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: Fundal height discrepancy
A 28-week gestation client reports that her uterine fundal
height measures 30 cm (greater than expected). Which nursing
action is best first?
A. Reassure the client — slight variation is normal.
B. Ask about fetal movement patterns and perform a fetal
movement count.
C. Arrange ultrasound to assess fetal size and amniotic fluid
volume.
D. Instruct the client to reduce oral fluid intake for 24 hours and
repeat measurement.
Correct: C. Arrange ultrasound to assess fetal size and amniotic
fluid volume.
,Rationale (correct): At 28 weeks, fundal height generally
approximates weeks ±2 cm; a measurement larger than
expected raises concerns for polyhydramnios, multiple
gestation, or fetal macrosomia (often due to gestational
diabetes). Ultrasound is the diagnostic test to evaluate fetal
size, fluid volume, and number of fetuses. Maternal uterine
enlargement reflects uterine contents; ultrasound directly
evaluates fetal–placental conditions that explain the
discrepancy.
Rationale (incorrect):
A — Reassurance alone delays diagnosis of conditions (e.g.,
macrosomia) that affect management.
B — Fetal movement counts are useful for fetal well-being but
do not determine size or fluid volume.
D — Reducing fluids will not reliably change fundal height and
could harm maternal hydration; unnecessary.
2 — High-risk pregnancy: Preeclampsia identification
A primigravida at 36 weeks has BP 152/100 mm Hg and 2+
protein on a dipstick. Which additional finding most supports a
diagnosis of preeclampsia with severe features?
A. Fetal heart rate 140 beats/min with accelerations.
B. Platelet count 110,000/mm³.
C. Urine specific gravity 1.020.
D. Respiratory rate 18 breaths/min.
,Correct: B. Platelet count 110,000/mm³.
Rationale (correct): Preeclampsia involves new hypertension
after 20 weeks and proteinuria or end-organ dysfunction.
Severe features include thrombocytopenia (<100,000 often
used, but trending low platelets are concerning) — 110,000
supports significant hematologic involvement and warrants
close monitoring/assessment for severe disease (lab trends
matter). Pathophysiology: abnormal placental spiral artery
remodeling → placental ischemia → systemic endothelial
dysfunction, vasospasm, and activation of coagulation
pathways.
Rationale (incorrect):
A — Normal fetal rate/accelerations indicate fetal reactivity but
don’t confirm maternal severe features.
C — Urine specific gravity reflects concentration, not
proteinuria or severity.
D — Normal RR — respiratory status not an indicator of
preeclampsia severity here.
3 — Prenatal education: Rubella immunity
During a prenatal visit the client asks whether she should get
the MMR vaccine now. Which response by the nurse is correct?
A. “Yes — the MMR is recommended during pregnancy to
prevent fetal rubella.”
B. “No — MMR is contraindicated during pregnancy; you can
, receive it postpartum if nonimmune.”
C. “You can receive MMR in the second trimester.”
D. “MMR is safe if you are past 20 weeks gestation.”
Correct: B. “No — MMR is contraindicated during pregnancy;
you can receive it postpartum if nonimmune.”
Rationale (correct): The MMR vaccine is a live-attenuated
vaccine and is contraindicated during pregnancy due to
theoretical risk of fetal infection. Women who lack rubella
immunity should be vaccinated postpartum before discharge;
contraception should be used for 28 days after MMR.
Physiology: maternal rubella infection during organogenesis
(first trimester) risks teratogenic effects; thus prevention prior
to pregnancy or postpartum vaccination is the safe approach.
Rationale (incorrect):
A/C/D — All incorrect because MMR is live and not given during
pregnancy. Timing during pregnancy does not remove the
contraindication.
4 — NGN-style: Prioritization in suspected placenta previa
(ordered response)
A client at 34 weeks suddenly reports painless bright vaginal
bleeding. Arrange the nursing actions in order of priority (1 =
first action). Options:
A. Obtain maternal vital signs and establish continuous fetal
monitoring.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MATERNITY AND NEWBORN NURSING (HIGH-
DEMAND AREA) TEST BANK
1 — Antepartum: Fundal height discrepancy
A 28-week gestation client reports that her uterine fundal
height measures 30 cm (greater than expected). Which nursing
action is best first?
A. Reassure the client — slight variation is normal.
B. Ask about fetal movement patterns and perform a fetal
movement count.
C. Arrange ultrasound to assess fetal size and amniotic fluid
volume.
D. Instruct the client to reduce oral fluid intake for 24 hours and
repeat measurement.
Correct: C. Arrange ultrasound to assess fetal size and amniotic
fluid volume.
,Rationale (correct): At 28 weeks, fundal height generally
approximates weeks ±2 cm; a measurement larger than
expected raises concerns for polyhydramnios, multiple
gestation, or fetal macrosomia (often due to gestational
diabetes). Ultrasound is the diagnostic test to evaluate fetal
size, fluid volume, and number of fetuses. Maternal uterine
enlargement reflects uterine contents; ultrasound directly
evaluates fetal–placental conditions that explain the
discrepancy.
Rationale (incorrect):
A — Reassurance alone delays diagnosis of conditions (e.g.,
macrosomia) that affect management.
B — Fetal movement counts are useful for fetal well-being but
do not determine size or fluid volume.
D — Reducing fluids will not reliably change fundal height and
could harm maternal hydration; unnecessary.
2 — High-risk pregnancy: Preeclampsia identification
A primigravida at 36 weeks has BP 152/100 mm Hg and 2+
protein on a dipstick. Which additional finding most supports a
diagnosis of preeclampsia with severe features?
A. Fetal heart rate 140 beats/min with accelerations.
B. Platelet count 110,000/mm³.
C. Urine specific gravity 1.020.
D. Respiratory rate 18 breaths/min.
,Correct: B. Platelet count 110,000/mm³.
Rationale (correct): Preeclampsia involves new hypertension
after 20 weeks and proteinuria or end-organ dysfunction.
Severe features include thrombocytopenia (<100,000 often
used, but trending low platelets are concerning) — 110,000
supports significant hematologic involvement and warrants
close monitoring/assessment for severe disease (lab trends
matter). Pathophysiology: abnormal placental spiral artery
remodeling → placental ischemia → systemic endothelial
dysfunction, vasospasm, and activation of coagulation
pathways.
Rationale (incorrect):
A — Normal fetal rate/accelerations indicate fetal reactivity but
don’t confirm maternal severe features.
C — Urine specific gravity reflects concentration, not
proteinuria or severity.
D — Normal RR — respiratory status not an indicator of
preeclampsia severity here.
3 — Prenatal education: Rubella immunity
During a prenatal visit the client asks whether she should get
the MMR vaccine now. Which response by the nurse is correct?
A. “Yes — the MMR is recommended during pregnancy to
prevent fetal rubella.”
B. “No — MMR is contraindicated during pregnancy; you can
, receive it postpartum if nonimmune.”
C. “You can receive MMR in the second trimester.”
D. “MMR is safe if you are past 20 weeks gestation.”
Correct: B. “No — MMR is contraindicated during pregnancy;
you can receive it postpartum if nonimmune.”
Rationale (correct): The MMR vaccine is a live-attenuated
vaccine and is contraindicated during pregnancy due to
theoretical risk of fetal infection. Women who lack rubella
immunity should be vaccinated postpartum before discharge;
contraception should be used for 28 days after MMR.
Physiology: maternal rubella infection during organogenesis
(first trimester) risks teratogenic effects; thus prevention prior
to pregnancy or postpartum vaccination is the safe approach.
Rationale (incorrect):
A/C/D — All incorrect because MMR is live and not given during
pregnancy. Timing during pregnancy does not remove the
contraindication.
4 — NGN-style: Prioritization in suspected placenta previa
(ordered response)
A client at 34 weeks suddenly reports painless bright vaginal
bleeding. Arrange the nursing actions in order of priority (1 =
first action). Options:
A. Obtain maternal vital signs and establish continuous fetal
monitoring.
