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 assessment / Prenatal education (Multiple
choice)
A 28-year-old primigravida at 28 weeks’ gestation reports
decreased fetal movement over the last 12 hours. Which action
should the nurse perform first?
A. Instruct the client to come to labor and delivery for
immediate ultrasound.
B. Have the client perform a fetal kick-count (count to 10) while
lying on her side.
C. Ask the client to drink a cold, sugary beverage and re-monitor
fetal activity.
D. Reassure the client that decreased activity is normal in the
third trimester.
,Correct answer: C.
Rationale (correct): A cold, sweet drink can stimulate fetal
activity; re-monitoring is a rapid, low-risk first step to determine
whether fetal movement can be elicited before more
invasive/urgent measures. Physiologically, increased maternal
glucose/temperature transiently increases fetal movement via
fetal metabolic stimulation.
Why others are incorrect:
A. Immediate ultrasound may be indicated if re-testing remains
abnormal; it is not the first, least invasive action.
B. Formal kick-counts are appropriate (counting to 10 in 2
hours) but when decreased movement is reported now, an
immediate short stimulation/re-monitoring is faster.
D. Decreased activity is not always normal; cant dismiss a
maternal report—this could signal fetal compromise (e.g.,
hypoxia).
2 — High-risk pregnancy (Preeclampsia) (Multiple choice)
A client at 36 weeks’ gestation is diagnosed with preeclampsia
with severe features. Which finding most clearly meets criteria
for “severe” preeclampsia?
A. BP 150/92 mm Hg on two readings 6 hours apart.
B. Persistent proteinuria 1+ on dipstick.
C. Blood pressure 164/112 mm Hg on two readings 4 hours
apart.
D. Mild peripheral edema and 1+ proteinuria.
,Correct answer: C.
Rationale (correct): Severe range blood pressure is ≥160 systolic
or ≥110 diastolic on two occasions at least 4 hours apart (unless
antihypertensive therapy initiated). This reflects increased risk
for maternal end-organ damage (stroke, eclampsia) and
uteroplacental insufficiency.
Why others are incorrect:
A. BP 150/92 is elevated but does not meet the severe
threshold.
B. 1+ dipstick is not a reliable marker for severe disease;
quantitative protein/other severe features are needed.
D. Mild edema with 1+ proteinuria are findings of mild
preeclampsia, not severe.
3 — Antepartum pharmacology (Multiple choice)
A pregnant client with gestational diabetes is started on insulin
therapy. Which statement by the client indicates correct
understanding?
A. “I’ll take insulin only when I eat carbohydrates.”
B. “Insulin does not cross the placenta, so it’s safe for my baby.”
C. “I’ll stop insulin after I give birth because glucose intolerance
always resolves right away.”
D. “Oral hypoglycemic agents are preferred because they’re
easier than injections.”
, Correct answer: B.
Rationale (correct): Insulin molecules are large and do not cross
the placenta; therefore insulin therapy controls maternal
glycemia without directly exposing the fetus to the drug. This
reduces fetal hyperinsulinemia risk from maternal
hyperglycemia.
Why others are incorrect:
A. Insulin dosing regimens vary; some require basal plus bolus—
“only when I eat” oversimplifies and risks hyper/hypoglycemia.
C. Some women’s glucose tolerance normalizes postpartum, but
not always immediately; follow-up testing is required.
D. Some oral agents cross the placenta and are not first-line in
pregnancy; insulin is the recommended standard when
diet/exercise insufficient.
4 — Prenatal education / Rh incompatibility (Multiple choice)
An Rh-negative mother with a previously sensitized pregnancy
is scheduled for a fetal blood sampling. Which maternal
intervention reduces risk of alloimmunization?
A. Administer Rho(D) immune globulin at 34–36 weeks only.
B. Administer Rho(D) immune globulin within 72 hours of any
invasive event if indicated.
C. Give maternal high-dose corticosteroids before sampling.
D. No intervention—alloimmunization can’t be prevented after
sensitization.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antepartum assessment / Prenatal education (Multiple
choice)
A 28-year-old primigravida at 28 weeks’ gestation reports
decreased fetal movement over the last 12 hours. Which action
should the nurse perform first?
A. Instruct the client to come to labor and delivery for
immediate ultrasound.
B. Have the client perform a fetal kick-count (count to 10) while
lying on her side.
C. Ask the client to drink a cold, sugary beverage and re-monitor
fetal activity.
D. Reassure the client that decreased activity is normal in the
third trimester.
,Correct answer: C.
Rationale (correct): A cold, sweet drink can stimulate fetal
activity; re-monitoring is a rapid, low-risk first step to determine
whether fetal movement can be elicited before more
invasive/urgent measures. Physiologically, increased maternal
glucose/temperature transiently increases fetal movement via
fetal metabolic stimulation.
Why others are incorrect:
A. Immediate ultrasound may be indicated if re-testing remains
abnormal; it is not the first, least invasive action.
B. Formal kick-counts are appropriate (counting to 10 in 2
hours) but when decreased movement is reported now, an
immediate short stimulation/re-monitoring is faster.
D. Decreased activity is not always normal; cant dismiss a
maternal report—this could signal fetal compromise (e.g.,
hypoxia).
2 — High-risk pregnancy (Preeclampsia) (Multiple choice)
A client at 36 weeks’ gestation is diagnosed with preeclampsia
with severe features. Which finding most clearly meets criteria
for “severe” preeclampsia?
A. BP 150/92 mm Hg on two readings 6 hours apart.
B. Persistent proteinuria 1+ on dipstick.
C. Blood pressure 164/112 mm Hg on two readings 4 hours
apart.
D. Mild peripheral edema and 1+ proteinuria.
,Correct answer: C.
Rationale (correct): Severe range blood pressure is ≥160 systolic
or ≥110 diastolic on two occasions at least 4 hours apart (unless
antihypertensive therapy initiated). This reflects increased risk
for maternal end-organ damage (stroke, eclampsia) and
uteroplacental insufficiency.
Why others are incorrect:
A. BP 150/92 is elevated but does not meet the severe
threshold.
B. 1+ dipstick is not a reliable marker for severe disease;
quantitative protein/other severe features are needed.
D. Mild edema with 1+ proteinuria are findings of mild
preeclampsia, not severe.
3 — Antepartum pharmacology (Multiple choice)
A pregnant client with gestational diabetes is started on insulin
therapy. Which statement by the client indicates correct
understanding?
A. “I’ll take insulin only when I eat carbohydrates.”
B. “Insulin does not cross the placenta, so it’s safe for my baby.”
C. “I’ll stop insulin after I give birth because glucose intolerance
always resolves right away.”
D. “Oral hypoglycemic agents are preferred because they’re
easier than injections.”
, Correct answer: B.
Rationale (correct): Insulin molecules are large and do not cross
the placenta; therefore insulin therapy controls maternal
glycemia without directly exposing the fetus to the drug. This
reduces fetal hyperinsulinemia risk from maternal
hyperglycemia.
Why others are incorrect:
A. Insulin dosing regimens vary; some require basal plus bolus—
“only when I eat” oversimplifies and risks hyper/hypoglycemia.
C. Some women’s glucose tolerance normalizes postpartum, but
not always immediately; follow-up testing is required.
D. Some oral agents cross the placenta and are not first-line in
pregnancy; insulin is the recommended standard when
diet/exercise insufficient.
4 — Prenatal education / Rh incompatibility (Multiple choice)
An Rh-negative mother with a previously sensitized pregnancy
is scheduled for a fetal blood sampling. Which maternal
intervention reduces risk of alloimmunization?
A. Administer Rho(D) immune globulin at 34–36 weeks only.
B. Administer Rho(D) immune globulin within 72 hours of any
invasive event if indicated.
C. Give maternal high-dose corticosteroids before sampling.
D. No intervention—alloimmunization can’t be prevented after
sensitization.
