ATI RN
ATI Maternal Newborn Proctored Exam Latest Update Questions
Extract:
Question 1 of 5
During the active phase of labor, the membranes rupture and the nurse notes green amniotic fluid. Which nursing action should be initiated immediately?
Correct Answer: D
Rationale: The correct answer is D: Assess fetal heart rate. This is because green amniotic fluid indicates meconium staining, which can be a sign of fetal distress. Assessing the fetal heart rate is essential to determine the well-being of the baby and to ensure timely intervention if needed. Calling the physician (
A) can be done after assessing the fetal heart rate. Replacing the underpad (
B) is not a priority over assessing fetal well-being. Testing the fluid with pH paper (
C) may confirm the presence of meconium but does not provide immediate information about fetal status.
Question 2 of 5
A nurse is caring for a child with acute glomerulonephritis. The child has edema, hypertension, and gross hematuria. Which of the following is the most appropriate nursing intervention?
Correct Answer: C
Rationale: The correct answer is C: Weigh the child daily and record intake and output. This intervention is crucial in monitoring fluid balance and kidney function in a child with acute glomerulonephritis. Daily weights help assess for fluid retention, while intake and output measurements help evaluate kidney function. Edema, hypertension, and gross hematuria are key symptoms of this condition, indicating the need for close monitoring.
Choice A is incorrect because monitoring oxygen saturation is not directly related to the management of acute glomerulonephritis.
Choice B is also incorrect as dietary restrictions regarding protein are not the priority in this situation.
Choice D is incorrect as counseling about follow-up is important but not the most immediate intervention needed.
Question 3 of 5
A 16-year-old client reports to the school nurse because of nausea and vomiting. After exploring the signs and symptoms with the client, the nurse asks the girl whether she could be pregnant. The girl confirms that she is pregnant, but states that she does not know how it happened. Which nursing diagnosis is most important?
Correct Answer: D
Rationale: The correct answer is D: Knowledge deficit related to the client's developmental stage and age. This nursing diagnosis is most important because the 16-year-old client's lack of understanding about how pregnancy occurs indicates a significant gap in knowledge. It is crucial to provide education to help the client make informed decisions about her health and pregnancy.
Choice A (Altered nutrition) is not the most important because addressing the client's lack of knowledge takes precedence over nutritional concerns.
Choice B (Risk for altered family processes) is not the priority as the immediate focus should be on educating the client.
Choice C (Ineffective coping) may be a concern but addressing knowledge deficit is more critical.
In summary, the client's lack of understanding about pregnancy and her developmental stage make addressing the knowledge deficit the priority nursing diagnosis in this situation.
Question 4 of 5
A nurse provided discharge teaching to new parents on how to care for their newborn following circumcision. Which of the following statements by the parents indicates the need for further clarification?
Correct Answer: D
Rationale:
Correct Answer: D - "I can give him a tub bath in two days."
Rationale:
1. The correct answer is D because newborns who have undergone circumcision should avoid tub baths until the circumcision is fully healed to prevent infection.
2. A: Leaving the yellow exudate is correct as it is a normal part of the healing process.
3. B: Cleaning the penis with each diaper change is important to prevent infection.
4. C: Circumcision typically heals within a couple of weeks, so this statement is accurate.
5.
Choice D is incorrect because it suggests giving a tub bath too soon, which could lead to complications.
Question 5 of 5
A client asks the nurse about the benefits of breastfeeding. Which response by the nurse provides the most accurate information?
Correct Answer: C
Rationale: The correct answer is C: Breast milk is easier to digest than formula. Breast milk is specifically designed to be easily digested by infants, leading to less digestive issues compared to formula. This is important for the baby's overall health and well-being.
Choice A is incorrect because weight loss varies among individuals and should not be the primary reason for breastfeeding.
Choice B is incorrect as breast milk contains the right balance of nutrients but not necessarily a greater amount of protein compared to formula.
Choice D is incorrect as breastfeeding is not a reliable method of contraception.