ATI RN
Complications of antenatal care Questions
Question 1 of 5
The priority nursing intervention when admitting a pregnant patient who has experienced a bleeding episode in late pregnancy is to
Correct Answer: B
Rationale: The correct answer is B because assessing fetal heart rate and maternal vital signs is crucial to determine the immediate status of both the mother and the baby. This helps in identifying any signs of distress and guiding further interventions. Monitoring uterine contractions (A) can be important too, but assessing fetal heart rate and maternal vital signs take priority for immediate evaluation. Placing clean disposable pads (C) is helpful for drainage management but not the top priority. Performing a venipuncture for hemoglobin and hematocrit levels (D) is important for assessing blood loss but is not as immediate as assessing fetal heart rate and maternal vital signs.
Question 2 of 5
Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication?
Correct Answer: C
Rationale: The correct answer is C: Normal deep tendon reflexes. This assessment indicates a therapeutic level of magnesium sulfate as it suggests that the medication is effectively preventing magnesium toxicity which would typically present as hyperreflexia or absent reflexes. Drowsiness (A) may indicate magnesium toxicity, urinary output of 20 mL/hour (B) may indicate renal impairment, and a respiratory rate of 10 to 12 breaths per minute (D) may indicate respiratory depression, all of which are signs of magnesium sulfate toxicity rather than therapeutic levels.
Question 3 of 5
A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting?
Correct Answer: D
Rationale: The correct answer is D: Undiagnosed chronic hypertension. The patient's history of significant maternal hypertension at birth and subsequent hypertension at the 6-week checkup indicates that she likely had pre-existing chronic hypertension that went undiagnosed. This type of hypertension can be asymptomatic and may only present during pregnancy or postpartum. Choices A, B, and C all involve hypertension that develops during pregnancy and are typically transient, whereas chronic hypertension persists before and after pregnancy.
Question 4 of 5
What is the priority nursing intervention for the patient who has had an incomplete abortion?
Correct Answer: C
Rationale: The priority nursing intervention for a patient with incomplete abortion is to ensure fluid replacement by inserting an IV line (Choice C). This is crucial to address potential hypovolemia and prevent further complications. Providing medication (Choice A) or positioning the patient (Choice D) is important but not as immediate as ensuring fluid replacement. Preoperative teaching (Choice B) is not necessary until the patient is stable.
Question 5 of 5
Which intervention is the priority for the patient diagnosed with an intact tubal pregnancy?
Correct Answer: B
Rationale: The correct answer is B: Administration of methotrexate. This is the priority intervention for a patient with an intact tubal pregnancy as it helps to stop the growth of the pregnancy tissue in the fallopian tube, reducing the risk of rupture and potentially saving the patient's life. Administering methotrexate promptly is crucial in managing tubal pregnancies. Assessing pain level (choice A) is important but not the priority in this case. Administration of Rh immune globulin (choice C) is not necessary for an intact tubal pregnancy. Explanation of common side effects (choice D) can be done after the priority intervention.