ATI RN
Monitoring Baby During Labour Questions
Question 1 of 5
A pregnant woman who is 36 weeks gestation reports sudden swelling in her hands and feet, along with a headache. What should the nurse do first?
Correct Answer: B
Rationale: The correct answer is B. Assessing the patient's blood pressure and urine for protein is the priority because sudden swelling in hands and feet, along with a headache, could indicate preeclampsia, a serious condition in pregnancy. High blood pressure and protein in the urine are key indicators of preeclampsia. This assessment will help determine if the patient needs immediate medical intervention. Choice A is incorrect because simply resting and elevating the feet may not address the underlying issue of preeclampsia. Choice C is incorrect as encouraging the patient to drink fluids will not address the potential serious condition. Choice D is incorrect because while lying on the left side can improve circulation, it does not address the urgent need to assess for preeclampsia.
Question 2 of 5
The nurse is caring for a 32-year-old pregnant patient who is 20 weeks gestation and has a BMI of 40. Which of the following conditions should the nurse monitor for more closely?
Correct Answer: A
Rationale: The correct answer is A: Gestational diabetes and preeclampsia. A BMI of 40 indicates obesity, which increases the risk of developing gestational diabetes and preeclampsia. Obesity is a significant risk factor for these conditions due to the increased strain on the body during pregnancy. Gestational diabetes can lead to complications for both the mother and the baby, while preeclampsia can be life-threatening if not managed properly. Monitoring for these conditions closely is crucial in this high-risk patient. Incorrect Choices: B: Hyperemesis gravidarum - This condition is characterized by severe nausea and vomiting during pregnancy and is not directly related to the patient's BMI. C: Iron-deficiency anemia - While obesity can impact iron levels, it is not the primary concern in this scenario. D: Intrauterine growth restriction (IUGR) - While obesity can increase the risk of certain pregnancy complications, IUGR is not directly linked to the patient's
Question 3 of 5
A nurse is providing prenatal care to a 24-week pregnant patient. Which of the following findings should be reported immediately?
Correct Answer: C
Rationale: The correct answer is C: Severe headaches and visual disturbances. These symptoms can indicate a serious condition such as preeclampsia, which requires immediate medical attention to prevent complications for both the mother and the baby. Severe headaches and visual disturbances are signs of increased blood pressure, protein in the urine, and potential organ damage. Reporting these findings promptly allows for timely intervention. Incorrect choices: A: Mild leg swelling and varicosities are common in pregnancy and typically not urgent unless accompanied by other concerning symptoms. B: Slight back pain and cramping are common discomforts in pregnancy and may not indicate a serious issue unless they are severe or persistent. D: Increased appetite and weight gain are expected during pregnancy and may not require immediate reporting unless there are other concerning symptoms present.
Question 4 of 5
The nurse is educating a pregnant patient about the symptoms of preterm labor. Which of the following symptoms should the nurse advise the patient to report immediately?
Correct Answer: C
Rationale: Step-by-step rationale: 1. Painful, regular contractions every 10 minutes or less can indicate preterm labor. 2. Regular contractions are a sign of the uterus preparing for birth. 3. Painful contractions at regular intervals can progress quickly to preterm delivery. 4. Reporting this symptom immediately allows for timely intervention to prevent premature birth. Summary: A: Low back pain and cramping are common in pregnancy but not necessarily indicative of preterm labor. B: Increased vaginal discharge may be normal in pregnancy and not a direct sign of preterm labor. C: Painful, regular contractions every 10 minutes or less are a critical sign of preterm labor. D: Feeling pelvic pressure after physical activity is common in late pregnancy and not specific to preterm labor.
Question 5 of 5
A nurse is caring for a pregnant patient who is at 26 weeks gestation and reports a sudden decrease in fetal movement. Which action should the nurse take first?
Correct Answer: A
Rationale: The correct answer is A: Encourage the patient to drink a sugary beverage and count fetal movements. This action is appropriate as decreased fetal movement can indicate fetal distress, and the sugary beverage can stimulate the baby to move. If the baby responds with increased movements, it indicates a reassuring fetal status. If there is no improvement, further evaluation can be pursued. Incorrect choices: B: Monitoring blood pressure is not the priority in this situation as the main concern is fetal movement. C: Performing a nonstress test is not the first action to take as it requires time and resources, which may delay immediate intervention. D: While eventually contacting the healthcare provider is important, the immediate action should be to assess fetal well-being by encouraging fetal movements.