ATI RN
ATI RN Maternal Newborn Latest Update. Questions
Question 1 of 5
A nurse is providing prenatal teaching to a client who practices a vegan diet and is trying to increase intake of vitamin B12. Which of the following foods should the nurse recommend?
Correct Answer: A
Rationale: The correct answer is A: Fortified soy milk. Soy milk is often fortified with vitamin B12, making it a suitable option for vegans. Vitamin B12 is primarily found in animal products, so vegans need to rely on fortified foods or supplements. Raw carrots (
B), fresh citrus fruits (
C), and brown rice (
D) do not contain significant amounts of vitamin B12 and are not suitable sources for increasing intake. It is important for the nurse to recommend a specific food that is known to be fortified with vitamin B12 to meet the client's dietary needs.
Question 2 of 5
A nurse is assessing a newborn following a forceps-assisted birth. Which of the following clinical manifestations should the nurse identify as a complication of this birth method?
Correct Answer: D
Rationale: The correct answer is D: Facial palsy. Forceps-assisted birth can put pressure on the baby's face, potentially leading to facial nerve injury and resulting in facial palsy. This occurs due to the compression of the facial nerve during delivery. Other choices are incorrect: A - Polycythemia is not directly related to forceps-assisted birth. B - Hypoglycemia is more commonly associated with maternal diabetes or prematurity. C - Bronchopulmonary dysplasia is a lung condition primarily seen in premature infants requiring mechanical ventilation or oxygen therapy. In summary, facial palsy is the most likely complication following a forceps-assisted birth due to the pressure exerted on the baby's face during delivery.
Extract:
A nurse is caring for a newborn.
Exhibit 1
Medical History
1600:
Apgar score 9 at 1 min and 9 at 5 min
Birth weight 4,706 g (10 lb 6 oz)
Gestational age 40 weeks
Difficult vaginal birth with shoulder dystocia. Exhibit 2
Nurses' Notes
1700:
Newborn is active and moves all extremities except for right arm. No spontaneous movement of
the right arm noted. Right arm remains at side during Moro reflex. Exhibit 3
Physical Examination
1830:
Absent Moro reflex noted in right arm.
Right shoulder and arm are internally rotated and adducted. Elbow extended. Forearm pronated
with wrist and fingers flexed. Diagnosis: Brachial plexus injury resulting in Erb-Duchenne (Erb's
palsy) paralysis.
Question 3 of 5
Which of the following actions should the nurse plan to implement? For each potential nursing action, click to specify if the intervention is indicated or contraindicated for the newborn.
Correct Answer:
Rationale:
Correct Answer: B: Assess for grasp reflex in the affected extremity.
Rationale:
- Assessing for grasp reflex is indicated to evaluate neurologic function and muscle tone in the affected arm.
- This helps in determining the extent of impairment and guiding further interventions.
- Range of motion exercises (
A) may worsen the condition if performed too early.
- Immobilizing the arm (
C) may lead to joint stiffness and muscle atrophy.
- Limiting physical handling (
D) may hinder bonding and infant's development.
Extract:
Question 4 of 5
A nurse is calculating the estimated date of delivery for a client who reports that the first day of her last menstrual period was August 10. Using Nägele’s Rule, which of the following is the client’s estimated date of delivery?
Correct Answer: B
Rationale: The correct answer is B: May 17. Nägele's Rule states to add 7 days to the first day of the last menstrual period, then subtract 3 months, and add 1 year. In this case, August 10 + 7 days = August 17. Subtracting 3 months gives us May 17. This date is the estimated date of delivery.
Choice A (May 13) is incorrect as it does not follow Nägele's Rule.
Choice C (May 3) is too early based on the calculation.
Choice D (May 20) is too late as it exceeds the estimated date.
Question 5 of 5
A nurse is caring for a client who is in active labor with a fetus in the occipitoposterior position. The nurse assists the client into a hands-and-knees position. Which of the following questions should the nurse ask to evaluate the effectiveness of this intervention?
Correct Answer: D
Rationale:
Rationale: The correct answer is D. In the occipitoposterior position, the fetus's head is pressing against the mother's sacrum, causing intense back pain known as back labor. By asking if the back labor has improved, the nurse can assess if the hands-and-knees position has helped relieve the pressure on the mother's sacrum, indicating effectiveness.
Incorrect
Choices:
A: Suprapubic pain is not directly related to the occipitoposterior position or the hands-and-knees position.
B: Pelvic pressure may not necessarily be alleviated by changing positions in occipitoposterior position.
C: Contractions feeling further apart may not directly correlate with the effectiveness of the hands-and-knees position for back labor relief.