ATI RN Maternal Newborn

The correct answer is: B. An increase in the pulse rate from 88 to 103 bpm

Explanation

An increase in the pulse rate is an early sign of excessive blood loss in the postpartum period. When blood volume decreases due to hemorrhage, the body compensates by increasing the heart rate in an effort to maintain adequate tissue perfusion and oxygen delivery. A pulse rate increase from baseline values can indicate early shock and the onset of hypovolemia (low blood volume), which is a common cause of postpartum hemorrhage.

Explanation of Other Options:

A. A temperature of 100.4°F (38°C)

A temperature of 100.4°F (38°C) in the first 24 hours postpartum is typically not a concern and can be a normal response to the exertion of labor. An elevated temperature after this period may indicate an infection, but it is not an early sign of hemorrhage.

C. A blood pressure change

 A change in blood pressure (e.g., a drop in blood pressure) is a later sign of significant blood loss, as the body initially compensates by increasing the heart rate and vasoconstriction to maintain adequate circulation. Hypotension often develops only after a significant amount of blood loss, so it would be a late sign of hemorrhage.

D. An increase in the respiratory rate from 18 to 22 breaths/minute

 An increase in respiratory rate can occur for various reasons, including pain, anxiety, or the body's response to a mild drop in oxygen levels. While it could be related to blood loss, an increase in respiratory rate is not the first or most specific sign of hemorrhage.

Summary:

The early sign of excessive blood loss in the postpartum period is typically an increase in pulse rate. This compensatory mechanism occurs as the body attempts to maintain adequate tissue perfusion in response to hypovolemia (low blood volume) caused by hemorrhage. Monitoring vital signs, especially pulse rate, is crucial in detecting early signs of postpartum hemorrhage.

Correct Answer: B. You should start feeling fetal activity between 16 to 20 weeks. 

Explanation

Fetal movement, also known as "quickening," is typically felt between 16 and 20 weeks of pregnancy for a first-time mother. This is when the fetus becomes large enough and develops the necessary muscle strength to produce noticeable movements that the mother can feel. For women who have been pregnant before, fetal movements might be noticed slightly earlier, around 14 to 16 weeks.

Why the Other Choices are Wrong:

A. You should start feeling fetal activity between 8 to 12 weeks: Fetal movement is generally not felt at this early stage. Although the fetus is moving from the very early stages of pregnancy, it is not large enough nor strong enough for the mother to feel these movements until later in the pregnancy.

C. You will feel fetal activity during labor: This statement is incorrect. While fetal movements are typically felt during the second trimester, labor itself is characterized by uterine contractions rather than the normal fetal movements that occur earlier in pregnancy.

D. You should start feeling fetal activity in the third trimester: By the third trimester, fetal movement will be more pronounced, but it is not the starting point for feeling fetal activity. This is the period when the movements are stronger and more frequent, but initial fetal activity is felt earlier, in the second trimester.

Summary:

The best response to a pregnant client asking about when she will feel fetal activity is between 16 to 20 weeks, as this is the typical time frame when first-time mothers feel their baby’s movements for the first time. The other options either overestimate or misstate the correct timing for fetal movement.

Correct Answer: Administer broad-spectrum antibiotics.

Explanation

A newborn with myelomeningocele (a type of spina bifida where the spinal cord and meninges protrude through an opening in the vertebrae) and leaking cerebrospinal fluid (CSF) is at high risk for infection due to exposure of the spinal cord and meninges to the external environment.Broad-spectrum antibiotics are essential in preventing meningitis or other infections, especially if the site is leaking CSF, which provides a potential entry point for pathogens.

Why the Other Options Are Incorrect:

Monitor the rectal temperature every 4 hr: While monitoring the newborn’s temperature is important, rectal temperatures should not be taken immediately after birth for neonates, particularly those with a myelomeningocele, due to the risk of causing trauma or injury to the exposed spinal cord. Instead, axillary temperature or another non-invasive method should be used for temperature monitoring.

Cleanse the site with povidone-iodine: Povidone-iodine is generally avoided in newborns with open wounds or exposed neural tissue, as it can be toxic to the skin and nervous tissue. Instead, the area should be kept moist and sterile, using sterile saline or other appropriate methods to prevent infection without causing further harm.

Prepare for surgical closure after 72 hr: The surgical closure of the myelomeningocele should be performed as soon as possible (within hours of birth) rather than waiting for 72 hours. Delaying surgical closure increases the risk of infection and neural damage. Early intervention is critical for improving outcomes and preventing further complications.

Summary:

The priority action for a newborn with a myelomeningocele and leaking CSF is to administer broad-spectrum antibiotics to reduce the risk of infection. Immediate surgical closure of the defect should also be prepared for, but antibiotics are necessary to prevent infection until surgery can be performed.

Correct Answer: Prepare to initiate cardiopulmonary resuscitation.

Explanation

An amniotic fluid embolism (AFE) is a rare but serious obstetric emergency that occurs when amniotic fluid, fetal cells, hair, or other debris enters the maternal circulation, causing an acute and often life-threatening reaction. The immediate priority in the management of AFE is to prepare for and initiate cardiopulmonary resuscitation (CPR) if needed. This may be necessary if the client experiences sudden cardiovascular collapse or respiratory distress, which are common in AFE due to the embolism's impact on cardiac function and oxygenation.

Why the Other Options Are Incorrect:

Plan to administer ephedrine IV: Ephedrine is a vasopressor used to manage hypotension in cases of shock, but it is not the immediate priority in the case of an amniotic fluid embolism. CPR should be initiated first to stabilize the client's cardiovascular status.

Assist the client to empty their bladder: While bladder distention should be avoided during labor and delivery, assisting with emptying the bladder is not a priority in the case of an amniotic fluid embolism. The main concern is managing the acute cardiovascular and respiratory effects.

Assess for the presence of clonus: Clonus is a sign of hyperreflexia and can be seen in conditions like preeclampsia, but it is not directly related to an amniotic fluid embolism. The priority is managing the immediate life-threatening complications of AFE, such as respiratory distress and cardiac instability.

Summary:

In the case of an amniotic fluid embolism, the priority action is to prepare to initiate cardiopulmonary resuscitation (CPR) due to the high risk of respiratory and cardiac collapse. Immediate stabilization of the client is critical in improving outcomes.

Correct Answer: "This test will detect the presence of Rh-positive antibodies in your blood."

Explanation

The indirect Coombs' test is used to detect Rh-positive antibodies in the blood of a Rh-negative pregnant client. If a mother is Rh-negative and the fetus is Rh-positive (inherited from an Rh-positive father), the mother’s immune system can produce antibodies against the Rh-positive red blood cells of the fetus, which may lead to hemolytic disease of the newborn. The indirect Coombs' test is done to check for the presence of these antibodies before any potential issues arise, so interventions (such as Rh immunoglobulin administration) can be made to prevent complications.

Why the Other Options Are Incorrect:

"This test will determine the amount of amniotic fluid around the fetus."

This description is more relevant to an amniotic fluid index or a biophysical profile, not the indirect Coombs' test. The Coombs' test is focused on antibodies, not amniotic fluid volume.

"This test determines if your baby is at risk for developing hypoglycemia after birth."

This statement refers to testing for blood glucose levels or other assessments like glucose screening, but the Coombs' test is unrelated to hypoglycemia and is specifically used for antibody detection.

"This test studies blood flow in the fetus and placenta using ultrasound waves."

This describes a Doppler ultrasound or a biophysical profile, both of which assess fetal blood flow and placental function. The indirect Coombs' test, however, is not related to blood flow; it checks for antibodies in the mother's blood.

Summary:

The indirect Coombs' test helps determine if there are Rh-positive antibodies in the mother’s blood, which can help prevent Rh incompatibility complications in pregnancy. The statement "This test will detect the presence of Rh-positive antibodies in your blood" best describes its purpose.

Correct Answer: C. Biophysical profile (BPP)

Explanation

A positive contraction stress test (CST) indicates late decelerations of the fetal heart rate (FHR) with uterine contractions, which can suggest uteroplacental insufficiency and potential fetal distress. A biophysical profile (BPP) is the next step to assess fetal well-being thoroughly. The BPP combines ultrasound imaging and a non-stress test (NST) to evaluate five parameters:

Fetal breathing movements

Fetal movements

Fetal muscle tone

Amniotic fluid volume

Fetal heart rate (via NST

A score of ≤6 on the BPP often indicates fetal compromise, guiding decisions about delivery planning.

Why not the other options?

A. Percutaneous umbilical blood sampling (PUBS): Used for fetal blood sampling or anemia diagnosis, not routinely indicated for positive CST results

B. Amnioinfusion: Involves infusing fluid into the amniotic sac to relieve cord compression, not a diagnostic test but a treatment for variable decelerations.

D. Chorionic villus sampling (CVS): A first-trimester genetic test for chromosomal abnormalities, not indicated in third-trimester fetal distress situations.

Key Teaching for Positive CST:

Positive CST requires further evaluation of fetal well-being.

Prepare for immediate intervention if fetal compromise is confirmed.

Educate about indications for potential induction of labor or cesarean delivery if fetal distress persists.

Correct Answer: D. "Staff members who take care of your baby will be wearing a photo identification badge."

Explanation

Ensuring the security and safety of the newborn is a critical part of postpartum care. Hospital policies should include steps to ensure that newborns are properly identified and cared for only by authorized personnel. Staff identification badges are an essential part of ensuring security in the postpartum setting. They help confirm that only authorized personnel are handling the newborn, reducing the risk of abduction or mistaken identity.

Why not the other options?

A. "The nurse will carry your newborn to the nursery for procedures."

While nurses do carry newborns for procedures, this statement does not directly address safety or security. The focus should be on identification protocols and authorized personnel for the safety of the newborn.

B. "We will document the relationship of visitors in your medical record."

While documenting visitors is important, it doesn't specifically address safety measures for the newborn, like identification badges for staff.

C. "Your baby will stay in the nursery while you are asleep."

This is not an appropriate or general safety measure. Many facilities encourage rooming-in (keeping the baby with the mother) for bonding, and security should focus on personnel and visitor controls, not just the baby's location.

Key Points for Newborn Security in Postpartum Care:

Proper identification for both the mother and baby (e.g., matching wristbands).

Staff and visitor identification protocols to limit access to the newborn.

Rooming-in is often encouraged for bonding, but security measures should still be in place.