ATI RN
ATI RN Maternal Newborn Latest Update. Questions
Question 1 of 5
A nurse is caring for a client who is hypotensive following the administration of epidural anesthesia. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Turn the client to a side-lying position. This action helps improve venous return and cardiac output, which can help increase blood pressure in a hypotensive client. Placing the client in a side-lying position can prevent compression of the vena cava by the uterus, which may occur with epidural anesthesia. Options B, C, and D are incorrect. Applying oxygen via nasal cannula, massaging the fundus, and assisting the client to empty their bladder are not the priority actions in addressing hypotension following epidural anesthesia. Oxygen administration may be important, but positioning the client is the priority in this situation.
Question 2 of 5
A nurse is assessing a newborn who has neonatal abstinence syndrome. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Excessive crying. Neonatal abstinence syndrome is characterized by withdrawal symptoms in newborns exposed to drugs in utero. Excessive crying is a common manifestation due to irritability and discomfort. Diminished deep tendon reflexes (choice
A) are not typically associated. Decreased muscle tone (choice
C) is more commonly seen in conditions like hypotonia. Absent Moro reflex (choice
D) is not typically part of neonatal abstinence syndrome.
Question 3 of 5
A nurse is caring for a newborn who has jaundice and a new prescription for phototherapy. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Close the newborn's eyes before applying eyepatches. This is important to protect the newborn's eyes during phototherapy as exposure to bright lights can damage the eyes. Closing the eyes with eyepatches helps prevent potential eye damage. Providing glucose water (
A) is not necessary for phototherapy. Turning the newborn every 4 hours (
B) is a routine nursing intervention but not specific to phototherapy. Applying hydrating lotion (
C) is not recommended as it may interfere with the effectiveness of the phototherapy.
Question 4 of 5
A nurse is admitting a client to the birthing unit who reports her contractions started 1 hr ago. The nurse determines the client is 80% effaced and 8 cm dilated. The nurse realizes that the client is at risk for which of the following conditions?
Correct Answer: D
Rationale: The correct answer is D: Postpartum hemorrhage. This is because the client's significant cervical dilation and effacement indicate that she is in active labor, not at risk for an ectopic pregnancy, hyperemesis gravidarum, or incompetent cervix. Postpartum hemorrhage can occur due to the rapid labor progression, leading to increased risk of excessive bleeding post-delivery. Other choices are incorrect as they do not align with the client's current presentation and stage of labor.
Extract:
A nurse is caring for a client who is 48 hr postpartum and has a deep vein thrombosis.
Medical History:
• Gravida 2 Para 2
• Cesarean birth
• Deep vein thrombosis with previous pregnancy
• Preeclampsia
• BMI of 32
Question 5 of 5
A nurse is caring for a client who is 48 hr postpartum and has a deep vein thrombosis.
| Findings 24 hr later | Indication of worsening condition | Indication of improving condition |
|---|---|---|
| Increased warmth in the extremity | ||
| Tachycardia | ||
| Leukocytosis | ||
| Scant lochia rubra | ||
| Decreased extremity edema |
Correct Answer:
Rationale:
Correct Answer: A: Increased warmth in the extremity
Rationale: In a client with deep vein thrombosis, increased warmth in the extremity is a concerning finding as it may indicate worsening of the condition due to potential inflammation or clot progression. This should be checked to monitor for complications. Tachycardia and leukocytosis are general indicators of systemic inflammation and infection, not specific to deep vein thrombosis. Scant lochia rubra and decreased extremity edema are not relevant to assessing deep vein thrombosis.