ATI RN
External Maternal Monitoring Questions
Question 1 of 5
A pregnant patient is at 34 weeks gestation and reports frequent headaches and visual changes. What should the nurse do first?
Correct Answer: A
Rationale: The correct answer is A. At 34 weeks gestation, headaches and visual changes can be signs of preeclampsia, a serious pregnancy complication. The nurse should first monitor the patient's blood pressure as elevated BP is a key indicator of preeclampsia. Assessing for other signs like proteinuria and edema is crucial for early detection and timely intervention. Encouraging rest and fluids (choice B) may not address the underlying issue. Administering pain medication (choice C) only masks symptoms without addressing the potential serious condition. Scheduling an eye specialist appointment (choice D) is not the priority as the symptoms are more indicative of a systemic issue like preeclampsia.
Question 2 of 5
A pregnant patient at 28 weeks gestation reports severe heartburn. What is the nurse's most appropriate recommendation?
Correct Answer: B
Rationale: The correct answer is B: Eat smaller meals more frequently throughout the day. This recommendation helps prevent overeating, which can contribute to heartburn. Smaller meals reduce pressure on the stomach, decreasing the likelihood of acid reflux. Eating more frequently also helps maintain stable blood sugar levels, which can further alleviate heartburn symptoms. Explanation for other choices: A: Over-the-counter antacids may provide temporary relief, but taking them regularly can lead to potential risks during pregnancy. C: Lying down immediately after eating can worsen heartburn symptoms as it allows stomach acid to flow back up into the esophagus. D: Drinking large amounts of water with meals can dilute stomach acid, but it may also distend the stomach and increase pressure, leading to heartburn.
Question 3 of 5
The nurse is caring for a pregnant patient at 36 weeks gestation who reports sudden, severe headache and blurred vision. What is the nurse's priority action?
Correct Answer: B
Rationale: The correct answer is B because sudden severe headache and blurred vision in a pregnant patient at 36 weeks gestation are potential signs of preeclampsia, a serious condition that can lead to complications for both the mother and the baby. Monitoring the patient's blood pressure and checking for signs of preeclampsia is crucial for early detection and timely intervention. Administering pain medication (choice A) may mask symptoms and delay appropriate treatment. Encouraging rest and fluids (choice C) may not address the underlying cause of the symptoms. Scheduling a follow-up appointment (choice D) may delay necessary immediate actions to address potential preeclampsia.
Question 4 of 5
A pregnant patient at 30 weeks gestation is complaining of severe heartburn. What should the nurse recommend?
Correct Answer: C
Rationale: The correct answer is C: Eat smaller meals more frequently and avoid lying down after meals. This is the best recommendation for the pregnant patient experiencing severe heartburn at 30 weeks gestation. Eating smaller meals more frequently can help reduce the amount of stomach acid produced, thus decreasing the likelihood of heartburn. Avoiding lying down after meals can prevent stomach acid from flowing back into the esophagus, further reducing heartburn symptoms. Rationale for why other choices are incorrect: A: Lying down after meals can worsen heartburn by allowing stomach acid to flow back into the esophagus. B: Drinking a large amount of water after eating may worsen heartburn by increasing stomach pressure and pushing stomach acid back up. D: Taking antacids regularly may provide temporary relief but is not addressing the root cause of the heartburn and may not be safe for long-term use during pregnancy.
Question 5 of 5
A pregnant patient is at 24 weeks gestation and reports occasional cramping and lower abdominal discomfort. What should the nurse do first?
Correct Answer: A
Rationale: The correct answer is A: Assess for signs of preterm labor and monitor the patient for regular contractions. This is the most appropriate action as the patient is experiencing cramping and lower abdominal discomfort, which could indicate preterm labor. Step 1: Assessing for signs of preterm labor, such as regular contractions, is crucial to determine the patient's condition. Step 2: Monitoring the patient for regular contractions helps in identifying any patterns and assessing the progression of labor. Other choices are incorrect as B: Administering pain medications without assessing for preterm labor can mask important indicators. C: Performing a pelvic exam may increase the risk of infection and is not the priority. D: Instructing the patient to increase fluid intake may not address the potential risk of preterm labor.