ATI RN
Chimat Maternity Needs Assessment Questions
Question 1 of 5
The nurse examines a client who is admitted in active labor and determines the cervix is 3 cm dilated 50% effaced, and the presenting part is at 0 stations. An hour later, she tells the nurse that she wants to go to the bathroom. Which action should the nurse implement first.
Correct Answer: D
Rationale: In this scenario, the most appropriate action for the nurse to implement first is to determine cervical dilation (Option D). This is crucial because the client was admitted in active labor, and any changes in the cervix dilation can indicate progress or abnormalities in the labor process. Monitoring the cervical dilation helps the nurse assess the stage of labor and make informed decisions regarding the client's care and potential interventions. Checking the pH of the vaginal fluid (Option A) is not the priority in this situation as it does not provide immediate information related to the client's current labor progress. Reviewing the fetal heart rate pattern (Option B) is essential but should come after assessing the cervix to ensure the progress of labor. Palpating the client's bladder (Option C) is important for assessing bladder fullness but is not as urgent as determining cervical dilation in this active labor situation. Educationally, understanding the significance of assessing cervical dilation in active labor is essential for nurses and healthcare providers involved in maternity care. It helps them make timely decisions, monitor labor progress, and provide appropriate care to ensure a safe delivery for the mother and baby. This rationale highlights the importance of prioritizing tasks based on the client's condition and the stage of labor.
Question 2 of 5
A new mother who is breastfeeding her 4-week old infant and has type 1 diabetes, reports that her insulin needs have decreased since the birth of her child. What action should the nurse implement?
Correct Answer: A
Rationale: The correct action for the nurse to implement is to inform the new mother that a decrease in insulin needs is common while breastfeeding. This is the correct answer because during lactation, the hormone prolactin can reduce insulin sensitivity, leading to lower insulin requirements in diabetic mothers. By providing this information, the nurse can reassure the mother that her decreased insulin needs are a normal physiological response to breastfeeding. Option B, advising the client to breastfeed more frequently, is incorrect because the issue is related to insulin needs, not breastfeeding frequency. Option C, counseling her to increase her calorie intake, is also incorrect as it does not address the underlying cause of decreased insulin needs in breastfeeding mothers with type 1 diabetes. Option D, scheduling an appointment with a diabetic nurse educator, is unnecessary at this point as the nurse can provide the necessary education and support regarding the relationship between breastfeeding and insulin needs. Educationally, this scenario highlights the importance of understanding the physiological changes that occur during breastfeeding in diabetic mothers. It underscores the need for healthcare providers to have knowledge about how breastfeeding can impact insulin requirements, allowing them to provide appropriate guidance and support to mothers in managing their diabetes postpartum.
Question 3 of 5
The postpartum admission prescription for a client who delivered a healthy newborn includes one liter of lactated ringers with oxytocin 20 units to infuse over 8 hours. How many milliunits/minute is the clients receiving?
Correct Answer: A
Rationale: The correct answer is A) 0.4 milliunits/minute for the oxytocin infusion rate. To calculate this, we first need to convert 20 units to milliunits by multiplying by 1000, resulting in 20,000 milliunits. Next, we divide this by the total infusion time in minutes (8 hours x 60 minutes = 480 minutes), giving us 41.67 milliunits/minute. Rounding this to one decimal place, we get 0.4 milliunits/minute. Option B) 0.5 is incorrect because it does not match the calculated infusion rate. Option C) 0.6 and Option D) 0.7 are also incorrect for the same reason. Educationally, understanding medication calculations is crucial for healthcare professionals, especially in maternal care where precise dosing is essential. By mastering these calculations, nurses and midwives can ensure safe and effective care for postpartum clients and their newborns. Practice with scenarios like this helps reinforce dosage calculation skills, promoting patient safety and confident clinical practice.
Question 4 of 5
The nurse is planning a class for pregnant women in the first trimester of pregnancy. Which information is most imported for the nurse to include in the class?
Correct Answer: B
Rationale: In this scenario, option B is the most important information for the nurse to include in the class for pregnant women in the first trimester. This is because any vaginal bleeding during pregnancy can be a sign of a serious issue such as miscarriage, ectopic pregnancy, or placental problems. Prompt notification of the healthcare provider is crucial for timely intervention to safeguard the health of both the mother and the baby. Option A is incorrect because while rest and sleep are important during pregnancy, there is no specific guideline that mandates increasing sleep time to an hour per day when experiencing fatigue in the first trimester. Option C is incorrect because while eating small, frequent meals can help alleviate nausea during pregnancy, the advice to carry low-fat snacks is not universally applicable and may not be suitable for all pregnant women. Option D is incorrect because morning dizziness during pregnancy is common due to hormonal changes, and while rising slowly and sitting on the bed for a minute can be helpful, it is not as critical as immediate notification of vaginal bleeding to the healthcare provider. Educationally, this question highlights the importance of prioritizing critical information for pregnant women in the first trimester. It emphasizes the significance of recognizing and acting upon potential warning signs that could indicate serious complications during pregnancy, ensuring the safety and well-being of both the mother and the developing fetus.
Question 5 of 5
A client who suspects she is pregnant tells the nurse she has a peptic ulcer that is being treated with misoprostol (Cytotec), a synthetic prostaglandin C drug, how should the nurse respond?
Correct Answer: A
Rationale: In this scenario, the correct response for the nurse is option A) "You may be at risk for having a spontaneous miscarriage." This is the most appropriate answer because misoprostol, a synthetic prostaglandin C drug used to treat peptic ulcers, is known to cause uterine contractions and can lead to miscarriage or preterm labor if used during pregnancy. Option B) "You may have an increased chance of having preeclampsia" is incorrect because misoprostol does not specifically increase the risk of preeclampsia. Option C) "This medication will have no effect on your unborn child" is also incorrect as misoprostol can indeed have serious effects on the pregnancy. Option D) "You may experience postpartum hemorrhaging after delivery" is not directly related to the use of misoprostol during pregnancy. Educationally, this question highlights the importance of understanding the potential risks associated with medications during pregnancy. Nurses should be aware of the teratogenic effects of certain drugs and provide accurate information to pregnant clients to ensure the safety of both the mother and the unborn child. This knowledge is crucial for effective antenatal care and counseling.