ATI RN
ATI RN Maternal Newborn Updated 2023 Questions
Extract:
A client and their newborn.
Question 1 of 5
Which of the following observations should indicate to the nurse that the client is in the taking-in phase of maternal role attainment?
Correct Answer: D
Rationale: The correct answer is D because during the taking-in phase of maternal role attainment, the client tends to review their birth experience with others as they seek validation and support. This phase is characterized by a passive and dependent behavior, where the client is reflecting on their experience and may express a need for validation and reassurance.
Choices A, B, and C are incorrect as they do not align with the characteristics of the taking-in phase. The client desiring privacy, taking charge of all tasks, or putting personal needs aside are more indicative of the taking-hold phase or the let-go phase.
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 newborn who was born via a forceps-assisted birth.
Question 3 of 5
Which of the following findings should the nurse identify as an injury caused by the forceps?
Correct Answer: D
Rationale: The correct answer is D: Facial asymmetry. Forceps during delivery can cause pressure and trauma to the baby's face, leading to facial asymmetry. The forceps compress one side of the face more than the other, resulting in an uneven appearance. Depressed anterior fontanel (
A) is not typically associated with forceps delivery. Uneven gluteal skinfolds (
B) and epicanthal folds (
C) are not specific indicators of forceps injury. In summary, facial asymmetry is a common finding in babies delivered with forceps due to the pressure exerted on the face during delivery.
Extract:
A newborn who has jaundice and a new prescription for phototherapy.
Question 4 of 5
Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct action for the nurse to take is to close the newborn's eyes before applying eyepatches (
Choice
C). This is crucial to prevent any irritation or discomfort to the newborn's eyes during the application of the eyepatches. Closing the eyes also ensures that the eyepatches are applied correctly and securely.
Choice A is incorrect because turning the newborn every 4 hours is not related to applying eyepatches.
Choice B is incorrect as hydrating lotion is not necessary prior to applying eyepatches.
Choice D is incorrect as providing glucose water after each feeding is not relevant to the situation at hand.
In summary, the correct action of closing the newborn's eyes before applying eyepatches is essential for the safety and comfort of the newborn during the procedure.
Extract:
A maternal unit policy to ensure proper identification of newborns.
Question 5 of 5
Which of the following should the nurse include in the policy?
Correct Answer: C
Rationale: The correct answer is C because obtaining an imprint of the infant's feet prior to taking him to the nursery is crucial for proper identification and ensuring the right baby goes to the correct parent. This step helps prevent mix-ups and enhances patient safety.
Choice A is incorrect because replacing the infant's identification band after his name has been recorded may lead to errors in identification.
Choice B is incorrect as checking the newborn's identification using the crib card alone may not be sufficient for accurate identification.
Choice D is incorrect as requiring visitors to wear an identification band does not directly address the issue of infant identification and safety.
In summary, choice C is the most appropriate as it directly contributes to proper infant identification and reduces the risk of errors, making it the best option for inclusion in the policy.