ATI-MN ATI Maternal Newborn Exam - Set 2 - Part 1

Correct Answer: Threatened

Slight bleeding with mild cramping and a cervix that remains closed describes a threatened abortion, where the pregnancy may still continue with careful monitoring. Option b is incorrect because an incomplete abortion involves heavy bleeding and a dilated cervix with some products of conception already passed. Option c is incorrect because a missed abortion is fetal death with retained tissue and a closed cervix, typically without the active bleeding seen here. Option d is incorrect because a complete abortion means all products of conception have passed and the cervix has closed afterward, not slight early spotting.

Correct Answer: Ectopic pregnancy

Unilateral lower abdominal pain with scant dark spotting early in pregnancy suggests an ectopic pregnancy, where the ovum implants outside the uterus and can rupture. Option a is incorrect because normal implantation does not produce sharp one-sided pain, which instead points to a pregnancy growing in the wrong location. Option b is incorrect because placenta previa causes painless bright red bleeding in the third trimester, not early one-sided pain. Option d is incorrect because hyperemesis involves severe vomiting and dehydration rather than localized abdominal pain and spotting.

Correct Answer: Avoid vitamins with folic acid

Methotrexate works by interfering with rapidly dividing cells, so the client avoids folic acid supplements because folic acid can reduce the medication's effectiveness. Option b is incorrect because heavy bright red bleeding is a warning sign to report, not an expected result of the medication. Option c is incorrect because the client is taught to avoid intercourse during treatment, since pelvic rest supports recovery and accurate follow-up. Option d is incorrect because added folic acid counteracts methotrexate, which is the opposite of what supports the treatment.

Correct Answer: Performing a vaginal examination

Painless bright red bleeding with a soft uterus suggests placenta previa, so the nurse avoids a vaginal examination because it can disrupt the placenta and trigger severe hemorrhage. Option a is incorrect because monitoring the fetal heart rate is a safe, expected action that helps detect fetal compromise from the bleeding. Option b is incorrect because assessing the amount of bleeding is necessary to gauge blood loss and does not endanger the placenta. Option c is incorrect because intravenous fluids support circulating volume and are appropriate when a client is bleeding.

Correct Answer: Abruptio placentae

Sudden sharp pain with dark red bleeding and a rigid, board-like tender uterus points to abruptio placentae, where the placenta separates early from the uterine wall. Option b is incorrect because a threatened abortion occurs early in pregnancy with mild cramping, not a tender rigid uterus in the third trimester. Option c is incorrect because placenta previa produces painless bright red bleeding with a soft uterus, unlike the painful rigid uterus described here. Option d is incorrect because Braxton Hicks contractions are painless and irregular and do not cause bleeding or a constantly rigid uterus.

Correct Answer: Abnormally high pregnancy hormone levels

A molar pregnancy produces abnormally high pregnancy hormone levels because the abnormal placental tissue overgrows, which also drives severe nausea and rapid uterine enlargement. Option a is incorrect because the high hormone levels usually cause excessive nausea and vomiting rather than reducing it. Option b is incorrect because a molar pregnancy has no viable fetus, so a fetal heart rate is not present. Option c is incorrect because the condition is linked with early high blood pressure, not low blood pressure.

Correct Answer: Use reliable contraception for a year

The client needs reliable contraception for about a year so pregnancy hormone levels can be tracked to detect any cancerous change after a molar pregnancy. Option a is incorrect because conceiving soon would mask the hormone monitoring used to confirm that no abnormal tissue remains. Option b is incorrect because follow-up hormone testing is essential, since a molar pregnancy carries a risk of developing into cancer. Option d is incorrect because an intrauterine device is avoided after a molar pregnancy, and another method is recommended during the monitoring period.

Correct Answer: Preeclampsia

Elevated blood pressure after the twentieth week combined with protein in the urine indicates preeclampsia, a hypertensive disorder that threatens both the client and fetus. Option b is incorrect because hyperemesis gravidarum involves severe vomiting and dehydration, not hypertension with proteinuria. Option c is incorrect because iron-deficiency anemia is shown by low hemoglobin and fatigue rather than elevated blood pressure with protein in the urine. Option d is incorrect because gestational diabetes is identified by abnormal glucose testing, not by high blood pressure and proteinuria.

Correct Answer: Severe headache with epigastric pain

A severe headache with epigastric pain can signal worsening preeclampsia and an impending seizure, so the nurse reports these findings right away for prompt treatment. Option a is incorrect because mild ankle swelling is common in pregnancy and is not the urgent warning that headache with epigastric pain represents. Option b is incorrect because fatigue is a frequent, nonspecific complaint and does not carry the same warning of a coming seizure. Option d is incorrect because a blood pressure in this range is within normal limits and is reassuring rather than concerning.

Correct Answer: Turn the client to the side

Turning the client to the side during a seizure keeps the airway clear and lets secretions drain, which protects breathing and is the priority safety action. Option a is incorrect because restraining the limbs can cause injury; the nurse protects the client from harm without holding them down. Option b is incorrect because the nurse stays with the client to maintain safety and the airway rather than leaving during the seizure. Option c is incorrect because forcing an airway into the mouth during active seizing can injure the client and is not done first.

Correct Answer: HELLP syndrome

Hemolysis, elevated liver enzymes, and low platelets together identify HELLP syndrome, a severe variant of the hypertensive disorders of pregnancy diagnosed by laboratory values. Option a is incorrect because placenta previa is a bleeding condition from placental position, unrelated to this cluster of laboratory findings. Option c is incorrect because hyperemesis gravidarum is severe vomiting with dehydration, not the laboratory pattern that defines HELLP syndrome. Option d is incorrect because gestational diabetes is a glucose disorder and does not produce hemolysis, liver enzyme changes, and low platelets.

Correct Answer: Absent deep-tendon reflexes

Magnesium sulfate depresses the nervous system, so the loss of deep-tendon reflexes is an early sign of toxicity and signals the need to stop the infusion. Option a is incorrect because this blood pressure reflects the underlying disorder rather than a sign of magnesium overdose. Option b is incorrect because this urine output is adequate, whereas toxicity is suggested by output that falls too low. Option c is incorrect because brisk reflexes suggest the magnesium level is not yet adequate, the opposite of toxicity.

Correct Answer: Calcium gluconate

Calcium gluconate is the antidote for magnesium sulfate toxicity, so the nurse anticipates giving it to reverse the dangerous depressant effects after stopping the infusion. Option a is incorrect because naloxone reverses opioids, which is unrelated to magnesium toxicity. Option b is incorrect because potassium chloride corrects low potassium and does not reverse the effects of magnesium. Option d is incorrect because oxytocin stimulates uterine contractions and has no role in treating magnesium overdose.

Correct Answer: Respiratory rate and reflexes

Because magnesium depresses the nervous system and breathing, the nurse closely monitors respiratory rate and deep-tendon reflexes to catch early signs of toxicity. Option b is incorrect because bowel sounds, while routine, do not reveal the respiratory depression that magnesium can cause. Option c is incorrect because skin turgor reflects hydration and is not the priority indicator of magnesium toxicity. Option d is incorrect because capillary refill checks perfusion and would not detect the respiratory and reflex changes magnesium produces.

Correct Answer: Lying on the side

Side-lying improves blood flow to the placenta and kidneys and helps lower blood pressure, so it is the recommended resting position in preeclampsia. Option a is incorrect because sitting fully upright does not improve placental perfusion the way the side-lying position does. Option b is incorrect because lying flat lets the uterus compress a major vessel, which can lower blood pressure and reduce placental flow. Option c is incorrect because lying face down is neither comfortable nor practical in pregnancy and does not aid blood flow.

Correct Answer: A three-hour glucose tolerance test

An elevated one-hour glucose screen is followed by a three-hour glucose tolerance test, which confirms whether the client has gestational diabetes before treatment begins. Option a is incorrect because an abnormal screen requires confirmatory testing rather than no further evaluation. Option c is incorrect because insulin is not started on a single screening result; a confirmatory test comes first. Option d is incorrect because the next step is the longer diagnostic test, not simply repeating the same screen later.

Correct Answer: Diet and regular exercise

Gestational diabetes is first managed with a controlled diet and regular exercise, and medication is added only if blood glucose remains above target despite these measures. Option a is incorrect because insulin is added when diet and exercise do not control glucose, not as the starting point. Option b is incorrect because most oral diabetes medications are generally avoided in pregnancy, so they are not the first approach. Option d is incorrect because prolonged fasting risks low blood glucose and ketones, which can harm the fetus.

Correct Answer: Low blood glucose

The newborn of a parent with diabetes is at risk for low blood glucose after birth, because high fetal insulin levels continue once the maternal glucose supply stops. Option b is incorrect because high blood pressure is not the typical newborn risk linked to maternal diabetes. Option c is incorrect because these newborns tend to be large rather than small, due to extra fetal growth from high glucose. Option d is incorrect because a delayed first breath is not the specific concern; the priority is monitoring blood glucose.

Correct Answer: Intravenous fluid replacement

Severe vomiting causes dehydration and electrolyte loss, so intravenous fluids are given first to restore hydration before food is slowly reintroduced. Option a is incorrect because ambulation does not address the fluid loss that must be corrected first. Option c is incorrect because oral iron is hard on the stomach and is not the priority during active dehydration. Option d is incorrect because a large meal would likely trigger more vomiting; the client is kept without food until vomiting settles.

Correct Answer: Take it with orange juice

Vitamin C enhances iron absorption, so taking the supplement with orange juice helps the body use the iron and correct the anemia more effectively. Option a is incorrect because compounds in tea interfere with iron uptake, working against the goal of treating the anemia. Option b is incorrect because antacids lower stomach acidity, which decreases iron absorption. Option d is incorrect because the calcium in milk binds iron and reduces how much the body absorbs.