ATI RN
ATI RN Maternal Newborn 2023 II Questions
Extract:
A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hr. ago.
Question 1 of 5
Which of the following findings place the client at risk for postpartum hemorrhage? (Select all that apply.)
Correct Answer: C, D, E
Rationale:
Correct Answer: C, D, E
Rationale:
C: Labor induction with oxytocin increases the risk of postpartum hemorrhage due to uterine hyperstimulation leading to poor uterine muscle contractions.
D: History of uterine atony indicates weak uterine muscles, which can result in ineffective contraction post-delivery, leading to hemorrhage.
E: Vacuum-assisted delivery can cause trauma to the birth canal and uterus, increasing the risk of postpartum hemorrhage.
Summary of Incorrect
Choices:
A: Newborn weight is not a direct risk factor for postpartum hemorrhage.
B: History of human papillomavirus does not predispose to postpartum hemorrhage.
F, G: No information provided.
Extract:
A nurse at an antepartum clinic is caring for four clients.
Question 2 of 5
Which of the following clients should the nurse assess first?
Correct Answer: C
Rationale: The correct answer is C. The nurse should assess the client at 8 weeks of gestation reporting severe vomiting first as it may indicate hyperemesis gravidarum, a serious condition causing dehydration and electrolyte imbalances, risking maternal and fetal health. Severe vomiting can lead to complications like malnutrition and weight loss, affecting the developing fetus. Assessing this client first is crucial to provide immediate interventions and prevent further harm.
Other choices are less urgent: A - tingling fingers can be related to carpal tunnel syndrome common in pregnancy; B - back pain post-intercourse is common in late pregnancy due to pressure on the pelvis; D - frequent urination is a common early pregnancy symptom. These symptoms are not as concerning as severe vomiting, making choice C the priority.
Extract:
A nurse is providing information about newborn security to the parents of a newborn.
Question 3 of 5
Which of the following instructions should the nurse provide?
Correct Answer: D
Rationale: The correct answer is D. Checking identification badges of staff who enter the room is crucial for ensuring the safety and security of the newborn and the mother. By verifying the identity of the staff, the nurse can prevent unauthorized individuals from accessing the room and potentially harming the newborn or the mother. This practice also helps in maintaining a secure and controlled environment within the healthcare setting.
Choice A is incorrect because limiting visitors to immediate family may not address all potential risks to the newborn and mother.
Choice B is incorrect as sending the newborn to the nursery while the mother is sleeping may disrupt bonding and breastfeeding.
Choice C is incorrect as removing the electronic monitoring band can compromise the monitoring of the newborn's vital signs.
Extract:
A nurse is reviewing laboratory findings for a client who is at 20 weeks of gestation.
Question 4 of 5
Which of the following findings should the nurse report to the provider?
Correct Answer: B
Rationale: The correct answer is B: Fasting blood glucose 180 mg/dL (74 to 106 mg/dL). This finding indicates hyperglycemia, which can be a sign of diabetes or other underlying health issues requiring immediate attention. The nurse should report this to the provider for further evaluation and management to prevent complications.
A: WBC count 11,000/mm3 - Slightly elevated WBC count is common and may not warrant immediate reporting unless there are other concerning symptoms.
C: Hematocrit 37% - Falls within normal range and does not indicate any immediate issues.
D: Creatinine 0.9 mg/dL - Normal creatinine levels suggest healthy kidney function and do not require urgent reporting.
In summary, the nurse should report the high fasting blood glucose level as it signifies a potential health problem that needs prompt attention, while the other choices fall within normal ranges and do not require immediate reporting.
Extract:
A nurse is preparing to obtain a blood sample from a newborn's heel.
Question 5 of 5
In what order should the nurse perform the procedure?
Order the Items
Source Container
Correct Answer: A, B, C, D, E
Rationale: The correct order for the nurse to perform the procedure is A, B, C, D, E. First, applying a warm cloth to the newborn's heel for 5 to 10 min helps dilate the blood vessels for easier blood collection. Second, cleaning the area with an antiseptic prevents infection during the puncture. Third, puncturing the outer aspect of the newborn's heel allows for blood collection. Fourth, collecting the blood specimen is the main objective of the procedure. Finally, applying pressure to the site with a dry gauze pad helps stop bleeding and promotes healing.
Choices F and G are not provided in the question, so they are not applicable.