ATI RN
Monitoring Baby During Labour Questions
Question 1 of 5
The nurse is caring for a pregnant patient who is 24 weeks gestation and reports nausea, vomiting, and weight loss. What is the most appropriate action for the nurse to take?
Correct Answer: C
Rationale: The correct answer is C: Assess the patient's hydration status and notify the healthcare provider if necessary. Rationale: 1. Nausea, vomiting, and weight loss in pregnancy may indicate hyperemesis gravidarum, a severe form of morning sickness that can lead to dehydration and electrolyte imbalances. 2. Assessing hydration status is crucial to determine the severity of the condition and guide appropriate interventions. 3. Notifying the healthcare provider allows for further evaluation, possible treatment adjustments, and monitoring to prevent complications. Summary: A: Instructing the patient to eat a high-protein diet and avoid fluids during meals does not address the immediate concern of dehydration and may worsen symptoms. B: Encouraging the patient to rest and avoid exercise is important but does not address the primary issue of dehydration. D: Recommending over-the-counter anti-nausea medications may provide symptomatic relief but does not address the underlying cause or hydration status.
Question 2 of 5
The nurse is assessing a pregnant patient who is 30 weeks gestation and is concerned about the possibility of gestational diabetes. Which of the following symptoms should the nurse educate the patient to report?
Correct Answer: A
Rationale: The correct answer is A: Increased thirst and frequent urination. This is because these symptoms are indicative of hyperglycemia, which is common in gestational diabetes. Increased thirst occurs due to the body trying to flush out excess sugar through urine, leading to frequent urination. This should be reported to the healthcare provider for further evaluation and management. Other choices are incorrect: B: Sudden weight loss and increased energy are not typical symptoms of gestational diabetes. Weight loss can occur in uncontrolled diabetes, but it is not a common symptom in gestational diabetes. C: Extreme fatigue and headaches can be non-specific symptoms and are not necessarily related to gestational diabetes. D: Decreased fetal movement and nausea are more commonly associated with other complications in pregnancy, such as placental insufficiency or preeclampsia, rather than gestational diabetes.
Question 3 of 5
A pregnant patient is 28 weeks gestation and reports feeling nauseated. What is the nurse's priority intervention?
Correct Answer: C
Rationale: The correct answer is C: Encourage the patient to eat smaller, more frequent meals. This is the priority intervention because nausea during pregnancy, especially in the second trimester, is common and can be alleviated by eating smaller, more frequent meals to prevent fluctuations in blood sugar levels. Ginger tea (A) may help with nausea, but ensuring proper nutrition through small, frequent meals is the priority. Recommending larger meals (B) can worsen nausea due to increased stomach distention. Instructing the patient to avoid all foods and drinks (D) is not appropriate as it can lead to dehydration and nutrient deficiencies.
Question 4 of 5
A nurse is caring for a pregnant patient who is at 20 weeks gestation and reports experiencing leg cramps. What is the nurse's most appropriate intervention?
Correct Answer: B
Rationale: The correct answer is B because elevating the legs and performing leg stretches can help improve circulation and relieve leg cramps during pregnancy. This intervention promotes blood flow and prevents muscle fatigue. Calcium supplements (choice A) may be helpful for preventing leg cramps in some cases but are not the first-line intervention. Instructing the patient to rest (choice C) may worsen leg cramps due to decreased circulation. Administering pain medication (choice D) should be avoided unless necessary, as it does not address the root cause of the leg cramps.
Question 5 of 5
The nurse is caring for a pregnant patient who is 38 weeks gestation and reports feeling pelvic pressure and mild cramping. What should the nurse do first?
Correct Answer: A
Rationale: The correct answer is A because monitoring the fetal heart rate and checking for signs of labor are essential in assessing the well-being of the fetus and determining if the patient is in active labor. This step helps the nurse identify any potential complications and take appropriate actions promptly. Choice B is incorrect because simply instructing the patient to rest may not address the underlying cause of pelvic pressure and cramping. Choice C is incorrect as assessing blood pressure and urine for protein is not the priority in this situation. Choice D is incorrect because performing a pelvic exam should be done after monitoring fetal well-being and ruling out active labor.