ATI RN
ATI RN Maternal Newborn 2023 II Questions
Extract:
A nurse in a prenatal clinic is caring for a group of clients.
Question 1 of 5
The nurse should recognize that which of the following clients has a contraindication for a contraction stress test?
Correct Answer: B
Rationale: The correct answer is B because a client with a previous classical incision (vertical uterine incision) is at risk for uterine rupture during a contraction stress test due to the weakened uterine wall. A uterine rupture can lead to severe complications for both the mother and the baby. Clients with previous classical incisions should not undergo contraction stress tests.
Choice A is incorrect because a previous stillbirth is not a contraindication for a contraction stress test.
Choice C is incorrect as gestational diabetes mellitus alone is not a contraindication for the test.
Choice D is also incorrect as a nonreactive nonstress test does not directly contraindicate a contraction stress test.
Extract:
A nurse is planning care for a client who is 1 hr postpartum and has peripartum cardiomyopathy.
Question 2 of 5
Which of the following actions should the nurse plan to take?
Correct Answer: A
Rationale: The correct answer is A: Restrict daily oral fluid intake. This is the appropriate action for a patient with fluid overload, as it helps manage fluid balance. Restricting fluid intake can prevent further fluid accumulation and complications. Administering an IV bolus of lactated Ringer's (
B) would worsen fluid overload. Assessing blood pressure twice daily (
C) is important but not the priority in managing fluid overload. Obtaining a prescription for misoprostol (
D) is unrelated to managing fluid overload.
Extract:
A nurse is caring for a client who has bladder distention following a vaginal birth.
Question 3 of 5
Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct answer is A: Escort the client to the bathroom. This action should be taken first to address the immediate need of the client for toileting. It promotes the client's comfort, maintains their dignity, and prevents potential complications like urinary retention. Option B (Offer the client a sitz bath) and C (Pour warm water over the client's perineum) are not priorities as they do not address the client's urgent need for toileting. Option D (Insert a urinary catheter) is an invasive procedure and should not be the first action unless indicated for a specific medical reason. Options E and F (None) are not appropriate as there is a clear immediate need that requires action.
Extract:
A nurse is caring for a client who is in the second stage of labor and is experiencing a shoulder dystocia. The provider instructs the nurse to perform the McRoberts maneuver.
Question 4 of 5
Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct action is D: Assist the client in pulling their knees toward their abdomen. This helps facilitate the delivery of the baby by opening up the pelvis and promoting the descent of the fetus. Moving the client onto their hands and knees (
A) may help in certain situations but is not as effective as D. Applying pressure to the fundus (
B) can cause complications. Pressing on the suprapubic area (
C) may not be helpful in this situation.
Therefore, option D is the most appropriate choice to assist in the birthing process.
Extract:
A nurse is reviewing the prescriptions for a client who is pregnant and is taking digoxin.
Question 5 of 5
Which of the following actions should the nurse take to best evaluate the client's medication adherence?
Correct Answer: C
Rationale: The correct answer is C: Check the client's serum medication level. Monitoring the client's serum medication level directly assesses medication adherence by measuring the actual concentration of the drug in the client's bloodstream. This objective measure provides concrete evidence of whether the client is taking the medication as prescribed. Asking the client (choice
A) may not always yield accurate information due to potential bias or forgetfulness. Determining the apical pulse rate (choice
B) is not directly related to medication adherence. Assessing kidney function (choice
D) is important but does not directly evaluate medication adherence.