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 lab interpretation
A 28-year-old primigravida at 10 weeks gestation has routine
prenatal labs: RBC mean corpuscular volume (MCV) = 72 fL
(low), hemoglobin 10.2 g/dL (low), ferritin 8 ng/mL (low).
Which action should the nurse prioritize?
A. Encourage increased dietary intake of red meat and green
leafy vegetables and repeat labs at next visit.
B. Start oral ferrous sulfate 325 mg once daily with vitamin C
and provide stool softener education. (Correct)
C. Refer for immediate blood transfusion due to severe anemia.
D. Order oral folic acid 1 mg daily only.
Rationale — Correct (B):
Findings indicate iron-deficiency anemia (low MCV, low Hgb,
low ferritin). Oral ferrous sulfate plus vitamin C (enhances iron
,absorption) is first-line therapy in pregnancy unless there are
contraindications. Maternal iron replacement increases
maternal hemoglobin and raises oxygen-carrying capacity,
reducing risk of fetal hypoxia and low birth weight. Ferrous
sulfate 325 mg daily (or every other day depending on
tolerance) is commonly used; stool softener advice can reduce
constipation.
Why A is incorrect: Dietary measures help but alone are
insufficient when ferritin is very low; pharmacologic iron
replacement is indicated now. Waiting risks worsening maternal
anemia and fetal oxygen delivery.
Why C is incorrect: Transfusion is reserved for hemodynamic
instability, severe symptomatic anemia, or Hgb levels much
lower than this with symptoms — not routine for a stable
patient with Hgb ~10.2 g/dL.
Why D is incorrect: Folic acid treats megaloblastic (macrocytic)
anemia and neural tube defect risk but does not correct iron-
deficiency anemia; folic acid alone would not address low
ferritin or microcytosis.
2 — High-risk: Preeclampsia recognition & physiology
A 34-year-old at 36 weeks gestation is admitted with BP
158/102 mm Hg on two readings 4 hours apart, +1 protein on
urine dip, and complaints of a severe frontal headache and
visual floaters. Which intervention should the nurse implement
,first?
A. Start oral nifedipine and schedule outpatient follow-up in 48
hours.
B. Administer magnesium sulfate IV bolus per protocol and
prepare for expedited delivery if severe features persist.
(Correct)
C. Instruct patient to rest and repeat BP in the morning.
D. Give a bolus of IV fluids to improve renal perfusion.
Rationale — Correct (B):
This patient meets criteria for preeclampsia with severe
features (BP ≥160/110 or end-organ symptoms like severe
headache, visual symptoms). Magnesium sulfate is used to
prevent eclamptic seizures (acts as a CNS depressant and
cerebral vasodilator). Preparing for delivery is appropriate
because the only definitive treatment for preeclampsia is
delivery; at 36 weeks, expedited delivery is often indicated
when severe features present. Prompt seizure prophylaxis and
maternal stabilization take priority.
Why A is incorrect: Oral nifedipine may be used for acute BP
control but management of severe preeclampsia requires
seizure prophylaxis (magnesium) and delivery planning;
outpatient follow-up is inappropriate.
Why C is incorrect: Waiting is unsafe — severe features
(headache/visual disturbance) warrant immediate inpatient
management.
, Why D is incorrect: Routine large fluid boluses are
contraindicated because preeclampsia often involves capillary
leak and risk of pulmonary edema; fluid management must be
cautious.
(Physiology note: In preeclampsia defective placentation and
abnormal spiral artery remodeling result in placental ischemia,
systemic endothelial dysfunction, vasoconstriction, and
increased vascular permeability — leading to hypertension, end-
organ ischemia, and risk of seizures.)
3 — Prenatal education: Rubella & teratogenic risk
A pregnant woman at 8 weeks asks whether she can receive the
MMR vaccine during pregnancy because she is not immune.
The best response is:
A. "Yes — it’s important to get vaccinated in pregnancy to
protect the fetus."
B. "No — MMR is a live attenuated vaccine and is
contraindicated in pregnancy; plan vaccination postpartum."
(Correct)
C. "You can have it now if you sign a consent form."
D. "You should take antiviral medication instead."
Rationale — Correct (B):
MMR is a live attenuated vaccine and is contraindicated during
pregnancy because of theoretical risk of vertical transmission. If
a woman is not immune to rubella, vaccination should be
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antepartum: Initial prenatal lab interpretation
A 28-year-old primigravida at 10 weeks gestation has routine
prenatal labs: RBC mean corpuscular volume (MCV) = 72 fL
(low), hemoglobin 10.2 g/dL (low), ferritin 8 ng/mL (low).
Which action should the nurse prioritize?
A. Encourage increased dietary intake of red meat and green
leafy vegetables and repeat labs at next visit.
B. Start oral ferrous sulfate 325 mg once daily with vitamin C
and provide stool softener education. (Correct)
C. Refer for immediate blood transfusion due to severe anemia.
D. Order oral folic acid 1 mg daily only.
Rationale — Correct (B):
Findings indicate iron-deficiency anemia (low MCV, low Hgb,
low ferritin). Oral ferrous sulfate plus vitamin C (enhances iron
,absorption) is first-line therapy in pregnancy unless there are
contraindications. Maternal iron replacement increases
maternal hemoglobin and raises oxygen-carrying capacity,
reducing risk of fetal hypoxia and low birth weight. Ferrous
sulfate 325 mg daily (or every other day depending on
tolerance) is commonly used; stool softener advice can reduce
constipation.
Why A is incorrect: Dietary measures help but alone are
insufficient when ferritin is very low; pharmacologic iron
replacement is indicated now. Waiting risks worsening maternal
anemia and fetal oxygen delivery.
Why C is incorrect: Transfusion is reserved for hemodynamic
instability, severe symptomatic anemia, or Hgb levels much
lower than this with symptoms — not routine for a stable
patient with Hgb ~10.2 g/dL.
Why D is incorrect: Folic acid treats megaloblastic (macrocytic)
anemia and neural tube defect risk but does not correct iron-
deficiency anemia; folic acid alone would not address low
ferritin or microcytosis.
2 — High-risk: Preeclampsia recognition & physiology
A 34-year-old at 36 weeks gestation is admitted with BP
158/102 mm Hg on two readings 4 hours apart, +1 protein on
urine dip, and complaints of a severe frontal headache and
visual floaters. Which intervention should the nurse implement
,first?
A. Start oral nifedipine and schedule outpatient follow-up in 48
hours.
B. Administer magnesium sulfate IV bolus per protocol and
prepare for expedited delivery if severe features persist.
(Correct)
C. Instruct patient to rest and repeat BP in the morning.
D. Give a bolus of IV fluids to improve renal perfusion.
Rationale — Correct (B):
This patient meets criteria for preeclampsia with severe
features (BP ≥160/110 or end-organ symptoms like severe
headache, visual symptoms). Magnesium sulfate is used to
prevent eclamptic seizures (acts as a CNS depressant and
cerebral vasodilator). Preparing for delivery is appropriate
because the only definitive treatment for preeclampsia is
delivery; at 36 weeks, expedited delivery is often indicated
when severe features present. Prompt seizure prophylaxis and
maternal stabilization take priority.
Why A is incorrect: Oral nifedipine may be used for acute BP
control but management of severe preeclampsia requires
seizure prophylaxis (magnesium) and delivery planning;
outpatient follow-up is inappropriate.
Why C is incorrect: Waiting is unsafe — severe features
(headache/visual disturbance) warrant immediate inpatient
management.
, Why D is incorrect: Routine large fluid boluses are
contraindicated because preeclampsia often involves capillary
leak and risk of pulmonary edema; fluid management must be
cautious.
(Physiology note: In preeclampsia defective placentation and
abnormal spiral artery remodeling result in placental ischemia,
systemic endothelial dysfunction, vasoconstriction, and
increased vascular permeability — leading to hypertension, end-
organ ischemia, and risk of seizures.)
3 — Prenatal education: Rubella & teratogenic risk
A pregnant woman at 8 weeks asks whether she can receive the
MMR vaccine during pregnancy because she is not immune.
The best response is:
A. "Yes — it’s important to get vaccinated in pregnancy to
protect the fetus."
B. "No — MMR is a live attenuated vaccine and is
contraindicated in pregnancy; plan vaccination postpartum."
(Correct)
C. "You can have it now if you sign a consent form."
D. "You should take antiviral medication instead."
Rationale — Correct (B):
MMR is a live attenuated vaccine and is contraindicated during
pregnancy because of theoretical risk of vertical transmission. If
a woman is not immune to rubella, vaccination should be
