ATI RN
ATI RN Maternal Newborn level 3 Final Exam 2023 (All Correct Answers). Maternal-Child Nursing Questions
Extract:
Question 1 of 5
A nurse is assessing a newborn immediately following a vaginal birth. For which of the following findings should the nurse intervene?
Correct Answer: D
Rationale: The correct answer is D: Sternal retractions. Sternal retractions in a newborn indicate respiratory distress, potentially due to a blocked airway or difficulty breathing. The nurse should intervene immediately to ensure the newborn's airway is clear and that they are able to breathe properly.
A: Molding is the overlapping of cranial bones during birth, a common and temporary finding.
B: Vernix Caseosa is a protective coating on the newborn's skin and is normal.
C: Acrocyanosis is the bluish discoloration of the hands and feet, a common finding in newborns due to immature circulation.
Question 2 of 5
A nurse is caring for four clients. For which of the following clients should the nurse auscultate the fetal heart rate during the prenatal visit?
Correct Answer: D
Rationale: The correct answer is D. The nurse should auscultate the fetal heart rate for a client who has felt quickening for the first time during the prenatal visit. Quickening is the first fetal movements felt by the mother, typically occurring around 18-20 weeks gestation. Auscultating the fetal heart rate confirms the presence of fetal life and ensures the fetus is developing appropriately. This step is crucial in assessing fetal well-being and monitoring for any potential complications.
Choice A: A client with a molar pregnancy does not have a viable fetus; auscultating the fetal heart rate is not necessary.
Choice B: A client with a crown-rump length of 7 weeks gestation may be too early for fetal heart rate detection using auscultation.
Choice C: A positive urine pregnancy test alone does not indicate fetal viability; auscultation is needed to assess the fetus.
In summary, choice D is correct as it aligns with the timing of fetal movement and the need to assess
Question 3 of 5
A nurse is planning care for a full-term newborn who is receiving phototherapy. Which of the following actions should the nurse include in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Avoid using lotion or ointment on the newborn skin. This is because lotions or ointments can interfere with the effectiveness of phototherapy by blocking the light from reaching the skin. Dressing the newborn in lightweight clothing (
Choice
A) is important to maximize skin exposure to the light. Keeping the newborn supine throughout treatment (
Choice
C) is not directly related to the effectiveness of phototherapy. Measuring the newborn's temperature every 8 hours (
Choice
D) is important but not specifically related to phototherapy.
Question 4 of 5
A nurse is assessing a client following an amniocentesis. Which of the following findings should the nurse recognize as complications? (SATA).
Correct Answer: A
Rationale: The correct answer is A because amnionitis, leakage of amniotic fluid, and preterm labor are potential complications following amniocentesis. Amnionitis is an infection of the amniotic fluid, leakage of amniotic fluid can lead to preterm labor, and preterm labor poses risks to both the mother and the baby. Hypertension (
B), hyperglycemia (
C), and maternal hypotension (
D) are not commonly associated with amniocentesis and are not typical complications of the procedure.
Question 5 of 5
A nurse on a labor and delivery unit is receiving infection control standards with a newly licensed nurse. The nurse should instruct the newly licensed nurse to don gloves for which of the following procedures?
Correct Answer: D
Rationale: The correct answer is D: Performing umbilical cord care. Gloves should be worn when performing any procedure that involves contact with bodily fluids or potentially infectious material, such as blood or bodily secretions. Umbilical cord care may involve cleaning the area, which can have potential exposure to bodily fluids. The other choices (A, B,
C) do not involve direct contact with bodily fluids or infectious material, so gloves are not necessary for those procedures. It is important to maintain infection control practices to prevent the spread of infections in the healthcare setting.