ATI RN MATERNAL PROCTORED ASSESSMENT
2023/2024(20 versions)/RN ATI MATERNAL
NEWBORN PROCTORED EXAM(20 versions)
Section 1: Antepartum Care & Complications
1. A nurse is caring for a client at 10 weeks of gestation who is experiencing hyperemesis
gravidarum. Which of the following findings should the nurse report to the provider
immediately?
A. Urine specific gravity of 1.025
B. Blood pressure of 100/60 mm Hg
C. Heart rate of 118/min
D. Urine ketones of 4+
Rationale: Large amounts of ketones in the urine (ketonuria) indicate the client is using fat
stores for energy due to inadequate carbohydrate intake, a sign of severe starvation and
metabolic decompensation. This is a critical finding that requires immediate intervention, likely
IV fluid and electrolyte replacement. Mild tachycardia and low-normal blood pressure can be
expected with dehydration, but ketonuria of 4+ is a sentinel sign of severity.
2. A nurse is teaching a client at 12 weeks of gestation about expected physiological changes.
Which of the following statements by the client indicates an understanding of the teaching?
A. "I should expect my blood pressure to increase significantly."
B. "I might notice a white, thick vaginal discharge."
C. "I will need to urinate less frequently now."
D. "My morning sickness should be gone by now."
Rationale: Leukorrhea, a white or slightly gray mucoid vaginal discharge with a faint musty
odor, is a normal response to the increased vascularity and hormonal changes of pregnancy.
Blood pressure typically remains the same or slightly decreases. Urinary frequency increases
due to pressure on the bladder. Morning sickness (NVP) often resolves by the end of the first
trimester (around 12-14 weeks), but it is not guaranteed to be gone by exactly 12 weeks.
3. A client at 36 weeks of gestation is being assessed for preeclampsia. Which of the following
findings is a late sign of severe preeclampsia?
A. 1+ pitting edema in the lower extremities
B. Blood pressure of 140/90 mm Hg
C. Report of a severe, unrelenting headache
, D. Weight gain of 1 kg (2.2 lb) in one week
Rationale: A severe, unrelenting headache that does not respond to usual analgesics is a
sign of CNS involvement and cerebral edema, indicating severe preeclampsia. Edema and a BP
of 140/90 are diagnostic criteria but can be present in mild preeclampsia. Rapid weight gain is a
concerning sign but a severe headache is a hallmark of worsening disease.
4. A nurse is providing discharge teaching to a client who has a new prescription for ferrous
sulfate. Which of the following instructions should the nurse include? (SATA)
A. "Take the medication with a glass of orange juice."
B. "Expect your stools to turn a dark green or black color."
C. "Take the medication with an antacid if it upsets your stomach."
D. "Increase your intake of fiber and fluids."
Rationale: (A) Vitamin C (in orange juice) enhances the absorption of iron. (B) Dark stools
are a harmless, expected side effect of iron supplementation. (D) Iron can cause constipation, so
increasing fiber and fluids is important. (C) is incorrect because antacids decrease the
absorption of iron.
5. A nurse is caring for a client who is at 32 weeks of gestation and has a prescription for
betamethasone. The nurse should understand that the primary purpose of this medication is
to:
A. Prevent preterm labor.
B. Treat maternal hypertension.
C. Enhance fetal lung maturity.
D. Prevent group B streptococcus infection.
Rationale: Betamethasone is a corticosteroid given to promote fetal lung maturity
(surfactant production) in clients at risk for preterm delivery between 24 and 34 weeks of
gestation. It does not stop labor (tocolysis) or treat hypertension.
6. A client who is at 8 weeks of gestation tells the nurse, "I am always so tired. I can barely get
through the day." Which of the following responses by the nurse is appropriate?
A. "You should be exercising more to increase your energy."
B. "This is a sign of something serious. We need to run tests."
C. "Fatigue is a common finding in the first trimester as your body adjusts to pregnancy."
D. "You will need to learn to push through the tiredness."
Rationale: Profound fatigue is a very common and normal physiological response in the first
trimester due to increased progesterone levels and the metabolic demands of pregnancy. The
nurse should provide reassurance and education about rest and nutrition.
,7. A nurse is assessing a client who is at 34 weeks of gestation. The client reports a sudden
gush of fluid from her vagina. Which of the following actions should the nurse take first?
A. Perform a sterile vaginal exam.
B. Obtain a urine specimen.
C. Check the fetal heart rate.
D. Apply a nitrazine paper to the fluid.
Rationale: The priority nursing action after a suspected rupture of membranes (ROM) is to
assess the fetal status by checking the fetal heart rate for signs of distress, such as variable
decelerations from cord prolapse. This is the most critical assessment. A sterile vaginal exam
should be avoided to prevent infection. Nitrazine testing confirms ROM but is not the first
priority.
8. A nurse is teaching a client about the physiological changes that occur during the third
trimester. Which of the following should the nurse include as a common cause of dyspnea in
the third trimester?
A. Decreased oxygen demand.
B. Pressure on the diaphragm from the enlarging uterus.
C. Increased lung capacity.
D. Anemia.
Rationale: As the uterus enlarges and elevates, it presses upward on the diaphragm,
reducing lung expansion and causing shortness of breath (dyspnea). This is a common and
expected finding in the third trimester.
9. A client at 20 weeks of gestation is scheduled for a maternal serum alpha-fetoprotein
(MSAFP) test. The nurse should explain that this test is used to screen for which of the
following?
A. Gestational diabetes.
B. Neural tube defects.
C. Down syndrome.
D. Preeclampsia.
Rationale: MSAFP is a screening test for open neural tube defects (e.g., spina bifida,
anencephaly). It can also be part of a quad screen that screens for Down syndrome and trisomy
18, but its primary association is with neural tube defects.
10. A nurse is caring for a client who is at 38 weeks of gestation and reports having a bloody
show. Which of the following actions should the nurse take?
A. Prepare the client for an immediate cesarean birth.
B. Advise the client to go to the hospital immediately.
, C. Reassure the client that this is a normal finding.
D. Notify the provider that the client has placenta previa.
Rationale: "Bloody show" is the passage of the mucous plug mixed with a small amount of
blood. It is a normal sign of impending labor and cervical change. The nurse should reassure the
client. Placenta previa presents with painless, bright red vaginal bleeding, not a bloody show.
11. A nurse is providing nutritional counseling to a client who is pregnant. Which of the
following foods should the nurse recommend as the best source of folic acid?
A. A glass of milk.
B. A cup of cooked lentils.
C. An apple.
D. A slice of whole-wheat bread.
Rationale: Lentils and other legumes (beans, peas) are excellent sources of folate (folic
acid). While whole grains and some fruits have some folate, legumes are significantly higher.
Milk is a good source of calcium and vitamin D.
12. A client is at 14 weeks of gestation and reports that she has not felt her baby move yet.
Which of the following responses by the nurse is best?
A. "You should have felt movement by now. We need to do an ultrasound."
B. "Don't worry, all first-time mothers feel movement by 16 weeks."
C. "Most women feel the first movements, called quickening, between 16 and 20 weeks."
D. "You may not feel movement because you are overweight."
Rationale: Quickening, the first perception of fetal movement, is typically felt between 16
and 20 weeks of gestation in a nulliparous client, and potentially earlier in a multiparous client.
It is not expected at 14 weeks, so reassurance is appropriate.
13. A nurse is caring for a client who is at 30 weeks of gestation and has been diagnosed with
gestational diabetes. Which of the following fetal complications should the nurse monitor for?
A. Intrauterine growth restriction (IUGR).
B. Macrosomia.
C. Oligohydramnios.
D. Hyperbilirubinemia.
Rationale: Gestational diabetes, especially if poorly controlled, leads to fetal hyperglycemia
and hyperinsulinemia. Insulin acts as a growth factor, leading to macrosomia (a large baby).
IUGR is more associated with maternal hypertension or placental insufficiency. Polyhydramnios,
not oligohydramnios, is common due to fetal polyuria.
14. A client at 24 weeks of gestation is being screened for gestational diabetes with a 1-hour
glucose challenge test. Which of the following instructions should the nurse provide?
2023/2024(20 versions)/RN ATI MATERNAL
NEWBORN PROCTORED EXAM(20 versions)
Section 1: Antepartum Care & Complications
1. A nurse is caring for a client at 10 weeks of gestation who is experiencing hyperemesis
gravidarum. Which of the following findings should the nurse report to the provider
immediately?
A. Urine specific gravity of 1.025
B. Blood pressure of 100/60 mm Hg
C. Heart rate of 118/min
D. Urine ketones of 4+
Rationale: Large amounts of ketones in the urine (ketonuria) indicate the client is using fat
stores for energy due to inadequate carbohydrate intake, a sign of severe starvation and
metabolic decompensation. This is a critical finding that requires immediate intervention, likely
IV fluid and electrolyte replacement. Mild tachycardia and low-normal blood pressure can be
expected with dehydration, but ketonuria of 4+ is a sentinel sign of severity.
2. A nurse is teaching a client at 12 weeks of gestation about expected physiological changes.
Which of the following statements by the client indicates an understanding of the teaching?
A. "I should expect my blood pressure to increase significantly."
B. "I might notice a white, thick vaginal discharge."
C. "I will need to urinate less frequently now."
D. "My morning sickness should be gone by now."
Rationale: Leukorrhea, a white or slightly gray mucoid vaginal discharge with a faint musty
odor, is a normal response to the increased vascularity and hormonal changes of pregnancy.
Blood pressure typically remains the same or slightly decreases. Urinary frequency increases
due to pressure on the bladder. Morning sickness (NVP) often resolves by the end of the first
trimester (around 12-14 weeks), but it is not guaranteed to be gone by exactly 12 weeks.
3. A client at 36 weeks of gestation is being assessed for preeclampsia. Which of the following
findings is a late sign of severe preeclampsia?
A. 1+ pitting edema in the lower extremities
B. Blood pressure of 140/90 mm Hg
C. Report of a severe, unrelenting headache
, D. Weight gain of 1 kg (2.2 lb) in one week
Rationale: A severe, unrelenting headache that does not respond to usual analgesics is a
sign of CNS involvement and cerebral edema, indicating severe preeclampsia. Edema and a BP
of 140/90 are diagnostic criteria but can be present in mild preeclampsia. Rapid weight gain is a
concerning sign but a severe headache is a hallmark of worsening disease.
4. A nurse is providing discharge teaching to a client who has a new prescription for ferrous
sulfate. Which of the following instructions should the nurse include? (SATA)
A. "Take the medication with a glass of orange juice."
B. "Expect your stools to turn a dark green or black color."
C. "Take the medication with an antacid if it upsets your stomach."
D. "Increase your intake of fiber and fluids."
Rationale: (A) Vitamin C (in orange juice) enhances the absorption of iron. (B) Dark stools
are a harmless, expected side effect of iron supplementation. (D) Iron can cause constipation, so
increasing fiber and fluids is important. (C) is incorrect because antacids decrease the
absorption of iron.
5. A nurse is caring for a client who is at 32 weeks of gestation and has a prescription for
betamethasone. The nurse should understand that the primary purpose of this medication is
to:
A. Prevent preterm labor.
B. Treat maternal hypertension.
C. Enhance fetal lung maturity.
D. Prevent group B streptococcus infection.
Rationale: Betamethasone is a corticosteroid given to promote fetal lung maturity
(surfactant production) in clients at risk for preterm delivery between 24 and 34 weeks of
gestation. It does not stop labor (tocolysis) or treat hypertension.
6. A client who is at 8 weeks of gestation tells the nurse, "I am always so tired. I can barely get
through the day." Which of the following responses by the nurse is appropriate?
A. "You should be exercising more to increase your energy."
B. "This is a sign of something serious. We need to run tests."
C. "Fatigue is a common finding in the first trimester as your body adjusts to pregnancy."
D. "You will need to learn to push through the tiredness."
Rationale: Profound fatigue is a very common and normal physiological response in the first
trimester due to increased progesterone levels and the metabolic demands of pregnancy. The
nurse should provide reassurance and education about rest and nutrition.
,7. A nurse is assessing a client who is at 34 weeks of gestation. The client reports a sudden
gush of fluid from her vagina. Which of the following actions should the nurse take first?
A. Perform a sterile vaginal exam.
B. Obtain a urine specimen.
C. Check the fetal heart rate.
D. Apply a nitrazine paper to the fluid.
Rationale: The priority nursing action after a suspected rupture of membranes (ROM) is to
assess the fetal status by checking the fetal heart rate for signs of distress, such as variable
decelerations from cord prolapse. This is the most critical assessment. A sterile vaginal exam
should be avoided to prevent infection. Nitrazine testing confirms ROM but is not the first
priority.
8. A nurse is teaching a client about the physiological changes that occur during the third
trimester. Which of the following should the nurse include as a common cause of dyspnea in
the third trimester?
A. Decreased oxygen demand.
B. Pressure on the diaphragm from the enlarging uterus.
C. Increased lung capacity.
D. Anemia.
Rationale: As the uterus enlarges and elevates, it presses upward on the diaphragm,
reducing lung expansion and causing shortness of breath (dyspnea). This is a common and
expected finding in the third trimester.
9. A client at 20 weeks of gestation is scheduled for a maternal serum alpha-fetoprotein
(MSAFP) test. The nurse should explain that this test is used to screen for which of the
following?
A. Gestational diabetes.
B. Neural tube defects.
C. Down syndrome.
D. Preeclampsia.
Rationale: MSAFP is a screening test for open neural tube defects (e.g., spina bifida,
anencephaly). It can also be part of a quad screen that screens for Down syndrome and trisomy
18, but its primary association is with neural tube defects.
10. A nurse is caring for a client who is at 38 weeks of gestation and reports having a bloody
show. Which of the following actions should the nurse take?
A. Prepare the client for an immediate cesarean birth.
B. Advise the client to go to the hospital immediately.
, C. Reassure the client that this is a normal finding.
D. Notify the provider that the client has placenta previa.
Rationale: "Bloody show" is the passage of the mucous plug mixed with a small amount of
blood. It is a normal sign of impending labor and cervical change. The nurse should reassure the
client. Placenta previa presents with painless, bright red vaginal bleeding, not a bloody show.
11. A nurse is providing nutritional counseling to a client who is pregnant. Which of the
following foods should the nurse recommend as the best source of folic acid?
A. A glass of milk.
B. A cup of cooked lentils.
C. An apple.
D. A slice of whole-wheat bread.
Rationale: Lentils and other legumes (beans, peas) are excellent sources of folate (folic
acid). While whole grains and some fruits have some folate, legumes are significantly higher.
Milk is a good source of calcium and vitamin D.
12. A client is at 14 weeks of gestation and reports that she has not felt her baby move yet.
Which of the following responses by the nurse is best?
A. "You should have felt movement by now. We need to do an ultrasound."
B. "Don't worry, all first-time mothers feel movement by 16 weeks."
C. "Most women feel the first movements, called quickening, between 16 and 20 weeks."
D. "You may not feel movement because you are overweight."
Rationale: Quickening, the first perception of fetal movement, is typically felt between 16
and 20 weeks of gestation in a nulliparous client, and potentially earlier in a multiparous client.
It is not expected at 14 weeks, so reassurance is appropriate.
13. A nurse is caring for a client who is at 30 weeks of gestation and has been diagnosed with
gestational diabetes. Which of the following fetal complications should the nurse monitor for?
A. Intrauterine growth restriction (IUGR).
B. Macrosomia.
C. Oligohydramnios.
D. Hyperbilirubinemia.
Rationale: Gestational diabetes, especially if poorly controlled, leads to fetal hyperglycemia
and hyperinsulinemia. Insulin acts as a growth factor, leading to macrosomia (a large baby).
IUGR is more associated with maternal hypertension or placental insufficiency. Polyhydramnios,
not oligohydramnios, is common due to fetal polyuria.
14. A client at 24 weeks of gestation is being screened for gestational diabetes with a 1-hour
glucose challenge test. Which of the following instructions should the nurse provide?
