LPN LPN
ATI Maternal Newborn Proctored
1. When monitoring uterine contractions in a client in the active phase of the first stage of labor, which finding should the nurse report to the provider?
- A. Contractions lasting longer than 90 seconds
- B. Contractions occurring every 3 to 5 minutes
- C. Contractions are strong in intensity
- D. Client reports feeling contractions in the lower back
Correct answer: A
Rationale: During the active phase of the first stage of labor, contractions lasting longer than 90 seconds can indicate uterine hyperstimulation, leading to decreased placental perfusion and fetal oxygenation. This finding should be reported to the provider for further evaluation and management. Choices B, C, and D are not the priority findings in this scenario. Contractions occurring every 3 to 5 minutes are within the normal range for the active phase of labor. Strong contractions and feeling contractions in the lower back are common experiences during labor and not necessarily concerning unless associated with other complications.
2. A client who is 6 hours postpartum and Rh-negative has an Rh-positive newborn. The client asks why an indirect Coombs test was ordered. Which of the following is an appropriate response by the healthcare provider?
- A. It determines if kernicterus will occur in the newborn.
- B. It detects Rh-negative antibodies in the newborn's blood.
- C. It detects Rh-positive antibodies in the mother's blood.
- D. It determines the presence of maternal antibodies in the newborn's blood.
Correct answer: C
Rationale: The indirect Coombs test is performed to detect Rh-positive antibodies in the mother's blood. In cases where the mother is Rh-negative and the baby is Rh-positive, the mother may develop antibodies against the baby's blood cells, which can lead to hemolytic disease of the newborn. Choice A is incorrect because kernicterus is a complication of severe jaundice, not directly assessed by the indirect Coombs test. Choice B is incorrect as the test aims to detect Rh-positive antibodies, not Rh-negative antibodies in the newborn's blood. Choice D is incorrect as the test is focused on detecting antibodies in the mother's blood, not the newborn's.
3. A client who is at 6 weeks of gestation with her first pregnancy asks the nurse when she can expect to experience quickening. Which of the following responses should the nurse make?
- A. This will occur during the last trimester of pregnancy.
- B. This will happen by the end of the first trimester of pregnancy.
- C. This will occur between the fourth and fifth months of pregnancy.
- D. This will happen once the uterus begins to rise out of the pelvis.
Correct answer: C
Rationale: Quickening, which is the first perception of fetal movements by the mother, typically occurs between the fourth and fifth months of pregnancy, around 18-20 weeks of gestation. Choice C is correct as it provides the client with accurate information about the expected timing of this significant milestone in her pregnancy. Choices A, B, and D are incorrect because quickening does not happen during the last trimester, by the end of the first trimester, or once the uterus begins to rise out of the pelvis. The correct timeframe for quickening is during the second trimester, specifically between the fourth and fifth months.
4. A patient on the labor and delivery unit is having induction of labor with oxytocin administered through a secondary IV line. Uterine contractions occur every 2 minutes, last 90 seconds, and are strong to palpation. The baseline fetal heart rate is 150/min, with uniform decelerations beginning at the peak of the contraction and a return to baseline after the contraction is over. Which of the following actions should the nurse take?
- A. Decrease the rate of infusion of the maintenance IV solution.
- B. Discontinue the infusion of the IV oxytocin.
- C. Increase the rate of infusion of the IV oxytocin.
- D. Slow the client's breathing rate.
Correct answer: B
Rationale: The described pattern suggests late decelerations, indicating uteroplacental insufficiency. Discontinuing the oxytocin infusion helps reduce uterine contractions, improving placental blood flow and fetal oxygenation. This intervention is essential to prevent fetal compromise and potential harm during labor. Choice A is incorrect because decreasing the rate of the maintenance IV solution does not directly address the cause of the late decelerations. Choice C is incorrect because increasing the rate of IV oxytocin can worsen uterine contractions, exacerbating the fetal distress. Choice D is incorrect because slowing the client's breathing rate is not indicated in the management of late decelerations during labor.
5. A client is being educated by a healthcare provider about the changes she should expect when planning to become pregnant. Identify the correct sequence of maternal changes. A. Amenorrhea B.Lightening C. Goodell's sign D. Quickening
- A. A,B,C,D
- B. D,B,A,C
- C. A,D,B,C
- D. A,C,D,B
Correct answer: D
Rationale: The correct sequence of maternal changes during pregnancy is as follows: Amenorrhea (absence of menstrual periods), Goodell's sign (softening of the cervix), Quickening (first fetal movements felt by the mother), and Lightening (baby descending into the pelvis). These changes occur at different stages of pregnancy and are important indicators of fetal development and maternal adaptation. Choice A is correct as it is the initial change indicating possible pregnancy. Choices B, C, and D follow in the correct order of occurrence during pregnancy. Choices B, C, and D are incorrect as they do not follow the correct sequence of maternal changes.
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