ATI RN
Maternal Newborn ATI Practice Questions Questions
Question 1 of 5
The nurse is preparing a client for a postpartum tubal ligation. What is the priority preoperative nursing action?
Correct Answer: B
Rationale: In the context of pharmacology and maternal newborn care, the priority preoperative nursing action for a client undergoing a postpartum tubal ligation is to verify signed informed consent, which is option B. This is crucial because informed consent is a legal and ethical requirement that ensures the client fully understands the procedure, risks, benefits, and alternatives before proceeding. By verifying the signed informed consent, the nurse ensures that the client has made an informed decision and is aware of what will happen during the procedure, promoting patient autonomy and safety. Inserting an indwelling catheter (option A) is not the priority preoperative nursing action in this scenario unless specifically indicated by the healthcare provider based on the client's individual needs. Administering prescribed antibiotics (option C) and checking for maternal vital signs (option D) are important aspects of preoperative care but do not take precedence over verifying informed consent, which is essential for protecting the client's rights and ensuring a safe and ethical care environment. Educationally, understanding the importance of informed consent in healthcare settings is critical for nurses and other healthcare professionals. It is a fundamental aspect of patient care that upholds ethical principles and legal standards. By prioritizing informed consent, nurses demonstrate respect for the client's autonomy, promote shared decision-making, and contribute to the overall quality and safety of care provided to maternal newborn clients undergoing surgical procedures like tubal ligation.
Question 2 of 5
The nurse is teaching a client about postpartum warning signs. Which symptom should be reported immediately?
Correct Answer: C
Rationale: In postpartum education, it is crucial to emphasize the importance of recognizing warning signs that could indicate a potential complication. In this scenario, the correct answer is C) Severe headache and blurred vision, which should be reported immediately. These symptoms could be indicative of conditions such as preeclampsia or eclampsia, which are serious and require prompt medical attention to prevent harm to the mother. Option A) Increased lochia on standing is a common postpartum occurrence, especially if the client has been active. It is important to educate clients on the expected amount and color of lochia, but increased flow upon standing alone is not typically a cause for immediate concern. Option B) Breast tenderness and fullness are common postpartum symptoms related to breastfeeding. While these symptoms should be addressed to ensure proper latch and milk supply, they do not typically indicate a serious complication that requires immediate reporting. Option D) Mild swelling in the feet is a common postpartum symptom due to fluid shifts in the body. While some swelling is expected, sudden severe swelling accompanied by other symptoms like headache and blurred vision could be concerning. However, mild swelling alone is not an immediate cause for alarm. Educational context is crucial in helping postpartum clients differentiate between normal postpartum experiences and potential warning signs. By explaining the rationale behind the correct answer and why the other options are not immediate concerns, nurses can empower clients to advocate for their health and seek timely medical intervention when necessary.
Question 3 of 5
The nurse is caring for a client with gestational diabetes. What fetal complication should the nurse monitor for after birth?
Correct Answer: C
Rationale: In caring for a client with gestational diabetes, monitoring for fetal complications is crucial. The correct answer is C) Hypoglycemia. Infants born to mothers with gestational diabetes are at risk for hypoglycemia due to their exposure to higher glucose levels in utero. After birth, the infant's insulin production remains high, leading to a drop in blood glucose levels, hence the need for vigilant monitoring. Option A) Hyperglycemia is incorrect because infants are not at risk for high blood sugar levels after birth. Option B) Macrosomia, referring to a large birth weight, is a risk factor associated with gestational diabetes but does not directly relate to postnatal complications. Option D) Hyperbilirubinemia, or jaundice, is a common condition in newborns but is not specifically linked to gestational diabetes. Educationally, understanding the impact of maternal gestational diabetes on fetal health is essential for nursing practice. By grasping the increased risk of hypoglycemia in infants of diabetic mothers, nurses can provide timely interventions and support to ensure optimal outcomes for both the mother and the newborn.
Question 4 of 5
The nurse is teaching a prenatal class about kick counts. When should the client contact the healthcare provider?
Correct Answer: A
Rationale: In the context of prenatal care, teaching expectant mothers about monitoring fetal movements, known as kick counts, is crucial for assessing fetal well-being. The correct answer, option A, states that the client should contact the healthcare provider if there are fewer than 10 movements in 2 hours. This guideline is based on the recommendation that expectant mothers should feel at least 10 distinct movements within a 2-hour period, which indicates normal fetal activity and a healthy baby. Option B, fewer than 5 movements in 1 hour, is incorrect because it sets a threshold that is too low and may lead to unnecessary anxiety and interventions. Fetal movement patterns can vary, and setting the bar too high may cause undue concern. Option C, no movements after a meal, is also incorrect as fetal movements can vary in relation to maternal activities and are not solely tied to meal times. Option D, no movements for 6 hours, is incorrect because waiting for this extended period without feeling fetal movements could potentially delay necessary medical intervention in cases of fetal distress. Educationally, it is important for nurses to teach expectant mothers the significance of kick counts, how to perform them correctly, and when to seek medical advice based on established guidelines. This empowers mothers to actively monitor their baby's well-being and promotes early detection of any potential issues, contributing to optimal maternal and fetal outcomes.
Question 5 of 5
The nurse is caring for a client at 39 weeks' gestation in active labor. The fetal monitor shows late decelerations. What is the priority nursing action?
Correct Answer: A
Rationale: In this scenario, the priority nursing action is to reposition the client to her left side (Option A). Late decelerations on the fetal monitor indicate uteroplacental insufficiency, which can lead to fetal hypoxia. Repositioning the client to her left side helps improve placental perfusion by relieving pressure on the vena cava, enhancing blood flow to the placenta, and subsequently improving fetal oxygenation. Increasing the oxytocin infusion rate (Option B) would be contraindicated as it can further stress the fetus by increasing the frequency and intensity of contractions, potentially worsening the late decelerations. Encouraging the client to push harder (Option C) would not address the underlying cause of the late decelerations and could potentially lead to fetal distress. Notifying the healthcare provider immediately (Option D) is important but not the most immediate action in this situation. Repositioning the client is the priority to address the fetal well-being promptly. In an educational context, understanding fetal monitoring and the significance of different deceleration patterns is crucial for nurses caring for laboring women. It also highlights the importance of quick and appropriate interventions to optimize maternal and fetal outcomes during labor and delivery.