ATI Custom NUR209 Final Assessment Summer 1
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Free ATI Custom NUR209 Final Assessment Summer 1 Questions
The nurse identifies the following assessment findings in a client who is 36 weeks' gestation. Which should be immediately reported to the provider?
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O+ negative blood type
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Positive rubella serum antibody titer
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Blood pressure 160/94 mm Hg in left arm
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Copious leukorrhea
Explanation
Correct Answer: (C) Blood pressure 160/94 mm Hg in left arm
A blood pressure of 160/94 mm Hg at 36 weeks gestation meets the diagnostic criteria for severe hypertension in pregnancy and is a hallmark sign of severe preeclampsia. This finding requires immediate provider notification as it places both the mother and fetus at risk for life-threatening complications including eclampsia, placental abruption, stroke, and HELLP syndrome.
Why Other Options are Incorrect:
A. O+ negative blood type Having O+ blood type is a normal finding and does not require immediate reporting. Rh-negative blood type would require monitoring and possible Rh immunoglobulin administration, but O-positive is not a concern during pregnancy.
B. Positive rubella serum antibody titer A positive rubella antibody titer indicates the client has immunity to rubella, which is a reassuring and protective finding during pregnancy. It does not require immediate reporting and is not a cause for concern.
D. Copious leukorrhea Increased vaginal discharge, or leukorrhea, is a normal physiological change during pregnancy caused by increased estrogen levels and cervical mucus production. Unless accompanied by foul odor, itching, or abnormal color suggesting infection, copious leukorrhea does not require immediate provider notification.
Which assessment findings would alert the nurse to an infant or child in heart failure? (Select All that Apply.)
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Wheezes or rales
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Edema in feet and legs
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Tires easily, gets fatigued during feedings
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Clear breath sounds
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Tachypnea
Explanation
Correct Answer: (A) Wheezes or rales, (B) Edema in feet and legs, (C) Tires easily, gets fatigued during feedings, (E) Tachypnea
In pediatric heart failure, the heart cannot pump effectively, leading to fluid backup into the lungs causing wheezes or rales, and into the peripheral tissues causing dependent edema. Infants and children compensate by working harder to breathe, resulting in tachypnea. Poor cardiac output also means inadequate perfusion during activity, so infants tire quickly and struggle to complete feedings, which is a hallmark sign of heart failure in this age group.
Why the other options are incorrect:
D. Clear breath sounds Clear breath sounds indicate normal lung fields without fluid accumulation. In heart failure, pulmonary congestion typically produces abnormal breath sounds such as crackles or wheezes, making clear breath sounds an expected finding in a healthy child, not one in heart failure.
A nurse is caring for a 5-year-old child who is postoperative following a tonsillectomy. Which of the following pain scales should the nurse use to determine the child's pain level?
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NIPS (Neonatal Infant Pain Scale)
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FACES
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Numeric Rating Scale (NRS)
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FLACC
Explanation
Correct Answer: (B) FACES
The FACES pain scale is the appropriate tool for a 5-year-old child. It uses a series of illustrated facial expressions ranging from a happy face representing no pain to a crying face representing the worst pain, allowing young children who may not yet have the cognitive or verbal ability to use numeric scales to communicate their pain level by pointing to the face that best represents how they feel.
Why Other Options are Incorrect:
A. NIPS (Neonatal Infant Pain Scale) The NIPS is designed for neonates and premature infants and assesses pain through behavioral indicators such as facial expression, crying, and limb movement. It is not appropriate for a 5-year-old child who is able to participate in self-reporting.
C. Numeric Rating Scale (NRS) The NRS requires the client to assign a number from 0 to 10 to describe their pain intensity. This scale is most appropriate for older children aged 9 and above and adults who have the cognitive ability to understand abstract numeric representation of pain intensity.
D. FLACC The FLACC scale assesses Face, Legs, Activity, Cry, and Consolability and is used for infants and children between 2 months and 7 years who are unable to self-report pain, such as those who are sedated, cognitively impaired, or nonverbal. A 5-year-old who is alert and cooperative postoperatively can self-report using the FACES scale, making FACES the more appropriate choice.
An 18-hour-old infant with hyperbilirubinemia is placed under phototherapy bank lights. Which of the following is an appropriate intervention for this infant?
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Keep eye shields on at all times, including when breastfeeding
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Tightly swaddle the infant in blanket
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Expose as much of the infant's skin to the lights as possible
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Keep skin moisturized with lotion
Explanation
Correct Answer: (C) Expose as much of the infant's skin to the lights as possible
Phototherapy works by converting bilirubin in the skin into a water-soluble form that can be excreted in urine and stool. Maximizing skin surface area exposure to the phototherapy lights increases the effectiveness of treatment by allowing more bilirubin to be broken down. The infant should be placed with minimal clothing, typically only a diaper, to maximize light exposure.
Why Other Options are Incorrect:
A. Keep eye shields on at all times, including when breastfeeding Eye shields are essential during phototherapy to protect the infant's eyes from the intense light, which can cause retinal damage. However, the shields should be removed during breastfeeding and direct interaction with caregivers to allow for eye contact, bonding, and assessment of the eyes for irritation or infection.
B. Tightly swaddle the infant in blanket Swaddling during phototherapy covers the skin and significantly reduces the surface area exposed to the therapeutic lights, making treatment far less effective. The infant should be unswaddled and dressed minimally to maximize skin exposure.
D. Keep skin moisturized with lotion Applying lotion to the skin during phototherapy is contraindicated as it can absorb the light and potentially cause skin burns. The skin should be kept clean and dry during phototherapy treatment.
A nurse is caring for an infant diagnosed with a cleft palate. Which complication should the nurse recognize as most common in this condition?
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Pyloric Stenosis
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Choking or coughing with feeds
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Congenital heart defect
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Intussusception
Explanation
A cleft palate creates an abnormal opening between the mouth and nasal cavity, which impairs the infant's ability to create suction and properly separate feeding from breathing, commonly resulting in choking, coughing, and nasal regurgitation during feeds.
Why the other options are incorrect:
A. Pyloric Stenosis — This is a separate gastrointestinal condition involving narrowing of the pylorus, unrelated to cleft palate anatomy.
C. Congenital heart defect — While cleft palate can occur alongside other congenital anomalies in syndromic cases, it is not the most common direct complication of the cleft palate itself.
D. Intussusception — This is a bowel condition involving telescoping of intestinal segments, unrelated to the anatomical feeding challenges caused by a cleft palate.
A nurse is assessing a newborn who is 2 hours old. Which of the following findings should the nurse recognize as a manifestation of neonatal hypoglycemia?
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Projectile vomiting after feeding
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Bounding peripheral pulses
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Jitteriness and tremors
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Hyperactive bowel sounds
Explanation
Correct Answer: (C) Jitteriness and tremors
Jitteriness and tremors are classic manifestations of neonatal hypoglycemia, occurring due to inadequate glucose supply to the central nervous system, resulting in neurologic irritability.
Why Other Options are Incorrect:
A. Projectile vomiting after feeding — This finding is more consistent with a gastrointestinal issue such as pyloric stenosis, not hypoglycemia.
B. Bounding peripheral pulses — This finding is associated with conditions like patent ductus arteriosus, unrelated to hypoglycemia.
D. Hyperactive bowel sounds — This is not a typical manifestation of neonatal hypoglycemia; hypoglycemia primarily presents with neurologic and autonomic symptoms like jitteriness, lethargy, and poor feeding.
An infant has just undergone surgical repair of a myelomeningocele. What is the priority nursing intervention to perform immediately following the procedure?
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Monitor head circumference
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Position the infant supine
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Limit caregiver visitation
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Measure abdominal circumference
Explanation
Correct Answer:
A
Why the other options are incorrect:
B. Position the infant supine — After myelomeningocele repair, the infant should be positioned prone or side-lying to avoid pressure on the surgical site, not supine.
C. Limit caregiver visitation — There is no indication to limit caregiver visitation following this surgery; family involvement and bonding should be encouraged.
D. Measure abdominal circumference — While general assessment is important, abdominal circumference is not the priority measurement specifically related to the key complication risk (hydrocephalus) following this particular surgery.
A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. For each assessment finding, indicate whether the finding requires immediate follow-up by the nurse or is an expected effect of magnesium sulfate therapy.
Assessment Finding | Placenta Previa | Placental Abruption
- Bright red vaginal bleeding — Placenta Previa
- Sudden severe abdominal pain — Placental Abruption
- Dark red vaginal bleeding — Placental Abruption
- Rigid, board like abdomen — Placental Abruption
- Fetal distress — Placental Abruption
- Painless vaginal bleeding — Placenta Previa
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Respiratory rate 18/min
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Respiratory rate 9/min
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Absent deep tendon reflexes
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Urine output 20 mL/hr
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Patient feels warm and flushed
Explanation
Correct Answer: Respiratory rate 18/min (Expected Finding); Respiratory rate 9/min (Requires Immediate Follow-Up); Absent deep tendon reflexes (Requires Immediate Follow-Up); Urine output 20 mL/hr (Requires Immediate Follow-Up); Patient feels warm and flushed (Expected Finding)
Magnesium sulfate commonly causes a sensation of warmth/flushing and a respiratory rate within the normal range (≥12/min) is expected, while signs of magnesium toxicity — a respiratory rate below 12/min, absent deep tendon reflexes, and inadequate urine output (less than 30 mL/hr) — indicate the need for immediate nursing follow-up to prevent serious complications.
Why Other Options are Incorrect:
Respiratory rate 9/min is dangerously low and indicates respiratory depression, a sign of magnesium toxicity requiring immediate action, not an expected therapeutic effect.
Absent deep tendon reflexes signal magnesium toxicity, as diminished (not absent) reflexes may be seen with therapeutic levels, but complete absence requires immediate follow-up.
Urine output of 20 mL/hr is below the acceptable minimum of 30 mL/hr, indicating impaired renal clearance of magnesium and risk for toxicity, requiring immediate follow-up rather than being an expected finding.
A nurse is providing caregiver education for a child who has Duchenne Muscular Dystrophy. Which of the following statements by the caregiver indicates an understanding of the teaching?
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"My child should avoid all social and school activities to conserve energy."
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"I will monitor my child for respiratory symptoms and signs of infection."
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"Assistive devices should only be used during severe weakness."
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"Range of motion exercises should be avoided to prevent muscle damage."
Explanation
Children with Duchenne Muscular Dystrophy are at increased risk for respiratory complications due to progressive muscle weakness affecting the respiratory muscles, so monitoring for respiratory symptoms and infection is essential for early identification and intervention.
Why the other options are incorrect:
A. "My child should avoid all social and school activities to conserve energy." — Children with DMD should be encouraged to participate in school and social activities to the extent possible to support quality of life and normal development, not avoid them entirely.
C. "Assistive devices should only be used during severe weakness." — Assistive devices should be introduced proactively as needed throughout disease progression, not delayed until severe weakness occurs, to help maintain function and independence.
D. "Range of motion exercises should be avoided to prevent muscle damage." — Range of motion exercises are actually recommended to help maintain joint flexibility and prevent contractures, which are common complications in DMD.
75 mg
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75 mg
Explanation
Correct Answer: 75 mg
To calculate the correct dose: 50 mg/kg/day × 6 kg = 300 mg/day. Since the medication is given every 6 hours, that means 4 doses per day. 300 mg ÷ 4 doses = 75 mg per dose. This ensures the infant receives the therapeutic amount without exceeding the safe daily limit.
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