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 — Initial prenatal labs
A 28-year-old gravida 1, para 0 presents for her first prenatal
visit at 8 weeks’ gestation. Which laboratory test result most
directly identifies a fetal risk that can be prevented by
administering a specific medication to the mother?
A. Rubella IgG positive
B. Maternal blood type O, antibody screen negative
C. Rubella IgM positive
D. Maternal RPR (syphilis) nonreactive
Answer: B. Maternal blood type O, antibody screen negative
Rationale (correct): A maternal blood type (O vs non-O) paired
with an antibody screen identifies Rh status and
alloimmunization risk. A mother who is Rh-negative with a
,negative antibody screen is a candidate for Rho(D) immune
globulin prophylaxis (e.g., at 28 weeks and within 72 hours
postpartum if infant Rh-positive). This prevents maternal anti-D
IgG formation, avoiding hemolytic disease of the fetus/newborn
(erythroblastosis fetalis). Even though the option states blood
type O (which may be Rh positive or negative), the key is
screening for alloantibodies; a negative screen plus an Rh-
negative mother is the scenario where prophylaxis prevents
harmful maternal IgG crossing the placenta and causing fetal
hemolysis.
Rationale (incorrect):
A. Rubella IgG positive — Indicates maternal immunity; no
preventive medication is given, and immunity protects the
fetus. Not a preventable risk requiring medication.
C. Rubella IgM positive — Suggests acute infection; there is no
maternal medication to prevent fetal teratogenesis, and often
counseling about risks and possible pregnancy termination is
required.
D. RPR nonreactive — Rules out syphilis; again no specific
prophylactic medication required.
2. Antepartum — Fundal height discrepancy
At 30 weeks’ gestation, fundal height measures 34 cm (greater
than expected). Which next step is most appropriate?
A. Schedule repeat measurement in 4 weeks.
B. Order a transvaginal ultrasound immediately.
,C. Obtain an ultrasound to assess fetal growth and amniotic
fluid volume.
D. Start magnesium sulfate for neuroprotection.
Answer: C. Obtain an ultrasound to assess fetal growth and
amniotic fluid volume.
Rationale (correct): A fundal height greater than expected
suggests macrosomia, multiple gestation, or polyhydramnios.
Ultrasound assessment of fetal biometry and amniotic fluid
index (AFI) differentiates these. Early identification guides
management (e.g., screen for gestational diabetes if
macrosomia, manage polyhydramnios). Ultrasound is an
appropriate diagnostic step at 30 weeks.
Rationale (incorrect):
A. Repeat in 4 weeks — Delays evaluation; discrepancy already
larger than expected and requires prompt assessment.
B. Transvaginal ultrasound — Not necessary for fetal growth or
AFI; abdominal ultrasound is appropriate at 30 weeks.
D. Start magnesium sulfate — Used for fetal neuroprotection
<32 weeks or for eclampsia seizure prophylaxis; not indicated
solely for fundal height discrepancy.
3. High-risk — Gestational diabetes screening
A 26-year-old pregnant client at 28 weeks’ gestation returns for
a 1-hour 50-g oral glucose screening test and has a plasma
glucose of 155 mg/dL. What is the best next action?
, A. Diagnose gestational diabetes and start insulin.
B. Perform a diagnostic 3-hour 100-g oral glucose tolerance test
(OGTT).
C. Reassure and repeat the 1-hour screen in 2 weeks.
D. Begin dietary carbohydrate restriction and exercise without
further testing.
Answer: B. Perform a diagnostic 3-hour 100-g OGTT.
Rationale (correct): A 1-hour screening value ≥140–152 mg/dL
(cutoffs vary by protocol; many use 140 or 130–140) is
considered abnormal and requires a diagnostic 3-hour OGTT.
Confirmatory testing distinguishes true GDM from false
positives. This is physiologically important because untreated
maternal hyperglycemia causes fetal hyperinsulinemia,
macrosomia, and neonatal hypoglycemia.
Rationale (incorrect):
A. Diagnose and start insulin — Premature without
confirmatory test; first-line therapy typically begins with
diet/exercise unless hyperglycemia is severe.
C. Reassure and repeat — Not appropriate; abnormal screen
requires diagnostic testing, not delay.
D. Start diet/exercise without testing — May be reasonable if
diagnostic testing unavailable, but standard of care is
confirmatory OGTT prior to definitive treatment.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1. Antepartum — Initial prenatal labs
A 28-year-old gravida 1, para 0 presents for her first prenatal
visit at 8 weeks’ gestation. Which laboratory test result most
directly identifies a fetal risk that can be prevented by
administering a specific medication to the mother?
A. Rubella IgG positive
B. Maternal blood type O, antibody screen negative
C. Rubella IgM positive
D. Maternal RPR (syphilis) nonreactive
Answer: B. Maternal blood type O, antibody screen negative
Rationale (correct): A maternal blood type (O vs non-O) paired
with an antibody screen identifies Rh status and
alloimmunization risk. A mother who is Rh-negative with a
,negative antibody screen is a candidate for Rho(D) immune
globulin prophylaxis (e.g., at 28 weeks and within 72 hours
postpartum if infant Rh-positive). This prevents maternal anti-D
IgG formation, avoiding hemolytic disease of the fetus/newborn
(erythroblastosis fetalis). Even though the option states blood
type O (which may be Rh positive or negative), the key is
screening for alloantibodies; a negative screen plus an Rh-
negative mother is the scenario where prophylaxis prevents
harmful maternal IgG crossing the placenta and causing fetal
hemolysis.
Rationale (incorrect):
A. Rubella IgG positive — Indicates maternal immunity; no
preventive medication is given, and immunity protects the
fetus. Not a preventable risk requiring medication.
C. Rubella IgM positive — Suggests acute infection; there is no
maternal medication to prevent fetal teratogenesis, and often
counseling about risks and possible pregnancy termination is
required.
D. RPR nonreactive — Rules out syphilis; again no specific
prophylactic medication required.
2. Antepartum — Fundal height discrepancy
At 30 weeks’ gestation, fundal height measures 34 cm (greater
than expected). Which next step is most appropriate?
A. Schedule repeat measurement in 4 weeks.
B. Order a transvaginal ultrasound immediately.
,C. Obtain an ultrasound to assess fetal growth and amniotic
fluid volume.
D. Start magnesium sulfate for neuroprotection.
Answer: C. Obtain an ultrasound to assess fetal growth and
amniotic fluid volume.
Rationale (correct): A fundal height greater than expected
suggests macrosomia, multiple gestation, or polyhydramnios.
Ultrasound assessment of fetal biometry and amniotic fluid
index (AFI) differentiates these. Early identification guides
management (e.g., screen for gestational diabetes if
macrosomia, manage polyhydramnios). Ultrasound is an
appropriate diagnostic step at 30 weeks.
Rationale (incorrect):
A. Repeat in 4 weeks — Delays evaluation; discrepancy already
larger than expected and requires prompt assessment.
B. Transvaginal ultrasound — Not necessary for fetal growth or
AFI; abdominal ultrasound is appropriate at 30 weeks.
D. Start magnesium sulfate — Used for fetal neuroprotection
<32 weeks or for eclampsia seizure prophylaxis; not indicated
solely for fundal height discrepancy.
3. High-risk — Gestational diabetes screening
A 26-year-old pregnant client at 28 weeks’ gestation returns for
a 1-hour 50-g oral glucose screening test and has a plasma
glucose of 155 mg/dL. What is the best next action?
, A. Diagnose gestational diabetes and start insulin.
B. Perform a diagnostic 3-hour 100-g oral glucose tolerance test
(OGTT).
C. Reassure and repeat the 1-hour screen in 2 weeks.
D. Begin dietary carbohydrate restriction and exercise without
further testing.
Answer: B. Perform a diagnostic 3-hour 100-g OGTT.
Rationale (correct): A 1-hour screening value ≥140–152 mg/dL
(cutoffs vary by protocol; many use 140 or 130–140) is
considered abnormal and requires a diagnostic 3-hour OGTT.
Confirmatory testing distinguishes true GDM from false
positives. This is physiologically important because untreated
maternal hyperglycemia causes fetal hyperinsulinemia,
macrosomia, and neonatal hypoglycemia.
Rationale (incorrect):
A. Diagnose and start insulin — Premature without
confirmatory test; first-line therapy typically begins with
diet/exercise unless hyperglycemia is severe.
C. Reassure and repeat — Not appropriate; abnormal screen
requires diagnostic testing, not delay.
D. Start diet/exercise without testing — May be reasonable if
diagnostic testing unavailable, but standard of care is
confirmatory OGTT prior to definitive treatment.
