ATI RN
ATI RN Maternal Newborn Updated 2023 Questions
Extract:
A postpartum client who delivered vaginally 8 hr ago.
Question 1 of 5
Select the 3 findings that require immediate follow-up.
Correct Answer: B,C,D
Rationale: The correct findings that require immediate follow-up are B: Lateral deviation of the uterus, C: Large amount of lochia rubra, and D: Uterine tone soft. Lateral deviation of the uterus could indicate a uterine anomaly or complication post-delivery. Large amount of lochia rubra may suggest excessive bleeding, which needs to be assessed promptly. Soft uterine tone can be a sign of uterine atony, a serious postpartum complication. Peripheral edema, soft breasts, low deep tendon reflexes, and mild pain rating do not typically require immediate intervention or follow-up.
Extract:
A newborn who was born at 39 weeks of gestation and is 36 hours old.
Question 2 of 5
Which of the following findings should the nurse report to the provider? Select all that apply.
Correct Answer: C,D,F
Rationale: The nurse should report findings that indicate potential issues requiring provider intervention. Coombs test result (
C) is crucial for detecting autoimmune hemolytic anemia. Abnormal sclera color (
D) may indicate liver dysfunction or jaundice. Intake and output (F) are essential for monitoring fluid balance. Glucose level (
A) is important but typically not an urgent concern. Head assessment finding (
B) may be relevant, but it depends on the specific abnormality. Heart rate (E) and mucous membrane assessment (G) are vital but generally do not require immediate provider notification.
Extract:
A client who is in labor and experiences abruptio placenta.
Question 3 of 5
Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Uterine tenderness. In the context of pregnancy, uterine tenderness may indicate a potential issue such as uterine infection or preterm labor. It is important for the nurse to assess this finding further to ensure the safety of the mother and baby. Hypertension (choice
A) may indicate preeclampsia, fetal tachycardia (choice
C) may suggest fetal distress, and leukorrhea (choice
D) is a common finding in pregnancy.
Choices E, F, and G are not provided.
Extract:
A client who is at 28 weeks of gestation and received no immunizations during childhood.
Question 4 of 5
Which of the following vaccines should the nurse plan to administer?
Correct Answer: C
Rationale: The correct answer is C: Tetanus. Tetanus vaccine should be administered routinely to prevent tetanus, a serious bacterial infection. The other choices are incorrect because: A: Human papillomavirus vaccine is typically given to prevent HPV-related cancers; B: Rubella vaccine is given to prevent rubella, a viral infection that can cause birth defects; D: Varicella vaccine is given to prevent chickenpox, a viral infection. In this case, the nurse should plan to administer the tetanus vaccine for routine preventive care.
Extract:
A newborn who was born via a forceps-assisted birth.
Question 5 of 5
Which of the following findings should the nurse identify as an injury caused by the forceps?
Correct Answer: D
Rationale: The correct answer is D: Facial asymmetry. Forceps during delivery can cause pressure and trauma to the baby's face, leading to facial asymmetry. The forceps compress one side of the face more than the other, resulting in an uneven appearance. Depressed anterior fontanel (
A) is not typically associated with forceps delivery. Uneven gluteal skinfolds (
B) and epicanthal folds (
C) are not specific indicators of forceps injury. In summary, facial asymmetry is a common finding in babies delivered with forceps due to the pressure exerted on the face during delivery.