RNC-OB Exam — Questions and Answers

Question 1: How many hours should the patient refrain from using drugs before Subutex (buprenorphine) administration's induction phase?

5 - 10
6 - 12
24 - 48
12 - 24 (Correct answer)

Correct answer: 12 - 24

Before the induction phase of Subutex (buprenorphine) administration, the patient should refrain from using opioids for 12-24 hours. This period of abstinence is crucial to ensure the patient is in a state of mild to moderate opioid withdrawal. Starting buprenorphine too soon can precipitate acute and severe withdrawal symptoms, as buprenorphine can displace other opioids from receptors.

Question 2: Which antidote must be immediately available at the bedside for any patient receiving intravenous magnesium sulfate?

Flumazenil (Romazicon)
Naloxone (Narcan)
Protamine sulfate
Calcium gluconate (Correct answer)

Correct answer: Calcium gluconate

Calcium gluconate reverses magnesium toxicity; 1g IV over 3 minutes is administered when signs of toxicity (absent DTRs, respiratory depression) are present.

Question 3: What is the recommended total weight gain during pregnancy for a woman with a normal pre-pregnancy BMI (18.5–24.9)?

15–25 lbs
28–40 lbs
11–20 lbs
25–35 lbs (Correct answer)

Correct answer: 25–35 lbs

Per IOM guidelines, women with a normal pre-pregnancy BMI are advised to gain 25–35 pounds during pregnancy to support optimal fetal growth.

Question 4: What treatment is recommended for a pregnant Graves' disease patient?

Methimazole
Radioactive iodine
Propylthiouracil (Correct answer)
None of the above

Correct answer: Propylthiouracil

Propylthiouracil (PTU) is the recommended treatment for a pregnant Graves' disease patient, especially during the first trimester. Unlike methimazole, which carries a higher risk of congenital anomalies in early pregnancy, PTU has a lower teratogenic risk. While PTU has a rare risk of hepatotoxicity, its safety profile in early gestation makes it the preferred antithyroid medication.

Question 5: A patient at 41 weeks gestation is undergoing cervical ripening with a Foley balloon catheter. Which finding indicates the catheter has served its purpose and should be removed?

The membranes rupture spontaneously
The patient reports severe cramping
The balloon spontaneously expels or the cervix reaches 3–4 cm dilation (Correct answer)
Contractions begin every 5 minutes

Correct answer: The balloon spontaneously expels or the cervix reaches 3–4 cm dilation

The Foley balloon catheter for cervical ripening is designed to fall out when the cervix dilates to approximately 3–4 cm, indicating adequate cervical change.

Question 6: Group B Streptococcus (GBS) screening is routinely performed at which gestational age?

28–32 weeks
35–37 weeks (Correct answer)
40–41 weeks
20–24 weeks

Correct answer: 35–37 weeks

Rectovaginal GBS swab cultures are obtained at 35–37 weeks; a positive result requires intrapartum antibiotic prophylaxis during labor.

Question 7: A client at her 2-week postpartum check-up is concerned because her vaginal bleeding, which had decreased to lochia serosa, has now become heavier and red again. She also reports ongoing pelvic discomfort. The nurse should suspect which late postpartum complication?

Postpartum endometritis
Normal lochia progression
Deep vein thrombosis
Subinvolution of the uterus (Correct answer)

Correct answer: Subinvolution of the uterus

Subinvolution is the failure of the uterus to return to its non-pregnant state in the expected timeframe. It is characterized by prolonged lochial discharge, irregular or excessive bleeding, and a uterus that is larger than expected for the postpartum period. Endometritis would typically also present with fever and foul-smelling lochia.

Question 8: A client who is 30 minutes postpartum after a vaginal delivery experiences a sudden gush of dark red blood and complains of severe uterine cramping. The nurse notes that the uterus is boggy. Which condition should the nurse suspect?

Retained placental fragments (Correct answer)
Cervical laceration
Placenta accreta
Uterine atony

Correct answer: Retained placental fragments

The signs of a boggy uterus, sudden bleeding, and increased cramping after the initial delivery of the placenta are classic indicators of retained placental fragments, which prevent the uterus from contracting effectively. Uterine atony presents with a boggy uterus but is the failure of the uterus to contract, not necessarily caused by retained fragments. Cervical lacerations typically involve a steady stream of bright red blood with a firm uterus.

Question 9: The fetus is at risk when a pregnant woman has organic mercury poisoning (methyl mercury) yet shows little symptoms.

High risk of impairment (Correct answer)
None of the above
Virtually no risk of impairment
Slight risk of impairment

Correct answer: High risk of impairment

When a pregnant woman has organic mercury poisoning (methylmercury), even with minimal maternal symptoms, the fetus is at a high risk of impairment. Methylmercury readily crosses the placenta and accumulates in the developing fetal brain, where it can cause severe and irreversible neurodevelopmental damage. The fetal nervous system is significantly more vulnerable to its toxic effects than the mother's.

Question 10: A client, 4 hours postpartum from a forceps-assisted vaginal delivery, reports intense, persistent perineal pain and a strong sensation of rectal pressure. Her fundus is firm at the umbilicus, and lochia rubra is moderate. What is the most likely cause of her symptoms?

Uterine atony
Puerperal hematoma (Correct answer)
Perineal laceration infection
Bladder distention

Correct answer: Puerperal hematoma

Intense perineal pain, a feeling of fullness, and rectal pressure that are disproportionate to visible trauma are classic signs of a developing puerperal hematoma, especially with a firm, contracted uterus. Forceps-assisted delivery is a significant risk factor for this complication.

Question 11: Antenatal corticosteroids (betamethasone) to accelerate fetal lung maturity are indicated between which gestational ages?

32–40 weeks
24–34 weeks (Correct answer)
20–28 weeks
28–37 weeks

Correct answer: 24–34 weeks

ACOG recommends a single course of betamethasone at 24 0/7 to 33 6/7 weeks for women at risk of preterm delivery within 7 days to reduce respiratory distress syndrome.

Question 12: Which symptom should the nurse instruct a pregnant patient to report to her provider immediately?

Mild swelling of the ankles in the evening
Sudden severe headache with visual disturbances (Correct answer)
Mild lower back ache
Braxton Hicks contractions after 36 weeks

Correct answer: Sudden severe headache with visual disturbances

Sudden severe headache with visual changes (e.g., blurring, spots) are warning signs of preeclampsia and require immediate evaluation.

Question 13: Before epidural placement in a laboring patient, which assessment is most critical for patient safety?

Platelet count and coagulation status (Correct answer)
Blood glucose level
Cervical dilation
Urine protein level

Correct answer: Platelet count and coagulation status

Coagulopathy is a contraindication to epidural placement because it increases the risk of epidural hematoma, a potentially catastrophic complication.

Question 14: A nurse is managing a labor augmentation with an IV oxytocin infusion. The fetal heart rate tracing shows a Category I pattern, but the nurse notes uterine contractions are occurring every 1.5 minutes and lasting 90-100 seconds. What is the nurse's priority action?

Decrease the oxytocin infusion rate. (Correct answer)
Notify the healthcare provider immediately.
Administer an IV fluid bolus.
Reposition the patient to her left side.

Correct answer: Decrease the oxytocin infusion rate.

The patient is experiencing uterine tachysystole (more than five contractions in 10 minutes). Even with a reassuring (Category I) fetal heart rate tracing, the first action is to address the excessive uterine activity by reducing or stopping the causative agent. Decreasing the oxytocin infusion is the priority intervention to reduce contraction frequency and prevent potential fetal compromise. While other actions are appropriate, managing the oxytocin dose is the first step.

Question 15: A laboring client's membranes spontaneously rupture, and the nurse notes a loop of the umbilical cord protruding from the vagina. What is the nurse's immediate priority action?

Place the client in a knee-chest or Trendelenburg position. (Correct answer)
Cover the exposed cord with a dry, sterile gauze.
Administer a tocolytic agent as ordered.
Prepare the client for an amnioinfusion.

Correct answer: Place the client in a knee-chest or Trendelenburg position.

Umbilical cord prolapse is an obstetric emergency. The immediate priority is to relieve pressure on the cord to restore blood flow to the fetus. Placing the client in a knee-chest or Trendelenburg position uses gravity to shift the presenting part off the cord.

Question 16: A patient develops a temperature of 38.6°C after 8 hours of epidural analgesia with no other signs of infection. The nurse's best understanding of this finding is:

Epidural-associated fever can occur without infection and requires evaluation with clinical context (Correct answer)
The epidural must be discontinued to resolve the fever
This is an expected side effect requiring no action
This indicates an epidural abscess requiring immediate catheter removal

Correct answer: Epidural-associated fever can occur without infection and requires evaluation with clinical context

Epidural-associated fever (EAF) is a recognized phenomenon, possibly related to inflammatory mediators; it must be distinguished from infectious causes through clinical assessment but does not automatically require epidural removal.

Question 17: Amniocentesis for chromosomal analysis is typically performed at which gestational age?

32–36 weeks
15–20 weeks (Correct answer)
24–28 weeks
10–12 weeks

Correct answer: 15–20 weeks

Amniocentesis is generally performed between 15–20 weeks when sufficient amniotic fluid is present and procedural risk is minimized.

Question 18: What is the CORRECT sequence of cardinal movements of labor for a vertex presentation?

Descent, engagement, internal rotation, flexion, extension, external rotation, expulsion
Flexion, engagement, descent, internal rotation, extension, external rotation, expulsion
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion (Correct answer)
Engagement, flexion, descent, extension, internal rotation, external rotation, expulsion

Correct answer: Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

The seven cardinal movements in correct order are engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion.

Question 19: Supporting a patient's desire to get an opioid and an epidural throughout labor is an illustration of the moral rule of

Justice
None of the above
Autonomy (Correct answer)
Beneficence

Correct answer: Autonomy

Supporting a patient's desire to receive an opioid and an epidural throughout labor is an illustration of the moral rule of autonomy. Autonomy in healthcare respects the patient's right to make informed decisions about their own medical care and personal preferences, free from coercion. This principle empowers the patient to actively participate in choices regarding their labor and delivery experience.

Question 20: A nurse is assessing a 12-hour-old newborn and notes a yellowish tinge to the skin and sclera. This finding is most concerning for which of the following conditions?

Physiologic jaundice
Acrocyanosis
Pathologic jaundice (Correct answer)
Erythema toxicum

Correct answer: Pathologic jaundice

Jaundice appearing within the first 24 hours of life is considered pathologic and requires immediate investigation. It is often caused by hemolysis (e.g., ABO/Rh incompatibility) or other underlying medical conditions. Physiologic jaundice typically appears after 24 hours of life.

Question 21: Which medication is used to reverse opioid-induced respiratory depression in a laboring patient or newborn?

Naloxone (Narcan) (Correct answer)
Neostigmine
Atropine
Flumazenil (Romazicon)

Correct answer: Naloxone (Narcan)

Naloxone is a pure opioid antagonist that rapidly reverses respiratory depression, sedation, and analgesia caused by opioid medications.

Question 22: Immediately following the delivery of the placenta, the nurse observes a large, red, rounded mass protruding from the introitus. The client reports severe abdominal pain and her blood pressure drops to 80/40 mmHg. What is the nurse's priority action?

Administer a bolus of oxytocin.
Cover the mass with a warm, moist sterile towel.
Vigorously massage the protruding mass.
Anticipate the need for a tocolytic agent and notify the provider. (Correct answer)

Correct answer: Anticipate the need for a tocolytic agent and notify the provider.

This clinical picture describes an acute uterine inversion, a life-threatening emergency. The immediate priority is to facilitate uterine replacement by the provider. [2, 5, 34] This requires uterine relaxation, which is achieved with a tocolytic agent (e.g., terbutaline, nitroglycerin). [3, 26] Administering an uterotonic like oxytocin would cause the uterus to contract further, making replacement impossible. [3, 5] Massaging the inverted uterus is inappropriate. While covering the mass is a supportive measure, the absolute priority is alerting the provider and preparing for the intervention that will allow replacement, which is uterine relaxation.

Question 23: At what gestational age is the glucose challenge test (GCT) for gestational diabetes screening typically performed?

36–38 weeks
16–20 weeks
30–32 weeks
24–28 weeks (Correct answer)

Correct answer: 24–28 weeks

The 1-hour 50g glucose challenge test is routinely performed between 24–28 weeks when gestational diabetes is most likely to develop.

Question 24: A provider orders an IV antihypertensive for a patient with a blood pressure of 175/118 mmHg due to preeclampsia with severe features. Which medication order should the nurse question if the patient has a history of bronchial asthma?

Methyldopa
Labetalol (Correct answer)
Hydralazine
Nifedipine

Correct answer: Labetalol

Labetalol is a non-selective beta-blocker that can cause bronchospasm, which is dangerous for a patient with asthma. Hydralazine and nifedipine are first-line IV and oral agents, respectively, that do not carry this specific risk and would be safer alternatives in this patient.

Question 25: A cervical length of less than what measurement on transvaginal ultrasound is the standard threshold associated with significantly increased preterm birth risk?

2.5 cm (Correct answer)
3.0 cm
1.5 cm
3.5 cm

Correct answer: 2.5 cm

A cervical length of less than 2.5 cm (25 mm) on transvaginal ultrasound between 16–24 weeks is the established threshold for increased spontaneous preterm birth risk.

Question 26: A neonate is typically not considered viable until after

15 weeks of gestation
28 weeks of gestation
20 weeks of gestation
24 weeks of gestation (Correct answer)

Correct answer: 24 weeks of gestation

A neonate is typically not considered viable until after 24 weeks of gestation. This benchmark represents the earliest point at which a fetus has a reasonable chance of survival outside the womb, primarily due to the development of the lungs and other vital organs. While medical advancements continue to improve outcomes, significant risks remain for infants born before this gestational age.

Question 27: Fifteen minutes after the placement of an epidural, a laboring client's blood pressure drops from 125/80 mmHg to 90/50 mmHg. The fetal heart rate tracing shows a prolonged deceleration. Which of the following interventions should the nurse perform FIRST?

Place the patient in a left lateral position and administer an IV fluid bolus. (Correct answer)
Prepare for an emergency cesarean section.
Administer oxygen at 10 L/min via non-rebreather mask.
Increase the rate of the maintenance IV fluids.

Correct answer: Place the patient in a left lateral position and administer an IV fluid bolus.

Maternal hypotension is a common side effect of neuraxial anesthesia due to sympathetic blockade. This can lead to decreased uteroplacental perfusion and fetal distress, as evidenced by the deceleration. The priority is to correct the cause. Placing the patient in a lateral position displaces the uterus off the vena cava, and administering a rapid IV fluid bolus increases intravascular volume, both of which will help restore blood pressure and perfusion.

Question 28: If vaginal fluid has blood in it, the nitrazine test for amniotic fluid will show it.

None of the above
May show a false negative
Is unaffected by blood
May show a false positive (Correct answer)

Correct answer: May show a false positive

If vaginal fluid contains blood, the nitrazine test for amniotic fluid may show a false positive result. This is because blood, like amniotic fluid, has an alkaline pH. The presence of blood can elevate the pH of the vaginal fluid, leading the nitrazine paper to change color as if amniotic fluid were present, even if the membranes are intact.

Question 29: Which condition is a contraindication to epidural analgesia during labor?

Gestational age of 37 weeks
Nulliparity at term
Cervical dilation greater than 6 cm
Active coagulopathy or thrombocytopenia below 70,000/mm³ (Correct answer)

Correct answer: Active coagulopathy or thrombocytopenia below 70,000/mm³

Active coagulopathy markedly increases the risk of epidural hematoma, which can compress the spinal cord and cause permanent neurological injury.

Question 30: The condition known as fetal scalp edema, which develops when the skull presses against the cervix, is

None of the above
Caput succedaneum (Correct answer)
Molding
Cephalohematoma

Correct answer: Caput succedaneum

Caput succedaneum is the condition known as fetal scalp edema that develops when the skull presses against the cervix during labor. This pressure impedes venous and lymphatic return from the presenting part of the head, causing swelling and edema of the scalp. Unlike a cephalohematoma, caput succedaneum crosses suture lines and typically resolves within a few days after birth.

Question 31: When hypertension without proteinuria appears after 20 weeks of pregnancy and continues for 6 weeks into the postpartum period, it is referred to as

None of the above
Gestational hypertension (Correct answer)
Chronic hypertension
Preeclampsia

Correct answer: Gestational hypertension

When hypertension without proteinuria appears after 20 weeks of pregnancy and resolves by 6 weeks postpartum, it is referred to as gestational hypertension. This diagnosis is distinct from preeclampsia, which includes proteinuria or other signs of end-organ damage, and chronic hypertension, which is present before pregnancy or persists beyond the postpartum period. It represents new-onset high blood pressure specific to pregnancy.

Question 32: A nurse is providing care to a term newborn immediately following delivery. To prevent heat loss through convection, which nursing intervention is most appropriate?

Placing the newborn skin-to-skin with the mother.
Placing the newborn on a cold scale.
Keeping the newborn away from open windows and air vents. (Correct answer)
Thoroughly drying the newborn's skin.

Correct answer: Keeping the newborn away from open windows and air vents.

Convection is the loss of heat from the warm body surface to cooler air currents. Keeping the newborn away from drafts from open windows, doors, or air vents is a key intervention to prevent this type of heat loss. Drying the skin prevents evaporation, and placing the infant on a pre-warmed surface or skin-to-skin prevents conduction loss.

Question 33: Weekly 17-alpha hydroxyprogesterone caproate (17-OHPC) injections are indicated to reduce preterm birth risk in which patient population?

Women with a short cervix only, regardless of obstetric history
All women with multiple gestations
All women after 28 weeks regardless of risk factors
Women with a singleton pregnancy and a prior spontaneous preterm birth (Correct answer)

Correct answer: Women with a singleton pregnancy and a prior spontaneous preterm birth

17-OHPC is FDA-indicated for singleton pregnancies in women with a documented prior spontaneous preterm birth to reduce recurrence risk.

Question 34: A client with a history of a previous classical cesarean section is in active labor. Which of the following clinical findings would be most indicative of a uterine rupture?

A sudden, sharp abdominal pain followed by a cessation of contractions. (Correct answer)
A gradual increase in the intensity of contractions.
A fetal heart rate tracing showing early decelerations.
The presenting part moving down the birth canal.

Correct answer: A sudden, sharp abdominal pain followed by a cessation of contractions.

A classic sign of uterine rupture is the sudden onset of intense, tearing abdominal pain, often followed by a complete stop in uterine contractions as the uterus loses its integrity. [12, 39] Other signs include a non-reassuring fetal heart rate pattern (like bradycardia or prolonged decelerations), loss of fetal station (the presenting part moves up, not down), and signs of maternal shock. [27, 39] Early decelerations are generally benign, and a gradual increase in contraction intensity is expected in normal labor.

Question 35: The only definitive treatment to cure preeclampsia is:

Antenatal corticosteroids for fetal lung maturity
Antihypertensive therapy with labetalol
Delivery of the fetus and placenta (Correct answer)
Continuous magnesium sulfate infusion for 48 hours

Correct answer: Delivery of the fetus and placenta

Since preeclampsia is caused by placental factors, delivery of the fetus and placenta is the only cure; other treatments are supportive and temporizing.

Question 36: The quad screen (AFP, hCG, unconjugated estriol, inhibin A) is typically performed at which gestational age?

15–20 weeks (Correct answer)
22–24 weeks
10–13 weeks
28–32 weeks

Correct answer: 15–20 weeks

The quad screen is a second-trimester screening performed between 15–20 weeks gestation to assess risk for chromosomal abnormalities and neural tube defects.

Question 37: A patient at 40 weeks reports decreased fetal movement for the past 24 hours. The nurse performs a nonstress test (NST). The tracing shows two accelerations in 30 minutes, each reaching 15 bpm above baseline and lasting 15 seconds. How should the nurse interpret this result?

Reactive NST — reassuring finding indicating adequate fetal oxygenation (Correct answer)
Indeterminate NST — continue monitoring for another 30 minutes
Abnormal NST — immediate cesarean delivery is indicated
Nonreactive NST — further evaluation with a biophysical profile is needed

Correct answer: Reactive NST — reassuring finding indicating adequate fetal oxygenation

A reactive NST requires at least two accelerations of 15 bpm lasting 15 seconds within 20–40 minutes, which is a reassuring sign of fetal well-being.

Question 38: A multiparous client has a precipitous vaginal delivery. Moments after birth, she becomes acutely dyspneic, hypotensive, and cyanotic. She then experiences a seizure and develops disseminated intravascular coagulation (DIC). These findings are most characteristic of which obstetric emergency?

Postpartum hemorrhage.
Amniotic fluid embolism. (Correct answer)
Eclamptic seizure.
Pulmonary embolism.

Correct answer: Amniotic fluid embolism.

Amniotic fluid embolism (AFE), or anaphylactoid syndrome of pregnancy, is a rare but catastrophic complication. Its classic presentation is the sudden onset of cardiopulmonary collapse (hypotension, dyspnea), often followed by neurologic symptoms (seizures) and coagulopathy (DIC). [4, 10, 25] While a pulmonary embolism causes respiratory distress and eclampsia involves seizures, the rapid combination of all these symptoms, especially the profound coagulopathy, points strongly to AFE. [18, 29]

Question 39: During the third stage of labor, which clinical sign indicates placental separation has occurred?

The uterus becomes soft and boggy after delivery
The patient reports relief of pressure in the perineum
Contractions completely cease after the infant is born
The fundus rises in the abdomen, the cord lengthens, and a gush of blood is seen (Correct answer)

Correct answer: The fundus rises in the abdomen, the cord lengthens, and a gush of blood is seen

Signs of placental separation include the fundus rising and becoming globular, cord lengthening, and a sudden gush of blood.

Question 40: A client at 30 weeks gestation is experiencing regular uterine contractions and has a confirmed diagnosis of preterm labor. The provider orders a tocolytic medication to delay delivery. Which of the following medications is classified as a tocolytic agent?

Betamethasone
Rho(D) immune globulin
Ondansetron
Nifedipine (Correct answer)

Correct answer: Nifedipine

Nifedipine, a calcium channel blocker, is a commonly used tocolytic agent that works by inhibiting uterine smooth muscle contractions to delay preterm labor. Betamethasone is a corticosteroid given to promote fetal lung maturity. Rho(D) immune globulin is for Rh incompatibility, and Ondansetron is an antiemetic.

Question 41: During the second stage of labor, the nurse notes the fetal head crowning between pushes. What technique should the nurse use to control birth and prevent perineal lacerations?

Apply gentle counterpressure to the fetal head and support the perineum (Correct answer)
Encourage the mother to push forcefully between contractions
Apply firm downward pressure on the fetal head to speed delivery
Perform a routine mediolateral episiotomy

Correct answer: Apply gentle counterpressure to the fetal head and support the perineum

Gentle counterpressure on the crowning head (the Ritgen maneuver variant) and perineal support slows delivery and reduces severe laceration risk.

Question 42: A pregnant client presents to the labor unit with painless, bright red vaginal bleeding and a soft, non-tender uterus. Fetal heart tones are within the normal range. Which of the following conditions is most consistent with these findings?

Uterine rupture
Placenta previa (Correct answer)
Vasa previa
Placental abruption

Correct answer: Placenta previa

Placenta previa is characterized by painless, bright red vaginal bleeding, as the placenta is implanted over or near the cervical os. In contrast, placental abruption typically presents with dark red, painful bleeding and a rigid, tender uterus.

Question 43: Which action by the nurse BEST demonstrates application of evidence-based practice during pushing in the second stage of labor?

Instructing the patient to hold her breath and push for a count of 10 with each contraction
Encouraging open-glottis (laboring down) pushing, following the patient's own urge to push (Correct answer)
Keeping the patient in the lithotomy position throughout the second stage
Beginning directed pushing immediately upon reaching complete dilation

Correct answer: Encouraging open-glottis (laboring down) pushing, following the patient's own urge to push

Evidence-based practice supports open-glottis, spontaneous (physiologic) pushing triggered by the patient's urge, which reduces maternal exhaustion and improves fetal oxygenation compared to Valsalva pushing.

Question 44: TENS (transcutaneous electrical nerve stimulation) reduces labor pain primarily through which mechanism?

Increasing maternal blood pressure to counter hypotension
Blocking uterine prostaglandin synthesis
Stimulating endorphin release and activating gate control mechanisms in the spinal cord (Correct answer)
Relaxing the cervix to speed dilation

Correct answer: Stimulating endorphin release and activating gate control mechanisms in the spinal cord

TENS electrodes deliver low-voltage electrical pulses that stimulate endogenous endorphin release and activate inhibitory pathways via gate control theory, reducing the perception of uterine pain.

Question 45: A patient in the second stage of labor has a fetal heart rate tracing that shows a baseline of 130 bpm, moderate variability, and accelerations with fetal movement. During pushing, the nurse observes gradual, symmetrical decelerations that mirror the contractions, with the FHR returning to baseline as each contraction ends. What is the nurse's best interpretation of this finding?

Benign head compression from fetal descent. (Correct answer)
Fetal metabolic acidosis.
Umbilical cord prolapse requiring immediate action.
Uteroplacental insufficiency requiring intervention.

Correct answer: Benign head compression from fetal descent.

This scenario describes early decelerations. These are gradual, mirror the contraction, and are caused by fetal head compression during descent, which is considered a benign and reassuring finding, especially in the second stage of labor. It does not indicate fetal distress and requires continued monitoring rather than immediate intervention.

Question 46: The most crucial preoperative action for an elective Caesarean is to

Position the patient correctly
Confirm fetal maturity (Correct answer)
Determine the method of anesthesia
None of the above

Correct answer: Confirm fetal maturity

For an elective Caesarean section, the most crucial preoperative action is to confirm fetal maturity. This ensures that the baby's lungs and other vital organs are sufficiently developed to support life outside the womb, minimizing the risk of respiratory distress syndrome and other complications associated with prematurity. Without confirmed maturity, the risks of an elective early delivery outweigh the benefits.

Question 47: Which medication is administered prophylactically to a newborn shortly after birth to prevent ophthalmia neonatorum?

Hepatitis B vaccine
Gentamicin sulfate
Erythromycin ophthalmic ointment (Correct answer)
Phytonadione (Vitamin K)

Correct answer: Erythromycin ophthalmic ointment

Erythromycin ophthalmic ointment is instilled in the newborn's eyes as a prophylactic measure to prevent ophthalmia neonatorum, which is conjunctivitis caused by Neisseria gonorrhoeae or Chlamydia trachomatis acquired during passage through the birth canal. Phytonadione (Vitamin K) is for preventing hemorrhagic disease, and the Hepatitis B vaccine is for immunization.

Question 48: What position is most common for cervical lacerations during labor and delivery?

12 and 6 o’clock
10 and 4 o’clock
3 and 9 o’clock (Correct answer)
3 and 6 o’clock

Correct answer: 3 and 9 o’clock

Cervical lacerations during labor and delivery most commonly occur at the 3 and 9 o’clock positions. These lateral aspects of the cervix are subjected to the greatest stretching and pressure as the fetal head descends through the birth canal. The forces exerted during dilation and passage of the fetus make these areas particularly vulnerable to tearing.

Question 49: A nurse observes a colleague repeatedly dismissing a laboring patient's pain based on the colleague's stated belief that 'women of that culture always exaggerate.' The nurse recognizes this as a failure to uphold which specific professional nursing standard?

Resource Utilization
Chain of Command
Culturally Congruent Practice (Correct answer)
Evidence-Based Practice

Correct answer: Culturally Congruent Practice

This situation exemplifies a failure to provide culturally congruent care. Professional nursing standards, such as those from AWHONN, require nurses to deliver care that is respectful of and responsive to individual patient preferences, needs, and values. Making assumptions and altering care based on cultural stereotypes violates this core principle and the ethical duty to respect the dignity and worth of every person.

Question 50: Fetal traits during the initial phase of responsiveness after birth include

Alert state and movement of limbs (Correct answer)
None of the above
Sleepiness and/or prolonged sleeping
Periods of apnea and regurgitation

Correct answer: Alert state and movement of limbs

During the initial phase of responsiveness after birth, newborns typically exhibit an alert state and active movement of limbs. This 'first period of reactivity' usually lasts for about 30 minutes to an hour, during which the infant is wide awake, has strong sucking reflexes, and is highly responsive. This alert phase is crucial for initial bonding and successful breastfeeding.

Question 51: HELLP syndrome is characterized by which triad of laboratory findings?

Elevated hemoglobin, elevated platelets, elevated BUN
Hemolysis, elevated liver enzymes, and low platelet count (Correct answer)
Hemolysis, elevated LDH only, and normal platelets
Hematuria, elevated lipase, and low protein

Correct answer: Hemolysis, elevated liver enzymes, and low platelet count

HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets — a severe variant of preeclampsia associated with high maternal and fetal morbidity.

Question 52: What action is necessary if the biophysical profile indicates a score of 8 and a normal volume of amniotic fluid?

Induction of labor
Repeat test the same day
No intervention needed (Correct answer)
None of the above

Correct answer: No intervention needed

A biophysical profile (BPP) score of 8 out of 10, especially when accompanied by a normal volume of amniotic fluid, is considered reassuring and indicates fetal well-being. This score suggests that the fetus is not experiencing significant distress or compromise. Therefore, no immediate intervention is typically needed, and routine obstetric care can continue as planned.

Question 53: A patient is experiencing a postpartum hemorrhage that has not responded to uterine massage or an initial bolus of IV oxytocin. The provider orders carboprost tromethamine. The nurse should question this order if the patient has a significant history of which of the following conditions?

Diabetes mellitus
Renal disease
Asthma (Correct answer)
Hypertension

Correct answer: Asthma

Carboprost tromethamine (Hemabate) is a prostaglandin F2-alpha analogue used to treat postpartum hemorrhage. A major side effect is bronchoconstriction, which can be life-threatening in a patient with a history of asthma. While it should be used with caution in patients with hypertension or renal disease, a history of asthma is a significant contraindication.

Question 54: A nurse is assessing a client 30 minutes after the delivery of a 4,200-gram infant. The client has a continuous, steady stream of bright red vaginal bleeding. Upon palpation, the uterine fundus is firm and located at the umbilicus. These findings are most suggestive of which complication?

Bladder distention
Uterine atony
Cervical laceration (Correct answer)
Retained placental fragments

Correct answer: Cervical laceration

A steady trickle of bright red blood in the presence of a firm, well-contracted uterus is the classic sign of a genital tract laceration (e.g., cervical or vaginal). Uterine atony, the most common cause of PPH, would present with a soft, boggy uterus.

Question 55: Upon reviewing a fetal monitor strip, the nurse notes several abrupt, V-shaped decelerations that are not consistently related to the timing of contractions. The most appropriate initial nursing intervention is to:

Prepare for an amnioinfusion.
Administer a tocolytic medication.
Reposition the mother. (Correct answer)
Discontinue oxytocin if it is infusing.

Correct answer: Reposition the mother.

The described pattern is characteristic of variable decelerations, which are typically caused by umbilical cord compression. The initial and least invasive intervention is to change the maternal position (e.g., to a side-lying or knee-chest position) to relieve pressure on the umbilical cord. Other interventions may be necessary if repositioning is not effective.

Question 56: A postpartum client experiencing a massive hemorrhage develops disseminated intravascular coagulation (DIC). Which of the following laboratory findings would the nurse anticipate?

Decreased platelet count and increased fibrin degradation products (FDPs) (Correct answer)
Prolonged prothrombin time (PT) and decreased D-dimer
Increased hematocrit and normal activated partial thromboplastin time (aPTT)
Increased platelet count and increased fibrinogen

Correct answer: Decreased platelet count and increased fibrin degradation products (FDPs)

In DIC, a widespread activation of the clotting cascade leads to the consumption of platelets and clotting factors, resulting in thrombocytopenia (decreased platelets) and low fibrinogen. The subsequent breakdown of clots leads to elevated levels of fibrin degradation products (FDPs) and D-dimer. Coagulation times like PT and aPTT become prolonged.

Question 57: A client at 29 weeks gestation is being treated for preterm labor. The provider orders a course of betamethasone. What is the primary therapeutic goal of administering this medication?

To provide fetal neuroprotection against cerebral palsy
To relax the uterine muscle and stop contractions
To accelerate fetal lung maturity (Correct answer)
To prevent maternal chorioamnionitis

Correct answer: To accelerate fetal lung maturity

Betamethasone is an antenatal corticosteroid whose primary purpose is to stimulate the production and release of surfactant in the fetal lungs. This action helps to accelerate lung maturity and reduce the risk and severity of neonatal respiratory distress syndrome if the baby is born prematurely. It does not act as a tocolytic to stop contractions.

Question 58: A client at 34 weeks gestation is admitted with painless, bright red vaginal bleeding. Her uterus is soft and non-tender, and the fetal heart rate is stable. Which condition should the nurse suspect?

Preterm labor
Placenta previa (Correct answer)
Vasa previa
Abruptio placentae

Correct answer: Placenta previa

The classic presentation of placenta previa is painless, bright red vaginal bleeding after 20 weeks of gestation, with a soft, non-tender uterus. Abruptio placentae typically presents with painful, dark red bleeding and uterine tenderness or rigidity. Vasa previa often presents with bleeding upon rupture of membranes, and preterm labor involves regular contractions.

Question 59: What is the MOST reliable method for confirming rupture of membranes when a patient reports a slow fluid leak?

Performing an amnioinfusion and monitoring fluid return
Observing pooling of fluid in the posterior vaginal fornix and performing nitrazine and ferning tests (Correct answer)
Ordering a urine culture to rule out incontinence
Asking the patient to cough and observing fluid loss

Correct answer: Observing pooling of fluid in the posterior vaginal fornix and performing nitrazine and ferning tests

Confirming SROM requires visualizing pooling of amniotic fluid, a positive nitrazine test (pH >6.5 turns blue), and a ferning pattern on a dried vaginal slide.

Question 60: Monochorionic-diamniotic (MCDA) twins share a placenta and are at specific risk for which serious complication not seen in dichorionic twins?

Twin-to-twin transfusion syndrome (TTTS) (Correct answer)
Increased risk of gestational diabetes
Equal symmetric growth restriction in both twins
Independent chromosomal anomalies in each twin

Correct answer: Twin-to-twin transfusion syndrome (TTTS)

TTTS occurs in 10–15% of MCDA twins due to unequal sharing of blood flow through placental vascular anastomoses, causing one twin to become donor and the other recipient.

Question 61: A client at 30 weeks gestation is admitted with preterm labor. The nurse is preparing to administer a tocolytic medication. Which of the following agents is generally avoided after 32 weeks gestation due to the risk of premature closure of the fetal ductus arteriosus?

Nifedipine
Terbutaline
Indomethacin (Correct answer)
Magnesium Sulfate

Correct answer: Indomethacin

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting prostaglandin synthesis. Prostaglandins are necessary to keep the fetal ductus arteriosus patent. Using indomethacin, especially after 32 weeks of gestation, increases the risk of premature constriction or closure of this vessel, which can lead to fetal complications such as pulmonary hypertension.

Question 62: What is the most important teaching point regarding alcohol consumption during pregnancy?

Red wine in moderation supports fetal development
No amount of alcohol has been proven safe during pregnancy (Correct answer)
One drink per day is safe in the second trimester
Alcohol is safe after the first trimester is complete

Correct answer: No amount of alcohol has been proven safe during pregnancy

No level of alcohol consumption is considered safe during pregnancy, as it can cause fetal alcohol spectrum disorders at any stage.

Question 63: Which tocolytic agent is contraindicated in patients with cardiac disease due to its cardiovascular side effects?

Indomethacin (Indocin)
Magnesium sulfate
Terbutaline and other beta-agonists (Correct answer)
Nifedipine (Procardia)

Correct answer: Terbutaline and other beta-agonists

Beta-agonist tocolytics (terbutaline, ritodrine) cause tachycardia, hypotension, and increased myocardial oxygen demand, making them contraindicated in patients with cardiac disease.

Question 64: Which non-pharmacological labor pain relief technique involves applying firm pressure to the sacral area during contractions?

Acupuncture
Hydrotherapy
Counter-pressure (Correct answer)
Effleurage

Correct answer: Counter-pressure

Counter-pressure involves applying firm manual pressure to the lower back or sacrum, which helps relieve the intense back pain common in labor, especially with an occiput posterior fetus.

Question 65: Which patterned breathing technique taught in childbirth education classes (such as Lamaze) is primarily used to help manage contraction pain during labor?

Apneic intervals between contractions
Deliberate hyperventilation to induce mild alkalosis
Paced rhythmic breathing synchronized with contractions (Correct answer)
Valsalva maneuver with prolonged breath-holding

Correct answer: Paced rhythmic breathing synchronized with contractions

Paced rhythmic breathing promotes relaxation, provides a focus of concentration during contractions, and may stimulate endorphin release, helping the patient manage pain without pharmacological intervention.

Question 66: A laboring patient received IV fentanyl 50 mcg 20 minutes ago. Which assessment is the nurse's highest priority?

Contraction frequency and duration
Maternal respiratory rate and sedation level (Correct answer)
Fetal station
Cervical dilation progress

Correct answer: Maternal respiratory rate and sedation level

Opioids cause dose-dependent respiratory depression; monitoring maternal respiratory rate and level of sedation is the priority to detect this potentially life-threatening effect.

Question 67: A nurse is caring for a client receiving a continuous intravenous infusion of magnesium sulfate for preeclampsia with severe features. Which of the following assessment findings is the earliest sign of magnesium sulfate toxicity?

Loss of deep tendon reflexes (DTRs). (Correct answer)
Respiratory rate of 8 breaths per minute.
Sudden drop in blood pressure.
Urine output of 15 mL/hr.

Correct answer: Loss of deep tendon reflexes (DTRs).

Magnesium sulfate is a central nervous system depressant. The loss or diminution of patellar deep tendon reflexes is typically the first and most sensitive sign that the magnesium level is becoming toxic. [9, 13, 32] Respiratory depression (rate <12/min), oliguria (<30 mL/hr), and hypotension are later, more severe signs of toxicity that occur at higher serum concentrations. [1, 36, 38]

Question 68: What is the fasting blood glucose target for a patient with gestational diabetes managed with diet and exercise?

Less than 130 mg/dL
Less than 120 mg/dL
Less than 95 mg/dL (Correct answer)
Less than 110 mg/dL

Correct answer: Less than 95 mg/dL

ACOG recommends a fasting glucose target of less than 95 mg/dL for women with gestational diabetes to reduce the risk of macrosomia and perinatal complications.

Question 69: During a vaginal birth, after delivery of the fetal head, external rotation (restitution) occurs. What is the physiologic purpose of this movement?

To allow the fetal chin to clear the perineum before shoulder delivery
To disengage the posterior shoulder from beneath the sacral promontory
To flex the fetal head to navigate under the pubic symphysis
To realign the fetal head with the fetal spine so the shoulders can descend in the oblique diameter (Correct answer)

Correct answer: To realign the fetal head with the fetal spine so the shoulders can descend in the oblique diameter

External rotation (restitution) realigns the delivered head with the fetal body so the shoulders can rotate into the anteroposterior diameter of the outlet for delivery.

Question 70: A patient develops a severe positional headache 12 hours after receiving a spinal block during labor. This presentation is most consistent with:

Epidural abscess
Hypertensive crisis
Allergic reaction to local anesthetic
Post-dural puncture headache (PDPH) (Correct answer)

Correct answer: Post-dural puncture headache (PDPH)

PDPH results from cerebrospinal fluid leakage through an accidental dural puncture, causing traction on meningeal structures; the headache worsens in upright positions and improves when lying flat.

Question 71: A patient with gestational diabetes whose blood glucose normalized during delivery should be scheduled for which postpartum test?

Fasting glucose only at 1 week postpartum
HbA1c at 3 months only
No testing is required if glucose normalized during delivery
75g OGTT at 6–12 weeks postpartum (Correct answer)

Correct answer: 75g OGTT at 6–12 weeks postpartum

ACOG recommends a 75g 2-hour OGTT at 6–12 weeks postpartum to screen for persistent glucose intolerance or type 2 diabetes, as GDM significantly increases long-term risk.

Question 72: What is the typical fetal breathing movement (FBM) when being evaluated for the biophysical profile?

none of the above
1 FBM lasting ≥30 seconds in 30 minutes (Correct answer)
3 FBM lasting ≥30 seconds in 30 minutes
2 FBM lasting ≥30 seconds in 30 minutes

Correct answer: 1 FBM lasting ≥30 seconds in 30 minutes

When evaluating for the biophysical profile (BPP), a typical fetal breathing movement (FBM) score requires at least one episode of FBM lasting 30 seconds or more within a 30-minute observation period. This specific criterion indicates a healthy central nervous system and adequate oxygenation, contributing to a reassuring BPP score. Meeting this benchmark suggests fetal well-being.

Question 73: Which of the following is a defining characteristic of a Category I fetal heart rate tracing?

Presence of recurrent late decelerations
Minimal or absent variability
Moderate baseline variability (Correct answer)
Baseline rate of 100 bpm

Correct answer: Moderate baseline variability

A Category I FHR tracing is considered normal and strongly predictive of normal fetal acid-base status. Its components include a baseline rate of 110-160 bpm, moderate baseline FHR variability, the absence of late or variable decelerations, and accelerations may be present or absent.

Question 74: A patient at 39 weeks receives IV morphine for labor pain. The nurse should monitor the newborn most closely for:

Neonatal hypertension
Neonatal hypoglycemia
Neonatal seizures
Neonatal respiratory depression, especially if delivery occurs within 1–4 hours of administration (Correct answer)

Correct answer: Neonatal respiratory depression, especially if delivery occurs within 1–4 hours of administration

Opioids cross the placenta and can suppress fetal and neonatal respiratory drive; the risk is greatest when delivery occurs at peak maternal drug levels, typically 1–4 hours after IV morphine.

Question 75: Which maternal serum marker is ELEVATED in open neural tube defects on the second-trimester quad screen?

Alpha-fetoprotein (AFP) (Correct answer)
Unconjugated estriol
Inhibin A
hCG

Correct answer: Alpha-fetoprotein (AFP)

AFP leaks from the fetal cerebrospinal fluid into the amniotic fluid and then into maternal serum when the neural tube is open, causing an elevated MSAFP.

Question 76: A healthy pregnant patient asks about exercise during her second trimester. Which statement by the nurse is correct?

High-impact exercise like running is the best choice
Avoid all exercise to protect the fetus
Moderate aerobic exercise is safe and beneficial for most healthy pregnant women (Correct answer)
Exercise only during the first trimester

Correct answer: Moderate aerobic exercise is safe and beneficial for most healthy pregnant women

ACOG recommends 150 minutes of moderate-intensity aerobic exercise per week for healthy pregnant women with no obstetric contraindications.

Question 77: Which of the following is the MOST crucial element for ensuring legally valid informed consent for an invasive procedure, such as an external cephalic version (ECV)?

The nurse providing a detailed summary of the procedure to the patient.
The patient's signature on the consent form witnessed by the nurse.
Confirmation from the provider that the patient understands the procedure's risks, benefits, and alternatives. (Correct answer)
A family member being present during the explanation of the procedure.

Correct answer: Confirmation from the provider that the patient understands the procedure's risks, benefits, and alternatives.

The cornerstone of legally valid informed consent is the patient's comprehension. The provider performing the procedure is responsible for explaining the risks, benefits, and alternatives and ensuring the patient understands this information before making a voluntary decision. While a nurse often witnesses the signature and can reinforce teaching, the signature itself is not proof of understanding, and the primary explanation must come from the provider.

Question 78: A newborn is showing signs of neonatal abstinence syndrome (NAS). The mother tearfully admits to the nurse that she used unprescribed opioids during pregnancy and is afraid her baby will be taken away. What is the nurse's most appropriate initial action that balances ethical duties?

Provide compassionate, non-judgmental care to the infant and initiate a referral to social work to provide the mother with resources. (Correct answer)
Immediately report the mother to Child Protective Services without further discussion.
Focus care exclusively on the infant's withdrawal symptoms and avoid discussing the mother's substance use.
Inform the mother that losing custody is a definite consequence of her actions.

Correct answer: Provide compassionate, non-judgmental care to the infant and initiate a referral to social work to provide the mother with resources.

The nurse's ethical duty is to the maternal-infant dyad. The most appropriate initial action is to provide compassionate care, build trust, and engage a multidisciplinary team, including social work. This approach addresses the infant's immediate health needs while supporting the mother and connecting her with necessary resources for treatment and parenting support. While mandatory reporting laws must be followed, the initial nursing approach should be therapeutic and supportive, not punitive.

Question 79: A nurse is preparing to insert an intrauterine pressure catheter (IUPC). Which clinical indication is MOST appropriate for this intervention?

There is inadequate tracing quality and the need to assess contraction strength in Montevideo units (Correct answer)
The patient declines internal monitoring due to discomfort
The patient has a history of cesarean delivery and VBAC is planned
External monitoring is adequate and contractions appear strong

Correct answer: There is inadequate tracing quality and the need to assess contraction strength in Montevideo units

An IUPC is indicated when contraction quality cannot be adequately assessed externally and Montevideo units (MVUs) are needed to determine the adequacy of uterine activity.

Question 80: A nurse is preparing to administer Rh(D) immune globulin to a postpartum client. Which of the following conditions must be met for this intervention to be appropriate?

The mother is Rh-positive, and the newborn is Rh-negative.
The mother is Rh-negative, and her direct Coombs test is positive.
The mother is Rh-negative, and the newborn is Rh-positive. (Correct answer)
Both the mother and the newborn are Rh-negative.

Correct answer: The mother is Rh-negative, and the newborn is Rh-positive.

Rh(D) immune globulin is administered to an Rh-negative mother who has delivered an Rh-positive newborn. This is done to prevent the mother from developing antibodies against the Rh factor, which could cause hemolytic disease in future Rh-positive pregnancies. It is not indicated if the mother is Rh-positive or if the baby is Rh-negative.

Question 81: A multiparous patient at 6 cm dilation has contractions every 2 minutes, lasting 70 seconds, with strong intensity on palpation. Her labor has not progressed in 2 hours. What term BEST describes this situation?

Second stage failure
Latent phase prolongation
Active phase arrest (Correct answer)
Precipitous labor

Correct answer: Active phase arrest

Active phase arrest is defined as no cervical change for 4 hours with adequate contractions or 6 hours with inadequate contractions in the active phase.

Question 82: The kind of human milk that gives a newborn passive immunity is

Colostrum (Correct answer)
None of the above
Mature foremilk
Transitional

Correct answer: Colostrum

Colostrum is the specific type of human milk that provides a newborn with crucial passive immunity. Produced in the first few days after birth, colostrum is rich in antibodies, particularly secretory IgA, and other immune factors. These components help protect the infant from infections and diseases, effectively boosting their immature immune system during a vulnerable period.

Question 83: A 32-year-old patient in active labor has a fetal heart rate tracing that is persistently Category III. The obstetrician strongly recommends an emergency cesarean section, but the patient, who has decision-making capacity, refuses the surgery based on her personal beliefs. What is the nurse's primary ethical responsibility in this situation?

Prepare the operating room and surgical team, assuming the patient will change her mind under duress.
Contact the hospital's legal department to initiate a court order to perform the surgery against the patient's will.
Request a psychiatric evaluation to determine if the patient is competent to refuse treatment.
Inform the patient of the risks of refusal, document her decision thoroughly, and continue to provide supportive nursing care. (Correct answer)

Correct answer: Inform the patient of the risks of refusal, document her decision thoroughly, and continue to provide supportive nursing care.

The nurse's primary ethical responsibility is to respect the patient's autonomy and right to self-determination. This involves ensuring the patient is fully informed about the risks, benefits, and alternatives (including refusal of treatment), documenting the informed refusal process completely, and continuing to advocate for and provide the best possible care within the patient's accepted plan. Seeking a court order or proceeding against the patient's wishes violates her autonomy. Questioning competency solely based on refusal of medical advice is inappropriate.

Question 84: A client on postpartum day 6 complains of persistent pain, tenderness, and warmth in her right calf. The nurse's assessment reveals unilateral swelling and redness of the lower leg. What is the most appropriate initial nursing action?

Apply a heating pad to the affected area for comfort.
Encourage the client to ambulate to prevent venous stasis.
Gently massage the affected leg to improve circulation.
Instruct the client to maintain bed rest with the affected leg elevated. (Correct answer)

Correct answer: Instruct the client to maintain bed rest with the affected leg elevated.

The client's symptoms are highly suggestive of a deep vein thrombosis (DVT). The immediate priority is to prevent the thrombus from dislodging and traveling to the lungs, causing a pulmonary embolism. Therefore, the nurse should instruct the client to maintain bed rest and elevate the affected extremity to reduce swelling and promote venous return without disturbing the clot. Massaging the leg is strictly contraindicated as it can dislodge the clot.

Question 85: A client in the second stage of labor is pushing effectively. Which of the following nursing actions is most appropriate to support the client during this stage?

Encouraging the client to hold her breath and push for at least 15 seconds with each contraction.
Performing a fundal check every 5 minutes to assess progress.
Administering a bolus of intravenous fluids to prevent dehydration.
Assisting the client into an upright position, such as squatting or sitting. (Correct answer)

Correct answer: Assisting the client into an upright position, such as squatting or sitting.

Upright positions during the second stage of labor can utilize gravity to facilitate fetal descent, may shorten the pushing stage, and can enhance maternal comfort and control. Coached, prolonged breath-holding (Valsalva pushing) is generally discouraged. IV fluids are important but not the most direct support for pushing, and fundal height is not the primary assessment of progress in the second stage.

Question 86: Macrosomia in infants of mothers with gestational diabetes is primarily caused by:

Maternal hypoglycemia causing compensatory fetal growth
Fetal hyperinsulinemia secondary to maternal hyperglycemia (Correct answer)
Excess maternal caloric intake unrelated to blood sugar
Placental insufficiency causing catch-up growth

Correct answer: Fetal hyperinsulinemia secondary to maternal hyperglycemia

Maternal glucose crosses the placenta, stimulating the fetal pancreas to produce excess insulin, which acts as a growth factor and results in macrosomia.

Question 87: Which maternal position during labor is most effective for relieving back pain associated with an occiput posterior fetal position?

Semi-Fowler's with knees extended
Supine with legs elevated on pillows
Left lateral Sims position
Hands-and-knees (all-fours) position (Correct answer)

Correct answer: Hands-and-knees (all-fours) position

The hands-and-knees position uses gravity to encourage anterior rotation of the fetal occiput away from the maternal sacrum, reducing sacral pressure and back pain.

Question 88: Chorionic villus sampling (CVS) is typically performed at which gestational age?

10–13 weeks (Correct answer)
20–22 weeks
24–26 weeks
16–18 weeks

Correct answer: 10–13 weeks

CVS is performed in the first trimester at 10–13 weeks, allowing earlier chromosomal diagnosis than amniocentesis.

Question 89: A neonate born to a mother with poorly controlled gestational diabetes is at highest immediate risk for which complication?

Neonatal hyperthyroidism
Neonatal hypoglycemia (Correct answer)
Neonatal hyperglycemia
Neonatal anemia

Correct answer: Neonatal hypoglycemia

Maternal hyperglycemia causes fetal hyperinsulinemia; after delivery and removal of the maternal glucose source, the elevated insulin causes neonatal hypoglycemia.

Question 90: Which method of analgesia provides the most complete pain relief during active labor?

IV opioid analgesia
Nitrous oxide inhalation
Epidural analgesia (Correct answer)
Intrathecal opioids alone

Correct answer: Epidural analgesia

Epidural analgesia delivers continuous local anesthetic and opioid to the epidural space, providing superior and sustained pain relief compared to systemic or inhaled alternatives.

Question 91: An obstetric nurse is caring for a patient with a continuous epidural infusion for labor pain. Which of the following tasks falls outside the typical scope of practice for a registered nurse?

Assessing the patient's sensory level using a cold stimulus to check the effectiveness of the block.
Increasing the basal infusion rate per a specific order from the anesthesia provider.
Monitoring the patient's blood pressure and the fetal heart rate every 15 minutes after a bolus.
Administering the initial test dose of anesthetic into the epidural catheter after placement. (Correct answer)

Correct answer: Administering the initial test dose of anesthetic into the epidural catheter after placement.

The initial placement of the epidural catheter and the administration of the initial test dose or loading dose of anesthetic are advanced procedures performed by a licensed anesthesia provider (e.g., anesthesiologist, CRNA). Registered nurses are responsible for managing the continuous infusion, monitoring the patient's response and vital signs, assessing the sensory block, and managing side effects according to protocol, but not initiating the block.

Question 92: Which anesthetic approach reduces pain during labor and delivery the best?

Pudendal block
Spinal
Epidural (Correct answer)
None of the above

Correct answer: Epidural

An epidural is widely considered the most effective anesthetic approach for pain relief during labor and delivery. It provides continuous and comprehensive pain control by blocking nerve impulses from the uterus and birth canal. This allows the mother to remain awake and participate in the birth process while significantly reducing discomfort, making it a preferred choice for many.

Question 93: Which vitamin supplement is recommended before conception and in early pregnancy to prevent neural tube defects?

Vitamin C
Iron
Folic acid (Correct answer)
Vitamin D

Correct answer: Folic acid

Folic acid (400–800 mcg/day) taken before conception and through the first trimester significantly reduces the risk of neural tube defects such as spina bifida.

Question 94: A laboring patient at 34 weeks gestation presents with preterm labor. After confirming the diagnosis, which medication would the nurse anticipate giving to promote fetal lung maturity?

Magnesium sulfate 6 g IV loading dose
Nifedipine 30 mg oral loading dose
Indomethacin 100 mg rectal suppository
Betamethasone 12 mg IM given in two doses 24 hours apart (Correct answer)

Correct answer: Betamethasone 12 mg IM given in two doses 24 hours apart

Betamethasone (a corticosteroid) administered to the mother between 24 and 34 weeks promotes fetal surfactant production and lung maturity, reducing neonatal respiratory distress.

Question 95: A nurse is assessing a client who is two hours postpartum. The client's fundus is palpated as boggy, 2 cm above the umbilicus, and deviated to the right. The client's lochia rubra flow is heavy. What is the nurse's priority action?

Administer a PRN analgesic for afterpains.
Assist the client to the bathroom to void. (Correct answer)
Increase the rate of the intravenous oxytocin infusion.
Document the findings and reassess in 30 minutes.

Correct answer: Assist the client to the bathroom to void.

The assessment findings of a boggy fundus, located above the umbilicus and deviated from the midline, are classic indicators of a distended urinary bladder. A full bladder impedes the uterus's ability to contract effectively, leading to uterine atony, which is a primary cause of postpartum hemorrhage. Assisting the client to empty her bladder is the priority nursing action to allow the uterus to contract properly and control bleeding.

Question 96: Which maternal vital sign change during labor warrants IMMEDIATE provider notification regardless of other findings?

Blood pressure of 158/105 mmHg on two readings 15 minutes apart (Correct answer)
Respiratory rate of 20 breaths per minute during a contraction
Heart rate of 95 bpm after ambulation
Temperature of 38.0°C (100.4°F) after 4 hours of ruptured membranes

Correct answer: Blood pressure of 158/105 mmHg on two readings 15 minutes apart

A blood pressure of 158/105 mmHg or higher on two readings 15 minutes apart meets the diagnostic threshold for severe-range hypertension requiring urgent antihypertensive treatment.

Question 97: A 26-week pregnant client with no prior history of glucose intolerance is scheduled for routine screening for gestational diabetes mellitus (GDM). What is the standard initial screening test the nurse should prepare the client for?

A fasting blood glucose test
A 2-hour, 75-gram oral glucose tolerance test (OGTT)
A 3-hour, 100-gram oral glucose tolerance test (OGTT)
A 1-hour, 50-gram glucose challenge test (GCT) (Correct answer)

Correct answer: A 1-hour, 50-gram glucose challenge test (GCT)

The standard and most common initial screening for GDM in the United States, recommended by ACOG, is a 1-hour, 50-gram non-fasting glucose challenge test, typically performed between 24 and 28 weeks of gestation. The 3-hour OGTT is the diagnostic test used if the initial 1-hour screen is abnormal.

Question 98: A nurse is caring for a patient whose EFM strip displays recurrent late decelerations with minimal variability. According to the NICHD Three-Tier Fetal Heart Rate Interpretation System, this tracing would be classified as which category?

Category II
Category I
Indeterminate
Category III (Correct answer)

Correct answer: Category III

Category III tracings are abnormal and predictive of abnormal fetal acid-base status. They include patterns such as absent baseline variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia, or a sinusoidal pattern. This combination requires prompt evaluation and intervention.

Question 99: When educating a postpartum support group, how should the nurse best distinguish between postpartum 'baby blues' and postpartum depression (PPD)?

"Only postpartum depression requires professional treatment; the 'baby blues' can be managed with herbal remedies alone."
"The 'baby blues' often include thoughts of harming the infant, which are not present in postpartum depression."
"Postpartum depression typically begins within 2-3 days of delivery, while the 'baby blues' can start any time in the first year."
"Postpartum blues are a normal, transient condition of mood swings and tearfulness that resolves within two weeks, whereas PPD involves more severe, persistent symptoms that impair daily functioning." (Correct answer)

Correct answer: "Postpartum blues are a normal, transient condition of mood swings and tearfulness that resolves within two weeks, whereas PPD involves more severe, persistent symptoms that impair daily functioning."

The key differences between postpartum blues and PPD are the severity and duration of symptoms. Postpartum blues are common, characterized by mild mood swings and crying spells, and typically resolve spontaneously within two weeks of delivery. Postpartum depression is a more severe mood disorder with symptoms lasting longer than two weeks, significantly interfering with the mother's ability to function and care for her baby, and requires professional intervention.

Question 100: During delivery, the fetal head is born but the shoulders do not deliver with the next contraction. The nurse recognizes shoulder dystocia and initiates HELPERR. What does the first maneuver 'H' represent?

Hyperflexion of maternal thighs (McRoberts maneuver) (Correct answer)
Halt oxytocin and call for help
Hand pressure applied to fundus
Hypertonic uterine contraction management

Correct answer: Hyperflexion of maternal thighs (McRoberts maneuver)

In the HELPERR mnemonic for shoulder dystocia, 'H' stands for McRoberts maneuver — hyperflexing the maternal thighs onto the abdomen to flatten lumbar lordosis and widen the pelvic outlet.

Question 101: During active labor, a nurse notes the FHR baseline is 175 bpm for 15 minutes with minimal variability. Maternal temperature is 38.4°C. What condition should the nurse suspect?

Intrauterine infection (chorioamnionitis) causing fetal tachycardia (Correct answer)
Umbilical cord compression causing baseline changes
Fetal movement artifact on the monitor
Fetal sleep cycle reducing variability

Correct answer: Intrauterine infection (chorioamnionitis) causing fetal tachycardia

Maternal fever combined with fetal tachycardia and decreased variability is a classic presentation of chorioamnionitis, which requires antibiotic therapy and often expedited delivery.

Question 102: The gate control theory of pain, as applied to labor analgesia, explains how non-pharmacological methods reduce pain by:

Blocking oxytocin receptors in uterine smooth muscle
Relaxing uterine smooth muscle to reduce contraction intensity
Activating large sensory nerve fibers that inhibit pain signal transmission in the dorsal horn (Correct answer)
Increasing endogenous cortisol release

Correct answer: Activating large sensory nerve fibers that inhibit pain signal transmission in the dorsal horn

Stimulation of large-diameter A-beta fibers (via touch, heat, vibration, TENS) inhibits transmission of pain signals carried by smaller C and A-delta fibers at the spinal cord's dorsal horn.

Question 103: A nurse is analyzing a fetal heart rate tracing. The baseline is 140 bpm, variability is moderate, and there are abrupt increases of 15 bpm lasting 20 seconds with fetal movement. Late decelerations are absent. How should the nurse categorize this tracing?

Category III
Category II
Category I (Correct answer)
Indeterminate

Correct answer: Category I

This tracing meets all the criteria for a Category I pattern, which is strongly predictive of normal fetal acid-base status. It includes a normal baseline rate (110-160 bpm), moderate variability, presence of accelerations, and absence of late or variable decelerations.

Question 104: When assessing a newborn's reflexes, the nurse gently strokes the lateral aspect of the sole of the foot from the heel upward to the ball of the foot. Which response would indicate a normal Babinski reflex?

There is no discernible response from the toes.
The toes hyperextend and fan out. (Correct answer)
The infant pulls the foot away in response to the touch.
The toes curl downward and inward.

Correct answer: The toes hyperextend and fan out.

A positive (normal) Babinski reflex in a newborn is characterized by the fanning out (abduction) and hyperextension of the toes. This reflex is normal in infants up to about 1-2 years of age. A negative response, where the toes curl downward, is the normal finding in adults.

Question 105: A pregnant client at 32 weeks gestation presents with epigastric pain, nausea, and malaise. Laboratory results show: Alanine aminotransferase (ALT) 150 IU/L, Aspartate aminotransferase (AST) 180 IU/L, platelet count 80,000/μL, and schistocytes on the peripheral blood smear. These findings are most indicative of which complication?

HELLP syndrome (Correct answer)
Preeclampsia without severe features
Intrahepatic cholestasis of pregnancy (ICP)
Acute fatty liver of pregnancy (AFLP)

Correct answer: HELLP syndrome

HELLP syndrome is a severe variant of preeclampsia characterized by Hemolysis (indicated by schistocytes), Elevated Liver enzymes (AST and ALT >70 IU/L), and Low Platelets (count <100,000/μL). The client's lab values and symptoms are classic for this life-threatening condition.

Question 106: The drug of choice for seizure prophylaxis in patients with preeclampsia with severe features is:

Diazepam (Valium)
Phenytoin (Dilantin)
Magnesium sulfate (Correct answer)
Lorazepam (Ativan)

Correct answer: Magnesium sulfate

Magnesium sulfate is the standard of care for both prevention and treatment of eclamptic seizures in preeclampsia with severe features.

Question 107: A laboring patient's electronic fetal monitor (EFM) strip shows a baseline fetal heart rate of 170 bpm for the last 15 minutes, moderate variability, and no decelerations. Which of the following is a likely cause for this finding?

Maternal hypotension
Maternal fever (Correct answer)
Umbilical cord compression
Fetal sleep cycle

Correct answer: Maternal fever

A baseline fetal heart rate greater than 160 bpm is defined as tachycardia. One of the most common causes of fetal tachycardia is maternal fever or infection (chorioamnionitis). Fetal sleep cycles are associated with decreased variability, cord compression typically causes variable decelerations, and maternal hypotension is more likely to cause bradycardia or late decelerations.

Question 108: A primipara in active labor at 5 cm requests an epidural. After placement, her blood pressure drops from 118/72 to 88/54 mmHg. The FIRST nursing action should be:

Place her in left lateral position and increase IV fluid infusion rate (Correct answer)
Administer epinephrine 1 mg IV push
Notify anesthesia to remove the epidural immediately
Elevate the head of the bed to 90 degrees

Correct answer: Place her in left lateral position and increase IV fluid infusion rate

Epidural-induced hypotension is managed first by lateral positioning (to relieve aortocaval compression) and a rapid IV fluid bolus.

Question 109: Which food should pregnant women avoid to reduce the risk of listeriosis?

Deli meats and hot dogs (Correct answer)
Cooked chicken
Pasteurized milk
Well-cooked eggs

Correct answer: Deli meats and hot dogs

Deli meats and hot dogs can harbor Listeria monocytogenes and should be avoided or heated until steaming before consumption during pregnancy.

Question 110: Which insulin type is traditionally preferred for use during pregnancy due to its established safety profile?

Insulin lispro (Humalog) only
NPH and regular human insulin (Correct answer)
Insulin glargine (Lantus) only
Insulin detemir (Levemir) only

Correct answer: NPH and regular human insulin

NPH and regular human insulin have the longest safety records in pregnancy; however, insulin lispro and detemir are also considered acceptable per recent guidelines.

Question 111: Preeclampsia is defined as new-onset hypertension after 20 weeks gestation accompanied by:

Proteinuria OR severe features such as thrombocytopenia or renal insufficiency (Correct answer)
Edema and weight gain of more than 2 lbs/week
Only a single blood pressure reading ≥160/110 mmHg
Proteinuria alone, regardless of blood pressure level

Correct answer: Proteinuria OR severe features such as thrombocytopenia or renal insufficiency

Current ACOG criteria define preeclampsia as BP ≥140/90 mmHg on two occasions plus proteinuria OR one or more severe features even without proteinuria.

Question 112: A laboring patient at 39 weeks with GBS-positive status has been in labor for 2 hours since rupture of membranes. She has a penicillin allergy with a prior anaphylactic reaction. What antibiotic should the nurse anticipate administering?

Cefazolin IV
Clindamycin IV based on GBS sensitivity results
Ampicillin IV
Vancomycin IV (Correct answer)

Correct answer: Vancomycin IV

For GBS-positive patients with a high-risk penicillin allergy (anaphylaxis history) and GBS resistant to clindamycin, vancomycin is the recommended alternative agent.

Question 113: On postpartum day 4, a client who experienced a prolonged rupture of membranes reports uterine tenderness and chills. The nurse assesses a temperature of 101.5°F (38.6°C) and notes profuse, foul-smelling lochia. These findings are most indicative of which postpartum complication?

Mastitis
Urinary Tract Infection
Endometritis (Correct answer)
Thrombophlebitis

Correct answer: Endometritis

The classic signs and symptoms of endometritis, an infection of the uterine lining, include fever (typically >38°C), uterine tenderness, and foul-smelling lochia. A prolonged rupture of membranes is a significant risk factor for developing this infection. Mastitis would present with breast symptoms, a UTI with urinary symptoms, and thrombophlebitis with leg pain and swelling.

Question 114: Cell-free DNA (cfDNA) screening is most sensitive and specific for detecting which chromosomal condition?

Trisomy 18 (Edwards syndrome)
Trisomy 21 (Down syndrome) (Correct answer)
Turner syndrome (45,X)
Neural tube defects

Correct answer: Trisomy 21 (Down syndrome)

cfDNA screening has the highest sensitivity (>99%) and specificity for detecting trisomy 21 (Down syndrome) compared to other chromosomal conditions.

Question 115: A client who is 3 days postpartum suddenly becomes extremely agitated and confused. She tells the nurse that she hears voices saying her baby is an evil entity. Her partner states she has not slept and is talking nonsensically. These findings are most characteristic of which complication?

Postpartum anxiety disorder
Postpartum depression
Postpartum psychosis (Correct answer)
Severe postpartum 'baby blues'

Correct answer: Postpartum psychosis

Postpartum psychosis is a medical emergency characterized by a rapid onset of symptoms including hallucinations, delusions, paranoia, and disorganized thoughts or behavior. These symptoms represent a break from reality and are distinct from the mood swings of 'baby blues' or the persistent sadness of postpartum depression.

Question 116: When pregnant, mouth issues are frequently

Decreased saliva
Tooth demineralization
None of the above
Gingivitis (Correct answer)

Correct answer: Gingivitis

Gingivitis is a very common mouth issue frequently experienced during pregnancy. Hormonal changes, particularly increased estrogen and progesterone, make the gums more sensitive, leading to inflammation, swelling, and bleeding. This condition, often referred to as 'pregnancy gingivitis,' requires good oral hygiene to manage and prevent further complications.

Question 117: Using a fetoscope to listen to the fetal heartbeat if the fetus is in

in the left upper abdominal quadrant, to the left of the umbilicus
in the left lower abdominal quadrant, near the mother’s thigh (Correct answer)
in the right lower abdominal quadrant, near the mother’s thigh
none of the above

Correct answer: in the left lower abdominal quadrant, near the mother’s thigh

The most common fetal position for listening to the heartbeat with a fetoscope is in the left lower abdominal quadrant, near the mother’s thigh. This placement is optimal because the fetus is typically in a cephalic (head-down) presentation, with the fetal back, where the heart sounds are best heard, often positioned towards the mother's left side. This allows for clear auscultation of the fetal heart tones.

Question 118: When differentiating between abruptio placentae and placenta previa, which clinical finding is uniquely characteristic of abruptio placentae?

A soft, relaxed, non-tender uterus
Abnormal fetal presentation, such as breech or transverse lie (Correct answer)
Bright red, painless vaginal bleeding
Sudden onset of abdominal pain and uterine tenderness

Correct answer: Abnormal fetal presentation, such as breech or transverse lie

The hallmark sign of abruptio placentae is the sudden onset of abdominal pain, often described as sharp or constant, accompanied by uterine tenderness or a rigid, board-like abdomen. This is in contrast to the classic painless bleeding of placenta previa. While abnormal fetal presentation can occur with placenta previa, it is not the most distinct differentiating symptom from abruption.

Question 119: A nurse is reviewing the criteria for a diagnosis of preeclampsia with severe features. Which of the following findings is a key indicator of this condition?

Platelet count less than 100,000/μL (Correct answer)
Proteinuria of 300mg in a 24-hour urine collection
Mild pedal edema
Blood pressure of 150/95 mmHg on two occasions 4 hours apart

Correct answer: Platelet count less than 100,000/μL

According to ACOG guidelines, preeclampsia with severe features is diagnosed in the presence of new-onset hypertension along with specific signs of end-organ damage. A platelet count below 100,000/μL (thrombocytopenia) is a diagnostic criterion for severe features. While elevated blood pressure and proteinuria are present in preeclampsia, the other options describe findings of preeclampsia without severe features or common pregnancy symptoms.

Question 120: A patient with a positive NIPT result for trisomy 18 should be counseled that the next step is:

Confirmatory diagnostic testing such as amniocentesis or CVS should be offered (Correct answer)
No further testing is required; begin pregnancy management
Repeat NIPT in 4 weeks to confirm
The result is a definitive diagnosis and immediate delivery planning is needed

Correct answer: Confirmatory diagnostic testing such as amniocentesis or CVS should be offered

NIPT is a screening test, not diagnostic; a positive result must be confirmed with amniocentesis or CVS before any major clinical decisions are made.

Question 121: Which screening is routinely performed at the first prenatal visit to determine maternal blood compatibility?

ABO typing only
ABO and Rh typing (Correct answer)
HLA typing
Rh typing only

Correct answer: ABO and Rh typing

Both ABO and Rh blood typing are performed at the first prenatal visit to identify Rh-negative mothers who may need RhoGAM.

Question 122: Chronic hypertension in pregnancy is defined as hypertension diagnosed at which time point?

After 20 weeks gestation without proteinuria
Between 28 and 34 weeks gestation
Before 20 weeks gestation or pre-existing prior to pregnancy (Correct answer)
Within 48 hours of delivery only

Correct answer: Before 20 weeks gestation or pre-existing prior to pregnancy

Chronic hypertension is pre-existing hypertension or hypertension first identified before 20 weeks gestation, distinguishing it from gestational hypertension and preeclampsia.

Question 123: How many weeks do post-term pregnancy last?

39
42 (Correct answer)
40
41

Correct answer: 42

A post-term pregnancy is defined as one that lasts beyond 42 completed weeks of gestation. While a full-term pregnancy typically ranges from 37 to 40 weeks, pregnancies extending past 42 weeks carry increased risks for both the mother and the fetus, such as placental insufficiency and fetal macrosomia, necessitating careful monitoring and management.

Question 124: A nurse is assisting with a delivery complicated by shoulder dystocia. After the provider has attempted gentle traction without success, which nursing intervention should be prioritized?

Encouraging the client to push with an open glottis.
Assisting the client into the McRoberts maneuver position. (Correct answer)
Applying fundal pressure.
Preparing for an immediate cesarean section.

Correct answer: Assisting the client into the McRoberts maneuver position.

The McRoberts maneuver, which involves hyperflexing the mother's legs onto her abdomen, is a primary, evidence-based intervention for shoulder dystocia. [8, 14] This maneuver flattens the sacral promontory and rotates the pubic symphysis, which can free the impacted anterior shoulder. [6] Applying fundal pressure is contraindicated as it can worsen the impaction of the shoulder and increase the risk of fetal injury. [11, 15] While preparing for other interventions is important, McRoberts is a key initial step. Pushing is ineffective until the shoulder is dislodged.

Question 125: The most common serious complication of multiple gestation pregnancy is:

Preterm birth before 37 weeks (Correct answer)
Decreased risk of hypertensive disorders
Post-term delivery beyond 42 weeks
Fetal macrosomia in all twins

Correct answer: Preterm birth before 37 weeks

Preterm birth is the most frequent and clinically significant complication of twin and higher-order multiple pregnancies, occurring in the majority of cases.

Question 126: A nurse assesses the placenta after delivery and notes a ragged, incomplete cotyledon. The priority action is to:

Administer misoprostol to facilitate expulsion of remaining tissue
Notify the provider immediately due to risk of postpartum hemorrhage from retained placental fragments (Correct answer)
Document the finding and continue routine postpartum monitoring
Inspect the cord for a true knot

Correct answer: Notify the provider immediately due to risk of postpartum hemorrhage from retained placental fragments

Incomplete placenta with missing cotyledons indicates retained placental fragments, which can cause postpartum hemorrhage and infection requiring immediate provider notification.

Question 127: A nurse is providing education to a new mother on preventing mastitis. Which statement by the mother indicates a correct understanding of the teaching?

"If my breast gets sore, applying cold packs before feeding will be most helpful."
"I need to ensure my baby latches on correctly and empties the breast with each feeding." (Correct answer)
"A tight-fitting bra will help reduce milk flow and prevent engorgement."
"I should stop breastfeeding from the sore breast to let it heal."

Correct answer: "I need to ensure my baby latches on correctly and empties the breast with each feeding."

The most effective strategies for preventing and managing mastitis involve ensuring proper latch and frequent, complete emptying of the breasts to prevent milk stasis. Stopping breastfeeding on the affected side can worsen the condition, and tight bras can obstruct milk flow. Warm compresses are typically recommended before feeding to facilitate milk flow.

Question 128: The nurse is monitoring a patient receiving oxytocin augmentation. Which FHR pattern requires the nurse to STOP the infusion immediately?

Early decelerations with contractions
Accelerations with contractions
Repetitive late decelerations with minimal variability (Correct answer)
Variable decelerations that resolve within 30 seconds

Correct answer: Repetitive late decelerations with minimal variability

Repetitive late decelerations with minimal variability (Category III) indicate uteroplacental insufficiency, requiring immediate oxytocin discontinuation and further resuscitation measures.

Question 129: A patient's amniotic fluid appears green and thick immediately after spontaneous rupture of membranes. The priority nursing concern is:

Meconium aspiration syndrome risk requiring preparation for neonatal resuscitation (Correct answer)
Maternal dehydration due to fluid loss
Increased risk of maternal Group B Streptococcus transmission
Umbilical cord prolapse from increased fluid pressure

Correct answer: Meconium aspiration syndrome risk requiring preparation for neonatal resuscitation

Thick meconium-stained amniotic fluid indicates in-utero passage of meconium and places the neonate at risk for meconium aspiration syndrome, requiring a skilled neonatal team at delivery.

Question 130: A laboring client requests pain relief but wishes to avoid epidural anesthesia. Which non-pharmacological intervention utilizes the gate-control theory of pain?

Suggesting aromatherapy with lavender oil.
Administering nitrous oxide.
Applying counter-pressure to the sacral area. (Correct answer)
Encouraging the use of hypnosis.

Correct answer: Applying counter-pressure to the sacral area.

The gate-control theory suggests that the spinal cord contains a neurological 'gate' that either blocks pain signals or allows them to continue on to the brain. Applying counter-pressure provides a non-painful stimulus that can 'close the gate' to the painful stimuli of contractions. Hypnosis and aromatherapy work on the central nervous system control method, while nitrous oxide is a pharmacological agent.

Question 131: The main danger of having a midline episiotomy is

Urinary incontinence
Laceration (Correct answer)
Hemorrhage
None of the above

Correct answer: Laceration

The main danger of having a midline episiotomy is an increased risk of severe laceration, specifically extending into a third or fourth-degree perineal tear. Because the incision is straight, it is more prone to uncontrolled tearing downwards, potentially involving the anal sphincter or rectal mucosa. Such extensive lacerations can lead to complications like fecal incontinence.

Question 132: During a newborn head-to-toe assessment, the nurse observes a soft, edematous area on the infant's scalp that extends across the suture lines. This finding is most consistent with which condition?

Cephalohematoma
Caput succedaneum (Correct answer)
Subgaleal hemorrhage
Molding

Correct answer: Caput succedaneum

Caput succedaneum is generalized edema of the scalp that is present at birth. It feels soft and spongy and, crucially, crosses the cranial suture lines. It typically resolves within a few days. A cephalohematoma is a collection of blood that does not cross suture lines.

Question 133: Frequently, an excessively long umbilical cord leads to

Fetal death
Umbilical cord rupture
Transient decelerations (Correct answer)
None of the above

Correct answer: Transient decelerations

An excessively long umbilical cord frequently leads to transient decelerations in the fetal heart rate. A longer cord increases the likelihood of it becoming wrapped around the fetus or compressed during labor, temporarily reducing blood flow and oxygen. These brief interruptions in oxygen supply manifest as transient drops in the fetal heart rate, which are then monitored closely.

Question 134: What does a Bishop score of 3 indicate in a patient scheduled for labor induction?

Induction is contraindicated and cesarean delivery should be scheduled
The patient is in early latent labor and induction is unnecessary
The cervix is favorable and induction should proceed directly with oxytocin
The cervix is unfavorable and cervical ripening agents are indicated before induction (Correct answer)

Correct answer: The cervix is unfavorable and cervical ripening agents are indicated before induction

A Bishop score of 6 or less (especially ≤3) indicates an unfavorable cervix, and cervical ripening with prostaglandins or a mechanical device is recommended before oxytocin induction.

Question 135: A nurse working on the labor and delivery unit learns that a high-profile celebrity has been admitted. The nurse is not assigned to the celebrity's care but accesses her electronic health record (EHR) out of curiosity. This action is a direct violation of which professional standard?

Scope of Practice
Veracity
Beneficence
Patient Confidentiality (HIPAA) (Correct answer)

Correct answer: Patient Confidentiality (HIPAA)

Accessing a patient's protected health information (PHI) without a legitimate, job-related reason is a clear violation of the Health Insurance Portability and Accountability Act (HIPAA) and the ethical principle of patient confidentiality. Nurses should only access the records of patients to whom they are directly providing care.

Question 136: A patient's 1-hour glucose challenge test (GCT) result is 152 mg/dL. What is the appropriate next step?

Repeat the 1-hour GCT in 2 weeks
Diagnose gestational diabetes and start insulin immediately
Counsel on diet modifications and recheck in 1 month
Perform a 3-hour 100g oral glucose tolerance test (OGTT) (Correct answer)

Correct answer: Perform a 3-hour 100g oral glucose tolerance test (OGTT)

A 1-hour GCT result ≥140 mg/dL (some use ≥130 mg/dL) is abnormal and requires a diagnostic 3-hour 100g OGTT to confirm or rule out gestational diabetes.

Question 137: A patient's blood pressure drops to 88/54 mmHg immediately after epidural analgesia is initiated. The priority nursing intervention is:

Discontinue the epidural catheter
Increase IV fluid rate and position patient in left lateral tilt (Correct answer)
Administer IV epinephrine 1 mg immediately
Administer naloxone IV

Correct answer: Increase IV fluid rate and position patient in left lateral tilt

Epidural-induced hypotension results from sympathetic blockade causing vasodilation; IV fluid bolus and left lateral positioning to relieve aortocaval compression are the first-line interventions.

Question 138: At what gestational age is the first prenatal visit typically scheduled in the US?

14–16 weeks
6–8 weeks (Correct answer)
18–20 weeks
10–12 weeks

Correct answer: 6–8 weeks

The first prenatal visit is ideally scheduled at 6–8 weeks to confirm the pregnancy and establish baseline assessments.

Question 139: A client at 8 weeks gestation presents to the emergency department with a 2-day history of spotting and crampy lower abdominal pain. She now reports a sudden, severe, unilateral lower quadrant pain that radiates to her shoulder. Which condition should the nurse be most concerned about?

Miscarriage.
Ruptured ectopic pregnancy. (Correct answer)
Appendicitis.
Ovarian torsion.

Correct answer: Ruptured ectopic pregnancy.

The development of sudden, severe, unilateral pain along with referred shoulder pain (Kehr's sign) is a hallmark sign of a ruptured ectopic pregnancy with intraperitoneal hemorrhage. [7, 21] The bleeding irritates the diaphragm and phrenic nerve, causing pain to be referred to the shoulder area. [21] While the other conditions cause abdominal pain, the referred shoulder pain in a client with signs of early pregnancy is highly suggestive of a ruptured ectopic pregnancy. [23, 41]

Question 140: A nurse is providing discharge instructions to a new mother regarding normal postpartum lochia changes. Which statement by the client indicates a need for further teaching?

"The reddish discharge, lochia rubra, should last for the first 3 to 4 days after birth."
"I should call my doctor if I soak a perineal pad in an hour or less."
"The discharge will become pinkish-brown, called lochia serosa, for about a week after the red flow stops."
"It is normal for my bleeding to turn bright red again after it has become a yellowish-white color." (Correct answer)

Correct answer: "It is normal for my bleeding to turn bright red again after it has become a yellowish-white color."

The normal progression of lochia is from rubra (red) to serosa (pinkish-brown) to alba (yellowish-white). A return to bright red bleeding after the lochia has progressed to serosa or alba is an abnormal finding and may indicate late postpartum hemorrhage, which requires immediate medical evaluation. The other statements reflect an accurate understanding of normal lochia progression and warning signs.

Question 141: A nurse is assessing a newborn one minute after birth. The findings include: heart rate of 110 bpm, a strong cry, active motion of all extremities, a grimace in response to suctioning, and a body that is pink with blue hands and feet. What Apgar score should the nurse assign?

10
8 (Correct answer)
7
9

Correct answer: 8

The Apgar score is calculated as follows: Heart Rate (>100 bpm) = 2 points; Respiratory Effort (strong cry) = 2 points; Muscle Tone (active motion) = 2 points; Reflex Irritability (grimace) = 1 point; Color (pink body, blue extremities/acrocyanosis) = 1 point. The total score is 2+2+2+1+1 = 8.

Question 142: A pregnant patient at 30 weeks asks when to report decreased fetal movement. The nurse correctly advises her to call if she counts fewer than 10 movements in how many hours?

1 hour
4 hours
6 hours
2 hours (Correct answer)

Correct answer: 2 hours

The 'count to 10' method recommends that patients report if they do not feel 10 distinct fetal movements within 2 hours after 28 weeks.

Question 143: A multiparous patient delivers within 2 hours of the onset of regular contractions. Her birth is classified as:

Precipitous labor (Correct answer)
Second stage failure to progress
Active phase arrest
Prolonged latent phase

Correct answer: Precipitous labor

Precipitous labor is defined as labor and delivery completed in less than 3 hours from the onset of regular contractions and carries risks of perineal trauma and fetal hypoxia.

Question 144: An obstetric nurse is analyzing a fetal heart rate tracing and observes a gradual decrease in the FHR that begins after the peak of a contraction and returns to baseline after the contraction has ended. This pattern is identified as:

Prolonged deceleration
Variable deceleration
Early deceleration
Late deceleration (Correct answer)

Correct answer: Late deceleration

Late decelerations are characterized by a gradual decrease in the fetal heart rate with an onset that occurs after the beginning of the contraction, and the lowest point (nadir) occurs after the peak of the contraction. This timing suggests uteroplacental insufficiency. Early decelerations mirror the contraction, and variable decelerations are abrupt and V-shaped. A prolonged deceleration lasts for 2 minutes or more.

Question 145: A patient at 18 weeks has an anatomy ultrasound showing echogenic bowel. The nurse knows this finding is considered:

An absolute indication for immediate delivery
A normal variant with no follow-up needed
Diagnostic for Down syndrome
A soft marker that may be associated with trisomy 21, cystic fibrosis, or IUGR (Correct answer)

Correct answer: A soft marker that may be associated with trisomy 21, cystic fibrosis, or IUGR

Echogenic bowel is a soft ultrasound marker associated with several conditions including Down syndrome, cystic fibrosis, swallowed blood, and growth restriction, warranting further evaluation.

RNC-OB Exam

The RNC-OB (Inpatient Obstetric Nursing) certification from the National Certification Corporation validates specialized knowledge in caring for pregnant women, newborns, and families during antepartum, intrapartum, postpartum, and neonatal stages.

175

Questions

180 min

Time Limit

70%

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