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
Antepartum / Prenatal (Items 1–7)
1. (Single-best-answer) A 28-week gestation client with chronic
hypertension is prescribed labetalol. Which assessment finding
would most concern the nurse and require immediate follow
up?
A. Blood pressure 146/92 mm Hg sitting.
B. Heart rate 54 beats/min and reports lightheadedness.
C. Mild ankle edema after being on feet all day.
D. Urine dipstick negative for protein.
Correct answer: B
Rationale (correct): Labetalol is a nonselective β-blocker with α-
blocking properties; it lowers blood pressure but can cause
maternal bradycardia. A maternal HR of 54 with
lightheadedness suggests drug-induced symptomatic
,bradycardia that may compromise cardiac output and
uteroplacental perfusion; this requires immediate evaluation
and likely dose adjustment. Physiologically, reduced maternal
cardiac output decreases uterine blood flow and may cause
fetal hypoxia if persistent.
Incorrect options:
A — Elevated BP is important but not immediately life-
threatening when moderate; medication titration may be
needed.
C — Mild dependent edema is common in pregnancy and not
specific for hypertensive emergency.
D — Absence of proteinuria does not exclude hypertensive
disease; assessment must be holistic.
2. (Single-best-answer) A primigravida at 10 weeks’ gestation
has a positive serum hCG but vaginal bleeding and unilateral
pelvic pain. The nurse should prioritize assessment for:
A. Spontaneous abortion (miscarriage).
B. Ectopic pregnancy.
C. Molar pregnancy.
D. Urinary tract infection.
Correct answer: B
Rationale (correct): Unilateral pelvic pain with bleeding in early
pregnancy raises suspicion for ectopic implantation (commonly
tubal). Ectopic pregnancies can rupture causing intra-abdominal
,hemorrhage and hemodynamic compromise. Physiologically,
implantation outside the uterine cavity cannot support normal
placentation, and progressive trophoblastic growth can erode
tubal vessels — an emergency.
Incorrect options:
A — Miscarriage can present with bleeding, but unilateral
severe pain more strongly suggests ectopic; ultrasound and
serial hCG differentiate.
C — Molar pregnancy often has markedly elevated hCG and
uterine enlargement; pain is less classically unilateral.
D — UTI may cause suprapubic discomfort and dysuria but does
not explain unilateral pelvic pain and bleeding.
3. (NGN-style — case + multiple-response) Case: A client at 36
weeks’ gestation with known gestational diabetes mellitus (diet-
controlled) asks about teaching to reduce neonatal
hypoglycemia risk. Select all appropriate recommendations.
A. Encourage early breastfeeding or feeding within 30–60
minutes after birth.
B. Schedule cord clamping immediately and delay skin-to-skin
contact for 2 hours.
C. Monitor neonatal blood glucose at 30–60 minutes of life and
as ordered.
D. Give the neonate supplemental formula routinely regardless
of breastfeeding.
, E. Maintain maternal-neonatal skin-to-skin to promote thermal
stability and feeding.
Correct answer(s): A, C, E
Rationale (correct): Infants of diabetic mothers are at risk of
neonatal hypoglycemia due to fetal hyperinsulinemia (fetal
pancreatic β-cells upregulated by maternal hyperglycemia).
Early feeding and skin-to-skin stabilize glucose and
temperature; early monitoring allows prompt detection and
treatment. Physiologically, after birth maternal glucose supply
ceases while fetal hyperinsulinemia persists → glucose falls
rapidly.
Incorrect options:
B — Delaying skin-to-skin is counterproductive; early SSC
supports thermoregulation and feeding.
D — Routine formula feeding undermines breastfeeding;
supplemental feeds are indicated only if glucose falls or feeding
ineffective.
(NGN note: This item assesses clinical judgment and multiple
correct actions consistent with NGN format.)
4. (Single-best-answer) A client with suspected placenta previa
presents with painless bright red vaginal bleeding at 36 weeks.
Which intervention should the nurse perform first?
A. Prepare for immediate vaginal examination to determine
dilation.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
Antepartum / Prenatal (Items 1–7)
1. (Single-best-answer) A 28-week gestation client with chronic
hypertension is prescribed labetalol. Which assessment finding
would most concern the nurse and require immediate follow
up?
A. Blood pressure 146/92 mm Hg sitting.
B. Heart rate 54 beats/min and reports lightheadedness.
C. Mild ankle edema after being on feet all day.
D. Urine dipstick negative for protein.
Correct answer: B
Rationale (correct): Labetalol is a nonselective β-blocker with α-
blocking properties; it lowers blood pressure but can cause
maternal bradycardia. A maternal HR of 54 with
lightheadedness suggests drug-induced symptomatic
,bradycardia that may compromise cardiac output and
uteroplacental perfusion; this requires immediate evaluation
and likely dose adjustment. Physiologically, reduced maternal
cardiac output decreases uterine blood flow and may cause
fetal hypoxia if persistent.
Incorrect options:
A — Elevated BP is important but not immediately life-
threatening when moderate; medication titration may be
needed.
C — Mild dependent edema is common in pregnancy and not
specific for hypertensive emergency.
D — Absence of proteinuria does not exclude hypertensive
disease; assessment must be holistic.
2. (Single-best-answer) A primigravida at 10 weeks’ gestation
has a positive serum hCG but vaginal bleeding and unilateral
pelvic pain. The nurse should prioritize assessment for:
A. Spontaneous abortion (miscarriage).
B. Ectopic pregnancy.
C. Molar pregnancy.
D. Urinary tract infection.
Correct answer: B
Rationale (correct): Unilateral pelvic pain with bleeding in early
pregnancy raises suspicion for ectopic implantation (commonly
tubal). Ectopic pregnancies can rupture causing intra-abdominal
,hemorrhage and hemodynamic compromise. Physiologically,
implantation outside the uterine cavity cannot support normal
placentation, and progressive trophoblastic growth can erode
tubal vessels — an emergency.
Incorrect options:
A — Miscarriage can present with bleeding, but unilateral
severe pain more strongly suggests ectopic; ultrasound and
serial hCG differentiate.
C — Molar pregnancy often has markedly elevated hCG and
uterine enlargement; pain is less classically unilateral.
D — UTI may cause suprapubic discomfort and dysuria but does
not explain unilateral pelvic pain and bleeding.
3. (NGN-style — case + multiple-response) Case: A client at 36
weeks’ gestation with known gestational diabetes mellitus (diet-
controlled) asks about teaching to reduce neonatal
hypoglycemia risk. Select all appropriate recommendations.
A. Encourage early breastfeeding or feeding within 30–60
minutes after birth.
B. Schedule cord clamping immediately and delay skin-to-skin
contact for 2 hours.
C. Monitor neonatal blood glucose at 30–60 minutes of life and
as ordered.
D. Give the neonate supplemental formula routinely regardless
of breastfeeding.
, E. Maintain maternal-neonatal skin-to-skin to promote thermal
stability and feeding.
Correct answer(s): A, C, E
Rationale (correct): Infants of diabetic mothers are at risk of
neonatal hypoglycemia due to fetal hyperinsulinemia (fetal
pancreatic β-cells upregulated by maternal hyperglycemia).
Early feeding and skin-to-skin stabilize glucose and
temperature; early monitoring allows prompt detection and
treatment. Physiologically, after birth maternal glucose supply
ceases while fetal hyperinsulinemia persists → glucose falls
rapidly.
Incorrect options:
B — Delaying skin-to-skin is counterproductive; early SSC
supports thermoregulation and feeding.
D — Routine formula feeding undermines breastfeeding;
supplemental feeds are indicated only if glucose falls or feeding
ineffective.
(NGN note: This item assesses clinical judgment and multiple
correct actions consistent with NGN format.)
4. (Single-best-answer) A client with suspected placenta previa
presents with painless bright red vaginal bleeding at 36 weeks.
Which intervention should the nurse perform first?
A. Prepare for immediate vaginal examination to determine
dilation.
