ATI Maternal Newborn Proctored Exam Prep
Complete Practice Question Bank 4 VERSIONS
1. A nurse is caring for a client who is 4 hours postpartum and has saturated two
perineal pads in 30 minutes. The fundus is firm and midline. Which of the following
is the most likely cause of the bleeding?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or cervical laceration
D. Coagulopathy
Correct Answer: C. Vaginal or cervical laceration.
Rationale: When the fundus is firm, the cause of excessive bleeding is most likely a
laceration of the vagina, cervix, or perineum. Uterine atony would present with a boggy
fundus. Retained fragments cause subinvolution and a boggy fundus. Coagulopathy is rare
and diagnosed by lab tests.
2. A nurse is providing teaching about the Tdap vaccine to a client who is 30 weeks
gestation. The nurse should explain that the purpose of this vaccine is to:
A. Prevent tetanus in the mother
B. Prevent pertussis (whooping cough) in the newborn
C. Prevent diphtheria in the mother
D. Prevent influenza in the newborn
Correct Answer: B. Prevent pertussis (whooping cough) in the newborn.
Rationale: The Tdap vaccine (tetanus, diphtheria, acellular pertussis) is recommended at
27–36 weeks of gestation to protect the newborn from pertussis by transferring maternal
antibodies across the placenta. This is called cocooning and is critical because newborns
cannot receive the vaccine until 2 months of age.
,3. A nurse is assessing a newborn who is 8 hours old. The nurse notes the infant's
hands and feet are blue, but the trunk and face are pink. This finding is known as:
A. Acrocyanosis
B. Central cyanosis
C. Harlequin sign
D. Cyanotic heart defect
Correct Answer: A. Acrocyanosis.
Rationale: Acrocyanosis is bluish discoloration of the hands and feet only, which is a
normal finding in newborns due to immature peripheral circulation. Central cyanosis (blue
trunk, face, mucous membranes) is abnormal and indicates hypoxia or congenital heart
disease.
4. A nurse is caring for a client who is receiving magnesium sulfate for
preeclampsia. The nurse notes the client's urinary output is 20 mL/hr over the past
2 hours. Which of the following actions should the nurse take first?
A. Notify the provider.
B. Administer calcium gluconate.
C. Decrease the magnesium sulfate infusion rate.
D. Assess deep tendon reflexes.
Correct Answer: A. Notify the provider.
Rationale: A urinary output <30 mL/hr is a sign of magnesium toxicity and renal
impairment. The nurse should notify the provider immediately. Calcium gluconate is the
antidote and may be administered if there are signs of toxicity (e.g., respiratory depression,
loss of reflexes), but the provider must be notified first.
,5. A nurse is assessing a client who is 12 weeks gestation and reports vaginal
spotting after intercourse. Which of the following should the nurse include in the
teaching?
A. "You should avoid sexual activity for the rest of your pregnancy."
B. "Spotting after intercourse is common due to increased cervical vascularity."
C. "You should come to the emergency room immediately."
D. "This indicates a threatened miscarriage."
*Correct Answer: B. "Spotting after intercourse is common due to increased cervical
vascularity." *
Rationale: Vaginal spotting after intercourse is common in pregnancy due to increased
vascularity and engorgement of the cervix (friability). It is usually benign. However, the
client should report heavy bleeding, pain, or fever. Sexual activity does not need to be
avoided unless bleeding is persistent.
6. A nurse is caring for a newborn who is 2 days old and has a respiratory rate of
70/min with grunting and nasal flaring. The nurse should prepare for which of the
following interventions?
A. Administer oxygen via nasal cannula.
B. Prepare for intubation and mechanical ventilation.
C. Administer surfactant via endotracheal tube.
D. Provide continuous positive airway pressure (CPAP).
*Correct Answer: D. Provide continuous positive airway pressure (CPAP). *
Rationale: Tachypnea, grunting, and nasal flaring are signs of respiratory distress syndrome
(RDS). CPAP is often used first to keep alveoli open and reduce the work of breathing.
Surfactant is administered if the newborn is intubated. Oxygen alone may not be sufficient
if the newborn has RDS.
7. A nurse is providing teaching to a client who is 16 weeks gestation about the
anatomy scan ultrasound. The nurse should explain that this ultrasound is typically
performed at which gestational age?
, A. 12–14 weeks
B. 18–22 weeks
C. 24–28 weeks
D. 32–34 weeks
Correct Answer: B. 18–22 weeks.
Rationale: The anatomy scan (level II ultrasound) is typically performed at 18–22 weeks of
gestation to assess fetal anatomy, growth, amniotic fluid volume, placental location, and
screen for congenital anomalies. The nuchal translucency screen is performed at 11–13
weeks.
8. A nurse is assessing a client who is 3 days postpartum and reports a headache,
photophobia, and stiff neck. Which of the following conditions should the nurse
suspect?
A. Postpartum preeclampsia
B. Meningitis
C. Post-dural puncture headache
D. Sinusitis
Correct Answer: B. Meningitis.
Rationale: Headache, photophobia (sensitivity to light), and stiff neck are classic signs of
meningitis, a serious infection. This is a medical emergency. Post-dural puncture headache
improves when lying down and does not typically cause photophobia or neck stiffness.
Preeclampsia causes visual changes and hypertension without neck stiffness.
9. A nurse is caring for a client who is 34 weeks gestation and has a diagnosis of
placental abruption. Which of the following findings should the nurse expect?
A. Painless, bright red vaginal bleeding
B. Uterine tenderness and rigidity
C. Soft, nontender uterus
D. Fetal heart rate accelerations
Complete Practice Question Bank 4 VERSIONS
1. A nurse is caring for a client who is 4 hours postpartum and has saturated two
perineal pads in 30 minutes. The fundus is firm and midline. Which of the following
is the most likely cause of the bleeding?
A. Uterine atony
B. Retained placental fragments
C. Vaginal or cervical laceration
D. Coagulopathy
Correct Answer: C. Vaginal or cervical laceration.
Rationale: When the fundus is firm, the cause of excessive bleeding is most likely a
laceration of the vagina, cervix, or perineum. Uterine atony would present with a boggy
fundus. Retained fragments cause subinvolution and a boggy fundus. Coagulopathy is rare
and diagnosed by lab tests.
2. A nurse is providing teaching about the Tdap vaccine to a client who is 30 weeks
gestation. The nurse should explain that the purpose of this vaccine is to:
A. Prevent tetanus in the mother
B. Prevent pertussis (whooping cough) in the newborn
C. Prevent diphtheria in the mother
D. Prevent influenza in the newborn
Correct Answer: B. Prevent pertussis (whooping cough) in the newborn.
Rationale: The Tdap vaccine (tetanus, diphtheria, acellular pertussis) is recommended at
27–36 weeks of gestation to protect the newborn from pertussis by transferring maternal
antibodies across the placenta. This is called cocooning and is critical because newborns
cannot receive the vaccine until 2 months of age.
,3. A nurse is assessing a newborn who is 8 hours old. The nurse notes the infant's
hands and feet are blue, but the trunk and face are pink. This finding is known as:
A. Acrocyanosis
B. Central cyanosis
C. Harlequin sign
D. Cyanotic heart defect
Correct Answer: A. Acrocyanosis.
Rationale: Acrocyanosis is bluish discoloration of the hands and feet only, which is a
normal finding in newborns due to immature peripheral circulation. Central cyanosis (blue
trunk, face, mucous membranes) is abnormal and indicates hypoxia or congenital heart
disease.
4. A nurse is caring for a client who is receiving magnesium sulfate for
preeclampsia. The nurse notes the client's urinary output is 20 mL/hr over the past
2 hours. Which of the following actions should the nurse take first?
A. Notify the provider.
B. Administer calcium gluconate.
C. Decrease the magnesium sulfate infusion rate.
D. Assess deep tendon reflexes.
Correct Answer: A. Notify the provider.
Rationale: A urinary output <30 mL/hr is a sign of magnesium toxicity and renal
impairment. The nurse should notify the provider immediately. Calcium gluconate is the
antidote and may be administered if there are signs of toxicity (e.g., respiratory depression,
loss of reflexes), but the provider must be notified first.
,5. A nurse is assessing a client who is 12 weeks gestation and reports vaginal
spotting after intercourse. Which of the following should the nurse include in the
teaching?
A. "You should avoid sexual activity for the rest of your pregnancy."
B. "Spotting after intercourse is common due to increased cervical vascularity."
C. "You should come to the emergency room immediately."
D. "This indicates a threatened miscarriage."
*Correct Answer: B. "Spotting after intercourse is common due to increased cervical
vascularity." *
Rationale: Vaginal spotting after intercourse is common in pregnancy due to increased
vascularity and engorgement of the cervix (friability). It is usually benign. However, the
client should report heavy bleeding, pain, or fever. Sexual activity does not need to be
avoided unless bleeding is persistent.
6. A nurse is caring for a newborn who is 2 days old and has a respiratory rate of
70/min with grunting and nasal flaring. The nurse should prepare for which of the
following interventions?
A. Administer oxygen via nasal cannula.
B. Prepare for intubation and mechanical ventilation.
C. Administer surfactant via endotracheal tube.
D. Provide continuous positive airway pressure (CPAP).
*Correct Answer: D. Provide continuous positive airway pressure (CPAP). *
Rationale: Tachypnea, grunting, and nasal flaring are signs of respiratory distress syndrome
(RDS). CPAP is often used first to keep alveoli open and reduce the work of breathing.
Surfactant is administered if the newborn is intubated. Oxygen alone may not be sufficient
if the newborn has RDS.
7. A nurse is providing teaching to a client who is 16 weeks gestation about the
anatomy scan ultrasound. The nurse should explain that this ultrasound is typically
performed at which gestational age?
, A. 12–14 weeks
B. 18–22 weeks
C. 24–28 weeks
D. 32–34 weeks
Correct Answer: B. 18–22 weeks.
Rationale: The anatomy scan (level II ultrasound) is typically performed at 18–22 weeks of
gestation to assess fetal anatomy, growth, amniotic fluid volume, placental location, and
screen for congenital anomalies. The nuchal translucency screen is performed at 11–13
weeks.
8. A nurse is assessing a client who is 3 days postpartum and reports a headache,
photophobia, and stiff neck. Which of the following conditions should the nurse
suspect?
A. Postpartum preeclampsia
B. Meningitis
C. Post-dural puncture headache
D. Sinusitis
Correct Answer: B. Meningitis.
Rationale: Headache, photophobia (sensitivity to light), and stiff neck are classic signs of
meningitis, a serious infection. This is a medical emergency. Post-dural puncture headache
improves when lying down and does not typically cause photophobia or neck stiffness.
Preeclampsia causes visual changes and hypertension without neck stiffness.
9. A nurse is caring for a client who is 34 weeks gestation and has a diagnosis of
placental abruption. Which of the following findings should the nurse expect?
A. Painless, bright red vaginal bleeding
B. Uterine tenderness and rigidity
C. Soft, nontender uterus
D. Fetal heart rate accelerations
