Free RNC-OB Practice Questions (With Rationales)

✓ Correct: B Inadequate relaxation time between uterine contractions

Why. Uterine tachysystole, defined as more than five contractions in a ten-minute window, is a frequent complication of oxytocin administration. During a contraction, blood flow to the intervillous space is temporarily halted. If contractions occur too closely together, the uterus lacks adequate relaxation time, preventing the necessary reperfusion of oxygenated maternal blood to the placenta. This prolonged interruption in gas exchange causes acute uteroplacental insufficiency and results in a prolonged deceleration. Option A describes hypotension related to regional anesthesia, which isn’t supported by the cues of excessive uterine activity. Option C refers to the depletion of fetal reserves, which is a consequence of prolonged hypoxia over time rather than the immediate mechanical cause of the deceleration seen on this specific tracing.

✓ Correct: C Shift the patient to the left lateral position.

Why. When recurrent late decelerations occur, they indicate uteroplacental insufficiency, requiring immediate interventions to optimize uterine blood flow. Since the patient is already in the right lateral position, shifting her to the left lateral position can relieve specific vessel compression and improve maternal cardiac output. Elevating the patient to a high Fowler position is incorrect because an upright posture increases pelvic pressure and does not effectively relieve aortocaval compression. Returning the patient to a flat supine position is dangerous, as it directly worsens aortocaval compression and further degrades fetal oxygenation. Alternating lateral positions is a core component of intrauterine resuscitation to maximize placental perfusion.

✓ Correct: C Reposition the couple to ensure the background only displays a blank hospital wall.

Why. Protecting the privacy of all patients on the unit is a fundamental legal responsibility under HIPAA. Option C is correct because repositioning the couple allows the nurse to provide patient-centered care and support their birth experience while preventing the incidental disclosure of another patient’s protected health information on the monitor. Option A is incorrect because pausing or turning off a central fetal monitor compromises clinical surveillance and patient safety for the sake of a photograph. Option B is incorrect because while some facilities have policies regarding personal devices, the primary issue here is the visible health data in the background, not the use of the device itself. The nurse must proactively manage the environment to prevent unauthorized capture of sensitive clinical information.

✓ Correct: A Assess fetal heart tones before and immediately after the procedure.

Why. For a genetic amniocentesis performed in the second trimester (e.g., 19 weeks), the standard of care requires assessing fetal heart tones to establish a baseline before the procedure and confirming fetal viability immediately afterward (Option A). Option B is incorrect because continuous electronic fetal monitoring is not indicated or practical during the procedure, as the ultrasound transducer is actively used to guide the needle and maintain the sterile field. Option C is incorrect because a nonstress test is not clinically appropriate or interpretable at 19 weeks gestation due to neurological immaturity, and standard post-procedure care at this gestational age only requires a brief confirmation of fetal heart tones.

✓ Correct: B Plan for intrapartum antibiotic prophylaxis at labor

Why. GBS bacteriuria at less than 100,000 CFU/mL in an asymptomatic patient does not require immediate treatment to prevent preterm labor, but it does mandate intrapartum antibiotic prophylaxis to prevent neonatal infection. Option A is incorrect because immediate antibiotic treatment is only indicated if the colony count is 100,000 CFU/mL or higher. Option C is incorrect because there is no current threat of preterm delivery requiring corticosteroids for fetal lung maturity.