ATI PN Comprehensive Predictor 2026 –
Maternal-Newborn Nursing Practice Exam |
NGN Clinical Judgment Case Studies, Verified
Answers, & Comprehensive Rationales
1. A client at 34 weeks’ gestation reports sudden painless
vaginal bleeding. What is the nurse’s priority action?
A. Perform a sterile vaginal examination
B. Initiate maternal and fetal assessment and avoid vaginal
examination
C. Encourage ambulation to assess bleeding
D. Prepare the client for induction of labor
Rationale: Painless third-trimester bleeding strongly suggests
placenta previa. A vaginal exam is contraindicated because it
may provoke massive hemorrhage. Immediate priority is
maternal-fetal assessment and stabilization.
2. A newborn is born to a mother with uncontrolled
gestational diabetes. Which finding requires immediate
intervention?
A. Acrocyanosis
B. Respiratory distress with grunting and nasal flaring
C. Birth weight of 4,200 g
D. Large, round abdomen
,Rationale: Infants of diabetic mothers are at risk for
respiratory distress syndrome due to delayed lung maturity.
Signs of increased work of breathing require urgent
intervention.
3. A postpartum client is diagnosed with uterine atony.
Which medication should the nurse expect to administer
first?
A. Methylergonovine
B. Oxytocin
C. Magnesium sulfate
D. Misoprostol
Rationale: Oxytocin is first-line therapy for uterine atony due
to its rapid uterine contraction effect and safety profile.
4. A client at 28 weeks gestation presents with BP 168/112,
headache, and visual changes. What is the priority nursing
action?
A. Encourage bed rest
B. Administer oral antihypertensives
C. Prepare to administer magnesium sulfate
D. Discharge with follow-up in 24 hours
Rationale: Severe preeclampsia with neurologic symptoms
requires seizure prophylaxis with magnesium sulfate.
,5. Which assessment finding in a newborn requires
immediate notification of the provider?
A. Heart rate 150 bpm
B. Respirations 50/min
C. Central cyanosis
D. Acrocyanosis
Rationale: Central cyanosis indicates inadequate oxygenation
and requires immediate intervention.
6. A laboring client has contractions every 90 seconds lasting
90 seconds. The fetal heart rate shows late decelerations.
What is the priority action?
A. Increase oxytocin infusion
B. Stop oxytocin infusion and reposition client to left lateral
C. Prepare for cesarean section
D. Perform a vaginal exam
Rationale: Late decelerations with tachysystole suggest
uteroplacental insufficiency; stop oxytocin and reposition to
improve oxygenation.
7. A postpartum client has lochia rubra with large clots and
a boggy uterus. What is the nurse’s first action?
A. Notify provider
B. Perform fundal massage
C. Administer antibiotics
D. Insert urinary catheter
, Rationale: A boggy uterus indicates uterine atony; fundal
massage is the first intervention to promote contraction.
8. A pregnant client at 10 weeks gestation reports severe
vomiting and weight loss. Which condition is suspected?
A. Preterm labor
B. Hyperemesis gravidarum
C. Gestational hypertension
D. Placenta previa
Rationale: Severe nausea and vomiting with weight loss in
early pregnancy is consistent with hyperemesis gravidarum.
9. A newborn’s Apgar score is 3 at 1 minute. What is the
nurse’s priority intervention?
A. Place newborn with mother
B. Document findings
C. Initiate resuscitation and airway support
D. Encourage breastfeeding
Rationale: An Apgar score of 3 indicates severe distress
requiring immediate resuscitation.
10. A client receiving magnesium sulfate shows absent deep
tendon reflexes and respiratory rate of 10/min. What is the
priority action?
Maternal-Newborn Nursing Practice Exam |
NGN Clinical Judgment Case Studies, Verified
Answers, & Comprehensive Rationales
1. A client at 34 weeks’ gestation reports sudden painless
vaginal bleeding. What is the nurse’s priority action?
A. Perform a sterile vaginal examination
B. Initiate maternal and fetal assessment and avoid vaginal
examination
C. Encourage ambulation to assess bleeding
D. Prepare the client for induction of labor
Rationale: Painless third-trimester bleeding strongly suggests
placenta previa. A vaginal exam is contraindicated because it
may provoke massive hemorrhage. Immediate priority is
maternal-fetal assessment and stabilization.
2. A newborn is born to a mother with uncontrolled
gestational diabetes. Which finding requires immediate
intervention?
A. Acrocyanosis
B. Respiratory distress with grunting and nasal flaring
C. Birth weight of 4,200 g
D. Large, round abdomen
,Rationale: Infants of diabetic mothers are at risk for
respiratory distress syndrome due to delayed lung maturity.
Signs of increased work of breathing require urgent
intervention.
3. A postpartum client is diagnosed with uterine atony.
Which medication should the nurse expect to administer
first?
A. Methylergonovine
B. Oxytocin
C. Magnesium sulfate
D. Misoprostol
Rationale: Oxytocin is first-line therapy for uterine atony due
to its rapid uterine contraction effect and safety profile.
4. A client at 28 weeks gestation presents with BP 168/112,
headache, and visual changes. What is the priority nursing
action?
A. Encourage bed rest
B. Administer oral antihypertensives
C. Prepare to administer magnesium sulfate
D. Discharge with follow-up in 24 hours
Rationale: Severe preeclampsia with neurologic symptoms
requires seizure prophylaxis with magnesium sulfate.
,5. Which assessment finding in a newborn requires
immediate notification of the provider?
A. Heart rate 150 bpm
B. Respirations 50/min
C. Central cyanosis
D. Acrocyanosis
Rationale: Central cyanosis indicates inadequate oxygenation
and requires immediate intervention.
6. A laboring client has contractions every 90 seconds lasting
90 seconds. The fetal heart rate shows late decelerations.
What is the priority action?
A. Increase oxytocin infusion
B. Stop oxytocin infusion and reposition client to left lateral
C. Prepare for cesarean section
D. Perform a vaginal exam
Rationale: Late decelerations with tachysystole suggest
uteroplacental insufficiency; stop oxytocin and reposition to
improve oxygenation.
7. A postpartum client has lochia rubra with large clots and
a boggy uterus. What is the nurse’s first action?
A. Notify provider
B. Perform fundal massage
C. Administer antibiotics
D. Insert urinary catheter
, Rationale: A boggy uterus indicates uterine atony; fundal
massage is the first intervention to promote contraction.
8. A pregnant client at 10 weeks gestation reports severe
vomiting and weight loss. Which condition is suspected?
A. Preterm labor
B. Hyperemesis gravidarum
C. Gestational hypertension
D. Placenta previa
Rationale: Severe nausea and vomiting with weight loss in
early pregnancy is consistent with hyperemesis gravidarum.
9. A newborn’s Apgar score is 3 at 1 minute. What is the
nurse’s priority intervention?
A. Place newborn with mother
B. Document findings
C. Initiate resuscitation and airway support
D. Encourage breastfeeding
Rationale: An Apgar score of 3 indicates severe distress
requiring immediate resuscitation.
10. A client receiving magnesium sulfate shows absent deep
tendon reflexes and respiratory rate of 10/min. What is the
priority action?
