ATI RN
ATI RN Maternal Newborn Latest Update. Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is 12 hr postpartum and has a fourth-degree laceration of the perineum. Which of the following actions should the nurse take?
Correct Answer: A
Rationale:
Correct Answer: A - Apply a moist, warm compress to the perineum.
Rationale: Applying a moist, warm compress helps to reduce swelling and promote healing in the perineal area. This can provide comfort and pain relief for the client with a fourth-degree laceration. It also helps to increase blood flow to the area, aiding in the healing process.
Summary of other choices:
B: Providing a cool sitz bath may not be appropriate for a fourth-degree laceration as warmth is usually more soothing and beneficial.
C: Administering methylergonovine may be contraindicated as it can cause uterine contractions and increase the risk of bleeding in a client with a fourth-degree laceration.
D: Applying povidone-iodine may be too harsh for the delicate perineal area and can potentially cause irritation or delay healing.
Question 2 of 5
A nurse is assessing a newborn whose mother had gestational diabetes mellitus. The nurse should monitor for which of the following findings as a manifestation of hypoglycemia?
Correct Answer: D
Rationale: The correct answer is D: Jitteriness. Infants born to mothers with gestational diabetes are at risk for hypoglycemia due to hyperinsulinemia. Jitteriness is a common manifestation of hypoglycemia in newborns. It occurs due to the brain's response to low glucose levels, leading to neurologic symptoms. Abdominal distention (
A) is not typically associated with hypoglycemia in newborns. Petechiae (
B) are tiny red spots due to bleeding under the skin and are not related to hypoglycemia. Increased muscle tone (
C) is not a typical manifestation of hypoglycemia in newborns.
Question 3 of 5
A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus ß-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?
Correct Answer: D
Rationale: The correct answer is D: We need to know if you are positive for GBS at the time of delivery. This is the appropriate response because GBS status can change during pregnancy, and it is crucial to know the status closer to delivery to determine if antibiotics are needed during labor to prevent transmission to the newborn.
Choice A is incorrect as GBS is often asymptomatic in pregnant women.
Choice B is incorrect because past negative results do not guarantee current negative status.
Choice C is incorrect because GBS status can change over time.
Question 4 of 5
A nurse is providing discharge instructions to a client who is breastfeeding her newborn. Which of the following instructions should the nurse include?
Correct Answer: D
Rationale: The correct answer is D: Allow the baby to feed at least every 3 hours. This instruction is important because frequent feeding helps to establish and maintain a good milk supply, promotes bonding, and ensures the baby receives adequate nutrition.
Choice A is incorrect as breastfeeding should not be limited to a specific time duration.
Choice B is incorrect as offering water to a newborn can interfere with breastfeeding and increase the risk of water intoxication.
Choice C is incorrect as the number of wet diapers can vary, and it is not a reliable indicator of successful breastfeeding.
Question 5 of 5
A nurse is reviewing laboratory findings for a client who is at 20 weeks of gestation. Which of the following findings should the nurse report to the provider?
Correct Answer: D
Rationale: The correct answer is D: Fasting blood glucose 180 mg/dL (74 to 106 mg/dL). High blood glucose levels during pregnancy can indicate gestational diabetes, which poses risks to both the mother and the baby. The nurse should report this finding to the provider for further evaluation and management.
Choice A (Hematocrit 37%): Falls within the normal range for pregnancy and does not require immediate reporting.
Choice B (Creatinine 0.9 mg/dL): Within the normal range and does not indicate a concerning issue at this time.
Choice C (WBC count 11,000/mm3): Slightly elevated, but can be a normal physiological response during pregnancy and does not necessarily warrant immediate reporting.
In summary, the correct answer is D as it signifies a potential health concern that requires further assessment.
Choices A, B, and C are within normal ranges for pregnancy and do not pose immediate risks.