ATI RN Maternal Newborn Exam 2026 | 250 Exam-Style
Questions with Detailed Rationales | Comprehensive
Maternal–Newborn Nursing Assessment — 249 Questions
Section 1: Antepartum Care and Assessment (Questions 1-21)
1 A client at 28 weeks gestation presents with a blood pressure of 148/92 mm Hg and 2+ proteinuria on dipstick.
Which of the following laboratory findings would most strongly suggest progression to severe preeclampsia?
A) Platelet count 150,000/¼L
B) Serum creatinine 1.2 mg/dL
C) Aspartate aminotransferase (AST) 45 U/L
D) Lactate dehydrogenase (LDH) 700 U/L
Answer: D
Rationale: LDH >600 U/L is a criterion for severe preeclampsia (HELLP syndrome). Elevated LDH indicates
hemolysis and hepatic involvement. Platelet count >100,000/¼L (A) is not severe; creatinine >1.1 mg/dL (B) is
significant but LDH is more specific; AST >70 U/L (C) is severe but LDH rise often precedes.
2 A nurse is reviewing a 32-week gestation client's biophysical profile (BPP) score of 6/10. Which of the
following components is most likely the cause of the reduced score?
A) Amniotic fluid index 5 cm
B) Fetal breathing movements lasting 30 seconds
C) Fetal tone with flexion/extension of limbs
D) Nonstress test (NST) reactive
Answer: A
Rationale: A BPP score "d6 is abnormal; an amniotic fluid index (AFI) <5 cm is oligohydramnios (2 points lost).
Normal fetal breathing (B), tone (C), and reactive NST (D) each earn 2 points. The score of 6 suggests two
components are absent or abnormal; oligohydramnios is a common cause.
3 A client at 26 weeks gestation with a history of two prior preterm births is being evaluated for preterm labor.
Which of the following findings is most indicative of true preterm labor?
A) Cervical length 30 mm by transvaginal ultrasound
B) Positive fetal fibronectin test
C) Irregular, mild contractions every 15 minutes
D) Mucoid discharge with ferning pattern on microscopy
Answer: B
Rationale: Positive fetal fibronectin (>50 ng/mL) between 22-34 weeks is highly predictive of preterm delivery
within 7 days. Cervical length >25 mm (A) is low risk. Irregular contractions (C) are common in false labor.
Ferning (D) suggests amniotic fluid but not specific for preterm labor.
4 A client with gestational diabetes mellitus (GDM) is scheduled for a 3-hour oral glucose tolerance test (OGTT)
at 28 weeks. Which of the following results would confirm the diagnosis of GDM?
A) Fasting glucose 95 mg/dL, 1-hour 180 mg/dL, 2-hour 155 mg/dL, 3-hour 120 mg/dL
B) Fasting glucose 92 mg/dL, 1-hour 190 mg/dL, 2-hour 162 mg/dL, 3-hour 145 mg/dL
C) Fasting glucose 100 mg/dL, 1-hour 170 mg/dL, 2-hour 150 mg/dL, 3-hour 130 mg/dL
D) Fasting glucose 88 mg/dL, 1-hour 200 mg/dL, 2-hour 140 mg/dL, 3-hour 110 mg/dL
,Answer: B
Rationale: Two or more values meeting/exceeding thresholds (fasting "e92, 1-hr "e180, 2-hr "e153, 3-hr "e140)
diagnose GDM. Option B has two elevated values (1-hr 190, 3-hr 145). Option A has one (1-hr 180 borderline).
Option C has only fasting elevated. Option D has only 1-hr elevated.
5 A nurse is providing counseling to a client with a diagnosis of placenta previa at 32 weeks gestation. Which of
the following instructions is most critical to prevent complications?
A) Avoid sexual intercourse and heavy lifting
B) Report any painless vaginal bleeding immediately
C) Maintain strict bed rest in left lateral position
D) Monitor fetal movements twice daily
Answer: B
Rationale: Painless vaginal bleeding is the hallmark of placenta previa and may indicate abruptio or hemorrhage.
While all options are reasonable, immediate reporting of bleeding is most critical for timely intervention. Bed rest
(C) and activity restriction (A) are secondary; fetal movement monitoring (D) is standard but not emergent.
6 A client at 34 weeks gestation with preeclampsia without severe features has a blood pressure of 146/94 mm
Hg. Which of the following pharmacological interventions is most appropriate for seizure prophylaxis?
A) Labetalol 200 mg orally twice daily
B) Magnesium sulfate 4 g intravenous bolus then 1 g/hour
C) Nifedipine 30 mg orally once daily
D) Hydralazine 5 mg intravenous push
Answer: B
Rationale: Magnesium sulfate is the standard for seizure prophylaxis in preeclampsia, especially when delivery is
anticipated ("e34 weeks). Labetalol (A) and nifedipine (C) are antihypertensives, not anticonvulsants. Hydralazine
(D) is for acute hypertensive emergency, not prophylaxis.
7 A client at 30 weeks gestation reports regular, painful contractions every 5 minutes for 2 hours. Cervical exam
shows dilation 2 cm, effacement 50%, and station -2. Which of the following interventions should the nurse
anticipate?
A) Administer terbutaline 0.25 mg subcutaneously
B) Obtain a fetal fibronectin test
C) Prepare for emergent cesarean delivery
D) Administer betamethasone 12 mg intramuscularly
Answer: D
Rationale: Given preterm labor (30 weeks, cervical change), betamethasone accelerates fetal lung maturity.
Terbutaline (A) is a tocolytic but not first-line; fetal fibronectin (B) may be done but not urgent; cesarean (C) is not
indicated without contraindications to vaginal delivery.
8 A nurse is reviewing the results of a 1-hour glucose challenge test (GCT) for a client at 26 weeks gestation. The
result is 145 mg/dL. Which of the following actions should the nurse take?
A) Schedule a 3-hour oral glucose tolerance test (OGTT)
B) Diagnose the client with gestational diabetes mellitus
C) Repeat the 1-hour GCT in 2 weeks
D) Instruct the client to follow a diabetic diet
Answer: A
Rationale: A 1-hour GCT result "e140 mg/dL is abnormal and warrants a diagnostic 3-hour OGTT. A single elevated
,value does not diagnose GDM (B). Repeating the GCT (C) is not standard; dietary changes (D) should await
diagnosis.
9 A client at 35 weeks gestation with Rh-negative blood type has a negative antibody screen. The father of the
baby is Rh-positive. Which of the following interventions is indicated?
A) Administer Rho(D) immune globulin 300 mcg intramuscularly now
B) Repeat antibody screen at 37 weeks
C) No intervention is needed at this time
D) Administer Rho(D) immune globulin after delivery only
Answer: A
Rationale: Rho(D) immune globulin is recommended at 28 weeks for Rh-negative women with a negative antibody
screen and an Rh-positive partner, even if no sensitization has occurred. Option B is correct for post-administration
monitoring but not the primary intervention. Option C is wrong; D is incomplete as antepartum prophylaxis is
standard.
10 A nurse is assessing a client with suspected abruptio placentae at 30 weeks gestation. Which of the following
findings is most consistent with this diagnosis?
A) Painless bright red vaginal bleeding
B) Uterine tenderness and hypertonicity
C) Fundal height measurement 32 cm
D) Fetal heart rate baseline 145 bpm with moderate variability
Answer: B
Rationale: Abruptio placentae typically presents with painful, dark red bleeding and a tense, tender uterus
(Couvelaire uterus). Painless bleeding (A) suggests placenta previa. Fundal height > gestational age (C) is not
specific; a normal FHR (D) does not rule out abruption.
11 A client at 28 weeks gestation with a history of two prior cesarean deliveries presents with a fundal height
measurement of 32 cm. Which of the following is the most appropriate initial assessment?
A) Perform a biophysical profile to assess fetal well-being.
B) Obtain a detailed ultrasound to evaluate for polyhydramnios or multiple gestation.
C) Schedule a nonstress test to rule out fetal distress.
D) Reassess fundal height in two weeks, as this may be due to maternal positioning.
Answer: B
Rationale: A fundal height that is 4 cm greater than expected suggests possible polyhydramnios, multiple gestation,
or fetal macrosomia. Ultrasound is the best initial tool to evaluate these possibilities. A biophysical profile or
nonstress test assesses fetal status but does not identify the cause of increased fundal height. While positioning can
affect measurement, a discrepancy of this magnitude warrants immediate investigation.
12 A pregnant client at 32 weeks gestation has a negative antibody screen at 28 weeks. Which of the following
best explains the rationale for administering Rh(D) immune globulin at 28 weeks?
A) To prevent maternal sensitization from potential fetomaternal hemorrhage that may occur later in pregnancy.
B) To treat existing Rh incompatibility by binding maternal anti-D antibodies.
C) To promote fetal lung maturity by reducing hemolytic disease risk.
D) To decrease the risk of preterm labor by stabilizing maternal immune response.
Answer: A
Rationale: Rh(D) immune globulin is given prophylactically at 28 weeks to prevent sensitization in Rh-negative
women who may experience asymptomatic fetomaternal hemorrhage later in pregnancy. It does not treat existing
, sensitization; that would be ineffective. It has no role in fetal lung maturity or preterm labor prevention.
13 A client at 36 weeks gestation with a diagnosis of placenta previa (complete) is being managed expectantly at
home. Which finding would necessitate immediate hospital readmission?
A) A single episode of spotting that resolves with rest.
B) A painless, bright red vaginal bleed of 50 mL.
C) Mild, irregular contractions without bleeding.
D) Decreased fetal movement noted for 2 hours.
Answer: B
Rationale: In placenta previa, any significant bleeding (greater than spotting) is an emergency because it can rapidly
become life-threatening. A 50 mL painless bright red bleed is a classic sign of placenta previa hemorrhage and
requires immediate evaluation. Spotting that resolves may be managed conservatively, but active bleeding warrants
readmission. Contractions without bleeding and decreased fetal movement are concerning but not as immediately
critical as active hemorrhage.
14 A client at 24 weeks gestation presents with a blood pressure of 148/92 mmHg and 1+ proteinuria on dipstick.
Which of the following additional findings would most support a diagnosis of preeclampsia rather than
gestational hypertension?
A) Serum creatinine of 0.6 mg/dL.
B) Platelet count of 150,000/mm³.
C) Elevated liver enzymes (AST 80 U/L, ALT 90 U/L).
D) Fasting blood glucose of 95 mg/dL.
Answer: C
Rationale: Preeclampsia is diagnosed when hypertension with proteinuria is accompanied by evidence of end-organ
dysfunction. Elevated liver enzymes (AST/ALT > 40 U/L) indicate hepatic involvement, which is a criterion for
preeclampsia. Normal creatinine and platelet count do not support the diagnosis. Elevated blood glucose is not a
feature of preeclampsia.
15 A client at 30 weeks gestation with type 1 diabetes mellitus has a hemoglobin A1c of 7.8%. Which of the
following fetal complications is most associated with this level of glycemic control?
A) Fetal macrosomia due to maternal hyperglycemia.
B) Intrauterine growth restriction from placental insufficiency.
C) Congenital cardiac anomalies from early organogenesis exposure.
D) Polyhydramnios due to fetal polyuria.
Answer: A
Rationale: Poor glycemic control in the second and third trimesters (A1c > 7%) is strongly associated with fetal
macrosomia due to maternal hyperglycemia causing fetal hyperinsulinemia and increased fat deposition.
Congenital anomalies are linked to first-trimester hyperglycemia. IUGR is more common in vasculopathic diabetes.
Polyhydramnios can occur but is less specific than macrosomia.
16 A client at 34 weeks gestation with a history of preterm labor presents with regular contractions every 5
minutes, cervical dilation of 3 cm, and effacement of 80%. Fetal fibronectin testing is negative. Which of the
following is the most appropriate interpretation?
A) The negative test effectively rules out delivery within the next 7 days, and tocolysis may be withheld.
B) The negative test is inconclusive; continue tocolysis and administer corticosteroids.
C) The negative test indicates a high risk of preterm delivery within 48 hours due to advanced cervical changes.
D) The negative test confirms that preterm labor is not present, and the client can be discharged.
Questions with Detailed Rationales | Comprehensive
Maternal–Newborn Nursing Assessment — 249 Questions
Section 1: Antepartum Care and Assessment (Questions 1-21)
1 A client at 28 weeks gestation presents with a blood pressure of 148/92 mm Hg and 2+ proteinuria on dipstick.
Which of the following laboratory findings would most strongly suggest progression to severe preeclampsia?
A) Platelet count 150,000/¼L
B) Serum creatinine 1.2 mg/dL
C) Aspartate aminotransferase (AST) 45 U/L
D) Lactate dehydrogenase (LDH) 700 U/L
Answer: D
Rationale: LDH >600 U/L is a criterion for severe preeclampsia (HELLP syndrome). Elevated LDH indicates
hemolysis and hepatic involvement. Platelet count >100,000/¼L (A) is not severe; creatinine >1.1 mg/dL (B) is
significant but LDH is more specific; AST >70 U/L (C) is severe but LDH rise often precedes.
2 A nurse is reviewing a 32-week gestation client's biophysical profile (BPP) score of 6/10. Which of the
following components is most likely the cause of the reduced score?
A) Amniotic fluid index 5 cm
B) Fetal breathing movements lasting 30 seconds
C) Fetal tone with flexion/extension of limbs
D) Nonstress test (NST) reactive
Answer: A
Rationale: A BPP score "d6 is abnormal; an amniotic fluid index (AFI) <5 cm is oligohydramnios (2 points lost).
Normal fetal breathing (B), tone (C), and reactive NST (D) each earn 2 points. The score of 6 suggests two
components are absent or abnormal; oligohydramnios is a common cause.
3 A client at 26 weeks gestation with a history of two prior preterm births is being evaluated for preterm labor.
Which of the following findings is most indicative of true preterm labor?
A) Cervical length 30 mm by transvaginal ultrasound
B) Positive fetal fibronectin test
C) Irregular, mild contractions every 15 minutes
D) Mucoid discharge with ferning pattern on microscopy
Answer: B
Rationale: Positive fetal fibronectin (>50 ng/mL) between 22-34 weeks is highly predictive of preterm delivery
within 7 days. Cervical length >25 mm (A) is low risk. Irregular contractions (C) are common in false labor.
Ferning (D) suggests amniotic fluid but not specific for preterm labor.
4 A client with gestational diabetes mellitus (GDM) is scheduled for a 3-hour oral glucose tolerance test (OGTT)
at 28 weeks. Which of the following results would confirm the diagnosis of GDM?
A) Fasting glucose 95 mg/dL, 1-hour 180 mg/dL, 2-hour 155 mg/dL, 3-hour 120 mg/dL
B) Fasting glucose 92 mg/dL, 1-hour 190 mg/dL, 2-hour 162 mg/dL, 3-hour 145 mg/dL
C) Fasting glucose 100 mg/dL, 1-hour 170 mg/dL, 2-hour 150 mg/dL, 3-hour 130 mg/dL
D) Fasting glucose 88 mg/dL, 1-hour 200 mg/dL, 2-hour 140 mg/dL, 3-hour 110 mg/dL
,Answer: B
Rationale: Two or more values meeting/exceeding thresholds (fasting "e92, 1-hr "e180, 2-hr "e153, 3-hr "e140)
diagnose GDM. Option B has two elevated values (1-hr 190, 3-hr 145). Option A has one (1-hr 180 borderline).
Option C has only fasting elevated. Option D has only 1-hr elevated.
5 A nurse is providing counseling to a client with a diagnosis of placenta previa at 32 weeks gestation. Which of
the following instructions is most critical to prevent complications?
A) Avoid sexual intercourse and heavy lifting
B) Report any painless vaginal bleeding immediately
C) Maintain strict bed rest in left lateral position
D) Monitor fetal movements twice daily
Answer: B
Rationale: Painless vaginal bleeding is the hallmark of placenta previa and may indicate abruptio or hemorrhage.
While all options are reasonable, immediate reporting of bleeding is most critical for timely intervention. Bed rest
(C) and activity restriction (A) are secondary; fetal movement monitoring (D) is standard but not emergent.
6 A client at 34 weeks gestation with preeclampsia without severe features has a blood pressure of 146/94 mm
Hg. Which of the following pharmacological interventions is most appropriate for seizure prophylaxis?
A) Labetalol 200 mg orally twice daily
B) Magnesium sulfate 4 g intravenous bolus then 1 g/hour
C) Nifedipine 30 mg orally once daily
D) Hydralazine 5 mg intravenous push
Answer: B
Rationale: Magnesium sulfate is the standard for seizure prophylaxis in preeclampsia, especially when delivery is
anticipated ("e34 weeks). Labetalol (A) and nifedipine (C) are antihypertensives, not anticonvulsants. Hydralazine
(D) is for acute hypertensive emergency, not prophylaxis.
7 A client at 30 weeks gestation reports regular, painful contractions every 5 minutes for 2 hours. Cervical exam
shows dilation 2 cm, effacement 50%, and station -2. Which of the following interventions should the nurse
anticipate?
A) Administer terbutaline 0.25 mg subcutaneously
B) Obtain a fetal fibronectin test
C) Prepare for emergent cesarean delivery
D) Administer betamethasone 12 mg intramuscularly
Answer: D
Rationale: Given preterm labor (30 weeks, cervical change), betamethasone accelerates fetal lung maturity.
Terbutaline (A) is a tocolytic but not first-line; fetal fibronectin (B) may be done but not urgent; cesarean (C) is not
indicated without contraindications to vaginal delivery.
8 A nurse is reviewing the results of a 1-hour glucose challenge test (GCT) for a client at 26 weeks gestation. The
result is 145 mg/dL. Which of the following actions should the nurse take?
A) Schedule a 3-hour oral glucose tolerance test (OGTT)
B) Diagnose the client with gestational diabetes mellitus
C) Repeat the 1-hour GCT in 2 weeks
D) Instruct the client to follow a diabetic diet
Answer: A
Rationale: A 1-hour GCT result "e140 mg/dL is abnormal and warrants a diagnostic 3-hour OGTT. A single elevated
,value does not diagnose GDM (B). Repeating the GCT (C) is not standard; dietary changes (D) should await
diagnosis.
9 A client at 35 weeks gestation with Rh-negative blood type has a negative antibody screen. The father of the
baby is Rh-positive. Which of the following interventions is indicated?
A) Administer Rho(D) immune globulin 300 mcg intramuscularly now
B) Repeat antibody screen at 37 weeks
C) No intervention is needed at this time
D) Administer Rho(D) immune globulin after delivery only
Answer: A
Rationale: Rho(D) immune globulin is recommended at 28 weeks for Rh-negative women with a negative antibody
screen and an Rh-positive partner, even if no sensitization has occurred. Option B is correct for post-administration
monitoring but not the primary intervention. Option C is wrong; D is incomplete as antepartum prophylaxis is
standard.
10 A nurse is assessing a client with suspected abruptio placentae at 30 weeks gestation. Which of the following
findings is most consistent with this diagnosis?
A) Painless bright red vaginal bleeding
B) Uterine tenderness and hypertonicity
C) Fundal height measurement 32 cm
D) Fetal heart rate baseline 145 bpm with moderate variability
Answer: B
Rationale: Abruptio placentae typically presents with painful, dark red bleeding and a tense, tender uterus
(Couvelaire uterus). Painless bleeding (A) suggests placenta previa. Fundal height > gestational age (C) is not
specific; a normal FHR (D) does not rule out abruption.
11 A client at 28 weeks gestation with a history of two prior cesarean deliveries presents with a fundal height
measurement of 32 cm. Which of the following is the most appropriate initial assessment?
A) Perform a biophysical profile to assess fetal well-being.
B) Obtain a detailed ultrasound to evaluate for polyhydramnios or multiple gestation.
C) Schedule a nonstress test to rule out fetal distress.
D) Reassess fundal height in two weeks, as this may be due to maternal positioning.
Answer: B
Rationale: A fundal height that is 4 cm greater than expected suggests possible polyhydramnios, multiple gestation,
or fetal macrosomia. Ultrasound is the best initial tool to evaluate these possibilities. A biophysical profile or
nonstress test assesses fetal status but does not identify the cause of increased fundal height. While positioning can
affect measurement, a discrepancy of this magnitude warrants immediate investigation.
12 A pregnant client at 32 weeks gestation has a negative antibody screen at 28 weeks. Which of the following
best explains the rationale for administering Rh(D) immune globulin at 28 weeks?
A) To prevent maternal sensitization from potential fetomaternal hemorrhage that may occur later in pregnancy.
B) To treat existing Rh incompatibility by binding maternal anti-D antibodies.
C) To promote fetal lung maturity by reducing hemolytic disease risk.
D) To decrease the risk of preterm labor by stabilizing maternal immune response.
Answer: A
Rationale: Rh(D) immune globulin is given prophylactically at 28 weeks to prevent sensitization in Rh-negative
women who may experience asymptomatic fetomaternal hemorrhage later in pregnancy. It does not treat existing
, sensitization; that would be ineffective. It has no role in fetal lung maturity or preterm labor prevention.
13 A client at 36 weeks gestation with a diagnosis of placenta previa (complete) is being managed expectantly at
home. Which finding would necessitate immediate hospital readmission?
A) A single episode of spotting that resolves with rest.
B) A painless, bright red vaginal bleed of 50 mL.
C) Mild, irregular contractions without bleeding.
D) Decreased fetal movement noted for 2 hours.
Answer: B
Rationale: In placenta previa, any significant bleeding (greater than spotting) is an emergency because it can rapidly
become life-threatening. A 50 mL painless bright red bleed is a classic sign of placenta previa hemorrhage and
requires immediate evaluation. Spotting that resolves may be managed conservatively, but active bleeding warrants
readmission. Contractions without bleeding and decreased fetal movement are concerning but not as immediately
critical as active hemorrhage.
14 A client at 24 weeks gestation presents with a blood pressure of 148/92 mmHg and 1+ proteinuria on dipstick.
Which of the following additional findings would most support a diagnosis of preeclampsia rather than
gestational hypertension?
A) Serum creatinine of 0.6 mg/dL.
B) Platelet count of 150,000/mm³.
C) Elevated liver enzymes (AST 80 U/L, ALT 90 U/L).
D) Fasting blood glucose of 95 mg/dL.
Answer: C
Rationale: Preeclampsia is diagnosed when hypertension with proteinuria is accompanied by evidence of end-organ
dysfunction. Elevated liver enzymes (AST/ALT > 40 U/L) indicate hepatic involvement, which is a criterion for
preeclampsia. Normal creatinine and platelet count do not support the diagnosis. Elevated blood glucose is not a
feature of preeclampsia.
15 A client at 30 weeks gestation with type 1 diabetes mellitus has a hemoglobin A1c of 7.8%. Which of the
following fetal complications is most associated with this level of glycemic control?
A) Fetal macrosomia due to maternal hyperglycemia.
B) Intrauterine growth restriction from placental insufficiency.
C) Congenital cardiac anomalies from early organogenesis exposure.
D) Polyhydramnios due to fetal polyuria.
Answer: A
Rationale: Poor glycemic control in the second and third trimesters (A1c > 7%) is strongly associated with fetal
macrosomia due to maternal hyperglycemia causing fetal hyperinsulinemia and increased fat deposition.
Congenital anomalies are linked to first-trimester hyperglycemia. IUGR is more common in vasculopathic diabetes.
Polyhydramnios can occur but is less specific than macrosomia.
16 A client at 34 weeks gestation with a history of preterm labor presents with regular contractions every 5
minutes, cervical dilation of 3 cm, and effacement of 80%. Fetal fibronectin testing is negative. Which of the
following is the most appropriate interpretation?
A) The negative test effectively rules out delivery within the next 7 days, and tocolysis may be withheld.
B) The negative test is inconclusive; continue tocolysis and administer corticosteroids.
C) The negative test indicates a high risk of preterm delivery within 48 hours due to advanced cervical changes.
D) The negative test confirms that preterm labor is not present, and the client can be discharged.
