RNC-OB Exam — Questions and Answers

Question 1: TENS (transcutaneous electrical nerve stimulation) reduces labor pain primarily through which mechanism?

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

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 2: 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.
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.
The patient's signature on the consent form witnessed by the nurse.

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 3: A laboring patient suddenly develops fetal bradycardia to 60 bpm and the nurse visualizes a loop of umbilical cord at the vaginal introitus. The nurse's FIRST action is to:

Place the patient in lithotomy position and push the cord back
Apply oxygen and call the physician
Manually elevate the presenting part off the cord (Correct answer)
Begin IV fluid bolus immediately

Correct answer: Manually elevate the presenting part off the cord

Manual elevation of the presenting part relieves cord compression and is the immediate priority to restore fetal blood flow.

Question 4: A patient at 32 weeks gestation is admitted with preterm premature rupture of membranes (PPROM). She has no signs of infection or labor. Which medication is MOST appropriate to administer at this gestational age?

Oxytocin to augment labor
Magnesium sulfate for seizure prophylaxis
Terbutaline for long-term tocolysis
Betamethasone to promote fetal lung maturity (Correct answer)

Correct answer: Betamethasone to promote fetal lung maturity

Betamethasone is given at 24–34 weeks when preterm delivery is anticipated within 7 days to accelerate fetal lung maturation and reduce neonatal morbidity.

Question 5: During the third stage of labor, which clinical sign indicates placental separation has occurred?

The patient reports relief of pressure in the perineum
The uterus becomes soft and boggy after delivery
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 6: Which finding on an external fetal monitor tracing is MOST reassuring of fetal well-being during active labor?

Absent variability with occasional late decelerations
Minimal variability with no accelerations
Moderate variability with accelerations and no decelerations (Correct answer)
Sinusoidal pattern at 120 bpm baseline

Correct answer: Moderate variability with accelerations and no decelerations

Moderate variability (6–25 bpm) with accelerations and absence of decelerations is the most reassuring (Category I) tracing pattern.

Question 7: Which of the following fetal scalp electrode (FSE) placements is CONTRAINDICATED?

When external monitoring is inadequate in active labor
When fetal presentation is vertex
When the cervix is dilated ≥2 cm and membranes are ruptured
When the patient is HIV-positive (Correct answer)

Correct answer: When the patient is HIV-positive

FSE is contraindicated in patients with HIV, hepatitis B or C, or other blood-borne infections due to the risk of vertical transmission via the puncture site.

Question 8: Which local anesthetic agent is most commonly used in continuous epidural infusions for labor analgesia?

Low-concentration bupivacaine or ropivacaine (Correct answer)
Chloroprocaine 3%
Lidocaine 2%
Tetracaine 0.5%

Correct answer: Low-concentration bupivacaine or ropivacaine

Dilute bupivacaine (0.0625–0.125%) or ropivacaine, often combined with fentanyl, provides effective sensory blockade with minimal motor block, allowing ambulation during labor.

Question 9: Dinoprostone (Cervidil) cervical ripening insert is placed at 8 AM. At what point must it be removed?

After 24 hours or with onset of active labor
After 6 hours or with onset of active labor
After 12 hours or with onset of active labor (Correct answer)
Only when oxytocin infusion is started

Correct answer: After 12 hours or with onset of active labor

Cervidil is designed for up to 12 hours of use and must be removed at the onset of active labor or if uterine hyperstimulation occurs.

Question 10: A postpartum patient is prescribed methylergonovine (Methergine). Which condition is a contraindication to this medication?

Uterine subinvolution
Retained placental fragments
Hypertension (Correct answer)
Postpartum hemorrhage due to uterine atony

Correct answer: Hypertension

Methylergonovine causes vasoconstriction and is contraindicated in patients with hypertension because it can cause severe elevation of blood pressure.

Question 11: If vaginal fluid has blood in it, the nitrazine test for amniotic fluid will show it.

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

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 12: In postpartum hemorrhage secondary to uterine atony, which intervention should occur BEFORE fundal massage?

Administering methylergonovine
Performing bimanual compression
Ensuring the bladder is emptied (Correct answer)
Starting a blood transfusion

Correct answer: Ensuring the bladder is emptied

A full bladder displaces the uterus and prevents effective uterine contraction; bladder emptying must occur before fundal massage.

Question 13: Which newborn measurement correctly describes macrosomia?

Birth weight greater than 2,500 g
Birth weight greater than 4,000–4,500 g (8 lb 13 oz–9 lb 14 oz) (Correct answer)
Length greater than the 90th percentile regardless of weight
Birth weight at the 90th percentile for gestational age

Correct answer: Birth weight greater than 4,000–4,500 g (8 lb 13 oz–9 lb 14 oz)

Macrosomia is defined as birth weight exceeding 4,000–4,500 g (8 lb 13 oz to 9 lb 14 oz), with 4,500 g commonly used as the threshold for clinical significance.

Question 14: Which risk factor most significantly increases a postpartum patient's likelihood of developing endometritis?

Epidural analgesia during labor
Breastfeeding within the first hour after birth
Gestational diabetes controlled with diet alone
Cesarean delivery after prolonged labor and multiple vaginal exams (Correct answer)

Correct answer: Cesarean delivery after prolonged labor and multiple vaginal exams

Cesarean delivery is the single greatest risk factor for endometritis; risk increases further with prolonged labor, PROM, and multiple cervical exams.

Question 15: Which teaching point is most important for a postpartum patient being discharged home regarding her lochia?

Lochia should stop completely by day 5 postpartum
Lochia should always be bright red for the first 2 weeks
Lochia rubra lasting more than 3 days is abnormal
Report foul-smelling lochia, which may indicate infection (Correct answer)

Correct answer: Report foul-smelling lochia, which may indicate infection

Foul-smelling lochia is a key warning sign of postpartum endometritis and patients should be taught to report it promptly.

Question 16: During a postpartum home visit, the nurse notes the patient has erythema and induration in her right calf that is warm to touch. The patient's D-dimer is elevated. Which diagnostic test will CONFIRM the suspected diagnosis?

Compression ultrasonography of the lower extremity (Correct answer)
Ventilation-perfusion scan
Coagulation panel (PT/PTT)
Chest X-ray

Correct answer: Compression ultrasonography of the lower extremity

Compression duplex ultrasonography is the gold-standard first-line imaging test to confirm or rule out deep vein thrombosis in the lower extremities.

Question 17: A postpartum patient is prescribed sitz baths. Which instruction should the nurse provide?

Soak for 20 minutes, 3–4 times daily (Correct answer)
Use water as hot as tolerable for maximum benefit
Add antiseptic solution to the water every time
Avoid sitz baths if you have hemorrhoids

Correct answer: Soak for 20 minutes, 3–4 times daily

Sitz baths of warm water for 20 minutes, 3–4 times daily promote perineal healing and relieve discomfort.

Question 18: A Category II FHR tracing with recurrent late decelerations and minimal variability is observed. Which intervention bundle should the nurse initiate?

Lateral positioning, O2 via face mask, IV fluid bolus, and notify provider (Correct answer)
Administer terbutaline and continue monitoring
Increase oxytocin infusion and reposition
Prepare for immediate vacuum-assisted delivery

Correct answer: Lateral positioning, O2 via face mask, IV fluid bolus, and notify provider

The standard intrauterine resuscitation bundle includes lateral positioning, supplemental oxygen, IV fluid bolus, and provider notification to improve uteroplacental blood flow.

Question 19: During pushing in the second stage, the nurse observes FHR decelerations that begin after the contraction peaks and have a slow return to baseline. This pattern is MOST consistent with:

Variable decelerations due to cord occlusion
Accelerations misidentified as decelerations
Early decelerations due to head compression
Late decelerations indicating uteroplacental insufficiency (Correct answer)

Correct answer: Late decelerations indicating uteroplacental insufficiency

Late decelerations that begin after the contraction peak and slowly return to baseline reflect uteroplacental insufficiency and impaired gas exchange.

Question 20: A nurse documents 'baseline FHR 140 bpm, moderate variability, accelerations present, no decelerations.' According to NICHD classification, this tracing is:

Nonreassuring and requires scalp stimulation
Category III — abnormal
Category I — normal (Correct answer)
Category II — indeterminate

Correct answer: Category I — normal

A Category I tracing includes a baseline of 110–160 bpm, moderate variability, no late or variable decelerations, and presence of early decelerations or accelerations.

Question 21: Which maternal condition is MOST likely to cause fetal tachycardia during intrapartum monitoring?

Maternal chorioamnionitis (Correct answer)
Maternal epidural analgesia
Maternal hypoglycemia
Maternal hypothyroidism

Correct answer: Maternal chorioamnionitis

Chorioamnionitis causes maternal and fetal fever and infection, leading to fetal tachycardia (>160 bpm) as the fetal heart responds to inflammatory mediators and elevated temperature.

Question 22: A postpartum patient reports difficulty starting a urine stream and dribbling. She voided only 50 mL since delivery 8 hours ago. What should the nurse do next?

Palpate and percuss the suprapubic area to assess for bladder distention (Correct answer)
Reassure her that this is normal and encourage oral fluids
Administer a diuretic as ordered
Immediately insert an indwelling urinary catheter

Correct answer: Palpate and percuss the suprapubic area to assess for bladder distention

Assessing for bladder distention by palpation and percussion is the next step to determine whether the patient has urinary retention before proceeding to catheterization.

Question 23: In the management of uterine inversion, the nurse should anticipate which medication to be administered BEFORE manual replacement of the uterus?

Terbutaline or nitroglycerin for uterine relaxation (Correct answer)
Methylergonovine to control hemorrhage
Oxytocin to stimulate uterine contraction
Magnesium sulfate for neuroprotection

Correct answer: Terbutaline or nitroglycerin for uterine relaxation

Uterine relaxation with tocolytics (terbutaline, nitroglycerin) is required before manual replacement of the inverted uterus.

Question 24: A patient's blood pressure drops to 88/54 mmHg immediately after epidural analgesia is initiated. The priority nursing intervention is:

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

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 25: An obstetric nurse disagrees with a policy permitting elective cesarean delivery before 39 weeks without medical indication. The most professional course of action is to:

Comply and take no further action
Provide nursing care while formally advocating for evidence-based policy revision (Correct answer)
Discuss disagreements with patients to dissuade them from the procedure
Refuse to assist with any scheduled cesarean delivery

Correct answer: Provide nursing care while formally advocating for evidence-based policy revision

Nurses provide safe, non-judgmental care while using professional channels to advocate for policies aligned with evidence-based standards.

Question 26: A patient at 30 weeks gestation presents with painless vaginal bleeding following intercourse. Vital signs are stable. The MOST appropriate initial nursing action is:

Apply external fetal monitoring and prepare for amniocentesis
Perform a sterile speculum exam to assess the cervix
Withhold vaginal examination and notify the provider (Correct answer)
Administer betamethasone and prepare for delivery

Correct answer: Withhold vaginal examination and notify the provider

Painless vaginal bleeding after intercourse in late pregnancy is suspicious for placenta previa; digital vaginal exam is contraindicated until placenta previa is excluded.

Question 27: 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 28: During the newborn's first bath, the nurse should prioritize which action to prevent hypothermia?

Warm the room to at least 75°F (24°C), use warm water (38°C/100°F), and dry and wrap the infant immediately (Correct answer)
Submerge the newborn fully in a tub bath to maintain even heat distribution
Bathe the newborn within 30 minutes of birth to remove all blood and vernix
Use cool water to stimulate the newborn's thermoregulatory response

Correct answer: Warm the room to at least 75°F (24°C), use warm water (38°C/100°F), and dry and wrap the infant immediately

Newborns lose heat rapidly through evaporation; ensuring a warm environment, warm water, and immediate drying and swaddling are essential to prevent cold stress.

Question 29: Which fetal heart rate characteristic is defined as fluctuations in the baseline FHR that are irregular in amplitude and frequency, measured at 2 cycles per minute?

Variability (Correct answer)
Decelerations
Saltatory pattern
Accelerations

Correct answer: Variability

Baseline FHR variability refers to the irregular fluctuations above and below the baseline, reflecting the interplay between the sympathetic and parasympathetic nervous systems.

Question 30: A nurse is caring for a patient in transition labor (8–10 cm dilation). Which behavioral cue is MOST expected at this stage?

The patient is chatting between contractions and requests entertainment
The patient is calm and practicing breathing techniques effectively
The patient is requesting an epidural for the first time and is agitated
The patient reports a strong urge to push and is extremely irritable (Correct answer)

Correct answer: The patient reports a strong urge to push and is extremely irritable

During the transition phase, patients often experience an overwhelming urge to push, intense irritability, and difficulty coping between very close contractions.

Question 31: A patient at 36 weeks with poorly controlled gestational diabetes delivers a neonate who is jittery and hypotonic. Which complication is the nurse's immediate concern for the neonate?

Respiratory distress syndrome
Hyperbilirubinemia
Neonatal hypoglycemia (Correct answer)
Polycythemia

Correct answer: Neonatal hypoglycemia

Neonates of diabetic mothers are at high risk for hypoglycemia due to fetal hyperinsulinism responding to chronic maternal hyperglycemia.

Question 32: Which postpartum vital sign finding requires the most immediate nursing action?

Blood pressure 162/110 mmHg on day 2 postpartum (Correct answer)
Respiratory rate 18 breaths/min on day 1 postpartum
Heart rate 58 bpm on day 1 postpartum
Temperature 37.8°C on day 2 postpartum

Correct answer: Blood pressure 162/110 mmHg on day 2 postpartum

A blood pressure of 162/110 mmHg meets the threshold for severe hypertension and requires immediate intervention to prevent eclampsia or stroke.

Question 33: A patient develops a severe positional headache 12 hours after receiving a spinal block during labor. This presentation is most consistent with:

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

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 34: A gravida presents with uterine contractions every 2 minutes lasting 90 seconds each. The FHR shows late decelerations after each contraction. What condition does this uterine pattern suggest?

Uterine hyperstimulation (tachysystole) (Correct answer)
Normal active labor pattern
Precipitate labor
Uterine atony

Correct answer: Uterine hyperstimulation (tachysystole)

Tachysystole is defined as more than 5 contractions in 10 minutes averaged over 30 minutes, and prolonged contractions reduce placental perfusion, causing late decelerations.

Question 35: A postpartum patient on day 2 reports calf pain and swelling in her left leg. The nurse should FIRST:

Apply a warm compress and encourage ambulation
Massage the calf to relieve muscle tension
Reassure her that leg cramps are common postpartum
Elevate the leg and notify the provider immediately (Correct answer)

Correct answer: Elevate the leg and notify the provider immediately

Unilateral calf pain and swelling suggest deep vein thrombosis; massaging the leg is contraindicated as it may dislodge a clot.

Question 36: 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.
Anticipate the need for a tocolytic agent and notify the provider. (Correct answer)
Vigorously massage the protruding mass.

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 37: A competent postpartum patient declines recommended hepatitis B vaccination for her newborn citing religious beliefs. The nurse should:

Report the parents to child protective services immediately
Withhold discharge until the vaccine is accepted
Provide balanced education, document the informed refusal, and respect the decision (Correct answer)
Administer the vaccine anyway because it is standard of care

Correct answer: Provide balanced education, document the informed refusal, and respect the decision

While the nurse should educate, competent parents have the right to refuse non-emergent newborn treatments, and the refusal must be documented.

Question 38: 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:

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

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 39: Which nursing action is the priority when caring for a postpartum patient with suspected uterine subinvolution?

Assess for signs of retained placental fragments or infection (Correct answer)
Encourage early ambulation
Apply a cold compress to the fundus
Restrict oral intake to clear liquids

Correct answer: Assess for signs of retained placental fragments or infection

Uterine subinvolution is commonly caused by retained placental fragments or infection, and these causes must be assessed and addressed promptly.

Question 40: 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:

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

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 41: A postpartum nurse notes that a patient's fundus is displaced to the right of midline and is boggy. What is the most likely cause?

Bladder distention (Correct answer)
Postpartum endometritis
Retained placental fragments
Normal uterine involution

Correct answer: Bladder distention

A full bladder displaces the uterus to the right and inhibits uterine contraction, causing a boggy fundus; bladder emptying is the priority intervention.

Question 42: The nurse is monitoring a patient receiving oxytocin augmentation. Which FHR pattern requires the nurse to STOP the infusion immediately?

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

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 43: A patient with an epidural in place reports feeling pressure and an urge to push. Her last cervical exam 30 minutes ago was 7 cm. What is the nurse's BEST initial action?

Encourage her to begin pushing immediately
Perform a cervical examination to assess current dilation (Correct answer)
Call the provider to request an increase in epidural dosage
Tell her the urge is likely caused by the epidural and is normal

Correct answer: Perform a cervical examination to assess current dilation

An urge to push may signal rapid cervical change to complete dilation, and a repeat cervical exam is needed before allowing or discouraging pushing efforts.

Question 44: 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?

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.
Provide compassionate, non-judgmental care to the infant and initiate a referral to social work to provide the mother with resources. (Correct answer)
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 45: 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?

The presenting part moving down the birth canal.
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.

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

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

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 47: A patient asks about nitrous oxide (N2O) for labor pain. Which statement by the nurse is most accurate?

Nitrous oxide completely eliminates labor pain
It should not be used after 8 cm cervical dilation
It reduces pain perception and anxiety without eliminating sensation (Correct answer)
It causes significant respiratory depression in the newborn

Correct answer: It reduces pain perception and anxiety without eliminating sensation

Inhaled 50% nitrous oxide blunts pain perception and reduces anxiety through CNS effects but does not provide complete analgesia; it is rapidly exhaled and does not accumulate in the neonate.

Question 48: A prolonged deceleration is defined as a FHR decrease of at least 15 bpm below baseline lasting:

30 seconds to less than 2 minutes
10 minutes or longer
2 minutes or more but less than 10 minutes (Correct answer)
1 minute or more but less than 5 minutes

Correct answer: 2 minutes or more but less than 10 minutes

A prolonged deceleration lasts ≥2 minutes but <10 minutes; if it lasts ≥10 minutes, it represents a baseline change.

Question 49: Which newborn condition is best described as a collection of vernix, lanugo, and desquamated cells that may partially obstruct the colon?

Necrotizing enterocolitis
Meconium ileus
Meconium plug syndrome (Correct answer)
Hirschsprung disease

Correct answer: Meconium plug syndrome

Meconium plug syndrome involves a firm plug of concentrated meconium that delays passage and can often be relieved with a water-soluble contrast enema.

Question 50: What is the recommended total weight gain during pregnancy for a woman with a normal pre-pregnancy BMI (18.5–24.9)?

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

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 51: Which of the following actions is the nurse's responsibility when a Category III fetal heart rate tracing is identified?

Document the finding and wait for the next provider assessment
Continue current management and reassess in 30 minutes
Increase oxytocin to accelerate labor and hasten delivery
Initiate intrauterine resuscitation measures and notify the provider immediately for expedited delivery (Correct answer)

Correct answer: Initiate intrauterine resuscitation measures and notify the provider immediately for expedited delivery

Category III tracings require immediate provider notification, initiation of intrauterine resuscitation, and preparation for expedited delivery if the pattern does not resolve.

Question 52: 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?

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

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 53: 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?

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

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 54: Terbutaline is prescribed as a tocolytic. For which patient condition would this drug be most hazardous?

Gestational diabetes (Correct answer)
Iron deficiency anemia
Mild preeclampsia
Group B Strep colonization

Correct answer: Gestational diabetes

Terbutaline is a beta-2 agonist that causes hyperglycemia, making it particularly dangerous in patients with diabetes who require careful glucose management.

Question 55: 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 cervix is favorable and induction should proceed directly with oxytocin
The patient is in early latent labor and induction is unnecessary
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 56: A postpartum patient is concerned because her lochia changed from pink (serosa) back to red (rubra) after she returned home. She states she has been caring for a toddler and a newborn with minimal rest. What should the nurse advise?

Go to the ER immediately for possible hemorrhage
This change is permanent and she needs a uterine evaluation
Rest more, reduce activity, and monitor; return if soaking >1 pad/hour or passing clots (Correct answer)
Increase activity to promote uterine contractions

Correct answer: Rest more, reduce activity, and monitor; return if soaking >1 pad/hour or passing clots

Return of lochia to rubra with overexertion is a sign that the patient needs more rest; if bleeding remains light without clots, it usually resolves with decreased activity.

Question 57: 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.
Urine output of 15 mL/hr.
Sudden drop in blood pressure.

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 58: A primigravida is 42 weeks gestation and begins laboring. During monitoring, the nurse notes variable decelerations with slow return to baseline and loss of variability. These findings suggest:

Fetal sleep cycle
Umbilical cord compression with possible fetal acidosis (Correct answer)
Normal response to uterine contractions
Uteroplacental insufficiency

Correct answer: Umbilical cord compression with possible fetal acidosis

Variable decelerations with slow return to baseline and loss of variability are non-reassuring signs suggesting cord compression and evolving fetal acidosis.

Question 59: Using a fetoscope to listen to the fetal heartbeat if the fetus is in

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

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 60: 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
Preeclampsia
Chronic hypertension
Gestational hypertension (Correct answer)

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

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

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 62: A postpartum patient is prescribed low-molecular-weight heparin (enoxaparin) for DVT prophylaxis. Which lab value does NOT require routine monitoring with LMWH, unlike unfractionated heparin?

Anti-Xa level
Platelet count
CBC
aPTT (Correct answer)

Correct answer: aPTT

LMWH has a predictable pharmacokinetic profile and does not require routine aPTT monitoring, which is used to monitor unfractionated heparin therapy.

Question 63: 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
Thrombophlebitis
Urinary Tract Infection
Endometritis (Correct answer)

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

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

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 65: A patient 20 minutes postpartum has saturated four perineal pads and her fundus is firm at the umbilicus. The MOST likely cause of hemorrhage in this scenario is:

Coagulopathy
Lacerations of the birth canal (Correct answer)
Uterine atony
Retained placental fragments

Correct answer: Lacerations of the birth canal

A firm uterus rules out atony; continued bleeding with a contracted uterus points to lacerations as the source of hemorrhage.

Question 66: A patient at 26 weeks gestation presents with board-like uterine rigidity, constant severe abdominal pain, and dark vaginal bleeding. Fetal heart tones are absent. These findings are MOST consistent with:

Severe placental abruption with fetal demise (Correct answer)
Uterine rupture
Complete placenta previa
Vasa previa hemorrhage

Correct answer: Severe placental abruption with fetal demise

Severe placental abruption presents with painful, constant contractions, a rigid uterus, concealed or revealed bleeding, and can result in fetal demise.

Question 67: The nurse is evaluating a newborn for hypoglycemia. Which clinical manifestation warrants immediate glucose screening?

Acrocyanosis of hands and feet
Mongolian spots on the sacral area
Jitteriness and high-pitched cry (Correct answer)
Milia on the nose and cheeks

Correct answer: Jitteriness and high-pitched cry

Jitteriness, high-pitched cry, lethargy, and poor feeding are classic signs of neonatal hypoglycemia and require immediate point-of-care glucose testing.

Question 68: A nurse is administering Rh immune globulin (RhoGAM) to an Rh-negative postpartum patient. Within what timeframe must it be given to be effective?

Within 72 hours of delivery (Correct answer)
Within 48 hours of delivery
Within 24 hours of delivery
Within 96 hours of delivery

Correct answer: Within 72 hours of delivery

RhoGAM must be administered within 72 hours of delivery to prevent Rh sensitization by destroying fetal Rh-positive cells before the maternal immune system mounts a response.

Question 69: Which medication given in labor can cause neonatal respiratory depression and is best avoided within 4 hours of anticipated delivery?

Promethazine
Meperidine (Demerol) (Correct answer)
Fentanyl IV
Butorphanol (Stadol)

Correct answer: Meperidine (Demerol)

Meperidine has an active metabolite (normeperidine) that accumulates and causes prolonged neonatal respiratory depression; its peak neonatal effect occurs 2–4 hours after maternal administration.

Question 70: A patient in active labor asks the nurse not to document the presence of her doula in the medical record. The nurse should explain that:

The patient may remove the doula's name after discharge
The request will be honored to protect the patient's privacy
Accurate documentation of all persons present is required for legal and safety purposes (Correct answer)
Doulas are prohibited by hospital policy and will need to leave

Correct answer: Accurate documentation of all persons present is required for legal and safety purposes

Complete and accurate documentation is a legal and professional requirement that cannot be selectively omitted at patient request.

Question 71: 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?

Indeterminate
Category III (Correct answer)
Category II
Category I

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 72: A newborn's initial Apgar score is 5 at 1 minute. The nurse's priority action is to:

Provide tactile stimulation, position the airway, and administer supplemental oxygen if needed (Correct answer)
Administer epinephrine via the umbilical vein
Begin chest compressions immediately
Intubate the newborn and call the neonatal team

Correct answer: Provide tactile stimulation, position the airway, and administer supplemental oxygen if needed

An Apgar score of 4–6 indicates moderate depression; the nurse should initiate basic resuscitative steps (stimulation, airway positioning, supplemental oxygen) and reassess at 5 minutes.

Question 73: A laboring patient received IV fentanyl 50 mcg 20 minutes ago. Which assessment is the nurse's highest priority?

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

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

Edema and weight gain of more than 2 lbs/week
Only a single blood pressure reading ≥160/110 mmHg
Proteinuria OR severe features such as thrombocytopenia or renal insufficiency (Correct answer)
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 75: During a precipitous delivery, the nurse delivers the fetal head and notes the face is looking upward (occiput posterior). Before delivering the shoulders, the nurse should:

Allow the head to restitute naturally before assisting shoulder delivery (Correct answer)
Apply downward traction immediately to deliver the anterior shoulder
Call for emergency assistance before proceeding
Perform the Woods screw maneuver

Correct answer: Allow the head to restitute naturally before assisting shoulder delivery

Allowing natural restitution aligns the fetal shoulders with the pelvis before applying traction, reducing risk of shoulder dystocia.

Question 76: What is the CORRECT sequence of cardinal movements of labor for a vertex presentation?

Engagement, flexion, descent, extension, internal rotation, external rotation, expulsion
Flexion, engagement, descent, internal rotation, extension, external rotation, expulsion
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion (Correct answer)
Descent, engagement, internal rotation, flexion, extension, 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 77: Which action best reflects the obstetric nurse's role as a patient advocate during the informed consent process?

Witness the signature without assessing the patient's comprehension
Ensure the patient understands the information provided and has had questions answered (Correct answer)
Delegate advocacy entirely to the hospital social worker
Obtain the signed consent form before the physician explains the procedure

Correct answer: Ensure the patient understands the information provided and has had questions answered

Advocacy requires verifying the patient genuinely understands risks, benefits, and alternatives before signing.

Question 78: A multiparous patient delivers and then develops massive hemorrhage. The uterus is boggy despite fundal massage. After oxytocin fails, which uterotonic agent is contraindicated if the patient has hypertension?

Tranexamic acid
Methylergonovine (Methergine) (Correct answer)
Misoprostol
Carboprost (Hemabate)

Correct answer: Methylergonovine (Methergine)

Methylergonovine causes vasoconstriction and is contraindicated in hypertension as it can dangerously elevate blood pressure.

Question 79: Which action is CONTRAINDICATED during management of a prolapsed umbilical cord before delivery?

Attempting to push the cord back into the uterus (Correct answer)
Covering the cord with a warm saline-moistened gauze if it is outside the vagina
Elevating the presenting part manually
Placing the patient in knee-chest or Trendelenburg position

Correct answer: Attempting to push the cord back into the uterus

Attempting to reinsert the cord can cause vasospasm and further compromise fetal blood flow; cord decompression is managed by elevating the presenting part.

Question 80: What is the typical fetal breathing movement (FBM) when being evaluated for the biophysical profile?

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

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 81: When performing a vaginal exam and the nurse detects a pulsating cord at the cervix, what is the immediate priority action?

Elevate the presenting part manually and call for help (Correct answer)
Apply fundal pressure to expedite delivery
Place the patient in the lithotomy position
Withdraw the hand and call for a stat cesarean

Correct answer: Elevate the presenting part manually and call for help

Umbilical cord prolapse requires the nurse to manually elevate the fetal presenting part to relieve cord compression while emergency cesarean delivery is arranged.

Question 82: A nurse observes the umbilical cord prolapsing into the vagina after rupture of membranes. After calling for help, what is the IMMEDIATE priority intervention?

Apply warm saline-soaked gauze to the cord and document the finding
Reinsert the cord into the uterus
Place the patient in Trendelenburg or knee-chest position and manually elevate the presenting part (Correct answer)
Prepare for immediate vaginal delivery

Correct answer: Place the patient in Trendelenburg or knee-chest position and manually elevate the presenting part

Placing the patient in Trendelenburg or knee-chest and manually elevating the presenting part relieves cord compression to maintain fetal oxygenation until emergency cesarean delivery.

Question 83: 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 84: What action is necessary if the biophysical profile indicates a score of 8 and a normal volume of amniotic fluid?

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

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 85: 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?

Caput succedaneum (Correct answer)
Molding
Subgaleal hemorrhage
Cephalohematoma

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 86: When should oxytocin be discontinued or decreased in response to an abnormal FHR tracing?

When Category III features are present or tachysystole occurs with FHR changes (Correct answer)
After amnioinfusion has been attempted
Only if the patient requests it
Only during the transition phase of labor

Correct answer: When Category III features are present or tachysystole occurs with FHR changes

Oxytocin should be reduced or discontinued when tachysystole with associated FHR changes or Category III patterns occur to reduce uterine activity and improve fetal oxygenation.

Question 87: The nurse observes a FHR pattern where decelerations abruptly drop ≥15 bpm and vary in onset, depth, and duration with each contraction. This pattern is BEST described as:

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

Correct answer: Variable decelerations

Variable decelerations are characterized by an abrupt onset (reaching nadir in <30 seconds), variable timing relative to contractions, and variable depth and duration.

Question 88: Betamethasone is administered to a pregnant patient at 28 weeks gestation. What is the primary purpose of this medication?

Prevent preterm labor contractions
Lower maternal blood pressure
Accelerate fetal lung maturity (Correct answer)
Reduce maternal infection risk

Correct answer: Accelerate fetal lung maturity

Betamethasone stimulates fetal surfactant production to reduce the risk of neonatal respiratory distress syndrome.

Question 89: Cell-free DNA (cfDNA) screening is most sensitive and specific for detecting which chromosomal condition?

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

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

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

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

Insulin detemir (Levemir) only
Insulin lispro (Humalog) only
NPH and regular human insulin (Correct answer)
Insulin glargine (Lantus) 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 92: A nurse is teaching a patient about taking iron supplements prescribed during pregnancy. Which instruction is most important for maximizing absorption?

Take immediately after a full meal
Take with vitamin C such as orange juice (Correct answer)
Take with a calcium supplement for synergy
Take with a glass of milk to protect the stomach

Correct answer: Take with vitamin C such as orange juice

Vitamin C (ascorbic acid) converts ferric iron to the ferrous form, significantly enhancing non-heme iron absorption in the gastrointestinal tract.

Question 93: A postpartum client experiencing a massive hemorrhage develops disseminated intravascular coagulation (DIC). Which of the following laboratory findings would the nurse anticipate?

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

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 94: A postpartum patient with a third-degree perineal laceration asks the nurse about diet. Which recommendation is most appropriate?

Restrict fiber to prevent loose stools
Increase fiber and fluid intake to promote soft stools (Correct answer)
Avoid all dairy products
Follow a liquid diet for the first week

Correct answer: Increase fiber and fluid intake to promote soft stools

High fiber and fluid intake promotes soft, easy-to-pass stools, reducing strain on the repaired perineal laceration.

Question 95: Frequently, an excessively long umbilical cord leads to

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

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

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 97: What is the recommended timing for administering Rh immune globulin (RhoGAM) to an Rh-negative mother after delivery of an Rh-positive infant?

Within 1 week of delivery
Within 30 days of delivery
Within 72 hours of delivery (Correct answer)
Within 24 hours of delivery

Correct answer: Within 72 hours of delivery

Rh immune globulin must be administered within 72 hours of delivery to prevent Rh sensitization in Rh-negative mothers.

Question 98: At what gestational age is the glucose challenge test (GCT) for gestational diabetes screening typically performed?

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

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 99: 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?

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

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

"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."
"If my breast gets sore, applying cold packs before feeding will be most helpful."
"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 101: 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)
External monitoring is adequate and contractions appear strong
The patient has a history of cesarean delivery and VBAC is planned
The patient declines internal monitoring due to discomfort

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

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

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 103: The nurse performs a Dix-Hallpike-equivalent neurologic screen by holding a newborn in ventral suspension. In a term newborn, the expected response is:

No response; this reflex is absent until 3 months of age
The head aligns momentarily with the plane of the body (Landau reflex) (Correct answer)
Immediate opisthotonus with back arching
The head drops completely below the body with arms flailing

Correct answer: The head aligns momentarily with the plane of the body (Landau reflex)

In ventral suspension, a term newborn should briefly hold the head in line with the body, demonstrating the early Landau response and adequate truncal tone.

Question 104: The principle of beneficence in obstetric nursing is best exemplified by:

Administering pain medication without patient request to prevent discomfort
Limiting patient education to avoid anxiety
Proactively educating patients about their rights and options to promote well-being (Correct answer)
Performing routine procedures to meet hospital efficiency targets

Correct answer: Proactively educating patients about their rights and options to promote well-being

Beneficence means actively promoting patient welfare, and empowering patients with knowledge supports informed, positive outcomes.

Question 105: A nurse's personal moral objection to a legal obstetric procedure may be accommodated by the employer primarily through:

Requiring the nurse to resign if unwilling to participate
Allowing the nurse to educate patients against the procedure
Conscientious objection policies that reassign the nurse while ensuring uninterrupted patient care (Correct answer)
Eliminating the procedure from the unit's service offerings

Correct answer: Conscientious objection policies that reassign the nurse while ensuring uninterrupted patient care

Conscientious objection accommodations allow nurses to decline participation while the institution ensures patients still receive care without disruption.

Question 106: A patient develops an eclamptic seizure. After ensuring airway patency, the nurse's next priority is to:

Insert a tongue blade to prevent biting
Restrain the patient's extremities to prevent injury
Perform an emergency vaginal examination
Administer magnesium sulfate and position the patient on her left side (Correct answer)

Correct answer: Administer magnesium sulfate and position the patient on her left side

Magnesium sulfate is the drug of choice to stop eclamptic seizures, and left lateral positioning reduces aortocaval compression.

Question 107: A nurse is monitoring a patient receiving magnesium sulfate for eclampsia prophylaxis. Which finding warrants IMMEDIATE intervention and withholding the next dose?

Respiratory rate of 10 breaths per minute (Correct answer)
Serum magnesium level of 6 mg/dL
Urinary output of 35 mL/hour
Loss of deep tendon reflexes

Correct answer: Respiratory rate of 10 breaths per minute

Respiratory depression (RR <12) is a sign of magnesium toxicity and is an immediate life threat requiring the infusion to be stopped.

Question 108: A patient with preterm labor at 30 weeks is receiving magnesium sulfate tocolysis. Which finding requires the nurse to withhold the next dose?

Serum magnesium level of 5 mEq/L
Deep tendon reflexes 2+
Respiratory rate of 10 breaths/min (Correct answer)
Urine output of 35 mL/hr

Correct answer: Respiratory rate of 10 breaths/min

A respiratory rate below 12 breaths/min indicates magnesium toxicity and the infusion must be stopped immediately.

Question 109: Which of the following findings on an EFM tracing is associated with fetal metabolic acidemia and requires immediate intervention?

Absent variability with recurrent late decelerations (Correct answer)
Minimal variability with early decelerations
Marked variability without decelerations
Moderate variability with accelerations

Correct answer: Absent variability with recurrent late decelerations

Absent variability combined with recurrent late decelerations is a Category III pattern strongly predictive of fetal metabolic acidemia, requiring immediate delivery.

Question 110: Which medication is administered prophylactically to a newborn shortly after birth to prevent ophthalmia neonatorum?

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

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

Vitamin C
Vitamin D
Folic acid (Correct answer)
Iron

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 112: A patient with an epidural reports a "hot spot" — an area of persistent pain despite the epidural running. The nurse's first action is:

Discontinue the epidural and switch to IV opioids
Reposition the patient and notify the anesthesia provider (Correct answer)
Independently increase the epidural infusion rate
Administer IV ketorolac for the breakthrough pain

Correct answer: Reposition the patient and notify the anesthesia provider

Repositioning may redistribute epidural solution to cover the unblocked area; the anesthesia provider should then be notified to assess catheter placement and adjust the regimen.

Question 113: 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?

Acrocyanosis
Erythema toxicum
Pathologic jaundice (Correct answer)
Physiologic jaundice

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 114: A patient's lochia has a strong, fishy odor on postpartum day 4. The MOST appropriate nursing action is:

Advise increased fluid intake and recheck in 24 hours without provider notification
Instruct her to use a vaginal deodorant spray to mask the odor
Reassure her that all lochia normally has a fishy odor
Document the finding and notify the provider, as malodorous lochia may indicate uterine infection (Correct answer)

Correct answer: Document the finding and notify the provider, as malodorous lochia may indicate uterine infection

Normal lochia has a fleshy, menstrual-like odor; a fishy or foul odor is abnormal and may signal endometritis or other infection requiring evaluation.

Question 115: 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)
Reposition the patient to her left side.
Administer an IV fluid bolus.
Notify the healthcare provider immediately.

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 116: During the third stage of labor, the nurse observes a sudden gush of blood, cord lengthening, and the uterus rising in the abdomen. This indicates:

Vasa previa rupture
Umbilical cord prolapse
Uterine inversion
Placental separation (Correct answer)

Correct answer: Placental separation

These are the classic signs of placental separation: gush of blood, cord lengthening, and uterine fundus rising and becoming globular.

Question 117: A nurse is assessing a postpartum patient who had a cesarean delivery and notes the incision has red, warm edges with seropurulent drainage and the patient has a fever. This MOST likely indicates:

Wound infection requiring provider notification and possible opening/debridement (Correct answer)
Keloid formation in the early stages
Allergic reaction to suture material
Normal inflammatory healing response

Correct answer: Wound infection requiring provider notification and possible opening/debridement

Erythema, warmth, purulent drainage, and fever at a surgical site are classic signs of wound infection requiring medical management.

Question 118: 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
Fetal sleep cycle
Umbilical cord compression
Maternal fever (Correct answer)

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 119: 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?

Active phase arrest (Correct answer)
Second stage failure
Latent phase prolongation
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 120: A nurse is assessing a patient with epidural analgesia who develops sudden maternal hypotension. What is the EXPECTED effect on the fetal heart rate?

Fetal bradycardia or late decelerations due to decreased uteroplacental perfusion (Correct answer)
Increased fetal variability due to sympathetic stimulation
Fetal tachycardia due to increased catecholamines
No change because epidural does not cross the placenta

Correct answer: Fetal bradycardia or late decelerations due to decreased uteroplacental perfusion

Maternal hypotension after epidural reduces uteroplacental blood flow, resulting in fetal bradycardia or late decelerations as placental gas exchange is impaired.

Question 121: Which intervention is MOST effective in preventing postpartum venous thromboembolism in a high-risk cesarean delivery patient?

Strict bed rest for the first 48 hours to reduce strain
Compression stockings alone without pharmacologic prophylaxis
High-dose aspirin initiated immediately after surgery
Early ambulation combined with sequential compression devices and prophylactic low-molecular-weight heparin (Correct answer)

Correct answer: Early ambulation combined with sequential compression devices and prophylactic low-molecular-weight heparin

Multimodal VTE prophylaxis using early ambulation, mechanical compression, and LMWH is the evidence-based standard for high-risk postoperative obstetric patients.

Question 122: The nurse is performing a CRIES pain assessment on a postoperative neonate. Which parameter is NOT included in this tool?

Expression (facial grimace)
Gestational age (Correct answer)
Crying
Oxygen requirement

Correct answer: Gestational age

The CRIES scale assesses Crying, Requires O2, Increased vital signs, Expression, and Sleeplessness—gestational age is not one of its parameters.

Question 123: Which of the following interventions is used to assess fetal response and rule out acidosis when the FHR tracing shows absent accelerations?

Amnioinfusion
Fetal scalp blood sampling or vibroacoustic stimulation (Correct answer)
Immediate cesarean section
Maternal oxygen saturation monitoring

Correct answer: Fetal scalp blood sampling or vibroacoustic stimulation

Vibroacoustic stimulation (VAS) or fetal scalp stimulation can elicit an acceleration, indicating the fetus is not acidotic and that the absent accelerations are likely due to a sleep state.

Question 124: Which intervention is the FIRST priority when variable decelerations are identified on the fetal monitor?

Change maternal position to relieve cord compression (Correct answer)
Perform amnioinfusion
Prepare for immediate cesarean delivery
Administer oxygen at 10 L/min via non-rebreather mask

Correct answer: Change maternal position to relieve cord compression

Position change (lateral, Trendelenburg, or knee-chest) is the first intrauterine resuscitation step to relieve suspected umbilical cord compression causing variable decelerations.

Question 125: Which maternal serum marker is ELEVATED in open neural tube defects on the second-trimester quad screen?

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

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 126: 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?

9
10
8 (Correct answer)
7

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 127: A patient with a penicillin allergy requires GBS prophylaxis in labor. Which antibiotic is the recommended first alternative?

Cefazolin (Correct answer)
Clindamycin
Ampicillin
Vancomycin

Correct answer: Cefazolin

Cefazolin is the recommended first-line alternative for GBS prophylaxis in penicillin-allergic patients without high-risk allergy features because cross-reactivity is very low.

Question 128: 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 129: Weekly 17-alpha hydroxyprogesterone caproate (17-OHPC) injections are indicated to reduce preterm birth risk in which patient population?

All women after 28 weeks regardless of risk factors
Women with a short cervix only, regardless of obstetric history
All women with multiple gestations
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 130: Which method of analgesia provides the most complete pain relief during active labor?

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

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 131: A patient 72 hours postpartum reports visual disturbances (blurred vision, scotoma) and epigastric pain. Her BP is 162/110 mmHg. The nurse's PRIORITY action is:

Activate the rapid response team and prepare to administer antihypertensive medication per protocol (Correct answer)
Administer a PRN analgesic for epigastric pain and recheck BP in 1 hour
Encourage the patient to lie in a dark, quiet room and recheck in 30 minutes
Draw labs and wait for results before escalating

Correct answer: Activate the rapid response team and prepare to administer antihypertensive medication per protocol

Visual disturbances, epigastric pain, and BP ≥160/110 indicate severe postpartum preeclampsia or impending eclampsia — this is an emergency requiring immediate intervention.

Question 132: 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?

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

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 133: A nurse notices the FHR tracing has a baseline of 130 bpm with variability that appears to be 3–4 bpm. How is this variability classified?

Moderate variability
Minimal variability (Correct answer)
Absent variability
Marked variability

Correct answer: Minimal variability

Minimal variability is defined as amplitude range greater than undetectable but ≤5 bpm, which includes a 3–4 bpm range.

Question 134: 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)
Bladder distention
Perineal laceration infection

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 135: A laboring patient at 39 weeks reports sudden, severe, constant abdominal pain with a rigid, board-like abdomen. The FHR tracing shows late decelerations. What is the priority nursing action?

Administer IV morphine for pain relief
Increase the IV fluid rate and reposition the patient
Notify the provider immediately for suspected placental abruption (Correct answer)
Prepare for amniotomy to accelerate labor

Correct answer: Notify the provider immediately for suspected placental abruption

Sudden constant pain with a rigid abdomen and late decelerations suggests placental abruption, requiring immediate provider notification for emergent intervention.

Question 136: 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 soft marker that may be associated with trisomy 21, cystic fibrosis, or IUGR (Correct answer)
Diagnostic for Down syndrome
A normal variant with no follow-up needed

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.

Question 137: A patient is admitted at 26 weeks with preterm labor and is started on nifedipine. Which side effect requires immediate nursing assessment?

Urinary retention
Maternal hypotension and tachycardia (Correct answer)
Decreased fetal movement
Hyperglycemia

Correct answer: Maternal hypotension and tachycardia

Nifedipine, a calcium channel blocker used as a tocolytic, can cause significant maternal hypotension and reflex tachycardia.

Question 138: A breastfeeding patient on day 4 postpartum develops a firm, painful, erythematous area on one breast but is afebrile and otherwise well. This presentation MOST suggests:

Inflammatory breast cancer requiring biopsy
Plugged milk duct, managed with warm compresses and frequent feeding (Correct answer)
Breast abscess requiring incision and drainage
Bilateral engorgement treated by stopping breastfeeding

Correct answer: Plugged milk duct, managed with warm compresses and frequent feeding

A localized, tender lump without systemic symptoms in a breastfeeding patient on day 4 is most consistent with a plugged duct, which resolves with heat, massage, and frequent emptying.

Question 139: Supporting a patient's desire to get an opioid and an epidural throughout labor is an illustration of the moral rule of

Beneficence
Justice
Autonomy (Correct answer)
None of the above

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 140: Which route of administration is recommended for misoprostol when used to treat postpartum hemorrhage if the patient is actively vomiting?

Rectal (Correct answer)
Oral
Sublingual
Intranasal

Correct answer: Rectal

Rectal administration of misoprostol bypasses the gastrointestinal tract and is effective when oral or sublingual routes are not feasible due to vomiting.

Question 141: A fetal heart rate tracing shows a sinusoidal pattern persisting for 20 minutes. What is the most likely cause?

Fetal sleep cycle
Fetal hiccups
Severe fetal anemia or hypoxia (Correct answer)
Maternal narcotic administration

Correct answer: Severe fetal anemia or hypoxia

A true sinusoidal pattern lasting ≥20 minutes is associated with severe fetal anemia (e.g., Rh isoimmunization) or hypoxia and requires immediate evaluation.

Question 142: Which food should pregnant women avoid to reduce the risk of listeriosis?

Pasteurized milk
Cooked chicken
Deli meats and hot dogs (Correct answer)
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 143: 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?

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

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 144: A postpartum patient who delivered 48 hours ago has a temperature of 38.1°C taken once. What is the nurse's BEST initial action?

Obtain blood cultures and transfer to ICU
Document as normal and continue routine monitoring
Start broad-spectrum antibiotics immediately
Encourage fluids, reassess in 4 hours, and notify provider if fever persists or rises (Correct answer)

Correct answer: Encourage fluids, reassess in 4 hours, and notify provider if fever persists or rises

A single low-grade fever within the first 24 hours after delivery is common; persistent or higher fever warrants investigation for infection.

Question 145: A postpartum patient who delivered via cesarean section reports sharp, shooting chest pain and shortness of breath on day 3. What is the nurse's priority concern?

Anxiety related to postpartum adjustment
Pulmonary embolism (Correct answer)
Pleurisy from surgical inflammation
Intercostal muscle strain from coughing

Correct answer: Pulmonary embolism

Chest pain and dyspnea in the early postpartum period, especially post-cesarean, raise high concern for pulmonary embolism due to increased clotting risk.

Question 146: A postpartum patient asks when she can resume sexual intercourse. What is the standard nursing guidance?

After sutures from any perineal laceration are removed
When lochia has completely stopped, usually by week 2
Typically after the 6-week postpartum visit and provider clearance (Correct answer)
After her first postpartum menstrual period

Correct answer: Typically after the 6-week postpartum visit and provider clearance

Sexual intercourse is generally recommended to resume after the 6-week postpartum checkup and provider approval to ensure adequate healing.

Question 147: The nurse is caring for a newborn under phototherapy for hyperbilirubinemia. Which assessment finding requires the nurse to pause therapy and notify the provider?

Macular rash under the phototherapy lamp
Temperature of 38.5°C (101.3°F) and decreased urine output (Correct answer)
Bilirubin level decreasing by 1–2 mg/dL per hour
Loose green stools and slight skin bronzing

Correct answer: Temperature of 38.5°C (101.3°F) and decreased urine output

Hyperthermia and decreased urine output during phototherapy indicate dehydration, which worsens hyperbilirubinemia and requires prompt provider notification and fluid management.

Question 148: Which finding during postpartum assessment of a patient's extremities warrants immediate notification of the provider?

Unilateral calf redness, warmth, and tenderness (Correct answer)
Trace pedal pitting edema
Varicose veins noted on both legs
Mild bilateral ankle edema

Correct answer: Unilateral calf redness, warmth, and tenderness

Unilateral calf redness, warmth, and tenderness are classic signs of deep vein thrombosis, a serious postpartum complication requiring immediate evaluation.

Question 149: A nurse assesses a postpartum patient who had a vaginal delivery and notes the lochia has changed from rubra to serosa on day 2. What should the nurse do?

Document as a normal finding (Correct answer)
Notify the provider of abnormal progression
Encourage increased fluid intake
Assess for signs of infection

Correct answer: Document as a normal finding

Lochia transitioning from rubra to serosa within the first few days is a normal postpartum finding and should be documented as such.

Question 150: 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 151: A patient's FHR tracing shows accelerations with fetal movement. According to ACOG, an acceleration in a fetus ≥32 weeks gestation is defined as a peak increase of at least:

10 bpm above baseline lasting ≥30 seconds
15 bpm above baseline lasting ≥15 seconds (Correct answer)
20 bpm above baseline lasting ≥20 seconds
10 bpm above baseline lasting ≥10 seconds

Correct answer: 15 bpm above baseline lasting ≥15 seconds

In fetuses ≥32 weeks, a qualifying acceleration must reach a peak ≥15 bpm above the baseline and last ≥15 seconds but <2 minutes.

Question 152: 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)
Mild pedal edema
Blood pressure of 150/95 mmHg on two occasions 4 hours apart
Proteinuria of 300mg in a 24-hour urine collection

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

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

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 154: The Edinburgh Postnatal Depression Scale (EPDS) is used to screen for postpartum depression. A score of 13 or above indicates what?

Normal postpartum adjustment
Mild baby blues, no intervention needed
Confirmed diagnosis of postpartum psychosis
Possible postpartum depression requiring further evaluation (Correct answer)

Correct answer: Possible postpartum depression requiring further evaluation

An EPDS score of 13 or above suggests probable postpartum depression and warrants further clinical evaluation and intervention.

Question 155: A patient at 34 weeks is admitted with preterm labor. Which medication is used to accelerate fetal lung maturity?

Indomethacin
Nifedipine
Betamethasone (Correct answer)
Magnesium sulfate

Correct answer: Betamethasone

Betamethasone (a corticosteroid) is administered to the mother between 24-34 weeks to stimulate fetal surfactant production and reduce respiratory distress syndrome.

Question 156: A patient at 38 weeks gestation is receiving oxytocin augmentation. The FHR shows moderate variability, no accelerations, and occasional mild variable decelerations. What category is this tracing?

Category II (Correct answer)
Unclassifiable — requires consultation
Category I
Category III

Correct answer: Category II

Any tracing that does not meet Category I or Category III criteria is Category II; recurrent variable decelerations with moderate variability is Category II.

Question 157: 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?

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

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

Pudendal block
Epidural (Correct answer)
Spinal
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 159: Which class of medication is contraindicated in all trimesters of pregnancy due to risk of fetal renal dysgenesis and oligohydramnios?

Calcium channel blockers
ACE inhibitors (Correct answer)
Thiazide diuretics
Beta blockers

Correct answer: ACE inhibitors

ACE inhibitors are absolutely contraindicated in pregnancy because they impair fetal renal perfusion, leading to renal dysgenesis, oligohydramnios, and fetal/neonatal death.

Question 160: A postpartum patient with retained placental fragments would MOST likely present with which combination of findings?

Subinvoluted boggy uterus, persistent heavy bleeding, and low-grade fever (Correct answer)
Firm uterus with foul-smelling lochia and severe pelvic pain
Firm uterus, scant lochia, and normal temperature
Involuted uterus with lochia alba on day 5

Correct answer: Subinvoluted boggy uterus, persistent heavy bleeding, and low-grade fever

Retained placental fragments prevent uterine involution, causing a boggy subinvoluted uterus, ongoing hemorrhage, and potential secondary infection.

Question 161: 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?

Indomethacin (Correct answer)
Magnesium Sulfate
Terbutaline
Nifedipine

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 162: A nurse calculates that the fetal heart rate has been 95 bpm for the past 12 minutes. This should be classified as:

Bradycardia — a new baseline below 110 bpm (Correct answer)
Minimal variability artifact from external monitoring
Prolonged deceleration because it is lasting under 15 minutes
Normal fetal response to head compression

Correct answer: Bradycardia — a new baseline below 110 bpm

A baseline FHR below 110 bpm lasting ≥10 minutes constitutes bradycardia; at 12 minutes, the 95 bpm rate is now the baseline and represents bradycardia.

Question 163: A pregnant woman at 10 weeks presents with severe nausea, vomiting, and a uterus larger than expected for dates. Beta-hCG is extremely elevated. Which diagnosis should the nurse suspect?

Normal pregnancy variation
Twin gestation
Ectopic pregnancy
Hydatidiform mole (Correct answer)

Correct answer: Hydatidiform mole

Hydatidiform mole presents with markedly elevated beta-hCG, uterus large for dates, and hyperemesis gravidarum due to abnormal trophoblastic proliferation.

Question 164: A postpartum patient is being assessed using the 'BUBBLE-HE' framework. What does the second 'B' represent?

Blood pressure
Bleeding
Bladder
Bowel (Correct answer)

Correct answer: Bowel

In the BUBBLE-HE mnemonic (Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/laceration, Homan's sign/Homans, Emotions), the second B stands for Bowel.

Question 165: 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?

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

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 166: Which medication is used to reverse the effects of opioid-induced neonatal respiratory depression at delivery?

Naloxone (Correct answer)
Epinephrine
Flumazenil
Atropine

Correct answer: Naloxone

Naloxone (Narcan) is an opioid antagonist that rapidly reverses neonatal respiratory depression caused by transplacental opioid transfer.

Question 167: A postpartum patient with preeclampsia is receiving IV magnesium sulfate. Which assessment finding requires the nurse to HOLD the infusion and call the provider?

Respiratory rate of 10 breaths/min (Correct answer)
Urine output of 35 mL/hr
Deep tendon reflexes 2+
Mild flushing and warmth

Correct answer: Respiratory rate of 10 breaths/min

Respiratory depression (RR <12) indicates magnesium toxicity and requires holding the infusion; calcium gluconate should be at bedside.

Question 168: A gravida 3 para 2 delivers a 4,200g infant vaginally. After delivery of the placenta, the uterus appears to have turned inside out and is visible at the vaginal introitus. The nurse's IMMEDIATE priority is:

Administer oxytocin to contract the uterus around the inverted portion
Apply fundal pressure to expel the inverted uterus
Call for emergency assistance and do not remove the placenta if still attached (Correct answer)
Immediately attempt manual replacement of the uterus

Correct answer: Call for emergency assistance and do not remove the placenta if still attached

Calling for help and leaving the placenta attached prevents further hemorrhage; aggressive manual replacement before team assembly increases risk of hemorrhagic shock.

Question 169: A newborn is noted to have a cephalohematoma. Which of the following accurately describes this finding?

A benign fluid-filled cyst at the base of the skull requiring drainage
Diffuse edematous swelling of the scalp that crosses suture lines and resolves within days
Hemorrhage within the subdural space requiring neurosurgical consultation
Blood accumulation below the periosteum, confined to one cranial bone, does not cross suture lines (Correct answer)

Correct answer: Blood accumulation below the periosteum, confined to one cranial bone, does not cross suture lines

A cephalohematoma is subperiosteal bleeding confined by periosteal attachments at suture lines, causing a unilateral, well-demarcated swelling that resolves over weeks.

Question 170: When assessing a postpartum patient's REEDA score, what does the 'R' stand for?

Rupture
Rash
Redness (Correct answer)
Rigidity

Correct answer: Redness

REEDA is an acronym for Redness, Edema, Ecchymosis, Discharge, and Approximation used to assess perineal wound healing.

Question 171: The nurse notes that a newborn has not passed meconium within 48 hours of birth. This finding should prompt evaluation for:

Overfeeding causing intestinal slowdown
Hirschsprung disease or cystic fibrosis (Correct answer)
Normal variation; meconium can be delayed up to 72 hours
Hypothyroidism exclusively

Correct answer: Hirschsprung disease or cystic fibrosis

Failure to pass meconium within 24–48 hours warrants evaluation for conditions such as Hirschsprung disease, meconium ileus (cystic fibrosis), or imperforate anus.

Question 172: Which condition is a contraindication to epidural analgesia during labor?

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

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 173: A neonate is typically not considered viable until after

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

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 174: The only definitive treatment to cure preeclampsia is:

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

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

Respiratory rate of 20 breaths per minute during a contraction
Heart rate of 95 bpm after ambulation
Blood pressure of 158/105 mmHg on two readings 15 minutes apart (Correct answer)
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 176: What treatment is recommended for a pregnant Graves' disease patient?

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

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.

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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