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 (Traditional MCQ) — Antepartum assessment: maternal
physiology
A 28-week pregnant client reports increased fatigue and
shortness of breath when climbing stairs. Vital signs: BP 110/70
mm Hg, HR 92, RR 18. Which physiologic explanation best
accounts for dyspnea in the 2nd/3rd trimester?
A. Increased maternal oxygen consumption and diaphragm
elevation by the gravid uterus.
B. Increased maternal hemoglobin binding affinity for oxygen,
reducing tissue delivery.
C. Pulmonary edema from physiologic hypervolemia.
D. Hypoventilation due to progesterone suppression of
respiratory drive.
Answer: A
,Rationale (correct):
During pregnancy maternal metabolic demands rise and oxygen
consumption increases ~20–30%. The enlarging uterus elevates
the diaphragm, and progesterone-mediated increases in tidal
volume and minute ventilation attempt to meet demand. The
combination of diaphragm elevation and increased demand
produces exertional dyspnea even with normal oxygenation.
The physiologic response is increased ventilation (not
suppressed).
Rationales (incorrect):
B — Pregnancy tends to decrease hemoglobin concentration
(physiologic dilutional anemia) but maternal hemoglobin-O₂
affinity changes don’t produce exertional dyspnea the way
mechanics and increased demand do.
C — Pulmonary edema is pathological and would present with
crackles, hypoxia, and abnormal CXR; it is not normal
physiology.
D — Progesterone actually stimulates the respiratory center,
increasing ventilation (not suppressing it).
2 (Traditional MCQ) — High-risk: preeclampsia assessment
A G2P1 at 34 weeks has BP 158/102 mm Hg on two readings 4
hours apart, 3+ protein on urine dipstick, and 1+ ankle edema.
Which assessment finding most strongly indicates progression
to severe preeclampsia requiring prompt intervention?
A. Fetal movement decreased over the past 24 hours.
,B. New onset right upper quadrant (epigastric) pain.
C. Fundal height measuring 2 cm greater than expected.
D. Mild headache relieved by acetaminophen.
Answer: B
Rationale (correct):
Severe preeclampsia may cause hepatic capsule distension or
subcapsular hematoma producing RUQ/epigastric pain—this is
a red flag for end-organ involvement and possible impending
eclampsia or HELLP. Pathophysiology: widespread endothelial
dysfunction → vasospasm, ischemia, and end-organ injury (liver,
brain, kidneys). RUQ pain may reflect liver involvement and
demands urgent evaluation.
Rationales (incorrect):
A — Decreased fetal movement is important and warrants fetal
assessment (NST/BPP), but RUQ pain indicates maternal end-
organ compromise and more immediate maternal risk.
C — Fundal height discrepancy could indicate polyhydramnios
or growth issues but is less immediately life-threatening.
D — Mild headache relieved by acetaminophen is less specific;
a severe, persistent headache is more concerning for cerebral
involvement.
3 (Traditional MCQ) — Prenatal education: Rh incompatibility
A woman is Rh-negative and her partner is Rh-positive. Which
prenatal teaching is highest priority?
, A. She must avoid live vaccines during pregnancy.
B. She should receive Rho(D) immune globulin (RhoGAM) at 28
weeks and after any sensitizing event.
C. She should start aspirin 81 mg daily to prevent
alloimmunization.
D. She should have amniocentesis in the first trimester to
determine fetal blood type.
Answer: B
Rationale (correct):
Rho(D) immune globulin given at ~28 weeks and after potential
sensitizing events (e.g., delivery of Rh+ baby, miscarriage,
trauma, amniocentesis) prevents maternal anti-D antibody
formation. Physiologically, it clears fetal Rh-positive
erythrocytes before maternal immune recognition, preventing
hemolytic disease in future pregnancies.
Rationales (incorrect):
A — Vaccination recommendations are separate and not the
highest priority for Rh incompatibility.
C — Aspirin does not affect alloimmunization. Low-dose aspirin
is used for preeclampsia prevention in high-risk patients, not Rh
issues.
D — Amniocentesis in first trimester is not routine and carries
risk of sensitization; fetal blood type is typically assessed via
noninvasive cell-free fetal DNA or paternal testing; invasive
testing is not first-line solely to determine fetal Rh.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 (Traditional MCQ) — Antepartum assessment: maternal
physiology
A 28-week pregnant client reports increased fatigue and
shortness of breath when climbing stairs. Vital signs: BP 110/70
mm Hg, HR 92, RR 18. Which physiologic explanation best
accounts for dyspnea in the 2nd/3rd trimester?
A. Increased maternal oxygen consumption and diaphragm
elevation by the gravid uterus.
B. Increased maternal hemoglobin binding affinity for oxygen,
reducing tissue delivery.
C. Pulmonary edema from physiologic hypervolemia.
D. Hypoventilation due to progesterone suppression of
respiratory drive.
Answer: A
,Rationale (correct):
During pregnancy maternal metabolic demands rise and oxygen
consumption increases ~20–30%. The enlarging uterus elevates
the diaphragm, and progesterone-mediated increases in tidal
volume and minute ventilation attempt to meet demand. The
combination of diaphragm elevation and increased demand
produces exertional dyspnea even with normal oxygenation.
The physiologic response is increased ventilation (not
suppressed).
Rationales (incorrect):
B — Pregnancy tends to decrease hemoglobin concentration
(physiologic dilutional anemia) but maternal hemoglobin-O₂
affinity changes don’t produce exertional dyspnea the way
mechanics and increased demand do.
C — Pulmonary edema is pathological and would present with
crackles, hypoxia, and abnormal CXR; it is not normal
physiology.
D — Progesterone actually stimulates the respiratory center,
increasing ventilation (not suppressing it).
2 (Traditional MCQ) — High-risk: preeclampsia assessment
A G2P1 at 34 weeks has BP 158/102 mm Hg on two readings 4
hours apart, 3+ protein on urine dipstick, and 1+ ankle edema.
Which assessment finding most strongly indicates progression
to severe preeclampsia requiring prompt intervention?
A. Fetal movement decreased over the past 24 hours.
,B. New onset right upper quadrant (epigastric) pain.
C. Fundal height measuring 2 cm greater than expected.
D. Mild headache relieved by acetaminophen.
Answer: B
Rationale (correct):
Severe preeclampsia may cause hepatic capsule distension or
subcapsular hematoma producing RUQ/epigastric pain—this is
a red flag for end-organ involvement and possible impending
eclampsia or HELLP. Pathophysiology: widespread endothelial
dysfunction → vasospasm, ischemia, and end-organ injury (liver,
brain, kidneys). RUQ pain may reflect liver involvement and
demands urgent evaluation.
Rationales (incorrect):
A — Decreased fetal movement is important and warrants fetal
assessment (NST/BPP), but RUQ pain indicates maternal end-
organ compromise and more immediate maternal risk.
C — Fundal height discrepancy could indicate polyhydramnios
or growth issues but is less immediately life-threatening.
D — Mild headache relieved by acetaminophen is less specific;
a severe, persistent headache is more concerning for cerebral
involvement.
3 (Traditional MCQ) — Prenatal education: Rh incompatibility
A woman is Rh-negative and her partner is Rh-positive. Which
prenatal teaching is highest priority?
, A. She must avoid live vaccines during pregnancy.
B. She should receive Rho(D) immune globulin (RhoGAM) at 28
weeks and after any sensitizing event.
C. She should start aspirin 81 mg daily to prevent
alloimmunization.
D. She should have amniocentesis in the first trimester to
determine fetal blood type.
Answer: B
Rationale (correct):
Rho(D) immune globulin given at ~28 weeks and after potential
sensitizing events (e.g., delivery of Rh+ baby, miscarriage,
trauma, amniocentesis) prevents maternal anti-D antibody
formation. Physiologically, it clears fetal Rh-positive
erythrocytes before maternal immune recognition, preventing
hemolytic disease in future pregnancies.
Rationales (incorrect):
A — Vaccination recommendations are separate and not the
highest priority for Rh incompatibility.
C — Aspirin does not affect alloimmunization. Low-dose aspirin
is used for preeclampsia prevention in high-risk patients, not Rh
issues.
D — Amniocentesis in first trimester is not routine and carries
risk of sensitization; fetal blood type is typically assessed via
noninvasive cell-free fetal DNA or paternal testing; invasive
testing is not first-line solely to determine fetal Rh.
