rnc ob exam test bank | inpatient obstetric nurse exam prep 2022 2023 rnc study guide 350 test questions and answers with explanations
1 late in pregnancy
a patient often develops supine hypotensio
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1. Late in pregnancy, a patient often develops supine hypotension because of
a. partial occlusion of the vena cava and aorta.
b. decreased peripheral collateral circulation.
c. increased blood flow to the placenta. - A
because of partial occlusion of the vena cava and aorta from the weight of the uterus.
This impedes venous return from the lower extremities although increased collateral
circulation during pregnancy helps to compensate. Remaining in the supine position for
long periods of time could decrease fetal oxygenation as well. The lateral recumbent
position relieves the pressure on the vena cava and aorta, allowing the blood pressure
to increase and symptoms to decrease.
The nurse must educate the new mother that a contraindication to breast feeding is
a. fetal macrosomia.
b. type II diabetes.
c. infection with HIV/AIDS. - C
Some maternal contraindications to breastfeeding include:
-Infection with HIV/AIDS
-Use of antiretroviral medications
-Active TB not treated
-Infection with human T-cell lymphotropic virus
-Illicit drug use
-Use of chemotherapeutic agents
-Radiation therapy (may require only interruption during treatment)
-Use of other medications that pass into the breast milk and may harm the child
-Presence of herpes on the breast
-Presence of varicella lesions on the breast (may resume after lesions crust)
The initial postpartal intervention indicated for a soft boggy uterus is to
a. apply an ice compress.
b. massage the fundus until firm.
c. apply a warm compress. - B
...with the dominant hand while supporting the inferior uterus with the non-dominant
hand to prevent trauma. If the fundus does not contract with massage, then further
evaluation is indicated to determine if placental fragments remain. After the fundus
becomes contracted, the nurse should push firmly downward on the fundus to expel
clots that may have pooled.
With the vibroacoustic stimulation test, stimulus with an artificial larynx or other device is
applied to the maternal abdomen for
a. 1 to 3 seconds.
b. 5 to 10 seconds.
c. 1 to 2 minutes. - A
,Usually, stimulus is applied for 1-2 seconds and repeated up to 3 times with time
extending to 3 seconds in order to stimulate fetal movement. A positive or reactive
finding is an increased fetal heart rate of 15 bpm or more for at least 15 seconds;
however, a nonreactive result does not always indicate fetal abnormality but indicates
the need for further testing.
Absence of the Moro reflex on one side only in a neonate may indicate
a. fractured scapula.
b. cerebral palsy.
c. fractured clavicle. - C
a fractured clavicle or brachial plexus injury. Damage to the central nervous system,
such as may occur with cerebral palsy, often results in bilateral absence of the reflex.
The Moro reflex is elicited by allowing the infant's head and trunk to fall slightly
backward when the infant is raised. A positive Moro reflex includes immediate extension
and abduction of the arms(and sometimes the legs) with fingers fanning and forming a
C-shape with a return of the limbs to the flexed states
In a multiparous woman, what is the lowest Bishop score that predicts labor induction
will be successful?
a. 5
b. 7
c. 9 - A
In a multiparous woman, the Bishop score that predicts that labor induction will be
successful is 5 or more while it is a 9 or more for a nulliparous woman. The Bishop
score is a rating system to determine readiness for induction based on scores of 0-3 in
four different measures: dilation (cm), effacement (percentage), station (cm), and
cervical consistency (firm, medium, soft), and cervical position (posterior, mid position,
anterior). The fifth measure, cervical position, is scored only 0-2.
When cervical laceration occur during delivery, they are most common at what position?
a. 3 and 9 o'clock
b. 12 and 6 o'clock
c. 10 and 4 o'clock - A
Cervical lacerations are most often identified with vaginal retractors when bleeding is
persistent after delivery. The lacerations are sutured with absorbable sutures, so no
further treatment is usually indicated. Minor lacerations often occur during delivery, but
they usually require no treatment. Tears are more common after forceps assisted and
vacuum assisted deliveries than normal vaginal births
If using fetal pulse oximetry, what is normal oxygen saturation?
a. 30% to 65%
b. 65% to 90%
c. 90% to 100% - A
because of the fetus's high hemoglobin and hematocrit. A value below 30% may be
associated with hypoxia and metabolic acidosis. For fetal pulse oximetry, which may be
used to determine whether immediate intervention is needed for non-reassuring fetal
,heart rate, a special single-use sensor is placed internally along the fetal cheek, temple,
or forehead. However, fetal pulse oximetry has not been found to reduce overall rates of
Caesarean.
A decrease of fetal heart rate of at least 15 bpm for at least 10 minutes is classified as
a. recurrent deceleration.
b. prolonged deceleration.
c. baseline change. - C
If it persists more than 2 minutes but less than 10 minutes, it is classified as a prolonged
deceleration. Recurrent decelerations are classified as occurring with half or more of
uterine contractions in a 20 minute period. Intermittent decelerations occur with fewer
than half of uterine contractions in a 20 minute period.
With suspected fetal hypoxia, a cord blood gas specimen is obtained during delivery by
a. withdrawing blood from the vein/artery before the cord is clamped or cut and before
placental expulsion.
b. placing one clamp and withdrawing blood above the clamp before cutting the cord.
c. double clamping a 10 to 20 cm segment, cutting it out, and then withdrawing blood
from the segment. - C
The segment can be placed on ice temporarily as cord blood gas can be accurately
assessed for 60 minutes. An arterial sample is preferred over venous, but paired
sampling is recommended. A pH of 7.24 or less is associated with neurological
compromise. A base excess of 12 mmol/L or more is predictive of motor or cognitive
impairment.
When eliciting the scarf sign in a neonate, the infant's elbow crosses the midline of the
chest, probably indicating a
a. preterm infant.
b. term infant.
c. postterm infant. - A
At fullterm, the elbow should not cross the midline. For the scarf test, the neonate
should be placed supine. One arm is grasped and the hand pulled toward the opposite
shoulder and then the position of the elbow is assessed in relation to the midline of the
chest.
Following birth, which hormone stimulates the alveolar cells of the breast, promoting
production of milk?
a. Estrogen
b. Prolactin
c. Progesterone - B
which increases in response to the neonate's suckling. Suckling also promotes release
of oxytocin, which promotes the letdown reflex by increasing contractibility of the
muscles of the mammary ducts. After milk production is well established, prolactin
levels decrease, and most milk production is then facilitated by oxytocin. During
pregnancy, estrogen promotes proliferation of breast ducts and progesterone the
development of lobules and alveoli
, Which anesthetic technique provides the best relief of pain during labor and delivery?
a. Epidural
b. Spinal
c. Pudendal block - A
The epidural can provide continuous relief during both labor and delivery and does not
pose the risk of spinal headache and provides less motor blockade. Additionally, there
is a deceased risk of hypotension because of reduced risk of sympathetic blockade.
Spinal is now usually reserved for Cesareans. The pudendal block provides relief
primarily during delivery.
A patient with lupus erythematosus places the fetus at risk if she takes which
medication during pregnancy?
a. Prednisone
b. Methotrexate
c. Plaquenil® (hydroxychloroquine) - B
...methotrexate or cyclophosphamide. Both of these medications should be discontinued
at least 30 days prior to the patient becoming pregnant. Plaquenil and prednisone may
be continued during pregnancy. A patient with lupus should be stabilized for at least 6
months before attempting to become pregnant because pregnancy may exacerbate
symptoms, and the patient may have antibodies that increase risk of miscarriage or
stillbirth in late pregnancy.
A series of ultrasound scans after the 20th week show that the fetal head is growing
normally but the abdominal circumference is lower than expected. This may indicated
which of the following?
a. Down syndrome
b. Neural tube defect
c. Placental insufficiency - C
...common in patients who are diabetic, hypertensive, or anemic. With placental
insufficiency, the supply of oxygen and nutrients to the fetus is impaired, so the fetus
responds by sending the nutrients to the most critical organs (heart, brain, lungs) and
the other abdominal organs receive less, so they develop more slowly
Idiopathic cardiomyopathy of pregnancy is a condition that
a. precedes pregnancy and exacerbates due to the stress of pregnancy.
b. develops in the last month of pregnancy or soon after birth without preexisting cardiac
disease.
c. develops in the first trimester of pregnancy and must be monitored throughout the
pregnancy and delivery. - B
Develops in the last month of pregnancy or the first 5-6 postpartal months and is not
associated with pre-existing myocarditis, endocarditis, or cardiac disease. It is
characterized by left ventricular systolic dysfunction. Typical symptoms are similar to
heart failure and include dyspnea (the most common symptom), orthopnea, cough,
palpitations, and chest pain. The heart is markedly enlarged, and the ejection fraction is
less than 45%. It increases risk of thromboembolia, so the woman is often treated with
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