ATI Maternal-Newborn Nursing
Comprehensive Exam Review 2025–
2026
1. A nurse is assessing a client who is 38 weeks gestation and reports a sudden gush of fluid.
Which action should the nurse take first?
A) Check the fetal heart rate
B) Perform a sterile vaginal exam
C) Test the fluid with nitrazine paper
D) Notify the provider
Answer: A
Rationale: The first action is to check the fetal heart rate to assess fetal well-being. A sterile
vaginal exam is avoided until cord prolapse is ruled out.
2. A nurse is caring for a client who is 1 day postpartum and reports perineal pain. Which
action should the nurse take?
A) Apply a warm compress to the perineum
B) Apply an ice pack to the perineum
C) Encourage the client to sit for long periods
D) Administer a stool softener
Answer: B
Rationale: Ice packs are applied during the first 24 hours postpartum to reduce swelling and
pain.
3. A nurse is caring for a client who is in the active phase of labor. Which finding should the
nurse report immediately?
,A) Contractions every 3 minutes lasting 60 seconds
B) Fetal heart rate of 110 beats/min with late decelerations
C) Maternal blood pressure of 118/72 mm Hg
D) Cervical dilation of 4 cm
Answer: B
Rationale: Late decelerations with a fetal heart rate of 110 beats/min indicate
uteroplacental insufficiency and require immediate intervention.
4. A nurse is caring for a client who is receiving oxytocin for labor induction. Which finding
requires immediate intervention?
A) Contractions every 2 minutes lasting 60 seconds
B) Contractions every 1 minute lasting 90 seconds
C) Fetal heart rate of 140 beats/min
D) Maternal blood pressure of 120/80 mm Hg
Answer: B
Rationale: Contractions every 1 minute lasting 90 seconds indicate uterine hyperstimulation.
The oxytocin should be stopped and the provider notified.
5. A nurse is caring for a client who is 2 hours postpartum and has a boggy uterus. Which
action should the nurse take first?
A) Massage the fundus
B) Administer oxytocin
C) Encourage the client to void
D) Notify the provider
Answer: A
Rationale: A boggy uterus indicates uterine atony. The first action is to massage the fundus
to stimulate contraction.
6. A nurse is caring for a client who is in the first stage of labor and requests an epidural.
Which finding should the nurse report before the epidural is placed?
A) Platelet count of 80,000/mm³
B) Blood pressure of 118/72 mm Hg
C) Cervical dilation of 4 cm
D) Fetal heart rate of 140 beats/min
,Answer: A
Rationale: A platelet count below 100,000/mm³ increases the risk of bleeding with epidural
placement.
7. A nurse is caring for a client who is 3 days postpartum and reports breast engorgement.
Which action should the nurse take?
A) Apply warm compresses before feeding
B) Apply cold compresses after feeding
C) Wear a tight bra
D) Restrict fluid intake
Answer: A
Rationale: Warm compresses before feeding promote milk let-down. Cold compresses after
feeding reduce swelling.
8. A nurse is caring for a client who is 1 day postpartum and has a deep vein thrombosis.
Which action should the nurse take?
A) Massage the affected leg
B) Apply warm compresses
C) Administer anticoagulants as prescribed
D) Encourage ambulation
Answer: C
Rationale: Anticoagulants are administered as prescribed for DVT. Massaging the leg can
dislodge the clot.
9. A nurse is caring for a client who is 4 weeks postpartum and reports feeling sad and crying
frequently. Which action should the nurse take?
A) Reassure the client that this is normal
B) Screen the client for postpartum depression
C) Recommend the client stop breastfeeding
D) Tell the client to get more sleep
Answer: B
Rationale: Persistent sadness and crying at 4 weeks postpartum may indicate postpartum
depression. The nurse should screen the client.
, 10. A nurse is caring for a client who is 36 weeks gestation and has preeclampsia. Which
finding indicates worsening condition?
A) Blood pressure of 150/100 mm Hg
B) Blood pressure of 118/72 mm Hg
C) 1+ proteinuria
D) Mild ankle edema
Answer: A
Rationale: A blood pressure of 150/100 mm Hg indicates worsening preeclampsia.
11. A nurse is caring for a client who is 1 day postpartum and has a temperature of 100.4°F.
Which action should the nurse take?
A) Notify the provider immediately
B) Encourage increased fluid intake
C) Administer an antipyretic
D) Document the finding and reassess in 4 hours
Answer: B
Rationale: A low-grade temperature in the first 24 hours postpartum may be due to
dehydration. The nurse should encourage fluids and reassess.
12. A nurse is caring for a client who is 2 days postpartum and reports afterpains. Which
action should the nurse take?
A) Administer analgesics as prescribed
B) Apply a warm compress to the abdomen
C) Encourage the client to ambulate
D) Restrict fluid intake
Answer: A
Rationale: Afterpains are treated with analgesics as prescribed.
13. A nurse is caring for a client who is 1 day postpartum and has a distended bladder. Which
action should the nurse take?
A) Encourage the client to void
B) Catheterize the client
C) Administer a diuretic
D) Restrict fluid intake
Comprehensive Exam Review 2025–
2026
1. A nurse is assessing a client who is 38 weeks gestation and reports a sudden gush of fluid.
Which action should the nurse take first?
A) Check the fetal heart rate
B) Perform a sterile vaginal exam
C) Test the fluid with nitrazine paper
D) Notify the provider
Answer: A
Rationale: The first action is to check the fetal heart rate to assess fetal well-being. A sterile
vaginal exam is avoided until cord prolapse is ruled out.
2. A nurse is caring for a client who is 1 day postpartum and reports perineal pain. Which
action should the nurse take?
A) Apply a warm compress to the perineum
B) Apply an ice pack to the perineum
C) Encourage the client to sit for long periods
D) Administer a stool softener
Answer: B
Rationale: Ice packs are applied during the first 24 hours postpartum to reduce swelling and
pain.
3. A nurse is caring for a client who is in the active phase of labor. Which finding should the
nurse report immediately?
,A) Contractions every 3 minutes lasting 60 seconds
B) Fetal heart rate of 110 beats/min with late decelerations
C) Maternal blood pressure of 118/72 mm Hg
D) Cervical dilation of 4 cm
Answer: B
Rationale: Late decelerations with a fetal heart rate of 110 beats/min indicate
uteroplacental insufficiency and require immediate intervention.
4. A nurse is caring for a client who is receiving oxytocin for labor induction. Which finding
requires immediate intervention?
A) Contractions every 2 minutes lasting 60 seconds
B) Contractions every 1 minute lasting 90 seconds
C) Fetal heart rate of 140 beats/min
D) Maternal blood pressure of 120/80 mm Hg
Answer: B
Rationale: Contractions every 1 minute lasting 90 seconds indicate uterine hyperstimulation.
The oxytocin should be stopped and the provider notified.
5. A nurse is caring for a client who is 2 hours postpartum and has a boggy uterus. Which
action should the nurse take first?
A) Massage the fundus
B) Administer oxytocin
C) Encourage the client to void
D) Notify the provider
Answer: A
Rationale: A boggy uterus indicates uterine atony. The first action is to massage the fundus
to stimulate contraction.
6. A nurse is caring for a client who is in the first stage of labor and requests an epidural.
Which finding should the nurse report before the epidural is placed?
A) Platelet count of 80,000/mm³
B) Blood pressure of 118/72 mm Hg
C) Cervical dilation of 4 cm
D) Fetal heart rate of 140 beats/min
,Answer: A
Rationale: A platelet count below 100,000/mm³ increases the risk of bleeding with epidural
placement.
7. A nurse is caring for a client who is 3 days postpartum and reports breast engorgement.
Which action should the nurse take?
A) Apply warm compresses before feeding
B) Apply cold compresses after feeding
C) Wear a tight bra
D) Restrict fluid intake
Answer: A
Rationale: Warm compresses before feeding promote milk let-down. Cold compresses after
feeding reduce swelling.
8. A nurse is caring for a client who is 1 day postpartum and has a deep vein thrombosis.
Which action should the nurse take?
A) Massage the affected leg
B) Apply warm compresses
C) Administer anticoagulants as prescribed
D) Encourage ambulation
Answer: C
Rationale: Anticoagulants are administered as prescribed for DVT. Massaging the leg can
dislodge the clot.
9. A nurse is caring for a client who is 4 weeks postpartum and reports feeling sad and crying
frequently. Which action should the nurse take?
A) Reassure the client that this is normal
B) Screen the client for postpartum depression
C) Recommend the client stop breastfeeding
D) Tell the client to get more sleep
Answer: B
Rationale: Persistent sadness and crying at 4 weeks postpartum may indicate postpartum
depression. The nurse should screen the client.
, 10. A nurse is caring for a client who is 36 weeks gestation and has preeclampsia. Which
finding indicates worsening condition?
A) Blood pressure of 150/100 mm Hg
B) Blood pressure of 118/72 mm Hg
C) 1+ proteinuria
D) Mild ankle edema
Answer: A
Rationale: A blood pressure of 150/100 mm Hg indicates worsening preeclampsia.
11. A nurse is caring for a client who is 1 day postpartum and has a temperature of 100.4°F.
Which action should the nurse take?
A) Notify the provider immediately
B) Encourage increased fluid intake
C) Administer an antipyretic
D) Document the finding and reassess in 4 hours
Answer: B
Rationale: A low-grade temperature in the first 24 hours postpartum may be due to
dehydration. The nurse should encourage fluids and reassess.
12. A nurse is caring for a client who is 2 days postpartum and reports afterpains. Which
action should the nurse take?
A) Administer analgesics as prescribed
B) Apply a warm compress to the abdomen
C) Encourage the client to ambulate
D) Restrict fluid intake
Answer: A
Rationale: Afterpains are treated with analgesics as prescribed.
13. A nurse is caring for a client who is 1 day postpartum and has a distended bladder. Which
action should the nurse take?
A) Encourage the client to void
B) Catheterize the client
C) Administer a diuretic
D) Restrict fluid intake
