ATI RN MATERNAL NEWBORN CMS PROCTORED EXAM
ACTUAL 2026/2027 | Verified Detailed Solutions with A+
Grade Assured | Complete Questions Bank | Pass
Guaranteed
DOMAIN 1: ANTEPARTUM CARE (15 Questions)
Q1. A registered nurse is caring for a client at 32 weeks gestation who reports
decreased fetal movement over the past 24 hours. The nurse performs a nonstress test
(NST) and observes no accelerations in fetal heart rate over a 40-minute period. Which
action should the nurse implement first?
A. Perform a biophysical profile (BPP) immediately
B. Notify the healthcare provider and prepare for possible delivery
C. Apply acoustic stimulation and continue monitoring for another 20 minutes
D. Have the client drink orange juice and reposition on her left side
Correct Answer: D [CORRECT]
Rationale: The first nursing intervention for a nonreactive NST is to implement
noninvasive measures to stimulate fetal activity before escalating to more invasive
procedures. Having the client drink a glucose-containing beverage (orange juice)
provides energy substrate, while left lateral positioning improves uteroplacental
,perfusion by relieving aortocaval compression. These conservative measures should be
attempted before applying acoustic stimulation (Option C) or proceeding to biophysical
profile (Option A). Option B is premature without first attempting stimulation techniques
and extended monitoring. According to ATI Maternal Newborn CMS guidelines and
ACOG standards, a minimum of 80 minutes of monitoring may be required before
declaring a true nonreactive NST, provided fetal sleep cycles and other variables are
considered. The nurse must follow a systematic approach: maternal position change,
glucose administration, then acoustic stimulation, before notifying the provider for
further interventions.
Q2. A pregnant client at 18 weeks gestation asks the nurse about the purpose of the
alpha-fetoprotein (AFP) screening test. Which response by the nurse demonstrates
accurate understanding?
A. "This test detects chromosomal abnormalities such as Down syndrome with 100%
accuracy"
B. "AFP screening identifies open neural tube defects and certain chromosomal
anomalies; abnormal results require follow-up diagnostic testing"
C. "An elevated AFP level always indicates the fetus has spina bifida and requires
immediate intervention"
D. "This test is mandatory for all pregnant women and must be completed before 16
weeks gestation"
Correct Answer: B [CORRECT]
Rationale: Maternal serum AFP screening, typically performed between 15-22 weeks
gestation, is a screening (not diagnostic) tool for open neural tube defects (elevated
,AFP) and certain chromosomal abnormalities such as Trisomy 18 and Down syndrome
(low AFP). Option A is incorrect because AFP is not diagnostic and does not have 100%
accuracy—false positives and negatives occur. Option C is incorrect because elevated
AFP requires further diagnostic evaluation (ultrasound, amniocentesis) as it can result
from incorrect dates, multiple gestation, or placental abnormalities, not exclusively
neural tube defects. Option D is incorrect because AFP screening is optional, not
mandatory, and the optimal window is 16-18 weeks, though acceptable up to 22 weeks.
ATI Maternal Newborn CMS emphasizes that nurses must understand the difference
between screening and diagnostic tests and provide accurate, non-directive counseling
regarding prenatal testing options.
Q3. A nurse is reviewing the medical record of a client at 28 weeks gestation with a
history of class III heart disease. Which finding requires immediate nursing
intervention?
A. Client reports mild ankle edema at the end of the day
B. Heart rate increases from 78 bpm to 102 bpm after climbing stairs
C. Client experiences dyspnea at rest and a persistent cough
D. Blood pressure reading of 130/84 mmHg
Correct Answer: C [CORRECT]
Rationale: In pregnant clients with pre-existing cardiac disease, the physiological
changes of pregnancy (increased blood volume, cardiac output, and heart rate)
significantly stress the cardiovascular system. While mild ankle edema (Option A) and
mild tachycardia with exertion (Option B) are normal pregnancy adaptations, dyspnea at
rest and persistent cough indicate early heart failure and pulmonary
, congestion—medical emergencies requiring immediate intervention. Option D
represents a mildly elevated blood pressure but not an immediate crisis. According to
the NYHA functional classification and ATI Maternal Newborn CMS cardiovascular
content, clients with class III heart disease have marked limitation of physical activity
and are at high risk for decompensation. The nurse must immediately notify the
healthcare provider, position the client in high Fowler's, administer oxygen, and prepare
for potential hospitalization. This question tests prioritization and recognition of
life-threatening complications in high-risk antepartum clients.
Q4. [Select-All-That-Apply] A nurse is providing prenatal education to a client with a body
mass index (BMI) of 32 kg/m² at the initial prenatal visit. Which recommendations
should the nurse include regarding weight gain during pregnancy? (Select all that apply.)
A. Total weight gain should be limited to 11-20 pounds (5-9 kg)
B. Weight gain should occur at a rate of 0.5 pounds per week in the second and third
trimesters
C. Caloric intake should increase by approximately 300 calories per day
D. Weekly weight monitoring should be implemented to assess patterns
E. Strict dieting is acceptable to minimize pregnancy complications
F. Nutritional counseling with a registered dietitian should be offered
Correct Answer: A, B, C, D, F
Rationale: For clients with pre-pregnancy obesity (BMI ≥30 kg/m²), the Institute of
Medicine (IOM) recommends total gestational weight gain of 11-20 pounds (5-9 kg)
(Option A). Weight gain should occur at approximately 0.5 pounds (0.22 kg) per week in
ACTUAL 2026/2027 | Verified Detailed Solutions with A+
Grade Assured | Complete Questions Bank | Pass
Guaranteed
DOMAIN 1: ANTEPARTUM CARE (15 Questions)
Q1. A registered nurse is caring for a client at 32 weeks gestation who reports
decreased fetal movement over the past 24 hours. The nurse performs a nonstress test
(NST) and observes no accelerations in fetal heart rate over a 40-minute period. Which
action should the nurse implement first?
A. Perform a biophysical profile (BPP) immediately
B. Notify the healthcare provider and prepare for possible delivery
C. Apply acoustic stimulation and continue monitoring for another 20 minutes
D. Have the client drink orange juice and reposition on her left side
Correct Answer: D [CORRECT]
Rationale: The first nursing intervention for a nonreactive NST is to implement
noninvasive measures to stimulate fetal activity before escalating to more invasive
procedures. Having the client drink a glucose-containing beverage (orange juice)
provides energy substrate, while left lateral positioning improves uteroplacental
,perfusion by relieving aortocaval compression. These conservative measures should be
attempted before applying acoustic stimulation (Option C) or proceeding to biophysical
profile (Option A). Option B is premature without first attempting stimulation techniques
and extended monitoring. According to ATI Maternal Newborn CMS guidelines and
ACOG standards, a minimum of 80 minutes of monitoring may be required before
declaring a true nonreactive NST, provided fetal sleep cycles and other variables are
considered. The nurse must follow a systematic approach: maternal position change,
glucose administration, then acoustic stimulation, before notifying the provider for
further interventions.
Q2. A pregnant client at 18 weeks gestation asks the nurse about the purpose of the
alpha-fetoprotein (AFP) screening test. Which response by the nurse demonstrates
accurate understanding?
A. "This test detects chromosomal abnormalities such as Down syndrome with 100%
accuracy"
B. "AFP screening identifies open neural tube defects and certain chromosomal
anomalies; abnormal results require follow-up diagnostic testing"
C. "An elevated AFP level always indicates the fetus has spina bifida and requires
immediate intervention"
D. "This test is mandatory for all pregnant women and must be completed before 16
weeks gestation"
Correct Answer: B [CORRECT]
Rationale: Maternal serum AFP screening, typically performed between 15-22 weeks
gestation, is a screening (not diagnostic) tool for open neural tube defects (elevated
,AFP) and certain chromosomal abnormalities such as Trisomy 18 and Down syndrome
(low AFP). Option A is incorrect because AFP is not diagnostic and does not have 100%
accuracy—false positives and negatives occur. Option C is incorrect because elevated
AFP requires further diagnostic evaluation (ultrasound, amniocentesis) as it can result
from incorrect dates, multiple gestation, or placental abnormalities, not exclusively
neural tube defects. Option D is incorrect because AFP screening is optional, not
mandatory, and the optimal window is 16-18 weeks, though acceptable up to 22 weeks.
ATI Maternal Newborn CMS emphasizes that nurses must understand the difference
between screening and diagnostic tests and provide accurate, non-directive counseling
regarding prenatal testing options.
Q3. A nurse is reviewing the medical record of a client at 28 weeks gestation with a
history of class III heart disease. Which finding requires immediate nursing
intervention?
A. Client reports mild ankle edema at the end of the day
B. Heart rate increases from 78 bpm to 102 bpm after climbing stairs
C. Client experiences dyspnea at rest and a persistent cough
D. Blood pressure reading of 130/84 mmHg
Correct Answer: C [CORRECT]
Rationale: In pregnant clients with pre-existing cardiac disease, the physiological
changes of pregnancy (increased blood volume, cardiac output, and heart rate)
significantly stress the cardiovascular system. While mild ankle edema (Option A) and
mild tachycardia with exertion (Option B) are normal pregnancy adaptations, dyspnea at
rest and persistent cough indicate early heart failure and pulmonary
, congestion—medical emergencies requiring immediate intervention. Option D
represents a mildly elevated blood pressure but not an immediate crisis. According to
the NYHA functional classification and ATI Maternal Newborn CMS cardiovascular
content, clients with class III heart disease have marked limitation of physical activity
and are at high risk for decompensation. The nurse must immediately notify the
healthcare provider, position the client in high Fowler's, administer oxygen, and prepare
for potential hospitalization. This question tests prioritization and recognition of
life-threatening complications in high-risk antepartum clients.
Q4. [Select-All-That-Apply] A nurse is providing prenatal education to a client with a body
mass index (BMI) of 32 kg/m² at the initial prenatal visit. Which recommendations
should the nurse include regarding weight gain during pregnancy? (Select all that apply.)
A. Total weight gain should be limited to 11-20 pounds (5-9 kg)
B. Weight gain should occur at a rate of 0.5 pounds per week in the second and third
trimesters
C. Caloric intake should increase by approximately 300 calories per day
D. Weekly weight monitoring should be implemented to assess patterns
E. Strict dieting is acceptable to minimize pregnancy complications
F. Nutritional counseling with a registered dietitian should be offered
Correct Answer: A, B, C, D, F
Rationale: For clients with pre-pregnancy obesity (BMI ≥30 kg/m²), the Institute of
Medicine (IOM) recommends total gestational weight gain of 11-20 pounds (5-9 kg)
(Option A). Weight gain should occur at approximately 0.5 pounds (0.22 kg) per week in
