ATI RN
ATI Maternal Newborn Proctored Exam Latest Update Questions
Extract:
Question 1 of 5
During active labor, after a sudden slowing of the fetal heart rate, the nurse assesses the woman's perineum and observes a prolapsed cord. Which nursing action is most appropriate?
Correct Answer: A
Rationale: The correct answer is A: Hold the presenting part away from the cord. This action helps alleviate pressure on the cord, ensuring continued blood flow to the fetus. Holding the presenting part away from the cord prevents further cord compression and potential fetal distress. Option B: Inserting a scalp electrode is not the priority as managing the cord prolapse is crucial for fetal well-being. Option C: Placing the client in reverse Trendelenburg position may worsen the cord compression. Option D: Covering the cord with gauze does not address the immediate risk of cord compression.
Question 2 of 5
A nurse is caring for a client who is at 22 weeks of gestation and is HIV positive. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Report the client’s condition to the local health department. This is important to ensure proper monitoring, contact tracing, and support for the client and public health. Administering penicillin G (choice
A) is not indicated for HIV positive individuals. Instructing the client to schedule an annual pelvic exam (choice
B) is not a priority in this situation. Starting medication for HIV after delivery (choice
C) may delay necessary treatment for the client.
Therefore, reporting the client's condition to the local health department is the most appropriate action to ensure comprehensive care and public health measures.
Question 3 of 5
Which assessment finding indicates that placental separation has occurred during the third stage of labor?
Correct Answer: D
Rationale: The correct answer is D: Lengthening of the umbilical cord. This is indicative of placental separation because as the placenta detaches from the uterine wall, the cord lengthens due to the release of tension. This signals successful completion of the third stage of labor.
Incorrect choices:
A: Decreased vaginal bleeding is not a reliable indicator of placental separation.
B: Contractions stopping may occur after the placenta is delivered, but it is not a definitive sign of placental separation.
C: Maternal shaking and chills can be caused by various factors and are not specific to placental separation.
Question 4 of 5
An hour after delivery, the nurse instills erythromycin (Ilotycin) ointment into the eyes of a newborn. The main objective of the treatment is to prevent infection caused by which organism?
Correct Answer: B
Rationale: The correct answer is B: Gonorrhea. Erythromycin ointment is used to prevent ophthalmia neonatorum, an eye infection in newborns caused by Neisseria gonorrhoeae, the bacteria responsible for gonorrhea. This infection can lead to blindness if left untreated. Rubella, Syphilis, and HIV are not prevented by erythromycin ointment. Rubella is a viral infection, syphilis is caused by Treponema pallidum bacteria, and HIV is a retrovirus.
Therefore, the main objective of the treatment is to prevent gonorrhea infection in the newborn's eyes.
Question 5 of 5
Which data support a diagnosis of abruptio placenta in a pregnant woman?
Correct Answer: A
Rationale: The correct answer is A: Uterine rigidity and abdominal pain. In abruptio placenta, the placenta detaches prematurely from the uterine wall, leading to uterine rigidity and intense abdominal pain due to blood accumulating behind the placenta. Painless bleeding with a soft abdomen (
Choice
B) is more indicative of placenta previa. Premature rupture of membranes and uterine contractions (
Choice
C) are signs of preterm labor or premature rupture of membranes, not specific to abruptio placenta. Bright red blood loss and elevated blood pressure (
Choice
D) are more consistent with conditions like placenta previa or preeclampsia.