ATI RN
ATI Maternal Newborn Practice Questions Questions
Question 1 of 5
During the admission assessment of a client at 38 weeks of gestation with severe preeclampsia, what would the nurse expect as a finding?
Correct Answer: D
Rationale: Severe preeclampsia is characterized by hypertension and proteinuria after 20 weeks of gestation. Headache is a common symptom in clients with severe preeclampsia due to cerebral edema or vasospasm. Tachycardia (Choice A) is not typically associated with severe preeclampsia. Clonus (Choice B) is a sign of hyperactive reflexes, often seen in clients with severe preeclampsia. Polyuria (Choice C) is not a typical finding in clients with severe preeclampsia.
Question 2 of 5
A client who is 4 hours postpartum following a vaginal delivery is being assessed by a nurse. Which of the following findings should the nurse identify as the priority?
Correct Answer: A
Rationale: In a client who is 4 hours postpartum, a saturated perineal pad within 30 minutes is a priority finding as it may indicate excessive postpartum bleeding (hemorrhage), which requires immediate intervention to prevent further complications such as hypovolemic shock. Deep tendon reflexes being 4+ is within normal limits postpartum. The fundus at the level of the umbilicus is an expected finding at this time frame, indicating proper involution of the uterus. Approximated edges of an episiotomy suggest proper healing.
Question 3 of 5
A client at 37 weeks of gestation with severe gestational hypertension is being admitted by a nurse. Which of the following actions should the nurse NOT expect to implement?
Correct Answer: C
Rationale: Assessing respiratory status every 4 hours is not a priority for a client with severe gestational hypertension. In this scenario, the focus should be on monitoring blood pressure, assessing for signs of preeclampsia, administering medications like magnesium sulfate for seizure prophylaxis, and ensuring that calcium gluconate is readily available in case of magnesium toxicity. Respiratory status assessment is important in other conditions but is not directly related to managing severe gestational hypertension.
Question 4 of 5
A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first?
Correct Answer: D
Rationale: In this scenario, the nurse should prioritize seeing the client who is at 28 weeks of gestation and reports painless vaginal bleeding (Option D) first. This is because painless vaginal bleeding in the third trimester can be indicative of placenta previa or abruptio placentae, both of which are serious obstetric emergencies requiring immediate evaluation and intervention to prevent maternal and fetal complications. Option A is incorrect because while cough and fever in a late-term pregnancy should be assessed promptly, they do not pose an immediate threat to the client or the fetus as compared to painless vaginal bleeding in the third trimester. Option B is incorrect as vaginal spotting in early pregnancy could be indicative of a threatened miscarriage, but it is not as urgent as painless vaginal bleeding in the third trimester. Option C is incorrect as nausea and vomiting in the first trimester are common symptoms of early pregnancy and do not require immediate attention unless they are severe and causing dehydration or other complications. Educationally, this question highlights the importance of prioritizing care based on the acuity of the situation in maternal-newborn nursing. It underscores the significance of recognizing obstetric emergencies and the need for swift action to ensure the safety and well-being of both the mother and the baby.
Question 5 of 5
A healthcare provider is caring for a group of clients on an intrapartum unit. Which of the following findings should be reported to the provider immediately?
Correct Answer: D
Rationale: The correct answer is a client who has a diagnosis of preeclampsia reporting epigastric pain and an unresolved headache. These symptoms indicate severe preeclampsia, which requires immediate medical attention due to the potential risks of complications such as HELLP syndrome or eclampsia. The other options describe concerning situations but do not represent immediate life-threatening conditions like those seen in severe preeclampsia.