ATI RN
ATI Maternal Newborn Proctored Questions
Question 1 of 5
The nurse is assessing a client in labor with ruptured membranes. What finding indicates the need for immediate intervention?
Correct Answer: C
Rationale: The correct answer is C: Green, foul-smelling fluid. This indicates meconium-stained amniotic fluid, which can be a sign of fetal distress and possible meconium aspiration. Immediate intervention is needed to prevent potential complications for the baby. A: Temperature of 100.6°F could indicate maternal infection but does not require immediate intervention unless other signs are present. B: Clear amniotic fluid is a normal finding. D: Contractions every 5 minutes may indicate active labor, but it is not an immediate concern unless coupled with other signs of distress.
Question 2 of 5
The nurse is assessing a client in the third trimester with suspected placental abruption. What finding supports this diagnosis?
Correct Answer: B
Rationale: The correct answer is B: Boardlike abdomen and severe pain. This finding supports the diagnosis of placental abruption because it indicates a significant and sudden separation of the placenta from the uterine wall, leading to intense pain and rigidity of the abdomen due to internal bleeding. Painless bright red bleeding (choice A) is more indicative of placenta previa, not placental abruption. A soft, relaxed uterus (choice C) is not typical in placental abruption, which usually presents with uterine tenderness and rigidity. Increased fetal movement (choice D) is not specific to placental abruption and can occur in various pregnancy conditions.
Question 3 of 5
A client at 37 weeks' gestation reports sudden gush of clear fluid. What is the nurse's priority action?
Correct Answer: A
Rationale: The correct answer is A: Assess for fetal heart rate changes. This is the priority action because the sudden gush of clear fluid may indicate rupture of membranes, potentially leading to fetal distress. Assessing fetal heart rate changes helps determine the urgency of the situation and guides further interventions. Checking maternal vital signs (B) is important but not the priority in this scenario. Performing a sterile vaginal examination (C) should only be done after confirming rupture of membranes to prevent infection. Notifying the healthcare provider (D) can be done after assessing fetal well-being.
Question 4 of 5
The nurse is teaching a client about preterm labor prevention. What instruction is most appropriate?
Correct Answer: A
Rationale: The correct answer is A because adequate hydration helps prevent preterm labor by maintaining amniotic fluid levels and preventing dehydration-induced contractions. Drinking 8-10 glasses of water daily ensures proper hydration. B is incorrect because lying down during the day does not have a direct impact on preterm labor prevention. C is incorrect as excessive physical activity can sometimes trigger preterm labor instead of preventing it. D is incorrect as protein intake is important for fetal development and reducing it can lead to nutritional deficiencies, but it is not a direct factor in preventing preterm labor.
Question 5 of 5
The nurse is monitoring a client during the first stage of labor. What finding requires immediate intervention?
Correct Answer: C
Rationale: The correct answer is C because variable decelerations on the fetal monitor indicate umbilical cord compression, which can lead to fetal distress and hypoxia. Immediate intervention is needed to relieve the compression and prevent potential harm to the baby. Contractions every 3-5 minutes (A) are normal in the first stage of labor. A baseline fetal heart rate of 110 beats/minute (B) is within the normal range for a fetus. Client reporting back pain (D) is a common symptom of labor and not necessarily indicative of a complication requiring immediate intervention.