ATI RN
ATI RN Maternal Newborn level 3 Final Exam 2023 Questions
Extract:
Question 1 of 5
A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions Should the nurse include in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Bathe the newborn before initiating skin to skin contact. This is important to minimize the risk of HIV transmission from the mother to the newborn. Bathing the newborn helps to remove any potential blood or body fluids that may contain the virus. Initiating skin to skin contact without bathing the newborn first could increase the risk of transmission.
Choice A is incorrect because using a fetal scalp electrode during labor and delivery is unrelated to preventing HIV transmission.
Choice C is incorrect because instructing the client to stop taking antiretroviral medication at 32 weeks of gestation could harm both the mother and the baby by increasing the risk of HIV transmission.
Choice D is incorrect because administering pneumococcal immunization to the newborn within 4 hours following birth is not directly related to preventing HIV transmission.
In summary, bathing the newborn before initiating skin to skin contact is the most appropriate action to prevent HIV transmission in this scenario.
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
A nurse is planning care for a newborn who is scheduled to start phototherapy using a lap. Which of the following actions should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Ensure the newborn's eyes are closed beneath the shield. During phototherapy, the newborn's eyes must be protected from the light to prevent damage. Placing a shield over the eyes helps to minimize exposure.
Choice A is incorrect because lotions can interfere with the effectiveness of phototherapy.
Choice B is incorrect as clothing can also block the light needed for therapy.
Choice D is incorrect as giving glucose water is not necessary for phototherapy and may not be appropriate for a newborn.
Question 4 of 5
A nurse is assessing a client who is in preterm labor and has a new prescription or terbutaline 0.25 mg subcutaneous. For which of the following findings should the nurse Withhold the medication and Report to the provider?
Correct Answer: B
Rationale: The correct answer is B: Blood pressure 88/58 mmHg. This blood pressure reading indicates hypotension, which could be a potential side effect of terbutaline. Hypotension can worsen maternal and fetal perfusion, leading to adverse outcomes. The nurse should withhold the medication and report this finding to the provider immediately.
Choices A, C, and D are within normal limits and do not require withholding the medication. A fasting blood glucose of 75 mg/dL is normal, urinary output of 40 ml/hr is adequate, and a fetal heart rate of 120/min is also within the normal range for a preterm fetus.
Question 5 of 5
A nurse is using Niagele9s rule to calculate the expected delivery date of a client who reports the first day of the last menstrual cycle was July 28th. Which of the following dates should the nurse document as a client expected delivery date? 07/28
Correct Answer: C
Rationale: The correct answer is C: May 5th.
To calculate the expected delivery date using Naegele's rule, start with the first day of the last menstrual period (July 28th), subtract 3 months, and add 7 days.
Therefore, July 28th - 3 months = April 28th + 7 days = May 5th. This is the estimated due date.
Choice A (April 21st) is incorrect as it does not follow the correct calculation.
Choice B (April 4th) is too early based on the calculation.
Choice D (May 21st) is too late according to Naegele's rule.