(latest 2023) ATI CMS FINAL EXAM REVIEW

1. A pregnant client tells the nurse that the first day of her last menstrual period was August 2, 2019. Based on Nägele's rule, what is the estimated date of delivery? May 9, 2020 -Minus 3 months, add 7 days to first day of last menstrual period, consider year 2. A client who is at 8 weeks of gestation tells the nurse that she isn't sure she is happy about being pregnant. Which of the following is an appropriate response by the nurse to the client's statement? "It is normal to have these feelings during the first few months of pregnancy." 3. A 14-week gestational client, who weighed 125 pounds before pregnancy, comes into the health clinic for a prenatal appointment. The client's weight today is 129 pounds. What action should the nurse implement? • Document the finding in the medical record. -Gain 2.2-4.4 lb in 1st trimester, 1 lb each wk from 2nd trimester on -Total of 25-35 lbs for normal bmi 18-24 4. A primigravida who is at 34-weeks gestation complains she is experiencing heartburn. What recommendation should the nurse make? • Eat five small meals daily 5. Nausea Interventions • -Crackers before getting out of bed or dry toast "carbs" -Ginger* -Small meals, limit liquids with meals -Avoid fatty, greasy, foul odors 6. A nurse is monitoring a newborn for indications of septic shock. Which of the following findings should the nurse expect if the newborn develops this complication? • Decreased blood pressure 7. The nurse is reviewing self-care information with a pregestational client with type 1 diabetes mellitus. What information should the RN reinforce with the client? • HYPOglycemic episodes are more likely to occur during the first trimester. -HYPERglycemia common in 2nd and 3rd trimester as insulin resistance increases. Glucose tolerance test (GTT) at 28 wks! 8. Gestational Diabetes Mellitus (GDM) • -Keep blood glucose 70-110 -Nutrition Education: Low glucose, good complex carbs and fiber. May teach carb counting 9. A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis to assess fetal lung maturity. Which of the following is a test for fetal lung maturity? • Lecithin/sphingomyelin (L/S) ratio 10. Alpha-fetoprotein (AFP) • AFP is a test to assess for fetal neural tube defects or chromosome disorders. 11. Lecithin/sphingomyelin (L/S) ratio • A test of L/S ratio is done as part of an amniocentesis to determine fetal lung maturity. 12. Kleihauer-Betke test • A Kleihauer-Betke test is used to verify that fetal blood is present during a percutaneous umbilical blood sampling procedure. 13. Indirect Coombs' test • An indirect Coombs' test detects Rh antibodies in the mother's blood. 14. A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements by the client requires clarification? • "I need to have a full bladder at the time of the procedure." 15. Amniocentesis • -Report cramping and signs of infection following the procedure. • -Encourage client to drink extra fluids and rest during the 24 hrs following an amniocentesis. • -Client's bladder should be empty to avoid an inadvertent puncture during the procedure • -Amniotic fluid is tested to identify fetal genetic defects. 16. A client in active labor is admitted with preeclampsia. Which assessment finding is most significant in planning this client's care? Patellar reflex 4+ 17. A nurse administers betamethasone to a client who is at 33 weeks of gestation to stimulate fetal lung maturity. When planning care for the newborn, which of the following conditions should the nurse identify as an adverse effect of this medication? Decreased blood glucose 18. A nurse is preparing to administer naloxone to a newborn. Which of the following conditions can require administration of the medication? • IV narcotics administered to the mother during labor 19. A nurse is teaching a client about a nonstress test. Which of the following statements by the client indicates an understanding of the teaching? • "I should press the button on the handheld marker when my baby moves." 20. A nurse is planning care for a requires phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan of care? • Ensure the newborns eyes are closed before applying the eye shield 21. A nurse is caring for a client whose membranes have ruptured and is in active labor. the fetal monitor tracing reveals late decelerations. Which of the following actions should the nurse take first? • Turn the client onto her left side -veaL choP - Placental insufficiency 22. A nurse is planning care for a client who is pregnant and is Rh-negative. In which of the following situations should the nurse administer Rh(D) Immune Globulin? • At 28 weeks of gestation 23. A nurse is caring for a client who has a prescription for naloxone. Which of the following is the intended action of the medication in relation to the central nervous system (CNS)? • Block effects of narcotics on the CNS -Naloxone prevents CNS and resp depression in the newborn following delivery. 24. A nurse is planning care for a client who has a prescription for oxytocin. Which of the following is a contraindication for the use of this medication? Active genital herpes 25. A nurse is caring for a client who desires an intrauterine device for contraception. Which of the following findings is a contraindication for the use of this device? Menorrhagia -menorrhagia = menstrual bleeding lasting for longer than 7 days. -IUD is contraindicated in women who have menorrhagia, severe dysmenorrhea, or history of ectopic pregnancy. 26. A nurse is assessing a client receiving magnesium sulfate as treatment for preeclampsia. Which of the following clinical findings is the nurse's priority? Urinary output 40 mL in 2 hr -Discontinue magnesium sulfate if the hourly output is less than 30 mL/hr. -Urinary output is critical to the excretion of magnesium from the body. 27. A nurse is caring for a client at 34 weeks gestation and has a prescription for terbutaline for preterm labor. Which of the following statements by the patient is the priority? "My heart feels as if it is racing." 28. A nurse is caring for a client who has trichomoniasis and a prescription for metronidazole. Which of the following instructions should the nurse provide to the client about the treatment plan? "You and your partner need to take the medication and use a condom during intercourse until cultures are negative." 29. A nurse is assessing a newborn who is 12 hr old and notes mild jaundice of face and trunk. Which of the following actions should the nurse take? Obtain stat prescription for a bilirubin level 30. A nurse is caring for a newborn who was born to a client with a narcotic use disorder. Which of the following nursing actions is a contraindication for the care of the newborn? Frequent stimulation 31. A nurse is caring for a client who is in labor and has an epidural for pain relief. Which of the following is a complication from the epidural block? Hypotension 32. A nurse is caring for a client who is in labor. A vaginal exam reveals this information: 2cm, 50%, +1, right occiput anterior (ROA). Based on this information, which of the following fetal positions should the nurse document in the medical record? Vertex 33. A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following clinical findings should the nurse expect? Exaggerated reflexes - ^indicate CNS irritability 34. A nurse is caring for a client who is receiving oxytocin for induction of labor. Which of the following actions should the nurse take? Perform continuous fetal heart rate monitoring 35. A nurse is caring for a client who is at 16 weeks of gestation and has severe iron-deficiency anemia. The provider prescribes and injection of iron dextran IM. Which of the following methods should the nurse use to administer the medication? Use a 20-gauge needle, and administer the medication using the Z-track method -Z-track method prevents straining of tissue 36. A nurse is assessing a client on the first postpartum day. Findings include fundus firm and 1 fingerbreadth above and to the right of the umbilicus, moderate lochia rubra with small clots, temperature 37.3 C, and pulse rate 52/min. Which of the following actions should the nurse take? Ask the patient when she last voided -A deviated, firm fundus indicates a full bladder 37. A nurse in an antepartum clinic answers a phone call from a client who is at 37 weeks of gestation and reports, "I became very dizzy while lying in bed this morning, but the feeling went away when I turned on my side." Which of the following actions should the nurse take? Instruct the client about vena cava syndrome and measures to prevent it 38. A nurse is caring for a client who is pregnant and reports nausea and vomiting. Which of the following instructions should the nurse provide the client? Eat some crackers before rising from bed in the morning 39. 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 c section prior to the onset of labor 40. A nurse receives report on a client who is in labor and is experiencing contractions 4 min apart. Which of the following patterns should the nurse expect on the fetal monitoring tracing? Contractions that last for 60 seconds each with a 3 min rest between contractions 41. A nurse is caring for a client who has clinical manifestations of an ectopic pregnancy. Which of the following findings is a risk factor for an ectopic pregnancy? Pelvic inflammatory disease (PID) 42. A nurse is caring for four newborns. Which of the newborns is at greatest risk for hypoglycemia? A newborn who is large for gestational age 43. A nurse is caring for a client who is 2 hr postpartum. The nurse notes the client's perineal pad has a large amount of lochia rubra with several clots. Which of the following actions should the nurse take first? Massage the fundus