RNC-OB 2022 TEST QUESTIONS AND ANSWERS ALL CORRECT

RNC-OB PRACTICE QUESTIONS Dinoprostone (Cervidil) is used for cervical ripening in a woman at 39 weeks gestation. After one hour, tachysystole develops but the fetal heart rate pattern is normal. Appropriate management is to: Ans: remove the insert Nifedipine acts as a tocolytic agent by interfering with: Ans: availability of calcium The progression of labor is based on: Ans: individual factors and clinical conditions Universal alphafetoprotein sceening should be offered to all women because: Ans: there is little risk or complications from the testing A nurse observed a new mother breastfeeding her infant and hears "smacking sounds" as the infant feeds. The nurse should recognize this might indicate a problem with: Ans: Latch on the breast A woman with type-1 diabetes at 32 weeks gestation has diabetic ketoacidosis. Before administration of IV potassium, it is important to assure adequate: Ans: urine output Increased bloody show In a woman in labor is representative of: Ans: rapid cervical dilation According to NICHD terminology, accelerations and decelerations are based on their relationship to" Ans: fetal heart rate baseline Hindmilk promotes infant weight gain because of its: Ans: high fat content The concept of "day dreaming" is an integral part of the nonpharmacologic pain relief strategy in labor of: Ans: imagery After administration of an epidural, a woman experienced respiratory depression. This is likely due to: Ans: sympathetic blockade A main disadvantage of fentanyl use for pain relief in labor is: Ans: short duration of action The most common umbilical cord complication of monoamniotic twin gestation is: Ans: entanglement A potential complication from a vacuum extraction delivery is: Ans: depression skull fracture A shorter labor duration is seen with what type of maternal positioning: Ans: upright A breastfeeding mother notes that small amounts of milk drool from her infant's mouth after breastfeeding. This is an indication of what: Ans: a need to evaluate proper latch-on When administering oxytocin, it is important to understand that 40 minutes after administration: Ans: a steady state plasma concentration will be reached In the hypothermin neonate, heat production is accomplished by thermogenesis secondary to: Ans: brown fat metabolism Women are most likely to experience trauma leading to injury in pregnancy from: Ans: intimate partner violence A contraindication to neuraxial anesthesia during labor is: Ans: coagulation disorder A woman at 31 weeks gestation comes to labor and delivery with signs and symptoms of preterm labor. Antenatal steroids are given to: Ans: promote fetal lung alveoli growth Symptoms of deep vein thrombosis are most likely due to: Ans: inflammation Death from anaphylactoid syndrome of pregnancy(amniotic fluid embolism) is most commonly due to: Ans: hypoxic-ischemic insult Reversal of the diabetogenic effects of pregnancy occurs with: Ans: delivery of the placenta Rapid bolus of oxytocin after birth places the woman at risk for Ans: hypercontractility of the uterus To minimize bias in a research study, the best design includes Ans: randomized participants intrauterine growth restriction predisposes the neonate to Ans: sepsis Following sustained pushing, a woman in the second stage of labor reports tingling and numbness of the legs. A indicated intervention as she continues to push it to Ans: place her feet flat on the bed A woman in labor has just received an epidural anesthesia. Following a test dose of local anesthesia and ephederine, she experiences increased heart rate, palpitations, numbness of tongue and slurred speech and jitteriness. These symptoms reflect Ans: injection in the spinal fluid When using an external monitor, the fetal heart rate is detected by Ans: ultrasound A renal finding indicative of progressing preeclampsia is decreased Ans: creatinine clearance Stripping of membranes to augment labor results in release of Ans: prostaglandin Late preterm infants are at increased risk for hyperbilirubinemia because of Ans: poor feeding Damage to the myometrium or any process that interferes with placenta migration increases the risk for Ans: placenta previa The factor that will most influence whether a woman after having a cesarean can have future vaginal birth is Ans: type and location of the incision A factor that decreases the chance of success of external version is Ans: oligohydramnios A major contributory factor to the increasing cesarean rate in the U.S is Ans: decreased opportunity for VBAC trial When a woman in labor hyperventilates, the underlying physiology is Ans: poor oxygenation A herpetic lesion on the breast requires what management for the breastfeeding woman? Ans: use the breast shied so infant has no direct contact with the lesion The presence of fetal breathing movements on a biophysical profile reflects adequate Ans: neurologic function Combination tocolytic therapy of magnesium sulfate and nifedipine can result in Ans: low calcium levels A woman is being induced at 38 weeks gestation because of abnormal antenatal screening. What component is most concerning? Ans: Contraction pattern The factor that most affects the continuation of prolactin production during lactation is Ans: infant sucking The increased incidence of low birthweight neonates in women who smoke cigarettes is dependent on Ans: number of cigarettes smoked per day The hematologic change in pregnancy which predisposes the pregnant woman to deep vein thrombosis is increased Ans: clotting factors A woman develops varicella in the third trimester. This increases the risk for Ans: congenital varicella syndrome This representative of a 20 minute nonstress test. The best interpretation is Ans: vibroacoustic stimulation should be initiated to induce better fetal response Pseudomentration can occur in the female neonate due to Ans: withdrawal of maternal hormones A primigravida is 8cm dilated after 14 hours of labor. She is frustrated and expresses that she feels this will never end and wants this over with. This behavior is consistent with Ans: the transition phase The main cause of labor onset is Ans: hormonal After a sudden rupture of membranes, a woman experiences a prolonged deceleration. This is consistent with Ans: prolapse of the cord Variable decelerations are often noted with monitoring monochorionic-monoamniotic twins during labor because this type of twin pregnancy is prone to what complication? Ans: umbilical cord entanglement With accurate dating of the last menstrual period beginning on December 12, an elective birth can be attempted no sooner than Ans: September 12 Epidural anesthesia increases the risk of Ans: persistent occiput-posterior presentation As the placenta ages with pregnancy continuing beyond term, placental reserve is decreased because of Ans: amniotic basal membrane thinning Following birth, a sign of placental separation is Ans: sudden trickle or spurt of blood A woman who has positive group B streptococcal screen is having a planned cesarean birth. Administration of prophylactic antibiotics for this patient Ans: is not required A woman is admitted to labor and delivery at 38 weeks gestation with an active case of rubella. The risk of the neonate acquiring rubella is Ans: high The lower segment transverse incision is most commonly used for cesarean birth because of Ans: less blood loss At 37 weeks gestation a woman (G3P1) with current history of alcohol and cocaine use is admitted to labor and delivery. She denies drug use for "several days". She is dilated 4cm. Blood pressure is 148/92 and the pulse is 120. Reflexes were brisk and her urine protein is negative. This patient is at risk for Ans: withdrawal seizures The cause of metabolic acidosis is decreased Ans: alveolar ventilation Anticipated intrapartum insulin management of women with type 2 diabetes includes recognition that they Ans: will need less, or no, insulin A woman feels burning sensation in the perineal area as the fetal head is crowning, this is Ans: a result of perineal stretching Cervical ripeing with the use of a transcervical catheter works by releasing Ans: prostaglandin When to institute epidural anesthesia to a woman in active labor is based on Ans: her request for it Hypertonic contractions in latent labor persist. Appropriate management would be to Ans: increase hydration A rigid, painful abdomen that occurs with placental abruption is due to Ans: myometrial bleeding trapped in the uterus when R-R intervals are long, the fetal heart rate is Ans: slow When care is given based on what a reasonably prudent nurse with similar education and experience would do in a given situation, this is called Ans: standard of care During the early second stage of labor, a woman has been pushing but wants to stop for a while. The nurse should Ans: suggest she change to a different position In fetal vibroacoustic stimulation, a reactive response is indicated by fetal Ans: heart rate accelerations Fetal fibronectin is an early marker for preterm birth because its presence after 20 weeks gestation can indicate Ans: disruption of the attachment of the fetal membranes Open glottis pushing results in Ans: less fetal stress A 39 year old woman G1 at 40.4 weeks gestation is admitted in early labor. She is 59 inches tall and her prepregnancy weight was 100 pounds. Current weight is 138 pounds. There is an increased risk for Ans: cephlopelvic disproportion Fetal heart block is most likely to occur when a pregnancy is complicated by Ans: systemic lupus erythematosus Oxygenation of the fetal blood occurs in the Ans: placenta A late preterm birth is defined by Ans: gestational age Oxytocin is discontinued after tachysystole develops. One hour later, the infusion is to be restarted. The dose should be started Ans: at the initial starting dose A management consideration when using Indomethacin as a tocolytic agent is it Ans: should be used only if gestational age is 34 weeks Breech presentation occurs more frequently Ans: with macrosomia An application of the ethical principle of autonomy is Ans: informed consent Oxytocin has been classified as a high alert medication by the institute for safe medication practices. This means Ans: there is a heightened risk for significant patient harm when used in error Indomethacin is contraindicated for tocolysis in a woman who has Ans: diabetes A consequence of twin to twin transfusion is Ans: hypertension in the recipient twin Following fetal scalp stimulation with minimal variability, there are no induced accelerations. This response would be classified as Ans: indeterminate (category 2) A primigravida at term has been in labor for 10 hours. For the past two hours, she has been 5cm dilated. The cervix is 100% effaced and the vertex is at 0 station. The fetal heart rate is 140 bpm and variability is moderate. Contractions by palpation are easily indentable. This scenario is consistent with Ans: prolonged latent phase A woman at 22 weeks gestation presents with dysuria, suprapubic and lumbar pain, general malaise, loss of appetite, nausea, and vomiting. VS (T 102.6, HR 116, RR 26, and FHR 175) These symptoms are consistent with Ans: pyelonephritis As the parasympathetic nervous system matures and exerts control over the fetal heart activity, the fetal heart rate Ans: slows According to the joint commission sentinel event data, the number one cause of patient injuries is Ans: failure to follow the steps of unit policies or protocols Bleeding into the decidua basalis occurs with Ans: placenta accreta In neonatal resuscitation, if the heart rate is 80 bpm, the next step is Ans: bag mask and ventilation Amniotomy performed before active labor is established carries what risk? Ans: cesarean birth A maternal behavior a first time mother might perform in the immediate postpartum period that would require follow-up is that she Ans: is most concerned with her diet and exercise program so she will look like she never had a baby The second stage of labor covers the period of time of Ans: complete dilation to birth of the baby Return of blood to the venous circulation that was formerly supplying the uteroplacental unit increases cardiac output in the postpartum period secondary to increased Ans: systemic vascular resistance Preeclampsia is an abnormal vascular response involving dysfunction of the Ans: endothelium Piggybacking to oxytocin to the primary IV at the point closest to the IV insertion site will Ans: allow for rapid discontinuation In the neonate, the rise of PaO2 after birth is the potent stimulus for the closure of the Ans: foramen ovale Palpation of neonate's head at 3 hours of age reveals a soft edematous area that crosses suture lines. This is consistent with Ans: caput succadenum Coaching women to push with every other of third contraction during the second stage of labor is indicated when the Ans: fetal heart rate is abnormal A management strategy for prolonged latent phase of labor is a multigravid woman is Ans: oxytocin Immunoassay testing for premature rupture of membranes involves analysis of amniotic fluid for Ans: pH determination Misoprostol compared to other cervical ripening agents has Ans: a higher rate of tachysystole The fetal heart rate should be assessed on what time interval in a patient without complications in the active stage of labor? Ans: 30 minutes Transient loss of variablity as an intact fetus physiologically responds to hypoxic stress demonstrates Ans: ongoing fetal hypoxia The differences in side effects of parenteral analgesic medications given for pain relief in labor relate to the drug's Ans: half life Absorption of local anesthetic agents administered to a woman in labor depends primarily on the Ans: biovailability of the specified drug When tachysystole of hypertonus occurs with induction of labor with oxytocin, this results in Ans: decreased uterine blood flow The effect of prolonged use of the valsalva maneuver during second stage of labor is Ans: respiratory alkalosis The biophysical profile result of a woman at 37 weeks gestation is 6. The amniotic fluid volume was normal. The test should be repeated Ans: within 24-48 hours