ATI Custom: NUR 209 Summer 1 Midpoint

Question 2

ATI Custom: NUR 209 Summer 1 Midpoint. A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. The client asks, “How will I know if the medication is working?” Which response by the nurse is most appropriate?

• “We will monitor your blood pressure to see if it decreases.”
• “We will check for a reduction in swelling and fluid retention.”
• “We will assess for a decrease in seizure activity and improved reflexes.”
• “You should feel less pain and have fewer headaches.”

Question 3

A nurse is caring for a laboring client whose fetal heart rate (FHR) monitor shows recurrent late decelerations. Which is the priority nursing action to address the cause of these late decelerations?

• Reposition the client to a lateral position to improve uteroplacental blood flow
• Increase oxytocin infusion to strengthen contractions
• Encourage the client to bear down with each contraction
• Administer tocolytic medications to stop uterine contractions

Question 4

The client arrives at the emergency room following a sexual trafficking incident. She is experiencing significant pain but has difficulty swallowing pills. The provider prescribes 15 mL of Codeine with acetaminophen oral elixir to be taken by mouth once.

Pharmacy Formulary Codeine with acetaminophen oral elixir available: 2.4 mg/mL of codeine 24 mg/mL of acetaminophen

Complete the following sentence using the drop-down options. The client is prescribed [Select…] mL of codeine and acetaminophen elixir. She will receive [Select…] mg of codeine and [Select…] mg of acetaminophen based on the formulary concentration. Custom: NUR 209 Summer 1 Midpoint

• First Drop-down: 15
• Second Drop-down: 36
• Third Drop-down: 360

Question 5

A nurse is caring for a client in the first trimester of pregnancy and discovers that the client lacks immunity to rubella based on her blood work. When is the recommended time for administering rubella immunization?

• During the next attempt to get pregnant
• During the third trimester of pregnancy
• Immediately after delivery
• During the first trimester of pregnancy

Question 6

The nurse is assessing a patient in labor. Which finding indicates that the fetus is descending toward delivery?

• Fetal station of -3
• Fetal station of +2
• Effacement of 25%
• Cervical dilation of 2 cm

Question 7

A nurse observes variable decelerations on a fetal heart rate monitor during labor. Which of the following is the most likely cause of this fetal heart rate pattern and the priority nursing intervention? ATI Custom: NUR 209 Summer 1 Midpoint

• Fetal head compression; prepare for imminent delivery as this indicates fetal distress
• Maternal hypotension; increase IV fluids and lower the head of the bed
• Uteroplacental insufficiency; administer oxygen and notify the provider immediately
• Umbilical cord compression; reposition the client to a lateral position to relieve pressure

Question 8

A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

• “There is an increased risk of introducing infection.”
• “There is an increased risk of rupture of the membranes.”
• “This could result in profound bleeding.”
• “This could initiate preterm labor.”

Question 9

A nurse is assessing a postpartum client for signs of postpartum depression. Which of the following symptoms is most indicative of postpartum depression rather than normal postpartum adjustment?

• Experiencing occasional mood swings and irritability while adjusting to the new role of motherhood
• Feeling overwhelmed and having difficulty sleeping due to the demands of a newborn
• Persistent feelings of sadness, severe fatigue, and loss of interest in activities, including caring for the baby
• Feeling anxious about the baby’s health and well-being, but still able to care for the baby effectively

Question 10

A nurse is reviewing the different signs of pregnancy with a client who is in her first trimester. Which of the following symptoms should the nurse classify as a positive sign of pregnancy?

• Fetal heart tones auscultated with Doppler
• Breast tenderness and nausea
• Positive pregnancy test
• Hegar’s sign

Question 11

A nurse is caring for a client who is 3 days postpartum and is attempting to breastfeed. Which of the following findings indicate mastitis?

• A white patch on a nipple
• Swelling and redness in one breast, accompanied by flu-like symptoms
• Symmetrical breast swelling with a sudden increase in milk production
• Bilateral breast tenderness and engorgement with no fever

Case Study Question — Part 1 (Highlighting)

Analyze the case study data across the tabs (Client Assessment, Vital Signs, Laboratory Results) to choose which findings are abnormal and require immediate action. Custom: NUR 209 Summer 1 Midpoint

Correct Choices to Highlight:

• severe, persistent headache
• blurred vision
• epigastric pain
• 190/112 mmHg
• 3+ protein
• Deep tendon reflexes are 3+
• clonus present
• 85,000/mm³
• AST 92 U/L
• ALT 88 U/L

Case Study Question — Part 2 (Drop-downs)

Complete the following sentence using the drop-down options based on priority framework. The nurse should first address the client’s [Select…], followed by the client’s [Select…].

• First Drop-down (The nurse should first address): epigastric pain
• Second Drop-down (followed by): platelet count

Medication Matrix Question

Drag or select the correct nursing action associated with each labor and delivery medication. (Each category must have at least 1 response option selected).

• Oxytocin (Pitocin): Monitor the length, strength, and duration of contractions
• Misoprostol (Cytotec): Monitor for nausea, vomiting, and diarrhea
• Methylergonovine (Methergine): Do not administer to clients with hypertension
• Magnesium sulfate: Monitor for respiratory depression

Question 13 of 40

Which interpretation by the nurse of the patient’s current condition is most appropriate?

• The findings are consistent with the expected discomforts of pregnancy ATI Custom: NUR 209 Summer 1 Midpoint
• The patient is at increased risk for seizure activity
• The findings are consistent with mild preeclampsia
• The findings are consistent with Hyperemesis Gravidarum

Question 14 of 40

Which condition should the nurse identify as the priority diagnosis based on the patient’s current status?

Select the single most likely condition that requires immediate intervention considering the severity of findings and the risk for maternal and fetal complications.

• Gestational Hypertension
• Severe preeclampsia, with risk for eclampsia
• Acute fatty liver disease of pregnancy
• Preeclampsia, without severe features

Question 15 of 40

For each intervention, indicate whether the nurse should anticipate or not anticipate implementing it for this patient with severe preeclampsia.

• Encourage ambulation $\rightarrow$ Not Anticipated
• Initiate magnesium sulfate infusion $\rightarrow$ Anticipated
• Implement Seizure Precautions $\rightarrow$ Anticipated
• Administer antihypertensive medication $\rightarrow$ Anticipated
• Continuous Fetal Monitoring $\rightarrow$ Anticipated

Question 16 of 40

The patient is receiving a magnesium sulfate infusion. Which findings should the nurse identify as signs of possible magnesium toxicity? Select all that apply.

(Select All that Apply.)

• Oxygen saturation 99% on room air
• Deep tendon reflexes 2+
• Urine output of 10 mL/hr.
• Absent deep tendon reflexes
• Respiratory rate of 9 breaths/min

Question 17 of 40

After initiating interventions, which finding indicates to the nurse that the patient’s condition is improving?

• Urine output 20 mL/hr
• Blood pressure decreased to 128/78 mmHg
• Respiratory rate 10 breaths/min
• Deep tendon reflexes absent

Question 18 of 40

A pregnant client at 20 weeks gestation is concerned about vaccine safety and asks the nurse which vaccines are recommended during pregnancy to protect both her and her unborn child. Which vaccine should the nurse prioritize recommending to the client at this stage of pregnancy?

• Human papillomavirus (HPV) vaccine, to prevent Human papillomavirus during pregnancy
• Varicella vaccine, to prevent chickenpox complications during pregnancy
• Rubella vaccine, to prevent congenital rubella syndrome during pregnancy
• TdaP vaccine, ideally given between 27 and 36 weeks gestation to protect the newborn from pertussis

Question 19 of 40

A nurse is assessing a client who is suspected of having a threatened abortion. Which of the following clinical findings should the nurse identify as indicative of this condition?

• Fever, foul-smelling vaginal discharge, and retained products of conception
• No vaginal bleeding, but absence of fetal cardiac activity with a closed cervix
• Heavy vaginal bleeding with an open cervix and passage of fetal tissue
• A closed cervix, with a viable embryo on ultrasound

Question 20 of 40

A nurse is caring for a client who is 5 hr postpartum following a vaginal birth of a newborn weighing 9 lb 6 oz. (4252 g). The nurse should recognize that this client is at risk for which of the following postpartum complications?

• Retained placental fragments
• Puerperal infection
• Uterine atony
• Thrombophlebitis

Question 21 of 40

The nurse is assessing a patient with suspected pregnancy. Which finding should the nurse recognize as a probable sign of pregnancy?

• Reports of nausea in the morning
• Increased urinary frequency
• Missed menstrual period ATI Custom: NUR 209 Summer 1 Midpoint
• Bluish discoloration of the cervix

Question 22 of 40

After ambulating in the hall and returning to bed, the client states that her water broke. The fetal heart rate is 85 beats per minute, and the vaginal exam reveals the cervix is effaced (90%), dilated (2 cm), vertex presentation, and fetal station (-2). There is a pulsating cord felt in the anterior portion of the vagina. Which intervention would the nurse perform immediately?

• Call the provider and prepare for an emergency cesarean section
• Position the client on the left side to move the fetus off the vena cava
• Adjust the fetal monitor so the accurate fetal heart rate pattern can be assessed
• Apply pressure to the presenting part to prevent pressure on the umbilical cord

Question 23 of 40

A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception. Which of the following statements made by the client indicates a need for further teaching?

• “I should take the morning-after pill as soon as possible after unprotected intercourse.”
• “The morning-after pill does not protect against sexually transmitted infections.”
• “The morning-after pill can be less effective if I take it more than 72 hours after unprotected sex.”
• “I can use the morning-after pill as a regular form of birth control.”

Question 24

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

• “It halts cervical dilation.”
• “It increases the fetal heart rate.”
• “It promotes fetal lung maturity.”
• “It is used to stop preterm labor contractions.”

Question 25

A client presents to the clinic with complaints of thin, grayish-white vaginal discharge and a fishy odor that is more noticeable after intercourse. The client denies pain or lesions. After evaluation, the client is diagnosed with bacterial vaginosis. What education should the nurse include in the teaching plan? (Select all that Apply).

• [X] Use condoms to reduce recurrence risk
• [X] Avoid douching, as it disrupts normal vaginal flora
• [X] Take all prescribed medications exactly as directed
• [X] Avoid alcohol while taking Metronidazole
• [ ] Expect thick, white, cottage cheese-like discharge as a normal finding with bacterial vaginosis

Question 26

The nurse is assessing a patient who requests combination oral contraceptive pills. Which finding in the patient’s history is a contraindication to the use of combination oral contraceptives?

• Reports of mild acne
• No prior pregnancies
• History of Deep vein thrombosis
• Irregular menstrual cycles

Question 27

A nurse is caring for a client at the first prenatal visit who has a BMI of 23.5. The client asks how much weight she should gain during pregnancy. Which of the following responses should the nurse make?

• “The recommendation for you is about 15 to 25 pounds.”
• “It would be best if you gained about 11 to 20 pounds.”
• “A gain of about 25 to 35 pounds is recommended for you.”
• “A gain of about 1 pound per week is the best pattern for you.”

Question 28

The nurse is reviewing medications prescribed for a patient experiencing preterm labor. Which medications should the nurse recognize as tocolytics used to suppress uterine contractions? (Select all that apply.)

• [ ] Hydralazine
• [ ] Oxytocin
• [X] Indomethacin
• [X] Terbutaline
• [X] Magnesium sulfate
• [X] Nifedipine

Question 29

A client has just received an epidural for labor analgesia and develops a sudden drop in blood pressure. Which nursing action should be prioritized to manage the client’s hypotension and maintain fetal well-being?

• Administer oxygen and encourage the client to ambulate to improve circulation.
• Place the client supine with legs flat to increase venous return and monitor vital signs every 30 minutes.
• Immediately elevate the head of the bed to promote comfort and reduce venous pooling.
• Reposition the client to a lateral position, and increase IV fluid infusion

Question 30

Which of the following gravida clients is most appropriate for a charge nurse to assign to a new nurse with no obstetric (OB) experience?

• 38-week client with complete previa
• 32-week patient with preeclampsia receiving magnesium sulfate
• 34-week client with no fetal heartbeat
• 9-week client with hyperemesis receiving IV therapy

Question 31

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client?

• Temperature
• Fetal heart rate (FHR)
• Bowel sounds
• Respiratory rate

Question 32

The nurse is caring for a client at 32 weeks’ gestation who presents with a moderate amount of painless, bright red vaginal bleeding. Which interventions are priority to implement at this time? Select all that apply.

• [ ] Assess client for incidence of domestic violence.
• [X] Assess fetal heart tones.
• [X] Initiate Intravenous (IV) Lactated Ringers for fluid replacement.
• [ ] Perform a digital vaginal examination to assess cervical dilation.
• [X] Monitor vital signs.

Question 33

The nurse is reviewing a fetal heart rate tracing and notes recurrent late decelerations. What is the most likely cause of this finding?

• Fetal movement
• Fetal head compression
• Uteroplacental insufficiency
• Umbilical cord compression

Question 34

A nurse is educating a pregnant client about the differences between Braxton Hicks contractions and true labor contractions. Which statement should the nurse include?

• “Braxton Hicks contractions are felt in the lower back.”
• “Braxton Hicks contractions are felt in the lower abdomen.”
• “True labor contractions often resolve with rest and are not usually painful.”
• “Braxton Hicks contractions typically cause cervical dilation and effacement.”

Question 35

A client presents with complaints of frothy, greenish-yellow vaginal discharge, vulvar itching, and a foul-smelling genital odor. The client reports recent sexual activity with multiple partners and inconsistent use of barrier protection. Urine analysis shows yellow color, cloudy appearance, negative glucose, negative ketones, specific gravity 1.026, negative blood, negative nitrate, negative leukocytes, and 0 bacteria. Complete the clinical matrix matching the findings.

• Assessment Cues (Select 2): Green-yellow, frothy discharge & Foul-smelling vaginal discharge
• Condition (Select 1): Trichomoniasis
• Anticipated Solutions (Select 2): Oral Metronidazole & Educate on safe sexual practices

Question 36

A client diagnosed with HELLP syndrome is being assessed for manifestations and laboratory findings related to the condition. Which of the following signs and symptoms should the nurse expect to find in this client? Select all that apply.

• [ ] Increased platelet count
• [X] Elevated liver enzymes (AST/ALT)
• [X] Hemolysis
• [X] Low platelet count
• [X] Right upper quadrant abdominal pain

Question 37

A pregnant client at 28 weeks of gestation, who is receiving Rho(D) immune globulin for her Rh-negative status, asks the nurse if she will need another dose later. What is the most appropriate response from the nurse?

• “You will not need another dose since this is a one-time treatment for your entire pregnancy.”
• “You will need to receive another dose at delivery if your baby is Rh-positive.”
• “You will need Rho(D) immune globulin again in 72 hours to protect any future pregnancies”
• “You will need to come back for a dose of Rho(D) immune globulin only if you experience bleeding or trauma.”

Question 38

A nurse is monitoring a laboring patient and observes a gradual decrease in fetal heart rate that begins and ends in sync with uterine contractions, with the lowest point of deceleration coinciding with the peak of contraction. What is the most likely cause of this early deceleration pattern?

• Umbilical cord compression leading to abrupt decreases in fetal heart rate.
• Uteroplacental insufficiency resulting in hypoxia and delayed fetal heart rate deceleration.
• Fetal movement causing transient increases in fetal heart rate.
• Compression of the fetal head during contractions causing increased intracranial pressure and a vagal response.

Question 39

A nurse is assessing a client in the third trimester who reports sudden onset of sharp abdominal pain and vaginal bleeding. The uterus is tender and rigid on palpation. Which nursing action should be the priority?

• Prepare the client for immediate cesarean delivery and monitor fetal heart tones.
• Encourage bed rest and apply cold compresses to the abdomen to reduce bleeding.
• Monitor for painless bright red vaginal bleeding and prepare for vaginal delivery.
• Delay intervention while monitoring for changes

Question 40

A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

• Observe an area of redness on the breast of a client who is 1 day postpartum.
• Change the initial perineal pad of a client who just transferred from labor and delivery.
• Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.
• Monitor vital signs during admission of a client who has gestational hypertension.