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Maternal Newborn ATI Proctored Exam 2023
1. A client is postpartum and has idiopathic thrombocytopenic purpura (ITP). Which of the following findings should the nurse expect?
- A. Decreased platelet count
- B. Increased erythrocyte sedimentation rate (ESR)
- C. Decreased megakaryocytes
- D. Increased WBC
Correct answer: A
Rationale: Idiopathic thrombocytopenic purpura (ITP) is characterized by an autoimmune response that leads to a decreased platelet count. This condition increases the risk of bleeding due to the low platelet levels. Monitoring the platelet count is crucial in managing ITP, as it helps determine the risk of bleeding and guides treatment decisions. Therefore, the correct finding to expect in a client with ITP is a decreased platelet count. Choice B, an increased erythrocyte sedimentation rate (ESR), is not typically associated with ITP. Choice C, decreased megakaryocytes, may be seen in conditions like aplastic anemia but are not a typical finding in ITP. Choice D, an increased white blood cell count (WBC), is not a characteristic feature of ITP.
2. A healthcare professional is assessing a late preterm newborn. Which of the following clinical manifestations is an indication of hypoglycemia?
- A. Hypertonia
- B. Increased feeding
- C. Hyperthermia
- D. Respiratory distress
Correct answer: D
Rationale: The correct answer is D, respiratory distress, as it is a clinical manifestation of hypoglycemia in newborns. Other signs of hypoglycemia include an abnormal cry, jitteriness, lethargy, poor feeding, apnea, and seizures. Hypertonia, increased feeding, and hyperthermia are not typically associated with hypoglycemia in newborns. Hypertonia is more indicative of neurological issues, increased feeding is not a common sign of hypoglycemia, and hyperthermia is not a typical symptom of low blood sugar.
3. A client presents with uterine hypotonicity and postpartum hemorrhage. Which action should the nurse prioritize?
- A. Check the client's capillary refill.
- B. Massage the client's fundus.
- C. Insert an indwelling urinary catheter for the client.
- D. Prepare the client for a blood transfusion.
Correct answer: B
Rationale: In a client with uterine hypotonicity and postpartum hemorrhage, the priority is to address the risk of hypovolemic shock, which can lead to vital organ perfusion compromise and potentially death. Massaging the client's fundus helps to control bleeding by promoting uterine contraction and reducing blood loss, making it the nurse's priority intervention in this situation. Checking capillary refill may be important in assessing perfusion status but is not the priority over controlling the hemorrhage. Inserting an indwelling urinary catheter is not the priority in managing postpartum hemorrhage. Although preparing for a blood transfusion may be necessary, addressing the primary cause of bleeding by massaging the fundus takes precedence to stabilize the client's condition.
4. A client who is at 15 weeks of gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure?
- A. Check the client's temperature.
- B. Observe for uterine contractions.
- C. Administer Rho(D) immune globulin.
- D. Monitor the fetal heart rate (FHR).
Correct answer: D
Rationale: After an amniocentesis, the priority nursing intervention is to monitor the fetal heart rate (FHR) as the greatest risk to the client and fetus is fetal death. This monitoring helps in early identification of any fetal distress or compromise, allowing prompt intervention to ensure fetal well-being. Checking the client's temperature (Choice A) is not the priority as monitoring the fetus is crucial for immediate assessment. Observing for uterine contractions (Choice B) is important but not the priority after an amniocentesis. Administering Rho(D) immune globulin (Choice C) is typically done to Rh-negative clients after procedures that may lead to fetal-maternal hemorrhage, not immediately after an amniocentesis.
5. A client is to receive oxytocin to augment labor. Which finding contraindicates the initiation of the oxytocin infusion and should be reported to the provider?
- A. Late decelerations
- B. Moderate variability of the FHR
- C. Cessation of uterine dilation
- D. Prolonged active phase of labor
Correct answer: A
Rationale: Late decelerations are indicative of uteroplacental insufficiency, which can be exacerbated by oxytocin administration, potentially compromising fetal well-being. Therefore, detecting late decelerations should prompt immediate reporting to the provider to prevent harm to the fetus. Choices B, C, and D are not contraindications for initiating oxytocin infusion. Moderate variability of the FHR is a reassuring sign of fetal well-being, cessation of uterine dilation may indicate a pause in labor progress but does not contraindicate oxytocin, and prolonged active phase of labor may necessitate oxytocin administration to augment contractions and progress labor.
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