ATI RN Maternal Newborn 2026 NGN Complete
Study Guide Exam-Style Questions with Correct
Answers & Step-by-Step Rationales
SECTION 1: ANTEPARTUM
Question 1
A 32-year-old primigravida at 36 weeks gestation presents with blood pressure of
158/94 mmHg, 3+ proteinuria, and complaints of severe frontal headache and
epigastric pain. Which medication should the nurse anticipate administering first?
• A) Labetalol 20 mg IV push
• B) Hydralazine 5 mg IV push
• C) Magnesium sulfate 4 g IV loading dose over 20 minutes
• D) Nifedipine 30 mg extended release PO
Rationale: Magnesium sulfate is the first-line medication for seizure prophylaxis
in severe preeclampsia. While antihypertensives (labetalol, hydralazine) are
important for blood pressure control, preventing eclampsia takes priority. The
epigastric pain indicates liver involvement, suggesting HELLP syndrome
progression. Magnesium sulfate crosses the placenta but fetal monitoring can
detect complications. The loading dose is typically 4-6 g IV followed by
maintenance infusion of 1-2 g/hour.
Question 2
A pregnant patient at 28 weeks gestation has a positive 1-hour glucose challenge
test result of 165 mg/dL. Which action should the nurse take next?
• A) Instruct the patient to begin a low-carbohydrate diet
• B) Schedule a 100-g, 3-hour oral glucose tolerance test
• C) Diagnose the patient with gestational diabetes mellitus
• D) Repeat the 1-hour glucose challenge test in 1 week
,Rationale: A 1-hour glucose challenge test result ≥140 mg/dL (some facilities use
130-135 mg/dL) requires follow-up with the diagnostic 3-hour 100-g oral glucose
tolerance test (OGTT). GDM diagnosis requires at least two abnormal values on
the 3-hour OGTT. The patient should maintain normal diet before testing.
Treatment begins after confirmed diagnosis.
Question 3
A nurse is caring for a patient with placenta previa at 34 weeks gestation. Which
assessment finding requires immediate intervention?
• A) Fetal heart rate of 148 beats/minute with moderate variability
• B) Bright red, painless vaginal bleeding of 200 mL
• C) Blood pressure of 110/68 mmHg and heart rate of 92 beats/minute
• D) Fundal height measuring 33 cm
Rationale: Painless bright red bleeding is the classic presentation of placenta
previa. Any significant bleeding (≥200 mL) in the third trimester with known
previa requires immediate notification of the provider and preparation for possible
delivery. The bleeding occurs as the cervix begins to dilate and thins, shearing the
placental edge. A digital cervical examination is contraindicated due to risk of
catastrophic hemorrhage.
Question 4
A patient at 39 weeks gestation is receiving oxytocin for induction of labor. The
contraction pattern shows contractions every 1.5 minutes, lasting 110 seconds, with
baseline uterine tone of 25 mmHg between contractions. Which action should the
nurse take FIRST?
• A) Administer terbutaline 0.25 mg subcutaneously
• B) Stop the oxytocin infusion immediately
• C) Position the patient in left lateral position
• D) Increase the maintenance IV fluid rate
,Rationale: This contraction pattern demonstrates tachysystole (contractions <2
minutes apart) and prolonged contractions (>90 seconds) with elevated resting
tone (normal <20 mmHg). The priority action is discontinuing the oxytocin
infusion to reduce uterine stimulation. Left lateral positioning and IV fluids are
secondary interventions. Terbutaline is a uterine relaxant but is not first-line when
oxytocin can simply be stopped.
Question 5
A primigravida at 32 weeks gestation reports "spots" in her vision and right upper
quadrant pain. Laboratory results show platelets 85,000/mm³, AST 98 units/L,
ALT 112 units/L. Which additional finding would the nurse expect?
• A) Hemoglobin of 9.2 g/dL with schistocytes on smear
• B) White blood cell count of 4,500/mm³
• C) Prothrombin time of 11.5 seconds
• D) Fibrinogen level of 450 mg/dL
Rationale: This patient is exhibiting HELLP syndrome (Hemolysis, Elevated
Liver enzymes, Low Platelets). Hemolysis manifests as anemia with
schistocytes (fragmented RBCs) on peripheral smear. Other expected findings
include elevated LDH (>600 U/L), elevated bilirubin (>1.2 mg/dL), and decreased
haptoglobin. WBC count may be normal or slightly elevated. PT is typically
normal unless DIC develops. Fibrinogen is usually normal or elevated in
pregnancy.
Question 6
A blood type A-negative patient at 28 weeks gestation has an indirect Coombs test
positive for anti-D antibodies with a titer of 1:16. The patient asks about risks to
the baby. Which response by the nurse is most accurate?
• A) "Your baby is protected because you received RhoGAM at 28 weeks"
• B) "The antibodies indicate your body has already formed a response against
Rh-positive blood"
, • C) "Your baby is at risk for jaundice requiring phototherapy after birth"
• D) "Your baby may develop severe anemia requiring intrauterine
transfusions"
Rationale: A positive indirect Coombs test with anti-D titer ≥1:16 indicates
significant Rh sensitization that can cause fetal hemolytic disease. Severe anemia
can lead to hydrops fetalis (fetal heart failure, ascites, pleural effusions).
Treatment may require intrauterine transfusions to prevent fetal demise.
RhoGAM is ineffective once sensitization occurs. While jaundice is a risk, the
more critical concern is severe anemia and hydrops.
Question 7
A nurse is assessing a patient at 15 weeks gestation who is Rh-negative and has not
received RhoGAM. She experienced vaginal bleeding at 10 weeks and passed
clots. Which statement indicates understanding of her Rh status?
• A) "I don't need RhoGAM until after the baby is born if the baby is Rh-
positive"
• B) "I should have received RhoGAM after my bleeding episode at 10
weeks"
• C) "My partner needs to receive RhoGAM since I am Rh-negative"
• D) "I will receive RhoGAM now and again at 36 weeks"
Rationale: RhoGAM is indicated within 72 hours of any potential fetomaternal
hemorrhage including threatened abortion, spontaneous abortion, ectopic
pregnancy, or chorionic villus sampling. At 10 weeks, the patient's bleeding could
have caused sensitization. The standard schedule is RhoGAM at 28 weeks and
within 72 hours of delivery if the infant is Rh-positive, but additional doses are
needed for any antepartum bleeding after 12 weeks.
Question 8
A patient at 41 weeks gestation has a Bishop score of 4. She is scheduled for
cervical ripening. Which medication order should the nurse question?
Study Guide Exam-Style Questions with Correct
Answers & Step-by-Step Rationales
SECTION 1: ANTEPARTUM
Question 1
A 32-year-old primigravida at 36 weeks gestation presents with blood pressure of
158/94 mmHg, 3+ proteinuria, and complaints of severe frontal headache and
epigastric pain. Which medication should the nurse anticipate administering first?
• A) Labetalol 20 mg IV push
• B) Hydralazine 5 mg IV push
• C) Magnesium sulfate 4 g IV loading dose over 20 minutes
• D) Nifedipine 30 mg extended release PO
Rationale: Magnesium sulfate is the first-line medication for seizure prophylaxis
in severe preeclampsia. While antihypertensives (labetalol, hydralazine) are
important for blood pressure control, preventing eclampsia takes priority. The
epigastric pain indicates liver involvement, suggesting HELLP syndrome
progression. Magnesium sulfate crosses the placenta but fetal monitoring can
detect complications. The loading dose is typically 4-6 g IV followed by
maintenance infusion of 1-2 g/hour.
Question 2
A pregnant patient at 28 weeks gestation has a positive 1-hour glucose challenge
test result of 165 mg/dL. Which action should the nurse take next?
• A) Instruct the patient to begin a low-carbohydrate diet
• B) Schedule a 100-g, 3-hour oral glucose tolerance test
• C) Diagnose the patient with gestational diabetes mellitus
• D) Repeat the 1-hour glucose challenge test in 1 week
,Rationale: A 1-hour glucose challenge test result ≥140 mg/dL (some facilities use
130-135 mg/dL) requires follow-up with the diagnostic 3-hour 100-g oral glucose
tolerance test (OGTT). GDM diagnosis requires at least two abnormal values on
the 3-hour OGTT. The patient should maintain normal diet before testing.
Treatment begins after confirmed diagnosis.
Question 3
A nurse is caring for a patient with placenta previa at 34 weeks gestation. Which
assessment finding requires immediate intervention?
• A) Fetal heart rate of 148 beats/minute with moderate variability
• B) Bright red, painless vaginal bleeding of 200 mL
• C) Blood pressure of 110/68 mmHg and heart rate of 92 beats/minute
• D) Fundal height measuring 33 cm
Rationale: Painless bright red bleeding is the classic presentation of placenta
previa. Any significant bleeding (≥200 mL) in the third trimester with known
previa requires immediate notification of the provider and preparation for possible
delivery. The bleeding occurs as the cervix begins to dilate and thins, shearing the
placental edge. A digital cervical examination is contraindicated due to risk of
catastrophic hemorrhage.
Question 4
A patient at 39 weeks gestation is receiving oxytocin for induction of labor. The
contraction pattern shows contractions every 1.5 minutes, lasting 110 seconds, with
baseline uterine tone of 25 mmHg between contractions. Which action should the
nurse take FIRST?
• A) Administer terbutaline 0.25 mg subcutaneously
• B) Stop the oxytocin infusion immediately
• C) Position the patient in left lateral position
• D) Increase the maintenance IV fluid rate
,Rationale: This contraction pattern demonstrates tachysystole (contractions <2
minutes apart) and prolonged contractions (>90 seconds) with elevated resting
tone (normal <20 mmHg). The priority action is discontinuing the oxytocin
infusion to reduce uterine stimulation. Left lateral positioning and IV fluids are
secondary interventions. Terbutaline is a uterine relaxant but is not first-line when
oxytocin can simply be stopped.
Question 5
A primigravida at 32 weeks gestation reports "spots" in her vision and right upper
quadrant pain. Laboratory results show platelets 85,000/mm³, AST 98 units/L,
ALT 112 units/L. Which additional finding would the nurse expect?
• A) Hemoglobin of 9.2 g/dL with schistocytes on smear
• B) White blood cell count of 4,500/mm³
• C) Prothrombin time of 11.5 seconds
• D) Fibrinogen level of 450 mg/dL
Rationale: This patient is exhibiting HELLP syndrome (Hemolysis, Elevated
Liver enzymes, Low Platelets). Hemolysis manifests as anemia with
schistocytes (fragmented RBCs) on peripheral smear. Other expected findings
include elevated LDH (>600 U/L), elevated bilirubin (>1.2 mg/dL), and decreased
haptoglobin. WBC count may be normal or slightly elevated. PT is typically
normal unless DIC develops. Fibrinogen is usually normal or elevated in
pregnancy.
Question 6
A blood type A-negative patient at 28 weeks gestation has an indirect Coombs test
positive for anti-D antibodies with a titer of 1:16. The patient asks about risks to
the baby. Which response by the nurse is most accurate?
• A) "Your baby is protected because you received RhoGAM at 28 weeks"
• B) "The antibodies indicate your body has already formed a response against
Rh-positive blood"
, • C) "Your baby is at risk for jaundice requiring phototherapy after birth"
• D) "Your baby may develop severe anemia requiring intrauterine
transfusions"
Rationale: A positive indirect Coombs test with anti-D titer ≥1:16 indicates
significant Rh sensitization that can cause fetal hemolytic disease. Severe anemia
can lead to hydrops fetalis (fetal heart failure, ascites, pleural effusions).
Treatment may require intrauterine transfusions to prevent fetal demise.
RhoGAM is ineffective once sensitization occurs. While jaundice is a risk, the
more critical concern is severe anemia and hydrops.
Question 7
A nurse is assessing a patient at 15 weeks gestation who is Rh-negative and has not
received RhoGAM. She experienced vaginal bleeding at 10 weeks and passed
clots. Which statement indicates understanding of her Rh status?
• A) "I don't need RhoGAM until after the baby is born if the baby is Rh-
positive"
• B) "I should have received RhoGAM after my bleeding episode at 10
weeks"
• C) "My partner needs to receive RhoGAM since I am Rh-negative"
• D) "I will receive RhoGAM now and again at 36 weeks"
Rationale: RhoGAM is indicated within 72 hours of any potential fetomaternal
hemorrhage including threatened abortion, spontaneous abortion, ectopic
pregnancy, or chorionic villus sampling. At 10 weeks, the patient's bleeding could
have caused sensitization. The standard schedule is RhoGAM at 28 weeks and
within 72 hours of delivery if the infant is Rh-positive, but additional doses are
needed for any antepartum bleeding after 12 weeks.
Question 8
A patient at 41 weeks gestation has a Bishop score of 4. She is scheduled for
cervical ripening. Which medication order should the nurse question?
