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RNC-OB practice questions

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Question 1Antepartum care

A client reports that the first day of her last menstrual period was April 10. Using Naegele's rule, which estimated date of delivery should the nurse document?

  1. January 17 of the following year Correct answer.
  2. January 24 of the following year
  3. February 10 of the following year
  4. January 3 of the following year

Explanation

Naegele's rule subtracts 3 months from the first day of the last menstrual period, then adds 7 days and 1 year. April 10 minus 3 months is January 10, and adding 7 days gives January 17 of the following year.

Question 2Antepartum care

A client is currently pregnant for the fourth time. Her history includes one birth at 39 weeks, one birth at 34 weeks, and one miscarriage at 9 weeks, with both children living. Which GTPAL notation is correct?

  1. G4 T1 P1 A2 L1
  2. G4 T2 P1 A0 L2
  3. G4 T2 P0 A1 L2
  4. G4 T1 P1 A1 L2 Correct answer.

Explanation

G counts all pregnancies including the current one, T counts births at 37 weeks or later, P counts births from 20 0/7 through 36 6/7 weeks, A counts losses before 20 weeks, and L counts living children. This client has one term birth, one preterm birth, one loss at 9 weeks, and two living children.

Question 3Antepartum care

Which daily folic acid intake is recommended before conception and through early pregnancy for a client at average risk of a neural tube defect?

  1. 4000 mcg
  2. 400 mcg Correct answer.
  3. 100 mcg
  4. 200 mcg

Explanation

Clients at average risk are advised to take 400 mcg (0.4 mg) of folic acid daily beginning at least 1 month before conception. The 4 mg dose is reserved for clients with a prior pregnancy affected by a neural tube defect or other high-risk conditions.

Question 4Antepartum care

At which point in pregnancy should Tdap be administered?

  1. At 20 to 24 weeks' gestation
  2. As soon as the pregnancy is confirmed
  3. Immediately postpartum before discharge
  4. Between 27 and 36 weeks of each pregnancy Correct answer.

Explanation

Tdap is given during each pregnancy, preferably between 27 and 36 weeks, so that maternal antibodies transfer to the fetus before birth. It is recommended every pregnancy regardless of prior immunization history.

Question 5Antepartum care

A client at 28 weeks' gestation has her fundal height measured in centimeters. Which measurement should the nurse expect?

  1. 36 cm
  2. 32 cm
  3. 24 cm
  4. 28 cm Correct answer.

Explanation

Between roughly 20 and 36 weeks, fundal height in centimeters approximates gestational age in weeks. A value within about 2 to 3 cm of the expected number is generally acceptable, while larger discrepancies suggest inaccurate dating or abnormal fetal growth.

Question 6Antepartum care

Fetal heart tones are most reliably detected with a handheld Doppler at which gestational age?

  1. 10 to 12 weeks Correct answer.
  2. 6 to 8 weeks
  3. 20 to 22 weeks
  4. 16 to 18 weeks

Explanation

A handheld Doppler typically detects fetal heart tones by 10 to 12 weeks' gestation. Auscultation with a fetoscope is generally not reliable until about 20 weeks.

Question 7Antepartum care

What is the recommended total weight gain for a client with a normal prepregnancy BMI who is carrying a singleton pregnancy?

  1. 25 to 35 lb Correct answer.
  2. 40 to 50 lb
  3. 15 to 25 lb
  4. 11 to 20 lb

Explanation

For a normal prepregnancy BMI (18.5 to 24.9), the recommended total gain in a singleton pregnancy is 25 to 35 lb. Recommended ranges are higher for underweight clients and lower for clients with overweight or obesity.

Question 8Antepartum care

At what gestational age should a pregnant client be routinely screened for group B streptococcus?

  1. 36 0/7 to 37 6/7 weeks Correct answer.
  2. 34 to 35 weeks
  3. 30 to 32 weeks
  4. 24 to 28 weeks

Explanation

Routine culture-based group B streptococcus screening is performed at 36 0/7 to 37 6/7 weeks because colonization status can change and results should reflect the intrapartum period. Earlier results do not reliably predict status at delivery.

Question 9Antepartum care

A client at 26 weeks' gestation has no history of diabetes. Which screening test should the nurse anticipate?

  1. A fasting blood glucose level only
  2. A 75-g two-hour oral glucose tolerance test for all clients
  3. A hemoglobin A1c measurement
  4. A 50-g one-hour glucose challenge test Correct answer.

Explanation

Universal screening for gestational diabetes is performed at 24 to 28 weeks with a 50-g one-hour glucose challenge test. An elevated screening result is followed by a diagnostic 100-g three-hour oral glucose tolerance test.

Question 10Antepartum care

A client who is Rh-negative and unsensitized is at 28 weeks' gestation. Which action is indicated?

  1. Administer Rh immune globulin at this visit Correct answer.
  2. Administer Rh immune globulin only if the father is Rh negative
  3. Obtain a Coombs titer every two weeks
  4. Take no action until the client delivers

Explanation

Rh-negative, unsensitized clients receive Rh immune globulin at about 28 weeks and again within 72 hours after delivery if the newborn is Rh positive. Prophylaxis is given regardless of the father's Rh status when paternity is uncertain.

Question 11Antepartum care

A client had preeclampsia in a prior pregnancy that required delivery at 34 weeks. Which prophylactic measure is recommended during this pregnancy?

  1. Low-dose aspirin started at 12 to 16 weeks Correct answer.
  2. Prophylactic magnesium sulfate infusion starting at 20 weeks
  3. Bed rest beginning at 20 weeks
  4. Supplemental calcium 2 g daily

Explanation

A history of preeclampsia with preterm delivery is a high-risk factor for recurrence, and low-dose aspirin begun between 12 and 16 weeks reduces that risk. Aspirin prophylaxis is continued through delivery in most protocols.

Question 12Antepartum care

A client at 32 weeks' gestation presents with painless, bright red vaginal bleeding, and ultrasound shows the placenta covering the cervical os. Which nursing action is appropriate?

  1. Encourage ambulation to assess the bleeding pattern
  2. Perform a digital cervical examination to assess dilation
  3. Insert a fetal scalp electrode for continuous monitoring
  4. Notify the provider and prepare the client for admission Correct answer.

Explanation

Placenta previa causes painless bleeding, and digital or speculum examination can disrupt the placenta and cause life-threatening hemorrhage. The client should be admitted for monitoring, and delivery planning is based on gestational age and bleeding severity.

Question 13Antepartum care

A client at 34 weeks reports sudden severe abdominal pain and dark vaginal bleeding. The uterus is firm and tender, and the fetal heart tracing shows repetitive late decelerations. Which condition is most likely?

  1. Vasa previa with velamentous cord insertion
  2. Abruptio placentae Correct answer.
  3. Uterine rupture
  4. Placenta previa

Explanation

Abruptio placentae produces painful vaginal bleeding with a hypertonic, tender uterus and often fetal heart rate abnormalities from uteroplacental insufficiency. Placenta previa typically presents with painless bleeding and a relaxed uterus.

Question 14Antepartum care

A client at 31 weeks' gestation has confirmed preterm premature rupture of membranes and is not in labor. Which order should the nurse anticipate?

  1. Prophylactic tocolysis continued until 37 weeks
  2. Digital cervical examinations every shift to track dilation
  3. A course of latency antibiotics with group B streptococcus prophylaxis as indicated Correct answer.
  4. Immediate induction of labor regardless of fetal status

Explanation

With preterm premature rupture of membranes remote from term, expectant management includes latency antibiotics and group B streptococcus prophylaxis along with surveillance for infection and fetal wellbeing. Digital examinations are avoided because they increase infection risk.

Question 15Antepartum care

Which regimen correctly describes antenatal corticosteroid administration for fetal lung maturity?

  1. Dexamethasone 6 mg IM every 12 hours for 2 doses
  2. Betamethasone 12 mg IM every 24 hours for 4 doses
  3. Dexamethasone 12 mg IM as a single dose
  4. Betamethasone 12 mg IM every 24 hours for 2 doses Correct answer.

Explanation

The standard betamethasone regimen is 12 mg intramuscularly every 24 hours for two doses. The alternative dexamethasone regimen is 6 mg intramuscularly every 12 hours for four doses.

Question 16Antepartum care

A client at 10 weeks with hyperemesis gravidarum has persistent vomiting, 5% weight loss, and ketonuria. Which intervention is appropriate?

  1. Encourage large, high-fat meals frequently throughout the day
  2. Administer oral iron preparations with meals
  3. Restrict all oral intake for 48 hours
  4. Give IV fluids with thiamine and a pyridoxine-doxylamine antiemetic Correct answer.

Explanation

Hyperemesis with dehydration and ketonuria requires intravenous fluid and electrolyte replacement, thiamine to prevent Wernicke encephalopathy, and antiemetic therapy. Pyridoxine with doxylamine is a recommended first-line antiemetic in pregnancy.

Question 17Antepartum care

A 20-minute nonstress test on a client at 34 weeks shows two accelerations of 15 beats per minute lasting 15 seconds. How should the nurse interpret this tracing?

  1. Unsatisfactory
  2. Nonreactive
  3. Positive contraction stress test
  4. Reactive Correct answer.

Explanation

At 32 weeks and beyond, a reactive nonstress test requires at least two accelerations of 15 beats per minute lasting at least 15 seconds within a 20-minute window. This tracing meets those criteria and indicates a reassuring result.

Question 18Antepartum care

Which approach reflects recommended screening for intimate partner violence during pregnancy?

  1. Screen privately at the first visit and periodically through pregnancy with a validated tool Correct answer.
  2. Screen only when visible bruising is present
  3. Screen with the partner present to confirm the reported history
  4. Screen once at the first prenatal visit only

Explanation

Screening should occur in private, at the first prenatal visit, periodically across pregnancy, and postpartum, using a validated tool. Screening only for visible injury misses most affected clients.

Question 19Antepartum care

A client at 7 weeks has unilateral pelvic pain, vaginal spotting, and a positive pregnancy test. Ultrasound shows no intrauterine sac and an adnexal mass. Which finding most strongly supports treatment with methotrexate?

  1. Stable vital signs, hCG 1,800 mIU/mL, no fetal cardiac activity Correct answer.
  2. Severe shoulder pain with orthostatic vital sign changes
  3. hCG of 12,000 mIU/mL with fetal cardiac activity visible in the adnexa
  4. A ruptured fallopian tube with free fluid on ultrasound

Explanation

Methotrexate is appropriate for a hemodynamically stable client with an unruptured ectopic pregnancy, a relatively low hCG level, and no fetal cardiac activity. Rupture, instability, or cardiac activity in the adnexa generally favor surgical management.

Question 20Antepartum care

Maternal serum alpha-fetoprotein screening is best performed at which gestational age?

  1. 15 to 20 weeks Correct answer.
  2. 11 to 13 weeks
  3. 22 to 26 weeks
  4. 8 to 10 weeks

Explanation

Maternal serum alpha-fetoprotein screening is optimally drawn between 15 and 20 weeks' gestation. Results are interpreted with gestational age, and unexplained elevations warrant ultrasound evaluation for neural tube defects.

Question 21Antepartum care

A client at 11 weeks has marked nausea and vomiting, a uterus larger than dates, and ultrasound showing a heterogeneous echogenic mass with no visible fetus. Which follow-up is essential after uterine evacuation?

  1. Prophylactic hysterectomy at the time of evacuation
  2. No monitoring if pathology confirms a benign mole
  3. Serial hCG levels until undetectable Correct answer.
  4. Repeat pelvic ultrasound in six weeks

Explanation

After evacuation of a molar pregnancy, hCG is followed serially until undetectable to detect persistent trophoblastic disease or gestational trophoblastic neoplasia. Pregnancy is typically deferred for 6 to 12 months so that rising hCG can be attributed to neoplasia rather than a new gestation.

Question 22Antepartum care

Which set of components is scored in a biophysical profile?

  1. NST, contraction stress test, amniotic fluid index, and placental grade
  2. Fetal heart rate, umbilical artery Doppler, and estimated fetal weight
  3. NST, fetal movement, and maternal blood pressure
  4. NST, fetal breathing, movement, tone, and amniotic fluid volume Correct answer.

Explanation

The biophysical profile combines the nonstress test with four ultrasound parameters: fetal breathing movements, gross body movement, fetal tone, and amniotic fluid volume. Each of the five components is scored 0 or 2 for a maximum of 10.

Question 23Antepartum care

A client at 18 weeks has a history of a painless second-trimester loss at 17 weeks without labor or infection, and current cervical length is 22 mm. Which management is most appropriate?

  1. Cerclage placement Correct answer.
  2. Serial cervical length measurements every two weeks
  3. Bed rest until delivery
  4. Prophylactic broad-spectrum antibiotics

Explanation

A history of painless second-trimester loss plus a short cervix (less than 25 mm) supports cervical insufficiency, for which cerclage is indicated. Cerclage is placed after excluding infection and fetal anomaly.

Question 24Antepartum care

Which laboratory finding meets criteria for preeclampsia with severe features?

  1. Platelet count of 150,000/µL
  2. AST of 30 units/L
  3. Serum creatinine of 0.7 mg/dL
  4. Platelet count of 90,000/µL Correct answer.

Explanation

Severe features include thrombocytopenia with platelets below 100,000/µL, creatinine above 1.1 mg/dL or doubling of baseline, and liver transaminases at least twice the upper limit of normal. These findings reflect end-organ involvement and warrant close monitoring and magnesium sulfate prophylaxis.

Question 25Antepartum care

A client with antiphospholipid syndrome and three prior second-trimester losses is pregnant. Which regimen is recommended?

  1. Warfarin from the first trimester
  2. No treatment until a thrombotic event occurs
  3. Low-dose aspirin alone
  4. Low-dose aspirin plus prophylactic heparin Correct answer.

Explanation

Antiphospholipid syndrome with recurrent pregnancy loss is treated with low-dose aspirin plus prophylactic heparin or low molecular weight heparin to reduce loss and thrombosis. Warfarin is avoided in pregnancy because of teratogenicity.

Question 26Antepartum care

A client reports that the first day of her last menstrual period was April 2. Using Naegele's rule, which estimated date of delivery should the nurse calculate?

  1. January 2
  2. January 9 Correct answer.
  3. January 16
  4. December 26

Explanation

Naegele's rule subtracts 3 months from the first day of the last menstrual period and adds 7 days, then adjusts the year if needed. April 2 minus 3 months is January 2, and adding 7 days yields January 9 of the following year.

Question 27Antepartum care

A client planning a pregnancy asks how to reduce the risk of a neural tube defect in her fetus. Which recommendation is appropriate for a client at average risk?

  1. 4 mg of folic acid daily beginning at the first prenatal visit
  2. 1 mg of folic acid daily beginning in the second trimester
  3. 400 mcg of folic acid daily beginning at least 1 month before conception Correct answer.
  4. 800 mcg of folic acid weekly once the pregnancy is confirmed

Explanation

The neural tube closes by about 28 days after conception, so supplemental folic acid must be started before pregnancy to be protective. The standard dose for clients at average risk is 400 mcg (0.4 mg) daily, begun at least 1 month before conception and continued through the first trimester.

Question 28Antepartum care

A nulliparous client asks when she should expect to first feel her baby move. Which timeframe is most consistent with typical fetal movement perception?

  1. 26 to 28 weeks
  2. 12 to 14 weeks
  3. 18 to 20 weeks Correct answer.
  4. 22 to 24 weeks

Explanation

Quickening, the first maternal perception of fetal movement, is typically reported between 18 and 20 weeks in a first pregnancy. Clients who have been pregnant before often notice movement somewhat earlier.

Question 29Antepartum care

Which amount of elemental iron is routinely recommended each day for a pregnant client without anemia?

  1. 65 mg
  2. 16 mg
  3. 27 mg Correct answer.
  4. 45 mg

Explanation

Pregnancy increases iron requirements because of expanded maternal red cell mass and fetal stores. A daily supplement containing 27 mg of elemental iron is the standard routine recommendation for clients without anemia.

Question 30Antepartum care

A client at 10 weeks' gestation has no urinary symptoms. Which screening measure best prevents pyelonephritis in this pregnancy?

  1. Urinalysis with microscopy each trimester
  2. A 24-hour urine collection for protein
  3. Urine culture at the initial prenatal visit Correct answer.
  4. Monthly urine dipstick testing for nitrites

Explanation

Asymptomatic bacteriuria occurs in a minority of pregnant clients but, if untreated, progresses to pyelonephritis in a substantial proportion of them. A clean-catch urine culture is obtained at the first prenatal visit for all clients so that asymptomatic infection can be treated.

Question 31Antepartum care

A client at 16 weeks' gestation asks when she will receive the tetanus, diphtheria, and pertussis vaccine. Which response is correct?

  1. Between 27 and 36 weeks Correct answer.
  2. At 36 to 38 weeks only
  3. Between 8 and 12 weeks
  4. Immediately after delivery

Explanation

Tdap is given during each pregnancy, ideally between 27 and 36 weeks, so that maternal antibody is transferred across the placenta before birth. This timing maximizes protection of the newborn against pertussis.

Question 32Antepartum care

A client at 30 weeks' gestation has an uncomplicated pregnancy and no risk factors. When should the nurse schedule her next routine prenatal visit?

  1. In 2 weeks Correct answer.
  2. In 4 weeks
  3. In 3 weeks
  4. In 1 week

Explanation

For an uncomplicated pregnancy, visits are scheduled every 4 weeks until 28 weeks, every 2 weeks from 28 to 36 weeks, and weekly thereafter. At 30 weeks the client therefore returns in 2 weeks.

Question 33Antepartum care

A client at 28 weeks' gestation with contractions has a cervical length of 2 cm. Her fetal fibronectin result is negative. How should the nurse interpret this result?

  1. Preterm labor is confirmed and tocolysis is indicated
  2. Delivery within 7 to 14 days is unlikely Correct answer.
  3. Corticosteroids should be given immediately
  4. Chorioamnionitis must be ruled out with amniocentesis

Explanation

Fetal fibronectin has a very high negative predictive value in the 7 to 14 days after sampling, so a negative result makes imminent preterm delivery unlikely. It is used to avoid unnecessary intervention rather than to confirm preterm labor.

Question 34Antepartum care

A client with hypothyroidism treated with levothyroxine is confirmed pregnant at 6 weeks' gestation. Which action is appropriate?

  1. Reduce the levothyroxine dose to prevent fetal thyrotoxicosis
  2. Check thyroid-stimulating hormone once at 20 weeks
  3. Discontinue levothyroxine until the second trimester
  4. Increase the levothyroxine dose and recheck TSH in 4 weeks Correct answer.

Explanation

Thyroid hormone requirements typically rise early in pregnancy because of increased thyroid-binding globulin and placental transfer. The dose is usually increased at confirmation of pregnancy, and TSH is rechecked about every 4 weeks to guide titration.

Question 35Antepartum care

A client at 10 weeks' gestation asks about cell-free DNA testing. Which statement is accurate?

  1. It is offered only to clients older than 35 years
  2. It is a screening test that requires diagnostic confirmation Correct answer.
  3. It replaces the need for amniocentesis in most clients
  4. It is diagnostic for trisomy 21 and trisomy 18

Explanation

Cell-free DNA analyzes placental DNA in maternal blood and has high sensitivity for common aneuploidies, but it is a screening test. A positive result requires diagnostic testing such as chorionic villus sampling or amniocentesis before any irreversible decision is made.

Question 36Antepartum care

A client at 9 weeks' gestation has a twin pregnancy confirmed by ultrasound. Which assessment is most important to establish at this point?

  1. Recommend elective delivery at 36 weeks
  2. Determine chorionicity and amnionicity by ultrasound Correct answer.
  3. Begin weekly nonstress testing at 20 weeks
  4. Schedule monthly growth scans starting at 12 weeks

Explanation

Chorionicity and amnionicity are most accurately determined by ultrasound before 14 weeks, when membrane and placental characteristics are still clear. This determination drives surveillance intensity and timing of delivery, so it must be documented early.

Question 37Antepartum care

A client at 14 weeks' gestation has asthma that is well controlled on an inhaled corticosteroid. She asks whether she should keep using it. Which response is best?

  1. Use the inhaler only during acute exacerbations
  2. Switch to an oral bronchodilator for the rest of pregnancy
  3. Discontinue the inhaler until after delivery
  4. Continue the inhaled corticosteroid as prescribed Correct answer.

Explanation

Uncontrolled asthma poses greater risk to the pregnancy, including preterm birth and low birth weight, than do the recommended inhaled medications. Inhaled corticosteroids are continued throughout pregnancy to maintain control.

Question 38Antepartum care

A client at 22 weeks' gestation who teaches elementary school reports contact with a child who had fifth disease 2 weeks ago. She feels well. Which management is most appropriate?

  1. No further testing unless symptoms develop
  2. Immediate delivery by cesarean
  3. Reassurance, because adult infection is usually mild and self-limited
  4. Serial ultrasound surveillance for fetal hydrops Correct answer.

Explanation

Maternal parvovirus B19 infection can be asymptomatic yet still be transmitted to the fetus, where it may cause severe anemia and hydrops. After documented exposure, serial ultrasound surveillance for hydrops is performed for roughly 8 to 12 weeks after exposure.

Question 39Antepartum care

A client with chronic hypertension who takes lisinopril reports that she is 8 weeks pregnant. Which action is indicated?

  1. Stop lisinopril and start labetalol Correct answer.
  2. Add hydrochlorothiazide for better control
  3. Continue lisinopril at the current dose
  4. Discontinue all antihypertensive therapy

Explanation

Angiotensin-converting enzyme inhibitors are associated with fetal renal damage and oligohydramnios and should be stopped when pregnancy is recognized. An agent with an established safety record in pregnancy, such as labetalol, is substituted so that blood pressure remains controlled.

Question 40Antepartum care

A client at 29 weeks' gestation is in preterm labor with delivery anticipated within 24 hours. Which intervention is given specifically to reduce the risk of cerebral palsy?

  1. Prophylactic antibiotics
  2. Magnesium sulfate infusion Correct answer.
  3. Antenatal corticosteroids
  4. Tocolysis with nifedipine

Explanation

Magnesium sulfate given when preterm birth before about 32 weeks is anticipated has a neuroprotective effect and reduces the incidence of cerebral palsy. It is administered separately from tocolysis and corticosteroids, which serve different purposes.

Question 41Intrapartum care

Which fetal heart rate range is considered a normal baseline for a fetus at term?

  1. 90 to 140 beats per minute
  2. 110 to 160 beats per minute Correct answer.
  3. 100 to 150 beats per minute
  4. 120 to 180 beats per minute

Explanation

A normal baseline FHR for a term fetus is 110 to 160 bpm, defined as the rate rounded to increments of 5 bpm over a 10-minute window excluding accelerations, decelerations, and periods of marked variability. Rates below 110 are bradycardia and rates above 160 are tachycardia.

Question 42Intrapartum care

Early decelerations seen on the electronic fetal monitor are caused by which mechanism?

  1. Maternal hypotension
  2. Uteroplacental insufficiency
  3. Umbilical cord compression
  4. Fetal head compression Correct answer.

Explanation

Early decelerations are a vagally mediated response to compression of the fetal head during contractions, producing a mirror-image drop that begins and ends with the contraction. They are considered a normal, benign finding.

Question 43Intrapartum care

Variable decelerations on the fetal monitor most often result from which physiologic event?

  1. Uterine hyperstimulation
  2. Fetal head compression
  3. Placental abruption
  4. Umbilical cord compression Correct answer.

Explanation

Variable decelerations are abrupt decreases in FHR that vary in shape, depth, and timing relative to contractions and are caused by umbilical cord compression. Nursing interventions focus on relieving cord compression, such as repositioning and amnioinfusion.

Question 44Intrapartum care

Which set of parameters is included in the Apgar score?

  1. Heart rate, birth weight, respiratory effort, tone, color
  2. Respiratory effort, blood glucose, reflex irritability, tone, color
  3. Heart rate, respiratory effort, muscle tone, reflex irritability, color Correct answer.
  4. Heart rate, respiratory effort, blood pressure, reflex irritability, color

Explanation

The Apgar score assesses five parameters: heart rate, respiratory effort, muscle tone, reflex irritability, and color, each scored 0 to 2 at 1 and 5 minutes after birth. Birth weight, glucose, and blood pressure are not components.

Question 45Intrapartum care

Which finding signals the onset of the second stage of labor?

  1. Cervical dilation of 6 centimeters
  2. Rupture of the amniotic membranes
  3. Descent of the fetal head to zero station
  4. Complete cervical dilation Correct answer.

Explanation

The second stage of labor begins at complete cervical dilation and ends with the birth of the newborn. Rupture of membranes and fetal descent can occur at any stage and do not define stage transition.

Question 46Intrapartum care

Contraction frequency is measured from which point to which point?

  1. The end of one contraction to the end of the next contraction
  2. The end of one contraction to the beginning of the next contraction
  3. The beginning of one contraction to the end of the same contraction
  4. The beginning of one contraction to the beginning of the next contraction Correct answer.

Explanation

Frequency is the time from the onset of one contraction to the onset of the next, reported in minutes over a 10-minute window. Measuring onset to end of the same contraction describes duration, and end to onset describes the resting interval.

Question 47Intrapartum care

Which complication is most directly associated with amniotomy?

  1. Uterine inversion
  2. Retained placenta
  3. Umbilical cord prolapse Correct answer.
  4. Placental abruption with concealed hemorrhage

Explanation

Artificial rupture of membranes releases fluid that may carry the umbilical cord past the presenting part, causing cord prolapse. The nurse should assess fetal heart rate immediately after the procedure and check for cord presentation.

Question 48Intrapartum care

Fetal station describes which measurement?

  1. The level of the presenting part relative to the ischial spines Correct answer.
  2. The position of the fetal back in relation to the maternal spine
  3. The angle of the fetal head in relation to the pelvis
  4. The thickness of the cervix at the time of examination

Explanation

Station is the relationship of the lowest presenting part to the maternal ischial spines, recorded in centimeters from -5 to +5, with zero station meaning the presenting part is level with the spines. Cervical thickness describes effacement, and fetal back position describes fetal lie or position.

Question 49Intrapartum care

A laboring client at term has a baseline FHR of 145 bpm, variability of 3 bpm, no accelerations, and no decelerations over the past 40 minutes. How is this tracing categorized?

  1. Category I
  2. Category II Correct answer.
  3. Category III
  4. Sinusoidal

Explanation

Category I requires moderate variability plus a normal baseline with or without accelerations or early decelerations. Minimal variability (undetectable to 5 bpm) that is not accompanied by recurrent decelerations or absent variability places the tracing in Category II, which requires continued surveillance and evaluation.

Question 50Intrapartum care

A deceleration begins and returns to baseline over a period of 2 minutes and 40 seconds. How should the nurse describe this finding?

  1. Recurrent variable deceleration
  2. Late deceleration
  3. Baseline change
  4. Prolonged deceleration Correct answer.

Explanation

A prolonged deceleration is a decrease in FHR from baseline that lasts at least 2 minutes but less than 10 minutes. Decelerations lasting 10 minutes or longer are considered a baseline change.