ATI RN
ATI RN Maternal Newborn 2023 III Questions
Extract:
The client is a gravida 4, para 3, admitted at 28 weeks of gestation with vaginal bleeding for 2 hours, saturating pads with bright red blood. Abdomen soft, nontender, no pain. Fundal height 27 cm. FHR with minimal variability, no decelerations.
Question 1 of 5
Complete the diagram by specifying what condition the client is most likely experiencing, 2 actions the nurse should take, and 2 parameters to monitor: Condition Choices: A. Placenta previa, B. Abruptio placentae, C. Preterm labor, D. Miscarriage; Action Choices: A. Instruct bed rest, B. Prepare for cesarean, C. Administer tocolytics, D. Monitor vital signs every 15 min, E. Prepare for ultrasound; Parameter Choices: A. Fetal heart rate, B. Maternal blood pressure, C. Maternal heart rate, D. Hemoglobin and hematocrit, E. Uterine contractions
Correct Answer: A
Rationale: Placenta previa matches painless bright red bleeding; bed rest prevents further bleeding, cesarean may be needed; monitor FHR and hemoglobin/hematocrit for fetal well-being and blood loss.
Extract:
A nurse on the postpartum unit is caring for four patients.
Question 2 of 5
For which of the following patients should the nurse notify the provider?
Correct Answer: C
Rationale: Absent deep tendon reflexes in a patient on magnesium sulfate indicate magnesium toxicity, requiring immediate provider notification.
Extract:
A nurse is caring for a 32-year-old female client who is at 28 weeks of gestation,
Nurses Notes
• The client is a gravida 4, para 3. The client was admitted to the labor and delivery unit with a history of vaginal bleeding for 2 hours. The client states, “I started bleeding a couple of hours ago, but now I am saturating pads with bright red blood. I am so scared something is going to happen to my baby.” The abdomen is soft and nontender to palpation. The client reports no abdominal pain. The perineal pad is saturated with bright red vaginal bleeding, and blood is trickling down the client’s legs. Fundal height is at 27 cm. An electronic fetal monitor placed on the client shows FHR with minimal variability and no decelerations. No uterine contractions or uterine irritability noted. Blood was drawn for type and cross-match.
• 0600: Client admitted with a history of vaginal bleeding for 2 hours. Client reports saturating pads with bright red blood. Abdomen soft and nontender. No abdominal pain reported. Perineal pad saturated with bright red blood, blood trickling down legs. Fundal height at 27 cm. FHR with minimal variability, no decelerations. No uterine contractions or irritability noted. Blood drawn for type and cross-match.
Diagnostic Results
• Blood type and cross-match pending.
• Complete blood count (CBC): Hemoglobin 10.5 g/dL, Hematocrit 32%, Platelets 150,000/mm³.
Medical History
• Gravida 4, para 3.
• Previous pregnancies: 1 full-term vaginal delivery, 1 preterm delivery at 34 weeks, 1 miscarriage at 10 weeks.
• No known allergies.
• No history of hypertension or diabetes.
Vital Signs
• Temperature: 37°C (98.6°F)
• Heart rate: 88/min
• Respiratory rate: 18/min
• Blood pressure: 120/80 mmHg
• Oxygen saturation: 98% on room air
Physical Examination Results
• Abdomen: Soft, nontender, fundal height at 27 cm.
• Perineal area: Saturated pad with bright red blood, blood trickling down legs.
• Fetal heart rate: Minimal variability, no decelerations.
• No uterine contractions or irritability noted.
Provider’s Prescriptions
• Bed rest with bathroom privileges.
• Continuous electronic fetal monitoring.
• Administer Rho(D) immune globulin if the client is Rh-negative.
• IV access with normal saline at 125 mL/hr.
• Prepare for possible ultrasound to assess placental location and fetal well-being.
Question 3 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.
Correct Answer:
Rationale: Hematocrit 27%, vaginal bleeding, and FHR 174/min require immediate follow-up due to potential anemia, ongoing hemorrhage, and fetal distress in placenta previa.
Extract:
A 32-year-old female in postpartum unit, cesarean birth due to preeclampsia, given misoprostol, pale, dizzy, cool/clammy skin, no urine since medication.
Question 4 of 5
The nurse is assessing the client 1 hour later. How should the nurse interpret the findings?
| Findings | condition improving | condition worsening | unrelated to the diagnosis |
|---|---|---|---|
| Fundus 2 cm above umbilicus | |||
| BP 90/60, | |||
| HR 110/min | |||
| Heavy bleeding | |||
| Dizziness | |||
| Cloudy urine |
Correct Answer:
Rationale: Fundus 2 cm above, HR 110/min, heavy bleeding, dizziness worsening (hemorrhage); BP 90/60 improving (post-preeclampsia); cloudy urine unrelated.
Extract:
The newborn is a male, born at 38 weeks via vacuum-assisted birth. Mother GBS positive, received ampicillin. Initial assessment: weak cry, acrocyanosis, flaccid tone, temp 36.3°C (97 prefixes4°F).
Question 5 of 5
A nurse is assessing the newborn 24 hours later. Based on the exhibits, which findings indicate the newborn's condition is improving, worsening, or unrelated? Options: A. WBC 18,000/mm³, B. Hgb 18 g/dL, C. Hct 55%, D. Glucose 50 mg/dL, E. Temp 36.8°C, F. HR 130/min
Correct Answer: A
Rationale: WBC 18,000/mm³, glucose 50 mg/dL, temp 36.8°C, and HR 130/min improving within normal ranges; Hgb 18 g/dL and Hct 55% unrelated, normal for newborns.