ATI RN Maternal Newborn 2026 OB Proctored | NGN
Level 3 Questions and Verified Answers with Detailed
Rationale|
Section 1: Antepartum Assessment and Prenatal Care
Question 1
A nurse is performing an initial prenatal assessment on a client at 10 weeks of gestation.
Which of the following findings is a positive sign of pregnancy?
A) Amenorrhea
B) Chadwick's sign
C) Fetal heartbeat on Doppler
D) Nausea and breast tenderness
Correct Answer: C) Fetal heartbeat on Doppler
Detailed Rationale
Step 1: Understand the Categories of Pregnancy Signs
Pregnancy signs are classified into three categories: presumptive, probable, and positive.
Presumptive signs are subjective and can be caused by other conditions. Probable signs are
objective but can have other causes. Positive signs are definitive and can only be caused by
pregnancy .
Step 2: Classify Each Option
Option C is correct: Auscultation of a fetal heartbeat is a positive sign of pregnancy because
it can only be attributed to the presence of a fetus .
Option A is incorrect: Amenorrhea is a presumptive sign of pregnancy and can be caused by
stress, hormonal imbalances, or other medical conditions.
Option B is incorrect: Chadwick's sign (bluish discoloration of the cervix and vagina) is a
probable sign of pregnancy and can be caused by increased vascularity.
Option D is incorrect: Nausea and breast tenderness are presumptive signs and can be
caused by other conditions.
Step 3: Key Points for ATI
Positive signs: Fetal heartbeat on Doppler, ultrasound visualization of fetus, fetal movement
felt by examiner
Probable signs: Goodell's sign, Chadwick's sign, positive pregnancy test, Braxton-Hicks
contractions
,Presumptive signs: Amenorrhea, nausea, vomiting, breast changes, fatigue, urinary
frequency
Question 2
A nurse is calculating the estimated date of delivery (EDD) using Naegele's rule for a client
whose last menstrual period (LMP) was May 10. What is the EDD?
A) February 3
B) February 17
C) March 3
D) March 17
Correct Answer: B) February 17
Detailed Rationale
Step 1: Apply Naegele's Rule
Naegele's rule: subtract 3 months from the first day of the last menstrual period and add 7
days .
Step 2: Perform the Calculation
LMP: May 10
Subtract 3 months: May → February (May - 3 months = February)
Add 7 days: February 10 + 7 days = February 17
Step 3: Rationale for Each Option
Option B is correct: February 17 is the correct calculation.
Option A is incorrect: February 3 results from adding 3 days instead of 7.
Option C is incorrect: March 3 results from subtracting 2 months instead of 3.
Option D is incorrect: March 17 results from subtracting 2 months and adding 7 days.
Step 4: Clinical Considerations
Naegele's rule assumes a 28-day menstrual cycle
EDD should be adjusted for women with irregular cycles
Alternative method: add 280 days to the first day of LMP
Question 3
A nurse is teaching a client about the importance of folic acid during pregnancy. Which
statement by the client indicates understanding of the teaching?
A) "It prevents iron deficiency anemia."
B) "It reduces the risk of neural tube defects."
C) "It is only needed in the third trimester."
D) "It is found mainly in dairy products."
,Correct Answer: B) "It reduces the risk of neural tube defects."
Detailed Rationale
Step 1: Understand Folic Acid's Role
Folic acid (vitamin B9) is essential for fetal neural tube development, particularly in the first
trimester. Adequate folic acid intake before and during early pregnancy significantly reduces
the risk of neural tube defects such as spina bifida and anencephaly .
Step 2: Rationale for Each Option
Option B is correct: Folic acid reduces the risk of neural tube defects. Recommended daily
intake is 400-800 mcg daily during early pregnancy .
Option A is incorrect: Iron prevents iron deficiency anemia, not folic acid.
Option C is incorrect: Folic acid is most critical in the first trimester but recommended
throughout pregnancy.
Option D is incorrect: Folic acid is found in leafy green vegetables, citrus fruits, beans, and
fortified grains—not primarily dairy.
Step 3: Key Points
Neural tube closes by 28 days of gestation (before many women know they're pregnant)
All women of childbearing age should take folic acid supplementation
Women with a history of NTD-affected pregnancies require higher doses (4 mg daily)
Question 4
A nurse is assessing a client at 32 weeks of gestation during a routine prenatal appointment.
The nurse measures the fundal height at 26 cm. Which of the following should the nurse
suspect?
A) Multifetal gestation
B) Polyhydramnios
C) Intrauterine growth restriction
D) Macrosomia
Correct Answer: C) Intrauterine growth restriction
Detailed Rationale
Step 1: Understand Fundal Height Measurement
Fundal height in centimeters should correspond approximately to the gestational age in
weeks between 20 and 34 weeks (fundal height in cm = weeks of gestation ± 2 cm) .
Step 2: Interpret the Finding
At 32 weeks, expected fundal height range: 30-34 cm
, Measured fundal height: 26 cm (6 cm less than expected)
This significant discrepancy suggests the fetus may be small for gestational age or growth-
restricted.
Step 3: Rationale for Each Option
Option C is correct: Fundal height measuring 6 cm less than expected for gestational age
suggests intrauterine growth restriction .
Option A is incorrect: Multifetal gestation typically causes fundal height to measure larger
than expected.
Option B is incorrect: Polyhydramnios causes uterine size to measure larger than expected.
Option D is incorrect: Macrosomia would cause fundal height to measure larger than
expected.
Step 4: Nursing Actions
Assess for risk factors (smoking, hypertension, poor nutrition)
Notify provider for further evaluation (ultrasound, Doppler studies)
Monitor fetal movement and kick counts
Question 5
A nurse is providing teaching to a client about recommended weight gain during pregnancy.
The client has a pre-pregnancy BMI of 18.5. Which of the following weight gain ranges
should the nurse recommend?
A) 11.5 to 16 kg (25-35 lb)
B) 12.5 to 18 kg (28-40 lb)
C) 7 to 11.5 kg (15-25 lb)
D) 5 to 9 kg (11-20 lb)
Correct Answer: B) 12.5 to 18 kg (28-40 lb)
Detailed Rationale
Step 1: Understand BMI Classifications and Weight Gain Recommendations
BMI < 18.5 = Underweight: recommended gain 12.5-18 kg (28-40 lb)
BMI 18.5-24.9 = Normal: recommended gain 11.5-16 kg (25-35 lb)
BMI 25-29.9 = Overweight: recommended gain 7-11.5 kg (15-25 lb)
BMI ≥ 30 = Obese: recommended gain 5-9 kg (11-20 lb)
Step 2: Apply the Client's BMI
Client's BMI is 18.5, which falls in the underweight category
The recommended weight gain for underweight women is 12.5-18 kg (28-40 lb)
Step 3: Rationale for Each Option
Option B is correct: 12.5 to 18 kg (28-40 lb) is the recommended gain for underweight
women .
Level 3 Questions and Verified Answers with Detailed
Rationale|
Section 1: Antepartum Assessment and Prenatal Care
Question 1
A nurse is performing an initial prenatal assessment on a client at 10 weeks of gestation.
Which of the following findings is a positive sign of pregnancy?
A) Amenorrhea
B) Chadwick's sign
C) Fetal heartbeat on Doppler
D) Nausea and breast tenderness
Correct Answer: C) Fetal heartbeat on Doppler
Detailed Rationale
Step 1: Understand the Categories of Pregnancy Signs
Pregnancy signs are classified into three categories: presumptive, probable, and positive.
Presumptive signs are subjective and can be caused by other conditions. Probable signs are
objective but can have other causes. Positive signs are definitive and can only be caused by
pregnancy .
Step 2: Classify Each Option
Option C is correct: Auscultation of a fetal heartbeat is a positive sign of pregnancy because
it can only be attributed to the presence of a fetus .
Option A is incorrect: Amenorrhea is a presumptive sign of pregnancy and can be caused by
stress, hormonal imbalances, or other medical conditions.
Option B is incorrect: Chadwick's sign (bluish discoloration of the cervix and vagina) is a
probable sign of pregnancy and can be caused by increased vascularity.
Option D is incorrect: Nausea and breast tenderness are presumptive signs and can be
caused by other conditions.
Step 3: Key Points for ATI
Positive signs: Fetal heartbeat on Doppler, ultrasound visualization of fetus, fetal movement
felt by examiner
Probable signs: Goodell's sign, Chadwick's sign, positive pregnancy test, Braxton-Hicks
contractions
,Presumptive signs: Amenorrhea, nausea, vomiting, breast changes, fatigue, urinary
frequency
Question 2
A nurse is calculating the estimated date of delivery (EDD) using Naegele's rule for a client
whose last menstrual period (LMP) was May 10. What is the EDD?
A) February 3
B) February 17
C) March 3
D) March 17
Correct Answer: B) February 17
Detailed Rationale
Step 1: Apply Naegele's Rule
Naegele's rule: subtract 3 months from the first day of the last menstrual period and add 7
days .
Step 2: Perform the Calculation
LMP: May 10
Subtract 3 months: May → February (May - 3 months = February)
Add 7 days: February 10 + 7 days = February 17
Step 3: Rationale for Each Option
Option B is correct: February 17 is the correct calculation.
Option A is incorrect: February 3 results from adding 3 days instead of 7.
Option C is incorrect: March 3 results from subtracting 2 months instead of 3.
Option D is incorrect: March 17 results from subtracting 2 months and adding 7 days.
Step 4: Clinical Considerations
Naegele's rule assumes a 28-day menstrual cycle
EDD should be adjusted for women with irregular cycles
Alternative method: add 280 days to the first day of LMP
Question 3
A nurse is teaching a client about the importance of folic acid during pregnancy. Which
statement by the client indicates understanding of the teaching?
A) "It prevents iron deficiency anemia."
B) "It reduces the risk of neural tube defects."
C) "It is only needed in the third trimester."
D) "It is found mainly in dairy products."
,Correct Answer: B) "It reduces the risk of neural tube defects."
Detailed Rationale
Step 1: Understand Folic Acid's Role
Folic acid (vitamin B9) is essential for fetal neural tube development, particularly in the first
trimester. Adequate folic acid intake before and during early pregnancy significantly reduces
the risk of neural tube defects such as spina bifida and anencephaly .
Step 2: Rationale for Each Option
Option B is correct: Folic acid reduces the risk of neural tube defects. Recommended daily
intake is 400-800 mcg daily during early pregnancy .
Option A is incorrect: Iron prevents iron deficiency anemia, not folic acid.
Option C is incorrect: Folic acid is most critical in the first trimester but recommended
throughout pregnancy.
Option D is incorrect: Folic acid is found in leafy green vegetables, citrus fruits, beans, and
fortified grains—not primarily dairy.
Step 3: Key Points
Neural tube closes by 28 days of gestation (before many women know they're pregnant)
All women of childbearing age should take folic acid supplementation
Women with a history of NTD-affected pregnancies require higher doses (4 mg daily)
Question 4
A nurse is assessing a client at 32 weeks of gestation during a routine prenatal appointment.
The nurse measures the fundal height at 26 cm. Which of the following should the nurse
suspect?
A) Multifetal gestation
B) Polyhydramnios
C) Intrauterine growth restriction
D) Macrosomia
Correct Answer: C) Intrauterine growth restriction
Detailed Rationale
Step 1: Understand Fundal Height Measurement
Fundal height in centimeters should correspond approximately to the gestational age in
weeks between 20 and 34 weeks (fundal height in cm = weeks of gestation ± 2 cm) .
Step 2: Interpret the Finding
At 32 weeks, expected fundal height range: 30-34 cm
, Measured fundal height: 26 cm (6 cm less than expected)
This significant discrepancy suggests the fetus may be small for gestational age or growth-
restricted.
Step 3: Rationale for Each Option
Option C is correct: Fundal height measuring 6 cm less than expected for gestational age
suggests intrauterine growth restriction .
Option A is incorrect: Multifetal gestation typically causes fundal height to measure larger
than expected.
Option B is incorrect: Polyhydramnios causes uterine size to measure larger than expected.
Option D is incorrect: Macrosomia would cause fundal height to measure larger than
expected.
Step 4: Nursing Actions
Assess for risk factors (smoking, hypertension, poor nutrition)
Notify provider for further evaluation (ultrasound, Doppler studies)
Monitor fetal movement and kick counts
Question 5
A nurse is providing teaching to a client about recommended weight gain during pregnancy.
The client has a pre-pregnancy BMI of 18.5. Which of the following weight gain ranges
should the nurse recommend?
A) 11.5 to 16 kg (25-35 lb)
B) 12.5 to 18 kg (28-40 lb)
C) 7 to 11.5 kg (15-25 lb)
D) 5 to 9 kg (11-20 lb)
Correct Answer: B) 12.5 to 18 kg (28-40 lb)
Detailed Rationale
Step 1: Understand BMI Classifications and Weight Gain Recommendations
BMI < 18.5 = Underweight: recommended gain 12.5-18 kg (28-40 lb)
BMI 18.5-24.9 = Normal: recommended gain 11.5-16 kg (25-35 lb)
BMI 25-29.9 = Overweight: recommended gain 7-11.5 kg (15-25 lb)
BMI ≥ 30 = Obese: recommended gain 5-9 kg (11-20 lb)
Step 2: Apply the Client's BMI
Client's BMI is 18.5, which falls in the underweight category
The recommended weight gain for underweight women is 12.5-18 kg (28-40 lb)
Step 3: Rationale for Each Option
Option B is correct: 12.5 to 18 kg (28-40 lb) is the recommended gain for underweight
women .
