ATI RN
Maternal Monitoring During Labor Questions
Question 1 of 5
A nurse is caring for a laboring person who is experiencing irregular fetal heart rate patterns. What is the most appropriate intervention?
Correct Answer: B
Rationale: The correct answer is B, to increase fetal monitoring. This is crucial to assess the fetal well-being and identify any potential distress or complications early on. Monitoring allows for timely interventions to be implemented to optimize outcomes. Increasing oxygen flow (A) may be necessary in some cases, but it is not the initial priority. Administering an analgesic (C) may help with pain management but does not address the fetal heart rate patterns. Increasing fluid intake (D) is important for hydration but is not directly related to managing fetal heart rate patterns.
Question 2 of 5
A nurse is assisting a postpartum person with breastfeeding. What is the best intervention to help relieve nipple pain?
Correct Answer: A
Rationale: The correct answer is A: apply lanolin cream. Lanolin cream helps to soothe and moisturize the nipples, reducing pain and promoting healing. It is safe for the baby and does not need to be removed before breastfeeding. Applying analgesics (B) is not recommended as they can be harmful to the baby. Warm compresses (C) may not provide the same level of relief for nipple pain as lanolin cream. Cold compresses (D) are not suitable for relieving nipple pain as they can further exacerbate discomfort. Therefore, applying lanolin cream is the best intervention for relieving nipple pain during breastfeeding.
Question 3 of 5
A nurse is assisting with a vaginal delivery. What is the most important nursing intervention when the fetal head begins to crown?
Correct Answer: A
Rationale: The correct answer is A: apply gentle downward pressure. This intervention helps prevent rapid expulsion of the baby, reducing the risk of perineal tears and minimizing maternal discomfort. It also helps control the delivery process, ensuring a safe and controlled birth. Incorrect Choices: B: Perineal massage is not indicated at the crowning stage as it may interfere with the natural birthing process. C: Administering pain relief should have been addressed earlier in labor and is not a priority at this stage. D: Administering IV fluids is important for hydration but is not the most critical intervention when the fetal head is crowning.
Question 4 of 5
A nurse is caring for a postpartum person who is at risk for postpartum hemorrhage. What is the most important nursing action to reduce the risk?
Correct Answer: B
Rationale: The correct answer is B: administer IV fluids. IV fluids help maintain adequate circulating volume, preventing hypovolemia which is a major risk factor for postpartum hemorrhage. This action supports blood pressure and perfusion to reduce the risk of excessive bleeding. Administering oxytocin (A) helps with uterine contraction but does not address the underlying issue of hypovolemia. Administering an epidural (C) is not directly related to preventing postpartum hemorrhage. Fundal massage (D) is important but not the most critical action in reducing the risk of postpartum hemorrhage.
Question 5 of 5
A nurse is assessing a laboring person who is receiving oxytocin for labor induction. What is the most important intervention to prevent uterine hyperstimulation?
Correct Answer: B
Rationale: The correct answer is B: increase fetal monitoring. Monitoring the fetus closely is crucial to detect signs of uterine hyperstimulation, such as non-reassuring fetal heart rate patterns. This allows for timely interventions to prevent fetal distress or hypoxia. Monitoring contractions (choice D) is important but does not directly address fetal well-being. Administering an epidural (choice C) may help manage pain but does not prevent uterine hyperstimulation. While monitoring fetal heart rate (choice A) is important, increasing the frequency of monitoring (choice B) is more specific to detecting complications related to oxytocin-induced uterine hyperstimulation.