Inpatient OB Certification Questions And
Answers
Pain during the first stage of labor is caused by
A. Cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine
ligaments.
B. Pressure on the urethra, bladder, and rectum by the descending fetal presenting part
C. Uterine muscle hypoxia, lactic acid accumulation, and distention of the pelvic floor muscles.
Correct Answers: a. Cervical and lower uterine segment stretching and traction on ovaries, fallopian
tubes, and uterine ligaments.
A class of antihypertensive drugs that should be avoided in pregnancy is:
A. ACE inhibitors
B. Adrenergic blocking agents
C. Calcium channel blockers Correct Answers: a. ACE inhibitors
Gestational diabetes places a woman at increased risk of:
A. A birth with a congenital defect
B. Oligohydramnios with resultant fetal growth restriction
C. Overt diabetes in later life Correct Answers: Overt diabetes in later life
A sign of symptom that indicates a progression of preeclampsia to eclampsia and warrants a
consideration for delivery is:
A. Epigastric pain
B. Nausea or vomiting
C. Persistent proteinuria Correct Answers: epigastric pain
A predisposing factor for preeclampsia is:
A. Nulliparity
B. Obesity prior to pregnancy
C. Previous history of preeclampsia Correct Answers: A, B, and C
A women is receiving magnesium sulfate. A sign that the magnesium sulfate is reaching a toxic level
is:
A. Decreased appetite
B. Difficulty in swallowing
C. Slurring of speech Correct Answers: Slurring of the speech
A positive ankle clonus that occurs with preeclampsia is usually a result of
A. Cerebral edema
B. Decreased colloid osmotic pressure
,C. Dependent edema Correct Answers: cerebral edema
A potentially life saving measure for a fetus that is exposed to chicken pox just prior to delivery is for
the mother to receive:
A. Acyclovir (Zovirax)
B. The chicken pox vaccine
C. Varicella immune globulin (VZIG) Correct Answers: Varicella immune globulin (VZIG)
Following cesarean delivery for abrupt placenta, a clot observation test is initiated. Placing a small
amount of blood in a test tube for 20 minutes yields a soft clot that dissolves easily. This is consistent
with:
A. Hypofibriongenemia
B. Normal coagulation process
C. Presence of antithrombin III Correct Answers: Hypofibriongenemia
A finding that would indicate a pregnant diabetic patient is at increased risk for giving birth to an infant
with a congenital defect is:
A. A history of macrosomia in her previous pregnancy
B. An elevated hemoglobin A1C levels during the first trimester
C. Glucose levels above 140 mg/dl in the third trimester Correct Answers: b. An elevated hemoglobin
A1C levels during the first trimeter
(A1C) — Hemoglobin A1C levels are monitored during pregnancy because they correlate with a
woman's blood glucose concentration over the prior 8 to 12 weeks and are predictive of the risk for
congenital malformations and neonatal birth weight [9]. Lower values have been associated with
better outcomes. (<6)
When a pregnant woman experiences a cardiac arrest, the nurse should:
A. First focus on assessing fetal status
B. If the mother dies, discontinue resuscitative efforts
C. Treat the patient as the same as a non-pregnant patient Correct Answers: c. Treat the patient as
the same as a non-pregnant patient
At term, a woman is labor is found to have severe condylomata which has obstructed the vaginal
canal. The appropriate disposition is.
A. Cesarean delivery
B. Cryotherapy removal
C. Immediate removal with podophyllin Correct Answers: a. Cesarean delivery
A hematologic change in pregnancy that predisposes to venous thrombosis is
A. Depressed fibrinolytic activity
B. Increased white blood cell count
C. Reduced erythrocyte production Correct Answers: a. Depressed fibrinolytic activity
,A women is admitted to labor and delivery at 32 weeks gestation with vaginal bleeding. Her
hematocrit is falling and she is tachycardic. A Kleihauer-Betketest is ordered. This is done to:
A. Detect fetal red blood cells in the maternal circulation
B. Detect hemolysis of fetal red blood ells
C. Rule out Rh isoimmunization Correct Answers: a. Detect fetal red blood cells in the maternal
circulation
A pregnant woman at 33 weeks gestation experiences an eclamptic seizure. The medication of
choice for this patient is immediate, intravenous administration of:
A. Diazepam (Valium)
B. Magnesium sulfate
C. Phenytoin (Dilantin) Correct Answers: b. Magnesium sulfate
A pregnant woman has a hemoglobin level of 9 g/dl and is stable, afebrile, and can ambulate without
adverse symptoms. The indicated treatment is
A. Oral iron preparation
B. Parenteral iron therapy
C. Whole blood transfusions Correct Answers: a. Oral iron preparation
The Centers for Disease Control and Prevention (CDC) has defined anemia as hemoglobin levels of
less than 11 g/dl (hematocrit less than 33 percent) in the first and third trimesters and less than 10.5
g/dl (hematocrit less than 32 percent) in the second trimester [21]. Since hemoglobin and hematocrit
levels are lower in African-American adults, the Institute of Medicine recommends lowering the
hemoglobin cut-off level by 0.8 g/dl in this population
A women at 34 weeks gestation is admitted to the antepartum unit for influenza type symptoms and
lymphadenopathy. A culture shows an infection caused by T. Gondii. The most likely transmission
route for this infection is.
A. Ingestion of raw meat
B. Rectal transfer
C. Sexual intercourse Correct Answers: ingestion of raw meat
Toxoplasma gondii is a ubiquitous protozoan parasite that infects humans in various settings.
Acute infection in the mother is usually asymptomatic. When symptoms of infection occur, they are
nonspecific, such as fatigue, fever, headache, malaise, and myalgia. Lymphadenopathy is a more
specific sign of the disease.
A pregnant woman who is HIV positive is on combination antiviral therapy comes to the hospital for
delivery. Drug therapy should be:
A. Continued on the prenatal dosing regimen throughout labor and delivery
B. Discontinued until after delivery where combination therapy should be resumed postpartum
C. Switched to zidovudine IV for one hour and followed by continuous infusion until delivery Correct
Answers: a. Continued on the prenatal dosing regimen throughout labor and delivery.
Women should continue taking their ART regimen during labor and delivery or scheduled cesarean
delivery. For women who have HIV RNA ≥1000 copies/ml or unknown viral levels in late pregnancy
and around the time of delivery, we recommend intrapartum intravenous zidovudine to further reduce
, the risk of perinatal transmission (table 2) (Grade 1B). For women who have had HIV RNA <1000
copies/ml consistently in late pregnancy and around the time of delivery and have no concerns
related to adherence or resistance to the regimen, intrapartum intravenous zidovudine is not
associated with further reduction of HIV transmission.
A diagnostic test used in the diagnosis of HELLP syndrome is.
A. Decreased liver function studies
B. Increased creatinine clearance
C. Presence of burr cells Correct Answers: c. Decreased liver function studies
During labor, women on full dose prophylactic unfractionated heparin anticoagulation should have the
heparin dose.
A. Increased
B, maintained
C. Withheld Correct Answers: c. Withheld
An alternative regimen to hydrazine when treating severe maternal hypertension is
A. Diazoxide
B. Labetalol
C. Sodium nitroprusside Correct Answers: b. Labetalol
The vascular manifestation of pregnant women with Class F diabetes is
A. Atherosclerotic heart disease
B. Nephropathy
C. Proliferative retinopathy Correct Answers: b. Nephropathy
Which class of antidepressants is most safe for use by pregnant woman?
A. MAO inhibitors
B. Ssris
C. Tricyclic Correct Answers: b. Ssris
Selective Serotonin reuptake inhibitors
A woman who previously had an infant with anencephaly is planning another pregnancy. She should
be advised to supplement her diet with folic acid in the dosage of
A. 0.04 mg
B. 0.4 mg
C. 4.0 mg Correct Answers: c. 4.0 mg - recommendation from ACOG.
The dose is decreased to 0.4 mg per day after the first trimester. For most women of reproductive
potential, we suggest one multivitamin containing 0.4 mg of folic acid once per day beginning at least
one month prior to conception and continuing through the first trimester
A woman at 31 weeks gestation is admitted to labor and delivery for cuts and bruises on her stomach
and torso. When asked how she acquired the bruise, she admits that her partner beat her after she
Answers
Pain during the first stage of labor is caused by
A. Cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine
ligaments.
B. Pressure on the urethra, bladder, and rectum by the descending fetal presenting part
C. Uterine muscle hypoxia, lactic acid accumulation, and distention of the pelvic floor muscles.
Correct Answers: a. Cervical and lower uterine segment stretching and traction on ovaries, fallopian
tubes, and uterine ligaments.
A class of antihypertensive drugs that should be avoided in pregnancy is:
A. ACE inhibitors
B. Adrenergic blocking agents
C. Calcium channel blockers Correct Answers: a. ACE inhibitors
Gestational diabetes places a woman at increased risk of:
A. A birth with a congenital defect
B. Oligohydramnios with resultant fetal growth restriction
C. Overt diabetes in later life Correct Answers: Overt diabetes in later life
A sign of symptom that indicates a progression of preeclampsia to eclampsia and warrants a
consideration for delivery is:
A. Epigastric pain
B. Nausea or vomiting
C. Persistent proteinuria Correct Answers: epigastric pain
A predisposing factor for preeclampsia is:
A. Nulliparity
B. Obesity prior to pregnancy
C. Previous history of preeclampsia Correct Answers: A, B, and C
A women is receiving magnesium sulfate. A sign that the magnesium sulfate is reaching a toxic level
is:
A. Decreased appetite
B. Difficulty in swallowing
C. Slurring of speech Correct Answers: Slurring of the speech
A positive ankle clonus that occurs with preeclampsia is usually a result of
A. Cerebral edema
B. Decreased colloid osmotic pressure
,C. Dependent edema Correct Answers: cerebral edema
A potentially life saving measure for a fetus that is exposed to chicken pox just prior to delivery is for
the mother to receive:
A. Acyclovir (Zovirax)
B. The chicken pox vaccine
C. Varicella immune globulin (VZIG) Correct Answers: Varicella immune globulin (VZIG)
Following cesarean delivery for abrupt placenta, a clot observation test is initiated. Placing a small
amount of blood in a test tube for 20 minutes yields a soft clot that dissolves easily. This is consistent
with:
A. Hypofibriongenemia
B. Normal coagulation process
C. Presence of antithrombin III Correct Answers: Hypofibriongenemia
A finding that would indicate a pregnant diabetic patient is at increased risk for giving birth to an infant
with a congenital defect is:
A. A history of macrosomia in her previous pregnancy
B. An elevated hemoglobin A1C levels during the first trimester
C. Glucose levels above 140 mg/dl in the third trimester Correct Answers: b. An elevated hemoglobin
A1C levels during the first trimeter
(A1C) — Hemoglobin A1C levels are monitored during pregnancy because they correlate with a
woman's blood glucose concentration over the prior 8 to 12 weeks and are predictive of the risk for
congenital malformations and neonatal birth weight [9]. Lower values have been associated with
better outcomes. (<6)
When a pregnant woman experiences a cardiac arrest, the nurse should:
A. First focus on assessing fetal status
B. If the mother dies, discontinue resuscitative efforts
C. Treat the patient as the same as a non-pregnant patient Correct Answers: c. Treat the patient as
the same as a non-pregnant patient
At term, a woman is labor is found to have severe condylomata which has obstructed the vaginal
canal. The appropriate disposition is.
A. Cesarean delivery
B. Cryotherapy removal
C. Immediate removal with podophyllin Correct Answers: a. Cesarean delivery
A hematologic change in pregnancy that predisposes to venous thrombosis is
A. Depressed fibrinolytic activity
B. Increased white blood cell count
C. Reduced erythrocyte production Correct Answers: a. Depressed fibrinolytic activity
,A women is admitted to labor and delivery at 32 weeks gestation with vaginal bleeding. Her
hematocrit is falling and she is tachycardic. A Kleihauer-Betketest is ordered. This is done to:
A. Detect fetal red blood cells in the maternal circulation
B. Detect hemolysis of fetal red blood ells
C. Rule out Rh isoimmunization Correct Answers: a. Detect fetal red blood cells in the maternal
circulation
A pregnant woman at 33 weeks gestation experiences an eclamptic seizure. The medication of
choice for this patient is immediate, intravenous administration of:
A. Diazepam (Valium)
B. Magnesium sulfate
C. Phenytoin (Dilantin) Correct Answers: b. Magnesium sulfate
A pregnant woman has a hemoglobin level of 9 g/dl and is stable, afebrile, and can ambulate without
adverse symptoms. The indicated treatment is
A. Oral iron preparation
B. Parenteral iron therapy
C. Whole blood transfusions Correct Answers: a. Oral iron preparation
The Centers for Disease Control and Prevention (CDC) has defined anemia as hemoglobin levels of
less than 11 g/dl (hematocrit less than 33 percent) in the first and third trimesters and less than 10.5
g/dl (hematocrit less than 32 percent) in the second trimester [21]. Since hemoglobin and hematocrit
levels are lower in African-American adults, the Institute of Medicine recommends lowering the
hemoglobin cut-off level by 0.8 g/dl in this population
A women at 34 weeks gestation is admitted to the antepartum unit for influenza type symptoms and
lymphadenopathy. A culture shows an infection caused by T. Gondii. The most likely transmission
route for this infection is.
A. Ingestion of raw meat
B. Rectal transfer
C. Sexual intercourse Correct Answers: ingestion of raw meat
Toxoplasma gondii is a ubiquitous protozoan parasite that infects humans in various settings.
Acute infection in the mother is usually asymptomatic. When symptoms of infection occur, they are
nonspecific, such as fatigue, fever, headache, malaise, and myalgia. Lymphadenopathy is a more
specific sign of the disease.
A pregnant woman who is HIV positive is on combination antiviral therapy comes to the hospital for
delivery. Drug therapy should be:
A. Continued on the prenatal dosing regimen throughout labor and delivery
B. Discontinued until after delivery where combination therapy should be resumed postpartum
C. Switched to zidovudine IV for one hour and followed by continuous infusion until delivery Correct
Answers: a. Continued on the prenatal dosing regimen throughout labor and delivery.
Women should continue taking their ART regimen during labor and delivery or scheduled cesarean
delivery. For women who have HIV RNA ≥1000 copies/ml or unknown viral levels in late pregnancy
and around the time of delivery, we recommend intrapartum intravenous zidovudine to further reduce
, the risk of perinatal transmission (table 2) (Grade 1B). For women who have had HIV RNA <1000
copies/ml consistently in late pregnancy and around the time of delivery and have no concerns
related to adherence or resistance to the regimen, intrapartum intravenous zidovudine is not
associated with further reduction of HIV transmission.
A diagnostic test used in the diagnosis of HELLP syndrome is.
A. Decreased liver function studies
B. Increased creatinine clearance
C. Presence of burr cells Correct Answers: c. Decreased liver function studies
During labor, women on full dose prophylactic unfractionated heparin anticoagulation should have the
heparin dose.
A. Increased
B, maintained
C. Withheld Correct Answers: c. Withheld
An alternative regimen to hydrazine when treating severe maternal hypertension is
A. Diazoxide
B. Labetalol
C. Sodium nitroprusside Correct Answers: b. Labetalol
The vascular manifestation of pregnant women with Class F diabetes is
A. Atherosclerotic heart disease
B. Nephropathy
C. Proliferative retinopathy Correct Answers: b. Nephropathy
Which class of antidepressants is most safe for use by pregnant woman?
A. MAO inhibitors
B. Ssris
C. Tricyclic Correct Answers: b. Ssris
Selective Serotonin reuptake inhibitors
A woman who previously had an infant with anencephaly is planning another pregnancy. She should
be advised to supplement her diet with folic acid in the dosage of
A. 0.04 mg
B. 0.4 mg
C. 4.0 mg Correct Answers: c. 4.0 mg - recommendation from ACOG.
The dose is decreased to 0.4 mg per day after the first trimester. For most women of reproductive
potential, we suggest one multivitamin containing 0.4 mg of folic acid once per day beginning at least
one month prior to conception and continuing through the first trimester
A woman at 31 weeks gestation is admitted to labor and delivery for cuts and bruises on her stomach
and torso. When asked how she acquired the bruise, she admits that her partner beat her after she
