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
Standalone NCLEX-style items (1–14)
1 — Antepartum assessment (multiple choice)
A 28-year-old G2P1001 at 28 weeks’ gestation presents for a
routine visit. She reports decreased fetal movement over the
past 24 hours. Which initial nursing action is best?
A. Notify the provider immediately and prepare for an urgent
ultrasound.
B. Instruct the client to perform a fetal movement (kick) count
using a standardized method (e.g., 10 movements in 2 hours).
(Correct)
C. Reassure the client that decreased movement is common
and will resolve.
D. Offer a glucose drink and advise the client to come back in a
week.
,Correct answer: B
Rationale — correct (B): A standardized fetal movement count
is the recommended first-line screening method for reduced
fetal movement in a stable outpatient; it is noninvasive and
helps quantify concern. Physiologically, decreased movement
can indicate fetal sleep cycle or early compromise (hypoxia →
reduced fetal activity). Kick counts help identify fetuses at risk
of compromise so timely further evaluation (NST, BPP,
ultrasound) can occur.
Why others are wrong:
A — Not first action for decreased movement unless non-
reassuring findings after kick counts or NST/BPP; immediate
ultrasound may be premature.
C — Dismissing decreased movement risks missing fetal
compromise.
D — A glucose drink can stimulate fetal activity but advising
return in a week delays care; immediate kick counting or NST is
preferred.
2 — High-risk pregnancy: preeclampsia (SATA — select all that
apply)
Which findings are consistent with a diagnosis of severe
preeclampsia? (Select all that apply.)
A. BP 170/110 mm Hg. (Correct)
B. Proteinuria 1+ on dipstick.
,C. New onset visual disturbances (blurry vision). (Correct)
D. Platelets 85,000/mm³. (Correct)
E. Fundal height measuring 2 cm greater than dates.
Correct answers: A, C, D
Rationale — correct options:
A — Severe range blood pressure (≥160/110) reflects severe
preeclampsia and increased risk for end-organ damage;
maternal systemic vasospasm results from placental ischemia
and release of antiangiogenic factors.
C — Neuro symptoms (visual disturbance, headache) indicate
cerebral vasospasm/ischemia and are criteria for severe
disease.
D — Thrombocytopenia (<100,000) may occur due to
endothelial injury and consumption (HELLP spectrum), a severe
feature.
Why incorrect:
B — 1+ dipstick is mild and alone is insufficient; proteinuria
diagnosis uses 24-hour collection or protein/creatinine ratio;
severe disease has end-organ signs.
E — Increased fundal height suggests polyhydramnios or
growth anomaly, not diagnostic of severe preeclampsia.
3 — Prenatal education (multiple choice)
A primigravida asks why folic acid is recommended before
conception and in early pregnancy. The nurse explains the most
, important purpose is to:
A. Prevent maternal anemia from iron deficiency.
B. Decrease risk of neural tube defects (spina bifida,
anencephaly). (Correct)
C. Lower the chance of preeclampsia.
D. Promote adequate fetal weight gain.
Correct answer: B
Rationale — correct (B): Folic acid (400–800 mcg daily
preconception and in early pregnancy) is critical for neural tube
closure in the first 3–4 weeks post-conception; folate deficiency
increases risk of neural tube defects. This is embryologic —
neural tube forms early before many women know they are
pregnant.
Why others are wrong:
A — Iron prevents iron-deficiency anemia; folic acid is not the
primary iron treatment.
C — No strong evidence that folic acid prevents preeclampsia.
D — Folate contributes to cell division but is not the main
determinant of fetal weight.
4 — Gestational diabetes screening/management (multiple
choice)
At 26 weeks a client has a 1-hour glucose screen of 190 mg/dL.
What is the nurse’s best action?
A. Begin insulin immediately and teach injection technique.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
Standalone NCLEX-style items (1–14)
1 — Antepartum assessment (multiple choice)
A 28-year-old G2P1001 at 28 weeks’ gestation presents for a
routine visit. She reports decreased fetal movement over the
past 24 hours. Which initial nursing action is best?
A. Notify the provider immediately and prepare for an urgent
ultrasound.
B. Instruct the client to perform a fetal movement (kick) count
using a standardized method (e.g., 10 movements in 2 hours).
(Correct)
C. Reassure the client that decreased movement is common
and will resolve.
D. Offer a glucose drink and advise the client to come back in a
week.
,Correct answer: B
Rationale — correct (B): A standardized fetal movement count
is the recommended first-line screening method for reduced
fetal movement in a stable outpatient; it is noninvasive and
helps quantify concern. Physiologically, decreased movement
can indicate fetal sleep cycle or early compromise (hypoxia →
reduced fetal activity). Kick counts help identify fetuses at risk
of compromise so timely further evaluation (NST, BPP,
ultrasound) can occur.
Why others are wrong:
A — Not first action for decreased movement unless non-
reassuring findings after kick counts or NST/BPP; immediate
ultrasound may be premature.
C — Dismissing decreased movement risks missing fetal
compromise.
D — A glucose drink can stimulate fetal activity but advising
return in a week delays care; immediate kick counting or NST is
preferred.
2 — High-risk pregnancy: preeclampsia (SATA — select all that
apply)
Which findings are consistent with a diagnosis of severe
preeclampsia? (Select all that apply.)
A. BP 170/110 mm Hg. (Correct)
B. Proteinuria 1+ on dipstick.
,C. New onset visual disturbances (blurry vision). (Correct)
D. Platelets 85,000/mm³. (Correct)
E. Fundal height measuring 2 cm greater than dates.
Correct answers: A, C, D
Rationale — correct options:
A — Severe range blood pressure (≥160/110) reflects severe
preeclampsia and increased risk for end-organ damage;
maternal systemic vasospasm results from placental ischemia
and release of antiangiogenic factors.
C — Neuro symptoms (visual disturbance, headache) indicate
cerebral vasospasm/ischemia and are criteria for severe
disease.
D — Thrombocytopenia (<100,000) may occur due to
endothelial injury and consumption (HELLP spectrum), a severe
feature.
Why incorrect:
B — 1+ dipstick is mild and alone is insufficient; proteinuria
diagnosis uses 24-hour collection or protein/creatinine ratio;
severe disease has end-organ signs.
E — Increased fundal height suggests polyhydramnios or
growth anomaly, not diagnostic of severe preeclampsia.
3 — Prenatal education (multiple choice)
A primigravida asks why folic acid is recommended before
conception and in early pregnancy. The nurse explains the most
, important purpose is to:
A. Prevent maternal anemia from iron deficiency.
B. Decrease risk of neural tube defects (spina bifida,
anencephaly). (Correct)
C. Lower the chance of preeclampsia.
D. Promote adequate fetal weight gain.
Correct answer: B
Rationale — correct (B): Folic acid (400–800 mcg daily
preconception and in early pregnancy) is critical for neural tube
closure in the first 3–4 weeks post-conception; folate deficiency
increases risk of neural tube defects. This is embryologic —
neural tube forms early before many women know they are
pregnant.
Why others are wrong:
A — Iron prevents iron-deficiency anemia; folic acid is not the
primary iron treatment.
C — No strong evidence that folic acid prevents preeclampsia.
D — Folate contributes to cell division but is not the main
determinant of fetal weight.
4 — Gestational diabetes screening/management (multiple
choice)
At 26 weeks a client has a 1-hour glucose screen of 190 mg/dL.
What is the nurse’s best action?
A. Begin insulin immediately and teach injection technique.
