ATI RN
ATI RN Maternal Newborn Latest Update. Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is 1 day postpartum and breastfeeding her newborn. The client reports sore nipples. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Assess the newborn's latch while breastfeeding. This is the most appropriate action as sore nipples are often caused by improper latch. By assessing the newborn's latch, the nurse can identify and correct any issues that may be causing discomfort for the mother. Waiting 4 hours between feedings (choice
A) can lead to engorgement and decreased milk supply. Limiting breastfeeding time to 5 minutes per breast (choice
C) can prevent the newborn from getting enough milk and may worsen the soreness. Offering supplemental formula (choice
D) can decrease the mother's milk supply and hinder the establishment of breastfeeding.
Extract:
A nurse is caring for a client who is 48 hr postpartum and has a deep vein thrombosis.
Medical History:
• Gravida 2 Para 2
• Cesarean birth
• Deep vein thrombosis with previous pregnancy
• Preeclampsia
• BMI of 32
Question 2 of 5
A nurse is caring for a client who is 48 hr postpartum and has a deep vein thrombosis.
| Findings 24 hr later | Indication of worsening condition | Indication of improving condition |
|---|---|---|
| Increased warmth in the extremity | ||
| Tachycardia | ||
| Leukocytosis | ||
| Scant lochia rubra | ||
| Decreased extremity edema |
Correct Answer:
Rationale:
Correct Answer: A: Increased warmth in the extremity
Rationale: In a client with deep vein thrombosis, increased warmth in the extremity is a concerning finding as it may indicate worsening of the condition due to potential inflammation or clot progression. This should be checked to monitor for complications. Tachycardia and leukocytosis are general indicators of systemic inflammation and infection, not specific to deep vein thrombosis. Scant lochia rubra and decreased extremity edema are not relevant to assessing deep vein thrombosis.
Extract:
Question 3 of 5
A nurse is admitting a client to the birthing unit who reports her contractions started 1 hr ago. The nurse determines the client is 80% effaced and 8 cm dilated. The nurse realizes that the client is at risk for which of the following conditions?
Correct Answer: D
Rationale: The correct answer is D: Postpartum hemorrhage. This is because the client's significant cervical dilation and effacement indicate that she is in active labor, not at risk for an ectopic pregnancy, hyperemesis gravidarum, or incompetent cervix. Postpartum hemorrhage can occur due to the rapid labor progression, leading to increased risk of excessive bleeding post-delivery. Other choices are incorrect as they do not align with the client's current presentation and stage of labor.
Question 4 of 5
A nurse is caring for a client who is receiving an epidural block with an opioid analgesic. The nurse should monitor for which of the following findings as an adverse effect of the medication?
Correct Answer: C
Rationale: The correct answer is C: Hypotension. Opioid analgesics administered via epidural block can lead to vasodilation, resulting in decreased blood pressure. The nurse should monitor for signs of hypotension, such as dizziness, lightheadedness, and decreased urine output. Hyperglycemia (
A) is not typically associated with opioid analgesics. Bilateral crackles (
B) suggest fluid overload or pulmonary edema, not a common adverse effect of opioids. Polyuria (
D) is not a common side effect of opioid analgesics; in fact, opioids can cause urinary retention.
Question 5 of 5
A nurse is assessing a client who is 6 hr postpartum and has endometritis. Which of the following findings should the nurse expect?
Correct Answer: C
Rationale: The correct answer is C: Uterine tenderness. Postpartum endometritis is an infection of the uterine lining, causing inflammation and tenderness. This finding is characteristic of endometritis and requires immediate attention.
A: Temperature of 37.4°C is within normal range.
B: WBC count of 9,000/mm3 is within normal limits and may not indicate infection.
D: Scant lochia does not specifically indicate endometritis.
Therefore, the presence of uterine tenderness is the most significant finding in this scenario.