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 multiple-choice items
1. A 28-week-gestation client reports a sudden increase in
vaginal bleeding without pain. Vital signs are stable. Which
action should the nurse take first?
A. Prepare the client for a transvaginal ultrasound.
B. Assess fetal heart rate and continuous uterine activity
monitoring.
C. Obtain a complete blood count and coagulation panel.
D. Start two large-bore IVs and begin IV fluids.
Answer: B
Rationale:
• Correct — B: Immediate assessment of fetal status and
uterine activity (external or internal monitoring if
indicated) is the priority to determine fetal well-being and
, to identify ongoing contractions consistent with placenta
previa vs. abruption. Maternal/fetal assessment is first
because interventions depend on monitoring data
(safety/clinical judgment). Fetal heart rate (FHR) and
uterine activity provide rapid information about fetal
compromise (e.g., late decelerations with abruption).
• A (incorrect): Ultrasound is important to evaluate
placental location (placenta previa) but should follow
immediate maternal-fetal assessment and stabilization as
it is not the first immediate bedside action.
• C (incorrect): Labs are necessary but are not the first
action — assessment guides urgency.
• D (incorrect): IV access may be needed but starting
aggressive IV therapy before assessing FHR/uterine activity
is premature; obtain monitoring first and then establish IV
access if indicated.
2. Which description best characterizes a late deceleration on
external fetal heart monitoring?
A. Abrupt decrease in FHR variable in timing and shape; may
indicate cord compression.
B. Gradual decrease in FHR that begins after a contraction peak
and returns after the contraction ends; indicates uteroplacental
insufficiency.
C. Gradual decrease in FHR that mirrors the contraction;
,indicates fetal head compression.
D. Baseline FHR above 160 beats/min for >10 minutes.
Answer: B
Rationale:
• Correct — B: Late decelerations are gradual decreases in
FHR that begin after the contraction onset and recover
after the contraction ends — classic for uteroplacental
insufficiency (maternal hypotension, preeclampsia, uterine
hypertonus). Physiologically, decreased placental perfusion
during a contraction causes fetal hypoxia → vagal response
→ deceleration delayed relative to contraction peak.
• A (incorrect): That describes variable decelerations
(abrupt, variable timing) associated with cord
compression.
• C (incorrect): That describes early decelerations (gradual
and mirror contractions) due to fetal head compression;
early decels are benign.
• D (incorrect): Describes fetal tachycardia, not
decelerations.
3. A gravida 2 para 1 at 30 weeks is diagnosed with gestational
hypertension without proteinuria. Which statement by the
client indicates correct understanding of home management?
A. “I should check my blood pressure once per week and return
, if it’s high.”
B. “If I have a severe headache I should report it right away.”
C. “I do not need fetal movement counts until 36 weeks.”
D. “I should start bed rest and stop all physical activity.”
Answer: B
Rationale:
• Correct — B: Severe headache can indicate worsening
preeclampsia or cerebral involvement and requires
immediate reporting. Maternal neuro symptoms reflect
potential end-organ dysfunction and jeopardize placental
perfusion and fetal oxygenation.
• A (incorrect): BP should be monitored more frequently
than weekly (often daily or as ordered), especially with
new hypertension — weekly is inadequate.
• C (incorrect): Fetal movement counts (kick counts) are
recommended starting in the third trimester and are
appropriate now to monitor fetal well-being.
• D (incorrect): Routine bed rest is not universally
recommended and can increase thromboembolism risk;
activity should be individualized per provider’s guidance.
4. A pregnant client with type 1 diabetes asks why tight glucose
control is emphasized in pregnancy. Which physiologic
explanation is best?
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
Traditional multiple-choice items
1. A 28-week-gestation client reports a sudden increase in
vaginal bleeding without pain. Vital signs are stable. Which
action should the nurse take first?
A. Prepare the client for a transvaginal ultrasound.
B. Assess fetal heart rate and continuous uterine activity
monitoring.
C. Obtain a complete blood count and coagulation panel.
D. Start two large-bore IVs and begin IV fluids.
Answer: B
Rationale:
• Correct — B: Immediate assessment of fetal status and
uterine activity (external or internal monitoring if
indicated) is the priority to determine fetal well-being and
, to identify ongoing contractions consistent with placenta
previa vs. abruption. Maternal/fetal assessment is first
because interventions depend on monitoring data
(safety/clinical judgment). Fetal heart rate (FHR) and
uterine activity provide rapid information about fetal
compromise (e.g., late decelerations with abruption).
• A (incorrect): Ultrasound is important to evaluate
placental location (placenta previa) but should follow
immediate maternal-fetal assessment and stabilization as
it is not the first immediate bedside action.
• C (incorrect): Labs are necessary but are not the first
action — assessment guides urgency.
• D (incorrect): IV access may be needed but starting
aggressive IV therapy before assessing FHR/uterine activity
is premature; obtain monitoring first and then establish IV
access if indicated.
2. Which description best characterizes a late deceleration on
external fetal heart monitoring?
A. Abrupt decrease in FHR variable in timing and shape; may
indicate cord compression.
B. Gradual decrease in FHR that begins after a contraction peak
and returns after the contraction ends; indicates uteroplacental
insufficiency.
C. Gradual decrease in FHR that mirrors the contraction;
,indicates fetal head compression.
D. Baseline FHR above 160 beats/min for >10 minutes.
Answer: B
Rationale:
• Correct — B: Late decelerations are gradual decreases in
FHR that begin after the contraction onset and recover
after the contraction ends — classic for uteroplacental
insufficiency (maternal hypotension, preeclampsia, uterine
hypertonus). Physiologically, decreased placental perfusion
during a contraction causes fetal hypoxia → vagal response
→ deceleration delayed relative to contraction peak.
• A (incorrect): That describes variable decelerations
(abrupt, variable timing) associated with cord
compression.
• C (incorrect): That describes early decelerations (gradual
and mirror contractions) due to fetal head compression;
early decels are benign.
• D (incorrect): Describes fetal tachycardia, not
decelerations.
3. A gravida 2 para 1 at 30 weeks is diagnosed with gestational
hypertension without proteinuria. Which statement by the
client indicates correct understanding of home management?
A. “I should check my blood pressure once per week and return
, if it’s high.”
B. “If I have a severe headache I should report it right away.”
C. “I do not need fetal movement counts until 36 weeks.”
D. “I should start bed rest and stop all physical activity.”
Answer: B
Rationale:
• Correct — B: Severe headache can indicate worsening
preeclampsia or cerebral involvement and requires
immediate reporting. Maternal neuro symptoms reflect
potential end-organ dysfunction and jeopardize placental
perfusion and fetal oxygenation.
• A (incorrect): BP should be monitored more frequently
than weekly (often daily or as ordered), especially with
new hypertension — weekly is inadequate.
• C (incorrect): Fetal movement counts (kick counts) are
recommended starting in the third trimester and are
appropriate now to monitor fetal well-being.
• D (incorrect): Routine bed rest is not universally
recommended and can increase thromboembolism risk;
activity should be individualized per provider’s guidance.
4. A pregnant client with type 1 diabetes asks why tight glucose
control is emphasized in pregnancy. Which physiologic
explanation is best?
