MATERNAL AND CHILD HEALTH NURSING BY
SILBERT 2026 COMPREHENSIVE ASSESSMENT
SCRIPT SOLVED QUESTIONS ANSWERS
UPDATED REVIEW SET
◉ A postpartum client who is Rh-negative refuses to receive Rho (D)
immune globulin (RhoGam) after delivery of an infant who is Rh-
positive. Which information should the nure provide this client?
A. RhoGam is not necessary unless all her pregnancies are Rh-
positive
B. The R-positive factor from the fetus threatens her blood cells
C. The mother should receive RhoGam when the baby is Rh-negative
D. RhoGam prevents maternal antibody formation for future Rh-
positive babies
Answer: D. RhoGam prevents maternal antibody formation for
future Rh-positive babies
◉ A 6-week-old infant diagnosed with pyloric stenosis has recently
developed projectile vomiting. Which assessment finding indicates
to the nurse that the infant is becoming dehydrated?
A. Weak cry without any tears
B. Bulging fontanel
,C. Visible peristaltic wave.
D. Palpable mass in the right upper quadrant
Answer: A. Weak cry without any tears
◉ A full-term, 24-hour-old infant in the nursery regurgitates and
suddenly turns cyanotic. What should the nurse do first?
A. Suction the oral and nasal passages
B. Give oxygen by positive pressure
C. Stimulate the infant to cry
D. Turn the infant onto the right side
Answer: C. Stimulate the infant to cry
◉ A client at 40-weeks' gestation presents to the obstetrical floor
and indicates that the amniotic membranes ruptured spontaneously
at home. She is in active labor and feels the need to bear down and
push. What information is most important for the nurse to obtain
first?
A. the estimated amount of fluid
B. time the membranes ruptured
C. color and consistency of the fluid
D. any odor noted when membranes ruptured.
Answer: C. color and consistency of the fluid
,◉ An infant with tetralogy of Fallot becomes acutely cyanotic and
hyper apneic. Which action should the nurse implement first?A.
Administer morphine sulphate.
B. Start IV fluids.
C. Place the infant in a knee-chest position
D. Provide 100% oxygen by face mask.
Answer: C. Place the infant in a knee-chest position
◉ A one-day-old neonate develops a cephalohematoma. The nurse
should closely assess this neonate for which common complication?
A. jaundice
B. poor appetite
C. brain damage
D. hypoglycemia
Answer: A. jaundice
◉ The nurse is reviewing the serum laboratory finding for a 5-day-
old infant with congenital adrenal hyperplasia. Which laboratory
results should be reported to the healthcare provider immediatly?
A. Bilirubin of 1.5 mg/dl
B. Glucose of 80 mg/dl
C. Potassium of 4.5 mEq/L
D. Sodium of 119 mEq/L
, Answer: D. Sodium of 119 mEq/L
◉ At 39-weeks gestation, a multigravida is having a non-stress test
(NST). The fetal heart rate (FHR) has remained nonreactive during
the 30 minutes of evaluation. Based on this finding, which action
should the nurse implement?
A. Initiate an intravenous infusion
B. Observe the FHR pattern for 30 more minutes
C. Schedule a biophysical profile
D. Place an acoustic stimulator on the abdomen
Answer: D. Place an acoustic stimulator on the abdomen
◉ A community health nurse visits a family in which a 16-year-old
unmarried daughter is pregnant with her first child and is at 32-
weeks gestation. The client tells the nurse that she has been having
intermittent back pain since the night before. What is the priority
nursing intervention?
A. Ask the clients mother to call an ambulance for transport to the
hospital immediately.
B. Determine what physical activities the client has performed for
the past 24 hours
C. Teach the client if she has experienced any recent changes in
vaginal discharge.
Answer: C. Teach the client if she has experienced any recent
changes in vaginal discharge.
SILBERT 2026 COMPREHENSIVE ASSESSMENT
SCRIPT SOLVED QUESTIONS ANSWERS
UPDATED REVIEW SET
◉ A postpartum client who is Rh-negative refuses to receive Rho (D)
immune globulin (RhoGam) after delivery of an infant who is Rh-
positive. Which information should the nure provide this client?
A. RhoGam is not necessary unless all her pregnancies are Rh-
positive
B. The R-positive factor from the fetus threatens her blood cells
C. The mother should receive RhoGam when the baby is Rh-negative
D. RhoGam prevents maternal antibody formation for future Rh-
positive babies
Answer: D. RhoGam prevents maternal antibody formation for
future Rh-positive babies
◉ A 6-week-old infant diagnosed with pyloric stenosis has recently
developed projectile vomiting. Which assessment finding indicates
to the nurse that the infant is becoming dehydrated?
A. Weak cry without any tears
B. Bulging fontanel
,C. Visible peristaltic wave.
D. Palpable mass in the right upper quadrant
Answer: A. Weak cry without any tears
◉ A full-term, 24-hour-old infant in the nursery regurgitates and
suddenly turns cyanotic. What should the nurse do first?
A. Suction the oral and nasal passages
B. Give oxygen by positive pressure
C. Stimulate the infant to cry
D. Turn the infant onto the right side
Answer: C. Stimulate the infant to cry
◉ A client at 40-weeks' gestation presents to the obstetrical floor
and indicates that the amniotic membranes ruptured spontaneously
at home. She is in active labor and feels the need to bear down and
push. What information is most important for the nurse to obtain
first?
A. the estimated amount of fluid
B. time the membranes ruptured
C. color and consistency of the fluid
D. any odor noted when membranes ruptured.
Answer: C. color and consistency of the fluid
,◉ An infant with tetralogy of Fallot becomes acutely cyanotic and
hyper apneic. Which action should the nurse implement first?A.
Administer morphine sulphate.
B. Start IV fluids.
C. Place the infant in a knee-chest position
D. Provide 100% oxygen by face mask.
Answer: C. Place the infant in a knee-chest position
◉ A one-day-old neonate develops a cephalohematoma. The nurse
should closely assess this neonate for which common complication?
A. jaundice
B. poor appetite
C. brain damage
D. hypoglycemia
Answer: A. jaundice
◉ The nurse is reviewing the serum laboratory finding for a 5-day-
old infant with congenital adrenal hyperplasia. Which laboratory
results should be reported to the healthcare provider immediatly?
A. Bilirubin of 1.5 mg/dl
B. Glucose of 80 mg/dl
C. Potassium of 4.5 mEq/L
D. Sodium of 119 mEq/L
, Answer: D. Sodium of 119 mEq/L
◉ At 39-weeks gestation, a multigravida is having a non-stress test
(NST). The fetal heart rate (FHR) has remained nonreactive during
the 30 minutes of evaluation. Based on this finding, which action
should the nurse implement?
A. Initiate an intravenous infusion
B. Observe the FHR pattern for 30 more minutes
C. Schedule a biophysical profile
D. Place an acoustic stimulator on the abdomen
Answer: D. Place an acoustic stimulator on the abdomen
◉ A community health nurse visits a family in which a 16-year-old
unmarried daughter is pregnant with her first child and is at 32-
weeks gestation. The client tells the nurse that she has been having
intermittent back pain since the night before. What is the priority
nursing intervention?
A. Ask the clients mother to call an ambulance for transport to the
hospital immediately.
B. Determine what physical activities the client has performed for
the past 24 hours
C. Teach the client if she has experienced any recent changes in
vaginal discharge.
Answer: C. Teach the client if she has experienced any recent
changes in vaginal discharge.
