ATI Maternal-Newborn Nursing Exam Review and Study Guide |
Antepartum, Intrapartum, Postpartum Care, Newborn Assessment, Labor
and Delivery Management, Complications in Pregnancy, Pharmacology,
Patient Education, and ATI Practice Questions with Detailed Rationales |
Updated 2026 Nursing Test Prep
1. A client at 32 weeks gestation reports sudden, painless vaginal bleeding. The nurse
should suspect which condition first?
A. Placental abruption
B. Placenta previa
C. Ectopic pregnancy
D. Uterine rupture
Correct Answer: B
RATIONALE: Placenta previa typically presents with sudden, painless bright red vaginal
bleeding in the second or third trimester due to placental implantation over or near the
cervical os. Placental abruption usually involves painful bleeding with a rigid, tender
uterus. Ectopic pregnancy occurs in the first trimester, and uterine rupture is rare and
associated with severe abdominal pain and hemodynamic instability.
2. During the fourth stage of labor, the priority nursing assessment is:
A. Cervical dilation
B. Fetal heart rate
C. Uterine tone and lochia
D. Maternal temperature
Correct Answer: C
RATIONALE: The fourth stage of labor (first 1–4 hours postpartum) carries the highest
risk for postpartum hemorrhage. Assessing uterine tone (should be firm) and lochia
characteristics (amount, color, odor) is critical to identify uterine atony—the leading
cause of hemorrhage. Cervical dilation and fetal heart rate are no longer relevant after
delivery.
3. A newborn's APGAR score at 1 minute is 6. Which intervention should the nurse
perform first?
A. Administer oxygen via nasal cannula
B. Clear the airway and stimulate breathing
C. Begin chest compressions
D. Administer epinephrine
Correct Answer: B
RATIONALE: An APGAR score of 6 indicates moderate difficulty transitioning. The
priority follows the ABCs: ensure a patent airway (suction if needed) and provide tactile
stimulation to encourage spontaneous respirations before escalating to oxygen or more
,invasive interventions. Chest compressions are indicated only if heart rate remains <60
bpm after 30 seconds of effective ventilation.
4. Which finding in a client with preeclampsia requires immediate notification of the
provider?
A. Weight gain of 2 lb in one week
B. Epigastric pain and headache
C. +2 pedal edema
D. Blood pressure 142/92 mmHg
Correct Answer: B
RATIONALE: Epigastric or right upper quadrant pain with headache suggests worsening
preeclampsia and possible progression to HELLP syndrome or imminent eclampsia.
This requires urgent intervention (typically magnesium sulfate administration and
possible delivery). While the other findings warrant monitoring, they do not indicate
immediate maternal deterioration.
5. A breastfeeding client reports cracked, painful nipples. The nurse should first assess
for:
A. Maternal hydration status
B. Infant latch and positioning
C. Presence of candidiasis
D. Frequency of feedings
Correct Answer: B
RATIONALE: Improper latch and positioning are the most common causes of nipple
trauma during breastfeeding. Assessment should focus on whether the infant's mouth
covers adequate areola and the chin touches the breast. While candidiasis can cause
pain, it typically presents with burning pain and shiny nipples rather than cracking, and
should be considered only after latch issues are ruled out.
6. Which fetal heart rate pattern indicates uteroplacental insufficiency?
A. Early decelerations
B. Accelerations
C. Late decelerations
D. Variable decelerations
Correct Answer: C
RATIONALE: Late decelerations (gradual decrease in FHR that begins after the
contraction peak and returns to baseline after contraction ends) indicate
uteroplacental insufficiency and reduced oxygen transfer to the fetus. Early
,decelerations reflect head compression, variables reflect cord compression, and
accelerations are reassuring signs of fetal well-being.
7. A client at 28 weeks gestation has a hemoglobin of 10.2 g/dL. The nurse should
recognize this as:
A. Normal physiologic anemia of pregnancy
B. Iron-deficiency anemia requiring intervention
C. Hemodilution requiring immediate transfusion
D. Expected finding requiring no action
Correct Answer: B
RATIONALE: While hemodilution causes physiologic anemia in pregnancy, hemoglobin
below 11 g/dL in the second trimester is diagnostic of true anemia requiring iron
supplementation. Normal hemoglobin in second trimester should be ≥10.5 g/dL; values
below this threshold increase risks of preterm birth and low birth weight and require
treatment.
8. Which statement by a client 24 hours postpartum indicates understanding of lochia
progression?
A. "My lochia should turn bright red again by day 5."
B. "I should expect heavy bleeding for the first 3 weeks."
C. "My lochia will change from red to pink to white over several weeks."
D. "Lochia should stop completely by 10 days postpartum."
Correct Answer: C
RATIONALE: Normal lochia progression follows lochia rubra (red, days 1–3), lochia
serosa (pink/brown, days 4–10), and lochia alba (white/yellow, weeks 2–6). Bright red
bleeding after day 3 may indicate hemorrhage. Lochia typically continues for 4–6 weeks,
not 10 days or 3 weeks with heavy flow.
9. A newborn weighing 4,200 grams (9 lb 4 oz) is delivered vaginally. The nurse should
prioritize assessment for:
A. Hyperthermia
B. Brachial plexus injury
C. Hypoglycemia
D. Both B and C
Correct Answer: D
RATIONALE: Macrosomic infants (>4,000 grams) are at increased risk for birth trauma
(including brachial plexus injury from shoulder dystocia) and hypoglycemia due to fetal
hyperinsulinemia from maternal glucose exposure. Both complications require
, immediate assessment—the infant should be evaluated for arm movement symmetry
and have blood glucose monitored within the first hour of life.
10. Which client is at highest risk for gestational diabetes mellitus?
A. 24-year-old G1P0 with BMI 24
B. 32-year-old G3P2 with BMI 32 and previous 9-lb infant
C. 28-year-old G2P1 with family history of type 1 diabetes
D. 35-year-old G1P0 with history of preterm birth
Correct Answer: B
RATIONALE: Risk factors for gestational diabetes include obesity (BMI ≥30), previous
macrosomic infant (>9 lb), multiparity, and age >25. While family history of diabetes
increases risk, type 2 diabetes (not type 1) in first-degree relatives is the relevant risk
factor. Preterm birth history is not a significant risk factor for GDM.
11. During a prenatal visit, a client at 20 weeks gestation reports feeling fluttering
sensations in her abdomen. The nurse should document this as:
A. Quickening
B. Lightening
C. Ballottement
D. Engagement
Correct Answer: A
RATIONALE: Quickening refers to the mother's first perception of fetal movement,
typically occurring between 16–20 weeks in multiparas and 18–22 weeks in primiparas.
Lightening is descent of the fetus into the pelvis near term. Ballottement is a clinical
technique to assess fetal movement, and engagement is when the fetal presenting part
reaches the ischial spines.
12. A client receiving magnesium sulfate for preeclampsia has a respiratory rate of 10
breaths/minute and absent deep tendon reflexes. The nurse should immediately:
A. Increase the IV infusion rate
B. Administer calcium gluconate
C. Discontinue the magnesium sulfate infusion
D. Administer oxygen via non-rebreather mask
Correct Answer: C
RATIONALE: Respiratory depression (RR <12) and absent reflexes indicate magnesium
toxicity. The priority action is to stop the magnesium infusion immediately to prevent
respiratory arrest. Calcium gluconate is the antidote but should be administered after
discontinuing the infusion. Oxygen may be supportive but does not address the
underlying toxicity.
Antepartum, Intrapartum, Postpartum Care, Newborn Assessment, Labor
and Delivery Management, Complications in Pregnancy, Pharmacology,
Patient Education, and ATI Practice Questions with Detailed Rationales |
Updated 2026 Nursing Test Prep
1. A client at 32 weeks gestation reports sudden, painless vaginal bleeding. The nurse
should suspect which condition first?
A. Placental abruption
B. Placenta previa
C. Ectopic pregnancy
D. Uterine rupture
Correct Answer: B
RATIONALE: Placenta previa typically presents with sudden, painless bright red vaginal
bleeding in the second or third trimester due to placental implantation over or near the
cervical os. Placental abruption usually involves painful bleeding with a rigid, tender
uterus. Ectopic pregnancy occurs in the first trimester, and uterine rupture is rare and
associated with severe abdominal pain and hemodynamic instability.
2. During the fourth stage of labor, the priority nursing assessment is:
A. Cervical dilation
B. Fetal heart rate
C. Uterine tone and lochia
D. Maternal temperature
Correct Answer: C
RATIONALE: The fourth stage of labor (first 1–4 hours postpartum) carries the highest
risk for postpartum hemorrhage. Assessing uterine tone (should be firm) and lochia
characteristics (amount, color, odor) is critical to identify uterine atony—the leading
cause of hemorrhage. Cervical dilation and fetal heart rate are no longer relevant after
delivery.
3. A newborn's APGAR score at 1 minute is 6. Which intervention should the nurse
perform first?
A. Administer oxygen via nasal cannula
B. Clear the airway and stimulate breathing
C. Begin chest compressions
D. Administer epinephrine
Correct Answer: B
RATIONALE: An APGAR score of 6 indicates moderate difficulty transitioning. The
priority follows the ABCs: ensure a patent airway (suction if needed) and provide tactile
stimulation to encourage spontaneous respirations before escalating to oxygen or more
,invasive interventions. Chest compressions are indicated only if heart rate remains <60
bpm after 30 seconds of effective ventilation.
4. Which finding in a client with preeclampsia requires immediate notification of the
provider?
A. Weight gain of 2 lb in one week
B. Epigastric pain and headache
C. +2 pedal edema
D. Blood pressure 142/92 mmHg
Correct Answer: B
RATIONALE: Epigastric or right upper quadrant pain with headache suggests worsening
preeclampsia and possible progression to HELLP syndrome or imminent eclampsia.
This requires urgent intervention (typically magnesium sulfate administration and
possible delivery). While the other findings warrant monitoring, they do not indicate
immediate maternal deterioration.
5. A breastfeeding client reports cracked, painful nipples. The nurse should first assess
for:
A. Maternal hydration status
B. Infant latch and positioning
C. Presence of candidiasis
D. Frequency of feedings
Correct Answer: B
RATIONALE: Improper latch and positioning are the most common causes of nipple
trauma during breastfeeding. Assessment should focus on whether the infant's mouth
covers adequate areola and the chin touches the breast. While candidiasis can cause
pain, it typically presents with burning pain and shiny nipples rather than cracking, and
should be considered only after latch issues are ruled out.
6. Which fetal heart rate pattern indicates uteroplacental insufficiency?
A. Early decelerations
B. Accelerations
C. Late decelerations
D. Variable decelerations
Correct Answer: C
RATIONALE: Late decelerations (gradual decrease in FHR that begins after the
contraction peak and returns to baseline after contraction ends) indicate
uteroplacental insufficiency and reduced oxygen transfer to the fetus. Early
,decelerations reflect head compression, variables reflect cord compression, and
accelerations are reassuring signs of fetal well-being.
7. A client at 28 weeks gestation has a hemoglobin of 10.2 g/dL. The nurse should
recognize this as:
A. Normal physiologic anemia of pregnancy
B. Iron-deficiency anemia requiring intervention
C. Hemodilution requiring immediate transfusion
D. Expected finding requiring no action
Correct Answer: B
RATIONALE: While hemodilution causes physiologic anemia in pregnancy, hemoglobin
below 11 g/dL in the second trimester is diagnostic of true anemia requiring iron
supplementation. Normal hemoglobin in second trimester should be ≥10.5 g/dL; values
below this threshold increase risks of preterm birth and low birth weight and require
treatment.
8. Which statement by a client 24 hours postpartum indicates understanding of lochia
progression?
A. "My lochia should turn bright red again by day 5."
B. "I should expect heavy bleeding for the first 3 weeks."
C. "My lochia will change from red to pink to white over several weeks."
D. "Lochia should stop completely by 10 days postpartum."
Correct Answer: C
RATIONALE: Normal lochia progression follows lochia rubra (red, days 1–3), lochia
serosa (pink/brown, days 4–10), and lochia alba (white/yellow, weeks 2–6). Bright red
bleeding after day 3 may indicate hemorrhage. Lochia typically continues for 4–6 weeks,
not 10 days or 3 weeks with heavy flow.
9. A newborn weighing 4,200 grams (9 lb 4 oz) is delivered vaginally. The nurse should
prioritize assessment for:
A. Hyperthermia
B. Brachial plexus injury
C. Hypoglycemia
D. Both B and C
Correct Answer: D
RATIONALE: Macrosomic infants (>4,000 grams) are at increased risk for birth trauma
(including brachial plexus injury from shoulder dystocia) and hypoglycemia due to fetal
hyperinsulinemia from maternal glucose exposure. Both complications require
, immediate assessment—the infant should be evaluated for arm movement symmetry
and have blood glucose monitored within the first hour of life.
10. Which client is at highest risk for gestational diabetes mellitus?
A. 24-year-old G1P0 with BMI 24
B. 32-year-old G3P2 with BMI 32 and previous 9-lb infant
C. 28-year-old G2P1 with family history of type 1 diabetes
D. 35-year-old G1P0 with history of preterm birth
Correct Answer: B
RATIONALE: Risk factors for gestational diabetes include obesity (BMI ≥30), previous
macrosomic infant (>9 lb), multiparity, and age >25. While family history of diabetes
increases risk, type 2 diabetes (not type 1) in first-degree relatives is the relevant risk
factor. Preterm birth history is not a significant risk factor for GDM.
11. During a prenatal visit, a client at 20 weeks gestation reports feeling fluttering
sensations in her abdomen. The nurse should document this as:
A. Quickening
B. Lightening
C. Ballottement
D. Engagement
Correct Answer: A
RATIONALE: Quickening refers to the mother's first perception of fetal movement,
typically occurring between 16–20 weeks in multiparas and 18–22 weeks in primiparas.
Lightening is descent of the fetus into the pelvis near term. Ballottement is a clinical
technique to assess fetal movement, and engagement is when the fetal presenting part
reaches the ischial spines.
12. A client receiving magnesium sulfate for preeclampsia has a respiratory rate of 10
breaths/minute and absent deep tendon reflexes. The nurse should immediately:
A. Increase the IV infusion rate
B. Administer calcium gluconate
C. Discontinue the magnesium sulfate infusion
D. Administer oxygen via non-rebreather mask
Correct Answer: C
RATIONALE: Respiratory depression (RR <12) and absent reflexes indicate magnesium
toxicity. The priority action is to stop the magnesium infusion immediately to prevent
respiratory arrest. Calcium gluconate is the antidote but should be administered after
discontinuing the infusion. Oxygen may be supportive but does not address the
underlying toxicity.
