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 assessment (single best answer)
A 28-year-old primigravida at 32 weeks’ gestation presents for
routine prenatal care. Her fundal height measures 30 cm and
she reports decreased fetal movement over the past 24 hours.
Which is the nurse’s best initial action?
A. Instruct the client to return in 48 hours if fetal movement
remains decreased.
B. Perform a nonstress test (NST) and document results.
C. Schedule an immediate ultrasound for biophysical profile
(BPP).
D. Recommend increased oral fluids and rest for 2 hours and
then count fetal movements.
Answer: B. Perform a nonstress test (NST) and document
results.
,Rationale:
• Correct (B): Decreased fetal movement at 32 weeks is an
indication for immediate fetal surveillance. An NST is the
fastest, noninvasive bedside test to assess fetal
oxygenation and autonomic function by observing
accelerations with fetal movement; a reactive NST suggests
adequate fetal oxygenation due to intact autonomic
nervous system. Early testing identifies fetal compromise
and guides urgency of further testing (BPP, Doppler).
• Incorrect (A): Waiting 48 hours risks delaying diagnosis of
fetal compromise. Decreased movement warrants same-
day evaluation.
• Incorrect (C): A BPP provides detailed fetal well-being but
takes longer; most guidelines recommend starting with an
NST as an initial screening. If NST is nonreactive, proceed
to BPP.
• Incorrect (D): Counting movements and hydration may be
appropriate if the complaint is mild, but decreased
movements for 24 hours warrant immediate testing rather
than simple observation.
2 — High-risk pregnancy: preeclampsia (single best answer)
A client at 36 weeks’ gestation has blood pressure 152/98 mm
Hg and 2+ proteinuria on a urine dip. She has mild headache
and 1+ pitting edema. Which maternal physiologic change most
,directly contributes to the hypertension of preeclampsia?
A. Increased plasma renin activity causing vasodilation
B. Systemic endothelial dysfunction leading to vasospasm
C. Decreased cardiac output due to uterine compression
D. Hypovolemia from diuresis in pregnancy
Answer: B. Systemic endothelial dysfunction leading to
vasospasm.
Rationale:
• Correct (B): Preeclampsia pathophysiology centers on
abnormal placentation releasing antiangiogenic factors →
maternal systemic endothelial dysfunction, increased
vascular tone and vasospasm → hypertension and end-
organ ischemia (e.g., kidney causing proteinuria).
• Incorrect (A): Increased renin-angiotensin activity typically
raises blood pressure, but in normal pregnancy the
vascular responsiveness is decreased; preeclampsia is
characterized more by vasoconstriction than by renin-
mediated vasodilation.
• Incorrect (C): Uterine compression can affect venous
return late in pregnancy but does not explain systemic
hypertension of preeclampsia.
• Incorrect (D): Preeclampsia often has relative intravascular
volume depletion but not primary diuresis causing
hypertension; hypovolemia would not explain
hypertension.
, 3 — Prenatal education: teratogens (single best answer)
A woman planning pregnancy asks which medication is safest to
continue while trying to conceive. She takes sertraline (SSRI),
methotrexate, and a multivitamin with folic acid. Which
instruction is correct?
A. Continue sertraline and methotrexate; both are safe in early
pregnancy.
B. Discontinue methotrexate and consult prescriber before
conception.
C. Stop sertraline immediately and replace with herbal
remedies.
D. Stop all medications and rely on folic acid only.
Answer: B. Discontinue methotrexate and consult prescriber
before conception.
Rationale:
• Correct (B): Methotrexate is teratogenic and
contraindicated in conception; should be stopped and
cleared (often several months and according to prescriber
guidance) before attempting pregnancy. SSRIs like
sertraline are often continued when benefits outweigh
risks—discontinuation may risk maternal depression and
adverse pregnancy outcomes. Folic acid is recommended.
• Incorrect (A): Methotrexate is not safe in pregnancy.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antepartum assessment (single best answer)
A 28-year-old primigravida at 32 weeks’ gestation presents for
routine prenatal care. Her fundal height measures 30 cm and
she reports decreased fetal movement over the past 24 hours.
Which is the nurse’s best initial action?
A. Instruct the client to return in 48 hours if fetal movement
remains decreased.
B. Perform a nonstress test (NST) and document results.
C. Schedule an immediate ultrasound for biophysical profile
(BPP).
D. Recommend increased oral fluids and rest for 2 hours and
then count fetal movements.
Answer: B. Perform a nonstress test (NST) and document
results.
,Rationale:
• Correct (B): Decreased fetal movement at 32 weeks is an
indication for immediate fetal surveillance. An NST is the
fastest, noninvasive bedside test to assess fetal
oxygenation and autonomic function by observing
accelerations with fetal movement; a reactive NST suggests
adequate fetal oxygenation due to intact autonomic
nervous system. Early testing identifies fetal compromise
and guides urgency of further testing (BPP, Doppler).
• Incorrect (A): Waiting 48 hours risks delaying diagnosis of
fetal compromise. Decreased movement warrants same-
day evaluation.
• Incorrect (C): A BPP provides detailed fetal well-being but
takes longer; most guidelines recommend starting with an
NST as an initial screening. If NST is nonreactive, proceed
to BPP.
• Incorrect (D): Counting movements and hydration may be
appropriate if the complaint is mild, but decreased
movements for 24 hours warrant immediate testing rather
than simple observation.
2 — High-risk pregnancy: preeclampsia (single best answer)
A client at 36 weeks’ gestation has blood pressure 152/98 mm
Hg and 2+ proteinuria on a urine dip. She has mild headache
and 1+ pitting edema. Which maternal physiologic change most
,directly contributes to the hypertension of preeclampsia?
A. Increased plasma renin activity causing vasodilation
B. Systemic endothelial dysfunction leading to vasospasm
C. Decreased cardiac output due to uterine compression
D. Hypovolemia from diuresis in pregnancy
Answer: B. Systemic endothelial dysfunction leading to
vasospasm.
Rationale:
• Correct (B): Preeclampsia pathophysiology centers on
abnormal placentation releasing antiangiogenic factors →
maternal systemic endothelial dysfunction, increased
vascular tone and vasospasm → hypertension and end-
organ ischemia (e.g., kidney causing proteinuria).
• Incorrect (A): Increased renin-angiotensin activity typically
raises blood pressure, but in normal pregnancy the
vascular responsiveness is decreased; preeclampsia is
characterized more by vasoconstriction than by renin-
mediated vasodilation.
• Incorrect (C): Uterine compression can affect venous
return late in pregnancy but does not explain systemic
hypertension of preeclampsia.
• Incorrect (D): Preeclampsia often has relative intravascular
volume depletion but not primary diuresis causing
hypertension; hypovolemia would not explain
hypertension.
, 3 — Prenatal education: teratogens (single best answer)
A woman planning pregnancy asks which medication is safest to
continue while trying to conceive. She takes sertraline (SSRI),
methotrexate, and a multivitamin with folic acid. Which
instruction is correct?
A. Continue sertraline and methotrexate; both are safe in early
pregnancy.
B. Discontinue methotrexate and consult prescriber before
conception.
C. Stop sertraline immediately and replace with herbal
remedies.
D. Stop all medications and rely on folic acid only.
Answer: B. Discontinue methotrexate and consult prescriber
before conception.
Rationale:
• Correct (B): Methotrexate is teratogenic and
contraindicated in conception; should be stopped and
cleared (often several months and according to prescriber
guidance) before attempting pregnancy. SSRIs like
sertraline are often continued when benefits outweigh
risks—discontinuation may risk maternal depression and
adverse pregnancy outcomes. Folic acid is recommended.
• Incorrect (A): Methotrexate is not safe in pregnancy.
