ATI Maternal Newborn Proctored Exam 2026 OFFICIAL STUDY RESOURCE: FULL TEST BANK WITH RATIONALES 2026 COMPLETE EXAM SOLUTION - MULTIPLE VERSIONS INCLUDED

A nurse is caring for a newborn who was born to a client who has a narcotic use disorder. Which of the following nursing actions should the nurse identify as a contraindication for the care of the newborn? A. Promoting maternal-newborn bonding B. Tight swaddling of the newborn C. Small frequent feedings D. Frequent stimulation Correct Answer: D Rationale: A newborn experiencing neonatal abstinence syndrome (NAS) from narcotic withdrawal requires a quiet, dark, and calm environment with minimal stimulation to promote rest and reduce neurological stress. A highly stimulating environment can trigger extreme irritability, crying, tremors, and hyperactive behaviors. Promoting bonding, tight swaddling, and providing small, frequent feedings are all indicated supportive interventions. Question 2 A nurse is caring for a client who is in labor. A vaginal examination reveals the following information: 2 cm, 50%, +1, right occiput anterior (ROA). Based on this information, which of the following fetal presentations or positions should the nurse document in the medical record? A. Transverse B. Breech C. Vertex D. Mentum Correct Answer: C Rationale: The abbreviation ROA (right occiput anterior) describes the relationship of the presenting part of the fetus to the client's pelvis. Because the occipital bone (the back of the head) is noted as the presenting part, the fetus is in a cephalic, head-down position, which is classified as a vertex presentation. Question 3 A nurse is caring for a client who desires an intrauterine device (IUD) for contraception. Which of the following findings in the client's history is a contraindication for the use of this device? A. Hypertension B. Menorrhagia C. History of multiple gestations D. History of thromboembolic disease Correct Answer: B Rationale: An IUD (particularly non-hormonal copper variants) can alter the uterine environment and increase menstrual bleeding and cramping. Therefore, it is contraindicated in clients who already suffer from menorrhagia (heavy menstrual bleeding) or severe dysmenorrhea. Hypertension and thromboembolic diseases are contraindications for estrogencontaining hormonal contraceptives, not standard IUDs. Question 4 A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. Which of the following actions should the nurse include in the plan of care? A. Keep all four side rails up while the client is in bed. B. Monitor the fetal heart rate every hour. C. Insert an indwelling urinary catheter. D. Check the cervix prior to analgesic administration. Correct Answer: D Rationale: Prior to administering systemic analgesics or opioids during active labor, the nurse must perform a digital vaginal examination to determine cervical dilation. Administering these medications too close to delivery (e.g., when the client is transitionally dilated) can cause severe respiratory depression in the newborn at birth. Question 5 A nurse is caring for a client who has trichomoniasis and a new prescription for metronidazole. Which of the following instructions should the nurse provide to the client about the treatment plan? A. "Your partner needs to be cultured and will be treated with metronidazole only if his cultures are positive." B. "You and your partner need to take the medication and use a condom during intercourse until cultures are negative." C. "If both you and your partner are treated simultaneously, you may continue to engage in unprotected sexual intercourse." D. "Only you will need to take the metronidazole, but you should not have intercourse until your culture is negative." Correct Answer: B Rationale: Trichomoniasis is a sexually transmitted infection caused by the protozoan Trichomonas vaginalis. To ensure successful eradication and prevent immediate ping-pong reinfection, both sexual partners must be treated simultaneously with metronidazole. The couple must utilize condoms or abstain from intercourse entirely until follow-up evaluations confirm negative infection status. Question 6 A nurse is caring for four newborns. Which of the following newborns is at the greatest risk for developing hypoglycemia? A. A newborn who is large for gestational age (LGA) B. A newborn who has an Rh incompatibility C. A newborn who has pathologic jaundice D. A newborn who has fetal alcohol syndrome Correct Answer: A Rationale: Large for gestational age (LGA) infants—especially those born to diabetic mothers— experience high levels of maternal glucose in utero, causing fetal pancreatic hyperplasia and hyperinsulinism. Once the umbilical cord is cut, the sudden drop in maternal glucose combined with the infant's high circulating insulin levels puts them at severe risk for rapid neonatal hypoglycemia. Question 7 A nurse is caring for a client who is 2 hours postpartum. The nurse notes that the client's perineal pad has a large amount of lochia rubra with several large clots. Which of the following actions should the nurse take first? A. Check for a full bladder. B. Massage the fundus. C. Measure vital signs. D. Administer carboprost IM. Correct Answer: B Rationale: The most common cause of early postpartum hemorrhage is uterine atony (a relaxed, boggy uterus). Utilizing the "Assess/Intervene First" principle, the immediate priority action to halt active bleeding is to perform a firm fundal massage to stimulate uterine contractions and compress open blood vessels. Checking for a full bladder is important but secondary to direct uterine stimulation. Question 8 A nurse is caring for a client whose membranes have ruptured and who is in active labor. The fetal monitor tracing reveals late decelerations. Which of the following actions should the nurse take first? A. Turn the client onto her left side. B. Palpate the client's uterus. C. Administer oxygen to the client. D. Increase the client's IV fluid rate. Correct Answer: A Rationale: Late decelerations indicate uteroplacental insufficiency, which can be caused or worsened by maternal supine hypotension compressing the inferior vena cava. The immediate priority action is to reposition the client onto her left side to relieve vena cava pressure, maximize venous return, improve placental perfusion, and increase fetal oxygenation. Administering oxygen and increasing IV fluids are appropriate subsequent steps in the intrauterine resuscitation protocol. Question 9 A nurse is planning care for a client who has a prescription for oxytocin. Which of the following conditions is an absolute contraindication for the use of this medication? A. Prolonged rupture of membranes at 38 weeks of gestation B. Intrauterine growth restriction (IUGR) C. Postterm pregnancy D. Active genital herpes Correct Answer: D Rationale: The use of oxytocin to induce or augment labor is strictly contraindicated if the client has an active genital herpes simplex virus (HSV) infection. Passing through an infected birth canal poses a severe, life-threatening risk of neonatal transmission. A planned cesarean birth is indicated instead. Oxytocin is commonly used to induce labor for postterm pregnancies, IUGR, or prolonged rupture of membranes. Question 10 A nurse is assessing a newborn who has neonatal abstinence syndrome (NAS). Which of the following clinical findings should the nurse expect? A. Extended periods of sleep B. Poor muscle tone C. Respiratory rate of 50/min D. Exaggerated reflexes Correct Answer: D Rationale: Neonatal abstinence syndrome (NAS) causes severe central nervous system (CNS) irritability due to drug withdrawal. Expected clinical findings include hyperactive/exaggerated reflexes, tremors, high-pitched crying, hypertonia (not poor tone), and tachypnea (respiratory rate above 60/min). Sleep periods are typically fragmented and brief. Question 11 A nurse receives report on a client who is in labor and is experiencing contractions 4 minutes apart. Which of the following contraction patterns should the nurse expect to see on the fetal monitoring tracing? A. Contractions that last for 60 seconds each with a 4-minute rest between contractions B. Contractions that last for 60 seconds each with a 3-minute rest between contractions C. A contraction that lasts 4 minutes followed by a period of relaxation D. Contractions that last 45 seconds each with a 3-minute rest between contractions Correct Answer: B Rationale: A contraction frequency or interval is measured from the beginning of one contraction to the beginning of the next contraction. A pattern featuring a contraction lasting 60 seconds followed by a 3-minute relaxation period yields a total cycle time of 4 minutes ($60text{ seconds} + 3text{ minutes} = 4text{ minutes}$), representing contractions occurring every 4 minutes. Question 12 A nurse is caring for a client who has clinical manifestations of an ectopic pregnancy. Which of the following findings in the client's history is a significant risk factor for an ectopic pregnancy? A. Anemia B. Frequent urinary tract infections C. Previous cesarean birth D. Pelvic inflammatory disease (PID) Correct Answer: D Rationale: An ectopic pregnancy occurs when a fertilized ovum implants outside the endometrial cavity, most commonly inside a fallopian tube. Pelvic inflammatory disease (PID) causes severe inflammation, scarring, and narrowing of the fallopian tubes, which physically obstructs the embryo's transit into the uterus, making it a primary risk factor. Question 13 A nurse is caring for a client who is at 8 weeks of gestation with twins and is a primigravida. The client states that even though she and her husband planned this pregnancy, she is experiencing many ambivalent feelings about it. Which of the following responses should the nurse make? A. "Have you told your husband about these feelings?" B. "These feelings are quite normal at the beginning of pregnancy." C. "Perhaps you should see a counselor to discuss these feelings." D. "I am quite concerned about these feelings. Could you explain more?" Correct Answer: B Rationale: Ambivalence regarding pregnancy is a highly common, expected psychological adjustment finding during the first trimester, even when the pregnancy was planned. Providing reassurance that these feelings are normal and typical relieves parental anxiety and fosters open therapeutic communication. Question 14 A nurse is assessing a newborn who is 12 hours old and notes mild jaundice of the face and trunk. Which of the following actions should the nurse take? A. Administer phytonadione IM. B. Obtain a stat prescription for a serum bilirubin level. C. Obtain a bagged urine specimen. D. Perform a gestational age assessment. Correct Answer: B Rationale: Jaundice presenting within the first 24 hours of neonatal life is classified as pathologic (as opposed to benign physiological jaundice, which develops after 24–72 hours). Pathologic jaundice can lead to severe neurotoxicity (kernicterus). The nurse must immediately notify the provider and obtain a stat laboratory serum bilirubin level. Question 15 A nurse is teaching a client who has active genital herpes simplex virus, type 2 (HSV-2). Which of the following statements should the nurse include in the teaching? A. "You will have a cesarean birth prior to the onset of labor." B. "Your baby will receive erythromycin eye ointment after birth to treat the infection." C. "You should take oral metronidazole for 7 days prior to 37 weeks of gestation." D. "You should schedule a cesarean birth after your water breaks." Correct Answer: A Rationale: To completely eliminate the risk of neonatal transmission of active HSV-2, a cesarean birth must be scheduled and completed before the onset of labor or the rupture of amniotic membranes. Waiting until after the membranes break exposes the fetus to ascended pathogens. Erythromycin ointment treats ophthalmia neonatorum caused by gonorrhea or chlamydia, not viral herpes, and metronidazole treats bacterial vaginosis or trichomoniasis. Question 16 A nurse is caring for a client who has a prescription for naloxone. Which of the following is the intended action of this medication in relation to the central nervous system? A. Accentuate the effects of narcotics on the CNS B. Depress activity of the CNS C. Block the effects of narcotics on the CNS D. Stimulate activity of the CNS Correct Answer: C Rationale: Naloxone is a pure opioid antagonist that binds competitively to opioid receptors. Its mechanism of action is to completely block or reverse the effects of narcotic medications on the central nervous system, effectively reversing narcotic-induced CNS and respiratory depression.