ATI RN MATERNAL NEWBORN PROCTORED EXAM 2023/2024

ATI RN MATERNAL NEWBORN PROCTORED EXAM 2023/2024 The nurse is providing an education session to an adult community group about the effects of smoking on infection. Which information is most important for the nurse to include in the educational session? Smoke from tobacco products clings to your clothing and hair. Smoking affects the cilia lining the upper airways in the lungs. Smoking can affect the color of the patient’s fingernails. Smoking tobacco products can be very expensive. ANS: B A normal defense mechanism against infection in the respiratory tract is the cilia lining the upper airways of the lungs and normal mucus. When a patient inhales a microbe, the cilia and mucus trap the microbe and sweep them up and out to be expectorated or swallowed. Smoking may alter this defense mechanism and increase the patient’s potential for infection. Smoking can be expensive, the smell does cling to hair and clothing, and the tar within the smoke can alter the color of a patient’s nails. This information can be included in the education but does not constitute the most important point. A female adult patient presents to the clinic with reports of a white discharge and itching in the vaginalarea. A nurse is taking a health history. Which question is the priority? “When was the last time you visited your primary health care provider?” “Has this condition affected your eating habits in any way?” “What medications are you currently taking?” “Are you able to sleep at night?” ANS: C Antibiotics and oral contraceptives can disrupt normal flora in the vagina, causing an overgrowth of Candida albicans in that area. It is important to ask the patient about current medications to obtain information that mayassist with diagnosis. The body contains normal flora (microorganisms) that live on the surface of skin, saliva, oral mucosa, gastrointestinal tract, and genitourinary tract. The normal flora of the vagina causes vaginal secretions to achieve a low pH, inhibiting the growth of many microorganisms. Visiting the primary health care provider is important for the patient’s health maintenance but is not the priority. Learning about the patient’s eating and sleeping habits will assist in the plan of care but is not the priority. The nurse is caring for a school-aged child who has injured the right leg after a bicycle accident. Whichsigns and symptoms will the nurse assess for to determine if the child is experiencing a localized inflammatory response? Malaise, anorexia, enlarged lymph nodes, and increased white blood cells Chest pain, shortness of breath, and nausea and vomiting Dizziness and disorientation to time, date, and place 43 ANS: D The body’s cellular response to an injury is seen as inflammation. Signs of localized inflammation include swelling, redness, heat, pain or tenderness, and loss of function in the affected body part. Systemic signs of inflammation include fever, malaise, and anorexia, as well as enlarged lymph nodes and increased white blood cells. Chest pain, shortness of breath, and nausea and vomiting are signs and symptoms of a cardiac alteration.Dizziness and disorientation to time, date, and place may indicate a neurologic alteration. Which interventions utilized by the nurse will indicate the ability to recognize a localized inflammatory response? Vigorous range-of-motion exercises Turn, cough, and deep breathe Orient to date, time, and place Rest, ice, and elevation ANS: D Signs of localized inflammation include swelling, redness, heat, pain or tenderness, and loss of function in the affected body part. One sign of the inflammatory response, particularly after an injury, is swelling or edema. Resting the affected injured area, using ice as ordered, wrapping the area to provide support—particularly if it is an extremity—and elevating the injured area will help to decrease swelling or edema. Turning, coughing, and deep breathing are utilized for postoperative patients and for immobilized patients to help prevent an infectious process such as pneumonia. Orientation to date, time, and place is an intervention utilized with many different types of patients who may be confused. Vigorous range of motion would irritate the inflammatory process. Range of motion is utilized for individuals who need to improve movement of their extremities, including immobilized patients