ATI MATERNAL-NEWBORN NURSING PROCTORED
EXAM REVIEW | 2026/2027
70 Questions with Correct Answers & Rationales | NGN-Integrated
Official Elsevier ATI Specification
This comprehensive review covers essential maternal-newborn nursing content aligned with the NCSBN
NCLEX-RN Test Plan Client Needs framework. Topics include antepartum care, intrapartum management,
postpartum assessment (BUBBLE-HE), newborn transition and care, women’s health, high-alert
medication safety (magnesium sulfate, oxytocin, RhoGAM), patient education, legal/ethical standards, and
NGN test-taking strategies. Each question features clinical vignettes with detailed rationales referencing
ACOG, AAP, AWHONN, CDC, and WHO guidelines. Focus on prioritization skills: maternal and fetal safety
always comes first.
Domain Weighting & Question Distribution
Domain (NCSBN Client Needs) Section # Questions
Safe & Effective Care Environment Antepartum / Intrapartum Management 26
Postpartum / Newborn Care / Women’s
Health Promotion & Maintenance 28
Health
Psychosocial Integrity Patient Education / Legal-Ethical 7
Physiological Integrity Medication Safety / NGN Strategies 9
TOTAL 9 Sections 70
SECTION I: Antepartum Nursing Management (Q1–Q12)
1. A nurse is assessing a client at 28 weeks’ gestation. The fundal height measures 30 cm. Which
interpretation by the nurse is most appropriate?
A) The fetus is larger than expected
B) This is an expected finding
C) The client should be prepared for preterm delivery
D) A cesarean section will be necessary
Correct Answer: B) This is an expected finding
Rationale: Fundal height in centimeters approximately equals the gestational age in weeks between 20 and
36 weeks (±2 cm). At 28 weeks, a fundal height of 30 cm is within the normal range (26–30 cm). Option A is
incorrect because a 2-cm variance is expected. Options C and D are extreme conclusions not supported by the
data. (ACOG Practice Bulletin No. 233)
2. A pregnant client at 34 weeks’ gestation reports decreased fetal movement over the past 24
hours. What is the nurse’s priority action?
A) Reassure the client that decreased movement is normal at this stage
B) Instruct the client to drink cold water and count kicks for 1 hour
C) Schedule a non-stress test (NST) for the following week
D) Document the finding and continue routine prenatal care
Correct Answer: B) Instruct the client to drink cold water and count kicks for 1 hour
, Rationale: Decreased fetal movement can indicate fetal compromise. The nurse should first have the client
perform kick counts with stimulation (cold water). If fewer than 10 kicks in 2 hours or fewer than expected,
further evaluation with NST or BPP is warranted. Option A is dangerous as it dismisses a potential warning
sign. Option C delays assessment. Option D fails to act on a maternal concern. (ACOG Committee Opinion
No. 736, AWHONN Fetal Heart Monitoring Standards)
3. A client at 12 weeks’ gestation asks the nurse about common discomforts of pregnancy. Which
statement by the nurse is most appropriate?
A) Nausea typically worsens in the second trimester
B) Back pain is uncommon during the first trimester
C) Heartburn is caused by increased progesterone relaxing the lower esophageal
sphincter
D) Edema in the lower extremities requires immediate hospitalization
Correct Answer: C) Heartburn is caused by increased progesterone relaxing the lower
esophageal sphincter
Rationale: Increased progesterone during pregnancy relaxes smooth muscle, including the lower
esophageal sphincter, causing gastric reflux and heartburn. Option A is incorrect—nausea typically improves
in the second trimester. Option B is incorrect—back pain can begin in the first trimester due to hormonal
changes. Option D is excessive—mild dependent edema is common and expected. (ACOG Patient Education
Materials)
4. A nurse is caring for a client at 32 weeks’ gestation with a blood pressure of 158/98 mmHg,
proteinuria of 3+, and severe headache. The client has no history of hypertension prior to
pregnancy. Which condition should the nurse recognize?
A) Gestational hypertension B) Preeclampsia with severe features
C) Chronic hypertension D) Eclampsia
Correct Answer: B) Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when blood pressure is ≥160/110 mmHg or
≥140/90 mmHg with severe features (proteinuria ≥3 g/24 hr or end-organ involvement including headache,
visual disturbances, epigastric pain). This client meets criteria with elevated BP, significant proteinuria, and
severe headache. Gestational hypertension lacks proteinuria. Chronic hypertension predates pregnancy.
Eclampsia involves seizures. (ACOG Practice Bulletin No. 222)
5. A client at 26 weeks’ gestation has a 1-hour glucose tolerance test result of 155 mg/dL. What
should the nurse anticipate as the next step in management?
A) Initiate insulin therapy immediately
B) Schedule a 3-hour oral glucose tolerance test (OGTT)
C) Reassure the client that the result is within normal limits
D) Begin a 2,400-calorie diet restriction
Correct Answer: B) Schedule a 3-hour oral glucose tolerance test (OGTT)
Rationale: A 1-hour glucose screening result of 155 mg/dL is above the threshold of 130–140 mg/dL (varies
by facility), requiring a diagnostic 3-hour OGTT for confirmation of gestational diabetes. Option A is
premature—insulin is only initiated after confirmed diagnosis. Option C is incorrect—155 mg/dL is elevated.
Option D is inappropriate without confirmed diagnosis. (ACOG Practice Bulletin No. 190)
6. A nurse is performing Leopold maneuvers on a client in active labor. The nurse palpates a
hard, round, movable object in the fundus, a smooth firm structure on the right side, and
irregular soft structures in the lower abdomen. What is the fetal presentation?
A) Breech presentation B) Cephalic (vertex) presentation
C) Transverse lie D) Face presentation
Correct Answer: B) Cephalic (vertex) presentation
Rationale: Leopold maneuver findings: hard, round object in the fundus = fetal buttocks (the head is
therefore in the pelvis); smooth firm structure on the right = fetal back; irregular soft structures on the left =
fetal extremities. This indicates a cephalic (vertex) presentation with the fetal back on the right. In breech, the
, hard round head would be in the fundus area. Transverse lie presents differently. (AWHONN Perinatal
Nursing, ACOG Practice Bulletin No. 154)
7. A client at 35 weeks’ gestation is receiving terbutaline for preterm labor. Which finding should
the nurse report immediately to the provider?
A) Heart rate of 102 bpm B) Blood glucose of 120 mg/dL
C) Maternal heart rate of 132 bpm D) Fetal heart rate of 145 bpm
Correct Answer: C) Maternal heart rate of 132 bpm
Rationale: Terbutaline is a beta-2 agonist that can cause tachycardia as a side effect. A maternal heart rate
of 132 bpm is significantly elevated (normal resting HR is 60–100 bpm) and should be reported immediately
as it may indicate excessive dosing. Options A, B, and D are within normal parameters. Terbutaline can also
cause hyperglycemia, palpitations, and pulmonary edema. (ACOG Practice Bulletin No. 171)
8. A nurse is providing prenatal education to a client at 18 weeks’ gestation. The client is Rh-
negative. When should the nurse instruct the client that RhoGAM will be administered?
A) At 12 weeks and after delivery only
B) At 28 weeks’ gestation and within 72 hours after delivery
C) Only if the baby is Rh-positive at birth
D) During the first trimester and at 36 weeks
Correct Answer: B) At 28 weeks’ gestation and within 72 hours after delivery
Rationale: Rho(D) immune globulin (RhoGAM) is administered to Rh-negative clients at 28 weeks’
gestation (prevents sensitization from fetal-maternal hemorrhage during the third trimester) and within 72
hours after delivery if the infant is Rh-positive. Option A has incorrect timing. Option C is partially correct
but misses the 28-week dose, which is standard of care. Option D has incorrect timing. (ACOG Practice
Bulletin No. 181, CDC Immunization Guidelines)
9. A pregnant client at 36 weeks’ gestation is scheduled for a biophysical profile (BPP). The nurse
explains that the BPP evaluates five components. Which parameter is NOT included in the BPP
score?
A) Fetal breathing movements B) Fetal body movements
C) Amniotic fluid volume D) Maternal blood pressure
Correct Answer: D) Maternal blood pressure
Rationale: The BPP evaluates five components: (1) fetal heart rate reactivity (NST), (2) fetal breathing
movements (≥1 in 30 min), (3) fetal body movements (≥3 discrete limb/body movements in 30 min), (4) fetal
tone (≥1 extension/flexion), and (5) amniotic fluid volume (single deepest vertical pocket ≥2 cm). Maternal
blood pressure is not part of the BPP scoring system. (ACOG Practice Bulletin No. 116)
10. A client at 20 weeks’ gestation reports that she has not felt fetal movement yet. The nurse
reassures the client that this is expected. At approximately what gestational age do most
multiparous clients first perceive fetal movement?
A) 12 to 14 weeks B) 16 to 20 weeks
C) 24 to 28 weeks D) 30 to 34 weeks
Correct Answer: B) 16 to 20 weeks
Rationale: Fetal movement (quickening) is typically first perceived by multiparous clients at 16–20 weeks
and by nulliparous clients at 18–22 weeks. At 20 weeks, a nulliparous client may not yet feel movement,
which is not necessarily concerning. Option A is too early for most clients. Options C and D are too late for
first perception. (ACOG Patient Education, AWHONN Perinatal Nursing)
11. A nurse is reviewing the laboratory results of a pregnant client at 30 weeks’ gestation. The
hemoglobin level is 10.2 g/dL and the hematocrit is 31%. Which interpretation by the nurse is
correct?
A) The results indicate iron-deficiency anemia requiring immediate transfusion
B) These results are consistent with the physiologic anemia of pregnancy
C) The client has severe anemia and requires hospitalization
D) These values are too high and indicate polycythemia
EXAM REVIEW | 2026/2027
70 Questions with Correct Answers & Rationales | NGN-Integrated
Official Elsevier ATI Specification
This comprehensive review covers essential maternal-newborn nursing content aligned with the NCSBN
NCLEX-RN Test Plan Client Needs framework. Topics include antepartum care, intrapartum management,
postpartum assessment (BUBBLE-HE), newborn transition and care, women’s health, high-alert
medication safety (magnesium sulfate, oxytocin, RhoGAM), patient education, legal/ethical standards, and
NGN test-taking strategies. Each question features clinical vignettes with detailed rationales referencing
ACOG, AAP, AWHONN, CDC, and WHO guidelines. Focus on prioritization skills: maternal and fetal safety
always comes first.
Domain Weighting & Question Distribution
Domain (NCSBN Client Needs) Section # Questions
Safe & Effective Care Environment Antepartum / Intrapartum Management 26
Postpartum / Newborn Care / Women’s
Health Promotion & Maintenance 28
Health
Psychosocial Integrity Patient Education / Legal-Ethical 7
Physiological Integrity Medication Safety / NGN Strategies 9
TOTAL 9 Sections 70
SECTION I: Antepartum Nursing Management (Q1–Q12)
1. A nurse is assessing a client at 28 weeks’ gestation. The fundal height measures 30 cm. Which
interpretation by the nurse is most appropriate?
A) The fetus is larger than expected
B) This is an expected finding
C) The client should be prepared for preterm delivery
D) A cesarean section will be necessary
Correct Answer: B) This is an expected finding
Rationale: Fundal height in centimeters approximately equals the gestational age in weeks between 20 and
36 weeks (±2 cm). At 28 weeks, a fundal height of 30 cm is within the normal range (26–30 cm). Option A is
incorrect because a 2-cm variance is expected. Options C and D are extreme conclusions not supported by the
data. (ACOG Practice Bulletin No. 233)
2. A pregnant client at 34 weeks’ gestation reports decreased fetal movement over the past 24
hours. What is the nurse’s priority action?
A) Reassure the client that decreased movement is normal at this stage
B) Instruct the client to drink cold water and count kicks for 1 hour
C) Schedule a non-stress test (NST) for the following week
D) Document the finding and continue routine prenatal care
Correct Answer: B) Instruct the client to drink cold water and count kicks for 1 hour
, Rationale: Decreased fetal movement can indicate fetal compromise. The nurse should first have the client
perform kick counts with stimulation (cold water). If fewer than 10 kicks in 2 hours or fewer than expected,
further evaluation with NST or BPP is warranted. Option A is dangerous as it dismisses a potential warning
sign. Option C delays assessment. Option D fails to act on a maternal concern. (ACOG Committee Opinion
No. 736, AWHONN Fetal Heart Monitoring Standards)
3. A client at 12 weeks’ gestation asks the nurse about common discomforts of pregnancy. Which
statement by the nurse is most appropriate?
A) Nausea typically worsens in the second trimester
B) Back pain is uncommon during the first trimester
C) Heartburn is caused by increased progesterone relaxing the lower esophageal
sphincter
D) Edema in the lower extremities requires immediate hospitalization
Correct Answer: C) Heartburn is caused by increased progesterone relaxing the lower
esophageal sphincter
Rationale: Increased progesterone during pregnancy relaxes smooth muscle, including the lower
esophageal sphincter, causing gastric reflux and heartburn. Option A is incorrect—nausea typically improves
in the second trimester. Option B is incorrect—back pain can begin in the first trimester due to hormonal
changes. Option D is excessive—mild dependent edema is common and expected. (ACOG Patient Education
Materials)
4. A nurse is caring for a client at 32 weeks’ gestation with a blood pressure of 158/98 mmHg,
proteinuria of 3+, and severe headache. The client has no history of hypertension prior to
pregnancy. Which condition should the nurse recognize?
A) Gestational hypertension B) Preeclampsia with severe features
C) Chronic hypertension D) Eclampsia
Correct Answer: B) Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when blood pressure is ≥160/110 mmHg or
≥140/90 mmHg with severe features (proteinuria ≥3 g/24 hr or end-organ involvement including headache,
visual disturbances, epigastric pain). This client meets criteria with elevated BP, significant proteinuria, and
severe headache. Gestational hypertension lacks proteinuria. Chronic hypertension predates pregnancy.
Eclampsia involves seizures. (ACOG Practice Bulletin No. 222)
5. A client at 26 weeks’ gestation has a 1-hour glucose tolerance test result of 155 mg/dL. What
should the nurse anticipate as the next step in management?
A) Initiate insulin therapy immediately
B) Schedule a 3-hour oral glucose tolerance test (OGTT)
C) Reassure the client that the result is within normal limits
D) Begin a 2,400-calorie diet restriction
Correct Answer: B) Schedule a 3-hour oral glucose tolerance test (OGTT)
Rationale: A 1-hour glucose screening result of 155 mg/dL is above the threshold of 130–140 mg/dL (varies
by facility), requiring a diagnostic 3-hour OGTT for confirmation of gestational diabetes. Option A is
premature—insulin is only initiated after confirmed diagnosis. Option C is incorrect—155 mg/dL is elevated.
Option D is inappropriate without confirmed diagnosis. (ACOG Practice Bulletin No. 190)
6. A nurse is performing Leopold maneuvers on a client in active labor. The nurse palpates a
hard, round, movable object in the fundus, a smooth firm structure on the right side, and
irregular soft structures in the lower abdomen. What is the fetal presentation?
A) Breech presentation B) Cephalic (vertex) presentation
C) Transverse lie D) Face presentation
Correct Answer: B) Cephalic (vertex) presentation
Rationale: Leopold maneuver findings: hard, round object in the fundus = fetal buttocks (the head is
therefore in the pelvis); smooth firm structure on the right = fetal back; irregular soft structures on the left =
fetal extremities. This indicates a cephalic (vertex) presentation with the fetal back on the right. In breech, the
, hard round head would be in the fundus area. Transverse lie presents differently. (AWHONN Perinatal
Nursing, ACOG Practice Bulletin No. 154)
7. A client at 35 weeks’ gestation is receiving terbutaline for preterm labor. Which finding should
the nurse report immediately to the provider?
A) Heart rate of 102 bpm B) Blood glucose of 120 mg/dL
C) Maternal heart rate of 132 bpm D) Fetal heart rate of 145 bpm
Correct Answer: C) Maternal heart rate of 132 bpm
Rationale: Terbutaline is a beta-2 agonist that can cause tachycardia as a side effect. A maternal heart rate
of 132 bpm is significantly elevated (normal resting HR is 60–100 bpm) and should be reported immediately
as it may indicate excessive dosing. Options A, B, and D are within normal parameters. Terbutaline can also
cause hyperglycemia, palpitations, and pulmonary edema. (ACOG Practice Bulletin No. 171)
8. A nurse is providing prenatal education to a client at 18 weeks’ gestation. The client is Rh-
negative. When should the nurse instruct the client that RhoGAM will be administered?
A) At 12 weeks and after delivery only
B) At 28 weeks’ gestation and within 72 hours after delivery
C) Only if the baby is Rh-positive at birth
D) During the first trimester and at 36 weeks
Correct Answer: B) At 28 weeks’ gestation and within 72 hours after delivery
Rationale: Rho(D) immune globulin (RhoGAM) is administered to Rh-negative clients at 28 weeks’
gestation (prevents sensitization from fetal-maternal hemorrhage during the third trimester) and within 72
hours after delivery if the infant is Rh-positive. Option A has incorrect timing. Option C is partially correct
but misses the 28-week dose, which is standard of care. Option D has incorrect timing. (ACOG Practice
Bulletin No. 181, CDC Immunization Guidelines)
9. A pregnant client at 36 weeks’ gestation is scheduled for a biophysical profile (BPP). The nurse
explains that the BPP evaluates five components. Which parameter is NOT included in the BPP
score?
A) Fetal breathing movements B) Fetal body movements
C) Amniotic fluid volume D) Maternal blood pressure
Correct Answer: D) Maternal blood pressure
Rationale: The BPP evaluates five components: (1) fetal heart rate reactivity (NST), (2) fetal breathing
movements (≥1 in 30 min), (3) fetal body movements (≥3 discrete limb/body movements in 30 min), (4) fetal
tone (≥1 extension/flexion), and (5) amniotic fluid volume (single deepest vertical pocket ≥2 cm). Maternal
blood pressure is not part of the BPP scoring system. (ACOG Practice Bulletin No. 116)
10. A client at 20 weeks’ gestation reports that she has not felt fetal movement yet. The nurse
reassures the client that this is expected. At approximately what gestational age do most
multiparous clients first perceive fetal movement?
A) 12 to 14 weeks B) 16 to 20 weeks
C) 24 to 28 weeks D) 30 to 34 weeks
Correct Answer: B) 16 to 20 weeks
Rationale: Fetal movement (quickening) is typically first perceived by multiparous clients at 16–20 weeks
and by nulliparous clients at 18–22 weeks. At 20 weeks, a nulliparous client may not yet feel movement,
which is not necessarily concerning. Option A is too early for most clients. Options C and D are too late for
first perception. (ACOG Patient Education, AWHONN Perinatal Nursing)
11. A nurse is reviewing the laboratory results of a pregnant client at 30 weeks’ gestation. The
hemoglobin level is 10.2 g/dL and the hematocrit is 31%. Which interpretation by the nurse is
correct?
A) The results indicate iron-deficiency anemia requiring immediate transfusion
B) These results are consistent with the physiologic anemia of pregnancy
C) The client has severe anemia and requires hospitalization
D) These values are too high and indicate polycythemia
