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ATI PROCTORED OB MATERNAL NEWBORN EXAM
LATEST VERSION QUESTIONS AND ANSWERS 2026
EDITION
ATI Proctored OB Maternal Newborn Exam: 250 Practice Questions with Rationales
DOMAIN 1: ANTEPARTUM NURSING CARE AND ASSESSMENT (25 Questions)
1. A nurse is assessing a client who missed two menstrual cycles and reports she
might be pregnant. Which of the following findings is a positive sign of pregnancy?
A) Quickening
B) Breast tenderness
C) Uterine enlargement
D) Auscultation of a fetal heart rate
Answer: D) Auscultation of a fetal heart rate
Rationale: The auscultation of a fetal heart rate is a positive (conclusive) sign of
pregnancy because it can only be attributed to the presence of a fetus. Quickening is a
presumptive sign, and breast tenderness and uterine enlargement are probable signs .
2. The Maternal Serum Alpha-Fetoprotein (MSAFP) test is performed at which
gestational age?
A) 8-10 weeks
B) 10-12 weeks
C) 16-18 weeks
D) 24-28 weeks
Answer: C) 16-18 weeks
Rationale: The Maternal Serum Alpha-Fetoprotein (MSAFP) screening is performed
between 16 and 18 weeks of gestation to detect neural tube defects. Elevated levels
may indicate neural tube defects, while low levels are associated with Down syndrome .
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3. A client asks the nurse about the difference between CVS and amniocentesis.
Which statement about bladder requirements is correct?
A) CVS requires a full bladder; amniocentesis requires an empty bladder
B) CVS requires an empty bladder; amniocentesis requires a full bladder
C) Both procedures require a full bladder
D) Both procedures require an empty bladder
Answer: A) CVS requires a full bladder; amniocentesis requires an empty bladder
Rationale: Chorionic villus sampling (CVS) is performed with a full bladder to help
visualize the uterus and guide the procedure. Amniocentesis requires an empty bladder
to reduce the risk of bladder puncture and to provide a clear path for the needle .
4. A nurse is assessing a pregnant client at 38 weeks gestation. The client reports
that breathing has become easier but notes increased frequency of urination. The
nurse should document this occurrence as which of the following?
A) Effacement
B) Dilation
C) Lightening
D) Quickening
Answer: C) Lightening
Rationale: Lightening describes the engagement of the fetal head into the pelvis. When
this occurs, the diaphragm is relieved of pressure, making breathing easier; however, the
presenting part puts pressure on the bladder, increasing urinary frequency .
5. The ratio of lecithin to sphingomyelin (L/S ratio) indicating fetal lung maturity is:
A) 1:1
B) 1.5:1
C) 2:1
D) 2.5:1
Answer: C) 2:1
Rationale: An L/S ratio of 2:1 indicates fetal lung maturity and a low risk of respiratory
distress syndrome. This test is performed on amniotic fluid to assess fetal lung
development .
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6. A nurse is caring for a client at 33 weeks gestation who has placenta previa and
bleeding. Which prescription should the nurse clarify with the provider?
A) Perform a vaginal examination
B) Perform continuous external fetal monitoring
C) Insert a large-bore IV catheter
D) Obtain a blood sample for laboratory testing
Answer: A) Perform a vaginal examination
Rationale: In placenta previa, the placenta implants in the lower part of the uterus and
obstructs the cervical os. Any manipulation, including a vaginal examination, can cause
tearing of the placenta and increased bleeding. A vaginal examination is
contraindicated .
7. Low levels of MSAFP are associated with which fetal condition?
A) Neural tube defects
B) Down syndrome
C) Anencephaly
D) Spina bifida
Answer: B) Down syndrome
Rationale: Low levels of maternal serum alpha-fetoprotein are associated with Down
syndrome (trisomy 21). Elevated levels are associated with neural tube defects such as
spina bifida and anencephaly .
8. Smoking tobacco during pregnancy is associated with which neonatal outcome?
A) Macrosomia
B) Low birth weight
C) Hyperbilirubinemia
D) Polycythemia
Answer: B) Low birth weight
Rationale: Smoking tobacco during pregnancy is associated with low birth weight due to
decreased placental perfusion and oxygen delivery to the fetus. Nicotine causes
vasoconstriction, reducing blood flow to the placenta .
9. A client at 12 weeks gestation asks the nurse about alcohol consumption during
pregnancy. Which response is most appropriate?
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A) "One drink per day is considered safe."
B) "Occasional wine with meals is acceptable."
C) "There is no known safe amount of alcohol during pregnancy."
D) "Alcohol is only harmful in the first trimester."
Answer: C) "There is no known safe amount of alcohol during pregnancy."
Rationale: There is no known safe amount of alcohol during pregnancy. Alcohol
consumption during pregnancy can cause fetal alcohol spectrum disorders, and
abstinence is recommended throughout pregnancy.
10. The recommended daily protein intake during pregnancy is approximately:
A) 45 grams
B) 60 grams
C) 71 grams
D) 85 grams
Answer: C) 71 grams
Rationale: The recommended daily protein intake during pregnancy is approximately 71
grams to support fetal growth and maternal tissue development .
DOMAIN 2: INTRAPARTUM AND LABOR MANAGEMENT (25 Questions)
11. A nurse is caring for a client who is in the second stage of labor. The nurse
observes retraction of the fetal head against the maternal perineum. The client is
most likely experiencing which of the following?
A) Shoulder dystocia
B) Normal labor progression (crowning)
C) Nuchal cord
D) Cephalopelvic disproportion
Answer: B) Normal labor progression (crowning)
Rationale: Crowning occurs when the fetal head is visible at the vaginal opening and
does not retract between contractions. This is a normal part of the second stage of
labor .
12. The first stage of labor pain is described as:
ATI PROCTORED OB MATERNAL NEWBORN EXAM
LATEST VERSION QUESTIONS AND ANSWERS 2026
EDITION
ATI Proctored OB Maternal Newborn Exam: 250 Practice Questions with Rationales
DOMAIN 1: ANTEPARTUM NURSING CARE AND ASSESSMENT (25 Questions)
1. A nurse is assessing a client who missed two menstrual cycles and reports she
might be pregnant. Which of the following findings is a positive sign of pregnancy?
A) Quickening
B) Breast tenderness
C) Uterine enlargement
D) Auscultation of a fetal heart rate
Answer: D) Auscultation of a fetal heart rate
Rationale: The auscultation of a fetal heart rate is a positive (conclusive) sign of
pregnancy because it can only be attributed to the presence of a fetus. Quickening is a
presumptive sign, and breast tenderness and uterine enlargement are probable signs .
2. The Maternal Serum Alpha-Fetoprotein (MSAFP) test is performed at which
gestational age?
A) 8-10 weeks
B) 10-12 weeks
C) 16-18 weeks
D) 24-28 weeks
Answer: C) 16-18 weeks
Rationale: The Maternal Serum Alpha-Fetoprotein (MSAFP) screening is performed
between 16 and 18 weeks of gestation to detect neural tube defects. Elevated levels
may indicate neural tube defects, while low levels are associated with Down syndrome .
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3. A client asks the nurse about the difference between CVS and amniocentesis.
Which statement about bladder requirements is correct?
A) CVS requires a full bladder; amniocentesis requires an empty bladder
B) CVS requires an empty bladder; amniocentesis requires a full bladder
C) Both procedures require a full bladder
D) Both procedures require an empty bladder
Answer: A) CVS requires a full bladder; amniocentesis requires an empty bladder
Rationale: Chorionic villus sampling (CVS) is performed with a full bladder to help
visualize the uterus and guide the procedure. Amniocentesis requires an empty bladder
to reduce the risk of bladder puncture and to provide a clear path for the needle .
4. A nurse is assessing a pregnant client at 38 weeks gestation. The client reports
that breathing has become easier but notes increased frequency of urination. The
nurse should document this occurrence as which of the following?
A) Effacement
B) Dilation
C) Lightening
D) Quickening
Answer: C) Lightening
Rationale: Lightening describes the engagement of the fetal head into the pelvis. When
this occurs, the diaphragm is relieved of pressure, making breathing easier; however, the
presenting part puts pressure on the bladder, increasing urinary frequency .
5. The ratio of lecithin to sphingomyelin (L/S ratio) indicating fetal lung maturity is:
A) 1:1
B) 1.5:1
C) 2:1
D) 2.5:1
Answer: C) 2:1
Rationale: An L/S ratio of 2:1 indicates fetal lung maturity and a low risk of respiratory
distress syndrome. This test is performed on amniotic fluid to assess fetal lung
development .
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6. A nurse is caring for a client at 33 weeks gestation who has placenta previa and
bleeding. Which prescription should the nurse clarify with the provider?
A) Perform a vaginal examination
B) Perform continuous external fetal monitoring
C) Insert a large-bore IV catheter
D) Obtain a blood sample for laboratory testing
Answer: A) Perform a vaginal examination
Rationale: In placenta previa, the placenta implants in the lower part of the uterus and
obstructs the cervical os. Any manipulation, including a vaginal examination, can cause
tearing of the placenta and increased bleeding. A vaginal examination is
contraindicated .
7. Low levels of MSAFP are associated with which fetal condition?
A) Neural tube defects
B) Down syndrome
C) Anencephaly
D) Spina bifida
Answer: B) Down syndrome
Rationale: Low levels of maternal serum alpha-fetoprotein are associated with Down
syndrome (trisomy 21). Elevated levels are associated with neural tube defects such as
spina bifida and anencephaly .
8. Smoking tobacco during pregnancy is associated with which neonatal outcome?
A) Macrosomia
B) Low birth weight
C) Hyperbilirubinemia
D) Polycythemia
Answer: B) Low birth weight
Rationale: Smoking tobacco during pregnancy is associated with low birth weight due to
decreased placental perfusion and oxygen delivery to the fetus. Nicotine causes
vasoconstriction, reducing blood flow to the placenta .
9. A client at 12 weeks gestation asks the nurse about alcohol consumption during
pregnancy. Which response is most appropriate?
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A) "One drink per day is considered safe."
B) "Occasional wine with meals is acceptable."
C) "There is no known safe amount of alcohol during pregnancy."
D) "Alcohol is only harmful in the first trimester."
Answer: C) "There is no known safe amount of alcohol during pregnancy."
Rationale: There is no known safe amount of alcohol during pregnancy. Alcohol
consumption during pregnancy can cause fetal alcohol spectrum disorders, and
abstinence is recommended throughout pregnancy.
10. The recommended daily protein intake during pregnancy is approximately:
A) 45 grams
B) 60 grams
C) 71 grams
D) 85 grams
Answer: C) 71 grams
Rationale: The recommended daily protein intake during pregnancy is approximately 71
grams to support fetal growth and maternal tissue development .
DOMAIN 2: INTRAPARTUM AND LABOR MANAGEMENT (25 Questions)
11. A nurse is caring for a client who is in the second stage of labor. The nurse
observes retraction of the fetal head against the maternal perineum. The client is
most likely experiencing which of the following?
A) Shoulder dystocia
B) Normal labor progression (crowning)
C) Nuchal cord
D) Cephalopelvic disproportion
Answer: B) Normal labor progression (crowning)
Rationale: Crowning occurs when the fetal head is visible at the vaginal opening and
does not retract between contractions. This is a normal part of the second stage of
labor .
12. The first stage of labor pain is described as:
