ATI RN
Chimat Maternity Needs Assessment Questions
Question 1 of 5
With regard to an obstetric litigation case, a nurse working in labor and birth is found to be negligent. Which intervention performed by the nurse indicates that a breach of duty has occurred?
Correct Answer: A
Rationale: In this case, option A is the correct answer indicating a breach of duty by the nurse. The failure to document fetal heart tones (FHR) during the second stage of labor is a critical omission as it is a standard practice to monitor the fetal well-being closely during this stage to detect any signs of distress or complications. Proper documentation of FHR is essential for timely intervention and communication among the healthcare team. Option B, providing only ice chips during an 8-hour labor period, is not ideal but does not directly indicate negligence or breach of duty as long as the patient's hydration needs were met through other means. Option C, allowing the patient to use the bathroom instead of a bedpan during the first stage of labor, can be considered a minor issue and does not necessarily point to negligence unless specific medical conditions necessitated a different approach. Option D, asking family members to leave the room before a pelvic exam, is actually a proper professional boundary practice and does not signify negligence. Educationally, this scenario highlights the importance of thorough documentation in obstetric care to ensure patient safety and legal protection. It also emphasizes the need for nurses to adhere to standards of care and protocols in labor and birth settings to avoid potential litigation and uphold patient well-being.
Question 2 of 5
When explaining 'postpartum blues' to a client who is 1 day postpartum, which symptoms should the nurse include in the teaching plan? (Select one tha does not apply.)
Correct Answer: D
Rationale: In this scenario, the correct answer is option D) Disinterest in the infant. Postpartum blues, also known as baby blues, is a common temporary emotional state that can occur in the days following childbirth. It is characterized by mood swings, fatigue, and tearfulness. Disinterest in the infant is not a typical symptom of postpartum blues. It is important for the nurse to explain to the client that feeling overwhelmed, tired, or tearful is common and does not mean she is a bad mother. By recognizing and normalizing these feelings, the nurse can help the client understand that this is a temporary phase that often resolves on its own. Educationally, it is crucial for healthcare providers to educate new mothers about the range of emotions they may experience postpartum. By providing accurate information and support, nurses can help new mothers navigate this challenging time with confidence and reassurance. Encouraging open communication and seeking help if needed is essential in promoting maternal mental health and bonding with the newborn.
Question 3 of 5
A client in active labor complains of cramps in her leg. What intervention should the nurse implement?
Correct Answer: B
Rationale: In the scenario where a client in active labor complains of leg cramps, the appropriate intervention for the nurse to implement is option B - to extend the leg and dorsiflex the foot. This action helps to alleviate cramping by stretching the affected muscle and improving circulation. Option A is incorrect as asking about calcium tablet intake does not directly address the immediate issue of leg cramps during labor. Option C of lowering the leg off the side of the bed may exacerbate the cramping sensation due to the potential for increased muscle tension. Option D, elevating the leg above the heart, is not indicated for leg cramps and may not provide relief. In an educational context, understanding the correct intervention for leg cramps during labor is crucial for maternity nurses. It ensures the safety and comfort of the client during this critical time. Nurses need to possess this knowledge to provide optimal care and support to laboring individuals.
Question 4 of 5
A client who is in the second trimester of pregnancy tells the nurse that she wants to use herbal therapy. Which response is best for the nurse to provide?
Correct Answer: D
Rationale: The correct response, "D) It is important that you want to take part in your care," is the most appropriate because it acknowledges the client's autonomy and decision-making in their healthcare. In the context of maternity care, empowering the client to actively participate in their care can lead to better outcomes and increased satisfaction. By recognizing and supporting the client's desire to explore herbal therapy, the nurse promotes a collaborative and patient-centered approach. Option A is incorrect as it generalizes the use of herbs without considering individual circumstances or potential risks during pregnancy. Option B is not directly addressing the client's interest in herbal therapy. Option C is incorrect because while healthcare providers should guide treatment options, it is essential to involve the client in decision-making regarding their care to promote shared decision-making and patient autonomy. Educationally, this question highlights the importance of respecting the client's autonomy and involving them in decision-making processes, especially in the context of maternal healthcare where individual preferences and beliefs can significantly impact the care provided. Nurses need to communicate effectively, support informed decision-making, and collaborate with clients to ensure a holistic and personalized approach to care.
Question 5 of 5
The nurse is counseling a woman who wants to become pregnant. The woman tells the nurse that she has a 36-day menstrual cycle and the first day of her menstrual period was January *. The nurse correctly calculates that the woman's next fertile period is
Correct Answer: C
Rationale: This woman can expect her next period to begin 36 days from the first day of her last menstrual period - the cycle begins at the first day of the cycle and continues to the first day of the next cycle. Her next period would, therefore, begin on February 13. Ovulation occurs 14 days before the first day of the menstrual period. Therefore, ovulation for this woman would occur January 31 (C).