ATI Proctored Exam on High Risk Newborn

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Sample questions from ATI Proctored Exam on High Risk Newborn

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A nurse receives handoff for four newborns in a neonatal intensive care unit (NICU). Which newborn should the nurse assess first?

   • A.A 32-week newborn, age 3 days, with an axillary temperature of 36.3 C while receiving phototherapy
   • B.A 35-week newborn, age 2 days, with a respiratory rate of 64/min immediately after crying
   • C.A 34-week newborn, age 5 days, who requires gavage feeding because of an immature suck
   • D.A 29-week newborn, age 8 days, with new abdominal distention, bloody stool, and two episodes of apnea

   Rationale: Abdominal distention, bloody stool, and new apnea suggest necrotizing enterocolitis with possible systemic deterioration and require immediate assessment. Mild hypothermia requires intervention but is less urgent than possible bowel ischemia and sepsis. Brief tachypnea after crying and an immature suck in a preterm newborn are less concerning findings. Prioritize acute changes that indicate impaired perfusion or rapidly progressive illness.

2. 2.A 30-week newborn, age 6 days, is stable in an incubator in the NICU. The RN is working with an experienced unlicensed assistive personnel (UAP). Which task is appropriate to delegate?

   • A.Evaluate the skin beneath the nasal continuous positive airway pressure interface
   • B.Determine whether the newborn is ready for oral feeding
   • C.Weigh diapers and report the measured output to the RN
   • D.Teach the parents how to recognize respiratory distress

   Rationale: Weighing diapers and reporting measurements is a routine data-collection task that can be delegated with clear instructions. Assessing feeding readiness and evaluating skin integrity require nursing judgment. Parent teaching is also an RN responsibility. Delegate predictable tasks while retaining assessment, interpretation, and evaluation.

3. 3.A 28-week newborn, age 2 days, has repeated apnea with bradycardia in the NICU. The prescription reads, 'Caffeine citrate 20 mg/kg IV loading dose,' but the electronic medication record lists caffeine base at the same dose. What should the nurse do first?

   • A.Clarify the formulation and dose with the pharmacist and prescriber
   • B.Withhold all future caffeine therapy because apnea is expected
   • C.Administer the medication listed in the electronic record
   • D.Give half the prescribed volume without contacting the prescriber

   Rationale: Caffeine citrate and caffeine base are not dose-equivalent, so the discrepancy must be clarified before administration. Following the electronic record without verification could cause a dosing error. Independently changing the dose is unsafe, and abandoning therapy leaves clinically significant apnea untreated. Resolve discrepancies involving drug formulation before giving neonatal medications.

4. 4.A 27-week newborn, age 3 weeks, is being transferred from a community NICU to a surgical center for suspected necrotizing enterocolitis. The newborn is NPO, has a gastric decompression tube, and is receiving antibiotics. Which information should the nurse include in the transfer handoff? Select all that apply.

   • A.A statement that the receiving team can obtain all necessary information after arrival
   • B.Current vascular access, infusions, and dosing weight
   • C.Recent episodes of apnea and current respiratory support
   • D.Time and dose of the most recent antibiotics
   • E.Recent abdominal findings, laboratory results, and urine output

   Answer and rationale are in the full material.

5. 5.A term newborn, age 90 minutes, is in a regional nursery after a prolonged resuscitation. Cord arterial pH was 6.88, and the newborn is lethargic with hypotonia and a weak suck. Which action is the nurse's priority?

   • A.Delay referral until the neurologic examination is repeated tomorrow
   • B.Activate urgent evaluation and transfer for therapeutic hypothermia eligibility
   • C.Place ice packs around the newborn without a temperature protocol
   • D.Initiate feeding to determine whether the suck improves

   Answer and rationale are in the full material.