ATI RN
ATI RN Maternal Newborn level 3 Final Exam 2023 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is receiving oxytocin to induce labor. The nurse should discontinue the oxytocin if which of the following occurs?
Correct Answer: C
Rationale: The correct answer is C. 6 contractions in 10 minutes can indicate hyperstimulation of the uterus, which can lead to fetal distress. Discontinuing oxytocin in this situation is crucial to prevent harm to the fetus. Contractions lasting 60 seconds (
A) are within normal range. Non-repetitive early decelerations (
B) are common and not a reason to discontinue oxytocin. Moderate variability in fetal heart rate (
D) is a sign of fetal well-being.
Question 2 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: B
Rationale: The correct answer is B: Allow the baby to feed at least every 3 hours. This instruction is crucial for maintaining an adequate milk supply and ensuring the baby receives sufficient nutrition. Frequent feeding also helps prevent engorgement, promotes bonding, and supports the establishment of a successful breastfeeding relationship. Option A is incorrect because 2 to 4 wet diapers every 24 hours may indicate inadequate milk intake. Option C is incorrect as newborns should not be given water as it can interfere with breastfeeding and lead to water intoxication. Option D is incorrect because newborns should be allowed to feed as long as they want on each breast to ensure they receive hindmilk.
Question 3 of 5
The nurse is teaching a client and her partner about the technique of counter pressure during labor. Which of the following statements by the nurse is appropriate?
Correct Answer: D
Rationale:
Correct Answer: D
Rationale:
1. Counter pressure helps alleviate back pain during labor.
2. Applying steady pressure with a tennis ball to the lower back can help relieve discomfort.
3. This technique is effective for providing relief during contractions.
4. The pressure on the lower back helps to release tension and promote relaxation.
Summary:
A: Incorrect - Upward pressure on lower abdomen is not effective for back pain relief.
B: Incorrect - Pressure between thumb and index finger is unrelated to counter pressure.
C: Incorrect - Pressure to top of uterus is not effective for back pain relief.
D: Correct - Steady pressure with a tennis ball on lower back is effective for back pain relief.
Question 4 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 a sterile saline-saturated towel. This action helps prevent cord compression and protects the cord from drying out, reducing the risk of infection. It also helps maintain blood flow to the fetus.
A: Initiating IV fluids is not the priority in this situation.
B: Performing a vaginal examination could worsen the situation by causing further cord compression.
C: Administering oxygen is important but should not be the first action in this scenario.
In summary, covering the umbilical cord with a sterile saline-saturated towel is crucial to prevent complications and maintain fetal well-being.
Question 5 of 5
A nurse is assessing a newborn whose mother had a primary cytomegalovirus (CMV) infection during pregnancy. The newborn acquired CMV trans placenta Lee. Which of the following findings should the nurse expect the newborn to exhibit?
Correct Answer: B
Rationale: The correct answer is B: Hearing loss. CMV infection during pregnancy can lead to congenital CMV in newborns, causing hearing loss. CMV can affect the inner ear, leading to sensorineural hearing loss. This is a common complication of congenital CMV infection. The other options are not typically associated with congenital CMV infection. Urinary tract infection (
A) is not a common manifestation. Macrosomia (
C) refers to a large birth weight, which is not typically associated with CMV infection. Cataracts (
D) are not a common finding in newborns with congenital CMV infection.