ATI RN
ATI Nur 232 Maternity Final Exam SP24 Questions
Extract:
A nurse is caring for a client who is at 38 weeks of gestation and is in the first stage of labor.
Question 1 of 5
Which of the following assessment findings should the nurse report to the provider first?
Correct Answer: C
Rationale: A continuous contraction lasting 2 minutes is abnormal and may indicate uterine hyperstimulation or tetanic contractions, requiring immediate reporting to prevent fetal distress.
Extract:
A nurse is caring for a client who had a vaginal delivery 2 hours ago.
Question 2 of 5
Which of the following actions should the nurse anticipate in the care of this client? (Select all that apply.)
Correct Answer: A, C, E
Rationale: Observing lochia assesses bleeding, determining fundus position ensures proper uterine contraction, and administering methylergonovine maleate may be needed for a boggy uterus. Massaging a firm fundus and documenting fundal height are not typically required.
Extract:
A nurse is caring for a client who is in active labor and notes late decelerations on the fetal monitor.
Question 3 of 5
Which of the following is the priority nursing action?
Correct Answer: A
Rationale: Positioning the client on her side is the priority to improve placental blood flow and address late decelerations indicating fetal hypoxia.
Extract:
A nurse is preparing to administer vitamin K.
Question 4 of 5
Which of the following muscles should the nurse consider for the injection?
Correct Answer: B
Rationale: The vastus lateralis is the preferred site for vitamin K injection in infants due to its size and safety.
Extract:
A nurse in a prenatal clinic is caring for a client who is at 39 weeks of gestation and who asks about the signs that precede the onset of labor.
Question 5 of 5
Which of the following should the nurse identify as a sign that precedes labor?
Correct Answer: D
Rationale: A surge of energy, or 'nesting,' is a common sign preceding labor. Increased vaginal discharge, sudden weight gain, and urinary retention are not typical pre-labor signs.