ATI RN
Maternal Fetal Monitoring Questions
Question 1 of 5
A pregnant patient at 24 weeks gestation reports occasional dizziness and lightheadedness. What should the nurse assess first?
Correct Answer: A
Rationale: The correct answer is A: The patient's blood pressure and hydration status should be assessed first because dizziness and lightheadedness can be indicative of hypotension or dehydration, common issues during pregnancy. Monitoring blood pressure will help determine if the symptoms are related to low blood pressure, and assessing hydration status can identify if the patient needs to increase fluid intake. Summary of other choices: B: Assessing fetal heart rate and activity is important but not the priority in this situation as the focus should be on the maternal health first. C: Checking hemoglobin and hematocrit levels is important for detecting anemia, but it is not the initial assessment for dizziness and lightheadedness. D: Monitoring weight gain and diet history are essential aspects of prenatal care but are not the immediate concerns when a pregnant patient is experiencing dizziness and lightheadedness.
Question 2 of 5
What procedure might the nurse perform to determine the presentation of the fetus?
Correct Answer: B
Rationale: The correct answer is B: ultrasound. Ultrasound is the most accurate and non-invasive method to determine the presentation of the fetus by visualizing the position of the baby in the womb. It allows the nurse to see if the fetus is in a cephalic (head-down) or breech (feet or buttocks down) position. This information is crucial for assessing the progress of labor and planning appropriate interventions. A: Vaginal exam is not typically used to determine fetal presentation as it does not provide a clear view of the baby's position. C: Palpation of contractions helps assess the strength and frequency of contractions but does not directly determine fetal presentation. D: Laboring person interview may provide valuable information about symptoms and history but does not offer direct insight into fetal presentation.
Question 3 of 5
How long should clamping of the cord be delayed in an uncomplicated delivery to increase the newborn's hemoglobin levels and improve circulation?
Correct Answer: A
Rationale: The correct answer is A (30-60 seconds) for delayed cord clamping in an uncomplicated delivery. Delaying cord clamping for 30-60 seconds allows more blood to flow from the placenta to the baby, increasing the baby's hemoglobin levels and improving circulation. This extra blood transfer can provide the baby with essential nutrients and oxygen, reducing the risk of anemia and improving overall health outcomes. Choice B (15-30 seconds) may not provide enough time for sufficient blood transfer compared to the optimal window of 30-60 seconds. Choice C (30 seconds) is within the recommended range, but 30-60 seconds is considered more beneficial for maximizing blood flow to the newborn. Choice D (Delayed cord clamping is not recommended) is incorrect as delayed cord clamping has been shown to have various benefits for newborns when done in uncomplicated deliveries.
Question 4 of 5
A nurse is caring for a postpartum person during the fourth stage of labor. The nurse is assessing uterine involution to ensure that the uterus is returning to its prepregnancy size and position. Which finding is indicative of normal uterine involution during this stage?
Correct Answer: B
Rationale: The correct answer is B because during the fourth stage of labor, the uterine fundus should be firm and at the level of the umbilicus. This indicates proper involution as the uterus is contracting and reducing in size. Choice A is incorrect as the uterus should not be palpable at the level of the umbilicus during normal involution. Choice C is incorrect as the uterus should not be displaced to the right side of the abdomen. Choice D is incorrect as the uterus should not be above the level of the umbilicus, as this would suggest inadequate involution.
Question 5 of 5
A nurse is preparing to administer a medication to a birthing person with a history of hypertension. What is the nurse's priority assessment before administering this medication?
Correct Answer: A
Rationale: The correct answer is A: Blood pressure and pulse rate. For a birthing person with a history of hypertension, it is crucial to assess their blood pressure and pulse rate before administering medication to ensure the medication does not exacerbate their hypertension. Monitoring these vital signs helps in determining the appropriateness and safety of the medication. Summary: - Choice B is incorrect because respiratory rate and oxygen saturation are not the priority assessments for a person with a history of hypertension. - Choice C is incorrect as temperature and urine output are not directly related to assessing the risk of exacerbating hypertension. - Choice D is incorrect as oxygen saturation and urine output are not the primary indicators of medication safety for someone with hypertension.