ATI RN
ATI RN Maternal Newborn level 3 Final Exam 2023 (All Correct Answers). Maternal-Child Nursing Questions
Extract:
Question 1 of 5
A nurse on a labor and delivery unit is receiving infection control standards with a newly licensed nurse. The nurse should instruct the newly licensed nurse to don gloves for which of the following procedures?
Correct Answer: D
Rationale: The correct answer is D: Performing umbilical cord care. Gloves should be worn during this procedure to prevent the spread of infection. The umbilical cord stump is a potential entry point for bacteria. Assisting a mother with breastfeeding (
A) does not require gloves unless there are open wounds on the breast. Performing a newborn’s initial bath (
B) does not typically require gloves unless there is a specific reason such as the presence of infections. Administering the measles, mumps, rubella vaccine (
C) requires proper aseptic technique but not necessarily gloves unless there is a chance of exposure to blood or body fluids.
Question 2 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 sterile saline saturated towel. This action is essential to prevent compression and protect the exposed cord from infection. By covering the umbilical cord with a sterile saline-saturated towel, the nurse can maintain the cord's moisture and integrity, reducing the risk of cord compression and infection. This step is crucial in managing a prolapsed umbilical cord until emergency interventions can be performed.
Summary:
A: Initiating IV fluids is not the priority in this situation as the immediate concern is to protect the umbilical cord.
B: Performing a vaginal examination by applying upward pressure can further compress the cord and worsen the fetal distress.
C: Administering oxygen is important but is not the immediate priority compared to protecting the umbilical cord.
E, F, G: Not applicable.
Question 3 of 5
A client who is 16 weeks of gestation asks the nurse how to prepare her toddler for a younger sibling.
Correct Answer: B
Rationale: The correct answer is B. Moving the toddler out of the crib 2 weeks before the due date allows the toddler to adjust to the change before the newborn arrives, reducing feelings of displacement or jealousy. Holding the newborn when introducing them may overwhelm the toddler. Placing the toddler in timeout for regressive behavior is not an appropriate or effective way to address their emotions during this transition.
Question 4 of 5
A nurse is assessing a newborn whose mother had a primary cytomegalovirus (CMV) infection during pregnancy. The newborn acquired CMV transplacentally. 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 the newborn, affecting the auditory nerve and causing sensorineural hearing loss. This is because the virus can damage the inner ear structures. Urinary tract infection (
A) is not a typical manifestation of congenital CMV. Macrosomia (
C) refers to excessive birth weight, which is not associated with CMV. Cataracts (
D) are not a common finding in newborns with congenital CMV.
Question 5 of 5
A nurse is caring for a client who has preterm labor and receiving magnesium sulfate by continuous IV infusion. Which of the following laboratory values should the nurse review during tocolytic therapy?
Correct Answer: D
Rationale: The correct answer is D: Serum medication level. When a client is receiving magnesium sulfate by continuous IV infusion for preterm labor, it is crucial to monitor the serum medication level to ensure therapeutic effectiveness and prevent toxicity. Magnesium sulfate has a narrow therapeutic range, so monitoring the serum level helps in adjusting the dosage as needed.
Incorrect
Choices:
A: Indirect Coombs test - This test is used to detect antibodies in the blood that could cause destruction of red blood cells. It is not directly related to monitoring magnesium sulfate therapy.
B: Liver enzymes - While liver enzymes are important for assessing liver function, they are not specifically relevant to monitoring magnesium sulfate therapy.
C: Uric acid level - Monitoring uric acid levels is more commonly associated with conditions like gout or kidney disease, not magnesium sulfate therapy in preterm labor.