ATI MATERNAL
NEWBORN PROCTORED
EXAM
,1. Two days after delivery, a postpartum client prepares for discharge. What should the nurse teach
her about lochia flow?
Correct: Lochia normally lasts for about 21 days, and changes from a bright red, to pinkish brown, to
creamy white.
2. A nurse monitors fetal well-being by means of an external monitor. At the peak of the contractions,
the fetal heart rate has repeatedly dropped 30 beats/min below the baseline. Late decelerations are
suspected and the nurse notifies the physician. Which is the rationale for this action?
Correct: Late decelerations are associated with uteroplacental insufficiency and are a sign of fetal
hypoxia. Repeated late decelerations indicate fetal distress.
3. Which preoperative nursing interventions should be included for a client who is scheduled to have
an emergency cesarean birth?
Correct: Because this is an emergency, surgery must be performed quickly. Anxiety of the client and
the family will be high. Inserting an indwelling catheter helps to keep the bladder empty and free
from injury when the incision is made.
4. Which nursing instruction should be given to the breastfeeding mother regarding care of the breasts
after discharge?
Correct: In order to stimulate adequate milk production, the breasts should be pumped if the infant
is not sucking or eating well, or if the breasts are not fully emptied.
Incorrect: Engorgement occurs on about the third or fourth postpartum day and is a result of the
breast milk formation. The primary way to relieve engorgement is by pumping or longer nursing.
Giving a bottle of formula will compound the problem because the baby will not be hungry and will
not empty the breasts well.
5. A client in preterm labor is admitted to the hospital. Which classification of drugs should the nurse
anticipate administering?
, Correct: Tocolytics are used to stop labor. One of the most commonly used tocolytic drugs is
ritodrine (Yutopar).
6. Which of the following are probable signs, strongly indicating pregnancy? Incorrect: The presence of
fetal heart sounds is a positive sign of pregnancy;
quickening is a presumptive Sign of pregnancy.
Incorrect: These are presumptive signs. They may indicate pregnancy or they may be caused by other
conditions, such as disease processes.
Correct: These are probable signs that strongly indicate pregnancy. Hegar’s sign is a softening of the
lower uterine segment, and Chadwick's sign is the bluish or purplish color of the cervix as a result of
the increased blood supply and increased estrogen. Ballottement occurs when the cervix is tapped
by an examiner's finger and the fetus floats upward in the amniotic fluid and then falls downward.
7. Two hours after delivery the nurse assesses the client and documents that the fundus is soft, boggy,
above the level of the umbilicus, and displaced to the right side. The nurse encourages the client to
void. Which is the rationale for this nursing action?
Correct: Bladder distention can lead to postpartum hemorrhage. A full bladder displaces the uterus
causing it not to contract properly. Emptying the bladder allows the uterus to contract more firmly.
8. Which site is preferred for giving an IM injection to a newborn? Incorrect: Ventrogluteal muscles are
located in the hip area. It is not the
preferred site for injections in the newborn because of lack of muscle mass.
Correct: The middle third of the vastus lateralis is the preferred site for injections.
9. During the first twelve hours following a normal vaginal delivery, the client voids 2,000 mL of urine.
How should the nurse interpret this finding?
Correct: During pregnancy, the circulating blood volume increases by about 50%. In order to get rid
of the excess fluid volume after delivery, the woman experiences an increased amount of urine
output during the first few hours.
NEWBORN PROCTORED
EXAM
,1. Two days after delivery, a postpartum client prepares for discharge. What should the nurse teach
her about lochia flow?
Correct: Lochia normally lasts for about 21 days, and changes from a bright red, to pinkish brown, to
creamy white.
2. A nurse monitors fetal well-being by means of an external monitor. At the peak of the contractions,
the fetal heart rate has repeatedly dropped 30 beats/min below the baseline. Late decelerations are
suspected and the nurse notifies the physician. Which is the rationale for this action?
Correct: Late decelerations are associated with uteroplacental insufficiency and are a sign of fetal
hypoxia. Repeated late decelerations indicate fetal distress.
3. Which preoperative nursing interventions should be included for a client who is scheduled to have
an emergency cesarean birth?
Correct: Because this is an emergency, surgery must be performed quickly. Anxiety of the client and
the family will be high. Inserting an indwelling catheter helps to keep the bladder empty and free
from injury when the incision is made.
4. Which nursing instruction should be given to the breastfeeding mother regarding care of the breasts
after discharge?
Correct: In order to stimulate adequate milk production, the breasts should be pumped if the infant
is not sucking or eating well, or if the breasts are not fully emptied.
Incorrect: Engorgement occurs on about the third or fourth postpartum day and is a result of the
breast milk formation. The primary way to relieve engorgement is by pumping or longer nursing.
Giving a bottle of formula will compound the problem because the baby will not be hungry and will
not empty the breasts well.
5. A client in preterm labor is admitted to the hospital. Which classification of drugs should the nurse
anticipate administering?
, Correct: Tocolytics are used to stop labor. One of the most commonly used tocolytic drugs is
ritodrine (Yutopar).
6. Which of the following are probable signs, strongly indicating pregnancy? Incorrect: The presence of
fetal heart sounds is a positive sign of pregnancy;
quickening is a presumptive Sign of pregnancy.
Incorrect: These are presumptive signs. They may indicate pregnancy or they may be caused by other
conditions, such as disease processes.
Correct: These are probable signs that strongly indicate pregnancy. Hegar’s sign is a softening of the
lower uterine segment, and Chadwick's sign is the bluish or purplish color of the cervix as a result of
the increased blood supply and increased estrogen. Ballottement occurs when the cervix is tapped
by an examiner's finger and the fetus floats upward in the amniotic fluid and then falls downward.
7. Two hours after delivery the nurse assesses the client and documents that the fundus is soft, boggy,
above the level of the umbilicus, and displaced to the right side. The nurse encourages the client to
void. Which is the rationale for this nursing action?
Correct: Bladder distention can lead to postpartum hemorrhage. A full bladder displaces the uterus
causing it not to contract properly. Emptying the bladder allows the uterus to contract more firmly.
8. Which site is preferred for giving an IM injection to a newborn? Incorrect: Ventrogluteal muscles are
located in the hip area. It is not the
preferred site for injections in the newborn because of lack of muscle mass.
Correct: The middle third of the vastus lateralis is the preferred site for injections.
9. During the first twelve hours following a normal vaginal delivery, the client voids 2,000 mL of urine.
How should the nurse interpret this finding?
Correct: During pregnancy, the circulating blood volume increases by about 50%. In order to get rid
of the excess fluid volume after delivery, the woman experiences an increased amount of urine
output during the first few hours.
