ATI LPN
Maternal Newborn ATI Quizlet Questions
Question 1 of 5
During a client's active labor, a healthcare provider notes that the presenting part is at 0 station. What is the correct interpretation of this clinical finding?
Correct Answer: D
Rationale: The correct interpretation of 0 station is that the lowermost portion of the fetus is at the level of the ischial spines. This indicates the descent of the fetus into the birth canal. At 0 station, the presenting part has not yet passed through the pelvic outlet, ruling out choice B.
Choices A and C are incorrect as they refer to different aspects of fetal positioning and fontanel palpation, not specifically related to station.
Therefore, the correct answer is D as it directly relates to the position of the fetus in the birth canal.
Question 2 of 5
During newborn gestational age assessment, which finding should be recorded as part of this assessment on the newborn?
Correct Answer: C
Rationale: Rationale for
Choice C (Correct Answer):
Plantar creases covering 2/3 of the sole is a standard newborn assessment finding indicating normal development. This is a key milestone in assessing the newborn's muscle tone and neurological status. Absence or presence of plantar creases can provide insights into potential developmental issues.
Therefore, recording this finding is crucial for monitoring the newborn's growth and development.
Summary of Other
Choices:
A: Acrocyanosis of hands and feet - Common benign finding in newborns due to immature circulation, not a specific part of newborn assessment.
B: Anterior fontanel soft and level - Important assessment, but not specific to gestational age assessment.
D: Vernix caseosa in inguinal creases - Normal finding, but not a specific part of gestational age assessment.
Question 3 of 5
A client who is at 10 weeks of gestation reports abdominal pain and moderate vaginal bleeding, with a tentative diagnosis of inevitable abortion. Which of the following nursing interventions should be included in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Offer the option to view products of conception. This intervention allows the client to have closure and process the loss. It can also provide emotional support and facilitate the grieving process. Option A is not necessary unless the client is hypoxic. Option C is not relevant to the immediate management of an inevitable abortion. Option D may be advised for some clients, but it is not as crucial as offering emotional support and closure to the client in this situation.
Question 4 of 5
When assessing newborn reflexes, what action should be taken to elicit the Moro reflex?
Correct Answer: A
Rationale: The correct answer is A: Perform a sharp hand clap near the infant. This action elicits the Moro reflex by stimulating the startle response. The Moro reflex involves the baby's arms spreading out and then coming back in when they feel like they are falling. This reflex helps in assessing the baby's neurological development.
Choices B, C, and D do not specifically target the Moro reflex and may elicit other reflexes or responses. Holding the newborn vertically (
B) may trigger the stepping reflex, placing a finger at the base of the toes (
C) may provoke the Babinski reflex, and turning the newborn's head (
D) may elicit the tonic neck reflex.
Question 5 of 5
A nurse is admitting a term newborn following a cesarean birth. The nurse observes that the newborn's skin is slightly yellow. This finding indicates the newborn is experiencing a complication related to which of the following?
Correct Answer: A
Rationale:
Step-by-step rationale for why the correct answer is A:
1. Maternal/newborn blood group incompatibility can result in hemolytic disease of the newborn.
2. Hemolytic disease causes an increase in bilirubin levels, leading to jaundice.
3. Jaundice in this case is due to the breakdown of red blood cells and elevated unconjugated bilirubin levels.
4. Physiologic jaundice is a normal process in newborns and usually appears after the first 24 hours of life.
5. Absence of vitamin K would not directly cause jaundice.
6. Maternal cocaine abuse is not typically associated with neonatal jaundice.
In summary, the correct answer is A because maternal/newborn blood group incompatibility can lead to hemolytic disease and subsequent jaundice, while the other choices are not directly related to neonatal jaundice.