ATI RN Maternal Newborn Exam 2023 with NGN
— 200 Real Questions & 100% Verifi ed Answers |
Pass RN ATI Maternal Newborn Proctored Exam
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Question 1: NGN Case Study – Postpartum Hemorrhage
Case Study Prompt:
A 32-year-old G2P1 patient delivered a 9 lb 2 oz infant via vacuum-assisted delivery 2 hours
ago. She has a history of prolonged labor and oxytocin augmentation. Current vital signs: HR
120 bpm, BP 85/50 mmHg, RR 22, O2 sat 94% on room air. Fundus is boggy and displaced to
the right. Lochia is heavy with large clots. The perineum is intact, but there is a 2nd-degree
vaginal laceration noted.
Part A (Matrix/SATA):
Select the 3 most appropriate immediate nursing actions.
Administer methylergonovine 0.2 mg IM
Massage the fundus until firm
Have the patient void
Prepare for blood transfusion
Apply fundal pressure to express clots
Place an indwelling urinary catheter
Part B (Bow-tie):
Complete the bow-tie by selecting the most likely condition (center), 2 risk factors (left side),
and 2 potential complications (right side).
Answers & Rationales
Part A Correct Answers:
✅ Massage the fundus until firm
✅ Administer methylergonovine 0.2 mg IM
✅ Have the patient void
Rationale:
Massage fundus – First-line intervention for uterine atony (boggy fundus).
Methylergonovine – Uterotonic for sustained contraction after massage.
Contraindicated in hypertension.
Void – Full bladder displaces uterus and prevents contraction.
Incorrect options: Fundal pressure can cause uterine inversion. Catheterization is not
immediate if voiding possible. Blood transfusion is later if unresponsive.
Part B Bow-tie Answer:
Center (Condition): Uterine atony
Left (Risk factors): Prolonged labor, Large infant (macrosomia)
, Right (Complications): Hypovolemic shock, Disseminated intravascular coagulation
(DIC)
Rationale:
Uterine atony is the leading cause of early postpartum hemorrhage. Risk factors:
overdistended uterus (macrosomia), prolonged labor, oxytocin use. Complications include
hypovolemic shock and DIC from prolonged hypoperfusion and coagulopathy.
Question 2: Pharmacological Management of Preeclampsia
A patient with severe preeclampsia (BP 165/110 mmHg, 3+ proteinuria, headache, blurred
vision) is receiving IV magnesium sulfate. Which finding requires immediate intervention?
A. Urine output 25 mL/hr
B. Respiratory rate 14 breaths/min
C. Deep tendon reflexes 3+
D. Serum magnesium level 7.5 mg/dL
Answer: D
Rationale:
Therapeutic magnesium level is 4–7 mg/dL. 7.5 mg/dL is above therapeutic range, increasing
risk of magnesium toxicity (muscle weakness, respiratory depression, cardiac arrest).
A: 25 mL/hr is acceptable (>30 is ideal, but >25 is often minimum in protocols).
B: RR 14 is normal (toxicity if <12).
C: 3+ reflexes are brisk but not hyperreflexia (4+ is clonus).
Question 3: Newborn Assessment – Gestational Age
A newborn at 38 weeks weighs 2500 g (5 lb 8 oz). The nurse notes dry, cracked skin, minimal
vernix, and fingernails extending beyond the fingertips. Which finding is most consistent
with this infant?
A. Small for gestational age (SGA)
B. Appropriate for gestational age (AGA)
C. Post-term gestation
D. Intrauterine growth restriction (IUGR)
Answer: C
Rationale:
Dry, cracked skin, minimal vernix, and long nails indicate post-maturity syndrome, but at 38
weeks (term), these signs suggest accelerated maturation or possible incorrect dating.
However, among options, post-term gestation (≥42 weeks) best matches physical findings.
SGA/IUGR would have normal skin for age but low weight.
Weight 2500 g is borderline low for 38 weeks but not diagnostic alone.
,Question 4: NGN Matrix – Intrapartum Fetal Monitoring
Scenario: A patient at 40 weeks is in active labor. Contractions every 2–3 min, lasting 60 sec.
FHR baseline 140 bpm, moderate variability. For the past 20 min, late decelerations to 100
bpm occur with each contraction.
Matrix Question:
For each intervention, indicate if it is Indicated, Non-essential, or Contraindicated.
Non-
Intervention Indicated Contraindicated
essential
Turn patient to left lateral position X
Increase IV oxytocin X
Administer 10L O2 via face mask X
Perform vaginal exam X
Discontinue oxytocin if infusing X
Prepare for immediate C-section X
Rationale:
Left lateral → Improves uterine blood flow, relieves cord compression.
Increase oxytocin → Contraindicated; would worsen uterine tachysystole and late
decels.
O2 → Increases fetal oxygenation.
Vaginal exam → Assess for cord prolapse, rapid delivery.
Discontinue oxytocin → Essential if running; reduces uterine activity.
Immediate C-section → Not yet unless late decels persist after interventions.
Question 5: Newborn Care – Hypoglycemia Prevention
A newborn of a diabetic mother (GDM) is 30 minutes old. Which nursing action is most
important?
A. Assess blood glucose within 1 hour of birth
B. Initiate early breastfeeding or formula feeding
C. Monitor for jitteriness and poor feeding
D. Obtain a serum calcium level
Answer: B
Rationale:
Early feeding (breast or formula) is the primary prevention for neonatal hypoglycemia, which
is common in infants of diabetic mothers due to hyperinsulinism.
A: Glucose check is important but should be done before feeding if high risk? No –
ATI prioritizes feeding first unless symptomatic.
, C: Monitoring is assessment, not intervention.
D: Hypocalcemia can occur but is secondary.
Question 6: Postpartum Infection – Endometritis
A postpartum patient on day 2 has a fever of 39°C (102.2°F), chills, abdominal pain, and foul
lochia. Uterus is tender and subinvolution. Which diagnosis is most likely and what is the
priority intervention?
Answer: Endometritis
Priority intervention: Initiate broad-spectrum IV antibiotics (e.g., clindamycin + gentamicin).
Rationale:
Endometritis is common after C-section or prolonged labor. Fever + uterine tenderness + foul
lochia = hallmark signs. Oral antibiotics are insufficient; IV therapy is needed due to
endometrial vascularity.
Other interventions: blood cultures, but antibiotics should not be delayed.
Question 7: NGN Trend – Labor Progression
Trend data:
0800: 3 cm, 50% effaced, -2 station
1200: 5 cm, 70% effaced, -1 station
1600: 6 cm, 80% effaced, -1 station
2000: 6 cm, 80% effaced, 0 station
Question:
Interpret the labor pattern. What is the most likely cause and appropriate intervention?
Answer:
Prolonged latent phase → likely arrest of active phase (no change in dilation for 4 hours).
Cause: Possible cephalopelvic disproportion (CPD), ineffective contractions, or fetal
malposition.
Intervention: Notify provider, consider amniotomy, oxytocin augmentation, or C-section.
Rationale:
Active phase should progress at ≥1 cm/hr in nulliparas. No change from 1600–2000 = arrest
disorder.
Question 8: Contraindication to Breastfeeding
A mother is HIV-positive. Which statement indicates correct understanding of infant
feeding?
A. “I will exclusively formula feed my baby.”
B. “Breastfeeding is safe if I take antiretrovirals.”
C. “I can pump and heat treat my milk to kill the virus.”
D. “Breastfeeding is allowed if my viral load is undetectable.”
— 200 Real Questions & 100% Verifi ed Answers |
Pass RN ATI Maternal Newborn Proctored Exam
Guaranteed
Question 1: NGN Case Study – Postpartum Hemorrhage
Case Study Prompt:
A 32-year-old G2P1 patient delivered a 9 lb 2 oz infant via vacuum-assisted delivery 2 hours
ago. She has a history of prolonged labor and oxytocin augmentation. Current vital signs: HR
120 bpm, BP 85/50 mmHg, RR 22, O2 sat 94% on room air. Fundus is boggy and displaced to
the right. Lochia is heavy with large clots. The perineum is intact, but there is a 2nd-degree
vaginal laceration noted.
Part A (Matrix/SATA):
Select the 3 most appropriate immediate nursing actions.
Administer methylergonovine 0.2 mg IM
Massage the fundus until firm
Have the patient void
Prepare for blood transfusion
Apply fundal pressure to express clots
Place an indwelling urinary catheter
Part B (Bow-tie):
Complete the bow-tie by selecting the most likely condition (center), 2 risk factors (left side),
and 2 potential complications (right side).
Answers & Rationales
Part A Correct Answers:
✅ Massage the fundus until firm
✅ Administer methylergonovine 0.2 mg IM
✅ Have the patient void
Rationale:
Massage fundus – First-line intervention for uterine atony (boggy fundus).
Methylergonovine – Uterotonic for sustained contraction after massage.
Contraindicated in hypertension.
Void – Full bladder displaces uterus and prevents contraction.
Incorrect options: Fundal pressure can cause uterine inversion. Catheterization is not
immediate if voiding possible. Blood transfusion is later if unresponsive.
Part B Bow-tie Answer:
Center (Condition): Uterine atony
Left (Risk factors): Prolonged labor, Large infant (macrosomia)
, Right (Complications): Hypovolemic shock, Disseminated intravascular coagulation
(DIC)
Rationale:
Uterine atony is the leading cause of early postpartum hemorrhage. Risk factors:
overdistended uterus (macrosomia), prolonged labor, oxytocin use. Complications include
hypovolemic shock and DIC from prolonged hypoperfusion and coagulopathy.
Question 2: Pharmacological Management of Preeclampsia
A patient with severe preeclampsia (BP 165/110 mmHg, 3+ proteinuria, headache, blurred
vision) is receiving IV magnesium sulfate. Which finding requires immediate intervention?
A. Urine output 25 mL/hr
B. Respiratory rate 14 breaths/min
C. Deep tendon reflexes 3+
D. Serum magnesium level 7.5 mg/dL
Answer: D
Rationale:
Therapeutic magnesium level is 4–7 mg/dL. 7.5 mg/dL is above therapeutic range, increasing
risk of magnesium toxicity (muscle weakness, respiratory depression, cardiac arrest).
A: 25 mL/hr is acceptable (>30 is ideal, but >25 is often minimum in protocols).
B: RR 14 is normal (toxicity if <12).
C: 3+ reflexes are brisk but not hyperreflexia (4+ is clonus).
Question 3: Newborn Assessment – Gestational Age
A newborn at 38 weeks weighs 2500 g (5 lb 8 oz). The nurse notes dry, cracked skin, minimal
vernix, and fingernails extending beyond the fingertips. Which finding is most consistent
with this infant?
A. Small for gestational age (SGA)
B. Appropriate for gestational age (AGA)
C. Post-term gestation
D. Intrauterine growth restriction (IUGR)
Answer: C
Rationale:
Dry, cracked skin, minimal vernix, and long nails indicate post-maturity syndrome, but at 38
weeks (term), these signs suggest accelerated maturation or possible incorrect dating.
However, among options, post-term gestation (≥42 weeks) best matches physical findings.
SGA/IUGR would have normal skin for age but low weight.
Weight 2500 g is borderline low for 38 weeks but not diagnostic alone.
,Question 4: NGN Matrix – Intrapartum Fetal Monitoring
Scenario: A patient at 40 weeks is in active labor. Contractions every 2–3 min, lasting 60 sec.
FHR baseline 140 bpm, moderate variability. For the past 20 min, late decelerations to 100
bpm occur with each contraction.
Matrix Question:
For each intervention, indicate if it is Indicated, Non-essential, or Contraindicated.
Non-
Intervention Indicated Contraindicated
essential
Turn patient to left lateral position X
Increase IV oxytocin X
Administer 10L O2 via face mask X
Perform vaginal exam X
Discontinue oxytocin if infusing X
Prepare for immediate C-section X
Rationale:
Left lateral → Improves uterine blood flow, relieves cord compression.
Increase oxytocin → Contraindicated; would worsen uterine tachysystole and late
decels.
O2 → Increases fetal oxygenation.
Vaginal exam → Assess for cord prolapse, rapid delivery.
Discontinue oxytocin → Essential if running; reduces uterine activity.
Immediate C-section → Not yet unless late decels persist after interventions.
Question 5: Newborn Care – Hypoglycemia Prevention
A newborn of a diabetic mother (GDM) is 30 minutes old. Which nursing action is most
important?
A. Assess blood glucose within 1 hour of birth
B. Initiate early breastfeeding or formula feeding
C. Monitor for jitteriness and poor feeding
D. Obtain a serum calcium level
Answer: B
Rationale:
Early feeding (breast or formula) is the primary prevention for neonatal hypoglycemia, which
is common in infants of diabetic mothers due to hyperinsulinism.
A: Glucose check is important but should be done before feeding if high risk? No –
ATI prioritizes feeding first unless symptomatic.
, C: Monitoring is assessment, not intervention.
D: Hypocalcemia can occur but is secondary.
Question 6: Postpartum Infection – Endometritis
A postpartum patient on day 2 has a fever of 39°C (102.2°F), chills, abdominal pain, and foul
lochia. Uterus is tender and subinvolution. Which diagnosis is most likely and what is the
priority intervention?
Answer: Endometritis
Priority intervention: Initiate broad-spectrum IV antibiotics (e.g., clindamycin + gentamicin).
Rationale:
Endometritis is common after C-section or prolonged labor. Fever + uterine tenderness + foul
lochia = hallmark signs. Oral antibiotics are insufficient; IV therapy is needed due to
endometrial vascularity.
Other interventions: blood cultures, but antibiotics should not be delayed.
Question 7: NGN Trend – Labor Progression
Trend data:
0800: 3 cm, 50% effaced, -2 station
1200: 5 cm, 70% effaced, -1 station
1600: 6 cm, 80% effaced, -1 station
2000: 6 cm, 80% effaced, 0 station
Question:
Interpret the labor pattern. What is the most likely cause and appropriate intervention?
Answer:
Prolonged latent phase → likely arrest of active phase (no change in dilation for 4 hours).
Cause: Possible cephalopelvic disproportion (CPD), ineffective contractions, or fetal
malposition.
Intervention: Notify provider, consider amniotomy, oxytocin augmentation, or C-section.
Rationale:
Active phase should progress at ≥1 cm/hr in nulliparas. No change from 1600–2000 = arrest
disorder.
Question 8: Contraindication to Breastfeeding
A mother is HIV-positive. Which statement indicates correct understanding of infant
feeding?
A. “I will exclusively formula feed my baby.”
B. “Breastfeeding is safe if I take antiretrovirals.”
C. “I can pump and heat treat my milk to kill the virus.”
D. “Breastfeeding is allowed if my viral load is undetectable.”
