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 — single best answer)
A 28-year-old primigravida at 36 weeks’ gestation presents to
the clinic reporting decreased fetal movement for the past 12
hours. She has no contractions, no bleeding, and no fever.
Which action should the nurse take first?
A. Instruct the client to increase fluid intake and return for
reassessment in 24 hours.
B. Perform a nonstress test (NST) and review fetal heart rate
accelerations.
C. Schedule a biophysical profile (BPP) for one week from today.
D. Reassure the client that decreased movement is common in
the third trimester.
Correct answer: B
,Rationale — why B is correct:
Decreased fetal movement (especially a new onset decrease ≥
12 hours) is a red flag for possible fetal hypoxia or compromise
and requires immediate noninvasive assessment. An NST
evaluates fetal heart rate (FHR) reactivity to fetal movement
and can rapidly identify a reactive (reassuring) versus
nonreactive (potential compromise) pattern. Physiologically,
fetal movement correlates with intact CNS oxygenation and
energy stores; decreased movement may reflect decreased fetal
oxygenation or sleep cycles, so objective testing is needed.
Why A is incorrect:
Telling the client to increase fluids and return in 24 hours delays
evaluation. While maternal hydration and meals can sometimes
increase fetal activity (and “kick counts” protocols may instruct
this as immediate home step), an in-clinic NST is the priority for
an acute report of decreased movement.
Why C is incorrect:
Scheduling a BPP a week later is too delayed for an acute
change. A BPP may be indicated if the NST is nonreactive, but
initial immediate testing is the NST.
Why D is incorrect:
Downplaying the symptom is unsafe. Although fetal movement
patterns change across pregnancy, new decrease warrants
assessment. Clinically we must rule out fetal compromise.
,2 (High-risk pregnancy — preeclampsia; single best answer)
A client at 35 weeks’ gestation has blood pressure readings of
156/102 mm Hg and 160/104 mm Hg taken 4 hours apart, 2+
protein on urine dipstick, and 3+ edema of the lower
extremities. Which lab/result should most directly influence the
decision to deliver immediately?
A. Platelet count 120,000/mm³.
B. Hematocrit 34%.
C. Liver enzymes (AST/ALT) within normal limits.
D. 24-hour urine protein = 0.3 g.
Correct answer: A
Rationale — why A is correct:
Severe preeclampsia with thrombocytopenia (platelets
<100,000/mm³ often signals HELLP risk) is an indication for
prompt delivery depending on gestation and maternal/fetal
status because low platelets increase risk of maternal
hemorrhage and complicate anesthesia/operative delivery.
Platelet count 120,000 is concerning (mild thrombocytopenia)
and trending downward may prompt expedited delivery.
Pathophysiology: preeclampsia is mediated by abnormal
placentation → systemic endothelial dysfunction → platelet
activation/consumption and microangiopathic changes that
reduce platelet count.
, Why B is incorrect:
Hematocrit 34% is within near-normal range and does not by
itself necessitate immediate delivery.
Why C is incorrect:
Normal liver enzymes are reassuring; elevated AST/ALT would
be concerning for severe disease/HELLP and may push toward
delivery, but normal values do not argue for immediate delivery.
Why D is incorrect:
A 24-hour urine protein of 0.3 g (300 mg) meets the old
diagnostic threshold for proteinuria (≥300 mg/24 hr) but by
itself — especially with stable labs and fetal status — does not
automatically require immediate delivery. The decision is based
on overall maternal/fetal condition and severe features (BP
levels, end-organ dysfunction, platelet count, AST/ALT,
creatinine).
3 (Prenatal education — select-all-that-apply NGN style)
NGN — Case: A 22-year-old primigravida at 12 weeks comes to
the prenatal clinic for education. She asks which behaviors
reduce risk of neural tube defects and improve fetal
development. Select all that apply.
A. Begin folic acid 400–800 mcg daily (if not already).
B. Stop all forms of alcohol immediately and avoid thereafter.
C. Begin daily aspirin 81 mg to prevent neural tube defects.
D. Avoid high fevers in early pregnancy; seek care for febrile
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 (Antepartum assessment — single best answer)
A 28-year-old primigravida at 36 weeks’ gestation presents to
the clinic reporting decreased fetal movement for the past 12
hours. She has no contractions, no bleeding, and no fever.
Which action should the nurse take first?
A. Instruct the client to increase fluid intake and return for
reassessment in 24 hours.
B. Perform a nonstress test (NST) and review fetal heart rate
accelerations.
C. Schedule a biophysical profile (BPP) for one week from today.
D. Reassure the client that decreased movement is common in
the third trimester.
Correct answer: B
,Rationale — why B is correct:
Decreased fetal movement (especially a new onset decrease ≥
12 hours) is a red flag for possible fetal hypoxia or compromise
and requires immediate noninvasive assessment. An NST
evaluates fetal heart rate (FHR) reactivity to fetal movement
and can rapidly identify a reactive (reassuring) versus
nonreactive (potential compromise) pattern. Physiologically,
fetal movement correlates with intact CNS oxygenation and
energy stores; decreased movement may reflect decreased fetal
oxygenation or sleep cycles, so objective testing is needed.
Why A is incorrect:
Telling the client to increase fluids and return in 24 hours delays
evaluation. While maternal hydration and meals can sometimes
increase fetal activity (and “kick counts” protocols may instruct
this as immediate home step), an in-clinic NST is the priority for
an acute report of decreased movement.
Why C is incorrect:
Scheduling a BPP a week later is too delayed for an acute
change. A BPP may be indicated if the NST is nonreactive, but
initial immediate testing is the NST.
Why D is incorrect:
Downplaying the symptom is unsafe. Although fetal movement
patterns change across pregnancy, new decrease warrants
assessment. Clinically we must rule out fetal compromise.
,2 (High-risk pregnancy — preeclampsia; single best answer)
A client at 35 weeks’ gestation has blood pressure readings of
156/102 mm Hg and 160/104 mm Hg taken 4 hours apart, 2+
protein on urine dipstick, and 3+ edema of the lower
extremities. Which lab/result should most directly influence the
decision to deliver immediately?
A. Platelet count 120,000/mm³.
B. Hematocrit 34%.
C. Liver enzymes (AST/ALT) within normal limits.
D. 24-hour urine protein = 0.3 g.
Correct answer: A
Rationale — why A is correct:
Severe preeclampsia with thrombocytopenia (platelets
<100,000/mm³ often signals HELLP risk) is an indication for
prompt delivery depending on gestation and maternal/fetal
status because low platelets increase risk of maternal
hemorrhage and complicate anesthesia/operative delivery.
Platelet count 120,000 is concerning (mild thrombocytopenia)
and trending downward may prompt expedited delivery.
Pathophysiology: preeclampsia is mediated by abnormal
placentation → systemic endothelial dysfunction → platelet
activation/consumption and microangiopathic changes that
reduce platelet count.
, Why B is incorrect:
Hematocrit 34% is within near-normal range and does not by
itself necessitate immediate delivery.
Why C is incorrect:
Normal liver enzymes are reassuring; elevated AST/ALT would
be concerning for severe disease/HELLP and may push toward
delivery, but normal values do not argue for immediate delivery.
Why D is incorrect:
A 24-hour urine protein of 0.3 g (300 mg) meets the old
diagnostic threshold for proteinuria (≥300 mg/24 hr) but by
itself — especially with stable labs and fetal status — does not
automatically require immediate delivery. The decision is based
on overall maternal/fetal condition and severe features (BP
levels, end-organ dysfunction, platelet count, AST/ALT,
creatinine).
3 (Prenatal education — select-all-that-apply NGN style)
NGN — Case: A 22-year-old primigravida at 12 weeks comes to
the prenatal clinic for education. She asks which behaviors
reduce risk of neural tube defects and improve fetal
development. Select all that apply.
A. Begin folic acid 400–800 mcg daily (if not already).
B. Stop all forms of alcohol immediately and avoid thereafter.
C. Begin daily aspirin 81 mg to prevent neural tube defects.
D. Avoid high fevers in early pregnancy; seek care for febrile
