PN ATI Capstone Maternal Newborn

Correct Answer: D

Rationale: Gravida refers to the total number of pregnancies (4), and Para refers to the number of viable births (2 full-term + 0 preterm = 2). The correct documentation is Gravida 4, Para 2.

Correct Answer: D

Rationale: Acrocyanosis, or bluish discoloration of the hands and feet, is a normal finding in newborns in the first few hours after birth. The nurse should continue to monitor the newborn and reassess after some time.

Correct Answer: A

Rationale: Heavy bleeding and the passage of large clots after childbirth can indicate uterine atony. The nurse should first attempt to massage the fundus to stimulate uterine contractions and control the bleeding.

Correct Answer: A

Rationale: A boggy and displaced uterus is often a sign of bladder distention, which can prevent the uterus from contracting effectively. The priority intervention is to assist the client to void, which will allow the uterus to return to midline and become firm.

Correct Answer: B

Rationale: Magnesium sulfate can depress the central nervous system, leading to respiratory depression. A respiratory rate of 10 breaths per minute is below the normal range and requires immediate intervention.