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ATI MATERNAL NEWBORN PROCTORED TEST BANK EXAM
WITH NGN QUESTIONS & DETAILED VERIFIED ANSWERS
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Complete 270+ Questions with Detailed Answers
1. A nurse is assessing a client who is at 35 weeks of gestation and has
preeclampsia without severe features.Which of the following findings should the nurse
identify as the priority?
A. 480 mL urine output in 24 hr.
B. Blood pressure 144/92 mm Hg
C. +2 edema of the feet
D. 1+ protein in the urine
Ans: A. because, when using the urgent vs. non urgent approach to client care, the nurse
should determine that the priority finding is 480 mL or urine in 24 hr. because the
minimum acceptable urine output in an adult client is 30 mL/hr. This can indicate
progression of preeclampsia to preeclampsia with severe features, which requires
immediate intervention.Therefore, this is the priority finding.
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2. A nurse is reviewing the medical record of a client who is at 33 weeks of
gestation and has placenta previa and bleeding. Which if the following
prescriptions 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
Ans: A. because, what a client has a placenta previa, the placenta implants in the lower
part of the uterus and obstructs the cervical os (the opening to the vagina).The nurse
should clarify this prescription because any manipulation can cause tearing of the
placenta and increased bleed- ing.
3. A nurse is assessing a client who is at 35 weeks of gestation and is receiving magnesium
sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following
findings should the nurse report to the provider.
A. Deep tendon reflexes 2+
B. Blood pressure 150/96 mm Hg
C. Urinary output 20 mL/hr
D. Respiratory rate 16/min
Ans: C. because, the nurse should report a urinary output of 20 mL/hr because this can
indicate inadequate renal perfusion, increasing the risk of magnesium sulfate toxicity. A
decrease in urinary output can also indicate a decrease in renal perfusion secondary to a
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worsening of the client's pre-eclampsia.
4. A nurse is assessing a client who is at 12 weeks of gestation and has a hydatidiform
mole. Which of the following findings should the nurse expect?
A. Hypothermia
B. Dark brown vaginal discharge
C. Decreased urinary output
D. Fetal heart tones
Ans: B. because, a hydatidiform mole, or a molar pregnancy, is a benign proliferative
growth of the chorionic villi, which gives rise to multiple cysts. The products of
conception transform into a large number of edematous fluid-filled vesicles. As cells
slough off the uterine wall, vaginal discharge is usually dark brown and can contain grape
like clusters.
5. A nurse is caring for a client who is at 37 weeks of gestation and is undergoing a
non stress test. The fetal heart rate (FHR) is 130/min without accelerations for the
past 10 min. Which of the following actions should the nurse take?
A. Use vibroacoustic stimulation on the client's abdomen for 3 seconds
B. Report the nonreactive test result to the provider immediately.
C. Request a prescription for an internal fetal scalp electrode
D. Auscultate the FHR with a Doppler transducer
Ans: A. because, the nurse should use a vibroacoustic stimulator on the client's abdomen
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to elicit fetal activity because the fetus us most likely sleeping. Fetal movement should
cause accelerations in the FHR.
6. A nurse is caring for a client who is at 26 weeks of gestation and reports
constipation. Which of the following responses by the nurse is appropriate?
A. "You should drink 1 ounce of mineral oil every morning."
B. "You should walk for at least 30 minutes every day."
C. "You should eat at least 3 ounces of red meat per day."
D. "You should stop taking your prenatal vitamin."
Ans: B. because, the nurse should encourage the client to participate in moderate physical
activity, such as walking or swimming, every day. This activity increases intestinal
peristalsis, which will help alleviate constipation.
7. A nurse is teaching a client who is at 12 weeks of gestation about manifesta- tions of
potential complications that she should report to her provider. Which of the following
information should the nurse include in the teaching?
A. Swelling of the face
B. Urinary frequency
C. White vaginal discharge
D. Intermittent nausea
Ans: A. because, the nurse should instruct the client to report swelling of the face because
this can indicate hypertensive disorder or preeclampsia.
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8. A nurse is caring for a client who is at 35 weeks of gestation and has
severe pre-eclampsia,Which of the following assessments provides the most accurate
information regarding the client's fluid and electrolyte status?
A. Blood pressure
B. Intake and output
C. Daily weight
D. Severity of edema
Ans: C. because, evidence-based practice indicates that daily weight is the most accurate
assessment to determine a client's fluid and electrolyte status.
9. A nurse is providing teaching to a client who is at 8 weeks of gestation about
manifestations to report to the provider during pregnancy.Which of the following
should the nurse include in the teaching?
A. Nausea upon awakening
B. Leg cramps when sleeping
C. Increase in white vaginal discharge
D. Blurred or double vision
Ans: D. because, a client who is pregnant should report experiencing blurred or double
vision as these could be a manifestation of gestation hypertension or pre-eclampsia.
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10. A nurse is caring for a client who believes she may be pregnant. Which of the
following findings should the nurse identify as a positive sign of pregnancy?
A. Palpable fetal movement
B. Chadwick's sign
C. Positive pregnancy test
D. Amenorrhea
Ans: A. because, palpable fetal movements are a positive sign of preg- nancy. Quickening,
the client's report of fetal movement, is a presumptive sign of pregnancy.
11. A nurse is teaching a client who is at 8 weeks of gestation and has a uterine fibroid
about potential effects of the fibroid during pregnancy. Which of the following
information should the nurse include in the teaching?
A. "The fibroid will shrink during the pregnancy."
B. "The fibroid can increase the risk for postpartum hemorrhage.
C. "You will receive an injection of medroxyprogesterone acetate to shrink the fibroid."
D. "You will have to undergo a cesarean birth because of the fibroid."
Ans: B.
because, uterine fibroids can increase the risk for postpartum hemorrhage due to
the increase in blood supply to the uterus, which supports the fibroid.
12. A nurse is caring for a client whose last menstrual period (LMP) began July
8. Using Nagele's rule, the nurse should identify the client's estimated date of birth
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(EDB) as which of the following?
A. October 1
B. April 1
C. October 15
D. April 15
Ans: D. because, using Nagele's rule, the nurse determines the EDB by counting back
3 months from the first day of LMP and adding 7 days.
13. A nurse at a prenatal clinic is caring fir a client who suspects she may be pregnant
and asks the nurse how the provider will confirm her pregnancy.The nurse should inform
the client that which of the following laboratory tests will be used to confirm her
pregnancy?
A. A blood test for the presence of estrogen
B. A blood test for the amount of circulating progesterone
C. A urine test for the presence of human chorionic somatomammotropin
D. A
urine
test
for
the
presence
of
human
chorionic
gonadotropin
Ans: D. because, human chorionic gonadotropin is excreted by the placenta and promotes
the excretion of progesterone and estrogen. This hormone is the basis for pregnancy
testing.
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14. A nurse is caring for a client who is at 32 weeks of gestation and is experiencing
preterm labor.Which of the following medications should the nurse plan to
administer?
A. Betamethasone
B. Misoprostol
C. Methylergonovine
D. Poractant alfa
Ans: A. because, the nurse should plan to administer Betamethasone IM, a glucocorticoid,
to stimulate fetal lung maturity and thereby prevent respiratory depression.
15. A nurse is caring for a client who is in the latent phase of labor and is experiencing
low back pain. Which of the following actions should the nurse take?
A. Instruct the client to pant during contractions
B. Position the client supine with legs elevated
C. Encourage the client to soak in a warm bath
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D. Apply pressure to the client's sacral area during contractions
Ans: D. because,
the nurse should provide counter pressure to the sacral area with a palm or a firm object,
such as a tennis ball, during contractions. Counter pressure lifts the fetal head away from
the sacral nerves, which decreases pain.
16. A nurse is teaching a client who is at 12 weeks of gestation and has human
immunodeficiency virus (HIV). Which of the following statements should the nurse
include in the teaching?
A. "Breastfeed your newborn to provide passive immunity."
B. "Abstain from sexual intercourse throughout the pregnancy."
C. "You will be in isolation after delivery."
D. "You
should
continue
to
take
zidovudine
throughout
the
pregnancy."
Ans: D. be- cause, the nurse should inform the client that taking prescription antiviral
medication every day decreases the risk of transmission of HIV to her newborn.
17. A nurse is admitting a client who is in labor and experiencing moderate bright red
vaginal bleeding. Which of the following actions should the nurse take?
A. Perform a vaginal examination to determine cervical dilation.
B. Obtain blood samples for baseline laboratory values.
C. Place a spiral electrode on the fetal presenting part.
D. Prepare the client for a transvaginal ultrasound.
Ans: B. because, the nurse should obtain samples of the client's blood for baseline
testing of hemoglobin and hematocrit levels.
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18. A nurse is teaching a client who is at 10 weeks of gestation about an abdominal
ultrasound in the first trimester.Which of the following information should the nurse
include in the teaching.
A. "You will have a nonstress test prior to the ultrasound."
B. "You will need to have a full bladder during the ultrasound."
C. "The ultrasound will determine the length of your cervix."
D. "You
will
experience
uterine
cramping
during
the
ultrasound."
Ans: B. because, the nurse should tell the client that a full bladder helps to lift the gravid
uterus out of the pelvis during the examination. Therefore, it is important to ensure that
the client has a full bladder to obtain the most accurate image of the fetus.
19. A nurse is caring for a client who is in the latent phase of labor and is receiving
oxytocin every 2 min which last 100 to 110 seconds and that the fetal heart rate (FHR) is
reassuring. Which of the following actions should the nurse take?
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A. Decrease the infusion rate of the maintenance IV fluid.
B. Administer oxygen via nonrebreather mask.
C. Decrease the dose of oxytocin by half.
D. Administer terbutaline 0.25 mg subcutaneously.
Ans: C. because, the nurse should decrease the dose of oxytocin by half because the
client is experiencing uterine tachysystole.
20. A nurse is caring for a client who is at 38 weeks of gestation and reports no fetal
movement for 24 hr.Which of the following actions should the nurse take?
A. Auscultate for a fetal heart rate.
B. Have the client drink orange juice.
C. Reassure the client that a term fetus is less active.
D. Palpate the uterus for fetal movement.
Ans: A. because, presence of a fetal heart rate is a reassuring manifestation of fetal wellbeing. The nurse should auscultate for the fetal heart rate using a Doppler device or an
external fetal monitor.This is the priority nursing action.
21. A nurse is teaching a client who has pre-eclampsia and is to receive magnesium
sulfate via continuous IV infusion about expected adverse effects. Which of the following
adverse effects should the nurse include in the teach- ing?
A. Elevated blood pressure
B. Feeling of warmth
C. Hyperactivity
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D. Generalized pruritus
Ans: B. because, the nurse should tell the client to expect the feeling of warmth all over
her body while the magnesium sulfate is infusing.
22. A nurse is reviewing laboratory results for a client who is at 37 weeks
of gestation.The nurse notes that the client is rubella non-immune, positive for group A
beta-hemolytic streptococci, and has a blood type of O negative. Which of the following
actions should the nurse take?
A. Administer a dose of Rh0(D) immune globulin.
B. Request a prescription for an antibiotic until delivery.
C. Instruct the client to obtain a rubella immunization after delivery.
D. Inform the client that she will need to deliver via cesarean birth.
Ans: C. Instruct the client to obtain a rubella immunization after delivery.
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23. A nurse is reviewing the medical record of a client who is at 39 weeks of
gestation and has polyhydramnios.Which of the following findings should the nurse
expect?
A. Fundal height of 34 cm (13.4 in)
B. Total pregnancy weight gain of 3.6 kg (8 lb)
C. Gestational hypertension
D. Fetal gastrointestinal anomaly
Ans: D. because, polyhydramnios is the presence of excessive amniotic fluid surrounding
the unborn fetus. Gastrointestinal malforma- tions and neurologic disorders are expected
findings for a fetus experiencing the effects of polyhydramnios.
24. A nurse is teaching a client who is at 30 weeks of gestation about warning signs of
complications that she should report to her provider.Which of the following findings
should the nurse include in the teaching?
A. Mild constipation
B. Nasal congestion
C. Vaginal bleeding
D. 10 fetal movements per hour
Ans: C. because, vaginal bleeding can be an abnor- mal finding during pregnancy that
might indicate a complication such a placental abruption, placenta previa, or preterm
labor.
25. A nurse is assessing a client who is at 34 weeks of gestation and has a mild placental
abruption.Which of the following findings should the nurse expect?
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A. Increased platelet count
B. Fetal distress
C. Decreased urinary output
D. Dark red vaginal bleeding
Ans: D. because, the nurse should expect the client who has a mild placental abruption to
have minimal dark red vaginal bleeding.
26. A nurse is caring for a client who is at 39 weeks of gestation and is in the active
phase of labor.The nurse observes late decelerations in the fetal heart rate (FHR).
Which of the following findings should the nurse identify as the cause of late
decelerations?
A. Uteroplacental insufficiency
B. Fetal head compression
C. Fetal ventricular septal defect
D. Umbilical cord compression
Ans: A. because, a late deceleration in the FHR is a non reassuring FHR pattern resulting
from fetal hypoxemia due to insufficient placental
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perfusion. The nurse should reposition the client, initiate oxygen, and increase the
infusion rate of IV fluid to enhance placental perfusion.
27. A nurse is teaching a client who is at 13 weeks of gestation about the treatment of
incompetent cervix with cervical cerclage.Which of the following statements by the
client indicates an understanding of the teaching?
A. "I am sad that I won't be able to get pregnant again."
B. "I can resume having sex as soon as I feel up to it."
C. "I should go to the hospital if I think I may be in labor."
D. "I should expect bright red bleeding while the cerclage is in place."
Ans: C. because, cervical cerclage prevents premature opening of the cervix during pregnancy.The client should immediately go to a facility for evaluation if she experiences any
manifestations of labor while the cerclage is in place. If the client experiences preterm
uterine contractions she might require tocolytic therapy.
28. A nurse is caring for a client who has oligohydramnios. Which of the following
fetal anomalies should the nurse expect?
A. Atrial septal defect
B. Renal agenesis
C. Spina bifida
D. Hydrocephalus
Ans: B. because, Oligohydramnios is a volume of amniotic fluid less than 300 mL during
the third trimester of pregnancy and occurs when there is a renal system dysfunction or
obstructive uropathy. Absence of fetal kidneys will cause oligohydramnios.
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29. A nurse is assessing a client who is at 37 weeks of gestation and has a
suspected pelvic fracture due to blunt abdominal trauma. Which of the following
findings should the nurse expect?
A. Bradycardia
B. Uterine contractions
C. Seizures
D. Bradypnea
Ans: B. because, the nurse should expect the client to be experiencing uterine
contractions due to abdominal trauma.
30. A nurse is caring for a client who is in active labor and has meconium staining of
the amniotic fluid. The nurse notes a reassuring fetal heart rate (FHR) tracing from the
external fetal monitor. Which of the following actions should the nurse take?
A. Prepare the client for an ultrasound examination.