RNC-OB Certification Review Exam Questions and Answers, Exams of Nursing

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RNC-OB Certification Review Exam questions

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A patient's record states her pregnancy history is 1 term pregnancy, 1 miscarriage at 10 weeks, twins at 35 weeks with one who dies soon after birth. What is her GP? CORRECT ANSWER Gravida 3 Para 1212 Cholestasis is a condition that occurs in pregnancy and is caused by elevated... CORRECT ANSWER Bile acid What is a sign of deteriorating status in pregnancy complicated by hypertension? CORRECT ANSWER Increased serum creatinine A patient at 37 weeks gestation arrives to labor and delivery from the emergency room after admission for severe gastric discomfort with nausea and vomiting. She is anxious and dizzy. Her blood pressure is 156/100. She has 4+ protein in her urine. Most likely diagnosis is anxiety and... CORRECT ANSWER Preeclampsia with severe features Fluid balance should be monitored in a woman on mag sulfate therapy because there is an increased risk for... CORRECT ANSWER Pulmonary edema On admission to the labor unit, a woman's deep tendon reflexes are assessed at 2+. Intravenous magnesium sulfate is initiated. At her next assessment, her reflexes are absent with respiratory rate of 10. Which actions should be taken? CORRECT ANSWER Stop the magnesium sulfate and notify provider. A newly pregnant woman who is morbidly obese has a strong family history of Type 2 diabetes. The recommended time for this woman's initial glucose screen is... CORRECT ANSWER As soon as possible.

The relation of the fetal body parts to one another Is called fetal... CORRECT ANSWER Attitude. The most accurate dating of a pregnancy by ultrasound is... CORRECT ANSWER First trimester evaluation of the crown-rump length. A biophysical score of 6 is considered... CORRECT ANSWER Equivocal. At 32 weeks, a prenatal patient reported decreased fetal movement. A nonstress test is reported as nonreactive. Which is appropriate for this patient? CORRECT ANSWER Biophysical profile. Cordocentesis is more commonly used to detect fetal... CORRECT ANSWER Anemia. Quad screening compared to alphafetoprotein testing can better detect... CORRECT ANSWER Trisomies. A fetal heart rate baseline of 140 with moderate variability, no accelerations and no decelerations is a NICHD category... CORRECT ANSWER 1 (one) A series of sine waves with similar duration and amplitude develop on the electronic fetal monitor 10 minutes after stadol administration to a patient with a previously normal tracing. The appropriate response to this fetal heart rate pattern would be to... CORRECT ANSWER Continue to observe... Fetal metabolic acidosis in a tracing can be ruled out with the presence of... CORRECT ANSWER Variability.

Which tachyarrhythmia can result in fetal hydrops? CORRECT ANSWER Persistent supraventricular tachycardia-sign of anemia which can in turn cause hydrops. A G2P1 at 34 weeks gestation with a history of lupus was in for a routine prenatal visit. FHT's were auscultated at 60. She was sent to labor and delivery for further evaluation. A complete flat tracing suggests the fetus has... CORRECT ANSWER A complete heart block, which can be a complication of lupus. A woman at term is in labor and exhibits recurrent variable decelerations with moderate variability and meconium stained amniotic fluid. An amnioinfusion is ordered with the goal of... CORRECT ANSWER Relieving cord compression. Baroreceptors respond mainly to changes in... CORRECT ANSWER Blood pressure. Stimulation of the sympathetic nervous system causes the fetal heart rate to... CORRECT ANSWER increase. According to the NICHD definitions, which deceleration much drop at least 15 beats per minutes... CORRECT ANSWER Prolonged. Normal uterine activity... CORRECT ANSWER Resting tone less than 20- mmHg. The most common side effect of prostaglandin administration for cervical ripening is... CORRECT ANSWER Tachysystole.

The NICHD definition of uterine tachysystole is a contraction frequency averaged over 30 minutes of greater than... CORRECT ANSWER 5 contractions in 10 minutes. When fetal heart tones are heard about the umbilicus and the fetal head is palpated in the upper part of uterus, this is consistent with... CORRECT ANSWER Breech presentation. During auscultation of the fetal heart rate, the nurse notes a gradual decrease in the fetal heart rate after a contraction that lasts 60 seconds. The appropriate documentation of this finding is that after a contraction, there is a... CORRECT ANSWER decrease in the fetal heart rate after contraction. A reliable method for confirming the presence of an irregular fetal heart rhythm is a... CORRECT ANSWER Fetoscope, because you can HEAR heart sounds vs US soundwaves. The first Leopold's maneuver assists in identifying fetal... CORRECT ANSWER Position. An advantage of vibroacoustic testing is that it... CORRECT ANSWER can be used effectively at any gestational age. When differentiating false labor from true labor, a finding that would suggest a woman is in true labor is if after 1-2 hours of walking... CORRECT ANSWER back pain is radiating to the abdomen. The umbilical vein carries... CORRECT ANSWER oxygenated blood from the placenta to the fetus.

The Ferguson reflex is the result of... CORRECT ANSWER Pressure on the cervix. Compared to non-pregnant values, maternal carbon dioxide (pCO2) during pregnancy is... CORRECT ANSWER decreased, because mother breathing faster. The metabolic state of pregnancy is described as a chronic... CORRECT ANSWER respiratory alkalosis. During pregnancy, cardiac output increases by what percent? CORRECT ANSWER 30-50% A 39 week gestation G3P2 who is currently 6cm/90%/-1, who received an epidural test dose 10 minutes ago is having late decelerations. The most likely cause is... CORRECT ANSWER Maternal hypotension. The color of nitrazine paper most indicative of ruptured membranes is... CORRECT ANSWER Blue. The fetal heart tones of a baby in the ROP position would best be heard over the mother's... CORRECT ANSWER Right lower abdomen. On a vaginal exam the nurse determines the patient is 7cm dilated. She also notes the cervix is well applied posteriorly but that the cervix is not well applied anteriorly with a slight gap along the vertex. She should suspect that the fetal position is... CORRECT ANSWER OP (occiput posterior) In the low risk patient who is being monitored in the active stage of labor using auscultation, the fetal heart rate should be assessed every... CORRECT ANSWER 15 minutes

According to ACOG guidelines for continuous EFM, a patient without complications in the active phase of labor should have the FHR assessed every... CORRECT ANSWER 30 minutes The cervix of a labor patient is dilated to 3cm. She would be in what stage of labor? CORRECT ANSWER Latent phase of labor. When using EFM monitors in the second stage of labor, the high risk patient who is actively pushing should be assessed every... CORRECT ANSWER 5 minutes. The phase of labor that distraction techniques are most likely to be effective is... CORRECT ANSWER Latent. A prolonged second stage in the primigravida with regional anesthesia is defined as a lack of continuing progress and a second stage duration of greater than... CORRECT ANSWER 3 hours. Internal rotation of the head generally occurs in... CORRECT ANSWER mid pelvis. The transition phase of labor is characterized by maternal... CORRECT ANSWER panic and fear. One sign that suggests placental separation is... CORRECT ANSWER lengthening of umbilical cord.

A woman in labor is having contractions about every 2-3 minutes. She is 7-8cm/100%/+1. These findings are most consistent with which stage of labor? CORRECT ANSWER First. The pushing technique that a woman in second stage should be encouraged to use is... CORRECT ANSWER open-glottis pushing for 6-8 seconds with 3-4 pushes per contraction. In the multigravida with an epidural and no maternal or fetal contraindications, pushing efforts may be delayed up to... CORRECT ANSWER 2 hours. The second stage position that can increase the pelvic diameter as much as 28-30% is... CORRECT ANSWER Squatting. Use of stirrups during delivery can cause straining of pelvic ligaments due to... CORRECT ANSWER Poor position. After the last dose of Cytotec (misoprostol), oxytocin administration should be delayed for at least... CORRECT ANSWER 4 hours. Compared to the midline episiotomy, blood loss from a mediolateral episiotomy is... CORRECT ANSWER greater. The type of forceps used during a vaginal breech birth is... CORRECT ANSWER Piper. Attempting a vacuum assisted delivery should terminate if the vacuum device pops off the fetal scalp... CORRECT ANSWER 3 times.

One indication for a classic uterine incision performed during a cesarean is... CORRECT ANSWER Transverse lie. The current recommendation regarding timing of prophylactic antibiotics for a cesarean section is... CORRECT ANSWER within 60 minutes prior to the start of the incision. Which one of the following women is the best candidate for a vaginal birth after cesarean (VBAC)? CORRECT ANSWER A gravida 3 para 2 who had a vaginal delivery with her first pregnancy and a cesarean for breech with her second baby. A Bishop score of 4 indicates... CORRECT ANSWER an unfavorable cervix. The half-life of Pitocin (oxytocin) is how many minutes? CORRECT ANSWER 10- Pitocin dosages during labor induction should be documented in... CORRECT ANSWER mU/minute. A patient is being induced and is at an oxytocin level of 20 mU/min. She reports nausea and vomiting, feels her heart beating rapidly, feeling faint and has a headache. She most likely is experiencing... CORRECT ANSWER water intoxication. The recommended initial intravaginal dose of misoprostol (Cytotec) for cervical ripening is... CORRECT ANSWER 25 micrograms. When cervidil is used for induction of labor, at what point can oxytocin be initiated after removal of the cervidil? CORRECT ANSWER 4 hours

A contraindication to the use of Dinoprostone (cervidil) would be... CORRECT ANSWER A patient with 6 or more previous term pregnancies. Dinoprostone (cervidil) is being utilized for cervical ripening. The nurse should know the cervidil should be removed... CORRECT ANSWER in 12 hours or the onset of uterine contractions. Mechanical dilators open the cervix by stimulating the release of... CORRECT ANSWER endogenous prostaglandins. When active labor is achieved during a Pitocin induction or augmentation, the Pitocin dosage can be... CORRECT ANSWER incrementally decreased. The frequency of fetal heart rate assessments for a low risk woman in the second stage of labor on Pitocin is... CORRECT ANSWER 5 minutes. When a pattern of coupling and tripling contractions is occurring, the oxytocin dose should be... CORRECT ANSWER decreased. According to the gate control theory, relieving pain with massage, heat and cold acts by... CORRECT ANSWER blocking the capacity of nerve pathways. Therapeutic touch is based on the theory that... CORRECT ANSWER natural endorphin release will be induced by massaging the body. Compared to the brain of a nonhypoxic fetus, when a systemic analgesic is administered to the mother during labor, the hypoxic fetus will receive a... CORRECT ANSWER larger amount of the drug.

In order to decrease the effect of IV narcotics on the fetus, the nurse should administer them at what point in the contraction pattern? CORRECT ANSWER During a contraction. A woman in labor with a known history of drug abuse should not be given which narcotic drug? CORRECT ANSWER Butorphanol (stadol) Fentanyl requires more frequent dosing for management of labor pain because... CORRECT ANSWER it has a shorter duration of action. Which medication should be available for the infant at delivery for any mother who has received parenteral narcotics during labor? CORRECT ANSWER Narcan (naloxone) A postpartum patient has a spinal headache. The nurse that this can occur as a consequence of epidural anesthesia due to... CORRECT ANSWER leakage of fluid at the puncture site. Ten minutes after placement of an epidural, maternal blood pressure decreases by 20%. After performing IV hydration and lateral positioning, what should be the nurses next intervention? CORRECT ANSWER Administer ephedrine. Halogenated agents used for general anesthesia can result in a uterine tone that is... CORRECT ANSWER decreased. The release of catecholamines during labor can result in... CORRECT ANSWER a more rapid second stage.

A 39 week gestation primigravida has had regular contractions for the past 48 hours. She has remained 1 cm dilated since the onset of contractions. She is exhausted, uncomfortable and unable to sleep. Which medication is recommended for therapeutic rest? CORRECT ANSWER Morphine During a precipitous labor and imminent birth, the initial action by the attending nurse is to... CORRECT ANSWER prepare to deliver the newborn. The most common fetal malposition is... CORRECT ANSWER occiput posterior. A woman with a macrosomic fetus is at risk for a... CORRECT ANSWER dysfunctional labor. During a shoulder dystocia, the provider has the nurse place the patient on all fours to facilitate delivery. Which of the following maneuvers would the provider request? CORRECT ANSWER Gaskin. When fundal pressure is used during shoulder dystocia, the nurse is aware that it will potentially... CORRECT ANSWER impact the fetal shoulder. During a shoulder dystocia, one maneuver that a nurse may use to help relieve the stuck shoulder is... CORRECT ANSWER Suprapubic pressure. When a fetus is in the occiput posterior position, the position that is most helpful in facilitation rotation is... CORRECT ANSWER Hands and knees. A placenta in which the umbilical blood vessels are separated when they leave the placenta and not protected with Wharton jelly is what placental variation? CORRECT ANSWER Velamentous

At 36 weeks gestation, an ultrasound reveals a velamentous cord insertion. Based upon this knowledge, the nurse is aware this fetus is at higher risk for a... CORRECT ANSWER Hemorrhage AT 39 weeks gestation, a gravida 1 para 0 is admitted for elective induction of labor. Her vaginal exam shows her to be 2cm/50%/-3. The provider performs an AROM and goes back to the office. Two minutes later there is a prolonged fetal heart rate decal. The nurse's initial response to this situation is to... CORRECT ANSWER perform a vaginal exam. A gravida 2 para 1 in active labor just reported SROM. Ten minutes later, she suddenly complains of sever shortness of breath and lightheadedness. The nurse should suspect... CORRECT ANSWER Anaphylactoid syndrome. Hydramnios is common in which condition? CORRECT ANSWER Down syndrome. Oligohydramnios is diagnosed when a biophysical profile shows an amniotc fluid index of... CORRECT ANSWER 4 When the chorionic villi attached to the myometrium of the uterus, this represents... CORRECT ANSWER Placenta accrete. A woman is admitted to labor and delivery with a diagnosis of placental abruption. The test that determines the presence of a fetomaternal hemorrhage is... CORRECT ANSWER Kleihauer-Betke A woman is admitted to labor and delivery with moderate uterine pain without bleeding. On examination, the uterus has a high tonicity and the uterine contraction

tracing shows increased resting tone. The most likely cause is... CORRECT ANSWER placental abruption. A woman at 28 weeks gestation reports to L&D with painless vaginal bleeding that started this morning. The nurse's first step in caring for this woman is to determine... CORRECT ANSWER placental location. Following PROM, a woman at 33 weeks gestation is placed on a fetal heart rate monitor. The fetal heart rate is persistently 175 bpm. This is most likely consistent with... CORRECT ANSWER Uterine infection. Which one of the following women fits the definition of preterm labor? CORRECT ANSWER A 36 week gestation multigravida who is admitted WITH REGULAR CONTRACTIONS and is 3cm dilated. A negative fetal fibronectin at 30 weeks indicates... CORRECT ANSWER risk of delivery is very low for the next 7-14 days. Betamethasone given to the mother can transiently affect the fetal heart rate by... CORRECT ANSWER Decreasing variability. After administration of antenatal corticosteroids, the optimal neonatal benefit is observed when delivery occurs after... CORRECT ANSWER 48 hours. Nifedipine (Procardia) for tocolysis in preterm labor should be given cautiously with which other drug? CORRECT ANSWER Magnesium Sulfate. Beta-sympathomimetic drugs decrease the frequency and intensity of uterine contractions by... CORRECT ANSWER stimulating beta 2 receptor action.

A woman is pregnant with twins and had an US diagnose monochorionicity. Compared to dichorionicity, risk of an adverse outcome is... CORRECT ANSWER higher. A predisposing factor to breech presentation is... CORRECT ANSWER multifetal pregnancy. In twin-to-twin transfusion, the recipient twin is... CORRECT ANSWER Plethoric- red A pregnancy is classified as post term beginning at... CORRECT ANSWER 42 weeks. A woman is 12 hours postpartum and has a WBC count of 25,000 ul. This indicates... CORRECT ANSWER in the expected range at this time. The lochia that is pink or brown and occurs between 3-10 days postpartum is... CORRECT ANSWER serosa. To avoid a precipitous drop in intra-abdominal pressure during catheterization of a postpartum patient's bladder, what is the maximum amount of urine that should be removed at one time? CORRECT ANSWER 800 ml Guidelines from the CDC regarding tetanus toxoid, diphtheria toxoid, and a- cellular pertussis (Tdap) for a postpartum patient who had a tetanus booster two years ago would be to... CORRECT ANSWER administer before discharge.

Mei Lin, a Chinese woman gave birth to her first child by CS 12 hours ago. She grimaces when getting out of bed, but hasn't asked for anything for pain. Based on information about the Asian American cultures, the nurse should... CORRECT ANSWER Offer pain medication when due since they tend to be stoic and may not ask. The interactive process of the father with the newborn is termed... CORRECT ANSWER engrossment. A 36 hours old breastfeeding infant has nursed 8 times in the last 24 hours on one breast each feeding. The infant demonstrated rhythmic sucking and audible swallowing during feedings. The infant has had 2 wet diapers and 2 moderate-sized green bowel movements. This assessment indicates that the infant is... CORRECT ANSWER feeding well and as expected for this age. Following delivery, the insulin requirement for most diabetic breastfeeding women is... CORRECT ANSWER decreased. The most appropriate instruction to give parents about what breastfeeding frequency to expect during the first few weeks after birth is... CORRECT ANSWER Cluster feedings with 8-12 feedings in 24 hours. A patient is examined and found to have a tender, red area in one breast that feels small and hard, similar to a pea, just under the skin. The expected management for this patient is... CORRECT ANSWER gentle massage to relieve the lump. The type of neonatal jaundice caused by inadequate breastmilk intake is... CORRECT ANSWER breastfeeding jaundice.

A maternal contraindication to breastfeeding is... CORRECT ANSWER HTLV- (Human T-cell leukemia virus, type 1) Appropriate teaching about breast engorgement for a non-breastfeeding mother is to... CORRECT ANSWER wear a 24-hour support bra for comfort. A patient diagnosed with a postpartum infection states she does not have any pain but seems confused and agitated. Her VS are: T99.9, BP 98/50, P125, Urinary output is decreased. The most likely diagnosis is... CORRECT ANSWER Septic shock. Which medication is contraindicated for use with a patient with uterine atony who has preexisting hypertension? CORRECT ANSWER Methylergonovine (Methergine) After a massive hemorrhage of 2000ml blood loss, a woman presents to clinic on day 5 postpartum verbalizing her milk has not come in. You should suspect... CORRECT ANSWER Sheehan's syndrome. Forty eight hours after a woman's CS birth, the nurse notes that the woman's left calf and foot are cool and pale. The left pedal pulse is diminished and there is a decreased capillary refill. The Homan's sign is negative bilaterally. She reports some tenderness in her left calf. The most appropriate initial response to these finding would be to... CORRECT ANSWER Place on bedrest with elevation of the left leg. Just prior to hospital discharge, a postpartum patient is crying, still in her nightgown at 1pm and states she is overwhelmed from nursing the baby all of the time. Physical assessments of the mother and baby are normal. The nurse knows that this is a manifestation of postpartum... CORRECT ANSWER blues.

Increased perfusion of the newborn liver is initiated by closure of the... CORRECT ANSWER ductus venosus. A neonate has scrotal swelling which is soft, non-tender and transilluminates. There are no palpable masses. The most likely diagnosis is... CORRECT ANSWER hydrocele. When performing chest compression during neonatal resuscitation, the number of compressions should be at what rate per minute? CORRECT ANSWER 90 At birth, the newborn is noted to have absent breath sounds on the left with heart sounds shifted to the right. The abdomen is scaphoid and ventilation is difficult. The most likely diagnosis is... CORRECT ANSWER diaphragmatic hernia. A cause to physiological jaundice can be a result of... CORRECT ANSWER delayed cord clamping. GBS and what other organism are currently the most common pathogens seen in neonatal sepsis? CORRECT ANSWER E. Coli. A postpartum mother who would like to breastfeed her baby is diagnosed with Hepatitis B surface-antigen positive. What is the recommendation regarding breastfeeding for this mother? CORRECT ANSWER Administer HBIG and hepatitis vaccine to the newborn and then allow breastfeeding. A neonate born to a mother whose HBsAg status is unknown should have... CORRECT ANSWER the first dose of hep B within 12 hours after birth. The concept of nursing negligence requires that... CORRECT ANSWER an injury occurred to the patient.

The main tenet of evidence based practice is... CORRECT ANSWER translation of best available information into clinical guidelines. A provider asks a nurse to obtain a signature on informed consent for surgery. the nurse's responsibility in this situation is to... CORRECT ANSWER determine if the patient was advised of the reason, risks, and benefits of the surgery. Naegele's Rule CORRECT ANSWER Subtract months from first day of last menstrual period and add 7 days and 1 year LMP - 3Months + 7 days + 1 year Autonomy CORRECT ANSWER Capacity to make own independent decisions, right to non-interference, self-determination Non-Maleficence CORRECT ANSWER "First to do no harm", Avoid harm or risk of harm Beneficence CORRECT ANSWER Promote good and prevent harm, Mercy, kindness, charity to others, duty to do good Justice CORRECT ANSWER Benefits, Risks, Costs distributed fairly Fidelity CORRECT ANSWER Faithfulness to duties or obligations Empathy CORRECT ANSWER Experience the experience of others

Universalizability CORRECT ANSWER All moral principles/judgments have universal applicability Ethical Issues CORRECT ANSWER Nurses are no longer "silent bystanders". Ethical issues become dilemmas when people with different perspective take opposing sides. Reliability CORRECT ANSWER Extent to which a measure obtains similar results over repeated trials Validity CORRECT ANSWER Accuracy and truth of the data and findings that are produced Significance CORRECT ANSWER Statistics determine if something occurs by chance. Generalization CORRECT ANSWER Application of findings to the broader population that is represented by the sample of the study Liability CORRECT ANSWER having a legal responsibility Negligence CORRECT ANSWER failure to provide the care a reasonable prudent person would do in like circumstances Malpractice CORRECT ANSWER duty to provide care and a breath of that duty that produces patient harm

Standards of Care CORRECT ANSWER What similarly trained and experienced persons would do in similar circumstances, a declaration of care by a professional or authoritative body Chain of Command CORRECT ANSWER Specific course of action involving administrative and clinical lines of authority, established to ensure conflict resolution in patient care situations and is mostly applicable in emergency situations. Informed consent CORRECT ANSWER An agreement to do something or allow something to happen, made with complete knowledge of all the relevant facts, such as the risks involved or any available alternatives. Assault CORRECT ANSWER Apprehension, not fear, or unlawful physical contact; Crime that involves causing a victim to apprehend violence; A threat of violence caused by immediate show of force. Battery CORRECT ANSWER Involves the unlawful physical contact with another person; Use of force against another, resulting in harmful or offensive contact; "any unlawful touching of the person of another by the aggressor himself, or by a substance put in motion by him".