ATI RN
RN ATI Maternal Proctored Exam 2023-2024 with NGN Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is in the second stage of labor and is experiencing a shoulder dystocia. The provider instructs the nurse to perform the McRoberts maneuver. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Assist the client in pulling their knees toward their abdomen. This maneuver helps to widen the pelvic outlet, reducing the angle between the sacrum and the pubic symphysis, thus allowing for easier delivery of the baby's shoulder. By bringing the knees closer to the abdomen, the nurse can help facilitate the rotation of the baby's shoulder, aiding in the resolution of shoulder dystocia.
Applying pressure to the client's fundus (
Choice
A) would not directly address the shoulder dystocia. Pressing firmly on the client’s suprapubic area (
Choice
B) may not be effective in resolving shoulder dystocia. Moving the client onto their hands and knees (
Choice
C) could potentially worsen the situation by further obstructing the baby's passage.
In summary, the McRoberts maneuver, which involves assisting the client in pulling their knees toward their abdomen, is the most appropriate action in managing shoulder dystocia during the second stage of
Question 2 of 5
A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hr ago. Which of the following findings place the client at risk for postpartum hemorrhage? (Select all that apply.)
Correct Answer: A,C,D
Rationale: The correct answers are A, C, and D.
A: Labor induction with oxytocin can lead to uterine atony, increasing the risk of postpartum hemorrhage.
C: Vacuum-assisted delivery can cause uterine atony and trauma, contributing to postpartum hemorrhage.
D: History of uterine atony indicates a previous issue with uterine contractions, making the client more susceptible to postpartum hemorrhage.
B: Newborn weight is not directly related to postpartum hemorrhage risk.
E: History of human papillomavirus does not increase the risk of postpartum hemorrhage.
In summary, labor induction with oxytocin, vacuum-assisted delivery, and a history of uterine atony are factors that place the client at risk for postpartum hemorrhage.
Question 3 of 5
A nurse is administering a hepatitis B vaccine to a newborn. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Administer the injection into the vastus lateralis muscle. For newborns, the vastus lateralis muscle is the recommended site for intramuscular injections due to its larger muscle mass and reduced risk of hitting nerves or blood vessels. This site also allows for better absorption of the vaccine. Massaging the site vigorously (
B) can cause tissue damage. Inserting the needle at a 45° angle (
C) is not recommended as it may lead to improper vaccine delivery. Using a 21-gauge needle (
D) is not necessary for newborns and may cause unnecessary pain.
Question 4 of 5
A nurse is calculating the estimated date of delivery for a client who reports that the first day of her last menstrual period was August 10. Using Nägele’s Rule, which of the following is the client’s estimated date of delivery?
Correct Answer: B
Rationale: The correct answer is B: May 17. Nägele's Rule involves adding 7 days to the first day of the last menstrual period (August 10), then subtracting 3 months, and finally adding 1 year. So, August 10 + 7 days = August 17. Subtracting 3 months gives May 17. This estimation is based on the assumption of a 28-day menstrual cycle.
Choice A (May 13) is incorrect because it does not account for the full 3 months.
Choice C (May 3) is incorrect as it miscalculates the 3 months and adds 7 days incorrectly.
Choice D (May 20) is wrong as it adds 7 days to the correct date but does not subtract the 3 months accurately.
Therefore, B is the correct choice based on the accurate application of Nägele's Rule.
Question 5 of 5
A nurse is reviewing the prescriptions for a client who is pregnant and is taking digoxin. Which of the following actions should the nurse take to best evaluate the client’s medication adherence?
Correct Answer: D
Rationale: The correct answer is D: Check the client’s serum medication level. This is the best action to evaluate medication adherence for a client taking digoxin during pregnancy. Digoxin has a narrow therapeutic range, and monitoring serum levels helps ensure the medication is within the safe and effective range. Checking the medication level provides objective data on adherence compared to subjective responses from the client (choice
A). Assessing kidney function (choice
B) is important for digoxin dosing but does not directly evaluate adherence. Monitoring the apical pulse rate (choice
C) is essential for digoxin therapy but does not directly assess medication adherence. Checking the serum medication level is the most direct and reliable method to confirm if the client is taking the medication as prescribed.