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 — Antenatal assessment (single best answer)
A 28-week gestation client comes to the clinic reporting
decreased fetal movement for 18 hours. Which action should
the nurse take first?
A. Obtain a nonstress test (NST).
B. Instruct the client to perform a fetal kick count at home.
C. Schedule a biophysical profile (BPP) for tomorrow.
D. Assess maternal blood glucose.
Answer: A. Obtain a nonstress test (NST).
Rationale (correct): A decrease in fetal movement after 28
weeks is an immediate concern because it can indicate fetal
compromise (hypoxia, placental insufficiency). An NST is a
noninvasive, rapid assessment of fetal autonomic function and
reactivity; a reactive NST (accelerations with fetal movement)
,suggests intact fetal oxygenation and central nervous system
function. Prompt NST provides immediate data to guide further
testing (BPP) or interventions.
Rationale (incorrect choices):
B — Kick counts at home are useful for ongoing monitoring but
are not the first action when the client already reports
decreased movements for 18 hours (urgent in-clinic testing is
indicated).
C — A BPP provides more comprehensive information but
requires ultrasound and time; it is appropriate if NST is
nonreactive or inconclusive, not as the initial immediate step.
D — Maternal glucose assessment is unrelated to acute
decreased fetal movements as the first action (except if
diabetes complicates assessment over time).
2 — High-risk pregnancy: preeclampsia (single best answer)
A client at 34 weeks’ gestation has preeclampsia with severe
features (BP 170/112 mm Hg, 3+ proteinuria, headache). Which
order should the nurse prioritize?
A. Administer magnesium sulfate as prescribed.
B. Give oral hydralazine for blood pressure control.
C. Prepare for immediate induction of labor.
D. Encourage the client to ambulate and void.
Answer: A. Administer magnesium sulfate as prescribed.
,Rationale (correct): In severe preeclampsia, immediate seizure
prophylaxis with magnesium sulfate is indicated to prevent
eclampsia. Magnesium stabilizes neuronal membranes and
reduces excitatory neurotransmission. While BP control is
important (antihypertensives like IV labetalol or hydralazine
may be given), seizure prophylaxis is prioritized immediately for
severe features. Seizure activity poses direct risk to mother and
fetus (hypoxia, placental abruption).
Rationale (incorrect choices):
B — Antihypertensives are necessary, but medication route and
agent matter (IV agents such as labetalol or hydralazine are
preferred for severe hypertension); magnesium for seizure
prophylaxis is a higher immediate priority.
C — Delivery may be definitive treatment but requires
stabilization (seizure prophylaxis, BP control) and team
coordination; immediate induction is not the first nursing
action.
D — Ambulation is contraindicated due to risk and severity; bed
rest and monitoring are indicated until stabilized.
3 — Prenatal education: Rh isoimmunization (single best
answer)
A primigravida Rh-negative client asks why she needs Rho(D)
immune globulin at 28 weeks. Which explanation by the nurse
is best?
A. “It prevents your body from making antibodies that could
, harm a future baby who is Rh positive.”
B. “It strengthens your immune system to protect this baby
from infection.”
C. “It ensures your baby’s blood type will match yours.”
D. “It will prevent you from having any bleeding during
delivery.”
Answer: A. “It prevents your body from making antibodies
that could harm a future baby who is Rh positive.”
Rationale (correct): Rho(D) immune globulin (Rhogam) provides
passive anti-D antibodies that bind fetal Rh-positive red blood
cells entering the maternal circulation, preventing maternal
sensitization (active antibody formation). If the mother
becomes sensitized, her IgG anti-D antibodies could cross the
placenta in future pregnancies and cause hemolytic disease of
the fetus and newborn (HDFN).
Rationale (incorrect choices):
B — Rhogam does not boost maternal immunity against
infection; it prevents alloimmunization.
C — It does not change fetal blood type or make it match
maternal blood.
D — It does not prevent bleeding at delivery.
4 — Labor & delivery: fetal heart monitoring (interpretation)
(single best answer)
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antenatal assessment (single best answer)
A 28-week gestation client comes to the clinic reporting
decreased fetal movement for 18 hours. Which action should
the nurse take first?
A. Obtain a nonstress test (NST).
B. Instruct the client to perform a fetal kick count at home.
C. Schedule a biophysical profile (BPP) for tomorrow.
D. Assess maternal blood glucose.
Answer: A. Obtain a nonstress test (NST).
Rationale (correct): A decrease in fetal movement after 28
weeks is an immediate concern because it can indicate fetal
compromise (hypoxia, placental insufficiency). An NST is a
noninvasive, rapid assessment of fetal autonomic function and
reactivity; a reactive NST (accelerations with fetal movement)
,suggests intact fetal oxygenation and central nervous system
function. Prompt NST provides immediate data to guide further
testing (BPP) or interventions.
Rationale (incorrect choices):
B — Kick counts at home are useful for ongoing monitoring but
are not the first action when the client already reports
decreased movements for 18 hours (urgent in-clinic testing is
indicated).
C — A BPP provides more comprehensive information but
requires ultrasound and time; it is appropriate if NST is
nonreactive or inconclusive, not as the initial immediate step.
D — Maternal glucose assessment is unrelated to acute
decreased fetal movements as the first action (except if
diabetes complicates assessment over time).
2 — High-risk pregnancy: preeclampsia (single best answer)
A client at 34 weeks’ gestation has preeclampsia with severe
features (BP 170/112 mm Hg, 3+ proteinuria, headache). Which
order should the nurse prioritize?
A. Administer magnesium sulfate as prescribed.
B. Give oral hydralazine for blood pressure control.
C. Prepare for immediate induction of labor.
D. Encourage the client to ambulate and void.
Answer: A. Administer magnesium sulfate as prescribed.
,Rationale (correct): In severe preeclampsia, immediate seizure
prophylaxis with magnesium sulfate is indicated to prevent
eclampsia. Magnesium stabilizes neuronal membranes and
reduces excitatory neurotransmission. While BP control is
important (antihypertensives like IV labetalol or hydralazine
may be given), seizure prophylaxis is prioritized immediately for
severe features. Seizure activity poses direct risk to mother and
fetus (hypoxia, placental abruption).
Rationale (incorrect choices):
B — Antihypertensives are necessary, but medication route and
agent matter (IV agents such as labetalol or hydralazine are
preferred for severe hypertension); magnesium for seizure
prophylaxis is a higher immediate priority.
C — Delivery may be definitive treatment but requires
stabilization (seizure prophylaxis, BP control) and team
coordination; immediate induction is not the first nursing
action.
D — Ambulation is contraindicated due to risk and severity; bed
rest and monitoring are indicated until stabilized.
3 — Prenatal education: Rh isoimmunization (single best
answer)
A primigravida Rh-negative client asks why she needs Rho(D)
immune globulin at 28 weeks. Which explanation by the nurse
is best?
A. “It prevents your body from making antibodies that could
, harm a future baby who is Rh positive.”
B. “It strengthens your immune system to protect this baby
from infection.”
C. “It ensures your baby’s blood type will match yours.”
D. “It will prevent you from having any bleeding during
delivery.”
Answer: A. “It prevents your body from making antibodies
that could harm a future baby who is Rh positive.”
Rationale (correct): Rho(D) immune globulin (Rhogam) provides
passive anti-D antibodies that bind fetal Rh-positive red blood
cells entering the maternal circulation, preventing maternal
sensitization (active antibody formation). If the mother
becomes sensitized, her IgG anti-D antibodies could cross the
placenta in future pregnancies and cause hemolytic disease of
the fetus and newborn (HDFN).
Rationale (incorrect choices):
B — Rhogam does not boost maternal immunity against
infection; it prevents alloimmunization.
C — It does not change fetal blood type or make it match
maternal blood.
D — It does not prevent bleeding at delivery.
4 — Labor & delivery: fetal heart monitoring (interpretation)
(single best answer)
