Maternal-Newborn ATI Proctored Exam
Advanced Prep: Master Obstetrical and
Neonatal Nursing Practice Questions &
Detailed Explanations
Subject / Subtopic for Questions 1-30: Maternal-Newborn Nursing (ATI
Proctored Exam Alignment)
Question 1: A nurse is caring for a client at 34 weeks of gestation who presents with sudden-
onset, severe abdominal pain, uterine tenderness, and high-frequency, low-amplitude
contractions. The fetal heart rate tracing reveals a baseline of 160/min with minimal variability
and repetitive late decelerations. Which of the following interventions is the nurse's priority?
A) Obtain a urine specimen to screen for illicit substance use.
B) Insert an indwelling urinary catheter to monitor hourly output.
C) Administer a 500 mL IV bolus of lactated Ringer's solution.
D) Prepare the client for an emergent cesarean delivery.
Correct Answer: D) Prepare the client for an emergent cesarean delivery.
Explanation: The client's clinical presentation is highly indicative of a severe abruptio placentae
(placental abruption), evidenced by sudden severe abdominal pain, uterine rigidity/tenderness,
and a non-reassuring fetal heart rate pattern indicating acute hypoxia. Preparing for an
emergent cesarean delivery is the priority to save both maternal and fetal lives. While screening
for substances (like cocaine) or monitoring urinary output are appropriate components of care,
they delay definitive lifesaving management. Administering a fluid bolus is secondary to
immediate surgical preparation in the face of acute fetal distress.
Question 2: A nurse is reviewing the electronic medical record of a client who is at 32 weeks of
gestation and undergoing a contraction stress test (CST). The tracing shows late decelerations
occurring with three out of five contractions within a 10-minute window. How should the nurse
interpret and document this finding?
A) Negative CST, indicating fetal well-being and placental adequacy.
B) Positive CST, indicating uteroplacental insufficiency.
C) Equivocal CST, requiring a repeat test within 24 hours.
,D) Unsatisfactory CST, indicating inadequate uterine activity.
Correct Answer: B) Positive CST, indicating uteroplacental insufficiency.
Explanation: A contraction stress test is considered positive when late decelerations occur with
50% or more of the contractions, even if the contraction frequency is fewer than three in 10
minutes. A positive test indicates uteroplacental insufficiency and suggests that the fetus may not
tolerate the stress of labor. A negative test is characterized by no late decelerations. Equivocal
results involve intermittent or variable decelerations, and unsatisfactory means there were fewer
than three contractions in a 10-minute period to properly evaluate.
Question 3: A nurse is assessing a postpartum client 4 hr after a vaginal delivery of a 4,200 g (9
lb 4 oz) infant. The nurse notes that the fundus is boggy, displaced upward and to the right of the
umbilicus, and there is heavy vaginal bleeding. Which of the following actions should the nurse
take first?
A) Administer 20 units of oxytocin IM.
B) Assist the client to empty her bladder.
C) Perform vigorous fundal massage.
D) Notify the provider of suspected uterine atony.
Correct Answer: B) Assist the client to empty her bladder.
Explanation: A fundus that is boggy and displaced upward and to the right indicates uterine
atony caused by a distended bladder. A distended bladder pushes the uterus out of place and
prevents it from contracting efficiently, leading to increased bleeding. Assisting the client to
empty her bladder (or straight catheterization if she cannot void) allows the uterus to return to
the midline and contract. While fundal massage and oxytocin administration are standard
interventions for uterine atony, addressing the root cause (bladder distention) must happen
concurrently or immediately first to allow the massage to be effective.
Question 4: A nurse is preparing to administer magnesium sulfate IV to a client who has
preeclampsia with severe features. Which of the following clinical findings should prompt the
nurse to withhold the medication and immediately notify the provider?
A) Deep tendon reflexes of 1+ and a respiratory rate of 14/min.
B) Urinary output of 20 mL/hr over the past 2 hours.
C) Blood pressure of 168/112 mm Hg.
D) Generalized complaints of flushing and warmth.
, Correct Answer: B) Urinary output of 20 mL/hr over the past 2 hours.
Explanation: Magnesium sulfate is excreted solely by the kidneys. A urinary output of less than
30 mL/hr indicates renal impairment, which can lead to a rapid accumulation of magnesium and
subsequent toxicity. Therefore, decreased urinary output requires withholding the medication.
Respirations of 14/min and 1+ reflexes are low but do not strictly indicate acute toxic levels
(toxicity is defined by respirations less than 12/min and absent reflexes). Severe hypertension is
an indication for the drug, and flushing/warmth are expected side effects during administration.
Question 5: A nurse is assessing a newborn who was born at 39 weeks of gestation to a mother
with poorly controlled gestational diabetes. Which of the following assessment findings should
the nurse anticipate?
A) Microcephaly and low birth weight.
B) Hypobilirubinemia and thrombocytosis.
C) Jitteriness, tremors, and hypothermia.
D) Hyperglycemia and respiratory alkalosis.
Correct Answer: C) Jitteriness, tremors, and hypothermia.
Explanation: Infants of diabetic mothers are at high risk for hypoglycemia due to
hyperinsulinism caused by exposure to high maternal glucose levels in utero. Signs of neonatal
hypoglycemia include jitteriness, tremors, hypotonia, apnea, and hypothermia. These infants are
typically macrosomic (large for gestational age) rather than low birth weight, and they are at
increased risk for hyperbilirubinemia (due to polycythemia) and respiratory distress syndrome,
not respiratory alkalosis.
Question 6: A nurse is caring for a client at 38 weeks of gestation who is receiving an oxytocin
infusion for labor induction. The nurse notes contractions occurring every 90 seconds, lasting 70
to 80 seconds, with a resting uterine tone of 22 mm Hg via an intrauterine pressure catheter
(IUPC). The fetal heart rate shows repetitive variable decelerations. Which of the following
actions should the nurse take first?
A) Discontinue the oxytocin infusion.
B) Turn the client to a lateral position.
C) Administer oxygen at 10 L/min via a nonrebreather mask.
D) Increase the maintenance IV fluid rate.
Correct Answer: A) Discontinue the oxytocin infusion.
Advanced Prep: Master Obstetrical and
Neonatal Nursing Practice Questions &
Detailed Explanations
Subject / Subtopic for Questions 1-30: Maternal-Newborn Nursing (ATI
Proctored Exam Alignment)
Question 1: A nurse is caring for a client at 34 weeks of gestation who presents with sudden-
onset, severe abdominal pain, uterine tenderness, and high-frequency, low-amplitude
contractions. The fetal heart rate tracing reveals a baseline of 160/min with minimal variability
and repetitive late decelerations. Which of the following interventions is the nurse's priority?
A) Obtain a urine specimen to screen for illicit substance use.
B) Insert an indwelling urinary catheter to monitor hourly output.
C) Administer a 500 mL IV bolus of lactated Ringer's solution.
D) Prepare the client for an emergent cesarean delivery.
Correct Answer: D) Prepare the client for an emergent cesarean delivery.
Explanation: The client's clinical presentation is highly indicative of a severe abruptio placentae
(placental abruption), evidenced by sudden severe abdominal pain, uterine rigidity/tenderness,
and a non-reassuring fetal heart rate pattern indicating acute hypoxia. Preparing for an
emergent cesarean delivery is the priority to save both maternal and fetal lives. While screening
for substances (like cocaine) or monitoring urinary output are appropriate components of care,
they delay definitive lifesaving management. Administering a fluid bolus is secondary to
immediate surgical preparation in the face of acute fetal distress.
Question 2: A nurse is reviewing the electronic medical record of a client who is at 32 weeks of
gestation and undergoing a contraction stress test (CST). The tracing shows late decelerations
occurring with three out of five contractions within a 10-minute window. How should the nurse
interpret and document this finding?
A) Negative CST, indicating fetal well-being and placental adequacy.
B) Positive CST, indicating uteroplacental insufficiency.
C) Equivocal CST, requiring a repeat test within 24 hours.
,D) Unsatisfactory CST, indicating inadequate uterine activity.
Correct Answer: B) Positive CST, indicating uteroplacental insufficiency.
Explanation: A contraction stress test is considered positive when late decelerations occur with
50% or more of the contractions, even if the contraction frequency is fewer than three in 10
minutes. A positive test indicates uteroplacental insufficiency and suggests that the fetus may not
tolerate the stress of labor. A negative test is characterized by no late decelerations. Equivocal
results involve intermittent or variable decelerations, and unsatisfactory means there were fewer
than three contractions in a 10-minute period to properly evaluate.
Question 3: A nurse is assessing a postpartum client 4 hr after a vaginal delivery of a 4,200 g (9
lb 4 oz) infant. The nurse notes that the fundus is boggy, displaced upward and to the right of the
umbilicus, and there is heavy vaginal bleeding. Which of the following actions should the nurse
take first?
A) Administer 20 units of oxytocin IM.
B) Assist the client to empty her bladder.
C) Perform vigorous fundal massage.
D) Notify the provider of suspected uterine atony.
Correct Answer: B) Assist the client to empty her bladder.
Explanation: A fundus that is boggy and displaced upward and to the right indicates uterine
atony caused by a distended bladder. A distended bladder pushes the uterus out of place and
prevents it from contracting efficiently, leading to increased bleeding. Assisting the client to
empty her bladder (or straight catheterization if she cannot void) allows the uterus to return to
the midline and contract. While fundal massage and oxytocin administration are standard
interventions for uterine atony, addressing the root cause (bladder distention) must happen
concurrently or immediately first to allow the massage to be effective.
Question 4: A nurse is preparing to administer magnesium sulfate IV to a client who has
preeclampsia with severe features. Which of the following clinical findings should prompt the
nurse to withhold the medication and immediately notify the provider?
A) Deep tendon reflexes of 1+ and a respiratory rate of 14/min.
B) Urinary output of 20 mL/hr over the past 2 hours.
C) Blood pressure of 168/112 mm Hg.
D) Generalized complaints of flushing and warmth.
, Correct Answer: B) Urinary output of 20 mL/hr over the past 2 hours.
Explanation: Magnesium sulfate is excreted solely by the kidneys. A urinary output of less than
30 mL/hr indicates renal impairment, which can lead to a rapid accumulation of magnesium and
subsequent toxicity. Therefore, decreased urinary output requires withholding the medication.
Respirations of 14/min and 1+ reflexes are low but do not strictly indicate acute toxic levels
(toxicity is defined by respirations less than 12/min and absent reflexes). Severe hypertension is
an indication for the drug, and flushing/warmth are expected side effects during administration.
Question 5: A nurse is assessing a newborn who was born at 39 weeks of gestation to a mother
with poorly controlled gestational diabetes. Which of the following assessment findings should
the nurse anticipate?
A) Microcephaly and low birth weight.
B) Hypobilirubinemia and thrombocytosis.
C) Jitteriness, tremors, and hypothermia.
D) Hyperglycemia and respiratory alkalosis.
Correct Answer: C) Jitteriness, tremors, and hypothermia.
Explanation: Infants of diabetic mothers are at high risk for hypoglycemia due to
hyperinsulinism caused by exposure to high maternal glucose levels in utero. Signs of neonatal
hypoglycemia include jitteriness, tremors, hypotonia, apnea, and hypothermia. These infants are
typically macrosomic (large for gestational age) rather than low birth weight, and they are at
increased risk for hyperbilirubinemia (due to polycythemia) and respiratory distress syndrome,
not respiratory alkalosis.
Question 6: A nurse is caring for a client at 38 weeks of gestation who is receiving an oxytocin
infusion for labor induction. The nurse notes contractions occurring every 90 seconds, lasting 70
to 80 seconds, with a resting uterine tone of 22 mm Hg via an intrauterine pressure catheter
(IUPC). The fetal heart rate shows repetitive variable decelerations. Which of the following
actions should the nurse take first?
A) Discontinue the oxytocin infusion.
B) Turn the client to a lateral position.
C) Administer oxygen at 10 L/min via a nonrebreather mask.
D) Increase the maintenance IV fluid rate.
Correct Answer: A) Discontinue the oxytocin infusion.
