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 — Fundal height discrepancy in the third trimester
A 32-week-gestation primigravida returns for an antepartum
visit. Her fundal height measures 36 cm (greater than
expected). Which of the following is the most appropriate next
nursing action?
A. Reassure the client that this is normal variation and schedule
routine follow up in 4 weeks.
B. Ask about fetal movement and perform a bedside ultrasound
to assess fetal size and amniotic fluid volume.
C. Instruct the client to increase oral fluids and return if
contractions begin.
D. Immediately prepare the client for an induction of labor for
suspected macrosomia.
Correct answer: B.
,Rationale — correct (B): A fundal height larger than expected
for gestational age at 32 weeks can indicate fetal macrosomia,
multiple gestation, polyhydramnios, or
instrumentation/measurement error. The nurse should further
assess — ask about fetal movement (fetal well-being), and
obtain ultrasound to evaluate fetal size, number, and amniotic
fluid index (AFI). Ultrasound differentiates fetal growth versus
polyhydramnios and directs management. Physiologically,
excess fundal height reflects increased uterine volume from
extra fluid, extra fetal mass, or more than one fetus, so imaging
is the next step.
Rationale — incorrect choices:
A. Reassurance without further assessment risks missing
pathology (e.g., polyhydramnios or twins).
C. Increasing fluids targets dehydration and oligohydramnios,
not conditions that enlarge fundal height; it delays needed
assessment.
D. Immediate induction is inappropriate — induction is a
delivery intervention and requires clear clinical indications and
fetal maturity; macrosomia is confirmed with assessment, not
presumed.
2 — Preeclampsia: priority assessment and rationale
A primigravida at 35 weeks’ gestation is admitted with new-
onset hypertension and proteinuria. Which maternal finding is
the highest priority for immediate reporting to the provider?
,A. Weight gain of 1 kg (2.2 lb) in the past week.
B. Complaint of persistent right-upper-quadrant headache
unrelieved by acetaminophen.
C. Mild ankle edema that resolves with elevation.
D. Urine protein dipstick reading +1.
Correct answer: B.
Rationale — correct (B): In preeclampsia, severe headache,
especially persistent and unresponsive to analgesics, may
indicate cerebral involvement (cerebral edema, impending
eclampsia). This represents a neurologic sign of severe disease
and is an immediate safety concern. Pathophysiology: systemic
endothelial dysfunction and vasospasm reduce cerebral
perfusion and may trigger seizures. Immediate reporting allows
for expedited magnesium sulfate prophylaxis and further
evaluation.
Rationale — incorrect choices:
A. Rapid weight gain suggests fluid retention but is less specific
and not as emergent as neurologic symptoms.
C. Mild dependent edema is common in pregnancy; when it’s
isolated and non-progressive, it’s less specific for severe
preeclampsia.
D. +1 proteinuria indicates some renal involvement but is not as
urgent as a neurological sign; management depends on overall
severity and trends.
, 3 — Rho(D) immune globulin (RhIG) teaching
A pregnant client who is Rh-negative asks when Rho(D) immune
globulin is given during pregnancy. Which statement by the
nurse is most accurate?
A. “Rho(D) immune globulin is given only after delivery if your
baby is Rh-positive.”
B. “You should receive Rho(D) immune globulin at 28 weeks and
again after any potential fetal-maternal bleeding.”
C. “If you and the father are both Rh-negative, you still need
Rho(D) immune globulin.”
D. “Rho(D) immune globulin is given to protect the baby from
congenital anomalies.”
Correct answer: B.
Rationale — correct (B): Prophylactic RhIG is typically
administered at ~28 weeks gestation to prevent maternal
alloimmunization and then again postpartum if the neonate is
Rh-positive or after any event that could cause fetal-maternal
hemorrhage (e.g., amniocentesis, trauma). Physiology: if an Rh-
negative mother is exposed to Rh-positive fetal RBCs, she can
develop anti-D antibodies that cross the placenta in future
pregnancies and cause hemolytic disease of the fetus/newborn.
RhIG provides passive anti-D antibodies that neutralize fetal
RBCs before maternal sensitization.
Rationale — incorrect choices:
A. Giving only after delivery misses the antenatal prophylaxis
that reduces sensitization risk.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Fundal height discrepancy in the third trimester
A 32-week-gestation primigravida returns for an antepartum
visit. Her fundal height measures 36 cm (greater than
expected). Which of the following is the most appropriate next
nursing action?
A. Reassure the client that this is normal variation and schedule
routine follow up in 4 weeks.
B. Ask about fetal movement and perform a bedside ultrasound
to assess fetal size and amniotic fluid volume.
C. Instruct the client to increase oral fluids and return if
contractions begin.
D. Immediately prepare the client for an induction of labor for
suspected macrosomia.
Correct answer: B.
,Rationale — correct (B): A fundal height larger than expected
for gestational age at 32 weeks can indicate fetal macrosomia,
multiple gestation, polyhydramnios, or
instrumentation/measurement error. The nurse should further
assess — ask about fetal movement (fetal well-being), and
obtain ultrasound to evaluate fetal size, number, and amniotic
fluid index (AFI). Ultrasound differentiates fetal growth versus
polyhydramnios and directs management. Physiologically,
excess fundal height reflects increased uterine volume from
extra fluid, extra fetal mass, or more than one fetus, so imaging
is the next step.
Rationale — incorrect choices:
A. Reassurance without further assessment risks missing
pathology (e.g., polyhydramnios or twins).
C. Increasing fluids targets dehydration and oligohydramnios,
not conditions that enlarge fundal height; it delays needed
assessment.
D. Immediate induction is inappropriate — induction is a
delivery intervention and requires clear clinical indications and
fetal maturity; macrosomia is confirmed with assessment, not
presumed.
2 — Preeclampsia: priority assessment and rationale
A primigravida at 35 weeks’ gestation is admitted with new-
onset hypertension and proteinuria. Which maternal finding is
the highest priority for immediate reporting to the provider?
,A. Weight gain of 1 kg (2.2 lb) in the past week.
B. Complaint of persistent right-upper-quadrant headache
unrelieved by acetaminophen.
C. Mild ankle edema that resolves with elevation.
D. Urine protein dipstick reading +1.
Correct answer: B.
Rationale — correct (B): In preeclampsia, severe headache,
especially persistent and unresponsive to analgesics, may
indicate cerebral involvement (cerebral edema, impending
eclampsia). This represents a neurologic sign of severe disease
and is an immediate safety concern. Pathophysiology: systemic
endothelial dysfunction and vasospasm reduce cerebral
perfusion and may trigger seizures. Immediate reporting allows
for expedited magnesium sulfate prophylaxis and further
evaluation.
Rationale — incorrect choices:
A. Rapid weight gain suggests fluid retention but is less specific
and not as emergent as neurologic symptoms.
C. Mild dependent edema is common in pregnancy; when it’s
isolated and non-progressive, it’s less specific for severe
preeclampsia.
D. +1 proteinuria indicates some renal involvement but is not as
urgent as a neurological sign; management depends on overall
severity and trends.
, 3 — Rho(D) immune globulin (RhIG) teaching
A pregnant client who is Rh-negative asks when Rho(D) immune
globulin is given during pregnancy. Which statement by the
nurse is most accurate?
A. “Rho(D) immune globulin is given only after delivery if your
baby is Rh-positive.”
B. “You should receive Rho(D) immune globulin at 28 weeks and
again after any potential fetal-maternal bleeding.”
C. “If you and the father are both Rh-negative, you still need
Rho(D) immune globulin.”
D. “Rho(D) immune globulin is given to protect the baby from
congenital anomalies.”
Correct answer: B.
Rationale — correct (B): Prophylactic RhIG is typically
administered at ~28 weeks gestation to prevent maternal
alloimmunization and then again postpartum if the neonate is
Rh-positive or after any event that could cause fetal-maternal
hemorrhage (e.g., amniocentesis, trauma). Physiology: if an Rh-
negative mother is exposed to Rh-positive fetal RBCs, she can
develop anti-D antibodies that cross the placenta in future
pregnancies and cause hemolytic disease of the fetus/newborn.
RhIG provides passive anti-D antibodies that neutralize fetal
RBCs before maternal sensitization.
Rationale — incorrect choices:
A. Giving only after delivery misses the antenatal prophylaxis
that reduces sensitization risk.
