ATI RN
ATI RN Maternal Newborn Updated 2023 Questions
Extract:
A client.
Question 1 of 5
Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Verify that informed consent is obtained prior to administration. This is crucial to ensure the client is aware of the risks and benefits of the medication and has given their permission. It upholds the principle of autonomy and protects the client's right to make informed decisions about their healthcare. Placing the client in a semi-Fowler's position (
A) or allowing medication to reach room temperature (
B) are not directly related to ensuring informed consent. Instructing the client to avoid urinary elimination (
C) is unnecessary and could be harmful.
Extract:
A postpartum client who has a prescription for a rubella immunization.
Question 2 of 5
Which of the following client statements indicates understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D because it demonstrates understanding of the teaching regarding the need to avoid pregnancy for at least 1 month following the immunization to prevent any potential harm to the fetus.
Choice A is incorrect because breastfeeding is not contraindicated after immunization.
Choice B is incorrect because it provides incorrect information about the immunization schedule.
Choice C is incorrect because joint pain is a common side effect of some vaccines and does not necessarily require immediate reporting.
Extract:
A client who is in labor.
Question 3 of 5
The nurse observes late decelerations of the fetal heart rate on the external fetal monitor. After placing the client in a side-lying position, which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Administer oxygen via a face mask. Late decelerations indicate uteroplacental insufficiency, causing fetal hypoxia. Administering oxygen improves oxygenation to the fetus by increasing maternal oxygen levels. Placing the client in a side-lying position helps improve uteroplacental perfusion. Decreasing IV fluids may further compromise perfusion. Fetal scalp stimulation is used for non-reassuring fetal heart rate patterns, not specifically for late decelerations. Elevating the client's head does not directly address the fetal distress.
Extract:
A client who has chosen a diaphragm for birth control.
Question 4 of 5
Which of the following instructions should the nurse include?
Correct Answer: B
Rationale: The correct answer is B: Insert the diaphragm up to 6 hr before intercourse. This instruction is correct because diaphragms should be inserted at least 6 hours before intercourse to allow time for it to be effective in preventing pregnancy. Removing it too soon after intercourse (choice
A) would not provide adequate protection. Washing the diaphragm with detergent soap (choice
C) can damage the diaphragm and increase the risk of infection. Applying a vaginal lubricant (choice
D) may interfere with the diaphragm's effectiveness and should be avoided.
Extract:
A postpartum client who delivered vaginally 8 hr ago.
Question 5 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.