ATI RN
ATI RN Maternal Newborn Latest Update. Questions
Extract:
Question 1 of 5
A nurse is teaching about car seat safety to the parents of a newborn who was delivered at 38 weeks of gestation. Which of the following statements by a parent indicates an understanding of the teaching?
Correct Answer: C
Rationale: The correct answer is C: "The car seat should be positioned in the car at a 45-degree angle." This statement demonstrates understanding because it aligns with the recommendation for newborns to be positioned at a 45-degree angle in a rear-facing car seat to prevent head flop and ensure proper breathing. This angle helps maintain an open airway and reduces the risk of suffocation. Incorrect answers: A suggests using a sleep sack, which may interfere with the harness straps and compromise safety. B is incorrect as a car seat challenge test is typically done for premature infants, not full-term newborns. D is incorrect as the recommendation is to keep infants in a rear-facing position until they reach the height or weight limit specified by the car seat manufacturer, typically beyond the age of 1.
Question 2 of 5
A nurse is obtaining a 2-hr postprandial blood glucose from a client. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Select the lateral side of the finger for puncture. This is because the lateral side of the finger has fewer nerve endings, making it less painful for the client. Puncturing this area also minimizes the risk of nerve damage and ensures a more accurate blood sample. Smearing blood onto a reagent strip (choice
B) can lead to inaccurate results. Puncturing the finger while still damp with antiseptic solution (choice
A) can dilute the blood sample. Holding the finger above the heart prior to puncture (choice
C) can affect the blood flow and lead to inaccurate results.
Question 3 of 5
A nurse is performing an initial assessment of a newborn who was delivered with a nuchal cord. Which of the following clinical findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Facial petechiae. Nuchal cord occurs when the umbilical cord is wrapped around the baby's neck during delivery. This can cause pressure on the baby's face, leading to small red or purple spots called petechiae. The rationale is that the pressure from the nuchal cord can result in capillary rupture, manifesting as petechiae on the baby's face. Telangiectatic nevi (
A), periauricular papillomas (
C), and erythema toxicum (
D) are unrelated to nuchal cord and would not be expected findings in this scenario.
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.
Question 5 of 5
A nurse is caring for a client who is 12 hr postpartum and has a fourth-degree laceration of the perineum. Which of the following actions should the nurse take?
Correct Answer: A
Rationale:
Correct Answer: A - Apply a moist, warm compress to the perineum.
Rationale: Applying a moist, warm compress helps to reduce swelling and promote healing in the perineal area. This can provide comfort and pain relief for the client with a fourth-degree laceration. It also helps to increase blood flow to the area, aiding in the healing process.
Summary of other choices:
B: Providing a cool sitz bath may not be appropriate for a fourth-degree laceration as warmth is usually more soothing and beneficial.
C: Administering methylergonovine may be contraindicated as it can cause uterine contractions and increase the risk of bleeding in a client with a fourth-degree laceration.
D: Applying povidone-iodine may be too harsh for the delicate perineal area and can potentially cause irritation or delay healing.