ATI RN
ATI Maternal Newborn Proctored Exam Latest Update Questions
Extract:
Question 1 of 5
A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn?
Correct Answer: D
Rationale: The correct answer is D: Place the newborn skin to skin on the mother's chest. This technique, known as kangaroo care, helps minimize pain during procedures by providing comfort, warmth, and security to the newborn. The close physical contact with the mother can reduce stress and promote relaxation, leading to decreased perception of pain. Additionally, the release of oxytocin during skin-to-skin contact can further alleviate discomfort for the newborn.
Applying a cool pack (choice
A) may actually increase pain and vasoconstriction, making the heel stick more uncomfortable. Requesting an IM analgesic (choice
B) is unnecessary and may expose the newborn to unnecessary medications. Using a manual lancet blade (choice
C) can be painful and may not provide the same comfort and pain relief as skin-to-skin contact.
Question 2 of 5
Two days after delivery, a postpartum client prepares for discharge. What should the nurse teach her about lochia flow?
Correct Answer: D
Rationale: The correct answer is D. Lochia normally lasts for about 21 days, and changes from bright red to pinkish-brown to creamy white. This is accurate because the process of lochia flow typically follows this pattern as the uterus sheds its lining post-delivery. Lochia rubra occurs in the first few days due to blood, then transitions to serosa and alba as the bleeding decreases.
Choice A is incorrect as it presents the correct information but in a confusing manner.
Choices B and C are incorrect because they focus on abnormal findings rather than the normal progression of lochia.
Question 3 of 5
A nurse monitors fetal well-being by means of an external monitor. At the peak of the contractions, the fetal heart rate has repeatedly dropped 30 beats/min below the baseline. Late decelerations are suspected and the nurse notifies the physician. Which is the rationale for this action?
Correct Answer: D
Rationale: The correct answer is D because late decelerations are associated with uteroplacental insufficiency, indicating fetal hypoxia. During contractions, the placenta may not be receiving enough oxygen and nutrients, leading to decreased oxygen supply to the fetus, resulting in late decelerations. Repeated late decelerations indicate ongoing fetal distress and the need for immediate intervention to prevent further complications.
Choices A, B, and C are incorrect because they do not accurately reflect the characteristics and causes of late decelerations. A nuchal cord is associated with variable decelerations, not late decelerations. Variable decelerations are due to cord compression, not late decelerations. Late decelerations are indeed a result of hypoxia, but they are specifically related to uteroplacental insufficiency, not reflective of the strength of maternal contractions.
Question 4 of 5
Which preoperative nursing interventions should be included for a client who is scheduled to have an emergency cesarean birth?
Correct Answer: B
Rationale: The correct answer is B. Assessing vital signs every 15 minutes is crucial in an emergency cesarean birth to monitor the client's condition. Instructing the client about postoperative care ensures they are well-prepared. Alleviating anxiety is important for the client's emotional well-being. Inserting an indwelling catheter is also necessary for bladder emptying to prevent injury during surgery.
Choice A is incorrect because oxygen saturation monitoring is not typically a preoperative intervention for a cesarean birth, and administering pain medication may not be necessary preoperatively.
Choice C is incorrect as a sterile vaginal examination is not indicated before a cesarean birth, and assessing breath sounds does not directly relate to preoperative care for this procedure.
Choice D is incorrect because although anxiety management and indwelling catheter insertion are important, the rationale provided is not directly related to preoperative care for a cesarean birth.
Question 5 of 5
Which nursing instruction should be given to the breastfeeding mother regarding care of the breasts after discharge?
Correct Answer: C
Rationale: The correct answer is C. It is important to stimulate adequate milk production by pumping if the infant is not sucking or eating well, or if the breasts are not fully emptied. This helps maintain milk supply and prevents engorgement. Option A is incorrect as giving a bottle of formula does not effectively relieve engorgement and can lead to decreased milk production. Option B is incorrect as applying lotion to the nipples is not necessary and may introduce harmful microorganisms. Option D is incorrect as using soap can dry the nipples and lead to cracking, and giving formula is not the recommended solution for engorgement.