ATI Maternal Newborn Final Exam Version 1 Practice 2026 |Questions
|Answers |Rationales
1. A nurse is assessing a client who is at 34 weeks of gestation and has a
prescription for magnesium sulfate to treat preeclampsia. Which of the
following findings should the nurse identify as an indication of magnesium
toxicity?
A. Blood pressure 150/98 mmHg
B. Urinary output 40 mL/hr
C. Deep tendon reflexes 2+
D. Respiratory rate 10/min
Answer: D
Rationale: Magnesium toxicity is characterized by a respiratory rate of less than 12/min,
loss of deep tendon reflexes, and urinary output less than 30 mL/hr.
2. A nurse is caring for a client who is in the first stage of labor and has an
umbilical cord prolapse. Which of the following actions should the nurse take
first?
A. Administer oxygen via nonrebreather mask
B. Prepare the client for an immediate cesarean birth
C. Apply sterile saline-soaked gauze to the cord
D. Place the client in a knee-chest or Trendelenburg position
Answer: D
Rationale: The priority action when an umbilical cord prolapse is identified is to relieve
pressure on the cord by positioning the client to allow gravity to move the fetus away from
the pelvis.
,3. A nurse is teaching a client about the use of a diaphragm for contraception.
Which of the following instructions should the nurse include?
A. Apply spermicide to the rim before insertion
B. Remove the diaphragm 1 hr after intercourse
C. Replace the diaphragm every 5 years
D. The diaphragm is effective if weight changes by 2 kg (4.4 lb)
Answer: A
Rationale: Spermicide should be applied to the rim and the dome of the diaphragm. It must
stay in place for at least 6 hours after intercourse and should be replaced every 2 years or
after significant weight changes.
4. A nurse is reviewing the medical record of a client who is at 39 weeks of
gestation and has a prescription for oxytocin. Which of the following conditions
is a contraindication for oxytocin administration?
A. Active herpes simplex lesion
B. Preeclampsia
C. Post-term pregnancy
D. Prolonged rupture of membranes
Answer: A
Rationale: Active genital herpes is a contraindication for vaginal delivery and therefore for
the induction of labor with oxytocin, as it necessitates a cesarean birth to prevent neonatal
infection.
, 5. A nurse is assessing a newborn 2 hr after birth. Which of the following
findings should the nurse report to the provider?
A. Acrocyanosis of the hands and feet
B. Generalized petechiae on the trunk
C. Milia on the bridge of the nose
D. Overlapping cranial sutures
Answer: B
Rationale: Generalized petechiae can indicate a clotting factor deficiency or infection and
should be reported. Acrocyanosis, milia, and overlapping sutures are normal newborn
findings.
6. Using Naegele’s rule, what is the estimated date of delivery (EDD) for a client
whose last menstrual period (LMP) began on May 4th?
A. February 4th
B. February 11th
C. January 28th
D. February 14th
Answer: B
Rationale: To calculate the EDD using Naegele’s rule, subtract 3 months from the LMP and
add 7 days (May 4 - 3 months = February 4 + 7 days = February 11).
7. A nurse is caring for a client who is 2 hr postpartum and has a boggy fundus
that is displaced to the right. Which of the following actions should the nurse
take?
A. Assist the client to the bathroom to void
B. Massage the fundus until firm
C. Administer oxytocin IV
D. Notify the provider immediately
Answer: A
|Answers |Rationales
1. A nurse is assessing a client who is at 34 weeks of gestation and has a
prescription for magnesium sulfate to treat preeclampsia. Which of the
following findings should the nurse identify as an indication of magnesium
toxicity?
A. Blood pressure 150/98 mmHg
B. Urinary output 40 mL/hr
C. Deep tendon reflexes 2+
D. Respiratory rate 10/min
Answer: D
Rationale: Magnesium toxicity is characterized by a respiratory rate of less than 12/min,
loss of deep tendon reflexes, and urinary output less than 30 mL/hr.
2. A nurse is caring for a client who is in the first stage of labor and has an
umbilical cord prolapse. Which of the following actions should the nurse take
first?
A. Administer oxygen via nonrebreather mask
B. Prepare the client for an immediate cesarean birth
C. Apply sterile saline-soaked gauze to the cord
D. Place the client in a knee-chest or Trendelenburg position
Answer: D
Rationale: The priority action when an umbilical cord prolapse is identified is to relieve
pressure on the cord by positioning the client to allow gravity to move the fetus away from
the pelvis.
,3. A nurse is teaching a client about the use of a diaphragm for contraception.
Which of the following instructions should the nurse include?
A. Apply spermicide to the rim before insertion
B. Remove the diaphragm 1 hr after intercourse
C. Replace the diaphragm every 5 years
D. The diaphragm is effective if weight changes by 2 kg (4.4 lb)
Answer: A
Rationale: Spermicide should be applied to the rim and the dome of the diaphragm. It must
stay in place for at least 6 hours after intercourse and should be replaced every 2 years or
after significant weight changes.
4. A nurse is reviewing the medical record of a client who is at 39 weeks of
gestation and has a prescription for oxytocin. Which of the following conditions
is a contraindication for oxytocin administration?
A. Active herpes simplex lesion
B. Preeclampsia
C. Post-term pregnancy
D. Prolonged rupture of membranes
Answer: A
Rationale: Active genital herpes is a contraindication for vaginal delivery and therefore for
the induction of labor with oxytocin, as it necessitates a cesarean birth to prevent neonatal
infection.
, 5. A nurse is assessing a newborn 2 hr after birth. Which of the following
findings should the nurse report to the provider?
A. Acrocyanosis of the hands and feet
B. Generalized petechiae on the trunk
C. Milia on the bridge of the nose
D. Overlapping cranial sutures
Answer: B
Rationale: Generalized petechiae can indicate a clotting factor deficiency or infection and
should be reported. Acrocyanosis, milia, and overlapping sutures are normal newborn
findings.
6. Using Naegele’s rule, what is the estimated date of delivery (EDD) for a client
whose last menstrual period (LMP) began on May 4th?
A. February 4th
B. February 11th
C. January 28th
D. February 14th
Answer: B
Rationale: To calculate the EDD using Naegele’s rule, subtract 3 months from the LMP and
add 7 days (May 4 - 3 months = February 4 + 7 days = February 11).
7. A nurse is caring for a client who is 2 hr postpartum and has a boggy fundus
that is displaced to the right. Which of the following actions should the nurse
take?
A. Assist the client to the bathroom to void
B. Massage the fundus until firm
C. Administer oxytocin IV
D. Notify the provider immediately
Answer: A
