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
Traditional single-best-answer MCQs (1–12)
1. Antepartum — Rh sensitization and indirect Coombs
A 28-year-old primigravida at 28 weeks’ gestation is Rh-negative
(D-) and her partner is Rh-positive. Her indirect Coombs test is
positive. The nurse’s priority action is to:
A. Explain that no intervention is needed during pregnancy.
B. Prepare to administer Rho(D) immune globulin (RhoGAM)
immediately.
C. Notify the provider for fetal anemia surveillance (e.g., MCA
Doppler).
D. Arrange immediate intrauterine blood transfusion.
Correct answer: C
Rationale:
A positive indirect Coombs indicates maternal alloimmunization
,(IgG antibodies formed against fetal Rh antigen). Once
sensitization has occurred, RhoGAM cannot prevent
alloimmunization, so administering RhoGAM (B) is not
appropriate. The priority is surveillance for fetal hemolytic
disease and anemia (C) — e.g., middle cerebral artery (MCA)
Doppler velocimetry and serial ultrasounds. Immediate
intrauterine transfusion (D) is only indicated if severe fetal
anemia is documented. Declaring “no intervention” (A) is
incorrect and unsafe.
Physiology note: Maternal IgG crosses the placenta and targets
fetal Rh-positive red blood cells, causing hemolysis and
potential anemia, hydrops fetalis, or stillbirth. Monitoring
assesses fetal compromise and guides interventions like
intrauterine transfusion.
2. Prenatal education — Neural tube defect prevention
Which statement by a woman planning pregnancy indicates
correct understanding of folic acid counseling?
A. “I should start taking 400 mcg of folic acid once I know I’m
pregnant.”
B. “I should take 400 mcg of folic acid daily starting before
conception.”
C. “Folic acid isn’t necessary if I eat green vegetables.”
D. “I should avoid folic acid if I have a family history of neural
tube defects.”
Correct answer: B
,Rationale:
Neural tube closure occurs very early (by about day 28 post-
conception), so folic acid 400 mcg/day should be started prior
to conception (B). Waiting until pregnancy is confirmed (A) may
be too late. Dietary folate helps but does not reliably provide
the preventive dose alone (C). A family history of neural tube
defects increases the recommended dose (often higher than
400 mcg), so avoidance (D) is incorrect.
Physiology note: Folic acid (folate) is required for DNA synthesis
and cell division during early embryogenesis; adequate
preconception folate reduces neural tube defects by supporting
neural tube closure.
3. High-risk pregnancy — Preeclampsia assessment
A client at 34 weeks gestation has blood pressure 158/104 mm
Hg, 3+ protein on dipstick, and 2+ deep tendon reflexes (DTRs).
Which assessment finding is most concerning to the nurse and
requires immediate reporting?
A. Mild pedal edema
B. Headache unrelieved by medication
C. Fetal movement felt earlier in the day
D. Urine output 40 mL/hr
Correct answer: B
Rationale:
In preeclampsia, a severe, persistent headache suggests
, cerebral edema or impending eclampsia and requires
immediate reporting (B). Mild pedal edema (A) is common and
less specific. Increased fetal movement (C) is not concerning.
Urine output 40 mL/hr (D) is borderline but not as immediately
dangerous as neurologic symptoms — oliguria <30 mL/hr would
be more concerning.
Physiology note: Preeclampsia involves systemic endothelial
dysfunction causing vasospasm and capillary leakage. Cerebral
vasospasm and edema manifest as severe headaches and visual
disturbances and signal high seizure risk.
4. Fetal heart monitoring — Category II tracing interpretation
A client in active labor has an external monitor showing
recurrent variable decelerations with moderate variability and a
baseline heart rate of 150 bpm. Which nursing action is best
first?
A. Prepare for immediate cesarean birth.
B. Reposition the mother and assess maternal vital signs.
C. Give oxytocin bolus to augment labor.
D. Apply internal fetal scalp electrode.
Correct answer: B
Rationale:
Recurrent variable decelerations are often due to cord
compression. The first step is maternal repositioning (left
lateral) and assessment (B) to improve uteroplacental perfusion
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
Traditional single-best-answer MCQs (1–12)
1. Antepartum — Rh sensitization and indirect Coombs
A 28-year-old primigravida at 28 weeks’ gestation is Rh-negative
(D-) and her partner is Rh-positive. Her indirect Coombs test is
positive. The nurse’s priority action is to:
A. Explain that no intervention is needed during pregnancy.
B. Prepare to administer Rho(D) immune globulin (RhoGAM)
immediately.
C. Notify the provider for fetal anemia surveillance (e.g., MCA
Doppler).
D. Arrange immediate intrauterine blood transfusion.
Correct answer: C
Rationale:
A positive indirect Coombs indicates maternal alloimmunization
,(IgG antibodies formed against fetal Rh antigen). Once
sensitization has occurred, RhoGAM cannot prevent
alloimmunization, so administering RhoGAM (B) is not
appropriate. The priority is surveillance for fetal hemolytic
disease and anemia (C) — e.g., middle cerebral artery (MCA)
Doppler velocimetry and serial ultrasounds. Immediate
intrauterine transfusion (D) is only indicated if severe fetal
anemia is documented. Declaring “no intervention” (A) is
incorrect and unsafe.
Physiology note: Maternal IgG crosses the placenta and targets
fetal Rh-positive red blood cells, causing hemolysis and
potential anemia, hydrops fetalis, or stillbirth. Monitoring
assesses fetal compromise and guides interventions like
intrauterine transfusion.
2. Prenatal education — Neural tube defect prevention
Which statement by a woman planning pregnancy indicates
correct understanding of folic acid counseling?
A. “I should start taking 400 mcg of folic acid once I know I’m
pregnant.”
B. “I should take 400 mcg of folic acid daily starting before
conception.”
C. “Folic acid isn’t necessary if I eat green vegetables.”
D. “I should avoid folic acid if I have a family history of neural
tube defects.”
Correct answer: B
,Rationale:
Neural tube closure occurs very early (by about day 28 post-
conception), so folic acid 400 mcg/day should be started prior
to conception (B). Waiting until pregnancy is confirmed (A) may
be too late. Dietary folate helps but does not reliably provide
the preventive dose alone (C). A family history of neural tube
defects increases the recommended dose (often higher than
400 mcg), so avoidance (D) is incorrect.
Physiology note: Folic acid (folate) is required for DNA synthesis
and cell division during early embryogenesis; adequate
preconception folate reduces neural tube defects by supporting
neural tube closure.
3. High-risk pregnancy — Preeclampsia assessment
A client at 34 weeks gestation has blood pressure 158/104 mm
Hg, 3+ protein on dipstick, and 2+ deep tendon reflexes (DTRs).
Which assessment finding is most concerning to the nurse and
requires immediate reporting?
A. Mild pedal edema
B. Headache unrelieved by medication
C. Fetal movement felt earlier in the day
D. Urine output 40 mL/hr
Correct answer: B
Rationale:
In preeclampsia, a severe, persistent headache suggests
, cerebral edema or impending eclampsia and requires
immediate reporting (B). Mild pedal edema (A) is common and
less specific. Increased fetal movement (C) is not concerning.
Urine output 40 mL/hr (D) is borderline but not as immediately
dangerous as neurologic symptoms — oliguria <30 mL/hr would
be more concerning.
Physiology note: Preeclampsia involves systemic endothelial
dysfunction causing vasospasm and capillary leakage. Cerebral
vasospasm and edema manifest as severe headaches and visual
disturbances and signal high seizure risk.
4. Fetal heart monitoring — Category II tracing interpretation
A client in active labor has an external monitor showing
recurrent variable decelerations with moderate variability and a
baseline heart rate of 150 bpm. Which nursing action is best
first?
A. Prepare for immediate cesarean birth.
B. Reposition the mother and assess maternal vital signs.
C. Give oxytocin bolus to augment labor.
D. Apply internal fetal scalp electrode.
Correct answer: B
Rationale:
Recurrent variable decelerations are often due to cord
compression. The first step is maternal repositioning (left
lateral) and assessment (B) to improve uteroplacental perfusion
