ATI RN
Monitoring Baby During Labour Questions
Question 1 of 5
A nurse is educating a postpartum person about newborn care. Which of the following should be included in the teaching about umbilical cord care?
Correct Answer: A
Rationale: The correct answer is A: keep the cord dry and clean. This is because keeping the umbilical cord dry and clean helps prevent infection and promotes healing. Applying a sterile dressing (B) is unnecessary and may trap moisture, leading to infection. Using alcohol or iodine (C) is outdated and can delay cord separation. Applying a sterile dressing to the umbilicus (D) is not recommended as it can interfere with air circulation and healing. In summary, choice A is correct as it aligns with current best practices for umbilical cord care.
Question 2 of 5
A nurse is caring for a laboring person in the second stage of labor. What is the most appropriate intervention when the perineum starts to bulge?
Correct Answer: B
Rationale: The correct answer is B: apply gentle pressure to the perineum. This intervention helps to support the perineum and reduce the risk of perineal tearing during childbirth. Applying gentle pressure can slow down the baby's descent and allow the perineum to stretch gradually, reducing the likelihood of severe tearing. This intervention is important to promote a safe and controlled delivery. Incorrect answer explanations: A: Applying warm compresses may provide some comfort but does not specifically address the need to support the perineum during childbirth. C: Episiotomy should be considered only when necessary and not as a routine intervention when the perineum bulges. D: Perineal massage is typically done during the prenatal period to help prepare the perineum for childbirth but is not the most appropriate intervention when the perineum starts to bulge during labor.
Question 3 of 5
A nurse is assessing a postpartum person for signs of infection. What is the most concerning finding in the first 24 hours after delivery?
Correct Answer: A
Rationale: The correct answer is A: Fever. In the first 24 hours postpartum, fever is the most concerning finding as it can indicate infection, such as endometritis or mastitis. Fever is a common early sign of infection and requires immediate assessment and intervention. Redness and swelling at the site (B) could be normal postpartum findings. Increased heart rate (C) may be a nonspecific response to stress or dehydration. Fatigue (D) is common postpartum but not typically indicative of infection in the first 24 hours. Fever warrants prompt attention due to the risk of serious complications if left untreated.
Question 4 of 5
A nurse is caring for a postpartum person who is experiencing a boggy uterus. What is the most appropriate action to take?
Correct Answer: A
Rationale: The correct action is to perform uterine massage. This helps to prevent postpartum hemorrhage by promoting uterine contraction and reducing uterine atony. It stimulates the release of endogenous oxytocin, aiding in the expulsion of clots and reducing bleeding. Administering uterotonic medications (choice B) would be the next step if uterine massage alone is ineffective. Perineal massage (choice C) is unrelated to managing a boggy uterus. Administering oral pain relief (choice D) does not address the root cause of the issue.
Question 5 of 5
What is the primary purpose of assessing cervical dilation during labor?
Correct Answer: A
Rationale: The primary purpose of assessing cervical dilation during labor is to evaluate the progress of labor. Cervical dilation indicates how far the labor has advanced and helps determine if the labor is proceeding normally. Monitoring dilation helps healthcare providers make informed decisions about the timing of interventions and the overall management of labor. It does not directly assess the need for interventions (choice B), complications (choice C), or fetal position (choice D). These factors can be assessed through other means, but the main focus of assessing cervical dilation is to track the progression of labor.