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 caring for a client who has received an epidural during labor. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Position a wedge under the client's left hip. Placing a wedge under the left hip helps to optimize the effectiveness of the epidural by promoting even distribution of the medication, ensuring proper pain management during labor. This position also helps to prevent nerve compression and potential complications.
B: Placing the client in the lithotomy position is not recommended as it can increase the risk of nerve compression and hinder the effectiveness of the epidural.
C: Assisting the client to a knee-chest position is not appropriate for a client with an epidural, as it can cause discomfort and compromise the effectiveness of the medication.
D: Elevating the head of the client's bed to 90% is unrelated to the management of an epidural and does not contribute to optimal pain relief.
Question 2 of 5
A nurse is caring for a client who is in the second stage of labor. Which of the following manifestations should the nurse expect?
Correct Answer: D
Rationale: The correct answer is D: The client delivers the newborn. In the second stage of labor, the cervix is fully dilated, and the mother pushes to deliver the baby. This stage ends with the birth of the newborn.
Choice A is incorrect because expelling the placenta occurs in the third stage of labor.
Choice B is incorrect as gradual dilation of the cervix happens in the first stage.
Choice C is incorrect because regular contractions are characteristic of the first stage of labor.
Question 3 of 5
A nurse is caring for a client who reports spontaneous rupture. The nurse observed fetal bradycardia in the FHR tracing and notices the umbilical cord is protruding. After calling for assistance and notifying the provider, which of the following should the nurse take next?
Correct Answer: D
Rationale: The correct answer is D: Cover the umbilical cord with sterile saline saturated towel. This action is essential to prevent compression and protect the exposed cord from infection. By covering the umbilical cord with a sterile saline-saturated towel, the nurse can maintain the cord's moisture and integrity, reducing the risk of cord compression and infection. This step is crucial in managing a prolapsed umbilical cord until emergency interventions can be performed.
Summary:
A: Initiating IV fluids is not the priority in this situation as the immediate concern is to protect the umbilical cord.
B: Performing a vaginal examination by applying upward pressure can further compress the cord and worsen the fetal distress.
C: Administering oxygen is important but is not the immediate priority compared to protecting the umbilical cord.
E, F, G: Not applicable.
Question 4 of 5
A nurse is caring for a client who is experiencing sore nipples from breastfeeding. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Ensure the newborn’s mouth is wide open before latching to the breast. This is important because a proper latch is crucial in preventing sore nipples during breastfeeding. When the newborn's mouth is wide open, it ensures that the nipple is deeply in the baby's mouth, allowing for a more effective and comfortable feeding. This helps prevent nipple trauma and decreases the likelihood of soreness.
Choice A is incorrect because placing a snug dressing on the nipple can further irritate the area and hinder proper healing.
Choice C is incorrect as limiting the feeding time can lead to inadequate milk intake for the baby.
Choice D is incorrect as starting with the most tender nipple can worsen the soreness.
Question 5 of 5
A nurse is providing discharge teaching to a new parent about car seat safety. Which of the following statements by the parent indicates an understanding of the teaching?
Correct Answer: A
Rationale: The correct answer is A because positioning the baby's car seat at a 45-degree angle in the car helps prevent the baby's head from flopping forward and potentially obstructing the airway, ensuring optimal safety.
Choice B is incorrect because it doesn't specify the recommended weight limit for rear-facing seats, which is typically until the baby reaches 20-35 pounds.
Choice C is incorrect as the harness should be positioned at or below the baby's shoulders, not above.
Choice D is incorrect because the retainer clip should be positioned at armpit level, not at the top of the baby's abdomen.