RNC-OB Exam Questions and Answers Graded A
1. Late in pregnancy, a patient often develops ...with the dominant hand while supporting the
supine hypotension because of inferior uterus with the non-dominant hand to
a. partial occlusion of the vena cava and aorta. prevent trauma. If the fundus does not contract
b. decreased peripheral collateral circulation. with massage, then further evaluation is indicated
c. increased blood flow to the placenta. - - to determine if placental fragments remain. After
A the fundus becomes contracted, the nurse should
because of partial occlusion of the vena cava push firmly downward on the fundus to expel
and aorta from the weight of the uterus. This clots that may have pooled.
impedes venous return from the lower
extremities although increased collateral
circulation during pregnancy helps to With the vibroacoustic stimulation test, stimulus
compensate. Remaining in the supine position with an artificial larynx or other device is applied
for long periods of time could decrease fetal to the maternal abdomen for
oxygenation as well. The lateral recumbent a. 1 to 3 seconds.
position relieves the pressure on the vena cava b. 5 to 10 seconds.
and aorta, allowing the blood pressure to c. 1 to 2 minutes. - -A
increase and symptoms to decrease. 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
The nurse must educate the new mother that a positive or reactive finding is an increased fetal
contraindication to breast feeding is heart rate of 15 bpm or more for at least 15
a. fetal macrosomia. seconds; however, a nonreactive result does not
b. type II diabetes. always indicate fetal abnormality but indicates the
c. infection with HIV/AIDS. - -C need for further testing.
Some maternal contraindications to
breastfeeding include:
-Infection with HIV/AIDS Absence of the Moro reflex on one side only in a
-Use of antiretroviral medications neonate may indicate
-Active TB not treated a. fractured scapula.
-Infection with human T-cell lymphotropic virus b. cerebral palsy.
-Illicit drug use c. fractured clavicle. - -C
-Use of chemotherapeutic agents a fractured clavicle or brachial plexus injury.
-Radiation therapy (may require only interruption Damage to the central nervous system, such as
during treatment) may occur with cerebral palsy, often results in
-Use of other medications that pass into the bilateral absence of the reflex. The Moro reflex is
breast milk and may harm the child elicited by allowing the infant's head and trunk to
-Presence of herpes on the breast fall slightly backward when the infant is raised. A
-Presence of varicella lesions on the breast (may positive Moro reflex includes immediate
resume after lesions crust) 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 initial postpartal intervention indicated for a the flexed states
soft boggy uterus is to
a. apply an ice compress.
b. massage the fundus until firm. In a multiparous woman, what is the lowest
c. apply a warm compress. - -B Bishop score that predicts labor induction will be
, RNC-OB Exam Questions and Answers Graded A
successful? However, fetal pulse oximetry has not been found
a. 5 to reduce overall rates of Caesarean.
b. 7
c. 9 - -A
In a multiparous woman, the Bishop score that A decrease of fetal heart rate of at least 15 bpm
predicts that labor induction will be successful is for at least 10 minutes is classified as
5 or more while it is a 9 or more for a nulliparous a. recurrent deceleration.
woman. The Bishop score is a rating system to b. prolonged deceleration.
determine readiness for induction based on c. baseline change. - -C
scores of 0-3 in four different measures: dilation If it persists more than 2 minutes but less than 10
(cm), effacement (percentage), station (cm), and minutes, it is classified as a prolonged
cervical consistency (firm, medium, soft), and deceleration. Recurrent decelerations are
cervical position (posterior, mid position, classified as occurring with half or more of uterine
anterior). The fifth measure, cervical position, is contractions in a 20 minute period. Intermittent
scored only 0-2. decelerations occur with fewer than half of
uterine contractions in a 20 minute period.
When cervical laceration occur during delivery,
they are most common at what position? With suspected fetal hypoxia, a cord blood gas
a. 3 and 9 o'clock specimen is obtained during delivery by
b. 12 and 6 o'clock a. withdrawing blood from the vein/artery before
c. 10 and 4 o'clock - -A the cord is clamped or cut and before placental
Cervical lacerations are most often identified with expulsion.
vaginal retractors when bleeding is persistent b. placing one clamp and withdrawing blood
after delivery. The lacerations are sutured with above the clamp before cutting the cord.
absorbable sutures, so no further treatment is c. double clamping a 10 to 20 cm segment,
usually indicated. Minor lacerations often occur cutting it out, and then withdrawing blood from
during delivery, but they usually require no the segment. - -C
treatment. Tears are more common after forceps The segment can be placed on ice temporarily as
assisted and vacuum assisted deliveries than cord blood gas can be accurately assessed for
normal vaginal births 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
If using fetal pulse oximetry, what is normal compromise. A base excess of 12 mmol/L or
oxygen saturation? more is predictive of motor or cognitive
a. 30% to 65% impairment.
b. 65% to 90%
c. 90% to 100% - -A
because of the fetus's high hemoglobin and When eliciting the scarf sign in a neonate, the
hematocrit. A value below 30% may be infant's elbow crosses the midline of the chest,
associated with hypoxia and metabolic acidosis. probably indicating a
For fetal pulse oximetry, which may be used to a. preterm infant.
determine whether immediate intervention is b. term infant.
needed for non-reassuring fetal heart rate, a c. postterm infant. - -A
special single-use sensor is placed internally At fullterm, the elbow should not cross the
along the fetal cheek, temple, or forehead. midline. For the scarf test, the neonate should be
, RNC-OB Exam Questions and Answers Graded A
placed supine. One arm is grasped and the hand these medications should be discontinued at
pulled toward the opposite shoulder and then the least 30 days prior to the patient becoming
position of the elbow is assessed in relation to pregnant. Plaquenil and prednisone may be
the midline of the chest. continued during pregnancy. A patient with lupus
should be stabilized for at least 6 months before
attempting to become pregnant because
Following birth, which hormone stimulates the pregnancy may exacerbate symptoms, and the
alveolar cells of the breast, promoting production patient may have antibodies that increase risk of
of milk? miscarriage or stillbirth in late pregnancy.
a. Estrogen
b. Prolactin
c. Progesterone - -B A series of ultrasound scans after the 20th week
which increases in response to the neonate's show that the fetal head is growing normally but
suckling. Suckling also promotes release of the abdominal circumference is lower than
oxytocin, which promotes the letdown reflex by expected. This may indicated which of the
increasing contractibility of the muscles of the following?
mammary ducts. After milk production is well a. Down syndrome
established, prolactin levels decrease, and most b. Neural tube defect
milk production is then facilitated by oxytocin. c. Placental insufficiency - -C
During pregnancy, estrogen promotes ...common in patients who are diabetic,
proliferation of breast ducts and progesterone hypertensive, or anemic. With placental
the development of lobules and alveoli insufficiency, the supply of oxygen and nutrients
to the fetus is impaired, so the fetus responds by
sending the nutrients to the most critical organs
Which anesthetic technique provides the best (heart, brain, lungs) and the other abdominal
relief of pain during labor and delivery? organs receive less, so they develop more slowly
a. Epidural
b. Spinal
c. Pudendal block - -A Idiopathic cardiomyopathy of pregnancy is a
The epidural can provide continuous relief during condition that
both labor and delivery and does not pose the a. precedes pregnancy and exacerbates due to
risk of spinal headache and provides less motor the stress of pregnancy.
blockade. Additionally, there is a deceased risk b. develops in the last month of pregnancy or
of hypotension because of reduced risk of soon after birth without preexisting cardiac
sympathetic blockade. Spinal is now usually disease.
reserved for Cesareans. The pudendal block c. develops in the first trimester of pregnancy and
provides relief primarily during delivery. must be monitored throughout the pregnancy and
delivery. - -B
Develops in the last month of pregnancy or the
A patient with lupus erythematosus places the first 5-6 postpartal months and is not associated
fetus at risk if she takes which medication during with pre-existing myocarditis, endocarditis, or
pregnancy? cardiac disease. It is characterized by left
a. Prednisone ventricular systolic dysfunction. Typical
b. Methotrexate symptoms are similar to heart failure and include
c. Plaquenil® (hydroxychloroquine) - -B dyspnea (the most common symptom),
...methotrexate or cyclophosphamide. Both of orthopnea, cough, palpitations, and chest pain.
, RNC-OB Exam Questions and Answers Graded A
The heart is markedly enlarged, and the ejection To reduce the risk of hemorrhagic disease after
fraction is less than 45%. It increases risk of birth, a neonate should receive
thromboembolia, so the woman is often treated a. vitamin B9 (folic acid).
with heparin. Treatment is similar to that for heart b. vitamin C.
failure although if it occurs prior to delivery, ACE c. vitamin K. - -C
inhibitors are withheld because of adverse Neonates are born with low levels of vitamin K,
effects to the fetus. Management includes which is necessary to activate clotting factors.
bedrest, diuretics, and digoxin. Additionally, while platelet levels are near adult
level, the platelets do not respond effectively to
stimuli for several days after birth. Combined,
If 10% to 20% of the placental surface is these factors increase the risk of hemorrhage,
detached but the mother and fetus are not in but the risk is markedly reduced if the neonate
distress, the placental abruption is classified as receives an IM injection of vitamin K.
a. grade 1, mild.
b. grade 2, moderate.
c. grade 3, severe. - -A A patient is in active labor and has contractions
Grade 1: 10-20% of the placental surface is every 8 minutes lasting for 45 seconds and
detached o the mother and fetus are not in increasing in intensity by 25 mm Hg during
distress. Uterus may be tender and mild tetany contractions. This patient is likely experiencing
evident a. hypertonic labor.
b. hypotonic labor.
Grade 2: 20-50% is detached with or without c. normal labor. - -B
external bleeding. Uterine tenderness and tetany The average amplitude is 40-50 mmHG. Because
are evident. While the mother is not in shock, the the contractions are often irregular and have low
fetus shows distress. amplitude, cervical dilation is usually slowed or
may arrest so that labor becomes prolonged
Grade 3: over 50% detached with severe uterine without interventions. Treatment may include
tetany, maternal shock, and frequently ROM and/or oxytocin to strengthen the
coagulopathy. The fetus is dead. contractions
If vaginal fluid contains blood, the nitrazine test A pregnant patient who presents with sudden
for the presence of amniotic fluid onset of severe uterine pain with slow increase in
a. may show a false positive. fundal height but no vaginal bleeding should be
b. may show a false negative. assessed for
c. is unaffected by blood. - -A a. abruptio placentae.
because the pH of blood ranges from 7.35-7.45 b. bladder retention.
and the pH of amniotic fluid ranges from 7.0-7.5, c. fecal impaction. - -A
so they may react similarly. A pH in the range of Up to 80% of patients with abruptio placentae
6.57.5 is considered positive for amniotic fluid in exhibit vaginal bleeding, but bleeding may be
the absence of other factors (blood, semen, contained between the uterine wall and the
urine) that may affect results. The test sample placenta, resulting in maternal shock without
should include vaginal secretions from the obvious bleeding. If the fetus is at term, bleeding
posterior vagina but not the mucous plug is severe, or the mother or fetus is in jeopardy,
immediate delivery is indicated.
1. Late in pregnancy, a patient often develops ...with the dominant hand while supporting the
supine hypotension because of inferior uterus with the non-dominant hand to
a. partial occlusion of the vena cava and aorta. prevent trauma. If the fundus does not contract
b. decreased peripheral collateral circulation. with massage, then further evaluation is indicated
c. increased blood flow to the placenta. - - to determine if placental fragments remain. After
A the fundus becomes contracted, the nurse should
because of partial occlusion of the vena cava push firmly downward on the fundus to expel
and aorta from the weight of the uterus. This clots that may have pooled.
impedes venous return from the lower
extremities although increased collateral
circulation during pregnancy helps to With the vibroacoustic stimulation test, stimulus
compensate. Remaining in the supine position with an artificial larynx or other device is applied
for long periods of time could decrease fetal to the maternal abdomen for
oxygenation as well. The lateral recumbent a. 1 to 3 seconds.
position relieves the pressure on the vena cava b. 5 to 10 seconds.
and aorta, allowing the blood pressure to c. 1 to 2 minutes. - -A
increase and symptoms to decrease. 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
The nurse must educate the new mother that a positive or reactive finding is an increased fetal
contraindication to breast feeding is heart rate of 15 bpm or more for at least 15
a. fetal macrosomia. seconds; however, a nonreactive result does not
b. type II diabetes. always indicate fetal abnormality but indicates the
c. infection with HIV/AIDS. - -C need for further testing.
Some maternal contraindications to
breastfeeding include:
-Infection with HIV/AIDS Absence of the Moro reflex on one side only in a
-Use of antiretroviral medications neonate may indicate
-Active TB not treated a. fractured scapula.
-Infection with human T-cell lymphotropic virus b. cerebral palsy.
-Illicit drug use c. fractured clavicle. - -C
-Use of chemotherapeutic agents a fractured clavicle or brachial plexus injury.
-Radiation therapy (may require only interruption Damage to the central nervous system, such as
during treatment) may occur with cerebral palsy, often results in
-Use of other medications that pass into the bilateral absence of the reflex. The Moro reflex is
breast milk and may harm the child elicited by allowing the infant's head and trunk to
-Presence of herpes on the breast fall slightly backward when the infant is raised. A
-Presence of varicella lesions on the breast (may positive Moro reflex includes immediate
resume after lesions crust) 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 initial postpartal intervention indicated for a the flexed states
soft boggy uterus is to
a. apply an ice compress.
b. massage the fundus until firm. In a multiparous woman, what is the lowest
c. apply a warm compress. - -B Bishop score that predicts labor induction will be
, RNC-OB Exam Questions and Answers Graded A
successful? However, fetal pulse oximetry has not been found
a. 5 to reduce overall rates of Caesarean.
b. 7
c. 9 - -A
In a multiparous woman, the Bishop score that A decrease of fetal heart rate of at least 15 bpm
predicts that labor induction will be successful is for at least 10 minutes is classified as
5 or more while it is a 9 or more for a nulliparous a. recurrent deceleration.
woman. The Bishop score is a rating system to b. prolonged deceleration.
determine readiness for induction based on c. baseline change. - -C
scores of 0-3 in four different measures: dilation If it persists more than 2 minutes but less than 10
(cm), effacement (percentage), station (cm), and minutes, it is classified as a prolonged
cervical consistency (firm, medium, soft), and deceleration. Recurrent decelerations are
cervical position (posterior, mid position, classified as occurring with half or more of uterine
anterior). The fifth measure, cervical position, is contractions in a 20 minute period. Intermittent
scored only 0-2. decelerations occur with fewer than half of
uterine contractions in a 20 minute period.
When cervical laceration occur during delivery,
they are most common at what position? With suspected fetal hypoxia, a cord blood gas
a. 3 and 9 o'clock specimen is obtained during delivery by
b. 12 and 6 o'clock a. withdrawing blood from the vein/artery before
c. 10 and 4 o'clock - -A the cord is clamped or cut and before placental
Cervical lacerations are most often identified with expulsion.
vaginal retractors when bleeding is persistent b. placing one clamp and withdrawing blood
after delivery. The lacerations are sutured with above the clamp before cutting the cord.
absorbable sutures, so no further treatment is c. double clamping a 10 to 20 cm segment,
usually indicated. Minor lacerations often occur cutting it out, and then withdrawing blood from
during delivery, but they usually require no the segment. - -C
treatment. Tears are more common after forceps The segment can be placed on ice temporarily as
assisted and vacuum assisted deliveries than cord blood gas can be accurately assessed for
normal vaginal births 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
If using fetal pulse oximetry, what is normal compromise. A base excess of 12 mmol/L or
oxygen saturation? more is predictive of motor or cognitive
a. 30% to 65% impairment.
b. 65% to 90%
c. 90% to 100% - -A
because of the fetus's high hemoglobin and When eliciting the scarf sign in a neonate, the
hematocrit. A value below 30% may be infant's elbow crosses the midline of the chest,
associated with hypoxia and metabolic acidosis. probably indicating a
For fetal pulse oximetry, which may be used to a. preterm infant.
determine whether immediate intervention is b. term infant.
needed for non-reassuring fetal heart rate, a c. postterm infant. - -A
special single-use sensor is placed internally At fullterm, the elbow should not cross the
along the fetal cheek, temple, or forehead. midline. For the scarf test, the neonate should be
, RNC-OB Exam Questions and Answers Graded A
placed supine. One arm is grasped and the hand these medications should be discontinued at
pulled toward the opposite shoulder and then the least 30 days prior to the patient becoming
position of the elbow is assessed in relation to pregnant. Plaquenil and prednisone may be
the midline of the chest. continued during pregnancy. A patient with lupus
should be stabilized for at least 6 months before
attempting to become pregnant because
Following birth, which hormone stimulates the pregnancy may exacerbate symptoms, and the
alveolar cells of the breast, promoting production patient may have antibodies that increase risk of
of milk? miscarriage or stillbirth in late pregnancy.
a. Estrogen
b. Prolactin
c. Progesterone - -B A series of ultrasound scans after the 20th week
which increases in response to the neonate's show that the fetal head is growing normally but
suckling. Suckling also promotes release of the abdominal circumference is lower than
oxytocin, which promotes the letdown reflex by expected. This may indicated which of the
increasing contractibility of the muscles of the following?
mammary ducts. After milk production is well a. Down syndrome
established, prolactin levels decrease, and most b. Neural tube defect
milk production is then facilitated by oxytocin. c. Placental insufficiency - -C
During pregnancy, estrogen promotes ...common in patients who are diabetic,
proliferation of breast ducts and progesterone hypertensive, or anemic. With placental
the development of lobules and alveoli insufficiency, the supply of oxygen and nutrients
to the fetus is impaired, so the fetus responds by
sending the nutrients to the most critical organs
Which anesthetic technique provides the best (heart, brain, lungs) and the other abdominal
relief of pain during labor and delivery? organs receive less, so they develop more slowly
a. Epidural
b. Spinal
c. Pudendal block - -A Idiopathic cardiomyopathy of pregnancy is a
The epidural can provide continuous relief during condition that
both labor and delivery and does not pose the a. precedes pregnancy and exacerbates due to
risk of spinal headache and provides less motor the stress of pregnancy.
blockade. Additionally, there is a deceased risk b. develops in the last month of pregnancy or
of hypotension because of reduced risk of soon after birth without preexisting cardiac
sympathetic blockade. Spinal is now usually disease.
reserved for Cesareans. The pudendal block c. develops in the first trimester of pregnancy and
provides relief primarily during delivery. must be monitored throughout the pregnancy and
delivery. - -B
Develops in the last month of pregnancy or the
A patient with lupus erythematosus places the first 5-6 postpartal months and is not associated
fetus at risk if she takes which medication during with pre-existing myocarditis, endocarditis, or
pregnancy? cardiac disease. It is characterized by left
a. Prednisone ventricular systolic dysfunction. Typical
b. Methotrexate symptoms are similar to heart failure and include
c. Plaquenil® (hydroxychloroquine) - -B dyspnea (the most common symptom),
...methotrexate or cyclophosphamide. Both of orthopnea, cough, palpitations, and chest pain.
, RNC-OB Exam Questions and Answers Graded A
The heart is markedly enlarged, and the ejection To reduce the risk of hemorrhagic disease after
fraction is less than 45%. It increases risk of birth, a neonate should receive
thromboembolia, so the woman is often treated a. vitamin B9 (folic acid).
with heparin. Treatment is similar to that for heart b. vitamin C.
failure although if it occurs prior to delivery, ACE c. vitamin K. - -C
inhibitors are withheld because of adverse Neonates are born with low levels of vitamin K,
effects to the fetus. Management includes which is necessary to activate clotting factors.
bedrest, diuretics, and digoxin. Additionally, while platelet levels are near adult
level, the platelets do not respond effectively to
stimuli for several days after birth. Combined,
If 10% to 20% of the placental surface is these factors increase the risk of hemorrhage,
detached but the mother and fetus are not in but the risk is markedly reduced if the neonate
distress, the placental abruption is classified as receives an IM injection of vitamin K.
a. grade 1, mild.
b. grade 2, moderate.
c. grade 3, severe. - -A A patient is in active labor and has contractions
Grade 1: 10-20% of the placental surface is every 8 minutes lasting for 45 seconds and
detached o the mother and fetus are not in increasing in intensity by 25 mm Hg during
distress. Uterus may be tender and mild tetany contractions. This patient is likely experiencing
evident a. hypertonic labor.
b. hypotonic labor.
Grade 2: 20-50% is detached with or without c. normal labor. - -B
external bleeding. Uterine tenderness and tetany The average amplitude is 40-50 mmHG. Because
are evident. While the mother is not in shock, the the contractions are often irregular and have low
fetus shows distress. amplitude, cervical dilation is usually slowed or
may arrest so that labor becomes prolonged
Grade 3: over 50% detached with severe uterine without interventions. Treatment may include
tetany, maternal shock, and frequently ROM and/or oxytocin to strengthen the
coagulopathy. The fetus is dead. contractions
If vaginal fluid contains blood, the nitrazine test A pregnant patient who presents with sudden
for the presence of amniotic fluid onset of severe uterine pain with slow increase in
a. may show a false positive. fundal height but no vaginal bleeding should be
b. may show a false negative. assessed for
c. is unaffected by blood. - -A a. abruptio placentae.
because the pH of blood ranges from 7.35-7.45 b. bladder retention.
and the pH of amniotic fluid ranges from 7.0-7.5, c. fecal impaction. - -A
so they may react similarly. A pH in the range of Up to 80% of patients with abruptio placentae
6.57.5 is considered positive for amniotic fluid in exhibit vaginal bleeding, but bleeding may be
the absence of other factors (blood, semen, contained between the uterine wall and the
urine) that may affect results. The test sample placenta, resulting in maternal shock without
should include vaginal secretions from the obvious bleeding. If the fetus is at term, bleeding
posterior vagina but not the mucous plug is severe, or the mother or fetus is in jeopardy,
immediate delivery is indicated.
