ATI Maternal
Newborn Practice
Assessment A well
written one year
2025 /2026
updated graded A+
Version 3.1 - Advanced Comprehensive
Examination
,SECTION 1: ANTEPARTUM CARE – Prenatal Assessment & Screening
(Questions 1–30)
1. A nurse in a high-risk antenatal clinic is reviewing the electronic fetal monitoring strip of a
client at 34 weeks of gestation who has been diagnosed with intrauterine growth restriction
(IUGR) secondary to placental insufficiency. The baseline fetal heart rate is 130/min with
minimal variability and recurrent late decelerations. The nurse notes the client's blood pressure
is 158/96 mm Hg, and she has 3+ proteinuria. Which of the following nursing actions is the
priority?
A) Administer labetalol 20 mg IV push as prescribed for blood pressure control
B) Prepare the client for immediate induction of labor or cesarean delivery
C) Position the client in a left lateral tilt and administer oxygen at 10 L/min via face mask
D) Obtain a stat urine sample for protein-to-creatinine ratio assessment
- detailed answer 100% correct :-C) Position the client in a left lateral tilt and administer
oxygen at 10 L/min via face mask
Rationale: The priority action is to improve uteroplacental perfusion. The presence of recurrent late
decelerations with minimal variability indicates fetal compromise. The nurse must immediately position
the client to maximize venous return and administer oxygen to improve fetal oxygenation. While the
client has severe preeclampsia features, the fetal heart rate pattern is the most immediate threat.
2. A nurse is providing preconception counseling to a client who has a body mass index of 38
and a history of polycystic ovarian syndrome (PCOS). The client is planning to conceive within
,the next 6 months. Which of the following recommendations should the nurse prioritize to
optimize pregnancy outcomes?
A) "Begin taking metformin 500 mg twice daily to regulate ovulation and improve insulin sensitivity."
B) "Initiate a weight loss program with a goal of reducing your BMI to less than 30 before conception."
C) "Start folic acid supplementation at 800 mcg daily to reduce the risk of neural tube defects."
D) "Schedule an oral glucose tolerance test to evaluate for preexisting diabetes mellitus."
- detailed answer 100% correct :-B) "Initiate a weight loss program with a goal of reducing
your BMI to less than 30 before conception."
Rationale: Maternal obesity (BMI ≥30) is associated with significant adverse pregnancy outcomes
including gestational diabetes, preeclampsia, macrosomia, and congenital anomalies. Weight loss
before conception is the most effective intervention to reduce these risks. While folic acid
supplementation (C) is important (recommended at 400-800 mcg daily), weight loss has broader
impact. Metformin (A) may be indicated but is not the priority. Glucose screening (D) is important but
secondary to weight loss.
3. A nurse is caring for a client at 16 weeks of gestation who underwent chorionic villus
sampling (CVS) 3 days ago. The client now reports a temperature of 38.2°C (100.8°F), chills, and
foul-smelling vaginal discharge. Which of the following actions should the nurse take first?
A) Obtain blood cultures and administer broad-spectrum antibiotics as prescribed
B) Notify the provider of possible chorioamnionitis or septic abortion
C) Assess fetal heart rate and perform a sterile speculum examination
D) Administer acetaminophen 650 mg orally for fever management
- detailed answer 100% correct :-B) Notify the provider of possible chorioamnionitis or
septic abortion
Rationale: CVS carries a risk of infection (chorioamnionitis) and septic abortion. The combination of
fever, chills, and foul-smelling discharge is an emergency. The nurse should notify the provider
immediately. While obtaining cultures and administering antibiotics (A) may be needed, they require a
provider's order. Fetal assessment (C) is important but does not take precedence over provider
notification. Acetaminophen (D) addresses symptoms but delays critical treatment.
, 4. A nurse is assessing a client at 28 weeks of gestation who is being treated for gestational
diabetes with insulin glargine (long-acting) and insulin lispro (rapid-acting). The client reports
episodes of dizziness, diaphoresis, and palpitations occurring approximately 3 hours after her
evening meal. Which of the following nursing interventions is most appropriate?
A) Instruct the client to reduce her insulin lispro dose at dinner to prevent hypoglycemia
B) Recommend consuming a bedtime snack containing protein and complex carbohydrates
C) Advise the client to perform a fasting blood glucose check at 3 AM for 3 consecutive nights
D) Suggest increasing her evening exercise to improve glycemic control
- detailed answer 100% correct :-B) Recommend consuming a bedtime snack containing
protein and complex carbohydrates
Rationale: The client's symptoms indicate hypoglycemia occurring 3 hours post-meal, likely due to the
peak action of her rapid-acting insulin combined with the basal insulin. A bedtime snack prevents
nocturnal hypoglycemia. Reducing insulin lispro (A) without consulting the provider is unsafe. 3 AM
glucose checks (C) may help identify the pattern but do not address prevention. Exercise (D) could
worsen hypoglycemia.
5. A nurse is caring for a client at 12 weeks of gestation who has a history of Graves' disease and
is taking propylthiouracil (PTU) 150 mg daily. Which of the following laboratory findings
indicates that the client's medication dose requires adjustment?
A) Free T4 0.8 ng/dL (normal: 0.8-1.8 ng/dL)
B) TSH 0.1 mIU/L (normal: 0.4-4.0 mIU/L)
C) Free T3 4.2 pg/mL (normal: 2.3-4.2 pg/mL)
D) Maternal antibody titer 1:160
- detailed answer 100% correct :-B) TSH 0.1 mIU/L (normal: 0.4-4.0 mIU/L)
Rationale: A suppressed TSH (<0.1 mIU/L) indicates continued hyperthyroidism, suggesting the PTU
dose is insufficient. The goal of treatment is to maintain maternal free T4 in the upper-normal range
while avoiding fetal hypothyroidism. Free T4 (A) at the lower limit may actually indicate overtreatment.
The medication dose should be adjusted to normalize thyroid function. Maternal antibody titers (D)
monitor for fetal thyroid dysfunction but do not directly guide dosing.
Newborn Practice
Assessment A well
written one year
2025 /2026
updated graded A+
Version 3.1 - Advanced Comprehensive
Examination
,SECTION 1: ANTEPARTUM CARE – Prenatal Assessment & Screening
(Questions 1–30)
1. A nurse in a high-risk antenatal clinic is reviewing the electronic fetal monitoring strip of a
client at 34 weeks of gestation who has been diagnosed with intrauterine growth restriction
(IUGR) secondary to placental insufficiency. The baseline fetal heart rate is 130/min with
minimal variability and recurrent late decelerations. The nurse notes the client's blood pressure
is 158/96 mm Hg, and she has 3+ proteinuria. Which of the following nursing actions is the
priority?
A) Administer labetalol 20 mg IV push as prescribed for blood pressure control
B) Prepare the client for immediate induction of labor or cesarean delivery
C) Position the client in a left lateral tilt and administer oxygen at 10 L/min via face mask
D) Obtain a stat urine sample for protein-to-creatinine ratio assessment
- detailed answer 100% correct :-C) Position the client in a left lateral tilt and administer
oxygen at 10 L/min via face mask
Rationale: The priority action is to improve uteroplacental perfusion. The presence of recurrent late
decelerations with minimal variability indicates fetal compromise. The nurse must immediately position
the client to maximize venous return and administer oxygen to improve fetal oxygenation. While the
client has severe preeclampsia features, the fetal heart rate pattern is the most immediate threat.
2. A nurse is providing preconception counseling to a client who has a body mass index of 38
and a history of polycystic ovarian syndrome (PCOS). The client is planning to conceive within
,the next 6 months. Which of the following recommendations should the nurse prioritize to
optimize pregnancy outcomes?
A) "Begin taking metformin 500 mg twice daily to regulate ovulation and improve insulin sensitivity."
B) "Initiate a weight loss program with a goal of reducing your BMI to less than 30 before conception."
C) "Start folic acid supplementation at 800 mcg daily to reduce the risk of neural tube defects."
D) "Schedule an oral glucose tolerance test to evaluate for preexisting diabetes mellitus."
- detailed answer 100% correct :-B) "Initiate a weight loss program with a goal of reducing
your BMI to less than 30 before conception."
Rationale: Maternal obesity (BMI ≥30) is associated with significant adverse pregnancy outcomes
including gestational diabetes, preeclampsia, macrosomia, and congenital anomalies. Weight loss
before conception is the most effective intervention to reduce these risks. While folic acid
supplementation (C) is important (recommended at 400-800 mcg daily), weight loss has broader
impact. Metformin (A) may be indicated but is not the priority. Glucose screening (D) is important but
secondary to weight loss.
3. A nurse is caring for a client at 16 weeks of gestation who underwent chorionic villus
sampling (CVS) 3 days ago. The client now reports a temperature of 38.2°C (100.8°F), chills, and
foul-smelling vaginal discharge. Which of the following actions should the nurse take first?
A) Obtain blood cultures and administer broad-spectrum antibiotics as prescribed
B) Notify the provider of possible chorioamnionitis or septic abortion
C) Assess fetal heart rate and perform a sterile speculum examination
D) Administer acetaminophen 650 mg orally for fever management
- detailed answer 100% correct :-B) Notify the provider of possible chorioamnionitis or
septic abortion
Rationale: CVS carries a risk of infection (chorioamnionitis) and septic abortion. The combination of
fever, chills, and foul-smelling discharge is an emergency. The nurse should notify the provider
immediately. While obtaining cultures and administering antibiotics (A) may be needed, they require a
provider's order. Fetal assessment (C) is important but does not take precedence over provider
notification. Acetaminophen (D) addresses symptoms but delays critical treatment.
, 4. A nurse is assessing a client at 28 weeks of gestation who is being treated for gestational
diabetes with insulin glargine (long-acting) and insulin lispro (rapid-acting). The client reports
episodes of dizziness, diaphoresis, and palpitations occurring approximately 3 hours after her
evening meal. Which of the following nursing interventions is most appropriate?
A) Instruct the client to reduce her insulin lispro dose at dinner to prevent hypoglycemia
B) Recommend consuming a bedtime snack containing protein and complex carbohydrates
C) Advise the client to perform a fasting blood glucose check at 3 AM for 3 consecutive nights
D) Suggest increasing her evening exercise to improve glycemic control
- detailed answer 100% correct :-B) Recommend consuming a bedtime snack containing
protein and complex carbohydrates
Rationale: The client's symptoms indicate hypoglycemia occurring 3 hours post-meal, likely due to the
peak action of her rapid-acting insulin combined with the basal insulin. A bedtime snack prevents
nocturnal hypoglycemia. Reducing insulin lispro (A) without consulting the provider is unsafe. 3 AM
glucose checks (C) may help identify the pattern but do not address prevention. Exercise (D) could
worsen hypoglycemia.
5. A nurse is caring for a client at 12 weeks of gestation who has a history of Graves' disease and
is taking propylthiouracil (PTU) 150 mg daily. Which of the following laboratory findings
indicates that the client's medication dose requires adjustment?
A) Free T4 0.8 ng/dL (normal: 0.8-1.8 ng/dL)
B) TSH 0.1 mIU/L (normal: 0.4-4.0 mIU/L)
C) Free T3 4.2 pg/mL (normal: 2.3-4.2 pg/mL)
D) Maternal antibody titer 1:160
- detailed answer 100% correct :-B) TSH 0.1 mIU/L (normal: 0.4-4.0 mIU/L)
Rationale: A suppressed TSH (<0.1 mIU/L) indicates continued hyperthyroidism, suggesting the PTU
dose is insufficient. The goal of treatment is to maintain maternal free T4 in the upper-normal range
while avoiding fetal hypothyroidism. Free T4 (A) at the lower limit may actually indicate overtreatment.
The medication dose should be adjusted to normalize thyroid function. Maternal antibody titers (D)
monitor for fetal thyroid dysfunction but do not directly guide dosing.
