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ATI RN MATERNAL NEWBORN PROCTORED EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2025 Q&A | INSTANT DOWNLOAD PDF
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According to the ABCs and neonatal resuscitation guidelines, drying the newborn stimulates breathing and helps prevent heat loss.
A tight-fitting bra supports the breasts and reduces stimulation, aiding in suppression. 11.A nurse is caring for a newborn receiving phototherapy. Which of the following findings should the nurse report? a. Bronze-colored skin b. Skin rash c. Loose green stools d. Increased urination A rash could indicate a sensitivity or reaction and should be reported. 12.A nurse is assessing a newborn. Which of the following findings should the nurse report to the provider? a. Positive Babinski reflex b. Two vessels in the umbilical cord c. Nasal flaring d. Acrocyanosis Nasal flaring can indicate respiratory distress in a newborn. 13.A nurse is teaching a group of pregnant clients about expected changes during pregnancy. Which of the following statements should the nurse include?
16.A nurse is monitoring a newborn after circumcision. Which of the following findings requires immediate intervention? a. Small amount of yellow exudate b. Spot of blood on diaper c. Active bleeding d. Crying during diaper change Active bleeding is not expected and requires immediate action. 17.A nurse is assessing a pregnant client for signs of preeclampsia. Which of the following findings should the nurse report? a. Mild pedal edema b. Frequent urination c. Proteinuria d. Supine hypotension Proteinuria is a hallmark sign of preeclampsia and should be reported. 18.A nurse is reviewing lab results for a postpartum client who is Rh-negative and just delivered an Rh-positive newborn. Which of the following actions should the nurse take? a. Administer rubella vaccine b. Administer Rho(D) immune globulin c. Begin iron supplements d. Document blood type only
RhoGAM is necessary to prevent isoimmunization in future pregnancies. 19.A nurse is caring for a client in labor who is receiving oxytocin. Which of the following findings requires immediate intervention? a. Contractions lasting 60 seconds b. Contractions occurring every 1 minute c. Moderate variability d. Cervical dilation Too frequent contractions can lead to uterine hyperstimulation and fetal compromise. 20.A nurse is caring for a newborn with a suspected tracheoesophageal fistula. Which of the following findings supports this diagnosis? a. Meconium passage within 24 hours b. Excessive oral secretions c. Pink-tinged urine d. Soft abdomen Excessive oral secretions and choking indicate TEF. 21.A nurse is caring for a newborn who is small for gestational age (SGA). Which of the following complications should the nurse monitor for? a. Hypercalcemia b. Hypoglycemia
24.A nurse is assessing a newborn who is 6 hours old. Which of the following findings should the nurse report? a. Positive Moro reflex b. Respiratory rate of 50/min c. Sternal retractions d. Acrocyanosis Sternal retractions suggest respiratory distress and require immediate action. 25.A nurse is performing Leopold maneuvers. Which of the following fetal positions is indicated if the nurse palpates a hard, round, moveable part in the fundus? a. Breech presentation b. Cephalic presentation c. Transverse lie d. Posterior position The head is hard and round and indicates a cephalic (head-down) presentation. 26.A nurse is assessing a newborn for signs of cold stress. Which of the following findings should the nurse expect? a. Bradycardia b. Hypoglycemia
c. Hyperreflexia d. Jaundice Cold stress increases metabolism, consuming glucose and leading to hypoglycemia. 27.A nurse is caring for a postpartum client who is breastfeeding and reports nipple pain. Which of the following should the nurse recommend? a. Stop breastfeeding on the affected side b. Ensure proper latch c. Use ice packs after feeding d. Increase feeding intervals Proper latch reduces friction and pain during breastfeeding. 28.A nurse is teaching a client who is 28 weeks pregnant about signs of preterm labor. Which of the following should the client report? a. Breast tenderness b. Increased appetite c. Lower back pain d. Occasional fetal movement Lower back pain can indicate preterm labor and should be reported immediately.
c. Apply counterpressure to the sacral area d. Encourage the client to lie supine Counterpressure relieves back pain caused by fetal occiput posterior position. 32.A nurse is monitoring fetal heart rate and observes late decelerations. Which of the following is the appropriate action? a. Reposition the client b. Discontinue oxytocin c. Increase IV fluids d. Administer oxygen Repositioning helps improve uteroplacental perfusion during late decelerations. 33.A nurse is preparing to administer vitamin K to a newborn. What is the purpose of this medication? a. Prevent infection b. Enhance immune function c. Promote blood clotting d. Stimulate digestion Vitamin K promotes synthesis of clotting factors in the liver to prevent bleeding. 34.A nurse is caring for a newborn who is 24 hours old and has a respiratory rate of 68/min. Which of the following actions should the nurse take?
a. Continue routine care b. Notify the provider c. Begin CPR d. Administer surfactant A respiratory rate above 60/min in a newborn requires provider notification. 35.A nurse is assessing a client who is 2 days postpartum. Which of the following findings should the nurse report? a. Fundus firm and midline b. Foul-smelling lochia c. Perineal edema d. Pain during breastfeeding Foul-smelling lochia indicates infection and should be reported. 36.A nurse is caring for a newborn who is receiving phototherapy. Which of the following is an appropriate nursing action? a. Keep the newborn dressed b. Turn the newborn every 2 hours c. Apply lotion to the skin d. Limit feedings Repositioning every 2 hours ensures even exposure to phototherapy light.
Calf pain may indicate a deep vein thrombosis and should be reported immediately. 40.A nurse is caring for a postpartum client with a perineal laceration. Which comfort measure should the nurse recommend? a. Warm sitz baths immediately after delivery b. Apply ice packs for the first 24 hours c. Avoid sitting upright d. Perform Kegel exercises immediately Ice packs reduce swelling and discomfort in the first 24 hours. 41.A nurse is assessing a newborn who is post-term. Which of the following findings should the nurse expect? a. Vernix covering the body b. Cracked, peeling skin c. Lanugo present on the shoulders d. Abundant subcutaneous fat Post-term infants have dry, cracked skin due to prolonged exposure to amniotic fluid. 42.A nurse is assessing a pregnant client for complications of pregnancy. Which of the following findings should the nurse recognize as a sign of gestational diabetes?
a. Hypotension b. Polyuria c. Decreased appetite d. Constipation Polyuria is a sign of hyperglycemia associated with gestational diabetes. 43.A nurse is providing teaching to a pregnant client about nutrition. Which of the following should the nurse include? a. Consume 200 extra calories per day in the third trimester b. Increase iron intake during pregnancy c. Avoid all seafood d. Decrease calcium intake Iron needs increase to support fetal development and maternal blood volume. 44.A nurse is teaching a client about newborn safety. Which of the following statements indicates understanding? a. "I will place my baby on his side to sleep." b. "I will place my baby on his back to sleep." c. "I will use a soft pillow in the crib." d. "I will let my baby sleep in bed with me." Placing the baby on their back reduces the risk of SIDS.
48.A nurse is reviewing discharge instructions for a postpartum client who is bottle-feeding. Which of the following should the nurse include? a. Use a breast pump to relieve discomfort b. Apply cold cabbage leaves to the breasts c. Apply warm compresses d. Stimulate nipples to reduce pain Cabbage leaves reduce swelling and help with suppression of lactation. 49.A nurse is caring for a newborn who has not voided in the first 24 hours. What is the priority action? a. Reassure the parent b. Notify the provider c. Warm the newborn d. Record the finding Failure to void may indicate renal or genitourinary abnormalities and requires evaluation. 50.A nurse is caring for a client who is breastfeeding and taking a prenatal vitamin. Which additional supplement should the nurse recommend? a. Calcium b. Iron
c. Vitamin C d. Magnesium Iron helps replenish maternal stores depleted during pregnancy and delivery. 51.A nurse is caring for a client who is postpartum and reports urinary retention. Which of the following actions should the nurse take first? a. Assist the client to the bathroom b. Insert a urinary catheter c. Notify the provider d. Increase oral fluids Helping the client void naturally by assisting to the bathroom is the least invasive and should be attempted first. 52.A nurse is assessing a client at 36 weeks of gestation. Which of the following findings should the nurse report? a. Fundal height 36 cm b. Fetal heart rate 140/min c. 1+ lower extremity edema d. Persistent headaches Persistent headaches can indicate gestational hypertension or preeclampsia. 53.A nurse is preparing to administer Hepatitis B vaccine to a newborn. Which of the following is the correct site?