RNC-OB Exam: Questions With Accurate Solutions
1. Late in pregnancy, a patient often develops supine hypotension
because of
a. partial occlusion of the vena cava and aorta.
b. decreased peripheral collateral circulation.
c. increased blood flow to the placenta. Correct Answer - A
because of partial occlusion of the vena cava and aorta from the
weight of the uterus. This impedes venous return from the lower
extremities although increased collateral circulation during
pregnancy helps to compensate. Remaining in the supine position
for long periods of time could decrease fetal oxygenation as well.
The lateral recumbent position relieves the pressure on the vena
cava and aorta, allowing the blood pressure to increase and
symptoms to decrease.
The nurse must educate the new mother that a contraindication to
breast feeding is
a. fetal macrosomia.
b. type II diabetes.
c. infection with HIV/AIDS. Correct Answer - C
Some maternal contraindications to breastfeeding include:
-Infection with HIV/AIDS
-Use of antiretroviral medications
-Active TB not treated
-Infection with human T-cell lymphotropic virus
-Illicit drug use
-Use of chemotherapeutic agents
-Radiation therapy (may require only interruption during
treatment)
-Use of other medications that pass into the breast milk and may
harm the child
-Presence of herpes on the breast
,-Presence of varicella lesions on the breast (may resume after
lesions crust)
The initial postpartal intervention indicated for a soft boggy uterus
is to
a. apply an ice compress.
b. massage the fundus until firm.
c. apply a warm compress. Correct Answer - B
...with the dominant hand while supporting the inferior uterus with
the non-dominant hand to prevent trauma. If the fundus does not
contract with massage, then further evaluation is indicated to
determine if placental fragments remain. After the fundus becomes
contracted, the nurse should push firmly downward on the fundus
to expel clots that may have pooled.
With the vibroacoustic stimulation test, stimulus with an artificial
larynx or other device is applied to the maternal abdomen for
a. 1 to 3 seconds.
b. 5 to 10 seconds.
c. 1 to 2 minutes. Correct Answer - A
Usually, stimulus is applied for 1-2 seconds and repeated up to 3
times with time extending to 3 seconds in order to stimulate fetal
movement. A positive or reactive finding is an increased fetal heart
rate of 15 bpm or more for at least 15 seconds; however, a
nonreactive result does not always indicate fetal abnormality but
indicates the need for further testing.
Absence of the Moro reflex on one side only in a neonate may
indicate
a. fractured scapula.
b. cerebral palsy.
c. fractured clavicle. Correct Answer - C
a fractured clavicle or brachial plexus injury. Damage to the central
nervous system, such as may occur with cerebral palsy, often results
,in bilateral absence of the reflex. The Moro reflex is elicited by
allowing the infant's head and trunk to fall slightly backward when
the infant is raised. A positive Moro reflex includes immediate
extension and abduction of the arms(and sometimes the legs) with
fingers fanning and forming a C-shape with a return of the limbs to
the flexed states
In a multiparous woman, what is the lowest Bishop score that
predicts labor induction will be successful?
a. 5
b. 7
c. 9 Correct Answer - A
In a multiparous woman, the Bishop score that predicts that labor
induction will be successful is 5 or more while it is a 9 or more for a
nulliparous woman. The Bishop score is a rating system to
determine readiness for induction based on scores of 0-3 in four
different measures: dilation (cm), effacement (percentage), station
(cm), and cervical consistency (firm, medium, soft), and cervical
position (posterior, mid position, anterior). The fifth measure,
cervical position, is scored only 0-2.
When cervical laceration occur during delivery, they are most
common at what position?
a. 3 and 9 o'clock
b. 12 and 6 o'clock
c. 10 and 4 o'clock Correct Answer - A
Cervical lacerations are most often identified with vaginal retractors
when bleeding is persistent after delivery. The lacerations are
sutured with absorbable sutures, so no further treatment is usually
indicated. Minor lacerations often occur during delivery, but they
usually require no treatment. Tears are more common after forceps
assisted and vacuum assisted deliveries than normal vaginal births
If using fetal pulse oximetry, what is normal oxygen saturation?
, a. 30% to 65%
b. 65% to 90%
c. 90% to 100% Correct Answer - A
because of the fetus's high hemoglobin and hematocrit. A value
below 30% may be associated with hypoxia and metabolic acidosis.
For fetal pulse oximetry, which may be used to determine whether
immediate intervention is needed for non-reassuring fetal heart
rate, a special single-use sensor is placed internally along the fetal
cheek, temple, or forehead. However, fetal pulse oximetry has not
been found to reduce overall rates of Caesarean.
A decrease of fetal heart rate of at least 15 bpm for at least 10
minutes is classified as
a. recurrent deceleration.
b. prolonged deceleration.
c. baseline change. Correct Answer - C
If it persists more than 2 minutes but less than 10 minutes, it is
classified as a prolonged deceleration. Recurrent decelerations are
classified as occurring with half or more of uterine contractions in a
20 minute period. Intermittent decelerations occur with fewer than
half of uterine contractions in a 20 minute period.
With suspected fetal hypoxia, a cord blood gas specimen is obtained
during delivery by
a. withdrawing blood from the vein/artery before the cord is
clamped or cut and before placental expulsion.
b. placing one clamp and withdrawing blood above the clamp before
cutting the cord.
c. double clamping a 10 to 20 cm segment, cutting it out, and then
withdrawing blood from the segment. Correct Answer - C
The segment can be placed on ice temporarily as cord blood gas can
be accurately assessed for 60 minutes. An arterial sample is
preferred over venous, but paired sampling is recommended. A pH
of 7.24 or less is associated with neurological compromise. A base
1. Late in pregnancy, a patient often develops supine hypotension
because of
a. partial occlusion of the vena cava and aorta.
b. decreased peripheral collateral circulation.
c. increased blood flow to the placenta. Correct Answer - A
because of partial occlusion of the vena cava and aorta from the
weight of the uterus. This impedes venous return from the lower
extremities although increased collateral circulation during
pregnancy helps to compensate. Remaining in the supine position
for long periods of time could decrease fetal oxygenation as well.
The lateral recumbent position relieves the pressure on the vena
cava and aorta, allowing the blood pressure to increase and
symptoms to decrease.
The nurse must educate the new mother that a contraindication to
breast feeding is
a. fetal macrosomia.
b. type II diabetes.
c. infection with HIV/AIDS. Correct Answer - C
Some maternal contraindications to breastfeeding include:
-Infection with HIV/AIDS
-Use of antiretroviral medications
-Active TB not treated
-Infection with human T-cell lymphotropic virus
-Illicit drug use
-Use of chemotherapeutic agents
-Radiation therapy (may require only interruption during
treatment)
-Use of other medications that pass into the breast milk and may
harm the child
-Presence of herpes on the breast
,-Presence of varicella lesions on the breast (may resume after
lesions crust)
The initial postpartal intervention indicated for a soft boggy uterus
is to
a. apply an ice compress.
b. massage the fundus until firm.
c. apply a warm compress. Correct Answer - B
...with the dominant hand while supporting the inferior uterus with
the non-dominant hand to prevent trauma. If the fundus does not
contract with massage, then further evaluation is indicated to
determine if placental fragments remain. After the fundus becomes
contracted, the nurse should push firmly downward on the fundus
to expel clots that may have pooled.
With the vibroacoustic stimulation test, stimulus with an artificial
larynx or other device is applied to the maternal abdomen for
a. 1 to 3 seconds.
b. 5 to 10 seconds.
c. 1 to 2 minutes. Correct Answer - A
Usually, stimulus is applied for 1-2 seconds and repeated up to 3
times with time extending to 3 seconds in order to stimulate fetal
movement. A positive or reactive finding is an increased fetal heart
rate of 15 bpm or more for at least 15 seconds; however, a
nonreactive result does not always indicate fetal abnormality but
indicates the need for further testing.
Absence of the Moro reflex on one side only in a neonate may
indicate
a. fractured scapula.
b. cerebral palsy.
c. fractured clavicle. Correct Answer - C
a fractured clavicle or brachial plexus injury. Damage to the central
nervous system, such as may occur with cerebral palsy, often results
,in bilateral absence of the reflex. The Moro reflex is elicited by
allowing the infant's head and trunk to fall slightly backward when
the infant is raised. A positive Moro reflex includes immediate
extension and abduction of the arms(and sometimes the legs) with
fingers fanning and forming a C-shape with a return of the limbs to
the flexed states
In a multiparous woman, what is the lowest Bishop score that
predicts labor induction will be successful?
a. 5
b. 7
c. 9 Correct Answer - A
In a multiparous woman, the Bishop score that predicts that labor
induction will be successful is 5 or more while it is a 9 or more for a
nulliparous woman. The Bishop score is a rating system to
determine readiness for induction based on scores of 0-3 in four
different measures: dilation (cm), effacement (percentage), station
(cm), and cervical consistency (firm, medium, soft), and cervical
position (posterior, mid position, anterior). The fifth measure,
cervical position, is scored only 0-2.
When cervical laceration occur during delivery, they are most
common at what position?
a. 3 and 9 o'clock
b. 12 and 6 o'clock
c. 10 and 4 o'clock Correct Answer - A
Cervical lacerations are most often identified with vaginal retractors
when bleeding is persistent after delivery. The lacerations are
sutured with absorbable sutures, so no further treatment is usually
indicated. Minor lacerations often occur during delivery, but they
usually require no treatment. Tears are more common after forceps
assisted and vacuum assisted deliveries than normal vaginal births
If using fetal pulse oximetry, what is normal oxygen saturation?
, a. 30% to 65%
b. 65% to 90%
c. 90% to 100% Correct Answer - A
because of the fetus's high hemoglobin and hematocrit. A value
below 30% may be associated with hypoxia and metabolic acidosis.
For fetal pulse oximetry, which may be used to determine whether
immediate intervention is needed for non-reassuring fetal heart
rate, a special single-use sensor is placed internally along the fetal
cheek, temple, or forehead. However, fetal pulse oximetry has not
been found to reduce overall rates of Caesarean.
A decrease of fetal heart rate of at least 15 bpm for at least 10
minutes is classified as
a. recurrent deceleration.
b. prolonged deceleration.
c. baseline change. Correct Answer - C
If it persists more than 2 minutes but less than 10 minutes, it is
classified as a prolonged deceleration. Recurrent decelerations are
classified as occurring with half or more of uterine contractions in a
20 minute period. Intermittent decelerations occur with fewer than
half of uterine contractions in a 20 minute period.
With suspected fetal hypoxia, a cord blood gas specimen is obtained
during delivery by
a. withdrawing blood from the vein/artery before the cord is
clamped or cut and before placental expulsion.
b. placing one clamp and withdrawing blood above the clamp before
cutting the cord.
c. double clamping a 10 to 20 cm segment, cutting it out, and then
withdrawing blood from the segment. Correct Answer - C
The segment can be placed on ice temporarily as cord blood gas can
be accurately assessed for 60 minutes. An arterial sample is
preferred over venous, but paired sampling is recommended. A pH
of 7.24 or less is associated with neurological compromise. A base
