as cervical change.
C. Station of the presenting part — Fetal station describes the position of the presenting part in relation to the ischial spines, and while it may change with labor progression, it is not the primary defining sign used to confirm true labor.
D. Rupture of the membranes — Rupture of membranes can occur before, during, or independent of true labor and does not confirm that a client is in true labor.
Which of the following are risk factors for the woman due to repeated and/or untreated STIs? (Select all that apply.)
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Pelvic inflammatory disease
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Infertility
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Cervical cancer
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Healthy uterine pregnancy
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Ectopic pregnancy
Explanation
Correct Answer: (A) Pelvic inflammatory disease, (B) Infertility, (C) Cervical cancer, (E) Ectopic pregnancy
Repeated or untreated sexually transmitted infections can cause ascending infections that lead to pelvic inflammatory disease, which in turn can result in scarring of the fallopian tubes. This scarring increases the risk of infertility and ectopic pregnancy due to impaired tubal transport of the fertilized egg. Certain STIs, particularly HPV, are also directly linked to the development of cervical cancer due to chronic infection and cellular changes in the cervix.
Why the Other Option is Incorrect:
D. Healthy uterine pregnancy — Untreated STIs increase the risk of complications such as ectopic pregnancy and infertility; they do not promote a healthy uterine pregnancy.
A nurse is caring for a client who is in labor and assists the provider who performs an amniotomy. Which of the following is the priority action by the nurse following the procedure?
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Monitor the client's temperature.
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Assess the odor of the amniotic fluid.
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Assess the fetal heart rate.
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Provide clean, dry underpads.
Explanation
Correct Answer: (C) Assess the fetal heart rate.
Following an amniotomy (artificial rupture of membranes), the priority nursing action is to assess the fetal heart rate immediately. This is critical because the sudden release of amniotic fluid can result in umbilical cord prolapse or cord compression, which can cause acute fetal distress that must be identified right away.
Why Other Options are Incorrect:
A. Monitor the client's temperature — Temperature monitoring is important after membrane rupture to detect infection, but it is not the immediate priority compared to fetal status.
B. Assess the odor of the amniotic fluid — Assessing fluid characteristics, including odor, color, and amount, is important but secondary to first confirming fetal well-being.
D. Provide clean, dry underpads — This is a comfort measure and not a priority over assessing for potential fetal compromise.
A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first?
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A client who is at 28 weeks of gestation and reports of painless vaginal bleeding
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A client who has missed a period and reports vaginal spotting
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A client who is at 14 weeks of gestation and reports nausea and vomiting
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A client who is at 38 weeks of gestation and reports a cough and fever
Explanation
Correct Answer: (A) A client who is at 28 weeks of gestation and reports of painless vaginal bleeding
Painless vaginal bleeding in the third trimester is a classic sign of placenta previa, a potentially life-threatening condition for both the client and fetus. This client requires immediate assessment to rule out significant blood loss and determine fetal status, making her the priority.
Why Other Options are Incorrect:
B. A client who has missed a period and reports vaginal spotting — This may indicate early pregnancy or a possible early miscarriage, but it is not as immediately life-threatening as painless bleeding in the third trimester.
C. A client who is at 14 weeks of gestation and reports nausea and vomiting — This is a common finding in pregnancy and is not an emergency requiring immediate attention.
D. A client who is at 38 weeks of gestation and reports a cough and fever — This suggests a possible infection that needs evaluation, but it is not as acutely life-threatening as active bleeding in a client with a previa.
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