ATI RN
Maternal Monitoring Questions
Question 1 of 5
During the first stage of labor, what is the primary goal of nursing care in the early phase?
Correct Answer: C
Rationale: The correct answer is C because during the early phase of labor, the primary goal of nursing care is to promote relaxation and provide comfort measures to help the mother cope with contractions and manage pain. This helps create a calm and supportive environment, enhancing the progress of labor. Administering pain medication (A) may be necessary later, not necessarily in the early phase. Monitoring fetal heart rate continuously (B) is important but not the primary goal in the early phase. Preparing for imminent delivery (D) is premature in the early phase, as labor can be lengthy.
Question 2 of 5
Which of the following interventions is most appropriate for a postpartum person who has difficulty initiating breastfeeding?
Correct Answer: B
Rationale: The correct answer is B: administer pain relief. Pain can be a common barrier to initiating breastfeeding. By providing pain relief, the postpartum person may feel more comfortable and be better able to initiate breastfeeding. Hand expression (A) may not address the underlying issue of pain. Offering additional support and education (C) may be beneficial but addressing pain is more urgent. Administering a breast pump (D) is not necessary at this stage unless there are specific indications.
Question 3 of 5
Which of the following is an appropriate intervention for a birthing person experiencing preterm labor?
Correct Answer: A
Rationale: The correct answer is A: administer tocolytics. Tocolytics help inhibit uterine contractions and can delay preterm labor, giving time for other interventions. Administering antibiotics (B) would not directly address preterm labor. Providing hydration and rest (C) may be helpful but not a direct intervention. Offering pain relief (D) does not address the underlying cause of preterm labor. Administering tocolytics is crucial in managing preterm labor to prevent premature birth and associated complications.
Question 4 of 5
A nurse is caring for a postpartum person who is at risk for deep vein thrombosis (DVT). What is the most appropriate nursing intervention?
Correct Answer: B
Rationale: The correct answer is B: Apply compression stockings. This intervention is appropriate for a postpartum person at risk for DVT as it helps promote circulation and prevent blood clots by applying pressure to the legs. Compression stockings are a safe and non-invasive method to reduce the risk of DVT. Encouraging ambulation (choice A) is important but may not be feasible immediately postpartum. Administering low-molecular-weight heparin (choice C) would require a prescription and may not be the first-line intervention. Monitoring for signs of edema (choice D) is important but does not directly address the prevention of DVT like compression stockings do.
Question 5 of 5
A nurse is assisting with a vaginal birth and notices a prolapsed umbilical cord. What is the immediate nursing action?
Correct Answer: A
Rationale: The correct immediate nursing action for a prolapsed umbilical cord is to administer oxygen via mask (Choice A). This is crucial to ensure adequate oxygenation to the fetus as the prolapsed cord can compress and compromise blood flow. Administering oxygen helps maintain fetal oxygenation until emergency measures can be taken. Placing the person in the knee-chest position (Choice B) is contraindicated as it can further compress the cord. Repositioning the laboring person (Choice C) may not effectively relieve pressure on the cord. While preparing for an emergency delivery (Choice D) is important, administering oxygen is the priority to ensure fetal well-being.