Maternal Newborn Nursing: ATI-Style Practice Questions
1–10: Antepartum Care
1. A nurse is providing prenatal teaching to a client in the first trimester. Which of the following
statements by the client indicates a need for further teaching?
A. “I will avoid hot tubs during pregnancy.”
B. “I will take 600 mcg of folic acid daily.”
C. “I should increase my calcium intake.”
D. “I can continue drinking a glass of wine with dinner.”
Answer: D
Rationale: Alcohol should be avoided entirely during pregnancy due to the risk of fetal alcohol
syndrome.
2. A client at 28 weeks gestation reports dizziness and lightheadedness when lying on her back.
What is the appropriate nursing action?
A. Encourage her to drink water
B. Turn her to a side-lying position
C. Administer oxygen
D. Check her reflexes
Answer: B
Rationale: Supine hypotensive syndrome is relieved by turning the client to her left side.
3. Which of the following lab findings should the nurse report for a pregnant client at 28 weeks?
A. Hemoglobin 11.0 g/dL
B. Platelets 250,000/mm³
C. WBC 16,000/mm³
D. Glucose 170 mg/dL after 1-hour glucose tolerance test
Answer: D
Rationale: A 1-hour glucose tolerance test result ≥140 mg/dL is abnormal and requires a 3-hour
GTT.
4. A pregnant client is Rh-negative and has just had an amniocentesis. Which of the following
medications should the nurse anticipate administering?
A. Rubella vaccine
B. Rho(D) immune globulin
C. Oxytocin
D. Magnesium sulfate
Answer: B
Rationale: Rho(D) immune globulin is given to Rh-negative clients after procedures that may
cause fetal blood to mix with maternal blood.
5. A nurse is caring for a client at 10 weeks gestation with severe nausea and vomiting. Which of
the following findings indicates hyperemesis gravidarum?
A. Weight loss of 1 lb
B. Urine ketones present
C. Normal electrolytes
D. BP 120/80 mmHg
Answer: B
Rationale: Presence of ketones indicates significant dehydration and malnutrition, a hallmark of
hyperemesis.
6. A nurse is teaching a client with gestational hypertension about warning signs of
preeclampsia. Which should she report immediately?
A. Headache
B. Fatigue
C. Increased fetal movement
D. Nausea
Answer: A
Rationale: Persistent headache is a sign of worsening preeclampsia and should be reported.
7. At 36 weeks gestation, which fetal position is ideal for birth?
A. Breech
B. Occiput anterior
C. Transverse
D. Shoulder
Answer: B
Rationale: Occiput anterior is the optimal fetal position for vaginal birth.
8. A nurse assesses a client with placenta previa. What is an expected finding?
A. Painful vaginal bleeding
B. Rigid abdomen
C. Painless vaginal bleeding
D. Absent fetal heart tones
Answer: C
Rationale: Placenta previa presents with painless vaginal bleeding in the third trimester.
9. Which of the following is a contraindication for using internal fetal monitoring?
A. Cervix dilated to 4 cm
B. HIV-positive client
C. Occasional variable decelerations
D. Active labor
Answer: B
Rationale: Internal monitoring is contraindicated in clients with active infections like HIV due
to risk of transmission.
10. A nurse is providing dietary teaching to a pregnant client with iron-deficiency anemia. Which
food should the nurse recommend?
A. Milk
B. Leafy greens
C. Applesauce
D. Orange juice only
Answer: B
Rationale: Leafy greens are rich in iron; vitamin C (like orange juice) helps absorb iron but
doesn't contain iron.
11–20: Intrapartum Care
11. A laboring client reports pressure and an urge to push. What should the nurse do first?
A. Encourage pushing
B. Check the cervix
C. Call the provider
D. Offer pain relief
Answer: B
Rationale: Cervical assessment is necessary to confirm complete dilation before pushing.
12. Which fetal heart pattern indicates late decelerations?
A. Drop in FHR before a contraction
B. Drop in FHR at the peak of a contraction
C. Drop after contraction begins and returns after it ends
D. Variable drop unrelated to contractions
Answer: C
Rationale: Late decelerations suggest uteroplacental insufficiency and require intervention.
13. What is the priority action for a cord prolapse?
A. Administer oxygen
B. Reposition the client
C. Prepare for cesarean
D. Elevate presenting part off cord
Answer: D
Rationale: Relieving pressure on the cord is the first life-saving step.
14. A nurse notes variable decelerations. What intervention is indicated?
A. Administer oxytocin
B. Turn the client
C. Prepare for cesarean
D. Increase IV fluids
Answer: B
Rationale: Repositioning often relieves cord compression causing variable decels.
15. During labor, the client is GBS positive. What intervention is essential?
A. Administer IV antibiotics during labor
B. Schedule an induction
C. Administer antibiotics postpartum
D. Avoid fetal monitoring
Answer: A
Rationale: IV antibiotics during labor reduce neonatal GBS infection risk.
16. A nurse is assessing a laboring client who is hyperventilating. What is the appropriate action?
A. Give oxygen
B. Have her breathe into a paper bag
C. Administer sedatives
D. Increase IV rate
Answer: B
Rationale: Rebreathing CO₂ helps correct respiratory alkalosis from hyperventilation.
17. Which of the following is a contraindication to induction with oxytocin?
A. Premature rupture of membranes
B. Positive group B strep
C. Active genital herpes
D. Post-term pregnancy
Answer: C
Rationale: Active genital herpes requires cesarean delivery to prevent neonatal infection.
18. A nurse is assessing uterine contractions in the latent phase. Which frequency is expected?
A. Every 10–15 minutes
B. Every 5–30 minutes
C. Every 2–3 minutes
D. Every minute
Answer: B
Rationale: Early labor contractions typically occur every 5–30 minutes.
19. Which pain management method requires the nurse to assess for maternal hypotension?
A. IV fentanyl
B. Epidural anesthesia
C. Pudendal block
D. Local perineal infiltration
Answer: B
Rationale: Epidurals can cause vasodilation and hypotension due to sympathetic blockade.
20. The fetus is in occiput posterior position. What complaint is most likely?
A. Sharp lower back pain
B. Chest pain
C. Perineal pressure
D. Right-sided abdominal pain
Answer: A
Rationale: Back labor is common with OP position due to pressure on the sacrum.
Maternal Newborn Nursing: ATI-Style Practice Questions
(Part 2)
21–35: Postpartum Care
21. A nurse is assessing a postpartum client’s fundus and notes it is boggy and deviated to the
right. What should the nurse do first?
A. Massage the fundus
B. Notify the provider
C. Check for bladder distention
D. Increase IV fluids
Answer: C
Rationale: A deviated fundus often indicates a full bladder. Have the client void, then reassess.
22. How often should the nurse assess the fundus during the first hour after delivery?
A. Every 30 minutes
B. Every 15 minutes
C. Every hour
D. Once per shift
Answer: B
Rationale: Fundal assessment is done every 15 minutes in the first hour postpartum to monitor
for hemorrhage.
23. Which finding is abnormal 24 hours postpartum?
A. Lochia rubra
B. Fundus firm and midline
C. Elevated WBC (15,000)
D. Pulse 120 bpm
Answer: D
Rationale: Tachycardia may indicate hemorrhage or infection.
24. A nurse notes perineal bruising and increasing pain in a postpartum client. Fundus is firm.
What should the nurse suspect?
A. Uterine atony
B. Endometritis
C. Perineal hematoma
D. Urinary retention
Answer: C
Rationale: Hematomas may present with pain and bruising even with a firm fundus.
25. What teaching should be included for a postpartum client with a 3rd-degree laceration?
A. Use a rectal thermometer
B. Apply ice packs for the first 24 hours
C. Begin sitz baths immediately
D. Use enemas daily
Answer: B
Rationale: Ice helps reduce swelling and pain initially. Sitz baths are started later.
26. A nurse is teaching about breastfeeding. Which hormone is responsible for milk ejection?
A. Estrogen
B. Prolactin
C. Progesterone
D. Oxytocin
Answer: D
Rationale: Oxytocin is responsible for the milk let-down reflex.
27. A client who delivered 5 hours ago saturates one pad in 15 minutes. What is the nurse’s first
action?
A. Document the finding
B. Increase IV oxytocin
C. Check fundus and massage
D. Reassure the client
Answer: C
Rationale: A firm fundus should stop excessive bleeding. Massage if boggy.
28. What is a priority teaching point for a postpartum client with mastitis?
A. Stop breastfeeding from affected breast
B. Apply cold compresses
C. Continue breastfeeding frequently
D. Limit fluid intake
Answer: C
Rationale: Frequent emptying of the breast helps resolve mastitis.
29. Which of the following is a risk factor for postpartum hemorrhage?
A. Labor less than 6 hours
B. Gravida 2, Para 0
C. Preeclampsia
D. Uterine atony
Answer: D
Rationale: Uterine atony is the most common cause of postpartum hemorrhage.
30. A nurse is teaching a postpartum client about signs of infection. Which symptom should be
reported?
A. Fatigue
B. Breast tenderness
C. Foul-smelling lochia
D. Mild cramping
Answer: C
Rationale: Foul odor is a sign of endometrial or uterine infection.
31. What is the priority assessment after administration of methylergonovine (Methergine)?
A. Deep tendon reflexes
B. Blood pressure
C. Urine output
D. Fundal height
Answer: B
Rationale: Methergine can cause hypertension. Monitor BP before administration.
32. A postpartum client is Rh-negative and the newborn is Rh-positive. What should the nurse
do?
A. Offer rubella vaccine
B. Administer Rho(D) immune globulin within 72 hours
C. Reassure client that no treatment is needed
D. Prepare for phototherapy
Answer: B
Rationale: Rho(D) immune globulin prevents maternal sensitization to fetal Rh-positive blood.
33. A client is 2 days postpartum and reports “feeling sad.” What is the nurse’s best response?
A. “This may be postpartum depression.”
B. “This is common and called the baby blues.”
C. “Let’s start an antidepressant.”
D. “You should not feel this way.”
Answer: B
Rationale: Mild mood swings or “baby blues” are normal in the first 2 weeks postpartum.
34. A nurse teaches a client how to prevent postpartum thrombophlebitis. Which instruction is
appropriate?
A. Massage legs daily
B. Stay on bedrest
C. Ambulate frequently
D. Apply ice packs to calves
Answer: C
Rationale: Early ambulation promotes circulation and reduces clot risk.
35. A nurse is assessing bonding between a mother and her newborn. Which behavior suggests a
positive bond?
A. Refers to the baby as “it”
B. Avoids eye contact
C. Smiles and talks to the baby
D. Hands baby to nurse after feeding
Answer: C
Rationale: Verbal interaction and affection are signs of positive bonding.
36–50: Newborn Care
36. A newborn’s axillary temperature is 96.5°F (35.8°C). What should the nurse do?
A. Call the provider
B. Reassess in 1 hour
C. Wrap the baby in blankets and place skin-to-skin
D. Bathe the baby
Answer: C
Rationale: Hypothermia should be treated with skin-to-skin and warming measures.
37. Which of the following is an expected finding in a newborn 2 hours after birth?
A. Central cyanosis
B. Heart rate 90 bpm
C. Acrocyanosis
D. Grunting
Answer: C
Rationale: Acrocyanosis is normal in the immediate newborn period.
38. What is the priority action after birth?
A. Weigh the newborn
B. Administer vitamin K
C. Dry and stimulate the newborn
D. Apply ID bands
Answer: C
Rationale: Drying and stimulating the newborn prevents heat loss and supports transition.
39. Which reflex causes the newborn to turn their head toward a cheek that is stroked?
A. Moro
B. Babinski
C. Rooting
D. Stepping
Answer: C
Rationale: The rooting reflex helps the baby locate the breast or bottle for feeding.
40. A nurse is caring for a newborn with a large cephalhematoma. Which is a potential
complication?
A. Hyperglycemia
B. Hyperbilirubinemia
C. Hypotension
D. Hypoxia
Answer: B
Rationale: Breakdown of RBCs in a cephalhematoma increases bilirubin levels.
41. A nurse is teaching about umbilical cord care. Which statement requires correction?
A. “I will fold the diaper below the cord.”
B. “I will keep the cord dry.”
C. “I can use alcohol to clean the cord.”
D. “I’ll remove the cord clamp at home in 3 days.”
Answer: D
Rationale: The clamp is removed by the provider; not at home.
42. A newborn receives an Apgar score of 4 at 1 minute. What is the priority intervention?
A. Suction the mouth
B. Provide stimulation
C. Begin resuscitation
D. Administer oxygen via mask
Answer: C
Rationale: Apgar 4 indicates need for immediate resuscitative efforts.
43. Which finding in a newborn is abnormal?
A. Irregular respirations
B. Nasal flaring
C. Positive Babinski
D. Two fontanels
Answer: B
Rationale: Nasal flaring is a sign of respiratory distress.
44. When should the hepatitis B vaccine be given to a healthy newborn?
A. Immediately after birth
B. Within 12 hours of birth
C. After the first feeding
D. At 2 months
Answer: B
Rationale: The first dose is given within 12 hours of birth.
45. Which lab finding should the nurse report for a newborn?
A. Glucose 45 mg/dL
B. Hematocrit 60%
C. Bilirubin 18 mg/dL at 36 hours
D. WBC 22,000/mm³
Answer: C
Rationale: Bilirubin above 15 mg/dL in the first 48 hours is concerning for jaundice.
46. How often should a newborn be breastfed?
A. Every 6 hours
B. Every 3–4 hours
C. Every 1–2 hours
D. On demand, at least every 2–3 hours
Answer: D
Rationale: Frequent feeding supports hydration, glucose regulation, and milk production.
47. A nurse observes a new parent feeding their baby formula and propping the bottle. What
should the nurse do?
A. Praise the technique
B. Remove the bottle and explain risks
C. Offer a pacifier
D. Document feeding behavior
Answer: B
Rationale: Bottle propping is unsafe due to aspiration risk.
48. A nurse is teaching about safe sleep. Which statement indicates correct understanding?
A. “My baby will sleep on her stomach.”
B. “I’ll place stuffed toys in the crib.”
C. “I’ll place my baby on her back.”
D. “I’ll co-sleep in the same bed.”
Answer: C
Rationale: Supine sleep reduces risk of sudden infant death syndrome (SIDS).
49. A term newborn has a respiratory rate of 70/min with nasal flaring. What action is indicated?
A. Reassess in 4 hours
B. Prepare for immediate feeding
C. Notify the provider
D. Suction the nose
Answer: C
Rationale: RR >60 with flaring indicates distress and requires provider evaluation.
50. When is the newborn metabolic screen ideally performed?
A. Immediately after birth
B. Before discharge
C. After 24 hours of age
D. Within 1 hour of feeding
Answer: C
Rationale: The newborn screen is most accurate after 24 hours of feeding.
🔍 Fetal Accelerations & Variability – 20 ATI-Style
Questions with Rationales
1.
A nurse observes an FHR tracing with moderate variability. What does this finding indicate?
A. Fetal sleep cycle
B. Normal oxygenation
C. Fetal hypoxia
D. Maternal hypotension
Answer: B. Normal oxygenation
Rationale: Moderate variability (6–25 bpm) is a reassuring sign that indicates adequate
oxygenation and a well-oxygenated central nervous system.
2.
A client’s NST reveals accelerations of 15 bpm lasting 15 seconds after fetal movement. What
should the nurse do next?
A. Prepare for delivery
B. Administer oxygen
C. Document findings
D. Notify the provider immediately
Answer: C. Document findings
Rationale: This is a reactive NST, which is reassuring. No further intervention is needed beyond
documentation.
3.
Which of the following defines a fetal heart rate acceleration in a term fetus?
A. 5 bpm increase lasting 5 seconds
B. 10 bpm increase lasting 10 seconds
C. 15 bpm increase lasting 15 seconds
D. 25 bpm increase lasting 30 seconds
Answer: C. 15 bpm increase lasting 15 seconds
Rationale: An acceleration is defined as an increase of at least 15 bpm above baseline for at
least 15 seconds in fetuses ≥32 weeks.
4.
Which of the following findings is the most reassuring on an FHR strip?
A. Absent variability
B. Minimal variability
C. Moderate variability
D. Marked variability
Answer: C. Moderate variability
Rationale: Moderate variability reflects a normal, functioning autonomic nervous system and
oxygenation.
5.
A nurse notes minimal variability in the FHR tracing. What is the best initial action?
A. Call the provider
B. Turn off oxytocin and reposition the client
C. Increase IV fluids and begin pushing
D. Perform amnioinfusion
Answer: B. Turn off oxytocin and reposition the client
Rationale: The nurse should take steps to improve uterine perfusion and oxygenation, such as
turning off oxytocin and repositioning the client.
6.
An FHR tracing shows absent variability with no accelerations. What does this indicate?
A. Fetal well-being
B. Maternal dehydration
C. Fetal distress
D. Active labor
Answer: C. Fetal distress
Rationale: Absent variability without accelerations is a non-reassuring pattern that may indicate
hypoxia or acidosis.
7.
A nurse is reviewing FHR patterns. Which pattern indicates temporary fetal well-being?
A. Late decelerations
B. Accelerations
C. Variable decelerations
D. Sinusoidal pattern
Answer: B. Accelerations
Rationale: Accelerations are a reassuring sign of fetal movement and adequate oxygenation.
8.
What action should a nurse take for marked variability in the FHR tracing?
A. Administer terbutaline
B. Discontinue labor induction agents
C. Encourage the client to ambulate
D. Begin immediate delivery
Answer: B. Discontinue labor induction agents
Rationale: Marked variability may indicate fetal stress or stimulation; reducing stimulation (e.g.,
stopping oxytocin) can help normalize the FHR.
9.
Which of the following is the expected fetal heart rate variability in a healthy term fetus?
A. 1–5 bpm
B. 6–25 bpm
C. 26–30 bpm
D. >30 bpm
Answer: B. 6–25 bpm
Rationale: This is considered moderate variability and reflects good fetal oxygenation and
neurological function.
10.
A nurse notes an FHR baseline of 140 bpm with minimal variability and no accelerations. What
is the most likely cause?
A. Fetal hypoxia
B. Fetal sleep cycle
C. Normal variation
D. Uterine rupture
Answer: B. Fetal sleep cycle
Rationale: Fetal sleep cycles may cause minimal variability and absence of accelerations
temporarily. Continue monitoring unless it persists beyond 40 minutes.
11.
Which of the following describes an abnormal variability pattern?
A. Moderate
B. Minimal
C. Absent
D. Marked
Answer: C. Absent
Rationale: Absent variability is considered abnormal and is a potential sign of fetal compromise.
12.
The nurse observes accelerations following fetal scalp stimulation. This indicates:
A. Fetal acidosis
B. Fetal hypoxia
C. Fetal well-being
D. Need for immediate delivery
Answer: C. Fetal well-being
Rationale: Accelerations in response to stimulation are reassuring and suggest normal fetal pH
and oxygenation.
13.
A nurse is interpreting an FHR tracing with minimal variability and recurrent late
decelerations. What should be done first?
A. Reposition the client and administer oxygen
B. Perform an amniotomy
C. Begin pushing
D. Decrease IV fluids
Answer: A. Reposition the client and administer oxygen
Rationale: These are signs of fetal compromise. Increasing oxygen and uteroplacental perfusion
is the priority.
14.
Which condition is least likely to cause decreased FHR variability?
A. Fetal hypoxia
B. Magnesium sulfate administration
C. Fetal sleep
D. Maternal infection
Answer: D. Maternal infection
Rationale: Maternal infection more commonly causes fetal tachycardia. It’s not typically a cause
of decreased variability.
15.
A nurse is assessing a non-stress test. What indicates a reactive result?
A. Two accelerations in 20 minutes
B. No accelerations in 40 minutes
C. Early decelerations present
D. Moderate variability with bradycardia
Answer: A. Two accelerations in 20 minutes
Rationale: A reactive NST has at least two accelerations (15 bpm x 15 seconds) in 20 minutes.
16.
Which FHR finding is a normal response to contractions in a healthy fetus?
A. Accelerations
B. Late decelerations
C. Sinusoidal pattern
D. Minimal variability
Answer: A. Accelerations
Rationale: Accelerations indicate fetal responsiveness and a healthy oxygenation status.
17.
What is the significance of marked variability (>25 bpm)?
A. Normal fetal response
B. Indicative of fetal sleep
C. Sign of fetal hypoxia or cord compression
D. Related to epidural use
Answer: C. Sign of fetal hypoxia or cord compression
Rationale: Marked variability may reflect acute hypoxia or stimulation; requires close
monitoring.
18.
Which of the following would NOT typically cause minimal variability?
A. Narcotic use
B. Magnesium sulfate
C. Fetal hypoxia
D. Terbutaline
Answer: D. Terbutaline
Rationale: Terbutaline is a beta-agonist used to stop contractions and does not reduce variability
significantly.
19.
An NST shows no accelerations after 40 minutes despite maternal repositioning. What is the
nurse’s next action?
A. Prepare for cesarean section
B. Continue monitoring for 2 hours
C. Notify the provider for further testing
D. Perform amniotomy
Answer: C. Notify the provider for further testing
Rationale: A non-reactive NST after 40 minutes requires follow-up testing such as a biophysical
profile or contraction stress test.
20.
A nurse observes absent variability and a baseline FHR of 100 bpm. What is the priority nursing
intervention?
A. Begin pushing
B. Reposition the client and apply oxygen
C. Give IV fluids and continue monitoring
D. Document as a reassuring pattern
Answer: B. Reposition the client and apply oxygen
Rationale: Absent variability and bradycardia are non-reassuring; increasing oxygenation is the
priority.