ATI Maternal Newborn OB Proctored
Exam Review | 70 NGN-Style Questions,
Answers & Rationales | Bow-Tie & Case
Study Edition 2026
CASE 1 — ANTEPARTUM BLEEDING
Questions 1–7
A 32-year-old client at 34 weeks of gestation presents with sudden,
painless, bright-red vaginal bleeding. The uterus is soft and nontender.
Fetal heart rate is 144/min.
1. Which condition should the nurse suspect?
A. Abruptio placentae
B. Placenta previa
C. Ectopic pregnancy
D. Uterine rupture
Answer: B. Placenta previa
Rationale: Placenta previa classically presents with painless, bright-red
vaginal bleeding during the second half of pregnancy. Abruptio
placentae usually causes painful vaginal bleeding accompanied by
uterine tenderness or rigidity. Vaginal examination should be avoided
,until placenta previa has been excluded because manipulation can
precipitate severe hemorrhage.
2. Which prescription should the nurse question?
A. Continuous fetal monitoring
B. Ultrasound examination
C. Assess amount of vaginal bleeding
D. Perform a digital vaginal examination
Answer: D. Perform a digital vaginal examination
Rationale: A digital vaginal examination can disrupt a placenta covering
or near the cervical os and cause massive maternal hemorrhage.
Ultrasound is used to identify placental location. Maternal vital signs
and fetal status should be closely monitored.
3. Which assessment finding is most concerning?
A. Maternal pulse 88/min
B. Fetal heart rate 140/min
C. Saturating one perineal pad in 15 minutes
D. Blood pressure 118/72 mm Hg
Answer: C. Saturating one perineal pad in 15 minutes
Rationale: Rapid blood loss indicates potentially severe hemorrhage.
Maternal hemodynamic instability and fetal compromise can develop
quickly with placenta previa.
,4. Which fetal finding requires immediate intervention?
A. Baseline 140/min
B. Moderate variability
C. Recurrent late decelerations
D. Accelerations with movement
Answer: C. Recurrent late decelerations
Rationale: Recurrent late decelerations indicate uteroplacental
insufficiency and possible fetal hypoxia. This requires prompt
intrauterine resuscitation and evaluation for expedited birth if
unresolved.
5. Which interventions are appropriate? Select all that apply.
A. Establish IV access
B. Monitor fetal heart rate
C. Quantify blood loss
D. Perform vaginal examination
E. Prepare blood products if indicated
Answers: A, B, C, E
Rationale: Placenta previa can cause significant hemorrhage. IV access,
fetal monitoring, blood-loss assessment, and preparation for blood
replacement are appropriate. Vaginal examination is contraindicated
until placental location is established.
6. The nurse reviews the client's laboratory results. Which result is
most important to monitor?
, A. Hemoglobin
B. Platelet count
C. Blood glucose
D. Calcium
Answer: A. Hemoglobin
Rationale: Ongoing vaginal hemorrhage can produce acute blood loss
anemia. Hemoglobin and hematocrit help evaluate the severity of blood
loss and the need for replacement therapy.
7. Bow-Tie Question
Complete the clinical judgment pathway.
Condition: Placenta previa
Actions:
1. Avoid digital vaginal examination
2. Monitor fetal status
3. Encourage vigorous ambulation
4. Establish IV access
5. Apply fundal pressure
Expected findings:
A. Painless bright-red bleeding
B. Rigid tender uterus
C. Soft, nontender uterus
D. Fetal monitoring changes if hemorrhage becomes significant
Exam Review | 70 NGN-Style Questions,
Answers & Rationales | Bow-Tie & Case
Study Edition 2026
CASE 1 — ANTEPARTUM BLEEDING
Questions 1–7
A 32-year-old client at 34 weeks of gestation presents with sudden,
painless, bright-red vaginal bleeding. The uterus is soft and nontender.
Fetal heart rate is 144/min.
1. Which condition should the nurse suspect?
A. Abruptio placentae
B. Placenta previa
C. Ectopic pregnancy
D. Uterine rupture
Answer: B. Placenta previa
Rationale: Placenta previa classically presents with painless, bright-red
vaginal bleeding during the second half of pregnancy. Abruptio
placentae usually causes painful vaginal bleeding accompanied by
uterine tenderness or rigidity. Vaginal examination should be avoided
,until placenta previa has been excluded because manipulation can
precipitate severe hemorrhage.
2. Which prescription should the nurse question?
A. Continuous fetal monitoring
B. Ultrasound examination
C. Assess amount of vaginal bleeding
D. Perform a digital vaginal examination
Answer: D. Perform a digital vaginal examination
Rationale: A digital vaginal examination can disrupt a placenta covering
or near the cervical os and cause massive maternal hemorrhage.
Ultrasound is used to identify placental location. Maternal vital signs
and fetal status should be closely monitored.
3. Which assessment finding is most concerning?
A. Maternal pulse 88/min
B. Fetal heart rate 140/min
C. Saturating one perineal pad in 15 minutes
D. Blood pressure 118/72 mm Hg
Answer: C. Saturating one perineal pad in 15 minutes
Rationale: Rapid blood loss indicates potentially severe hemorrhage.
Maternal hemodynamic instability and fetal compromise can develop
quickly with placenta previa.
,4. Which fetal finding requires immediate intervention?
A. Baseline 140/min
B. Moderate variability
C. Recurrent late decelerations
D. Accelerations with movement
Answer: C. Recurrent late decelerations
Rationale: Recurrent late decelerations indicate uteroplacental
insufficiency and possible fetal hypoxia. This requires prompt
intrauterine resuscitation and evaluation for expedited birth if
unresolved.
5. Which interventions are appropriate? Select all that apply.
A. Establish IV access
B. Monitor fetal heart rate
C. Quantify blood loss
D. Perform vaginal examination
E. Prepare blood products if indicated
Answers: A, B, C, E
Rationale: Placenta previa can cause significant hemorrhage. IV access,
fetal monitoring, blood-loss assessment, and preparation for blood
replacement are appropriate. Vaginal examination is contraindicated
until placental location is established.
6. The nurse reviews the client's laboratory results. Which result is
most important to monitor?
, A. Hemoglobin
B. Platelet count
C. Blood glucose
D. Calcium
Answer: A. Hemoglobin
Rationale: Ongoing vaginal hemorrhage can produce acute blood loss
anemia. Hemoglobin and hematocrit help evaluate the severity of blood
loss and the need for replacement therapy.
7. Bow-Tie Question
Complete the clinical judgment pathway.
Condition: Placenta previa
Actions:
1. Avoid digital vaginal examination
2. Monitor fetal status
3. Encourage vigorous ambulation
4. Establish IV access
5. Apply fundal pressure
Expected findings:
A. Painless bright-red bleeding
B. Rigid tender uterus
C. Soft, nontender uterus
D. Fetal monitoring changes if hemorrhage becomes significant
