ATI RN
Advanced Maternal Age Monitoring Questions
Question 1 of 5
A pregnant patient is at 34 weeks gestation and reports sudden sharp abdominal pain and difficulty breathing. What is the nurse's priority action?
Correct Answer: C
Rationale: The correct answer is C - Call the healthcare provider immediately and prepare for possible preterm labor. At 34 weeks gestation, sudden sharp abdominal pain and difficulty breathing could indicate a serious complication such as placental abruption or pulmonary embolism. Calling the healthcare provider ensures prompt assessment and appropriate intervention to prevent harm to the mother and baby. Encouraging the patient to lie down may delay necessary intervention. Administering pain medication before determining the cause of pain could mask important symptoms. Assessing the fetal heart rate and monitoring for contractions are important but secondary actions to calling the healthcare provider in this urgent situation.
Question 2 of 5
A pregnant patient at 30 weeks gestation reports swelling in her legs and feet. Which intervention is most appropriate for the nurse to recommend?
Correct Answer: A
Rationale: The correct answer is A: Encourage the patient to elevate her legs and rest regularly. This intervention is appropriate because elevating the legs helps reduce swelling by promoting venous return and decreasing fluid accumulation in the lower extremities. Resting regularly also helps reduce the strain on the circulatory system. Choice B is incorrect because increasing sodium intake can exacerbate fluid retention and swelling. Choice C is incorrect because administering diuretics during pregnancy can pose risks to the fetus and should only be done under medical supervision. Choice D is incorrect because limiting fluid intake can lead to dehydration and is not recommended during pregnancy, especially when experiencing swelling.
Question 3 of 5
A pregnant patient at 36 weeks gestation reports sudden swelling of the face and hands. What is the nurse's priority action?
Correct Answer: A
Rationale: The correct answer is A: Monitor the patient's blood pressure and check for signs of preeclampsia. At 36 weeks gestation, sudden swelling of the face and hands can indicate preeclampsia, a serious condition characterized by high blood pressure and proteinuria in pregnancy. Monitoring blood pressure and assessing for other signs of preeclampsia, such as headache or vision changes, is crucial for timely diagnosis and intervention to prevent complications for both the mother and baby. Summary: B: Instructing the patient to rest and elevate her feet may provide some relief for swelling but does not address the underlying potential issue of preeclampsia. C: Recommending increased water intake may not be appropriate if the swelling is due to preeclampsia and can worsen the condition. D: Administering diuretics without proper assessment and diagnosis of preeclampsia can be harmful and is not the initial priority action.
Question 4 of 5
A nurse is assessing a pregnant patient at 28 weeks gestation who reports occasional dizziness and fainting. What should the nurse assess first?
Correct Answer: A
Rationale: The correct answer is A: The patient's blood pressure and hydration status. This is the priority because dizziness and fainting can be signs of hypotension or dehydration, which can be dangerous during pregnancy. Checking blood pressure and hydration status will help determine if these symptoms are related to these issues. B: Assessing fetal heart rate and activity levels is important but not the priority in this scenario as the patient's symptoms are more likely related to her own health rather than the fetus. C: Checking hemoglobin and hematocrit levels is important for assessing anemia but is not the immediate concern in a patient experiencing dizziness and fainting. D: Weight gain and diet history are important aspects of prenatal care but are not the priority when dealing with symptoms of dizziness and fainting.
Question 5 of 5
A pregnant patient at 24 weeks gestation reports pain in the lower abdomen and back. What is the nurse's first priority action?
Correct Answer: B
Rationale: The correct answer is B: Assess the patient for signs of preterm labor, including regular contractions. At 24 weeks gestation, lower abdominal and back pain can indicate preterm labor, a serious complication. The nurse's first priority should be to assess for signs such as regular contractions, vaginal bleeding, pelvic pressure, or changes in vaginal discharge. Prompt identification of preterm labor allows for timely interventions to prevent preterm birth and its associated risks. Administering pain relief (choice A) without assessing for preterm labor can delay necessary interventions. Recommending rest and heat application (choice C) may not address the underlying cause of the pain. Instructing the patient to lie flat on her back (choice D) may worsen symptoms and is not recommended in pregnancy.