ATI RN
ATI RN Maternal Newborn 2023/24 1st Attempt & Retake Questions
Extract:
Question 1 of 5
A nurse is caring for a client following an amniocentesis at 18 weeks of gestation. Which of the following findings should the nurse report to the provider as a potential complication?
Correct Answer: B
Rationale: The correct answer is B: Leakage of fluid from the vagina. After an amniocentesis, leakage of amniotic fluid from the vagina can indicate a potential complication like premature rupture of membranes. This complication can lead to preterm labor and delivery, endangering both the mother and the fetus. Reporting this finding promptly to the provider allows for timely intervention to prevent further complications. Increased fetal movement , upper abdominal discomfort , and urinary frequency are common and expected after an amniocentesis and do not necessarily indicate a complication.
Question 2 of 5
A nurse is caring for a newborn immediately following birth. For which of the following reasons should the nurse delay the instillation of antibiotic ophthalmic ointment?
Correct Answer: D
Rationale: The correct answer is D:
To facilitate bonding between the newborn and parent. Delaying the instillation of antibiotic ophthalmic ointment allows for uninterrupted skin-to-skin contact and bonding between the newborn and parent, which is crucial for establishing a strong emotional connection and promoting breastfeeding. This initial bonding period is a critical time for the newborn's emotional and psychological development.
Choices A, B, and C are incorrect because immediate instillation of the ointment is essential to prevent neonatal conjunctivitis, regardless of the newborn's weight, mode of delivery, or the need to identify infection manifestations.
Question 3 of 5
A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan?
Correct Answer: C
Rationale:
Correct Answer: C - Remove all clothing from the newborn except the diaper.
Rationale: Phototherapy involves exposing the newborn's skin to light to breakdown excess bilirubin.
To maximize the effectiveness of phototherapy, the newborn should have as much skin exposed to the light as possible. Removing all clothing except the diaper ensures that the most surface area is exposed to the light, improving bilirubin breakdown.
Summary of other choices:
A: Feeding water is not directly related to phototherapy for hyperbilirubinemia.
B: Applying lotion does not aid in the effectiveness of phototherapy.
D: Discontinuing therapy due to a rash may compromise the treatment of hyperbilirubinemia.
Question 4 of 5
A nurse is caring for a newborn who was transferred to the nursery 30 min after birth because of mild respiratory distress. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Verify the newborn's identification. This is the first action the nurse should take because ensuring the correct identification of the newborn is crucial for providing safe and effective care. Without proper identification, there is a risk of administering medications or treatments to the wrong newborn. Confirming the newborn's Apgar score can be important but is not as time-sensitive as verifying identification. Administering vitamin K and determining obstetrical risk factors are important tasks but should come after verifying the newborn's identification to ensure the safety of the care provided.
Question 5 of 5
A nurse is planning care immediately following birth for a newborn who has a myelomeningocele that is leaking cerebrospinal fluid. Which of the following actions should the nurse include in the plan of care?
Correct Answer: A
Rationale: The correct answer is A: Administer broad-spectrum antibiotics. This is crucial to prevent infection in the exposed neural tissue. Myelomeningocele increases the risk of meningitis due to the breach in the protective layers of the spinal cord. Administering antibiotics helps to prevent bacterial invasion and subsequent infection. Monitoring rectal temperature is not directly related to the myelomeningocele issue. Cleaning the site with povidone-iodine may cause further irritation to the exposed tissue. Immediate surgical closure is usually necessary to prevent infection; waiting 72 hours is not appropriate in this case.