ATI RN Maternal Newborn Updated 2023 | Nurselytic

Questions 53

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ATI RN Maternal Newborn Updated 2023 Questions

Extract:

A client who is postpartum and just delivered a newborn who weighs 4.5 kg (10 lb).


Question 1 of 5

Which of the following manifestations should the nurse recognize as a potential sign of hemorrhage?

Correct Answer: A

Rationale: The correct answer is A. A blood pressure of 88/40 mm Hg is indicative of hypotension, which is a common sign of hemorrhage due to decreased blood volume. Hypotension results from the body's compensatory mechanisms to maintain perfusion. Options B, C, and D are not specific indicators of hemorrhage. Urinary output of 40 mL/hr is within normal range, moderate rubra lochia is expected in the postpartum period, and a heart rate of 90/min is not necessarily abnormal. It is crucial for the nurse to recognize hypotension as a potential sign of hemorrhage to intervene promptly and prevent further complications.

Extract:

A client about the purpose of her upcoming indirect Coombs' test.


Question 2 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 client who has preeclampsia.


Question 3 of 5

Which of the following actions is the nurse's priority when implementing seizure precautions?

Correct Answer: C

Rationale: The correct answer is C: Pad the side rails of the client's bed. This is the priority because it helps prevent injury during a seizure by providing a soft surface if the client hits the rails. Dimming the lights (
A) and ensuring the call button is within reach (
B) are important but not the priority. Suction equipment (
D) is important for respiratory support post-seizure but not the priority during seizure precautions.

Extract:

A client who is postpartum and just delivered a newborn who weighs 4.5 kg (10 lb).


Question 4 of 5

Which of the following manifestations should the nurse recognize as a potential sign of hemorrhage?

Correct Answer: A

Rationale: The correct answer is A. A blood pressure of 88/40 mm Hg is indicative of hypotension, which is a common sign of hemorrhage due to decreased blood volume. Hypotension results from the body's compensatory mechanisms to maintain perfusion. Options B, C, and D are not specific indicators of hemorrhage. Urinary output of 40 mL/hr is within normal range, moderate rubra lochia is expected in the postpartum period, and a heart rate of 90/min is not necessarily abnormal. It is crucial for the nurse to recognize hypotension as a potential sign of hemorrhage to intervene promptly and prevent further complications.

Extract:

A client who is experiencing an amniotic fluid embolism during labor.


Question 5 of 5

Which of the following actions should the nurse take?

Correct Answer: D

Rationale: The correct action for the nurse to take is to prepare to initiate cardiopulmonary resuscitation (CPR) as indicated by the situation's urgency and potential life-threatening nature. CPR is essential in cases of cardiac or respiratory arrest to maintain circulation and oxygenation. Administering ephedrine IV (
Choice
A) is not appropriate without further assessment and may not be indicated in this scenario. Assisting the client to empty their bladder (
Choice
B) is important for comfort but is not the priority over CPR. Assessing for clonus (
Choice
C) is not relevant in an emergency requiring immediate CPR.
Therefore, preparing to initiate CPR (
Choice
D) is the most critical and life-saving action to take in this situation.

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