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
Question 1 (NCLEX single-best)
Client needs: Health Promotion & Maintenance.
Integrated process: Nursing Process — Assessment.
Cognitive level: Application.
A 28-year-old G1 at 28 weeks’ gestation comes to the clinic for
routine prenatal care. She asks about screening for gestational
diabetes. Which statement by the nurse is most accurate?
A. “Screening for gestational diabetes is not recommended
unless you have symptoms.”
B. “We’ll perform a 1-hour 50-g glucose challenge screening
between 24 and 28 weeks.”
C. “We’ll wait until 36 weeks to screen for gestational diabetes.”
D. “If you have a family history of diabetes, screening is done
only after delivery.”
,Correct answer: B.
Rationale (correct): ACOG and commonly used clinical guidance
recommend screening for gestational diabetes during
pregnancy—typically between 24–28 weeks—using a 1-hour
50-g glucose challenge (followed by a diagnostic 3-hour 100-g
OGTT if the screen is positive). The reason is that insulin
resistance increases in mid-pregnancy due to placental
hormones (human placental lactogen, progesterone), raising
maternal glucose and revealing glucose intolerance. The ObG
Project
Rationale (incorrect):
A. False — screening is routine regardless of symptoms because
many women are asymptomatic.
C. False — waiting until 36 weeks is too late to identify and
manage most cases; 24–28 weeks is standard.
D. False — family history increases risk and may prompt earlier
screening, but not only after delivery.
Question 2 (NCLEX single-best)
Client needs: Physiological Integrity — Reduction of Risk
Potential.
Integrated process: Clinical Judgment/Nursing Process.
Cognitive level: Analysis.
A woman in active labor has continuous external fetal
monitoring. The nurse notes recurrent late decelerations with
,minimal variability after contractions. Which immediate nursing
action is best?
A. Encourage the mother to push harder.
B. Place the mother in left lateral position, give oxygen, and
stop oxytocin (if running).
C. Document and continue to observe; late decelerations are
benign.
D. Begin a tocolytic infusion to stop contractions.
Correct answer: B.
Rationale (correct): Late decelerations (gradual decreases in
FHR that begin after the contraction onset with nadir after the
peak) are indicative of uteroplacental insufficiency and fetal
hypoxemia. Immediate interventions aim to improve
uteroplacental perfusion: maternal repositioning (left lateral),
supplemental oxygen, IV fluid bolus, and stopping uterotonics
(e.g., oxytocin) if they are increasing uterine activity. These
actions increase maternal cardiac output and uterine blood
flow to improve fetal oxygenation. NCBI
Rationale (incorrect):
A. Pushing harder worsens fetal stress—contraindicated when
fetal intolerance is present.
C. Incorrect—late decelerations are potentially ominous and
require intervention.
D. Tocolytics are not standard intrapartum first-line therapy for
late decelerations and can be contraindicated depending on
, clinical context; correct immediate steps are repositioning,
oxygen, fluids, and stopping uterotonics.
Question 3 (NGN case — hotspot / multiple-response type
simulated in text)
Client needs: Safe and Effective Care Environment.
Integrated process: Clinical Judgment — Respond/Implement.
Cognitive level: Analysis → Evaluation.
Vignette: A 38-year-old G2P1 at 39 weeks is in the second stage
of labor. Suddenly the nurse notes a loop of umbilical cord
protruding from the introitus after rupture of membranes. The
fetal heart rate is variable with repetitive profound
decelerations.
Select all immediate actions the nurse should take (choose all
that apply):
A. Manually elevate the presenting fetal part off the cord and
call for immediate OR/cesarean.
B. Push the cord back into the vagina and tape it in place.
C. Place the mother in a knee-chest or Trendelenburg position
and provide oxygen.
D. Apply fundal pressure to speed delivery.
E. Prepare for immediate cesarean delivery and notify the
provider.
Correct answers: A, C, E.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
Question 1 (NCLEX single-best)
Client needs: Health Promotion & Maintenance.
Integrated process: Nursing Process — Assessment.
Cognitive level: Application.
A 28-year-old G1 at 28 weeks’ gestation comes to the clinic for
routine prenatal care. She asks about screening for gestational
diabetes. Which statement by the nurse is most accurate?
A. “Screening for gestational diabetes is not recommended
unless you have symptoms.”
B. “We’ll perform a 1-hour 50-g glucose challenge screening
between 24 and 28 weeks.”
C. “We’ll wait until 36 weeks to screen for gestational diabetes.”
D. “If you have a family history of diabetes, screening is done
only after delivery.”
,Correct answer: B.
Rationale (correct): ACOG and commonly used clinical guidance
recommend screening for gestational diabetes during
pregnancy—typically between 24–28 weeks—using a 1-hour
50-g glucose challenge (followed by a diagnostic 3-hour 100-g
OGTT if the screen is positive). The reason is that insulin
resistance increases in mid-pregnancy due to placental
hormones (human placental lactogen, progesterone), raising
maternal glucose and revealing glucose intolerance. The ObG
Project
Rationale (incorrect):
A. False — screening is routine regardless of symptoms because
many women are asymptomatic.
C. False — waiting until 36 weeks is too late to identify and
manage most cases; 24–28 weeks is standard.
D. False — family history increases risk and may prompt earlier
screening, but not only after delivery.
Question 2 (NCLEX single-best)
Client needs: Physiological Integrity — Reduction of Risk
Potential.
Integrated process: Clinical Judgment/Nursing Process.
Cognitive level: Analysis.
A woman in active labor has continuous external fetal
monitoring. The nurse notes recurrent late decelerations with
,minimal variability after contractions. Which immediate nursing
action is best?
A. Encourage the mother to push harder.
B. Place the mother in left lateral position, give oxygen, and
stop oxytocin (if running).
C. Document and continue to observe; late decelerations are
benign.
D. Begin a tocolytic infusion to stop contractions.
Correct answer: B.
Rationale (correct): Late decelerations (gradual decreases in
FHR that begin after the contraction onset with nadir after the
peak) are indicative of uteroplacental insufficiency and fetal
hypoxemia. Immediate interventions aim to improve
uteroplacental perfusion: maternal repositioning (left lateral),
supplemental oxygen, IV fluid bolus, and stopping uterotonics
(e.g., oxytocin) if they are increasing uterine activity. These
actions increase maternal cardiac output and uterine blood
flow to improve fetal oxygenation. NCBI
Rationale (incorrect):
A. Pushing harder worsens fetal stress—contraindicated when
fetal intolerance is present.
C. Incorrect—late decelerations are potentially ominous and
require intervention.
D. Tocolytics are not standard intrapartum first-line therapy for
late decelerations and can be contraindicated depending on
, clinical context; correct immediate steps are repositioning,
oxygen, fluids, and stopping uterotonics.
Question 3 (NGN case — hotspot / multiple-response type
simulated in text)
Client needs: Safe and Effective Care Environment.
Integrated process: Clinical Judgment — Respond/Implement.
Cognitive level: Analysis → Evaluation.
Vignette: A 38-year-old G2P1 at 39 weeks is in the second stage
of labor. Suddenly the nurse notes a loop of umbilical cord
protruding from the introitus after rupture of membranes. The
fetal heart rate is variable with repetitive profound
decelerations.
Select all immediate actions the nurse should take (choose all
that apply):
A. Manually elevate the presenting fetal part off the cord and
call for immediate OR/cesarean.
B. Push the cord back into the vagina and tape it in place.
C. Place the mother in a knee-chest or Trendelenburg position
and provide oxygen.
D. Apply fundal pressure to speed delivery.
E. Prepare for immediate cesarean delivery and notify the
provider.
Correct answers: A, C, E.
