A 28-year-old primigravida at 39 weeks gestation is admitted in early labor. Her cervix is 3 cm dilated, 80% effaced, and the fetus is at 0 station. Which statement best describes the normal progress of labor for a primigravida in the active phase?
Inpatient Obstetric Labor Birth
Question · Medium
Which hormones are primarily responsible for initiating the onset of labor at term?
Chapter 0: Introduction & How to Use This Guide
0.1 About the RNC-OB Credential & Exam Blueprint
Study guide
During the assessment of a woman in active labor, the nurse notes that the presenting part is at +1 station. This indicates that the presenting part is:
Question · Easy
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A woman in the second stage of labor is experiencing inadequate progress. Which finding would most strongly suggest the need for assisted vaginal delivery or cesarean birth?
Question · Hard
Which characteristic distinguishes true labor contractions from Braxton Hicks contractions?
A woman in active labor requests epidural anesthesia. Which assessment finding would contraindicate immediate epidural placement?
0.2 How to Use This Study Guide & Clinical Learning Methodology
Following epidural placement, the patient reports nausea and hypotension is noted (BP 90/50 mmHg). Which intervention should the nurse implement first?
Which non-pharmacological pain relief technique works primarily by stimulating the gate control mechanism to block pain signals?
A patient with an epidural reports inadequate pain relief on one side. Which nursing intervention is most appropriate?
Following epidural administration, which assessment finding requires immediate notification of the anesthesia provider?
Chapter 1: Pregnancy Complications — Maternal Medical Conditions
1.1 Hypertensive Disorders of Pregnancy
A patient is scheduled for labor induction at 41 weeks gestation. Her Bishop score is calculated as 4. Which statement is most accurate?
When administering oxytocin for labor augmentation, which finding requires the nurse to decrease or discontinue the infusion?
Which method of cervical ripening is associated with the lowest risk of uterine tachysystole with fetal heart rate changes?
During oxytocin administration, the nurse observes late decelerations in the fetal heart rate pattern. Contractions are occurring every 2 minutes, lasting 75 seconds. Which action is the priority?
1.2 HELLP Syndrome & Hepatic Disorders of Pregnancy
During the second stage of labor, the fetal head delivers but then retracts tightly against the perineum (turtle sign). The shoulders do not deliver with the next contraction. What is the priority nursing action?
A patient attempting vaginal birth after cesarean (VBAC) is in active labor. Her previous cesarean was for breech presentation. Which finding is a contraindication to continuing VBAC?
Umbilical cord prolapse is diagnosed when the umbilical cord slips past the presenting part. Which nursing action has the highest priority?
Following vaginal delivery, the patient experiences a postpartum hemorrhage of 800 mL. Uterine atony is suspected. Which medication should be administered first?
1.3 Diabetes Mellitus in Pregnancy
A patient at 34 weeks gestation is admitted with blood pressure of 160/110 mmHg, proteinuria of 2+ on dipstick, and severe headache. Which classification and management is most appropriate?
Inpatient Obstetric Pregnancy Complications
A patient receiving magnesium sulfate for preeclampsia develops absent patellar reflexes and a respiratory rate of 10 breaths per minute. Which action is the priority?
Which finding is diagnostic of eclampsia?
A patient with chronic hypertension presents at 20 weeks gestation with well-controlled blood pressure on labetalol. Which complication is she at increased risk for developing?
1.4 Maternal Cardiac and Respiratory Disorders
Which medication is contraindicated in the treatment of acute hypertension in a patient with preeclampsia?
A patient with pregestational diabetes (Type 1) is admitted in active labor at 38 weeks. Her blood glucose is 92 mg/dL. Which insulin management is most appropriate?
Which maternal blood glucose target during labor is recommended for women with diabetes to reduce neonatal hypoglycemia?
A pregnant patient with class II heart disease (NYHA functional class) is admitted in early labor. Which intervention is most important for managing her cardiac status?
1.5 Infectious Diseases in Inpatient Obstetrics
Which pregnant patient should receive prophylactic anticoagulation for venous thromboembolism (VTE) prevention during the antepartum period?
A pregnant patient with sickle cell disease presents with acute chest syndrome at 28 weeks gestation. Which intervention is contraindicated?
A patient at 32 weeks gestation presents with sudden onset of vaginal bleeding, uterine tenderness, and a firm, tense uterus. Fetal heart rate tracing shows late decelerations. Which condition is most likely?
A patient at 34 weeks gestation with placenta previa has a second episode of moderate vaginal bleeding. Which management is most appropriate?
1.6 Hematologic, Endocrine, Connective Tissue & Other Systemic Disorders
A patient at 28 weeks gestation presents with regular uterine contractions every 5 minutes, cervical dilation of 3 cm, and intact membranes. Which medication is the first-line tocolytic to delay delivery?
A patient with preterm premature rupture of membranes (PPROM) at 32 weeks has been managed expectantly for 48 hours. Which finding would necessitate immediate delivery?
The fetal heart rate tracing shows a baseline of 150 bpm with moderate variability and occasional accelerations. No decelerations are present. Which category does this tracing represent?
Inpatient Obstetric Fetal Assessment
During a contraction, the fetal heart rate gradually decreases from a baseline of 140 bpm to a nadir of 110 bpm, with the lowest point occurring after the peak of the contraction. The rate returns to baseline after the contraction ends. What type of deceleration is this?
Chapter 2: Pregnancy Complications — Preterm Labor, Multiple Gestation, Placental & Fetal Disorders
2.1 Psychosocial Disorders, Substance Use & Environmental Exposures
The fetal heart rate tracing shows abrupt decreases from baseline to nadir in less than 30 seconds. The decelerations vary in onset, depth, and duration with contractions. Some have a "shoulder" pattern after recovery. What is the likely cause?
A Category III fetal heart rate tracing is identified. Which finding is NOT consistent with Category III?
Which intervention is appropriate for fetal heart rate late decelerations with absent variability in the presence of maternal hypotension?
A non-stress test (NST) shows two accelerations of the fetal heart rate in a 20-minute period, each ≥15 bpm above baseline lasting ≥15 seconds. There are no decelerations. How should this be interpreted?
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