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Maternal Newborn ATI
A nurse on the postpartum unit is caring for a client following a
cesarean birth. Which of the following assessments is the nurse’s
priority?
**Amount of lochia**
- When using the airway, breathing, circulation approach to
client care, the nurse should place the priority in the
immediate postpartum period on assessing the amount of
postpartum lochia. The greatest risk to the client is
bleeding and postpartum hemorrhage.
A nurse is caring for a client who is in labor and whose fetus is in
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the right occiput posterior position. The client is dilated to 8 cm
and reports back pain. Which of the following actions should the
nurse take?
**Apply sacral counterpressure**
- Sacral counterpressure assists in relieving back labor
pain related to fetal posterior position.
A nurse is demonstrating to a client how to bathe her newborn.
In which order should the nurse perform the following actions?
**Wipe the newborn’s eyes from the inner canthus outward.
Wash the newborn’s neck by lifting the newborn’s chin. Cleanse
the skin around the newborn’s umbilical cord stump. Wash the
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newborn’s legs and feet. Clean the newborn’s diaper area.**
- Use a head to toe, clean to dirty approach when washing a
newborn.
A nurse is caring for a client and her partner who have
experienced a fetal death. Which of the following actions should
the nurse take?
**Take photos of the newborn to give to the parents.**
- The nurse should create a memory box that includes
mementos of the newborn (ex: photos, the newborn’s ID
bands, the newborn’s hat, & the newborn’s blanket).
A nurse is caring for a client who is at 36 weeks of gestation and
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has a positive contraction stress test. The nurse should plan to
prepare the client for which of the following diagnostic tests?
**Biophysical profile**
- A positive contraction stress test indicates that further
evaluation of the fetus is necessary (baby’s heart slowed
or showed abnormality during contraction). A biophysical
profile will provide further evaluation with real-time
ultrasound.
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