ATI RN
ATI RN Maternal Newborn 2023/24 1st Attempt & Retake Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is at 36 weeks of gestation and has methicillin-resistant Staphylococcus aureus. Which of the following types of isolation precautions should the nurse initiate?
Correct Answer: B
Rationale: The correct answer is B: Contact precautions. Methicillin-resistant Staphylococcus aureus (MRS
A) is primarily spread through direct contact with contaminated skin or surfaces. Contact precautions involve wearing gloves and gowns when in contact with the client or the client's environment to prevent the spread of the infection. Droplet precautions are used for infections transmitted through respiratory droplets, such as influenza. Protective environment precautions are for immunocompromised clients. Airborne precautions are for infections transmitted through small droplets that stay in the air for long periods, such as tuberculosis.
Therefore, the most appropriate precaution for a client with MRSA at 36 weeks of gestation is contact precautions to prevent transmission of the infection through direct contact.
Question 2 of 5
A nurse is caring for a client immediately following the delivery of a stillborn fetus. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Provide the client with photos of the fetus. This action allows the client to have tangible memories of their stillborn baby and aids in the grieving process. It can provide closure and help in acknowledging the loss.
Choice A may not be necessary if the client desires more time with the fetus.
Choice C about an autopsy is not necessary unless the client consents.
Choice D is incorrect as there is no law requiring the client to name the fetus.
Question 3 of 5
A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hr ago. Which of the following findings place the client at risk for postpartum hemorrhage? (Select all that apply.)
Correct Answer: A,C,D
Rationale: The correct answers are A, C, and D.
A: Labor induction with oxytocin can lead to uterine hyperstimulation, increasing the risk of postpartum hemorrhage.
C: Vacuum-assisted delivery can cause trauma to the birth canal, leading to increased bleeding.
D: History of uterine atony indicates a potential inability of the uterus to contract effectively, increasing the risk of postpartum hemorrhage.
B: Newborn weight and history of human papillomavirus are not directly related to postpartum hemorrhage.
Question 4 of 5
A nurse is caring for a client who is receiving oxytocin via continuous IV infusion and is experiencing persistent late decelerations in the FHR. After discontinuing the infusion, which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Administer oxygen at 10 L/min via nonrebreather facemask. Late decelerations in the fetal heart rate (FHR) indicate uteroplacental insufficiency, which could lead to fetal hypoxia. Providing oxygen at 10 L/min via a nonrebreather facemask helps improve oxygenation for both the mother and the fetus. This intervention aims to increase oxygen delivery to the placenta and subsequently improve fetal oxygenation. In contrast, option A (instructing the client to bear down and push with contractions) can further compromise fetal oxygenation. Option C (placing the client in a supine position) can worsen uteroplacental perfusion. Option D (initiating an amnioinfusion) is not indicated for late decelerations and does not address the underlying cause of fetal hypoxia.
Question 5 of 5
A nurse is assessing a client who is at 6 weeks of gestation and adheres to a vegan diet. Which of the following questions should the nurse ask to assess the client’s dietary intake?
Correct Answer: A
Rationale: The correct answer is A: How much protein do you eat in a day? This question is important because a vegan diet may lack sufficient protein, which is crucial for fetal development during pregnancy. Protein intake should be monitored to ensure the client is meeting their nutritional needs.
Incorrect choices:
B: Are you taking a Vitamin C supplement? - While Vitamin C is important, assessing protein intake is more critical for a vegan diet.
C: Have you considered eating shellfish? - Shellfish is not suitable for a vegan diet.
D: When was the last time you ate meat? - Irrelevant for a vegan client.