ATI Maternity Proctored Exam Version 5 With Answers (181 Solved Questions)

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ANTEPARTUM
Stages of Pregnancy
• The third through eighth weeks after conception are called the embryonic stage.
• The fetal period starts 9 weeks after conception and lasts through the end of gestation.
Fetal Development: Embryonic Stage
Week 1
• Free-floating blastocyst
Weeks 2 to 3
• The embryo is 1.5 to 2 mm long.
• Lung buds appear.
• Blood circulation begins.
• The heart is tubular.
• The neural plate becomes the brain
and spinal cord.
Week 5
• The embryo is 0.4 to 0.5 cm long.
• The embryo weighs 0.4 g.
• Double heart chambers are visible.
• The heart beats.
• Limb buds begin to form.
Week 8
• The embryo is 3 cm long.
• The embryo weighs 2 g.
• The eyelids begin to fuse.
• The circulatory system through the
umbilical cord is well established.
• Every organ system is present.
Week 12
• Fetus is 6 to 9 cm long.
• Fetus weighs 19 g.
• Face is well formed.
• Limbs are long and slender.
• Kidneys begin to form urine.
• Spontaneous movements occur.
• Heartbeat is detectable with a
Doppler transducer between 10 and
12 weeks.
• Sex is visually recognizable.
Week 16
• Fetus is 11.5 to 13.5 cm long.
• Fetus weighs 100 g.
• Active movements are present.
• Skin is transparent.
• Lanugo hair begins to develop.
• Skeletal ossification takes place.
Week 20
• Fetus is 16 to 18.5 cm long.
• Fetus weighs 300 g.VERSION 5

• Lanugo covers the entire body.
• Fetus has fingernails and toenails.
• Muscles are developed.
• Enamel and dentin are being
deposited.
• Heartbeat is detectable with a
regular (nonelectronic) fetoscope.
Week 24
• Fetus is 23 cm long.
• Fetus weighs 600 g.
• Hair on head is well formed.
• Skin is reddish and wrinkled.
• Reflex hand grasp is functioning.
• Vernix caseosa covers the entire
body.
• Fetus can hear.
Week 28
• Fetus is 27 cm long.
• Fetus weighs 1100 g.
• Limbs are well flexed.
• Brain is developing rapidly.
• Eyelids open and close.
• Lungs are developed sufficiently to
provide gas exchange (lecithin
forming).
• If born at this time, neonate can
breathe.
Week 32
• Fetus is 31 cm long.
• Fetus weighs 1800 to 2100 g.
• Bones are fully developed.
• Subcutaneous fat has accumulated.
• Lecithin-to-sphingomyelin (L/S) ratio
is 2:1.
Week 36
• Fetus is 35 cm long.
• Fetus weighs 2200 to 2900 g.
• Skin is pink and the body rounded.
• Skin is less wrinkled.
• Lanugo is disappearing.
• L/S ratio is higher than 2:1.
Week 40
• Fetus is 40 cm long.
• Fetus weighs 3200 g or more. 3Kg
• Skin is pinkish and smooth.
• Lanugo remains on the upper arms and shoulders.
• Vernix caseosa coverage decreases.
• Fingernails extend beyond fingertips.
• Sole (plantar) creases run down to the heels.

Umbilical Cord
• Cord contains two arteries and one vein.
• Arteries carry deoxygenated blood and waste products from the fetus.
• Vein carries oxygenated blood and provides oxygen and nutrients to the fetus.
Remember AVA: two arteries and one vein.
• The arteries carry deoxygenated blood and waste products away from the fetus to the
placenta, where these substances are transferred to the mother's circulation.
• The umbilical vein carries freshly oxygenated and nutrient-laden blood from the
placenta back to the fetus.
Nagele's rule : Used to determine the estimated date of delivery/confinement.
❖ Subtract 3 months from the first day of the last menstrual period (LMP), add 7
days, and then adjust the year as necessary.
• The ductus arteriosus connects
the pulmonary artery to the
aorta, bypassing the lungs.
• The ductus venosus connects the
umbilical vein and the inferior
vena cava, bypassing the liver.
• The foramen ovale is the opening
between the right and the left
atria of the heart, bypassing the
lungs
Fetal HR: 160 to 170 beats/min in the first
trimester but slowing with fetal growth to
120 to 160 beats/min near or at term.

Signs of Pregnancy
Presumptive Signs
• Amenorrhea
• Nausea and vomiting
• Increased size and feeling of fullness in breasts
• Pronounced nipples
• Urinary frequency
• Quickening
• Fatigue
• Discoloration and thickening of the vaginal mucosa
Probable signs
• Uterine enlargement
• Hegar sign
• Goodell sign: Softening of the cervix
• Chadwick sign: Violet coloration of the mucous membranes
• Ballottement: Rebounding of the fetus against the examiner's finger on palpation.
• Positive result on pregnancy test for human chorionic gonadotropin (hCG)
Positive signs
• G stands for gravidity, or the number of pregnancies, including the current one.
• T represents term births, the number of children born at term (longer than 37 weeks’
gestation).
• P is preterm births, the number of children born before 37 weeks’ gestation.
• A represents abortions and miscarriages, the number of abortions and/or miscarriages
(included in gravida if before 20 weeks’ gestation; included in parity if past 20 weeks’
gestation). Note that the termination of a pregnancy after 20 weeks is referred to as
therapeutic termination.
• L stands for the number of current living children.

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• Fetal heart rate, detectable with an electronic device (Doppler transducer) at 10 to 12
weeks and with a nonelectronic device (fetoscope) at 20 weeks of gestation
• Active fetal movements palpable by examiner
• Outline of fetus on ultrasound
Fundal Height: The fundal height is measured to help gauge the fetus' gestational age.
**fundal height in centimeters approximately equals the fetus's age in weeks, plus or minus 2
cm.**
In the early weeks of pregnancy, the cervix softens as a result of pelvic congestion (Goodell
sign). Cervical softening is noted on physical examination. The presence of the Goodell sign is a
probable indication of pregnancy. Another probable indication of pregnancy is the Chadwick
sign, in which the cervix changes from pink to a violet color. Presumptive indications of
pregnancy are also termed subjective changes because they are experienced and reported by
the woman. Positive indications of pregnancy include auscultation of fetal heart sounds, fetal
movement felt by the examiner, and visualization of the fetus on ultrasonography.
When a pregnant woman is in the supine position, particularly during the second and third
trimesters, the weight of the gravid uterus partially occludes the vena cava and descending
aorta. The occlusion impedes return of blood from the lower extremities and consequently
reduces cardiac return, cardiac output, and blood pressure. This is known as supine hypotensive
syndrome. Symptoms include faintness, lightheadedness, dizziness, and agitation. A lateral
recumbent position alleviates the pressure on the blood vessels and quickly corrects supine
hypotension. Although the nurse may take the woman's blood pressure, this is not the action to
take immediately. It is not necessary to call the obstetrician to the examining room. Placing a
cool cloth on the woman's forehead will not alleviate the problem.
Urinalysis and Urine Culture
• A urine specimen for glucose and protein determinations should be obtained at every
prenatal visit.
• Glycosuria is a common result of the decreased renal threshold that occurs during
pregnancy.

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• Persistent glycosuria may indicate diabetes.
• White blood cells in the urine may indicate infection.
• Ketonuria may result from insufficient food intake or vomiting.
• Levels of 2+ to 4+ protein in the urine may indicate infection or preeclampsia.
If the client is Rh negative and the result of an antibody screen is negative, she will need repeat
antibody screens and should receive Rh immune globulin around 28 weeks' gestation to
prevent the formation of anti-Rh antibodies. An Rh-negative woman should also receive Rh
immune globulin within 72 hours of delivery if her newborn is Rh-positive. On the basis of the
data provided in the question, the other options are incorrect.
Amniocentesis is a relatively simple and safe procedure that permits the diagnosis of many fetal
anomalies and confirms fetal maturity. It is a relatively painless procedure that takes only a
short amount of time. Ultrasonography is used to locate the fetus and placenta and identify the
largest pockets of amniotic fluid that can safely be sampled. A small amount of local anesthetic
may be injected into the skin. The woman may feel pressure as the needle is inserted and mild
cramping as the needle enters the myometrium. Informed consent will need to be provided by
the client before the procedure. Although risks are associated with the procedure, the need for
several informed consents to be signed is not warranted.
Maternity
Nursing 214
• A nurse is caring for a client who is pregnant and states that her last menstrual period
was April 1, 2013. Which of the following is the client’s estimated date of delivery?
A. Jan. 8, 2014
B. Jan. 15, 2014
C. Feb. 8, 2014
D. Feb. 15, 2014
A.
Jan. 8, 2014
• A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy.
The client's health record includes this data: G3 T1 P0 A1 L1. How should the nurse
interpret this information? (Select all that apply)
A. Client has delivered one newborn at terms.
B. Client has experienced no preterm labor.
C. Client has been through active labor.
D. Client has had two prior pregnancies.
E. Client has one living child.
A. Client has delivered one newborn at terms.
D. Client has had two prior pregnancies.

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E. Client has one living child.
• A nurse is reviewing the health record of a client who is pregnant. The provider
indicated the client exhibits probable signs of pregnancy. Which of the following would
be included? (Select all that apply)
A. Montgomery's glands
B. Goodall's sign
C. Ballottement
D. Chadwick's sign
E. Quickening
B. Goodall's sign
C. Ballottement
D. Chadwick's sign
• A nurse in a prenatal clinic is caring for client who is pregnant and experiencing episodes
of maternal hypotension. The client asks the nurse what causes these episodes. Which
of the following is an appropriate response by the nurse?
A. "This is due to an increase in blood volume."
B. "This is due to pressure from the uterus on the diaphragm"
C. "This is due to the weight of the uterus on the vena cava."
D. "This is due to increased cardiac output."
C. "This is due to the weight of the uterus on the vena cava."
• A nurse in a clinic receives a phone call from a client who believes she is pregnant and
would like to be tested in the clinic to confirm her pregnancy. Which of the following
information should the nurse provide to the client?
A. "You should wait until 4 weeks after conception to be tested."
B. "You should be off any medication for 24 hours prior to the test."
C. "You should be NPO for at least 8 hours prior to the test."
D. "You should collect urine from the first morning void."
D. "You should collect urine from the first morning void."
• A nurse is teaching a group of women who are pregnant about measures to relieve
backache during pregnancy. The nurse should should teach the women which of the
following? (Select all that apply)
A. Avoid any lifting
B. Perform Kegel exercises twice a day.
C. Perform the pelvic rock exercise every day.
D. Use proper body mechanics.
E. Avoid constrictive clothing.
C. Perform the pelvic rock exercise every day.
D. Use proper body mechanics.

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• A client who is at 8 weeks of gestation tells the nurse that she isn't sure she is happy
about being pregnant. Which of the following is an appropriate response by the nurse to
the client's statement?
A. "I will inform the provider that you are having these feelings."
B. "It is normal to have these feelings during the first few months of pregnancy."
C. "You should be happy that you are going to bring new life into the world."
D. "I am going to make an appointment with the counselor for you to discuss these thoughts."
B. "It is normal to have these feelings during the first few months of pregnancy."
• A nurse is caring for a client who is pregnant and reviewing signs of complications that
should be promptly reported to the provider. Which of the following should be
included?
A. Vaginal bleeding
B. Swelling
C. Heartburn after eating
D. Lightheadedness when lying on back
A. Vaginal bleeding
• A client who is at 7 weeks of gestation is experiencing nausea and vomiting in the
morning. The nurse in the prenatal clinic provides teaching that should include which of
the following?
A. Eat crackers or plain toast before getting out of bed.
B. Awaken during the night to eat a snack
C. Skip breakfast and eat lunch after nausea has subsided
D. Eat a large evening meal.
A. Eat crackers or plain toast before getting out of bed.
• A nurse is teaching a group of clients who are pregnant about behaviors to avoid during
pregnancy. Which of the following statements by a client indicates a need for further
instruction?
A. "I can have a glass of wine with dinner."
B. "Smoking is a cause of low birth weight in babies."
C. "Signs of infection should be reported to my doctor."
D. "I should not take over-the-counter medications without checking with my obstetrician."
A. "I can have a glass of wine with dinner."
• A nurse in a prenatal clinic is providing education to a client who is in the 8th week of
gestation, The client states that she does not like milk. What is a good source of calcium
that the nurse can recommend to the client?
A. Dark green, leafy vegetables
B. Deep red or orange vegetables
C. White bread and rice
D. Meat, poultry, and fish
A. Dark green, leafy vegetables

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• A nurse in a prenatal clinic is caring for a group of clients. Which of the following clients
should the nurse be concerned about regarding weight gain?
A. 1.8kg (4lb) weight gain and is in her first trimester
B. 3.6kg (8lb) weight gain and is in her first trimester
C. 6.8kg (15lb) weight gain and is in her second trimester
D. 11.3kg (25lb) weight gain and is in her third trimester
B. 3.6kg (8lb) weight gain and is in her first trimester
• A nurse in clinic is teaching a client of childbearing age about recommended folic acid
supplements. Which of the following defects can occur in the fetus or neonate as a
result of folic acid deficiency?
A. Iron deficiency anemia
B. Poor bone formation
C. Macrosomic fetus
D. Neural tube defects
D. Neural tube defects
• A nurse is reviewing a new prescription for iron supplements with a client who is in the
8th week of gestation and has iron deficiency anemia. The nurse should advise the client
to take the iron supplements with which of the following?
A. Ice water
B. Low-fat or whole milk
C. Tea or coffee
D. Orange juice
D. Orange juice
• A nurse is reviewing postpartum nutrition needs with a group of new mothers who are
breastfeeding their newborns. Which of the following statements by a member of the
group requires clarification?
A. "I am glad I can have my morning coffee."
B. "I know that certain foods that I eat will affect my baby."
C. "I will continue adding 330 calories per day to my diet."
D. "I will continue my calcium supplements because I don't like milk."
A. "I am glad I can have my morning coffee."
• A nurse is caring for a client and reviewing the findings of the client's biophysical profile
(BPP). Which of the following variables are included in this test? (Select all that apply)
A. Fetal weight
B. Fetal breathing movement
C. Fetal tone
D. Reactive FHR
E. Amniotic fluid volume
B. Fetal breathing movement
C. Fetal tone

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D. Reactive FHR
E. Amniotic fluid volume
• A nurse is caring for a client who is in preterm labor and is scheduled to undergo an
amniocentesis to assess fetal lung maturity. Which of the following is a test for fetal lung
maturity?
A. Alpha-fetoprotein (AFP)
B. Lecithin/sphingomyelin (L/S) ratio
C. Kleihauer-Betke test
D. Indirect Coomb's test
B. Lecithin/sphingomyelin (L/S) ratio
• A nurse is caring for a client who is pregnant and undergoing a nonusers test. The client
asks why the nurse is using an acoustic vibration device. Which of following is an
appropriate response by the nurse?
A. "It is used to stimulate uterine contractions."
B. "It will decrease the incidence of uterine contractions."
C. "It lulls the fetus to sleep."
D. "It awaken a sleeping fetus."
D. "It awaken a sleeping fetus."
• A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which
of the following statements by the client requires clarification?
A. "I will report cramping or signs of infection to the physician."
B. "I should drink lots of fluids during the 24 hours following the procedure."
C. "I need to have a full bladder at the time of the procedure."
D. "The test is done to detect genetic abnormalities."
C. "I need to have a full bladder at the time of the procedure."
• A nurse is caring for a client who is pregnant and is to undergo a contraction stress test
(CST). Which of the following findings are indications for the procedure? (Select all that
apply)
A. Decreased fetal movement
B. Intrauterine growth restriction (IUGR)
C. Postmaturity
D. Advanced maternal age
E. Amniotic fluid emboli
A. Decreased fetal movement
B. Intrauterine growth restriction (IUGR)
C. Postmaturity
D. Advanced materal age
• A nurse in L&D receives a phone call from a client who reports that her contractions
started about 2 hrs ago, did not go away when she had 2 glasses of water and rested,
and became stronger since she started walking. Her contractions occur every 10 mins

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and last about 30 seconds. She hasn't had much fluid leak from her vagina. However,
she saw some blood when she wiped after voiding. Based on this report the nurse
should recognize that the client is experiencing
A. Braxton Hicks contractions
B. rupture of membranes
C. fetal decent
D. true contractions
D. True contractions
• A nurse in L&D is caring for a client in labor and applies an external fetal monitor and
tocotranducer. The FHR is around 140/min. Contractions are every 8 min and 30-40
seconds in duration. The nurse performs a vaginal exam and finds the cervix is 2cm
dilated, 50% effaced, and the fetus is at -2 station. Which of the following stages and
phases of labor is this client experiencing?
A. The 1st stage, latent phase
B. The 1st stage, active phase
C. The 1st stage, transition phase
D. The 2nd stage of labor
A. The 1st stage, latent phase
• A client experiences a large gush of fluid from her vagina while walking in the hallway of
the birthing unit. The nurse's first action after establishing that the fluid is amniotic fluid
should be to
A. Asses the amniotic fluid for meconium
B. Monitor the FHR for distress
C. Dry the client and make her comfortable
D. Monitor the client's uterine contractions.
B. Monitor the FHR for distress
• A nurse in L&D is completing an admission history for a client who is at 39 weeks of
gestation. The client reports that she has been leaking fluid from her vagina for 2 days.
The nurse knows that this client is at risk for
A. Cord Prolapse
B. Infection
C, Postpartum hemorrhage
D. Hydramnios
B. Infection
• A nurse is caring for a client who is in active labor and becomes nauseous and vomits.
The client is very irritable and feels the urge to have a bowel movement. She states,
"I've had enough. I can't do this anymore. I want to go home right now." the nurse
knows that these signs indication the client is in the
A. 2nd stage of labor
B. 4th stage of labor

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C. transition phase of labor
D. latent phase of labor
C. transition phase of labor
• A nurse is caring for a client at 40 weeks of gestation who is experiencing contraction
every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is
3 cm dilated, 80% effaced and -1 station. The client asks for pain medication. Which of
the following actions should the nurse take at the time? (Select all that apply)
A. Encourage the use of patterned breathing techniques
B. Insert an indwelling urinary catheter
C. Administer opioid analgestic medication as prescribed
D. Suggest application of cold
E. Provide ice chips.
A. Encourage the use of patterned breathing techniques
C. Administer opioid analgestic medication as prescribed
D. Suggest application of cold
• A nurse is caring for a client who is in active labor. The client reports lower back pain.
The nurse suspects that this pain is related to a persistent occiput posterior fetal
position. Which of the following nonpharmocological nursing interventions is
appropriate?
A. abdominal effleurage
B. sacral counterpressure
C. showing if not contraindicated
D. back rub and massage
B. sacral counterpressure
• A nurse is caring for a client following the administration of an epidural block and is
preparing to administer a prescribed IV fluid bolus. The client's partner asks about the
purpose of the IV fluids. Which of the following is an appropriate response by the nurse?
A. "It is needed to promote increased urine output."
B. "It is needed to counteract respiratory depression."
C "It is needed to counteract hypotension."
D. "It is needed to prevent olihohyramnios"
C "It is needed to counteract hypotension."
• A nurse in L&D is caring for a client who is in the 2nd stage of labor. The client's labor
has been progressing and she is expected to deliver vaginally in 20 mins. The provider is
preparing to administer lidocaine (Xylocaine) for pain relief and perform an episiotomy.
The nurse should know that the type of regional anesthetic block that is to be
administered is which of the following?
A. Pudendal block
B. Epidural block
C. Spinal block

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