RNC-OB Inpatient obstetric nursing
certification validating expertise in
maternal care, labor management, and
childbirth practices.
Question 1
A 34-week gestation patient presents with vaginal bleeding, uterine contractions,
and a history of two prior cesarean deliveries. The APRN should suspect which of
the following conditions?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Vasa previa
Answer: C. Uterine rupture
Rationale: Uterine rupture is a life-threatening emergency characterized by
vaginal bleeding, uterine contractions, and a history of prior cesarean delivery.
Risk factors include prior uterine surgery, including cesarean section, and uterine
overdistention. Placenta previa typically presents with painless bleeding. Placental
abruption presents with painful bleeding and a rigid abdomen. Vasa previa presents
with bleeding after membrane rupture. Patients with a prior cesarean delivery
attempting a trial of labor after cesarean (TOLAC) require close monitoring for
signs of uterine rupture, including sudden fetal heart rate decelerations, cessation
of contractions, and maternal hypotension.
Question 2
A 28-year-old patient at 32 weeks gestation presents with a blood pressure of
160/100 mmHg and 3+ proteinuria. She reports a headache and visual changes.
The APRN should recognize this as:
,A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia with severe features
D. Eclampsia
Answer: C. Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when a patient with
gestational hypertension or preeclampsia develops severe hypertension (systolic
≥160 mmHg or diastolic ≥110 mmHg) and/or signs of end-organ damage,
including headache, visual disturbances, or proteinuria. This patient meets the
criteria for preeclampsia with severe features due to her blood pressure and
neurological symptoms. Eclampsia is diagnosed when seizures occur. Gestational
hypertension is hypertension without proteinuria. Chronic hypertension is present
before pregnancy or before 20 weeks gestation.
Question 3
A patient at 36 weeks gestation with preeclampsia is receiving magnesium sulfate
for seizure prophylaxis. Which of the following assessment findings indicates
magnesium toxicity?
A. Respiratory rate of 14 breaths/min
B. Urine output of 40 mL/hour
C. Loss of deep tendon reflexes
D. Serum magnesium level of 5 mEq/L
Answer: C. Loss of deep tendon reflexes
Rationale: Loss of deep tendon reflexes (DTRs) is an early sign of magnesium
toxicity, typically occurring at serum magnesium levels of 7-10 mEq/L. Other
signs include respiratory depression (rate <12 breaths/min) and oliguria (<30
mL/hour). A respiratory rate of 14 breaths/min is within normal limits. Urine
output of 40 mL/hour is adequate. A serum magnesium level of 5 mEq/L is within
the therapeutic range (4-7 mEq/L). The antidote for magnesium toxicity is calcium
gluconate.
Question 4
A patient with gestational diabetes is being educated about dietary management.
,The APRN should instruct the patient that the PRIMARY goal of dietary
management is to:
A. Maintain normal maternal weight
B. Prevent fetal macrosomia and maintain euglycemia
C. Eliminate all carbohydrates from the diet
D. Promote maternal weight loss
Answer: B. Prevent fetal macrosomia and maintain euglycemia
Rationale: The primary goal of dietary management in gestational diabetes is to
maintain maternal euglycemia and prevent fetal macrosomia. This is achieved
through carbohydrate-controlled meals distributed throughout the day.
Carbohydrates should not be eliminated entirely, as they are essential for fetal
development. Maternal weight loss is not recommended during pregnancy. Weight
management is important but secondary to glycemic control.
Question 5
A patient at 28 weeks gestation with a history of preterm birth is being evaluated
for cervical insufficiency. Which of the following findings is MOST consistent
with this diagnosis?
A. Cervical dilation of 2 cm with a funneled cervix on ultrasound
B. Cervical length of 4.5 cm on transvaginal ultrasound
C. Regular uterine contractions every 5 minutes
D. Positive fetal fibronectin test
Answer: A. Cervical dilation of 2 cm with a funneled cervix on ultrasound
Rationale: Cervical insufficiency is characterized by painless cervical dilation in
the second trimester, often with a funneled cervix on ultrasound. A cervical length
of <2.5 cm on transvaginal ultrasound is associated with increased risk of preterm
birth. Regular contractions suggest preterm labor rather than cervical insufficiency.
Fetal fibronectin testing can help predict preterm birth but is not diagnostic of
cervical insufficiency.
Question 6
A patient at 38 weeks gestation with premature rupture of membranes (PROM)
, develops a fever of 101.5°F (38.6°C), tachycardia, and uterine tenderness. The
APRN should suspect which of the following?
A. Chorioamnionitis
B. Urinary tract infection
C. Influenza
D. Appendicitis
Answer: A. Chorioamnionitis
Rationale: Chorioamnionitis is an intra-amniotic infection characterized by
maternal fever (>100.4°F or 38°C), maternal tachycardia, fetal tachycardia, uterine
tenderness, and foul-smelling amniotic fluid. It is a complication of prolonged
rupture of membranes. The diagnosis requires at least two of these criteria. UTI,
influenza, and appendicitis are in the differential but are less likely given the
combination of symptoms and the context of PROM.
Question 7
A patient at 32 weeks gestation with a history of asthma presents with worsening
dyspnea, cough, and wheezing. Which of the following is the MOST appropriate
initial treatment?
A. Oral corticosteroids
B. Inhaled albuterol
C. IV magnesium sulfate
D. Intubation
Answer: B. Inhaled albuterol
Rationale: Inhaled albuterol is the first-line treatment for acute asthma
exacerbation in pregnancy. It is safe and effective for both maternal and fetal well-
being. Oral corticosteroids may be needed for severe exacerbations but are not
first-line. IV magnesium sulfate may be used in severe cases but is not first-line.
Intubation is reserved for respiratory failure. Maternal hypoxia must be avoided to
prevent fetal compromise.
Question 8
A patient at 20 weeks gestation with a twin pregnancy is being evaluated for
certification validating expertise in
maternal care, labor management, and
childbirth practices.
Question 1
A 34-week gestation patient presents with vaginal bleeding, uterine contractions,
and a history of two prior cesarean deliveries. The APRN should suspect which of
the following conditions?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Vasa previa
Answer: C. Uterine rupture
Rationale: Uterine rupture is a life-threatening emergency characterized by
vaginal bleeding, uterine contractions, and a history of prior cesarean delivery.
Risk factors include prior uterine surgery, including cesarean section, and uterine
overdistention. Placenta previa typically presents with painless bleeding. Placental
abruption presents with painful bleeding and a rigid abdomen. Vasa previa presents
with bleeding after membrane rupture. Patients with a prior cesarean delivery
attempting a trial of labor after cesarean (TOLAC) require close monitoring for
signs of uterine rupture, including sudden fetal heart rate decelerations, cessation
of contractions, and maternal hypotension.
Question 2
A 28-year-old patient at 32 weeks gestation presents with a blood pressure of
160/100 mmHg and 3+ proteinuria. She reports a headache and visual changes.
The APRN should recognize this as:
,A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia with severe features
D. Eclampsia
Answer: C. Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when a patient with
gestational hypertension or preeclampsia develops severe hypertension (systolic
≥160 mmHg or diastolic ≥110 mmHg) and/or signs of end-organ damage,
including headache, visual disturbances, or proteinuria. This patient meets the
criteria for preeclampsia with severe features due to her blood pressure and
neurological symptoms. Eclampsia is diagnosed when seizures occur. Gestational
hypertension is hypertension without proteinuria. Chronic hypertension is present
before pregnancy or before 20 weeks gestation.
Question 3
A patient at 36 weeks gestation with preeclampsia is receiving magnesium sulfate
for seizure prophylaxis. Which of the following assessment findings indicates
magnesium toxicity?
A. Respiratory rate of 14 breaths/min
B. Urine output of 40 mL/hour
C. Loss of deep tendon reflexes
D. Serum magnesium level of 5 mEq/L
Answer: C. Loss of deep tendon reflexes
Rationale: Loss of deep tendon reflexes (DTRs) is an early sign of magnesium
toxicity, typically occurring at serum magnesium levels of 7-10 mEq/L. Other
signs include respiratory depression (rate <12 breaths/min) and oliguria (<30
mL/hour). A respiratory rate of 14 breaths/min is within normal limits. Urine
output of 40 mL/hour is adequate. A serum magnesium level of 5 mEq/L is within
the therapeutic range (4-7 mEq/L). The antidote for magnesium toxicity is calcium
gluconate.
Question 4
A patient with gestational diabetes is being educated about dietary management.
,The APRN should instruct the patient that the PRIMARY goal of dietary
management is to:
A. Maintain normal maternal weight
B. Prevent fetal macrosomia and maintain euglycemia
C. Eliminate all carbohydrates from the diet
D. Promote maternal weight loss
Answer: B. Prevent fetal macrosomia and maintain euglycemia
Rationale: The primary goal of dietary management in gestational diabetes is to
maintain maternal euglycemia and prevent fetal macrosomia. This is achieved
through carbohydrate-controlled meals distributed throughout the day.
Carbohydrates should not be eliminated entirely, as they are essential for fetal
development. Maternal weight loss is not recommended during pregnancy. Weight
management is important but secondary to glycemic control.
Question 5
A patient at 28 weeks gestation with a history of preterm birth is being evaluated
for cervical insufficiency. Which of the following findings is MOST consistent
with this diagnosis?
A. Cervical dilation of 2 cm with a funneled cervix on ultrasound
B. Cervical length of 4.5 cm on transvaginal ultrasound
C. Regular uterine contractions every 5 minutes
D. Positive fetal fibronectin test
Answer: A. Cervical dilation of 2 cm with a funneled cervix on ultrasound
Rationale: Cervical insufficiency is characterized by painless cervical dilation in
the second trimester, often with a funneled cervix on ultrasound. A cervical length
of <2.5 cm on transvaginal ultrasound is associated with increased risk of preterm
birth. Regular contractions suggest preterm labor rather than cervical insufficiency.
Fetal fibronectin testing can help predict preterm birth but is not diagnostic of
cervical insufficiency.
Question 6
A patient at 38 weeks gestation with premature rupture of membranes (PROM)
, develops a fever of 101.5°F (38.6°C), tachycardia, and uterine tenderness. The
APRN should suspect which of the following?
A. Chorioamnionitis
B. Urinary tract infection
C. Influenza
D. Appendicitis
Answer: A. Chorioamnionitis
Rationale: Chorioamnionitis is an intra-amniotic infection characterized by
maternal fever (>100.4°F or 38°C), maternal tachycardia, fetal tachycardia, uterine
tenderness, and foul-smelling amniotic fluid. It is a complication of prolonged
rupture of membranes. The diagnosis requires at least two of these criteria. UTI,
influenza, and appendicitis are in the differential but are less likely given the
combination of symptoms and the context of PROM.
Question 7
A patient at 32 weeks gestation with a history of asthma presents with worsening
dyspnea, cough, and wheezing. Which of the following is the MOST appropriate
initial treatment?
A. Oral corticosteroids
B. Inhaled albuterol
C. IV magnesium sulfate
D. Intubation
Answer: B. Inhaled albuterol
Rationale: Inhaled albuterol is the first-line treatment for acute asthma
exacerbation in pregnancy. It is safe and effective for both maternal and fetal well-
being. Oral corticosteroids may be needed for severe exacerbations but are not
first-line. IV magnesium sulfate may be used in severe cases but is not first-line.
Intubation is reserved for respiratory failure. Maternal hypoxia must be avoided to
prevent fetal compromise.
Question 8
A patient at 20 weeks gestation with a twin pregnancy is being evaluated for
