ATI Maternal Newborn OB Comprehensive Exam Mastery Guide: In-Depth Study Companion, Updated Practice Tests, Detailed Test Bank Review, and Advanced Knowledge Assessment Manual

A full-term newborn has just been delivered and is breathing spontaneously. Which action should the nurse perform first? A. Assign the Apgar score B. Measure the newborn’s weight C. Apply identification bracelets D. Thoroughly dry the newborn Correct Answer: D. Thoroughly dry the newborn Rationale: Drying the newborn helps prevent evaporative heat loss and provides tactile stimulation that supports effective respirations. Preventing hypothermia is an immediate priority because newborns lose heat rapidly after birth. Apgar scoring is performed at designated times, while weighing and applying identification bands can occur after immediate stabilization. Question 2 A pregnant client reports persistent morning nausea but is able to tolerate food. Which dietary recommendation is most appropriate? A. Brush the teeth immediately after each meal B. Eat meals while the food is very warm C. Drink a full glass of water with every meal D. Choose small portions of high-carbohydrate foods Correct Answer: D. Choose small portions of high-carbohydrate foods Rationale: Small, frequent portions of bland, high-carbohydrate foods such as crackers or toast are often better tolerated during pregnancy-related nausea. Warm foods may produce odors that worsen nausea. Drinking large amounts of fluid with meals can increase gastric distention, so fluids are better consumed between meals. Question 3 A postpartum client with preeclampsia has several laboratory results available. Which result requires immediate reporting because it may indicate progression to HELLP syndrome? A. Hematocrit of 39% B. Serum albumin of 4.5 g/dL C. White blood cell count of 9,000/mm³ D. Platelet count of 50,000/mm³ Correct Answer: D. Platelet count of 50,000/mm³ Rationale: A platelet count of 50,000/mm³ represents severe thrombocytopenia and may indicate HELLP syndrome, which involves hemolysis, elevated liver enzymes, and low platelets. This condition increases the risk of bleeding, organ injury, and maternal deterioration. The other laboratory values listed are generally within expected ranges. Question 4 During a routine prenatal assessment at 18 weeks of gestation, which finding is expected? A. Deep-tendon reflexes rated 4+ B. Fundal height measuring 14 cm C. Urine protein concentration of 2+ D. Fetal heart rate of 152 beats/min Correct Answer: D. Fetal heart rate of 152 beats/min Rationale: A fetal heart rate of approximately 110 to 160 beats/min is generally expected, making 152 beats/min normal. At 18 weeks, the fundal height should generally approximate the gestational age. Reflexes rated 4+ suggest marked hyperreflexia and require evaluation. Proteinuria of 2+ is abnormal and may indicate renal disease or a hypertensive pregnancy disorder. Question 5 A nurse is teaching a client how to use a newly prescribed diaphragm for contraception. Which instruction should the nurse emphasize? A. Replace the diaphragm every five years regardless of fit B. Leave the diaphragm in place for at least six hours after intercourse C. Apply an oil-based lubricant before insertion D. Insert the diaphragm while the bladder is full Correct Answer: B. Leave the diaphragm in place for at least six hours after intercourse Rationale: The diaphragm should remain in place for at least six hours after intercourse to allow the spermicide to remain effective. It should not generally remain in place longer than 24 hours because of infection risk. Oil-based lubricants can damage latex diaphragms, so compatible water-based products are preferred. Emptying the bladder before insertion may improve comfort and placement. Question 6 A newborn is prescribed phototherapy for hyperbilirubinemia. Which nursing intervention most effectively promotes the treatment’s therapeutic effect? A. Offer 30 mL of water every four hours B. Apply moisturizing lotion three times daily C. Remove all clothing except the diaper D. Discontinue treatment if a mild rash develops Correct Answer: C. Remove all clothing except the diaper Rationale: Exposing as much skin as possible increases the amount of bilirubin exposed to the phototherapy light. The newborn should generally wear only a diaper, with appropriate eye protection according to facility policy. Adequate milk feedings support bilirubin excretion, while routine water supplementation is not usually necessary. Lotions may interfere with treatment or increase the risk of burns. Question 7 At a 26-week prenatal visit, which finding should the nurse report to the provider? A. One-hour glucose screening result of 128 mg/dL B. Hematocrit level of 34% C. Fundal height measuring 21 cm D. Fetal heart rate of 145 beats/min Correct Answer: C. Fundal height measuring 21 cm Rationale: Between approximately 20 and 36 weeks, fundal height in centimeters should generally correspond closely to gestational age. A measurement of 21 cm at 26 weeks is smaller than expected and may indicate inaccurate dating, fetal growth restriction, or decreased amniotic fluid. The other findings are generally within acceptable ranges. Question 8 A nurse is explaining hospital newborn-security procedures to a new parent. Which statement provides the most useful safety information? A. “All unidentified visitors are prevented from entering the hospital.” B. “The relationship of every visitor is entered in your medical record.” C. “Your newborn will remain in the nursery whenever you sleep.” D. “Staff members handling your newborn will wear approved photo identification.” Correct Answer: D. “Staff members handling your newborn will wear approved photo identification.” Rationale: Parents should verify that anyone taking or caring for their newborn has appropriate facility-issued identification. Many hospitals also use matching identification bands and electronic security devices. Hospitals cannot guarantee that every unidentified visitor is excluded, and newborns do not necessarily need to remain in the nursery whenever the parents sleep. Question 9 A client and partner have experienced an intrauterine fetal death. Which nursing action best supports healthy grieving? A. Offer to take photographs of the newborn for the parents B. Immediately discuss the possibility of organ donation C. Discourage siblings from visiting the newborn D. Require the parents to choose a name before discharge Correct Answer: A. Offer to take photographs of the newborn for the parents Rationale: Photographs and other keepsakes can help parents acknowledge the newborn’s existence and preserve meaningful memories. These options should be offered sensitively and without pressure because families grieve differently. The nurse should not require parents to name, view, hold, or involve siblings with the newborn. Question 10 A nurse is caring for a pregnant client with hyperemesis gravidarum who is receiving intravenous fluid replacement. Which finding should the nurse report because it suggests persistent dehydration? A. Blood urea nitrogen level of 25 mg/dL B. Serum creatinine level of 0.8 mg/dL C. Urine output of 280 mL over 8 hours D. Urine test negative for ketones Correct Answer: A. Blood urea nitrogen level of 25 mg/dL Rationale: An elevated blood urea nitrogen level can indicate dehydration resulting from prolonged vomiting and inadequate fluid intake. A creatinine level of 0.8 mg/dL is within the expected range. Urine output of 280 mL over 8 hours averages 35 mL/hr, which is generally adequate. Negative urine ketones suggest that starvation and dehydration are improving.