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 in labor and reports increasing rectal pressure. They are experiencing contractions 2 to 3 min apart, each lasting 80 to 90 seconds, and a vaginal examination reveals that their cervix is dilated to 9 cm. The nurse should identify that the client is in which of the following phases of labor?
Correct Answer: B
Rationale: The correct answer is B: Active phase. At 9cm dilation, the client is transitioning from the latent phase to the active phase of the first stage of labor. In the active phase, contractions are stronger and more frequent, leading to increased rectal pressure and cervical dilation. This phase typically ranges from 6-10cm dilation. Passive descent (
A) refers to the early phase of labor when the cervix is dilating but contractions are mild. Early phase (
C) is characterized by 0-3cm dilation. Descent (
D) is not a recognized phase of labor. The client's symptoms align with the characteristics of the active phase, making option B the correct choice.
Question 2 of 5
A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D: "I will eliminate products that contain dairy from my diet." This is correct because dairy products can exacerbate nausea and vomiting in hyperemesis gravidarum. Dairy is often harder to digest and can trigger gastrointestinal distress. Avoiding dairy can help reduce symptoms and improve tolerance to food.
Choice A is incorrect because focusing on taste over balanced nutrition is not advisable for someone with hyperemesis gravidarum.
Choice B is irrelevant to the condition.
Choice C is also not recommended as caffeine in tea can worsen nausea.
Question 3 of 5
A nurse is caring for a client who is at 22 weeks of gestation and is HIV positive. Which of the following actions should the nurse take?
Correct Answer: C
Rationale:
Correct
Answer: C. Tell the client they will start medication for HIV immediately after delivery.
Rationale: Starting HIV medication immediately after delivery is crucial in preventing mother-to-child transmission of HIV. Antiretroviral therapy should be initiated during pregnancy to reduce the viral load and continued postpartum to protect the baby. This approach has been shown to significantly reduce the risk of transmission.
Summary of other choices:
A: Administering penicillin G is not directly related to managing HIV in pregnancy.
B: Annual pelvic examinations are important for overall health but not specific to managing HIV in pregnancy.
D: Reporting the client's condition to the health department may be necessary but does not address the immediate need for HIV medication.
E, F, G: No additional choices provided.
Question 4 of 5
A nurse is caring for a client who is at 10 weeks of gestation. Which of the following findings should the nurse report to the provider?
Correct Answer: A
Rationale: The correct answer is A: Frequent vomiting with weight loss of 3 lb in 1 week. This finding is concerning as it may indicate hyperemesis gravidarum, a severe form of morning sickness that can lead to dehydration and electrolyte imbalances, posing a risk to both the mother and fetus. The weight loss is significant and needs immediate attention from the provider to prevent complications.
B: Reports of mood swings are common in pregnancy due to hormonal changes and are not typically a cause for immediate concern.
C: Nosebleeds occurring approximately 3 times per week are often due to increased blood volume and hormone changes during pregnancy and are not considered a serious issue unless they are severe or frequent.
D: Increased vaginal discharge is a common symptom of pregnancy and is usually not a cause for alarm unless accompanied by other symptoms like itching or a foul odor.
Question 5 of 5
A nurse is assessing a newborn who is 16 hr old. Which of the following findings should the nurse report to the provider?
Correct Answer: A
Rationale: The correct answer is A: Substernal retractions. Substernal retractions in a newborn indicate respiratory distress and can be a sign of a serious issue such as respiratory distress syndrome. This finding requires immediate attention from the provider to assess and manage the newborn's respiratory status. Acrocyanosis (
B) is a common finding in newborns and is not typically concerning. Overlapping suture lines (
C) can be normal in newborns due to molding during birth. A head circumference of 33 cm (13 in) (
D) falls within the normal range for a newborn and does not require immediate reporting.