Maternity ATI Exam: Comprehensive Study Guide COMPREHENSIVE FINAL PREP: VERIFIED QUESTIONS & EXPERT ANSWERS ULTIMATE EXAM PASS PACK – LATEST 2026/2027 UPDATES

A nurse on an antepartum unit is reviewing the electronic medical records for four clients. Which of the following clients should the nurse assess first? • A) A client with hyperemesis gravidarum who has a serum sodium level of 110 mEq/L. • B) A client with preeclampsia who has a serum creatinine level of 1.1 mg/dL. • C) A client with diabetes mellitus who has a hemoglobin A1c (HbA1c) of 5.8%. • D) A client with placenta previa who has a hematocrit (Hct) of 36%. Correct Answer: A) A client who has hyperemesis gravidarum and a sodium level of 110 Rationale: A serum sodium level of 110 mEq/L indicates severe, critical hyponatremia (normal range is 135–145 mEq/L). This represents a medical emergency that can result in profound neurological complications, including cerebral edema, seizures, coma, and death. The other laboratory values (B, C, D) are stable or near expected baseline parameters for pregnancy. Question 2 A nurse is performing a nonstress test (NST) on a client who is at 35 weeks of gestation and has gestational diabetes. The test reveals no accelerations of the fetal heart rate over a 20-minute monitoring period. Which of the following actions should the nurse take next? • A) Perform vibroacoustic stimulation. • B) Collect a maternal blood specimen for an indirect Coombs test. • C) Conduct an immediate sterile vaginal examination. • D) Place the client in the Trendelenburg position. Correct Answer: A) Perform vibroacoustic stimulation. Rationale: An NST is considered nonreactive if it lacks sufficient fetal heart rate accelerations over a 20-minute window, often due to a normal fetal sleep cycle. Vibroacoustic stimulation (applying a sound/vibration device to the maternal abdomen) is used to safely wake the fetus, prompt fetal movement, and elicit therapeutic accelerations to complete the test. Question 3 A charge nurse is teaching a newly licensed nurse about Rh(D) immune globulin (RhoGAM) administration. Which of the following conditions or procedures should the charge nurse include as an indication for its administration? • A) Hyperemesis gravidarum • B) An Rh-positive maternal blood type result • C) A scheduled amniocentesis procedure • D) Gestational iron-deficiency anemia Correct Answer: C) Prescription for amniocentesis Rationale: Rh(D) immune globulin is administered to Rh-negative clients who experience an event with an inherent risk of fetomaternal hemorrhage (such as an amniocentesis, abdominal trauma, or miscarriage). This prevents maternal alloimmunization (sensitization) against Rhpositive fetal red blood cells. Question 4 A nurse is reviewing the medical record for a client who requires pharmacological treatment to manage gestational diabetes mellitus. Which of the following medications should the nurse expect to administer? • A) Nifedipine • B) Chlorpromazine • C) Glyburide • D) Levothyroxine Correct Answer: C) Glyburide Rationale: Glyburide is a second-generation oral sulfonylurea (hypoglycemic agent) that can be utilized during pregnancy to manage blood glucose levels in clients with gestational diabetes when lifestyle modifications alone are insufficient. Nifedipine (A) is a calcium channel blocker used for hypertension or tocolysis. Intrapartum Care & Obstetric Emergencies Question 5 A nurse is admitting a client who is in active labor and has a obstetric history of two prior lowtransverse cesarean births. The nurse should identify that this client is at an increased risk for which of the following life-threatening complications? • A) Uterine rupture • B) Precipitous labor delivery • C) Functional failure to progress • D) Abruptio placentae Correct Answer: A) Uterine rupture Rationale: A history of prior cesarean deliveries significantly elevates the risk of uterine rupture during subsequent trials of labor. The mechanical stress of uterine contractions can compromise the structural integrity of the old, fibrotic myometrial scar tissue. Question 6 A nurse is caring for a client who is in active labor and reports a sudden, tearing, and severe lower abdominal pain. On assessment, the nurse notes a rapid drop in maternal blood pressure, cool/pale skin, and a fetal heart rate tracing showing prolonged bradycardia. Which of the following complications should the nurse suspect? • A) Placenta previa • B) Amniotic fluid embolism (AFE) • C) Uterine rupture • D) Umbilical cord prolapse Correct Answer: C) Uterine rupture Rationale: The triad of sudden, sharp abdominal pain, maternal hypovolemic shock (hypotension, pallor, cool skin), and non-reassuring fetal bradycardia or loss of fetal station are classic indicators of an acute uterine rupture. This is a catastrophic obstetric emergency requiring immediate surgical intervention. Question 7 A nurse is admitting a client who is at 38 weeks of gestation following the spontaneous rupture of her membranes. The nurse performs a sterile vaginal examination and distinctly palpates a loop of the umbilical cord. Which of the following actions must the nurse take first? • A) Request that the provider immediately insert an intrauterine pressure catheter (IUPC). • B) Initiate oxytocin via continuous intravenous infusion to accelerate labor. • C) Place the client in a left lateral side-lying position. • D) Exert continuous upward internal pressure on the fetal presenting part using two gloved fingers. Correct Answer: D) Exert continuous upward pressure on the presenting part Rationale: An umbilical cord prolapse threatens fetal survival due to severe cord compression. The immediate priority action is to insert two fingers into the vagina and apply continuous, manual upward pressure against the fetal presenting part to lift it off the cord and restore fetal perfusion. This position must be held until an emergency cesarean delivery is executed. Question 8 A nurse is assessing a client who is at 39 weeks of gestation and determines via Leopold maneuvers that the fetus is in the left occiputoanterior (LOA) position. On which of the following abdominal sites should the nurse place the ultrasound transducer to assess the point of maximum intensity (PMI) of the fetal heart rate? • A) Left lower quadrant (LLQ) • B) Left upper quadrant (LUQ) • C) Right lower quadrant (RLQ) • D) Right upper quadrant (RUQ) Correct Answer: A) LLQ Rationale: In a vertex presentation where the fetal back is facing the mother's left side (LOA), fetal heart tones are transmitted clearest through the fetal upper back. The point of maximum intensity is located in the maternal left lower quadrant. Question 9 A nurse is caring for a client who is in labor. Which of the following clinical findings should prompt the nurse to immediately reassess the client's cervical dilation and fetal station? • A) An intense urge to have a bowel movement during contractions • B) Progressive sacral discomfort and back pain during contractions • C) A expressed sense of excitement paired with warm, flushed skin • D) Regular contractions lasting between 45 to 60 seconds each Correct Answer: A) An urge to have a bowel movement during contractions Rationale: An intense urge to defecate indicates that the fetal presenting part has descended deeply into the pelvis, exerting direct mechanical pressure on the internal rectal sphincters. This signifies transition into the second stage of labor (fetal expulsion), requiring immediate reassessment for delivery readiness. Postpartum Care, Diabetes, & Lactation Question 10 A nurse is providing discharge teaching to a postpartum client who has type 1 diabetes mellitus and is exclusively breastfeeding her newborn. Which of the following instructions should the nurse incorporate into the teaching? • A) "Take a higher dose of insulin with each meal than you did prior to your pregnancy." • B) "Maintain strictly scheduled, consistent mealtimes for yourself." • C) "Check your capillary blood glucose levels every 8 hours." • D) "Limit your total carbohydrate intake to less than 30 grams per day." Correct Answer: B) Maintain scheduled mealtimes for yourself Rationale: Breastfeeding utilizes maternal glucose for milk production, which significantly lowers maternal blood glucose and drops overall insulin requirements below pre-pregnancy baselines (making option A dangerous). To avoid severe hypoglycemia, clients with type 1 diabetes must maintain consistent, scheduled mealtimes and match meals with glucose monitoring, which must be performed more frequently than every 8 hours (C). Extreme carbohydrate restriction (D) is contraindicated during lactation. Question 11 A nurse is caring for a client who is 1 day postpartum and breastfeeding her newborn. The client reports severe, sore nipples. Which of the following actions should the nurse execute? • A) Have the client limit the length of breastfeeding to exactly 5 minutes per breast. • B) Directly assess the newborn’s mouth latch while breastfeeding. • C) Offer supplemental commercial formula between the newborn’s regular feedings. • D) Instruct the client to wait a full 4 hours between daytime feedings. Correct Answer: B) Assess the newborn’s latch while breastfeeding Rationale: The primary cause of early postpartum nipple soreness is an improper infant latch. The nurse should observe a full feeding session to verify that the newborn takes a wide mouthful of the breast (areola included, not just the nipple tip). Limiting feeding times (A) or spacing out feedings (D) does not solve the root cause and can impair milk supply. Neonatal Care, Reflexes, & Interventions Question 12 A nurse is assessing the neurological reflexes of a healthy term newborn. After placing the newborn in a supine position on the examination table, which of the following actions should the nurse perform to elicit a Moro reflex? • A) Turn the newborn's head quickly to one side. • B) Make a sudden loud noise or simulate a dropping motion above the newborn. • C) Tap the center of the newborn's forehead with a finger pad. • D) Lightly touch the outer aspect of the newborn's cheek with a finger. Correct Answer: B) Make a loud noise above the newborn Rationale: The Moro (or startle) reflex is an involuntary protective motor response elicited by a sudden loud noise or a sensation of falling. The normal infant response involves bilateral extension and abduction of the arms with fingers forming a "C" shape, followed by adduction and flexion. Turning the head (A) elicits the asymmetric tonic neck reflex; touching the cheek (D) triggers the rooting reflex. Question 13 A nurse is planning care for a newborn who is scheduled to begin phototherapy using an overhead lamp. Which of the following actions must the nurse include in the clinical care plan? A) Administer 1 ounce of glucose water every 4 hours between feedings. • B) Apply a thin layer of moisturizing lotion to the newborn’s skin every 8 hours. • C) Dress the newborn in a thin layer of breathable cotton clothing during therapy. • D) Ensure the newborn’s eyes are closed beneath the protective eye shields. Correct Answer: D) Ensure the newborn’s eyes are closed beneath the shield Rationale: Opaque eye shields are mandatory during phototherapy to block ultraviolet light from causing retinal and corneal damage. The nurse must verify that the infant's eyelids are completely closed before placing the mask to avoid scratching the corneas. Skin must be fully exposed (no clothing except a diaper, ruling out C), and lotions (B) are contraindicated because they can cause heat-induced skin burns under phototherapy lights. Question 14 A nurse is caring for a 2-day-old premature newborn who was delivered at 35 weeks of gestation. Which of the following actions should the nurse plan to perform as part of routine monitoring? • A) Measure the abdominal circumference at the level of the umbilicus every 12 hours. • B) Provide the newborn with an iron-rich formula containing vitamin B12 every 12 hours. • C) Administer continuous nitric oxide inhalation therapy to the newborn. • D) Insert an orogastric decompression tube attached to low continuous wall suction. Correct Answer: A) Measure the abdominal circumference at the level of the newborn's umbilicus every 12 hours Rationale: Preterm infants are at a high risk for developing necrotizing enterocolitis (NEC) due to gastrointestinal immaturity. Serial measurements of abdominal girth (circumference) at the umbilical level are highly effective for tracking early pathological abdominal distention, a hallmark sign of NEC.