ATI RN Maternal Newborn 2026 Proctored Assessment:
200-Question NGN Practice Exam
Section I: Antepartum Assessment, Prenatal Care & Fetal Development
(Questions 1–35)
1. A nurse is calculating the estimated date of delivery (EDD) for a client whose
last menstrual period (LMP) began on April 10. Using Naegele's rule, what is the
client's EDD?
A) January 17
B) January 10
C) January 24
D) January 3
Correct Answer: A) January 17
Rationale: Naegele's rule calculates the EDD by subtracting 3 months from
the first day of the LMP and adding 7 days. April 10 minus 3 months = January 10;
January 10 plus 7 days = January 17. This is a fundamental antepartum calculation
tested on every proctored maternal-newborn assessment.
2. A nurse is reviewing the obstetric history of a client who is pregnant for the
fourth time. She has had 2 term births, 1 preterm birth, 1 abortion, and 3 living
children. Which GTPAL notation is correct?
A) G4 T2 P1 A1 L3
B) G4 T2 P0 A1 L3
C) G4 T2 P1 A0 L3
D) G4 T2 P1 A1 L2
Correct Answer: A) G4 T2 P1 A1 L3
Rationale: GTPAL stands for Gravida, Term births, Preterm births,
Abortions, Living children. G = 4 (current pregnancy plus 3 prior pregnancies). T =
2 (term births). P = 1 (preterm birth at 20–36 6/7 weeks). A = 1 (abortion, either
,spontaneous or induced before 20 weeks). L = 3 (currently living children). This is
a high-yield antepartum assessment concept.
3. A nurse is teaching a client at 12 weeks of gestation about expected
physiological changes during pregnancy. Which of the following statements by the
client indicates a need for further teaching?
A) "I may notice my gums bleeding when I brush my teeth."
B) "I should expect my blood pressure to decrease slightly."
C) "I will likely have more frequent bowel movements."
D) "My heart rate may increase by 10 to 15 beats per minute."
Correct Answer: C) "I will likely have more frequent bowel movements."
Rationale: Progesterone slows gastrointestinal motility, leading to
constipation—not more frequent bowel movements. Gingival bleeding (epulis) is
common due to increased vascularity. Blood pressure often decreases slightly in
the second trimester. Heart rate increases by 10–15 bpm due to increased cardiac
output. Recognizing normal versus abnormal pregnancy adaptations is critical for
antepartum assessment.
4. A nurse is performing a prenatal assessment on a client at 32 weeks of
gestation. Which of the following findings should the nurse report to the provider
immediately?
A) Fundal height of 32 cm
B) Blood pressure 142/92 mm Hg
C) Mild ankle edema
D) Fetal heart rate 148 bpm
Correct Answer: B) Blood pressure 142/92 mm Hg
Rationale: A blood pressure of 142/92 mm Hg exceeds the threshold for
gestational hypertension (≥140/90 mm Hg) and requires immediate evaluation for
preeclampsia. Fundal height should approximate gestational age in weeks (32 cm
,at 32 weeks is expected). Mild ankle edema is common. A fetal heart rate of 148
bpm is within the normal range of 110–160 bpm. Elevated blood pressure is a red-
flag finding that mandates prompt notification.
5. A nurse is providing nutritional counseling to a client who is at 10 weeks of
gestation and has a pre-pregnancy BMI of 28. Which of the following statements
by the client indicates correct understanding of recommended weight gain?
A) "I should gain between 25 and 35 pounds."
B) "I should gain between 15 and 25 pounds."
C) "I should gain between 11 and 20 pounds."
D) "I should gain between 28 and 40 pounds."
Correct Answer: B) "I should gain between 15 and 25 pounds."
Rationale: For a client with a pre-pregnancy BMI of 25–29.9 (overweight),
the Institute of Medicine recommends total gestational weight gain of 15–25
pounds. Underweight clients (BMI <18.5) should gain 28–40 pounds. Normal-
weight clients (BMI 18.5–24.9) should gain 25–35 pounds. Obese clients (BMI ≥30)
should gain 11–20 pounds. Nutritional assessment is a core antepartum
competency.
6. (SATA) A nurse is assessing a client at 36 weeks of gestation who reports a
sudden gush of fluid from the vagina. Which of the following actions should the
nurse take? Select all that apply.
A) Assess the color and odor of the fluid.
B) Perform a sterile speculum examination.
C) Test the fluid with nitrazine paper.
D) Insert a gloved finger into the vagina to check for cord prolapse.
E) Place the client on bed rest and monitor fetal heart tones.
Correct Answer: A, C, E
Rationale: When rupture of membranes (ROM) is suspected, the nurse
should assess the characteristics of the fluid (A), test with nitrazine paper (C)—
, which turns blue in the presence of amniotic fluid—and place the client on bed
rest while monitoring fetal heart tones (E) to detect cord compression or
prolapse. A sterile speculum examination (B) may be performed by the provider,
but digital vaginal examination (D) should be avoided to prevent infection and
cord prolapse.
7. A nurse is caring for a client at 28 weeks of gestation who is Rh-negative and
has not been sensitized. The client is scheduled to receive Rho(D) immune
globulin (RhoGAM). Which of the following statements by the client indicates a
need for further teaching?
A) "This medication will protect my baby from Rh incompatibility."
B) "I will need another dose after delivery if my baby is Rh-positive."
C) "This injection will make me immune to Rh-positive blood permanently."
D) "I should receive this at 28 weeks and within 72 hours after birth."
Correct Answer: C) "This injection will make me immune to Rh-positive
blood permanently."
Rationale: RhoGAM provides passive immunity and is not permanent; it
must be administered at 28 weeks and again within 72 hours after delivery of an
Rh-positive infant. It prevents sensitization but does not confer lifelong immunity.
Understanding the mechanism of RhoGAM is essential for preventing hemolytic
disease of the newborn.
8. A nurse is assessing a client at 20 weeks of gestation who reports a fluttering
sensation in her abdomen. The nurse documents this as:
A) Hegar's sign
B) Quickening
C) Ballottement
D) Chadwick's sign
Correct Answer: B) Quickening
200-Question NGN Practice Exam
Section I: Antepartum Assessment, Prenatal Care & Fetal Development
(Questions 1–35)
1. A nurse is calculating the estimated date of delivery (EDD) for a client whose
last menstrual period (LMP) began on April 10. Using Naegele's rule, what is the
client's EDD?
A) January 17
B) January 10
C) January 24
D) January 3
Correct Answer: A) January 17
Rationale: Naegele's rule calculates the EDD by subtracting 3 months from
the first day of the LMP and adding 7 days. April 10 minus 3 months = January 10;
January 10 plus 7 days = January 17. This is a fundamental antepartum calculation
tested on every proctored maternal-newborn assessment.
2. A nurse is reviewing the obstetric history of a client who is pregnant for the
fourth time. She has had 2 term births, 1 preterm birth, 1 abortion, and 3 living
children. Which GTPAL notation is correct?
A) G4 T2 P1 A1 L3
B) G4 T2 P0 A1 L3
C) G4 T2 P1 A0 L3
D) G4 T2 P1 A1 L2
Correct Answer: A) G4 T2 P1 A1 L3
Rationale: GTPAL stands for Gravida, Term births, Preterm births,
Abortions, Living children. G = 4 (current pregnancy plus 3 prior pregnancies). T =
2 (term births). P = 1 (preterm birth at 20–36 6/7 weeks). A = 1 (abortion, either
,spontaneous or induced before 20 weeks). L = 3 (currently living children). This is
a high-yield antepartum assessment concept.
3. A nurse is teaching a client at 12 weeks of gestation about expected
physiological changes during pregnancy. Which of the following statements by the
client indicates a need for further teaching?
A) "I may notice my gums bleeding when I brush my teeth."
B) "I should expect my blood pressure to decrease slightly."
C) "I will likely have more frequent bowel movements."
D) "My heart rate may increase by 10 to 15 beats per minute."
Correct Answer: C) "I will likely have more frequent bowel movements."
Rationale: Progesterone slows gastrointestinal motility, leading to
constipation—not more frequent bowel movements. Gingival bleeding (epulis) is
common due to increased vascularity. Blood pressure often decreases slightly in
the second trimester. Heart rate increases by 10–15 bpm due to increased cardiac
output. Recognizing normal versus abnormal pregnancy adaptations is critical for
antepartum assessment.
4. A nurse is performing a prenatal assessment on a client at 32 weeks of
gestation. Which of the following findings should the nurse report to the provider
immediately?
A) Fundal height of 32 cm
B) Blood pressure 142/92 mm Hg
C) Mild ankle edema
D) Fetal heart rate 148 bpm
Correct Answer: B) Blood pressure 142/92 mm Hg
Rationale: A blood pressure of 142/92 mm Hg exceeds the threshold for
gestational hypertension (≥140/90 mm Hg) and requires immediate evaluation for
preeclampsia. Fundal height should approximate gestational age in weeks (32 cm
,at 32 weeks is expected). Mild ankle edema is common. A fetal heart rate of 148
bpm is within the normal range of 110–160 bpm. Elevated blood pressure is a red-
flag finding that mandates prompt notification.
5. A nurse is providing nutritional counseling to a client who is at 10 weeks of
gestation and has a pre-pregnancy BMI of 28. Which of the following statements
by the client indicates correct understanding of recommended weight gain?
A) "I should gain between 25 and 35 pounds."
B) "I should gain between 15 and 25 pounds."
C) "I should gain between 11 and 20 pounds."
D) "I should gain between 28 and 40 pounds."
Correct Answer: B) "I should gain between 15 and 25 pounds."
Rationale: For a client with a pre-pregnancy BMI of 25–29.9 (overweight),
the Institute of Medicine recommends total gestational weight gain of 15–25
pounds. Underweight clients (BMI <18.5) should gain 28–40 pounds. Normal-
weight clients (BMI 18.5–24.9) should gain 25–35 pounds. Obese clients (BMI ≥30)
should gain 11–20 pounds. Nutritional assessment is a core antepartum
competency.
6. (SATA) A nurse is assessing a client at 36 weeks of gestation who reports a
sudden gush of fluid from the vagina. Which of the following actions should the
nurse take? Select all that apply.
A) Assess the color and odor of the fluid.
B) Perform a sterile speculum examination.
C) Test the fluid with nitrazine paper.
D) Insert a gloved finger into the vagina to check for cord prolapse.
E) Place the client on bed rest and monitor fetal heart tones.
Correct Answer: A, C, E
Rationale: When rupture of membranes (ROM) is suspected, the nurse
should assess the characteristics of the fluid (A), test with nitrazine paper (C)—
, which turns blue in the presence of amniotic fluid—and place the client on bed
rest while monitoring fetal heart tones (E) to detect cord compression or
prolapse. A sterile speculum examination (B) may be performed by the provider,
but digital vaginal examination (D) should be avoided to prevent infection and
cord prolapse.
7. A nurse is caring for a client at 28 weeks of gestation who is Rh-negative and
has not been sensitized. The client is scheduled to receive Rho(D) immune
globulin (RhoGAM). Which of the following statements by the client indicates a
need for further teaching?
A) "This medication will protect my baby from Rh incompatibility."
B) "I will need another dose after delivery if my baby is Rh-positive."
C) "This injection will make me immune to Rh-positive blood permanently."
D) "I should receive this at 28 weeks and within 72 hours after birth."
Correct Answer: C) "This injection will make me immune to Rh-positive
blood permanently."
Rationale: RhoGAM provides passive immunity and is not permanent; it
must be administered at 28 weeks and again within 72 hours after delivery of an
Rh-positive infant. It prevents sensitization but does not confer lifelong immunity.
Understanding the mechanism of RhoGAM is essential for preventing hemolytic
disease of the newborn.
8. A nurse is assessing a client at 20 weeks of gestation who reports a fluttering
sensation in her abdomen. The nurse documents this as:
A) Hegar's sign
B) Quickening
C) Ballottement
D) Chadwick's sign
Correct Answer: B) Quickening
