ATI RN Maternal Newborn Proctored Exam –
Assessment Technologies Institute (ATI) – 2026/2027
Edition – Questions and Answers for Registered
Nursing Students
Exam Description
This comprehensive examination is designed for registered nursing students preparing for the ATI
RN Maternal Newborn Proctored Exam for the 2026/2027 testing cycle. The exam follows the ATI
content mastery blueprint covering essential maternal-newborn nursing concepts including
antepartum care, intrapartum labor and delivery, postpartum recovery and complications,
newborn assessment and care, high-risk pregnancy emergencies, and Next Generation NCLEX
(NGN) clinical judgment scenarios. The exam contains multiple-choice, select-all-that-apply, and
NGN-style questions designed to mirror the actual ATI proctored assessment. Each question
includes a detailed rationale to reinforce clinical reasoning and evidence-based practice essential
for achieving Level 2 or higher proficiency.
Section 1: Antepartum Care – Prenatal Assessment and Complications (Questions 1-75)
Question 1
A nurse is providing teaching to a client who is at 8 weeks of gestation about manifestations to
report to the provider during pregnancy. Which information should the nurse include?
A. Nausea upon awakening
B. Blurred or double vision
C. Increase in white vaginal discharge
D. Leg cramps when sleeping
Answer: B. Blurred or double vision
Rationale: Blurred or double vision can indicate preeclampsia or gestational hypertension and
should be reported immediately. Nausea upon awakening is a common first-trimester discomfort.
Increased white vaginal discharge (leukorrhea) is normal during pregnancy. Leg cramps are
common in later pregnancy.
Question 2
A nurse is caring for a client who believes she may be pregnant. Which finding should the nurse
identify as a positive sign of pregnancy?
,A. Palpable fetal movement
B. Amenorrhea
C. Chadwick's sign
D. Positive pregnancy test
Answer: A. Palpable fetal movement
Rationale: Palpable fetal movement (quickening felt by examiner) is a positive sign of pregnancy.
Amenorrhea and Chadwick's sign are probable signs. A positive pregnancy test is also a probable
sign because false positives can occur.
Question 3
A nurse is teaching a client who is at 12 weeks of gestation and has HIV. Which statement should
the nurse include in the teaching?
A. "You will be in isolation after delivery."
B. "Abstain from sexual intercourse throughout pregnancy."
C. "Breastfeed your newborn to provide passive immunity."
D. "You should continue to take zidovudine throughout the pregnancy."
Answer: D. "You should continue to take zidovudine throughout the pregnancy."
Rationale: Taking prescription antiviral medication daily decreases the risk of transmission of HIV
to the newborn. HIV can be transmitted through breastfeeding, so that is not recommended.
Question 4
A nurse is assessing a client who is at 16 weeks of gestation. The client reports feeling fetal
movement for the first time. Which term describes this finding?
A. Lightening
B. Quickening
C. Ballottement
D. Chadwick's sign
Answer: B. Quickening
Rationale: Quickening is the first perception of fetal movement by the mother, typically occurring
between 16 and 20 weeks of gestation. Lightening is the descent of the fetal head into the pelvis.
Ballottement is a technique used to assess fetal position. Chadwick's sign is a bluish discoloration
of the cervix and vagina.
Question 5
A nurse is caring for a client who has oligohydramnios. Which fetal anomaly should the nurse
expect?
,A. Renal agenesis
B. Atrial septal defect
C. Spina bifida
D. Hydrocephalus
Answer: A. Renal agenesis
Rationale: Oligohydramnios is associated with fetal renal anomalies including renal agenesis, as
amniotic fluid is primarily fetal urine in the second half of pregnancy. Neurologic disorders such
as spina bifida and hydrocephalus are associated with polyhydramnios.
Question 6
A nurse is teaching a client who is at 28 weeks of gestation about nutrition. Which statement by
the client indicates an understanding of the teaching?
A. "I should take 400 mcg of folic acid each day."
B. "I need to take extra iron to prevent anemia."
C. "I should stop taking prenatal vitamins after the first trimester."
D. "Prenatal vitamins are optional if I eat well."
Answer: B. "I need to take extra iron to prevent anemia."
Rationale: Prenatal vitamins contain iron to prevent anemia, folic acid to prevent neural tube
defects, and other essential nutrients. They should be taken throughout pregnancy. The
recommended folic acid intake during pregnancy is 600 mcg daily.
Question 7
A nurse is assessing a client who is at 36 weeks of gestation. Which finding should the nurse
report to the provider?
A. Blood pressure 110/70 mm Hg
B. 1+ protein in urine
C. Weight gain of 0.5 kg (1.1 lb) in one week
D. Mild ankle edema
Answer: B. 1+ protein in urine
Rationale: Proteinuria (≥1+) in the third trimester can indicate preeclampsia and should be
evaluated. Mild ankle edema and weight gain of 0.5 kg/week are expected in the third trimester.
Question 8
A nurse is performing Leopold maneuvers on a client at 38 weeks gestation. The nurse palpates a
firm, round mass in the fundus and a smooth, convex mass on the right side. Which presentation
is most likely?
, A. Cephalic, right occiput anterior
B. Breech, right sacrum anterior
C. Cephalic, left occiput anterior
D. Transverse lie
Answer: B. Breech, right sacrum anterior
Rationale: A firm, round mass in the fundus indicates the fetal head; a smooth convex mass on the
side indicates the back. Breech presentation (sacrum anterior) is suggested.
Question 9
A nurse is caring for a client who is at 20 weeks gestation. The fundal height is 24 cm. What
should the nurse do first?
A. Document as normal variant
B. Prepare for ultrasound
C. Notify the provider
D. Reposition the client and remeasure
Answer: B. Prepare for ultrasound
Rationale: Fundal height in cm should approximate weeks of gestation (±2 cm). 24 cm at 20 weeks
is larger than expected, possibly due to multiple gestation, polyhydramnios, or dates error.
Ultrasound is indicated.
Question 10
A nurse is teaching a client about the purpose of the alpha-fetoprotein (AFP) screening. Which
statement is correct?
A. "AFP screens for chromosomal abnormalities like Down syndrome."
B. "AFP detects neural tube defects such as spina bifida."
C. "AFP is a diagnostic test for fetal lung maturity."
D. "AFP is used to confirm gestational diabetes."
Answer: B. "AFP detects neural tube defects such as spina bifida."
Rationale: Elevated AFP in maternal serum is associated with open neural tube defects. It is a
screening test, not diagnostic. Low AFP may indicate Down syndrome, but AFP primarily screens
for neural tube defects.
Question 11
A nurse is caring for a client who is Rh-negative and has not been sensitized. At 28 weeks
gestation, the nurse should anticipate an order for which medication?
A. Rh immune globulin (RhoGAM)
Assessment Technologies Institute (ATI) – 2026/2027
Edition – Questions and Answers for Registered
Nursing Students
Exam Description
This comprehensive examination is designed for registered nursing students preparing for the ATI
RN Maternal Newborn Proctored Exam for the 2026/2027 testing cycle. The exam follows the ATI
content mastery blueprint covering essential maternal-newborn nursing concepts including
antepartum care, intrapartum labor and delivery, postpartum recovery and complications,
newborn assessment and care, high-risk pregnancy emergencies, and Next Generation NCLEX
(NGN) clinical judgment scenarios. The exam contains multiple-choice, select-all-that-apply, and
NGN-style questions designed to mirror the actual ATI proctored assessment. Each question
includes a detailed rationale to reinforce clinical reasoning and evidence-based practice essential
for achieving Level 2 or higher proficiency.
Section 1: Antepartum Care – Prenatal Assessment and Complications (Questions 1-75)
Question 1
A nurse is providing teaching to a client who is at 8 weeks of gestation about manifestations to
report to the provider during pregnancy. Which information should the nurse include?
A. Nausea upon awakening
B. Blurred or double vision
C. Increase in white vaginal discharge
D. Leg cramps when sleeping
Answer: B. Blurred or double vision
Rationale: Blurred or double vision can indicate preeclampsia or gestational hypertension and
should be reported immediately. Nausea upon awakening is a common first-trimester discomfort.
Increased white vaginal discharge (leukorrhea) is normal during pregnancy. Leg cramps are
common in later pregnancy.
Question 2
A nurse is caring for a client who believes she may be pregnant. Which finding should the nurse
identify as a positive sign of pregnancy?
,A. Palpable fetal movement
B. Amenorrhea
C. Chadwick's sign
D. Positive pregnancy test
Answer: A. Palpable fetal movement
Rationale: Palpable fetal movement (quickening felt by examiner) is a positive sign of pregnancy.
Amenorrhea and Chadwick's sign are probable signs. A positive pregnancy test is also a probable
sign because false positives can occur.
Question 3
A nurse is teaching a client who is at 12 weeks of gestation and has HIV. Which statement should
the nurse include in the teaching?
A. "You will be in isolation after delivery."
B. "Abstain from sexual intercourse throughout pregnancy."
C. "Breastfeed your newborn to provide passive immunity."
D. "You should continue to take zidovudine throughout the pregnancy."
Answer: D. "You should continue to take zidovudine throughout the pregnancy."
Rationale: Taking prescription antiviral medication daily decreases the risk of transmission of HIV
to the newborn. HIV can be transmitted through breastfeeding, so that is not recommended.
Question 4
A nurse is assessing a client who is at 16 weeks of gestation. The client reports feeling fetal
movement for the first time. Which term describes this finding?
A. Lightening
B. Quickening
C. Ballottement
D. Chadwick's sign
Answer: B. Quickening
Rationale: Quickening is the first perception of fetal movement by the mother, typically occurring
between 16 and 20 weeks of gestation. Lightening is the descent of the fetal head into the pelvis.
Ballottement is a technique used to assess fetal position. Chadwick's sign is a bluish discoloration
of the cervix and vagina.
Question 5
A nurse is caring for a client who has oligohydramnios. Which fetal anomaly should the nurse
expect?
,A. Renal agenesis
B. Atrial septal defect
C. Spina bifida
D. Hydrocephalus
Answer: A. Renal agenesis
Rationale: Oligohydramnios is associated with fetal renal anomalies including renal agenesis, as
amniotic fluid is primarily fetal urine in the second half of pregnancy. Neurologic disorders such
as spina bifida and hydrocephalus are associated with polyhydramnios.
Question 6
A nurse is teaching a client who is at 28 weeks of gestation about nutrition. Which statement by
the client indicates an understanding of the teaching?
A. "I should take 400 mcg of folic acid each day."
B. "I need to take extra iron to prevent anemia."
C. "I should stop taking prenatal vitamins after the first trimester."
D. "Prenatal vitamins are optional if I eat well."
Answer: B. "I need to take extra iron to prevent anemia."
Rationale: Prenatal vitamins contain iron to prevent anemia, folic acid to prevent neural tube
defects, and other essential nutrients. They should be taken throughout pregnancy. The
recommended folic acid intake during pregnancy is 600 mcg daily.
Question 7
A nurse is assessing a client who is at 36 weeks of gestation. Which finding should the nurse
report to the provider?
A. Blood pressure 110/70 mm Hg
B. 1+ protein in urine
C. Weight gain of 0.5 kg (1.1 lb) in one week
D. Mild ankle edema
Answer: B. 1+ protein in urine
Rationale: Proteinuria (≥1+) in the third trimester can indicate preeclampsia and should be
evaluated. Mild ankle edema and weight gain of 0.5 kg/week are expected in the third trimester.
Question 8
A nurse is performing Leopold maneuvers on a client at 38 weeks gestation. The nurse palpates a
firm, round mass in the fundus and a smooth, convex mass on the right side. Which presentation
is most likely?
, A. Cephalic, right occiput anterior
B. Breech, right sacrum anterior
C. Cephalic, left occiput anterior
D. Transverse lie
Answer: B. Breech, right sacrum anterior
Rationale: A firm, round mass in the fundus indicates the fetal head; a smooth convex mass on the
side indicates the back. Breech presentation (sacrum anterior) is suggested.
Question 9
A nurse is caring for a client who is at 20 weeks gestation. The fundal height is 24 cm. What
should the nurse do first?
A. Document as normal variant
B. Prepare for ultrasound
C. Notify the provider
D. Reposition the client and remeasure
Answer: B. Prepare for ultrasound
Rationale: Fundal height in cm should approximate weeks of gestation (±2 cm). 24 cm at 20 weeks
is larger than expected, possibly due to multiple gestation, polyhydramnios, or dates error.
Ultrasound is indicated.
Question 10
A nurse is teaching a client about the purpose of the alpha-fetoprotein (AFP) screening. Which
statement is correct?
A. "AFP screens for chromosomal abnormalities like Down syndrome."
B. "AFP detects neural tube defects such as spina bifida."
C. "AFP is a diagnostic test for fetal lung maturity."
D. "AFP is used to confirm gestational diabetes."
Answer: B. "AFP detects neural tube defects such as spina bifida."
Rationale: Elevated AFP in maternal serum is associated with open neural tube defects. It is a
screening test, not diagnostic. Low AFP may indicate Down syndrome, but AFP primarily screens
for neural tube defects.
Question 11
A nurse is caring for a client who is Rh-negative and has not been sensitized. At 28 weeks
gestation, the nurse should anticipate an order for which medication?
A. Rh immune globulin (RhoGAM)
