2026 ATI RN Maternal Newborn
Practice Exam Questions with Answers
and Detailed Rationales
1. A nurse is caring for a client at 34 weeks of gestation who
has severe preeclampsia. The client reports a severe
headache and epigastric pain. Which action should the
nurse take first?
A. Administer oral acetaminophen
B. Encourage the client to ambulate
C. Place the client in a supine position
D. Initiate seizure precautions and notify the provider
Rationale: Severe headache and epigastric pain are signs of
worsening preeclampsia and possible impending eclampsia.
The nurse should institute seizure precautions and promptly
notify the provider. Magnesium sulfate may be prescribed for
seizure prophylaxis. Supine positioning can worsen
uteroplacental perfusion, and ambulation is inappropriate.
2. A client receiving magnesium sulfate for severe
preeclampsia has a respiratory rate of 10/min, absent
patellar reflexes, and urine output of 20 mL/hr. Which
medication should the nurse prepare to administer?
,A. Protamine sulfate
B. Naloxone
C. Calcium gluconate
D. Vitamin K
Rationale: Respiratory depression, absent deep-tendon
reflexes, and oliguria indicate magnesium toxicity. Calcium
gluconate is the antidote. The nurse should stop the
magnesium infusion and notify the provider while preparing
the antidote.
3. A nurse is assessing a client at 32 weeks of gestation who
has painless bright-red vaginal bleeding. The fetal heart rate
is reassuring, and the client denies abdominal pain. Which
condition should the nurse suspect?
A. Abruptio placentae
B. Uterine rupture
C. Vasa previa
D. Placenta previa
Rationale: Placenta previa classically presents with painless,
bright-red vaginal bleeding in the second or third trimester.
Digital vaginal examinations should be avoided until placenta
previa is excluded because they can precipitate severe
hemorrhage.
4. A client at 37 weeks of gestation presents with painful
vaginal bleeding, a rigid abdomen, and uterine tenderness.
Which complication is most likely?
,A. Placenta previa
B. Abruptio placentae
C. Hydatidiform mole
D. Cervical insufficiency
Rationale: Abruptio placentae involves premature separation
of the placenta and typically causes painful bleeding, uterine
tenderness, and a firm or rigid uterus. Placenta previa usually
produces painless bleeding.
5. A nurse is caring for a client receiving oxytocin for labor
induction. The contraction pattern is every 1 minute and
lasts 100 seconds. The fetal heart rate shows recurrent late
decelerations. Which action should the nurse take first?
A. Increase the oxytocin infusion
B. Encourage pushing
C. Stop the oxytocin infusion
D. Perform a vaginal examination
Rationale: Excessive uterine activity with recurrent late
decelerations suggests uteroplacental insufficiency. The first
action is to discontinue oxytocin to reduce uterine stimulation.
Additional interventions include repositioning, IV fluids, and
notifying the provider.
6. A laboring client has a fetal heart rate tracing showing
recurrent variable decelerations. Which intervention should
the nurse anticipate?
, A. Administer magnesium sulfate
B. Change the client's maternal position
C. Administer terbutaline routinely
D. Place the client in a supine position
Rationale: Variable decelerations are commonly caused by
umbilical cord compression. Maternal repositioning can
relieve compression and improve fetal oxygenation.
Amnioinfusion may also be prescribed when variable
decelerations persist, particularly with oligohydramnios.
Difficulty: Hard
7. A client receiving an epidural during labor develops a
blood pressure of 82/48 mm Hg. Which action should the
nurse take first?
A. Encourage the client to ambulate
B. Administer an additional opioid
C. Increase IV fluids and place the client in a lateral position
D. Prepare the client for immediate cesarean birth
Rationale: Epidural anesthesia can cause maternal
hypotension due to sympathetic blockade. The nurse should
reposition the client laterally, increase IV fluids as prescribed,
and monitor fetal status. Vasopressors may be administered if
hypotension persists.
Difficulty: Hard
Practice Exam Questions with Answers
and Detailed Rationales
1. A nurse is caring for a client at 34 weeks of gestation who
has severe preeclampsia. The client reports a severe
headache and epigastric pain. Which action should the
nurse take first?
A. Administer oral acetaminophen
B. Encourage the client to ambulate
C. Place the client in a supine position
D. Initiate seizure precautions and notify the provider
Rationale: Severe headache and epigastric pain are signs of
worsening preeclampsia and possible impending eclampsia.
The nurse should institute seizure precautions and promptly
notify the provider. Magnesium sulfate may be prescribed for
seizure prophylaxis. Supine positioning can worsen
uteroplacental perfusion, and ambulation is inappropriate.
2. A client receiving magnesium sulfate for severe
preeclampsia has a respiratory rate of 10/min, absent
patellar reflexes, and urine output of 20 mL/hr. Which
medication should the nurse prepare to administer?
,A. Protamine sulfate
B. Naloxone
C. Calcium gluconate
D. Vitamin K
Rationale: Respiratory depression, absent deep-tendon
reflexes, and oliguria indicate magnesium toxicity. Calcium
gluconate is the antidote. The nurse should stop the
magnesium infusion and notify the provider while preparing
the antidote.
3. A nurse is assessing a client at 32 weeks of gestation who
has painless bright-red vaginal bleeding. The fetal heart rate
is reassuring, and the client denies abdominal pain. Which
condition should the nurse suspect?
A. Abruptio placentae
B. Uterine rupture
C. Vasa previa
D. Placenta previa
Rationale: Placenta previa classically presents with painless,
bright-red vaginal bleeding in the second or third trimester.
Digital vaginal examinations should be avoided until placenta
previa is excluded because they can precipitate severe
hemorrhage.
4. A client at 37 weeks of gestation presents with painful
vaginal bleeding, a rigid abdomen, and uterine tenderness.
Which complication is most likely?
,A. Placenta previa
B. Abruptio placentae
C. Hydatidiform mole
D. Cervical insufficiency
Rationale: Abruptio placentae involves premature separation
of the placenta and typically causes painful bleeding, uterine
tenderness, and a firm or rigid uterus. Placenta previa usually
produces painless bleeding.
5. A nurse is caring for a client receiving oxytocin for labor
induction. The contraction pattern is every 1 minute and
lasts 100 seconds. The fetal heart rate shows recurrent late
decelerations. Which action should the nurse take first?
A. Increase the oxytocin infusion
B. Encourage pushing
C. Stop the oxytocin infusion
D. Perform a vaginal examination
Rationale: Excessive uterine activity with recurrent late
decelerations suggests uteroplacental insufficiency. The first
action is to discontinue oxytocin to reduce uterine stimulation.
Additional interventions include repositioning, IV fluids, and
notifying the provider.
6. A laboring client has a fetal heart rate tracing showing
recurrent variable decelerations. Which intervention should
the nurse anticipate?
, A. Administer magnesium sulfate
B. Change the client's maternal position
C. Administer terbutaline routinely
D. Place the client in a supine position
Rationale: Variable decelerations are commonly caused by
umbilical cord compression. Maternal repositioning can
relieve compression and improve fetal oxygenation.
Amnioinfusion may also be prescribed when variable
decelerations persist, particularly with oligohydramnios.
Difficulty: Hard
7. A client receiving an epidural during labor develops a
blood pressure of 82/48 mm Hg. Which action should the
nurse take first?
A. Encourage the client to ambulate
B. Administer an additional opioid
C. Increase IV fluids and place the client in a lateral position
D. Prepare the client for immediate cesarean birth
Rationale: Epidural anesthesia can cause maternal
hypotension due to sympathetic blockade. The nurse should
reposition the client laterally, increase IV fluids as prescribed,
and monitor fetal status. Vasopressors may be administered if
hypotension persists.
Difficulty: Hard
