ATI RN Maternal-Newborn Proctored Exam | 2026/2027
Maternal-Newborn Nursing Competency Assessment | 70 Questions
Elsevier ATI Content Mastery Series® | NGN-Integrated
This assessment evaluates maternal-newborn nursing competency aligned with NCSBN NCLEX-RN and Elsevier ATI
Content Mastery Series® blueprints. Select the BEST answer for each question. Content covers antepartum,
intrapartum, postpartum, and newborn care. Time: 2 hours (institution-configured).
SECTION I: ANTEPARTUM CARE (Q1–Q12)
1. A nurse in a prenatal clinic is calculating the estimated date of delivery (EDD) for a client whose last
menstrual period (LMP) began on March 1. Using Naegele's rule, the nurse should determine the EDD to be
which of the following dates?
A. November 8 B. December 8
C. November 24 D. December 1
Correct Answer: B. December 8
Rationale: Naegele's rule adds 7 days to the first day of the LMP and subtracts 3 months. March 1 plus 7 days
equals March 8, minus 3 months equals December 8. This calculation assumes a 28-day menstrual cycle and is
the standard method for EDD estimation per ACOG guidelines.
2. A nurse is reviewing the obstetric history of a client who is gravida 4, para 3, abortus 1. The nurse should
interpret this as which of the following?
A. The client has had 4 pregnancies, 3 term births, B. The client has had 4 pregnancies, 3 living
and 1 miscarriage children, and 1 stillbirth
C. The client has had 4 pregnancies, 3 deliveries D. The client has had 4 pregnancies, 3 cesarean
after 20 weeks, and 1 loss before 20 weeks births, and 1 elective termination
Correct Answer: C. The client has had 4 pregnancies, 3 deliveries after 20 weeks, and 1 loss before 20
weeks
Rationale: GTPAL terminology: Gravida 4 = total of 4 pregnancies. Para 3 = 3 deliveries after 20 weeks'
gestation (viability threshold per ACOG). Abortus 1 = 1 pregnancy ending before 20 weeks, regardless of whether
spontaneous or induced. GTPAL does not specify route of delivery or viability status beyond the 20-week
threshold.
3. A nurse is assessing a client at 28 weeks gestation. Which of the following findings is an expected
physiological change of pregnancy?
A. Decreased cardiac output B. Increase in systolic blood pressure of 30 mm Hg
C. Elevated white blood cell count of 14,000/mm³ D. Decreased glomerular filtration rate (GFR)
Correct Answer: C. Elevated white blood cell count of 14,000/mm³
1
,Rationale: Leukocytosis is a normal physiological change during pregnancy, with WBC counts ranging from
10,000 to 15,000/mm³ due to increased stress and hormonal effects. Cardiac output increases by 30–50%, blood
pressure typically remains stable or may decrease slightly in early pregnancy, and GFR increases by 50% due to
vasodilation of renal vasculature.
4. A pregnant client at 34 weeks gestation reports heartburn that is worse at night. Which of the following
nonpharmacological interventions should the nurse recommend?
A. Eat three large meals per day and avoid snacking B. Lie flat immediately after meals to aid digestion
C. Eat small, frequent meals and avoid lying D. Increase intake of spicy and fried foods to
down for 2 hours after eating stimulate digestion
Correct Answer: C. Eat small, frequent meals and avoid lying down for 2 hours after eating
Rationale: Heartburn during pregnancy is caused by decreased gastrointestinal motility and progesterone-
induced relaxation of the lower esophageal sphincter. Eating small, frequent meals and remaining upright for at
least 2 hours after eating reduces gastric reflux. Large meals, lying flat after eating, and spicy/fried foods worsen
symptoms.
5. A nurse is providing prenatal teaching to a client at 12 weeks gestation regarding first-trimester screening.
The nurse should explain that a nuchal translucency (NT) ultrasound is performed between which weeks of
gestation?
A. 8 to 10 weeks B. 11 to 13 weeks and 6 days
C. 15 to 20 weeks D. 20 to 24 weeks
Correct Answer: B. 11 to 13 weeks and 6 days
Rationale: Nuchal translucency measurement is performed between 11 weeks and 13 weeks 6 days gestation as
part of first-trimester aneuploidy screening. Increased NT thickness is associated with trisomy 21 (Down
syndrome), trisomy 18, and other chromosomal abnormalities. This timing is critical per ACOG guidelines for
accurate measurement.
6. A nurse is caring for a client who is at 16 weeks gestation and is scheduled for an amniocentesis. Which of
the following statements by the client indicates an understanding of the procedure?
A. The test will be done through my cervix B. The procedure carries a risk of preterm labor
C. The test results will tell me if my baby has Down D. I will need general anesthesia for the procedure
syndrome with 100% certainty
Correct Answer: B. The procedure carries a risk of preterm labor
Rationale: Amniocentesis is performed percutaneously (through the abdomen, not the cervix) using ultrasound
guidance between 15 and 20 weeks. It carries a small risk of complications including preterm labor, membrane
rupture, and fetal loss (approximately 0.1–0.3%). It provides a definitive diagnosis for chromosomal
abnormalities but results take 10–14 days. Local anesthesia is used, not general.
2
, 7. A nurse is assessing a client at 24 weeks gestation. The fundal height measurement is 26 cm. The nurse
should interpret this finding as which of the following?
A. The fundal height is less than expected for B. The fundal height is greater than expected for
gestational age gestational age
C. The fundal height is within the expected range D. The fundal height measurement is inaccurate and
for gestational age should be repeated
Correct Answer: C. The fundal height is within the expected range for gestational age
Rationale: After 20 weeks' gestation, fundal height in centimeters should approximately equal the weeks of
gestation, with a normal variance of plus or minus 2 cm. At 24 weeks, a measurement of 26 cm is within the
expected range (22–28 cm). This measurement is used to screen for fetal growth abnormalities.
8. A nurse is caring for an Rh-negative client at 28 weeks gestation. The nurse should anticipate
administering which of the following medications?
A. Rho(D) immune globulin (RhoGAM) 300 mcg B. Rho(D) immune globulin (RhoGAM) 150 mcg IV
IM
C. Rho(D) immune globulin (RhoGAM) 50 mcg IM D. Rho(D) immune globulin (RhoGAM) 120 mcg
IM
Correct Answer: A. Rho(D) immune globulin (RhoGAM) 300 mcg IM
Rationale: Rho(D) immune globulin (RhoGAM) 300 mcg IM is administered to all Rh-negative unsensitized
clients at 28 weeks gestation to prevent sensitization from fetomaternal hemorrhage during the third trimester. A
second dose is given within 72 hours of delivery if the infant is Rh-positive. The 300 mcg dose provides protection
for a fetomaternal hemorrhage of up to 30 mL of fetal blood.
9. A nurse is providing teaching to a client at 10 weeks gestation who has a history of pregestational type 2
diabetes mellitus. Which of the following should the nurse include as a risk to the fetus?
A. Fetal macrosomia and congenital anomalies B. Intrauterine growth restriction (IUGR)
C. Placenta previa D. Premature rupture of membranes
Correct Answer: A. Fetal macrosomia and congenital anomalies
Rationale: Pregestational diabetes increases the risk of fetal macrosomia (excessive fetal growth due to
hyperglycemia) and congenital anomalies (especially cardiac, neural tube, and renal defects). Poor glycemic
control during the first trimester when organogenesis occurs significantly increases congenital anomaly risk.
Tight glycemic control before and during early pregnancy is essential per ACOG/ADA guidelines.
10. A client at 32 weeks gestation presents to the prenatal clinic with a blood pressure of 150/96 mm Hg, 2+
proteinuria, and facial edema. The nurse should recognize these findings as indicative of which condition?
A. Gestational hypertension B. Preeclampsia with severe features
C. Chronic hypertension D. Eclampsia
Correct Answer: B. Preeclampsia with severe features
3
Maternal-Newborn Nursing Competency Assessment | 70 Questions
Elsevier ATI Content Mastery Series® | NGN-Integrated
This assessment evaluates maternal-newborn nursing competency aligned with NCSBN NCLEX-RN and Elsevier ATI
Content Mastery Series® blueprints. Select the BEST answer for each question. Content covers antepartum,
intrapartum, postpartum, and newborn care. Time: 2 hours (institution-configured).
SECTION I: ANTEPARTUM CARE (Q1–Q12)
1. A nurse in a prenatal clinic is calculating the estimated date of delivery (EDD) for a client whose last
menstrual period (LMP) began on March 1. Using Naegele's rule, the nurse should determine the EDD to be
which of the following dates?
A. November 8 B. December 8
C. November 24 D. December 1
Correct Answer: B. December 8
Rationale: Naegele's rule adds 7 days to the first day of the LMP and subtracts 3 months. March 1 plus 7 days
equals March 8, minus 3 months equals December 8. This calculation assumes a 28-day menstrual cycle and is
the standard method for EDD estimation per ACOG guidelines.
2. A nurse is reviewing the obstetric history of a client who is gravida 4, para 3, abortus 1. The nurse should
interpret this as which of the following?
A. The client has had 4 pregnancies, 3 term births, B. The client has had 4 pregnancies, 3 living
and 1 miscarriage children, and 1 stillbirth
C. The client has had 4 pregnancies, 3 deliveries D. The client has had 4 pregnancies, 3 cesarean
after 20 weeks, and 1 loss before 20 weeks births, and 1 elective termination
Correct Answer: C. The client has had 4 pregnancies, 3 deliveries after 20 weeks, and 1 loss before 20
weeks
Rationale: GTPAL terminology: Gravida 4 = total of 4 pregnancies. Para 3 = 3 deliveries after 20 weeks'
gestation (viability threshold per ACOG). Abortus 1 = 1 pregnancy ending before 20 weeks, regardless of whether
spontaneous or induced. GTPAL does not specify route of delivery or viability status beyond the 20-week
threshold.
3. A nurse is assessing a client at 28 weeks gestation. Which of the following findings is an expected
physiological change of pregnancy?
A. Decreased cardiac output B. Increase in systolic blood pressure of 30 mm Hg
C. Elevated white blood cell count of 14,000/mm³ D. Decreased glomerular filtration rate (GFR)
Correct Answer: C. Elevated white blood cell count of 14,000/mm³
1
,Rationale: Leukocytosis is a normal physiological change during pregnancy, with WBC counts ranging from
10,000 to 15,000/mm³ due to increased stress and hormonal effects. Cardiac output increases by 30–50%, blood
pressure typically remains stable or may decrease slightly in early pregnancy, and GFR increases by 50% due to
vasodilation of renal vasculature.
4. A pregnant client at 34 weeks gestation reports heartburn that is worse at night. Which of the following
nonpharmacological interventions should the nurse recommend?
A. Eat three large meals per day and avoid snacking B. Lie flat immediately after meals to aid digestion
C. Eat small, frequent meals and avoid lying D. Increase intake of spicy and fried foods to
down for 2 hours after eating stimulate digestion
Correct Answer: C. Eat small, frequent meals and avoid lying down for 2 hours after eating
Rationale: Heartburn during pregnancy is caused by decreased gastrointestinal motility and progesterone-
induced relaxation of the lower esophageal sphincter. Eating small, frequent meals and remaining upright for at
least 2 hours after eating reduces gastric reflux. Large meals, lying flat after eating, and spicy/fried foods worsen
symptoms.
5. A nurse is providing prenatal teaching to a client at 12 weeks gestation regarding first-trimester screening.
The nurse should explain that a nuchal translucency (NT) ultrasound is performed between which weeks of
gestation?
A. 8 to 10 weeks B. 11 to 13 weeks and 6 days
C. 15 to 20 weeks D. 20 to 24 weeks
Correct Answer: B. 11 to 13 weeks and 6 days
Rationale: Nuchal translucency measurement is performed between 11 weeks and 13 weeks 6 days gestation as
part of first-trimester aneuploidy screening. Increased NT thickness is associated with trisomy 21 (Down
syndrome), trisomy 18, and other chromosomal abnormalities. This timing is critical per ACOG guidelines for
accurate measurement.
6. A nurse is caring for a client who is at 16 weeks gestation and is scheduled for an amniocentesis. Which of
the following statements by the client indicates an understanding of the procedure?
A. The test will be done through my cervix B. The procedure carries a risk of preterm labor
C. The test results will tell me if my baby has Down D. I will need general anesthesia for the procedure
syndrome with 100% certainty
Correct Answer: B. The procedure carries a risk of preterm labor
Rationale: Amniocentesis is performed percutaneously (through the abdomen, not the cervix) using ultrasound
guidance between 15 and 20 weeks. It carries a small risk of complications including preterm labor, membrane
rupture, and fetal loss (approximately 0.1–0.3%). It provides a definitive diagnosis for chromosomal
abnormalities but results take 10–14 days. Local anesthesia is used, not general.
2
, 7. A nurse is assessing a client at 24 weeks gestation. The fundal height measurement is 26 cm. The nurse
should interpret this finding as which of the following?
A. The fundal height is less than expected for B. The fundal height is greater than expected for
gestational age gestational age
C. The fundal height is within the expected range D. The fundal height measurement is inaccurate and
for gestational age should be repeated
Correct Answer: C. The fundal height is within the expected range for gestational age
Rationale: After 20 weeks' gestation, fundal height in centimeters should approximately equal the weeks of
gestation, with a normal variance of plus or minus 2 cm. At 24 weeks, a measurement of 26 cm is within the
expected range (22–28 cm). This measurement is used to screen for fetal growth abnormalities.
8. A nurse is caring for an Rh-negative client at 28 weeks gestation. The nurse should anticipate
administering which of the following medications?
A. Rho(D) immune globulin (RhoGAM) 300 mcg B. Rho(D) immune globulin (RhoGAM) 150 mcg IV
IM
C. Rho(D) immune globulin (RhoGAM) 50 mcg IM D. Rho(D) immune globulin (RhoGAM) 120 mcg
IM
Correct Answer: A. Rho(D) immune globulin (RhoGAM) 300 mcg IM
Rationale: Rho(D) immune globulin (RhoGAM) 300 mcg IM is administered to all Rh-negative unsensitized
clients at 28 weeks gestation to prevent sensitization from fetomaternal hemorrhage during the third trimester. A
second dose is given within 72 hours of delivery if the infant is Rh-positive. The 300 mcg dose provides protection
for a fetomaternal hemorrhage of up to 30 mL of fetal blood.
9. A nurse is providing teaching to a client at 10 weeks gestation who has a history of pregestational type 2
diabetes mellitus. Which of the following should the nurse include as a risk to the fetus?
A. Fetal macrosomia and congenital anomalies B. Intrauterine growth restriction (IUGR)
C. Placenta previa D. Premature rupture of membranes
Correct Answer: A. Fetal macrosomia and congenital anomalies
Rationale: Pregestational diabetes increases the risk of fetal macrosomia (excessive fetal growth due to
hyperglycemia) and congenital anomalies (especially cardiac, neural tube, and renal defects). Poor glycemic
control during the first trimester when organogenesis occurs significantly increases congenital anomaly risk.
Tight glycemic control before and during early pregnancy is essential per ACOG/ADA guidelines.
10. A client at 32 weeks gestation presents to the prenatal clinic with a blood pressure of 150/96 mm Hg, 2+
proteinuria, and facial edema. The nurse should recognize these findings as indicative of which condition?
A. Gestational hypertension B. Preeclampsia with severe features
C. Chronic hypertension D. Eclampsia
Correct Answer: B. Preeclampsia with severe features
3
