ATI RN
ATI Maternal Newborn Proctored Exam 2023
1. A woman at 38 weeks of gestation and in early labor with ruptured membranes has an oral temperature of 38.9°C (102°F). Besides notifying the provider, which of the following is an appropriate nursing action?
- A. Recheck the client’s temperature in 4 hours
- B. Administer glucocorticoids intramuscularly
- C. Assess the odor of the amniotic fluid
- D. Prepare the client for emergency cesarean section
Correct answer: C: Assess the odor of the amniotic fluid
Rationale: In a pregnant woman with a temperature of 38.9°C (102°F) in early labor with ruptured membranes, assessing the odor of the amniotic fluid is crucial. Foul-smelling or malodorous amniotic fluid could indicate infection, such as chorioamnionitis, which poses risks to both the woman and the fetus. This assessment can help in determining if an infection is present and prompt appropriate interventions. Rechecking the temperature, administering glucocorticoids, or preparing for an emergency cesarean section are not the most immediate or appropriate actions in this scenario.
2. A client at 11 weeks of gestation reports slight occasional vaginal bleeding over the past 2 weeks. Following an examination, the provider informs the client that the fetus has died, indicating a:
- A. Incomplete miscarriage
- B. Missed miscarriage
- C. Inevitable miscarriage
- D. Complete miscarriage
Correct answer: Missed miscarriage
Rationale: A missed miscarriage, also known as a silent or delayed miscarriage, occurs when the embryo or fetus has died, but no bleeding or contractions have occurred to expel it from the uterus. In this scenario, the client's experiencing slight occasional vaginal bleeding over the past two weeks indicates a missed miscarriage as the fetus has died, but the body has not recognized the loss or expelled the products of conception.
3. A newborn's mother is positive for the hepatitis B surface antigen. Which of the following should the infant receive?
- A. Hepatitis B immune globulin at 1 week followed by hepatitis B vaccine monthly for 6 months
- B. Hepatitis B vaccine monthly until the newborn tests negative for the hepatitis B surface antigen
- C. Hepatitis B immune globulin and hepatitis B vaccine within 12 hr of birth
- D. Hepatitis B vaccine at 24 hr followed by hepatitis B immune globulin every 12 hr for 3 days
Correct answer: Hepatitis B immune globulin and hepatitis B vaccine within 12 hr of birth
Rationale: In the scenario where a newborn's mother is positive for hepatitis B surface antigen, the infant should receive both hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth. This is crucial to provide passive and active immunity against the Hepatitis B virus. Hepatitis B immune globulin provides immediate protection by giving passive immunity, while the vaccine stimulates active immunity in the infant. Administering both within 12 hours of birth is important to prevent vertical transmission of the virus.
4. A healthcare provider in the emergency department is caring for a client who comes to the emergency department reporting severe abdominal pain in the left lower quadrant. The provider suspects a ruptured ectopic pregnancy. Which of the following signs indicates to the provider the presence of intra-abdominal bleeding?
- A. Chvostek’s sign
- B. Cullen’s sign
- C. Chadwick’s sign
- D. Goodell’s sign
Correct answer: B: Cullen’s sign
Rationale: Cullen’s sign is the presence of periumbilical ecchymosis indicating intra-abdominal bleeding, which can be associated with a ruptured ectopic pregnancy. Chvostek’s sign is a facial spasm related to hypocalcemia. Chadwick’s sign is a bluish discoloration of the cervix, vagina, and labia during early pregnancy. Goodell’s sign is a softening of the cervix in early pregnancy.
5. A client at 37 weeks of gestation with severe gestational hypertension is being admitted by a nurse. Which of the following actions should the nurse NOT expect to implement?
- A. Administer magnesium sulfate IV.
- B. Provide a dark, quiet environment.
- C. Assess respiratory status every 4 hours.
- D. Ensure that calcium gluconate is readily available.
Correct answer: C: Assess respiratory status every 4 hours.
Rationale: Assessing respiratory status every 4 hours is not a priority for a client with severe gestational hypertension. In this scenario, the focus should be on monitoring blood pressure, assessing for signs of preeclampsia, administering medications like magnesium sulfate for seizure prophylaxis, and ensuring that calcium gluconate is readily available in case of magnesium toxicity. Respiratory status assessment is important in other conditions but is not directly related to managing severe gestational hypertension.
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