ATI RN
Chimat Maternity Needs Assessment Questions
Question 1 of 5
The nurse is teaching care of the newborn to a group of prospective parents and describes the need for administering antibiotic ointment into the eyes of the newborn. Which infectious organism will this treatment prevent from harming the infant?
Correct Answer: C
Rationale: Erythromycin ointment is instilled into the lower conjunctive of each eye within 2 hours after birth to prevent ophthalmic neonatorum, an infection caused by gonorrhea, and inclusion conjunctivitis, an infection caused by chlamydia (C). The infant may be exposed to these bacteria when passing the birth canal.
Question 2 of 5
The total bilirubin level of a 36-hour, breastfeeding newborns is 14 mg/dl. Based on this finding, which intervention should the nurse implement?
Correct Answer: B
Rationale: The normal total bilirubin level is 6 to 12 mg/dl after Day 1 of life. This infant's bilirubin is beginning to climb, and the infant should be monitored to prevent further complications. Breast milk provides calories and enhances GI motility, which will assist the bowel in eliminating bilirubin (C).
Question 3 of 5
A client who gave birth to a healthy 8-pound infant 3 hours ago is admitted to the postpartum unit. Which nursing plan is best in assisting this mother to bond with her newborn infant?
Correct Answer: D
Rationale: It is most important to meet the mother's requirement for attention to her needs so that she can begin infant care-taking (D). Nurse theorist Reva Rubin describes the initial postpartum period as the 'taking-in phase,' which is characterized by maternal reliance on others to satisfy the needs for comfort, rest, nourishment, and closeness to families and the newborn.
Question 4 of 5
The nurse is providing discharge teaching for a client who is 24 hours postpartum. The nurse explains to the client that her vaginal discharge will change from red to pink and then to white. The client asks, 'What if I start having red bleeding after it changes?' What should the nurse instruct the client to do?
Correct Answer: A
Rationale: The correct answer is A) Reduce activity level and notify the healthcare provider. This response is appropriate because red bleeding after the initial postpartum discharge signifies fresh bleeding and could indicate a potential issue such as hemorrhage or infection. Instructing the client to reduce activity level helps minimize further bleeding, while notifying the healthcare provider promptly allows for timely intervention and assessment. Option B) Go to bed and assume a knee-chest position is incorrect as it does not address the potential underlying cause of the red bleeding and may delay necessary medical evaluation. Option C) Massage the uterus and go to the emergency room is also incorrect as massaging the uterus without proper assessment could be harmful, and going to the emergency room should be guided by healthcare provider instructions. Option D) Do not worry as this is a normal occurrence is incorrect because red bleeding after the initial postpartum period should not be dismissed as normal without proper evaluation to rule out complications. In an educational context, it is crucial for nurses to be able to provide accurate and timely information to postpartum clients regarding expected changes and potential warning signs after childbirth. This scenario emphasizes the importance of postpartum monitoring and the need for appropriate intervention in case of abnormal signs or symptoms to ensure the well-being of both the mother and the newborn.
Question 5 of 5
A client at 32-weeks gestation comes to the prenatal clinic with complaints of pedal edema, dyspnea, fatigue, and a moist cough. Which question is most important for the nurse to ask this client?
Correct Answer: D
Rationale: In this scenario, the most important question for the nurse to ask the client is option D: "Do you have a history of rheumatic fever?" This is the correct answer because the symptoms described by the client, such as pedal edema, dyspnea, fatigue, and a moist cough, are indicative of heart failure, a condition that can be a complication of rheumatic fever. Option A, asking which symptom the client experienced first, is less critical at this moment as it does not provide immediate insight into the potential cause of the current symptoms. Option B, about salty foods, is relevant for conditions like hypertension but is not as directly related to the symptoms presented. Option C, asking about recent travel, is more pertinent for infectious diseases but less likely to be the cause of the client's symptoms in this case. Educational context: Understanding the significance of a thorough health history and its role in identifying potential underlying conditions is crucial for nurses in providing effective care. In this scenario, linking the symptoms to a history of rheumatic fever highlights the importance of connecting past medical conditions to current health issues to ensure appropriate assessment and intervention.