ATI RN
ATI RN Maternal Newborn Latest Update. Questions
Extract:
Question 1 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 hyperstimulation, increasing the risk of postpartum hemorrhage.
C) Vacuum-assisted delivery can cause trauma to the birth canal, leading to excessive bleeding.
D) A history of uterine atony indicates a weak uterine muscle tone, which is a significant risk factor for postpartum hemorrhage.
B) Newborn weight and E) history of human papillomavirus are not directly related to postpartum hemorrhage.
Question 2 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.
Question 3 of 5
A nurse is assessing a client who is 1 hr postpartum following a vaginal birth. The nurse notes that the client has excessive vaginal bleeding. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct answer is A: Massage the client's fundus. This is the first action the nurse should take because excessive vaginal bleeding postpartum could indicate uterine atony, which is a common cause of postpartum hemorrhage. Massaging the fundus helps stimulate uterine contractions, which can help control bleeding. This should be done before administering medications like oxytocin (
B) or providing oxygen (
D), as addressing the underlying cause is crucial. Emptying the bladder (
C) is important but comes after addressing the uterine atony.
Question 4 of 5
A nurse is assessing a client who is 3 days postpartum. Which of the following findings should the nurse report to the provider?
Correct Answer: A
Rationale: The correct answer is A: Cool, clammy skin. This finding could indicate hypovolemic shock, a serious postpartum complication. The nurse should report this to the provider immediately for further evaluation and intervention to prevent deterioration. Lochia serosa at 3 days postpartum is normal, as is a heart rate of 89/min and blood pressure of 120/70 mm Hg. These vital signs and lochia color suggest normal postpartum recovery. Reporting cool, clammy skin is crucial to prevent potential complications.
Extract:
A nurse is caring for a client who is at 33 weeks of gestation.
Diagnostic Results:
• Proteinuria 3+, straw-colored urine
• Platelet count 150,000/mm3 (150,000 to 400,000/mm3)
• BUN 18 mg/dL (10 to 20 mg/dL)
Question 5 of 5
The nurse is assessing the client 24 hr later. How should the nurse interpret the findings?
| Findings 24 hr later | Sign of potential worsening condition | Sign of potential improvement | Unrelated to diagnosis |
|---|---|---|---|
| Hematuria | |||
| Proteinuria 2+ | |||
| Leukorrhea | |||
| Positive clonus | |||
| BUN 40 mg/dL | |||
| Platelet count 110,000/mm3 |
Correct Answer:
Rationale:
Correct Answer:
Rationale: The nurse should interpret Proteinuria 2+ as a sign of a potential worsening condition due to kidney damage. Hematuria could indicate a urinary tract issue but is less specific than proteinuria for this client. Leukorrhea is unrelated to the diagnosis. Positive clonus is typically associated with neurological issues, not related to kidney function. BUN and platelet count are not provided in the table, so they should not be considered in the interpretation.