ATI Maternal Newborn Exam 2

Extract:

A client who is pregnant and has HIV

Question 1 of 5

A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care?

A. Instruct the client to stop taking the antiretroviral medications at 32 weeks of gestation.B. Use a fetal scalp electrode during labor and delivery.C. Bathe the newborn before initiating skin-to-skin contact.D. Administer a pneumococcal immunization to the newborn within 4 hr following birth.

Correct Answer: C

Rationale: Bathing the newborn removes maternal fluids, reducing HIV transmission risk, unlike stopping antiretrovirals (continued), scalp electrodes (increase risk), or pneumococcal vaccine (not routine).

Extract:

A client who is at 32 weeks of gestation and has gestational diabetes mellitus

Question 2 of 5

A nurse is caring for a client who is at 32 weeks of gestation and has gestational diabetes mellitus. Which of the following findings should the nurse report to the provider?

A. The client has a fundal height of 38 cmB. The client has a fasting blood glucose of 90 mg/dLC. The client reports 12 fetal movements in 1 hrD. The client has nonpitting pedal edema

Correct Answer: A

Rationale: A fundal height of 38 cm at 32 weeks suggests macrosomia, a gestational diabetes complication, requiring reporting, unlike normal glucose, fetal movements, or edema.

Extract:

A newborn undergoing Babinski reflex assessment

Question 3 of 5

A nurse is performing an assessment of a newborn's Babinski reflex. Which of the following findings should the nurse expect?

A. Eversion of the great toeB. Flexion of the forearmC. The downward curl of the toesD. Extension of the leg

Correct Answer: A

Rationale: A positive Babinski reflex in newborns shows dorsiflexion and fanning of toes, unlike forearm flexion, toe curling, or leg extension.

Extract:

An antepartum client at 35 weeks of gestation undergoing a nonstress test

Question 4 of 5

A nurse is assessing the results of a nonstress test for an antepartum client at 35 weeks of gestation. Which of the following findings should indicate to the nurse the need for further diagnostic testing?

A. Three fetal movements perceived by the client in a 20 min testing periodB. No late decelerations in the fetal heart rate noted with three uterine contractions of 60 seconds in duration within a 10-min resting periodC. An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40-min testing periodD. Irregular contractions of 10 to 20 seconds in duration that are not felt by the client

Correct Answer: A

Rationale: Only three fetal movements in 20 minutes is below the expected activity level, suggesting possible fetal compromise, unlike reassuring heart rate responses or minor contractions.

Extract:

Four newborns in a nursery

Question 5 of 5

A nurse in a newborn nursery is receiving a change-of-shift report for four newborns. Which of the following newborns should the nurse assess first?

A. A newborn who has a short frenulum and is having difficulty breastfeedingB. A newborn who is 24 hr old and has not had a meconium stoolC. A newborn who is 10 hr old and has blood-tinged discharge in her diaperD. A newborn who is 10 hr old and has new onset tachypnea

Correct Answer: D

Rationale: New onset tachypnea signals potential respiratory distress, requiring urgent assessment, unlike breastfeeding issues, delayed stool, or normal blood-tinged discharge.

ATI Maternal Newborn Exam 2 | Nurselytic

Nurselytic

ATI RN

ATI RN