FULL TEST BANK FOR ATI RN MATERNAL NEWBORN PROCTORED EXAM (2026 NGN REVISED) COMPLETE
COVERAGE QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Question 1
A nurse is caring for a client who is at 38 weeks of gestation and is experiencing contractions every 3 to 4
minutes. The client's cervix is 5 cm dilated, 80% effaced, and the fetus is at 0 station. Which of the following
phases of labor is the client experiencing?
A. Latent phase
B. Active phase
C. Transition phase
D. Second stage
🟢 Correct Answer:
B. Active phase
🔴 RATIONALE:
The active phase of the first stage of labor is characterized by cervical dilation from 4 to 7 cm, more frequent
contractions (every 3 to 5 minutes), and descent of the presenting part. The latent phase is 0 to 3 cm dilation;
transition is 8 to 10 cm; the second stage begins with full dilation and ends with delivery of the fetus. This
client's findings of 5 cm dilation, 80% effacement, and contractions every 3 to 4 minutes are consistent with the
active phase.
,Question 2
A nurse is assessing a newborn who is 1 hour old. Which of the following findings should the nurse report to
the healthcare provider?
A. Heart rate of 140 beats per minute
B. Respiratory rate of 60 breaths per minute
C. Axillary temperature of 97.5°F (36.4°C)
D. Acrocyanosis of the hands and feet
🟢 Correct Answer:
C. Axillary temperature of 97.5°F (36.4°C)
🔴 RATIONALE:
A normal newborn axillary temperature ranges from 97.7°F to 99.5°F (36.5°C to 37.5°C). A temperature of 97.5°F
is below the normal range and may indicate hypothermia, which can lead to hypoglycemia, respiratory distress,
and other complications. A heart rate of 140 bpm and respiratory rate of 60 bpm are within normal limits for a
newborn. Acrocyanosis (bluish discoloration of hands and feet) is a normal finding in the first 24 hours of life
due to immature peripheral circulation.
Question 3
,A nurse is reinforcing teaching with a client who is postpartum and plans to breastfeed. Which of the following
statements by the client indicates an understanding of the teaching?
A. "I should wash my nipples with soap and water before each feeding."
B. "I should wait until my nipples are sore before using lanolin."
C. "I should offer both breasts at each feeding."
D. "I should breastfeed my baby at least every 4 hours during the day."
🟢 Correct Answer:
C. "I should offer both breasts at each feeding."
🔴 RATIONALE:
Offering both breasts at each feeding helps ensure adequate milk removal, stimulates milk production, and
prevents engorgement. Nipples should be washed with water only, not soap, to prevent drying and cracking.
Lanolin should be applied after feedings, not when soreness develops. Breastfeeding should occur at least every
2 to 3 hours, or on demand, not every 4 hours.
Question 4
A nurse is caring for a client who is receiving magnesium sulfate for preeclampsia. Which of the following
findings indicates magnesium toxicity?
A. Urinary output of 40 mL per hour
B. Deep tendon reflexes 2+
, C. Serum magnesium level of 6 mEq/L
D. Respiratory rate of 10 breaths per minute
🟢 Correct Answer:
D. Respiratory rate of 10 breaths per minute
🔴 RATIONALE:
Magnesium toxicity can cause respiratory depression (rate below 12 breaths per minute), which is a life-
threatening complication. Therapeutic magnesium levels range from 4 to 7 mEq/L. Urine output should be at
least 30 mL/hour; deep tendon reflexes should be 1+ to 2+. A respiratory rate of 10 is below the safe threshold
and requires immediate intervention, including discontinuing the infusion and administering calcium gluconate.
Question 5
A nurse is assessing a client who is at 34 weeks of gestation and reports persistent headache, blurred vision, and
epigastric pain. The client's blood pressure is 158/94 mmHg. Which of the following conditions should the nurse
suspect?
A. Gestational diabetes
B. Placental abruption
C. Preeclampsia
D. Chorioamnionitis
🟢 Correct Answer:
C. Preeclampsia
COVERAGE QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Question 1
A nurse is caring for a client who is at 38 weeks of gestation and is experiencing contractions every 3 to 4
minutes. The client's cervix is 5 cm dilated, 80% effaced, and the fetus is at 0 station. Which of the following
phases of labor is the client experiencing?
A. Latent phase
B. Active phase
C. Transition phase
D. Second stage
🟢 Correct Answer:
B. Active phase
🔴 RATIONALE:
The active phase of the first stage of labor is characterized by cervical dilation from 4 to 7 cm, more frequent
contractions (every 3 to 5 minutes), and descent of the presenting part. The latent phase is 0 to 3 cm dilation;
transition is 8 to 10 cm; the second stage begins with full dilation and ends with delivery of the fetus. This
client's findings of 5 cm dilation, 80% effacement, and contractions every 3 to 4 minutes are consistent with the
active phase.
,Question 2
A nurse is assessing a newborn who is 1 hour old. Which of the following findings should the nurse report to
the healthcare provider?
A. Heart rate of 140 beats per minute
B. Respiratory rate of 60 breaths per minute
C. Axillary temperature of 97.5°F (36.4°C)
D. Acrocyanosis of the hands and feet
🟢 Correct Answer:
C. Axillary temperature of 97.5°F (36.4°C)
🔴 RATIONALE:
A normal newborn axillary temperature ranges from 97.7°F to 99.5°F (36.5°C to 37.5°C). A temperature of 97.5°F
is below the normal range and may indicate hypothermia, which can lead to hypoglycemia, respiratory distress,
and other complications. A heart rate of 140 bpm and respiratory rate of 60 bpm are within normal limits for a
newborn. Acrocyanosis (bluish discoloration of hands and feet) is a normal finding in the first 24 hours of life
due to immature peripheral circulation.
Question 3
,A nurse is reinforcing teaching with a client who is postpartum and plans to breastfeed. Which of the following
statements by the client indicates an understanding of the teaching?
A. "I should wash my nipples with soap and water before each feeding."
B. "I should wait until my nipples are sore before using lanolin."
C. "I should offer both breasts at each feeding."
D. "I should breastfeed my baby at least every 4 hours during the day."
🟢 Correct Answer:
C. "I should offer both breasts at each feeding."
🔴 RATIONALE:
Offering both breasts at each feeding helps ensure adequate milk removal, stimulates milk production, and
prevents engorgement. Nipples should be washed with water only, not soap, to prevent drying and cracking.
Lanolin should be applied after feedings, not when soreness develops. Breastfeeding should occur at least every
2 to 3 hours, or on demand, not every 4 hours.
Question 4
A nurse is caring for a client who is receiving magnesium sulfate for preeclampsia. Which of the following
findings indicates magnesium toxicity?
A. Urinary output of 40 mL per hour
B. Deep tendon reflexes 2+
, C. Serum magnesium level of 6 mEq/L
D. Respiratory rate of 10 breaths per minute
🟢 Correct Answer:
D. Respiratory rate of 10 breaths per minute
🔴 RATIONALE:
Magnesium toxicity can cause respiratory depression (rate below 12 breaths per minute), which is a life-
threatening complication. Therapeutic magnesium levels range from 4 to 7 mEq/L. Urine output should be at
least 30 mL/hour; deep tendon reflexes should be 1+ to 2+. A respiratory rate of 10 is below the safe threshold
and requires immediate intervention, including discontinuing the infusion and administering calcium gluconate.
Question 5
A nurse is assessing a client who is at 34 weeks of gestation and reports persistent headache, blurred vision, and
epigastric pain. The client's blood pressure is 158/94 mmHg. Which of the following conditions should the nurse
suspect?
A. Gestational diabetes
B. Placental abruption
C. Preeclampsia
D. Chorioamnionitis
🟢 Correct Answer:
C. Preeclampsia
