Extract:

The nurse is performing a newborn physical assessment.

Question 1 of 5

The nurse is performing a newborn physical assessment and is about to elicit the Moro reflex. Which of the following responses should the nurse expect to see?

A. The cheek of the newborn is touched, and the newborn turns toward the side that was touchedB. The newborn is suddenly lowered or startled, and they extend their arms, legs and neck, then rapidly bring their arms togetherC. The newborn is supine and their head is turned to one side, then the arm on that same side extendsD. The lateral aspect of the sole of the newborn's foot is stroked, and the toes extend and fan outward

Correct Answer: B

Rationale: The Moro reflex involves arm and leg extension then adduction when startled, indicating neurological health, unlike the other reflexes described.

Extract:

A client following an amniotomy who is now in the active phase of the first stage of labor

Question 2 of 5

A nurse is caring for a client following an amniotomy who is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?

A. Maintain the client in the lithotomy position.B. Encourage the client to empty her bladder every 2 hr.C. Remind the client to bear down with each contraction.D. Perform vaginal examinations frequently.

Correct Answer: B

Rationale: Encouraging bladder emptying every 2 hours prevents obstruction of fetal descent. Lithotomy is for delivery, bearing down is for the second stage, and frequent exams risk infection.

Extract:

A laboring client in the active phase of the first stage of labor.

Question 3 of 5

A client who is in labor is in the active phase of the first stage. Which of the following assessment findings would the nurse expect?

A. Contractions every 8 to 10 minutes lasting 20 secondsB. Complete cervical effacementC. Cervical dilation of 6 cmD. Rupture of membranes with pink-tinged amniotic fluid

Correct Answer: C

Rationale: Active phase involves 4-8 cm dilation, with 6 cm typical, unlike the other findings which occur in different stages or are nonspecific.

Extract:

A full-term infant with a slightly decreased temperature.

Question 4 of 5

The nurse's initial action when caring for an otherwise stable, full term infant with a slightly decreased temperature is to:

A. Place the infant skin to skin with the mother and re-check temperature in 30 minutesB. Check the infant's CBC and blood cultures, as this is a sign of probable sepsisC. Return the infant to the nursery for close observation under warming lightsD. Notify the physician immediately and suggest orders for placement in an incubator

Correct Answer: A

Rationale: Skin-to-skin contact effectively warms a stable infant while promoting bonding, avoiding unnecessary interventions like blood tests or incubator use.

Extract:

After the birth of a newborn.

Question 5 of 5

After the birth of a newborn, the nursing intervention that most effectively promotes parental attachment is:

A. Taking the newborn to the nursery for the initial assessmentB. Allowing the mother a chance to rest without the baby immediately after deliveryC. Placing the newborn under a radiant warmer to do the initial assessmentD. Placing the newborn on the maternal abdomen and doing the initial assessment

Correct Answer: D

Rationale: Skin-to-skin contact on the abdomen fosters bonding and breastfeeding, unlike interventions that separate mother and baby.

Nurselytic

ATI RN

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ATI Maternity Exam 3 Questions

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Question 1 of 5

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Question 2 of 5

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