RNC-NIC Questions Ch 1-4 General Assessment and
Management with correct answers
Which of the following descriptions defines a cephalohematoma?
A. Pitting edema that extends across the suture lines caused by pressure
generated on the fetal skull by the cervix. Edema generally resolves in a
few days.
B. Collection of blood between the periosteum and the skull and does
not cross the suture line. It may enlarge during the 24hrs after birth and
may take several months to resolve.
C. Premature closure of the cranial suture with a palpable suture line.
D. Hemorrhage into the space between the galea aponeurotica and the
periosteum. Hematoma may cross the suture lines and may lead to
exsanguinations of the infant. Correct Answer-B. A cephalohematoma is
a collection of blood between the periosteum and the skull that does not
cross the suture line. It may enlarge during the 24hrs after birth and may
take several months to resolve. These infants are at higher risk for
developing hyperbilirubinemia. A caput succedaneum is caused from
pressure on the fetal skull by the cervix during labor. A common
characteristic of a caput succedaneum is pitting edema that extends
across the suture lines. Edema generally resolves within a few days.
Craniosynostosis is the premature closure of the cranial sutures. A
hemorrhage into the space between the galea aponeurotica and the
periosteum is a subgaleal hemorrhage.
A patient who is G3P2 at 33 wks gestation arrives at the triage unit
complaining of regular uterine contractions. Her pregnancy Hx includes
a preterm delivery at 34 wks. Before examining her, the nurse performs
electronic fetal monitoring and obtains a complete Hx. The pt reports no
bleeding and no ROM. She has had no vaginal examinations or sexual
,activity for more than 24 hours. The biochemical marker useful in this
situation for predicting preterm birth is:
A. cervical ferritin
B. fetal fibronectin
C. Corticotropin-releasing hormone
D. placental α-microglobulin-1 Correct Answer-B. Fibronectins are a
family of proteins found in the extracellular matrix. Fetal fibronectins
(fFns) are found in fetal membranes and decidua throughout pregnancy.
As the gestational sac implants and attaches to the interior of the uterus
in the first half of pregnancy, fFns are normally found in the
cervicovaginal fluid. After 22 weeks, the presence of fFns normally is no
longer detected in vaginal secretions until approximately 2 weeks before
the onset of delivery, term or preterm. It is suggested that fFns be
released into the cervix and the vagina when mechanical- or
inflammatory-mediated damage occurs to the membranes. Cervical
ferritin is not a biomarker, but an inflammatory marker whose presence
provides support for the theory that infection is a mediator of preterm
birth. Maternal plasma concentrations of corticotropin-releasing
hormone are elevated in both term and preterm pregnancies. It appears
to be a component of the common pathway of labor, regardless of
gestation. Placental α-microglobulin-1 is a protein found in amniotic
fluid that is a biomarker for ROM.
When electronic fetal monitoring is used, the best indicator of fetal
oxygenation status during labor is:
A. FHR baseline within the normal range
B. moderate FHR variability
C. absence of decelerations of the FHR
,D. presence of accelerations of the FHR Correct Answer-B. Variability
is the most important FHR characteristic. It is the most important
indicator of normal fetal pH or acidosis. Moderate FHR variability
reliably predicts the absence of fetal metabolic acidemia. The normal
FHR baseline range is 110-160 bpm regardless of GA. Decelerations are
categorized as late, early, variable, or prolonged. Decelerations are
caused by 2 basic mechanisms: 1. reflex autonomic slowing of the FHR
in response to changes in BP, blood gases, and possibly other factors; 2.
direct depression of the FHR resulting in disrupted O2 transfer. Like
moderate variability, accelerations reflect normal autonomic regulation
of the FHR and are highly predictive of the absence of fetal metabolic
acidemia.
The BPP is currently the primary method for evaluating fetal well-being
through the assessment of various activities that are controlled by the
nervous system and are sensitive to oxygenation. The five variables
included in the BPP are:
A. fetal tone, fetal breathing, fetal movement, nonstress test, and
amniotic fluid volume
B. fetal movement, fetal tone, nonstress test, amniotic fluid index, and
fetal position.
C. fetal tone, fetal position, amniotic fluid volume, FHR, and fetal
activity.
D. FHR, fetal movement, nonstress test, amniotic fluid volume, and fetal
tone Correct Answer-A. The BPP is an evaluation of fetal well-being
through the use of various reflex activities that are controlled by the
CNS and are sensitive to hypoxia, as well as the fetal environment that
can affect fetal well-being. The biophysical activities are the first to
develop and the last to disappear when asphyxia occurs. The BPP
consists of assessments of 5 fetal variables: fetal tone, fetal movement,
, fetal breathing, fetal reactivity (nonstress test), and amniotic fluid
volume. Fetal position and FHR are NOT included in the BPP.
An appropriate GA for glucose screening in women who are at low risk
for developing GDM in pregnancy is:
A. 20-21 wks gestation
B. 22-23 wks gestation
C. 24-28 wks gestation
D. 32-34 wks gestation Correct Answer-C. Pts who are at low risk for
developing GDM (<25 yrs, normal weight before pregnancy, not a
member of a high-risk ethnic or racial group, no diabetes in a 1st degree
relative, no Hx of abnormal glucose tolerance, and no Hx of poor
obstetric outcome) are tested between 24-28 wks gestation. Pts with risk
factors (>35 yrs, BMI >30, Hx of GDM, delivery of an LGA infant,
PCOS, strong family Hx of diabetes) should receive a plasma glucose
screening at their first prenatal visit followed by one at 24-28 wks.
When women give birth sitting upright, which of the following
indicators show lower values in cord blood?
A. pH
B. PCO2
C. PO2
D. Base excess Correct Answer-B. Values of PCO2 are lower when
women give birth in an upright position than when they give birth in the
supine position. The supine position can result in increased abdominal
and intrathoracic pressure, increased vasoconstriction, increased
maternal BP, and increased intrauterine pressure and result in decreased
