RECENT ATI CAPSTONE NEWBORN ASSESSMENT

RECENT ATI CAPSTONE NEWBORN ASSESSMENT

1. A nurse is performing a vaginal exam on a client who is in active labor. The nurse notes the umbilical cord protruding through the cervix. Which of the following actions should the nurse take?



Administer oxytocin to the client via intravenous infusion. Apply oxygen at 2 L/min via nasal cannula.

Prepare for insertion of an intrauterine pressure catheter. Assist the client into the knee-chest position.



2. A nurse is assessing a newborn who is 48 hr old and is experiencing opioid withdrawals. Which of the following findings should the nurse expect?



Hypotonicity



Moderate tremors of the extremities



Axillary temperature 36.1° C (96.9° F) Excessive sleeping



3. A nurse is reviewing a client's medical record and notes that the client is taking tamoxifen. The nurse should identify that tamoxifen is used to treat which of the following conditions?



Non-Hodgkin's lymphoma Endometriosis Breast cancer

Polycystic ovary syndrome



4.  A nurse is caring for a client who is receiving oxytocin to augment labor. The client has an intrauterine pressure catheter and an internal fetal scalp electrode for monitoring. Which of the following is an indication that the nurse should discontinue the infusion?



Contraction frequency every 3 min



Contraction duration of 100 seconds Fetal heart rate with moderate variability

Fetal heart rate of 118/min

5.  A nurse providing dietary teaching for a client who is at 29 weeks of gestation and has



phenylketonuria. Which of the following suggested foods should the nurse include in the teaching?



A peanut butter sandwich on wheat bread



A sliced apple and red grapes



A chocolate chip cookie with a glass of skim milk A scrambled egg with cheddar cheese



6.  A nurse is reviewing a laboratory report for a client who is at 33 weeks of gestation and has preeclampsia. Which of the following laboratory results should the nurse report to the provider?



BUN 35 mg/dL



Hgb 15 mg/dL Bilirubin 0.6 mg/dL Hct 37%



7.  A nurse is providing teaching about newborn safety to a client who is being admitted for induction of labor. Which of the following client statements indicate an understanding of the teaching?



"I will check the identication badge of anyone who removes my baby from our room."



"I should include a photo of my baby along with any public birth announcements to social media."



"I will allow my baby to sleep on the bed in my room when I am in the shower." "I should expect the nurses to carry my baby in their arms to the nursery."



8.  A nurse is assessing a client who is at 31 weeks of gestation. Which of the following findings should the nurse identify as an indication of a potential prenatal complication?



Periodic tingling of fingers Absence of clonus Leg cramps



Blurred vision



9.  A nurse is reviewing the laboratory results of a newborn who is 24 hr old. Which of the following findings should the nurse report to the provider?



Hemoglobin 12 g/dL



Glucose 50 mg/dL Bilirubin 4 mg/dL Platelets 200,000/mm



10.  A nurse is caring for a client who is in labor and has an epidural for pain control. Which of the following clinical manifestations is an adverse effect of epidural anesthesia?



Polyuria Hypertension Pruritus Dry mouth



11. A nurse is teaching a client about using an intrauterine device (IUD) for contraception. Which of the following client statements indicate an understanding of the teaching?



"I will need to have the IUD replaced each year."

"I will need to apply a spermicide prior to intercourse."

"I should expect my periods to stop while I have the IUD." "I should check for the string each month after menstruation."



12.  A nurse is assessing a newborn who is 10 hr old. Which of the following findings should the nurse report to the provider?



Axillary temperature 36.5° C (97.7° F)



Nasal faring



Heart rate 158/min One void since birth



13.  A nurse is assessing a client who gave birth 1 week ago. The client states, "I don't know what's wrong. I love my baby, but I feel so let down and I seem to cry for no reason." The



nurse should identify that the client is experiencing which of the following emotional responses to birth?



Postpartum depression Taking-in phase Postpartum blues Taking-hold phase



14.  A nurse is providing teaching to a group of women about risk factors for ovarian cancer. Which of the following risk factors should the nurse include? (Select all that apply.)



Nulliparity



History of breastfeeding

Previous use of oral contraceptives History of breast cancer Hormone replacement therapy



15.  A nurse is caring for a client who is at 38 weeks of gestation and is experiencing continuous abdominal pain and vaginal bleeding. The client has a history of cocaine use. The nurse should identify that the client is likely experiencing which of the following complications?



Abruptio placentae



Hydatidiform mole Preterm labor Placenta previa



16.  A nurse is caring for a client who is postpartum, has a deep-vein thrombosis, and is receiving heparin therapy via subcutaneous injections. Which of the following actions should the nurse take?



Request a prescription for PRN aspirin from the provider.

Massage the injection site thoroughly following administration. Instruct the client that they cannot breastfeed while receiving heparin. Administer the injection in the client's abdomen.