Exam (elaborations) Maternal Newborn ATI,
Maternal Newborn Proctor ATI 2023 |Q & A| Graded
A+
1. A client with a history of two prior cesarean births is admitted at 38 weeks gestation with a
diagnosis of placenta previa. The client is stable with minimal vaginal bleeding. The nurse reviews
the prescription for oral misoprostol. Which action is most appropriate?
A. Administer the misoprostol as prescribed to induce labor.
B. Hold the misoprostol and notify the provider of the contraindication.
C. Administer a half dose of misoprostol to reduce uterine stimulation.
D. Administer misoprostol along with oxytocin for synergistic effect.
Answer: B
Rationale: Misoprostol is contraindicated in clients with a uterine scar (prior cesarean) and placenta
previa due to risk of uterine rupture and hemorrhage. The nurse should hold the medication and notify
the provider. Options A, C, and D all involve administration, which could lead to catastrophic outcomes.
2. During a nonstress test, a fetus has a baseline heart rate of 135 bpm with minimal variability
and no accelerations after 30 minutes. Vibroacoustic stimulation is applied, and the fetal heart rate
accelerates by 15 bpm for 20 seconds. What is the most appropriate interpretation?
A. Reactive nonstress test; continue monitoring as scheduled.
B. Nonreactive nonstress test; prepare for biophysical profile.
C. Reactive nonstress test; repeat in 24 hours due to minimal variability.
D. Equivocal result; proceed to contraction stress test immediately.
Answer: A
Rationale: A reactive nonstress test is defined by two or more accelerations of 15 bpm above baseline
lasting 15 seconds within a 20-minute window. Vibroacoustic stimulation can elicit accelerations, and a
single acceleration of 15 bpm for 20 seconds meets criteria for reactivity. Minimal variability may be
due to fetal sleep cycle, but the acceleration confirms reactivity. B, C, and D are incorrect because the
test is reactive.
3. A client in active labor has an intrauterine pressure catheter showing Montevideo units of 200.
The nurse notes that contractions are every 2-3 minutes, lasting 70 seconds, and the client reports
pain 8/10. The fetal heart rate shows late decelerations with moderate variability. What is the
priority nursing intervention?
A. Increase the rate of oxytocin infusion to augment labor.
B. Administer terbutaline 0.25 mg subcutaneously.
C. Reposition the client to left lateral and administer oxygen via facemask.
D. Prepare for immediate cesarean birth due to fetal distress.
Page 1
,Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency. The priority is to improve uterine
blood flow and oxygenation. Left lateral positioning reduces aortocaval compression, and oxygen
administration increases fetal oxygen supply. Oxytocin (A) would worsen contractions and
decelerations. Terbutaline (B) is used for tachysystole, not present. Immediate cesarean (D) is not
indicated without evidence of worsening status or non-reassuring tracing unresponsive to interventions.
4. A client with severe preeclampsia at 32 weeks gestation is receiving magnesium sulfate. The
nurse assesses the client and finds: respiratory rate 10 breaths/min, deep tendon reflexes absent,
urine output 20 mL/hr. Which action should the nurse take first?
A. Decrease the magnesium sulfate infusion rate by half.
B. Administer calcium gluconate 1 g IV push.
C. Discontinue the magnesium sulfate infusion immediately.
D. Increase IV fluids to improve urine output.
Answer: B
Rationale: The client shows signs of magnesium toxicity: respiratory depression, absent reflexes, and
oliguria. Calcium gluconate is the antidote and should be given first to reverse life-threatening effects.
While discontinuing the infusion (C) is also important, administering the antidote takes priority.
Decreasing the rate (A) is insufficient. Increasing IV fluids (D) could worsen pulmonary edema.
5. A postpartum client has a boggy uterus that is deviated to the right and firm when massaged.
The nurse notes a steady trickle of bright red blood from the vagina. Which condition is most
likely?
A. Uterine atony
B. Laceration of the genital tract
C. Retained placental fragments
D. Uterine inversion
Answer: B
Rationale: A boggy uterus that firms with massage and deviates to the right suggests a distended bladder
(displacing uterus). However, the steady trickle of bright red blood despite a firm uterus indicates a
lower genital tract laceration (cervical, vaginal, or perineal). Uterine atony (A) would cause a boggy
uterus that does not firm. Retained fragments (C) usually cause intermittent bleeding and a boggy
uterus. Uterine inversion (D) presents with severe pain and a visible or palpable fundus at the introitus.
6. A newborn at 38 weeks gestation has a respiratory rate of 70 breaths/min, nasal flaring,
grunting, and intercostal retractions. Chest x-ray shows diffuse granular opacities and air
bronchograms. The mother had gestational diabetes and was not in labor prior to cesarean birth.
Which condition is most consistent with these findings?
A. Transient tachypnea of the newborn
B. Meconium aspiration syndrome
C. Respiratory distress syndrome
D. Congenital pneumonia
Page 2
,Answer: C
Rationale: Respiratory distress syndrome (RDS) is caused by surfactant deficiency, common in late
preterm infants and infants of diabetic mothers. The classic chest x-ray findings are diffuse granular
opacities (ground glass) and air bronchograms. TTN (A) typically shows prominent perihilar markings
and fluid in fissures, without granular opacities. MAS (B) occurs after meconium-stained fluid and
shows patchy infiltrates. Congenital pneumonia (D) would show focal infiltrates or consolidation.
7. A client at 28 weeks gestation with cholestasis of pregnancy reports severe pruritus, especially on
the palms and soles. Laboratory results show elevated total bile acids. The nurse expects which
prescription to be most appropriate for managing this condition?
A. Ursodeoxycholic acid 15 mg/kg/day divided into two doses
B. Diphenhydramine 25 mg orally every 6 hours as needed
C. Prednisone 40 mg orally daily
D. Cholestyramine 4 g twice daily
Answer: A
Rationale: Ursodeoxycholic acid (UDCA) is the first-line treatment for intrahepatic cholestasis of
pregnancy as it reduces bile acid levels and relieves pruritus. Diphenhydramine (B) provides only
symptomatic relief but does not lower bile acids. Prednisone (C) is not indicated. Cholestyramine (D)
can reduce pruritus but may interfere with fat-soluble vitamin absorption and is less effective than
UDCA.
8. A nurse is caring for a client in the second stage of labor. The fetal head is at +2 station, and the
client has a strong urge to push. The nurse notes a variable deceleration that drops to 60 bpm for
60 seconds and returns to baseline slowly. Which intervention should the nurse implement first?
A. Change the client's position to hands-and-knees.
B. Perform a vaginal examination to assess for cord prolapse.
C. Administer oxygen at 10 L/min via nonrebreather mask.
D. Prepare for vacuum-assisted delivery.
Answer: B
Rationale: Variable decelerations are caused by cord compression. A deep, prolonged variable with slow
return may indicate cord prolapse or severe compression. The priority is to perform a vaginal exam to
assess for cord prolapse. If cord prolapse is present, immediate intervention is needed. Position change
(A) and oxygen (C) are secondary. Vacuum (D) is not indicated without evidence of cord prolapse or
fetal distress.
9. A client with a history of postpartum hemorrhage is admitted for induction of labor at 39 weeks.
The provider prescribes oxytocin. The nurse reviews the client's record: hemoglobin 11.5 g/dL,
platelets 200,000/mm³, and no known allergies. Which action is most important for the nurse to
implement?
A. Administer oxytocin via infusion pump at a starting rate of 2 milliunits/min.
B. Ensure that at least one dose of carboprost tromethamine is available.
C. Obtain a type and crossmatch for two units of packed red blood cells.
D. Place a Foley catheter to monitor urine output closely.
Page 3
, Answer: B
Rationale: For a client at high risk for postpartum hemorrhage, having uterotonic agents readily
available is critical. Carboprost (a prostaglandin F2 analog) is a second-line agent for hemorrhage.
Oxytocin administration (A) is appropriate but not the most important action regarding hemorrhage
prevention. Type and crossmatch (C) may be considered but not immediately necessary. Foley catheter
(D) is useful but not the priority.
10. A newborn is receiving phototherapy for hyperbilirubinemia. The nurse notes that the
newborn's bilirubin level is 15 mg/dL on day 3 of life. The newborn is breastfeeding and has
adequate stool and urine output. Which additional intervention is most appropriate?
A. Supplement breastfeeding with formula to increase stool output.
B. Cover the newborn's eyes with opaque patches during phototherapy.
C. Increase the phototherapy intensity by adding a fiberoptic blanket.
D. Discontinue phototherapy for 30 minutes every 4 hours to allow bonding.
Answer: B
Rationale: Eye protection is essential during phototherapy to prevent retinal damage. Opaque patches
should cover the eyes securely. Supplementing with formula (A) is not routinely recommended unless
dehydration or inadequate intake is present. Increasing intensity (C) is not indicated for a level of 15
mg/dL on day 3, which is below exchange transfusion threshold. Interrupting phototherapy (D) would
reduce effectiveness and is not recommended.
11. A client at 30 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a
placenta previa. Which nursing intervention is most critical to include in the plan of care?
A. Perform a vaginal examination to assess cervical dilation
B. Initiate continuous electronic fetal monitoring
C. Administer oxytocin to augment labor
D. Prepare the client for an amniotomy
Answer: B
Rationale: Continuous fetal monitoring is essential in placenta previa to detect signs of fetal distress due
to potential hemorrhage. Vaginal exams are contraindicated as they may disrupt the placenta. Oxytocin
and amniotomy are inappropriate as delivery is typically by cesarean.
12. Which finding in a newborn assessment would indicate a need for further evaluation of
potential congenital heart disease?
A. Acrocyanosis of the hands and feet at 12 hours of age
B. A grade II/VI systolic murmur heard at the left upper sternal border
C. Differential cyanosis with higher oxygen saturation in the right hand than the lower extremities
D. A heart rate of 140 bpm during sleep
Answer: C
Rationale: Differential cyanosis (higher preductal than postductal saturations) suggests a right-to-left
shunt across a patent ductus arteriosus, as in critical coarctation of the aorta. Acrocyanosis is normal in
newborns. A grade II/VI systolic murmur may be innocent. Heart rate of 140 is normal.
Page 4
Maternal Newborn Proctor ATI 2023 |Q & A| Graded
A+
1. A client with a history of two prior cesarean births is admitted at 38 weeks gestation with a
diagnosis of placenta previa. The client is stable with minimal vaginal bleeding. The nurse reviews
the prescription for oral misoprostol. Which action is most appropriate?
A. Administer the misoprostol as prescribed to induce labor.
B. Hold the misoprostol and notify the provider of the contraindication.
C. Administer a half dose of misoprostol to reduce uterine stimulation.
D. Administer misoprostol along with oxytocin for synergistic effect.
Answer: B
Rationale: Misoprostol is contraindicated in clients with a uterine scar (prior cesarean) and placenta
previa due to risk of uterine rupture and hemorrhage. The nurse should hold the medication and notify
the provider. Options A, C, and D all involve administration, which could lead to catastrophic outcomes.
2. During a nonstress test, a fetus has a baseline heart rate of 135 bpm with minimal variability
and no accelerations after 30 minutes. Vibroacoustic stimulation is applied, and the fetal heart rate
accelerates by 15 bpm for 20 seconds. What is the most appropriate interpretation?
A. Reactive nonstress test; continue monitoring as scheduled.
B. Nonreactive nonstress test; prepare for biophysical profile.
C. Reactive nonstress test; repeat in 24 hours due to minimal variability.
D. Equivocal result; proceed to contraction stress test immediately.
Answer: A
Rationale: A reactive nonstress test is defined by two or more accelerations of 15 bpm above baseline
lasting 15 seconds within a 20-minute window. Vibroacoustic stimulation can elicit accelerations, and a
single acceleration of 15 bpm for 20 seconds meets criteria for reactivity. Minimal variability may be
due to fetal sleep cycle, but the acceleration confirms reactivity. B, C, and D are incorrect because the
test is reactive.
3. A client in active labor has an intrauterine pressure catheter showing Montevideo units of 200.
The nurse notes that contractions are every 2-3 minutes, lasting 70 seconds, and the client reports
pain 8/10. The fetal heart rate shows late decelerations with moderate variability. What is the
priority nursing intervention?
A. Increase the rate of oxytocin infusion to augment labor.
B. Administer terbutaline 0.25 mg subcutaneously.
C. Reposition the client to left lateral and administer oxygen via facemask.
D. Prepare for immediate cesarean birth due to fetal distress.
Page 1
,Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency. The priority is to improve uterine
blood flow and oxygenation. Left lateral positioning reduces aortocaval compression, and oxygen
administration increases fetal oxygen supply. Oxytocin (A) would worsen contractions and
decelerations. Terbutaline (B) is used for tachysystole, not present. Immediate cesarean (D) is not
indicated without evidence of worsening status or non-reassuring tracing unresponsive to interventions.
4. A client with severe preeclampsia at 32 weeks gestation is receiving magnesium sulfate. The
nurse assesses the client and finds: respiratory rate 10 breaths/min, deep tendon reflexes absent,
urine output 20 mL/hr. Which action should the nurse take first?
A. Decrease the magnesium sulfate infusion rate by half.
B. Administer calcium gluconate 1 g IV push.
C. Discontinue the magnesium sulfate infusion immediately.
D. Increase IV fluids to improve urine output.
Answer: B
Rationale: The client shows signs of magnesium toxicity: respiratory depression, absent reflexes, and
oliguria. Calcium gluconate is the antidote and should be given first to reverse life-threatening effects.
While discontinuing the infusion (C) is also important, administering the antidote takes priority.
Decreasing the rate (A) is insufficient. Increasing IV fluids (D) could worsen pulmonary edema.
5. A postpartum client has a boggy uterus that is deviated to the right and firm when massaged.
The nurse notes a steady trickle of bright red blood from the vagina. Which condition is most
likely?
A. Uterine atony
B. Laceration of the genital tract
C. Retained placental fragments
D. Uterine inversion
Answer: B
Rationale: A boggy uterus that firms with massage and deviates to the right suggests a distended bladder
(displacing uterus). However, the steady trickle of bright red blood despite a firm uterus indicates a
lower genital tract laceration (cervical, vaginal, or perineal). Uterine atony (A) would cause a boggy
uterus that does not firm. Retained fragments (C) usually cause intermittent bleeding and a boggy
uterus. Uterine inversion (D) presents with severe pain and a visible or palpable fundus at the introitus.
6. A newborn at 38 weeks gestation has a respiratory rate of 70 breaths/min, nasal flaring,
grunting, and intercostal retractions. Chest x-ray shows diffuse granular opacities and air
bronchograms. The mother had gestational diabetes and was not in labor prior to cesarean birth.
Which condition is most consistent with these findings?
A. Transient tachypnea of the newborn
B. Meconium aspiration syndrome
C. Respiratory distress syndrome
D. Congenital pneumonia
Page 2
,Answer: C
Rationale: Respiratory distress syndrome (RDS) is caused by surfactant deficiency, common in late
preterm infants and infants of diabetic mothers. The classic chest x-ray findings are diffuse granular
opacities (ground glass) and air bronchograms. TTN (A) typically shows prominent perihilar markings
and fluid in fissures, without granular opacities. MAS (B) occurs after meconium-stained fluid and
shows patchy infiltrates. Congenital pneumonia (D) would show focal infiltrates or consolidation.
7. A client at 28 weeks gestation with cholestasis of pregnancy reports severe pruritus, especially on
the palms and soles. Laboratory results show elevated total bile acids. The nurse expects which
prescription to be most appropriate for managing this condition?
A. Ursodeoxycholic acid 15 mg/kg/day divided into two doses
B. Diphenhydramine 25 mg orally every 6 hours as needed
C. Prednisone 40 mg orally daily
D. Cholestyramine 4 g twice daily
Answer: A
Rationale: Ursodeoxycholic acid (UDCA) is the first-line treatment for intrahepatic cholestasis of
pregnancy as it reduces bile acid levels and relieves pruritus. Diphenhydramine (B) provides only
symptomatic relief but does not lower bile acids. Prednisone (C) is not indicated. Cholestyramine (D)
can reduce pruritus but may interfere with fat-soluble vitamin absorption and is less effective than
UDCA.
8. A nurse is caring for a client in the second stage of labor. The fetal head is at +2 station, and the
client has a strong urge to push. The nurse notes a variable deceleration that drops to 60 bpm for
60 seconds and returns to baseline slowly. Which intervention should the nurse implement first?
A. Change the client's position to hands-and-knees.
B. Perform a vaginal examination to assess for cord prolapse.
C. Administer oxygen at 10 L/min via nonrebreather mask.
D. Prepare for vacuum-assisted delivery.
Answer: B
Rationale: Variable decelerations are caused by cord compression. A deep, prolonged variable with slow
return may indicate cord prolapse or severe compression. The priority is to perform a vaginal exam to
assess for cord prolapse. If cord prolapse is present, immediate intervention is needed. Position change
(A) and oxygen (C) are secondary. Vacuum (D) is not indicated without evidence of cord prolapse or
fetal distress.
9. A client with a history of postpartum hemorrhage is admitted for induction of labor at 39 weeks.
The provider prescribes oxytocin. The nurse reviews the client's record: hemoglobin 11.5 g/dL,
platelets 200,000/mm³, and no known allergies. Which action is most important for the nurse to
implement?
A. Administer oxytocin via infusion pump at a starting rate of 2 milliunits/min.
B. Ensure that at least one dose of carboprost tromethamine is available.
C. Obtain a type and crossmatch for two units of packed red blood cells.
D. Place a Foley catheter to monitor urine output closely.
Page 3
, Answer: B
Rationale: For a client at high risk for postpartum hemorrhage, having uterotonic agents readily
available is critical. Carboprost (a prostaglandin F2 analog) is a second-line agent for hemorrhage.
Oxytocin administration (A) is appropriate but not the most important action regarding hemorrhage
prevention. Type and crossmatch (C) may be considered but not immediately necessary. Foley catheter
(D) is useful but not the priority.
10. A newborn is receiving phototherapy for hyperbilirubinemia. The nurse notes that the
newborn's bilirubin level is 15 mg/dL on day 3 of life. The newborn is breastfeeding and has
adequate stool and urine output. Which additional intervention is most appropriate?
A. Supplement breastfeeding with formula to increase stool output.
B. Cover the newborn's eyes with opaque patches during phototherapy.
C. Increase the phototherapy intensity by adding a fiberoptic blanket.
D. Discontinue phototherapy for 30 minutes every 4 hours to allow bonding.
Answer: B
Rationale: Eye protection is essential during phototherapy to prevent retinal damage. Opaque patches
should cover the eyes securely. Supplementing with formula (A) is not routinely recommended unless
dehydration or inadequate intake is present. Increasing intensity (C) is not indicated for a level of 15
mg/dL on day 3, which is below exchange transfusion threshold. Interrupting phototherapy (D) would
reduce effectiveness and is not recommended.
11. A client at 30 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a
placenta previa. Which nursing intervention is most critical to include in the plan of care?
A. Perform a vaginal examination to assess cervical dilation
B. Initiate continuous electronic fetal monitoring
C. Administer oxytocin to augment labor
D. Prepare the client for an amniotomy
Answer: B
Rationale: Continuous fetal monitoring is essential in placenta previa to detect signs of fetal distress due
to potential hemorrhage. Vaginal exams are contraindicated as they may disrupt the placenta. Oxytocin
and amniotomy are inappropriate as delivery is typically by cesarean.
12. Which finding in a newborn assessment would indicate a need for further evaluation of
potential congenital heart disease?
A. Acrocyanosis of the hands and feet at 12 hours of age
B. A grade II/VI systolic murmur heard at the left upper sternal border
C. Differential cyanosis with higher oxygen saturation in the right hand than the lower extremities
D. A heart rate of 140 bpm during sleep
Answer: C
Rationale: Differential cyanosis (higher preductal than postductal saturations) suggests a right-to-left
shunt across a patent ductus arteriosus, as in critical coarctation of the aorta. Acrocyanosis is normal in
newborns. A grade II/VI systolic murmur may be innocent. Heart rate of 140 is normal.
Page 4
