ATI RN
ATI RN Maternal Newborn Updated 2023 Questions
Extract:
A client in the postpartum unit.
Question 1 of 5
Which of the following goals should the nurse identify for the client to accomplish during the taking-in phase of postpartum adjustment?
Correct Answer: D
Rationale: During the taking-in phase of postpartum adjustment, the focus is on the mother's own physical recovery and well-being.
Therefore, the most appropriate goal for the nurse to identify during this phase is D: The client will have adequate nutritional intake. This is crucial for the mother's own health and healing after childbirth. Proper nutrition supports her energy levels, helps with tissue repair, and aids in milk production if she chooses to breastfeed. The other choices are not as relevant during this phase. A and B are more related to infant care and safety, which are typically addressed in the later phases of postpartum adjustment. C involves family dynamics, which may be more pertinent in the later postpartum phases when the mother is more emotionally ready to focus on family roles.
Extract:
A client who is in labor and has a spontaneous rupture of membranes. The nurse notes that the umbilical cord is protruding from the client's vagina.
Question 2 of 5
After calling for help, which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct action is A: Use fingers to exert upward pressure on the presenting part. This is the first step in managing a prolapsed cord to alleviate pressure on the cord and prevent fetal hypoxia. Immediate action is crucial in this emergency situation. Administering tocolytic medication (
B) is not the priority as it does not address the immediate risk to the fetus. Applying oxygen via facemask (
C) is important but secondary to relieving cord compression. Wrapping the cord in a sterile towel (
D) is not recommended as it can further compress the cord.
Extract:
A client about the purpose of her upcoming indirect Coombs' test.
Question 3 of 5
Which of the following statements should the nurse include in the teaching?
Correct Answer: B
Rationale: The correct statement to include in the teaching is B: "This test will detect the presence of Rh-positive antibodies in your blood." This is the correct answer because it pertains to the purpose of the test, which is to identify Rh incompatibility between the mother and fetus. Detecting Rh-positive antibodies is crucial to prevent hemolytic disease of the newborn. The other options are incorrect because A refers to an amniotic fluid index test, C relates to a test for gestational diabetes, and D describes a Doppler ultrasound for evaluating fetal blood flow.
Therefore, B is the most relevant statement for the teaching regarding Rh testing during pregnancy.
Extract:
A full-term newborn upon admission to the nursery.
Question 4 of 5
Which of the following clinical findings should the nurse report to the provider?
Correct Answer: A
Rationale: The correct answer is A: Single palmar creases. This finding may indicate Down syndrome and requires further evaluation. B: Rust-stained urine could indicate hematuria, but it does not require immediate provider notification. C: Transient circumoral cyanosis is common in infants and usually resolves on its own. D: Subconjunctival hemorrhage is usually benign and does not typically necessitate immediate provider notification.
Extract:
A newborn who has a myelomeningocele that is leaking cerebrospinal fluid.
Question 5 of 5
Which of the following actions should the nurse include in the plan of care?
Correct Answer: D
Rationale: The correct answer is D: Administer broad-spectrum antibiotics. This is crucial in the plan of care to address potential infection post-injury. Antibiotics help prevent or treat infections that can develop in the wound site. Monitoring rectal temperature (
B) does not directly address wound care. Preparing for surgical closure (
A) can be important but addressing infection is a higher priority. Cleansing with povidone-iodine (
C) is a good practice, but antibiotics are necessary for systemic infection prevention.