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 reports
decreased fetal movement for the past 12 hours. She is
otherwise healthy. Which action should the nurse perform first?
A. Instruct the client to perform a fetal movement (kick) count
at home and report results tomorrow.
B. Arrange for immediate nonstress test (NST) with continuous
fetal monitoring.
C. Perform Leopold’s maneuvers to determine fetal lie and
position.
D. Administer betamethasone to accelerate fetal lung maturity.
E. Obtain maternal serum glucose.
Answer: B. Arrange for immediate nonstress test (NST) with
continuous fetal monitoring.
,Rationale — Correct (B):
Decreased fetal movement is an acute concern for fetal well-
being. The first priority is to assess fetal status immediately
using fetal monitoring (NST) or a biophysical profile as
indicated. An NST provides rapid, bedside information about
fetal heart rate reactivity and can identify signs of fetal
compromise. Physiologically, decreased movement may indicate
fetal hypoxia, acidosis, or sleep cycle; an NST helps determine
whether the fetus is heart-rate reactive (adequate oxygenation
and intact autonomic responses).
Rationales — Incorrect:
A. Kick counts are useful as screening for lower-risk situations,
but when decreased movement is reported for 12 hours,
immediate in-clinic testing is indicated rather than waiting until
tomorrow.
C. Leopold’s maneuvers provide position/lie information but do
not assess fetal well-being or reactivity; they are not the first
action for decreased movement.
D. Betamethasone is indicated for threatened preterm delivery
to mature fetal lungs, not as an immediate
diagnostic/assessment response to decreased movement.
E. Maternal glucose is not the immediate priority in this
scenario; it would not directly assess fetal oxygenation or
reactivity.
,2 — High-risk pregnancy: preeclampsia (multiple response —
select all that apply)
A 35-year-old at 36 weeks diagnosed with severe preeclampsia
is receiving intravenous magnesium sulfate for seizure
prophylaxis. Which nursing assessments/interventions are
appropriate? (Select all that apply.)
A. Monitor deep tendon reflexes (DTRs) every 15–30 minutes.
B. Assess respiratory rate and oxygen saturation frequently.
C. Check urine output hourly and notify provider if <30 mL/hr.
D. Administer calcium gluconate immediately if DTRs are
hyperreflexic.
E. Stop magnesium sulfate and prepare for immediate delivery
if pulmonary edema occurs.
Answers: A, B, C, E
Rationales — Correct:
A. Magnesium sulfate depresses neuromuscular transmission;
monitoring DTRs frequently helps detect early magnesium
toxicity (hyporeflexia).
B. Respiratory depression is a sign of magnesium toxicity;
frequent respiratory assessment is required.
C. Renal excretion clears magnesium; low urine output
increases risk of toxicity — <30 mL/hr is a common action
threshold for notifying the provider.
E. Pulmonary edema is a life-threatening complication of
preeclampsia; if it occurs, magnesium should be stopped and
urgent management/delivery planning initiated.
, Rationales — Incorrect:
D. Calcium gluconate is the antidote for severe magnesium
toxicity (e.g., absent reflexes, respiratory depression, cardiac
arrhythmia), but hyperreflexia is not a sign of magnesium
toxicity — it suggests worsening preeclampsia/seizure risk.
Administering calcium gluconate for hyperreflexia would be
inappropriate.
Physiologic note: Magnesium sulfate is a CNS depressant that
reduces seizure risk by blocking NMDA receptors and
decreasing neuromuscular excitability; toxicity leads to
decreased DTRs, respiratory depression, and cardiac conduction
changes.
3 — Prenatal education (single best answer)
A pregnant client asks why folic acid is recommended before
conception and during early pregnancy. The nurse’s best
explanation is:
A. “Folic acid increases your energy and prevents morning
sickness.”
B. “Folic acid helps prevent neural tube defects by supporting
early neural tube closure.”
C. “Folic acid will guarantee your baby has no birth defects.”
D. “Folic acid reduces the risk of preterm labor by strengthening
the cervix.”
E. “Folic acid prevents gestational diabetes by stabilizing blood
sugar.”
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 reports
decreased fetal movement for the past 12 hours. She is
otherwise healthy. Which action should the nurse perform first?
A. Instruct the client to perform a fetal movement (kick) count
at home and report results tomorrow.
B. Arrange for immediate nonstress test (NST) with continuous
fetal monitoring.
C. Perform Leopold’s maneuvers to determine fetal lie and
position.
D. Administer betamethasone to accelerate fetal lung maturity.
E. Obtain maternal serum glucose.
Answer: B. Arrange for immediate nonstress test (NST) with
continuous fetal monitoring.
,Rationale — Correct (B):
Decreased fetal movement is an acute concern for fetal well-
being. The first priority is to assess fetal status immediately
using fetal monitoring (NST) or a biophysical profile as
indicated. An NST provides rapid, bedside information about
fetal heart rate reactivity and can identify signs of fetal
compromise. Physiologically, decreased movement may indicate
fetal hypoxia, acidosis, or sleep cycle; an NST helps determine
whether the fetus is heart-rate reactive (adequate oxygenation
and intact autonomic responses).
Rationales — Incorrect:
A. Kick counts are useful as screening for lower-risk situations,
but when decreased movement is reported for 12 hours,
immediate in-clinic testing is indicated rather than waiting until
tomorrow.
C. Leopold’s maneuvers provide position/lie information but do
not assess fetal well-being or reactivity; they are not the first
action for decreased movement.
D. Betamethasone is indicated for threatened preterm delivery
to mature fetal lungs, not as an immediate
diagnostic/assessment response to decreased movement.
E. Maternal glucose is not the immediate priority in this
scenario; it would not directly assess fetal oxygenation or
reactivity.
,2 — High-risk pregnancy: preeclampsia (multiple response —
select all that apply)
A 35-year-old at 36 weeks diagnosed with severe preeclampsia
is receiving intravenous magnesium sulfate for seizure
prophylaxis. Which nursing assessments/interventions are
appropriate? (Select all that apply.)
A. Monitor deep tendon reflexes (DTRs) every 15–30 minutes.
B. Assess respiratory rate and oxygen saturation frequently.
C. Check urine output hourly and notify provider if <30 mL/hr.
D. Administer calcium gluconate immediately if DTRs are
hyperreflexic.
E. Stop magnesium sulfate and prepare for immediate delivery
if pulmonary edema occurs.
Answers: A, B, C, E
Rationales — Correct:
A. Magnesium sulfate depresses neuromuscular transmission;
monitoring DTRs frequently helps detect early magnesium
toxicity (hyporeflexia).
B. Respiratory depression is a sign of magnesium toxicity;
frequent respiratory assessment is required.
C. Renal excretion clears magnesium; low urine output
increases risk of toxicity — <30 mL/hr is a common action
threshold for notifying the provider.
E. Pulmonary edema is a life-threatening complication of
preeclampsia; if it occurs, magnesium should be stopped and
urgent management/delivery planning initiated.
, Rationales — Incorrect:
D. Calcium gluconate is the antidote for severe magnesium
toxicity (e.g., absent reflexes, respiratory depression, cardiac
arrhythmia), but hyperreflexia is not a sign of magnesium
toxicity — it suggests worsening preeclampsia/seizure risk.
Administering calcium gluconate for hyperreflexia would be
inappropriate.
Physiologic note: Magnesium sulfate is a CNS depressant that
reduces seizure risk by blocking NMDA receptors and
decreasing neuromuscular excitability; toxicity leads to
decreased DTRs, respiratory depression, and cardiac conduction
changes.
3 — Prenatal education (single best answer)
A pregnant client asks why folic acid is recommended before
conception and during early pregnancy. The nurse’s best
explanation is:
A. “Folic acid increases your energy and prevents morning
sickness.”
B. “Folic acid helps prevent neural tube defects by supporting
early neural tube closure.”
C. “Folic acid will guarantee your baby has no birth defects.”
D. “Folic acid reduces the risk of preterm labor by strengthening
the cervix.”
E. “Folic acid prevents gestational diabetes by stabilizing blood
sugar.”
