ATI PN Maternal Proctored Exam 2026 | ACTUAL EXAM |
Complete Maternal–Newborn & NGN OB Practice
Questions with Verified Answers | Latest Update
1
A primigravida at 39 weeks arrives in triage reporting a sudden gush of clear fluid and
contractions every 5 min. The PN performs a nitrazine test and observes ferning on
microscopic exam. Which action is most appropriate for the PN to take first?
A. Perform a sterile speculum exam to assess cervical dilation
B. Apply an external fetal monitor to assess fetal heart rate pattern
C. Check maternal temperature and vital signs
D. Notify the RN and prepare for immediate cesarean birth
Correct Answer: B
Rationale: Confirmation of ruptured membranes (ferning + nitrazine) requires immediate
fetal heart rate (FHR) assessment to detect cord compression or fetal compromise.
Sterile speculum (A) is performed by the RN/Provider. Vitals (C) are important but
secondary to fetal surveillance. Cesarean (D) is not indicated unless fetal distress.
2
Matrix NGN – Select all nursing actions that apply for each stage of labor.
TableCopy
, Encourage Assess cervical Apply internal Offer
Stage of Labor
voiding q2 h change q4 h monitor epidural info
First stage latent
✔ ✔ ✔
(<6 cm)
First stage active
✔ ✔ ✔ ✔
(6–10 cm)
Second stage
✔ ✔
(pushing)
Scoring logic: 1 point per correctly checked or unchecked box.
Rationale: Internal monitor is used in active/second stages when indicated; voiding and
pain teaching continue; cervical checks are less frequent in second stage (focus on
descent).
3
Case Study – Maria, G2P1, 35 weeks gestation, presents with BP 150/96 mmHg,
platelets 88,000/µL, AST 90 U/L, +3 proteinuria, epigastric pain 8/10.
Q3a. Which condition does the PN suspect?
A. Mild preeclampsia
B. HELLP syndrome
C. Chronic hypertension
D. Gestational thrombocytopenia
,Correct Answer: B
Rationale: Hemolysis (elevated AST), Elevated LFTs, Low Platelets define HELLP. Mild
preeclampsia (A) lacks severe features. Chronic HTN (C) is pre-existing without HELLP
labs. Gestational thrombocytopenia (D) is mild, asymptomatic, and isolated.
Q3b. The PN prepares magnesium sulfate per protocol. Which finding requires
immediate intervention?
A. Respiratory rate 14/min
B. DTRs 2+
C. Urine output 25 mL/h
D. Patellar reflex absent
Correct Answer: D
Rationale: Absent DTRs signal impending magnesium toxicity (respiratory arrest). RR 14
(A), DTRs 2+ (B), and UOP 25 mL/h (C) are acceptable but at lower thresholds; <30 mL/h
is cautionary.
4
Bow-tie NGN – A client is receiving magnesium sulfate 2 g/h IV for severe
preeclampsia. Current assessment: RR 10/min, DTRs absent, UOP 20 mL/h, Mg²⁺ level
3.2 mEq/L. Arrange the PN’s actions in sequence (place numbers 1–5):
1. Stop magnesium infusion
2. Call provider/RN immediately
3. Prepare calcium gluconate 1 g IV
4. Apply oxygen 8 L/min via face mask
, 5. Document findings and client response
Correct sequence: 1, 2, 3, 4, 5
Rationale: Immediate cessation limits further toxicity; provider notification enables
antidote order; calcium gluconate reverses respiratory depression; oxygen supports
ventilation; documentation completes process.
5
A client in active labor receives an epidural. Within 10 min her BP drops to 88/50 mmHg
and FHR shows late decelerations. The PN’s first action is to:
A. Turn client to left lateral position
B. Administer ephedrine IV per protocol
C. Increase IV fluid rate
D. Apply oxygen 10 L/min via face mask
Correct Answer: A
Rationale: Left lateral relieves aortocaval compression, restoring maternal cardiac
output and placental perfusion. Fluids (C) and oxygen (D) follow; ephedrine (B) is given
by RN/Provider.
6
A term newborn is noted to have acrocyanosis at 5 min of life. The PN should:
A. Apply oxygen via face mask
B. Document as normal variant if HR 140 and SpO₂ 92 %
Complete Maternal–Newborn & NGN OB Practice
Questions with Verified Answers | Latest Update
1
A primigravida at 39 weeks arrives in triage reporting a sudden gush of clear fluid and
contractions every 5 min. The PN performs a nitrazine test and observes ferning on
microscopic exam. Which action is most appropriate for the PN to take first?
A. Perform a sterile speculum exam to assess cervical dilation
B. Apply an external fetal monitor to assess fetal heart rate pattern
C. Check maternal temperature and vital signs
D. Notify the RN and prepare for immediate cesarean birth
Correct Answer: B
Rationale: Confirmation of ruptured membranes (ferning + nitrazine) requires immediate
fetal heart rate (FHR) assessment to detect cord compression or fetal compromise.
Sterile speculum (A) is performed by the RN/Provider. Vitals (C) are important but
secondary to fetal surveillance. Cesarean (D) is not indicated unless fetal distress.
2
Matrix NGN – Select all nursing actions that apply for each stage of labor.
TableCopy
, Encourage Assess cervical Apply internal Offer
Stage of Labor
voiding q2 h change q4 h monitor epidural info
First stage latent
✔ ✔ ✔
(<6 cm)
First stage active
✔ ✔ ✔ ✔
(6–10 cm)
Second stage
✔ ✔
(pushing)
Scoring logic: 1 point per correctly checked or unchecked box.
Rationale: Internal monitor is used in active/second stages when indicated; voiding and
pain teaching continue; cervical checks are less frequent in second stage (focus on
descent).
3
Case Study – Maria, G2P1, 35 weeks gestation, presents with BP 150/96 mmHg,
platelets 88,000/µL, AST 90 U/L, +3 proteinuria, epigastric pain 8/10.
Q3a. Which condition does the PN suspect?
A. Mild preeclampsia
B. HELLP syndrome
C. Chronic hypertension
D. Gestational thrombocytopenia
,Correct Answer: B
Rationale: Hemolysis (elevated AST), Elevated LFTs, Low Platelets define HELLP. Mild
preeclampsia (A) lacks severe features. Chronic HTN (C) is pre-existing without HELLP
labs. Gestational thrombocytopenia (D) is mild, asymptomatic, and isolated.
Q3b. The PN prepares magnesium sulfate per protocol. Which finding requires
immediate intervention?
A. Respiratory rate 14/min
B. DTRs 2+
C. Urine output 25 mL/h
D. Patellar reflex absent
Correct Answer: D
Rationale: Absent DTRs signal impending magnesium toxicity (respiratory arrest). RR 14
(A), DTRs 2+ (B), and UOP 25 mL/h (C) are acceptable but at lower thresholds; <30 mL/h
is cautionary.
4
Bow-tie NGN – A client is receiving magnesium sulfate 2 g/h IV for severe
preeclampsia. Current assessment: RR 10/min, DTRs absent, UOP 20 mL/h, Mg²⁺ level
3.2 mEq/L. Arrange the PN’s actions in sequence (place numbers 1–5):
1. Stop magnesium infusion
2. Call provider/RN immediately
3. Prepare calcium gluconate 1 g IV
4. Apply oxygen 8 L/min via face mask
, 5. Document findings and client response
Correct sequence: 1, 2, 3, 4, 5
Rationale: Immediate cessation limits further toxicity; provider notification enables
antidote order; calcium gluconate reverses respiratory depression; oxygen supports
ventilation; documentation completes process.
5
A client in active labor receives an epidural. Within 10 min her BP drops to 88/50 mmHg
and FHR shows late decelerations. The PN’s first action is to:
A. Turn client to left lateral position
B. Administer ephedrine IV per protocol
C. Increase IV fluid rate
D. Apply oxygen 10 L/min via face mask
Correct Answer: A
Rationale: Left lateral relieves aortocaval compression, restoring maternal cardiac
output and placental perfusion. Fluids (C) and oxygen (D) follow; ephedrine (B) is given
by RN/Provider.
6
A term newborn is noted to have acrocyanosis at 5 min of life. The PN should:
A. Apply oxygen via face mask
B. Document as normal variant if HR 140 and SpO₂ 92 %
