Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antepartum: Fetal Movement Counts
A 28-week G1P0 client reports that over the past 12 hours she
has felt only 4 fetal movements. Which response by the nurse is
best?
A. Ask the client to count movements for another 12 hours and
call if still decreased.
B. Instruct the client to come to the clinic now for a nonstress
test (NST).
C. Tell the client decreased movements are normal at 28 weeks
and reassure her.
D. Advise oral glucose and repeat kick counts for 1 hour at
home.
Correct answer: B
,Rationale — correct: At ≥28 weeks, decreased fetal movement
is a potentially significant indicator of fetal compromise
(reduced fetal activity can reflect hypoxia or placental
insufficiency). An NST in a clinic/hospital setting is the
appropriate immediate step to assess fetal well-being.
Physiologically, compromised oxygenation or placental
dysfunction reduces fetal activity; NST evaluates fetal heart rate
reactivity which correlates with intact autonomic function.
NCSBN+1
Rationales — incorrect:
A — Waiting another 12 hours risks delaying diagnosis of fetal
compromise.
C — Decreased movements are not considered normal and
must be evaluated.
D — Oral glucose can transiently increase movements, but in a
patient reporting markedly decreased movements (only 4/12
hr) the safer action is immediate clinical evaluation rather than
home testing alone.
2 — High-Risk Pregnancy: Preeclampsia Assessment
A 34-year-old at 36 weeks gestation with preeclampsia is
admitted. Which assessment finding most clearly indicates
worsening maternal condition requiring urgent intervention?
A. Headache that improves with analgesic.
B. Urine output 20 mL/hr for 2 hours.
,C. Blood pressure 150/92 mm Hg (baseline 148/90).
D. Proteinuria 1+ on dipstick.
Correct answer: B
Rationale — correct: Oliguria (urine output <30 mL/hr)
indicates decreasing renal perfusion from systemic vasospasm
and endothelial dysfunction in preeclampsia — sign of severe
disease and impending multi-organ involvement.
Physiologically, preeclampsia involves widespread
vasoconstriction and capillary leak reducing renal glomerular
filtration. Prompt evaluation and treatment (fluid status,
magnesium sulfate if indicated, consideration for delivery) are
required. NCSBN
Rationales — incorrect:
A — A persistent or severe headache refractory to treatment is
concerning (cerebral vasospasm), but one that improves with
analgesic is less specific.
C — BP is elevated but not markedly higher than baseline;
severe features are usually ≥160/110.
D — Proteinuria alone is expected in preeclampsia; progressive
oliguria is more immediately dangerous.
3 — Prenatal Education: Rh-negative Mom
A woman who is Rh-negative (Rh−) is at 28 weeks gestation and
has not yet received Rh immune globulin (RhoGAM). Which
statement by the nurse is most accurate?
, A. "You only need RhoGAM after delivery if the baby is Rh
positive."
B. "You should receive RhoGAM at 28 weeks prophylactically
and after any sensitizing event."
C. "RhoGAM causes fetal blood type changes, so it is given only
rarely."
D. "Prenatal RhoGAM is indicated only if the father is Rh
positive."
Correct answer: B
Rationale — correct: Standard practice is to give prophylactic
Rh immune globulin at ~28 weeks to Rh− mothers to prevent
maternal alloimmunization and again postpartum if infant is
Rh+. RhoGAM provides passive anti-D immunoglobulin that
neutralizes fetal Rh+ erythrocytes before the maternal immune
system mounts a response. Active maternal sensitization leads
to hemolytic disease in future pregnancies; prophylaxis
prevents that immune priming. NCSBN
Rationales — incorrect:
A — Waiting until delivery risks sensitization from antenatal
fetomaternal hemorrhage; prophylaxis at 28 weeks reduces this
risk.
C — RhoGAM does not change fetal blood type; it provides
passive antibodies to prevent maternal response.
D — Paternal status can be unknown; prophylactic
administration is based on maternal Rh status and risk of
exposure.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antepartum: Fetal Movement Counts
A 28-week G1P0 client reports that over the past 12 hours she
has felt only 4 fetal movements. Which response by the nurse is
best?
A. Ask the client to count movements for another 12 hours and
call if still decreased.
B. Instruct the client to come to the clinic now for a nonstress
test (NST).
C. Tell the client decreased movements are normal at 28 weeks
and reassure her.
D. Advise oral glucose and repeat kick counts for 1 hour at
home.
Correct answer: B
,Rationale — correct: At ≥28 weeks, decreased fetal movement
is a potentially significant indicator of fetal compromise
(reduced fetal activity can reflect hypoxia or placental
insufficiency). An NST in a clinic/hospital setting is the
appropriate immediate step to assess fetal well-being.
Physiologically, compromised oxygenation or placental
dysfunction reduces fetal activity; NST evaluates fetal heart rate
reactivity which correlates with intact autonomic function.
NCSBN+1
Rationales — incorrect:
A — Waiting another 12 hours risks delaying diagnosis of fetal
compromise.
C — Decreased movements are not considered normal and
must be evaluated.
D — Oral glucose can transiently increase movements, but in a
patient reporting markedly decreased movements (only 4/12
hr) the safer action is immediate clinical evaluation rather than
home testing alone.
2 — High-Risk Pregnancy: Preeclampsia Assessment
A 34-year-old at 36 weeks gestation with preeclampsia is
admitted. Which assessment finding most clearly indicates
worsening maternal condition requiring urgent intervention?
A. Headache that improves with analgesic.
B. Urine output 20 mL/hr for 2 hours.
,C. Blood pressure 150/92 mm Hg (baseline 148/90).
D. Proteinuria 1+ on dipstick.
Correct answer: B
Rationale — correct: Oliguria (urine output <30 mL/hr)
indicates decreasing renal perfusion from systemic vasospasm
and endothelial dysfunction in preeclampsia — sign of severe
disease and impending multi-organ involvement.
Physiologically, preeclampsia involves widespread
vasoconstriction and capillary leak reducing renal glomerular
filtration. Prompt evaluation and treatment (fluid status,
magnesium sulfate if indicated, consideration for delivery) are
required. NCSBN
Rationales — incorrect:
A — A persistent or severe headache refractory to treatment is
concerning (cerebral vasospasm), but one that improves with
analgesic is less specific.
C — BP is elevated but not markedly higher than baseline;
severe features are usually ≥160/110.
D — Proteinuria alone is expected in preeclampsia; progressive
oliguria is more immediately dangerous.
3 — Prenatal Education: Rh-negative Mom
A woman who is Rh-negative (Rh−) is at 28 weeks gestation and
has not yet received Rh immune globulin (RhoGAM). Which
statement by the nurse is most accurate?
, A. "You only need RhoGAM after delivery if the baby is Rh
positive."
B. "You should receive RhoGAM at 28 weeks prophylactically
and after any sensitizing event."
C. "RhoGAM causes fetal blood type changes, so it is given only
rarely."
D. "Prenatal RhoGAM is indicated only if the father is Rh
positive."
Correct answer: B
Rationale — correct: Standard practice is to give prophylactic
Rh immune globulin at ~28 weeks to Rh− mothers to prevent
maternal alloimmunization and again postpartum if infant is
Rh+. RhoGAM provides passive anti-D immunoglobulin that
neutralizes fetal Rh+ erythrocytes before the maternal immune
system mounts a response. Active maternal sensitization leads
to hemolytic disease in future pregnancies; prophylaxis
prevents that immune priming. NCSBN
Rationales — incorrect:
A — Waiting until delivery risks sensitization from antenatal
fetomaternal hemorrhage; prophylaxis at 28 weeks reduces this
risk.
C — RhoGAM does not change fetal blood type; it provides
passive antibodies to prevent maternal response.
D — Paternal status can be unknown; prophylactic
administration is based on maternal Rh status and risk of
exposure.
