ATI RN
ATI RN Maternal Newborn 2023 II Questions
Extract:
A nurse is preparing to obtain a blood sample from a newborn's heel.
Question 1 of 5
In what order should the nurse perform the procedure?
Order the Items
Source Container
Correct Answer: A, B, C, D, E
Rationale: The correct order for the nurse to perform the procedure is A, B, C, D, E. First, applying a warm cloth to the newborn's heel for 5 to 10 min helps dilate the blood vessels for easier blood collection. Second, cleaning the area with an antiseptic prevents infection during the puncture. Third, puncturing the outer aspect of the newborn's heel allows for blood collection. Fourth, collecting the blood specimen is the main objective of the procedure. Finally, applying pressure to the site with a dry gauze pad helps stop bleeding and promotes healing.
Choices F and G are not provided in the question, so they are not applicable.
Extract:
A nurse is preparing to perform Leopold maneuvers on a client who is at 36 weeks of gestation.
Question 2 of 5
Identify the sequence of actions the nurse should take.
Order the Items
Source Container
Correct Answer: A, B, D, E, C
Rationale: The correct order is A, B, D, E, C. Firstly, instructing the client to empty their bladder ensures a clearer examination. Positioning the client supine with knees flexed and placing a small, rolled towel under one hip helps relax the abdominal muscles for better palpation of the fundus (
D). Palpating the fetal parts along both sides of the uterus (E) helps determine the fetal position. Finally, palpating the fetal part positioned above the symphysis pubis (
C) allows for confirmation of the fetal presentation. This sequence ensures a systematic and thorough assessment of the fetal position and presentation.
Extract:
A nurse is caring for an infant who has signs of neonatal abstinence syndrome.
Question 3 of 5
Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Initiate seizure precautions. This is crucial in caring for an infant at risk for seizures. Seizure precautions involve ensuring a safe environment, padding the crib, keeping the infant away from sharp objects, and having emergency medications ready. Placing the infant on his back with legs extended (
A) is the recommended sleep position but not directly related to seizure precautions. Providing a stimulating environment (
B) may not be appropriate for an infant at risk for seizures. Monitoring blood glucose every hour (
C) is not typically done for seizure precautions unless there is a specific indication.
Extract:
A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS.
Question 4 of 5
She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?
Correct Answer: D
Rationale: The correct answer is D because testing for Group B Streptococcus (GBS) is typically done closer to the time of delivery to determine the current status of GBS colonization, which can change throughout pregnancy. Testing earlier may not accurately reflect the GBS status at delivery.
Choice A is incorrect as the presence of symptoms is not always indicative of GBS colonization.
Choice B is incorrect as GBS status can change between pregnancies.
Choice C is incorrect because previous prenatal testing does not guarantee GBS status at delivery.
Extract:
A nurse is caring for a client who is at 20 weeks of gestation and has trichomoniasis.
Question 5 of 5
Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Malodorous discharge. This finding is indicative of a possible vaginal infection, such as bacterial vaginosis or trichomoniasis. Malodor suggests an overgrowth of harmful bacteria or other pathogens in the vaginal flora. Vulva lesions (
A) may indicate a different issue like herpes or genital warts. Urinary frequency (
C) is more common in conditions like urinary tract infections. Thick, white vaginal discharge (
D) is typical of a yeast infection, not necessarily malodorous. In summary, malodorous discharge is the most concerning finding as it suggests an active infection requiring prompt evaluation and treatment.