Questions 49

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ATI N230 Exam 3 with NGN Maternal Newborn Exam Questions

Extract:

A nurse is assessing a newborn the day after delivery. The nurse notes a raised, bruised area on the left side of the scalp that does not cross the suture line.


Question 1 of 5

How should the nurse document this finding?

Correct Answer: D

Rationale: Cephalhematoma is a collection of blood under the periosteum, confined by suture lines, often with bruising, matching the description.

Extract:

A nurse is providing teaching about comfort measures for breast engorgement to a client who is postpartum and is breastfeeding.


Question 2 of 5

Which of the following statements by the client indicates a need for further teaching?

Correct Answer: B

Rationale: Hot packs during feeding can worsen engorgement by increasing blood flow; ice, cabbage leaves, and frequent feeding are appropriate measures.

Extract:

A nurse is preparing to administer vitamin K by IM injection to a newborn.


Question 3 of 5

The nurse should administer the medication into which of the following muscles?

Correct Answer: B

Rationale: The vastus lateralis is the preferred site for IM injections in newborns due to its size and accessibility, minimizing risk to other structures.

Extract:

A nurse is caring for a newborn immediately following birth.


Question 4 of 5

After assuring a patent airway, what is the priority nursing action?

Correct Answer: A

Rationale: Drying the skin prevents evaporative heat loss, which is critical immediately after birth to maintain thermoregulation, taking precedence over other actions.

Extract:

A nurse is caring for a client who reports unrelieved episiotomy pain 8 hours following a vaginal birth.


Question 5 of 5

Which of the following actions should the nurse take?

Correct Answer: D

Rationale: A warm sitz bath promotes healing and relieves episiotomy pain by increasing blood flow and relaxing muscles, more effective for persistent pain than other options.

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