Inpatient Obstetric Nursing (RNC-OB®) Study Guide

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At 33 weeks, a previously normotensive patient has pressures of 148/94 and 150/96 mm Hg four hours apart, AST 120 U/L with an upper normal limit of 35 U/L, and no alternative explanation for the liver injury. Even with a urine protein-to-creatinine ratio of 0.12, the findings meet criteria for pre-eclampsia with severe features. In contrast, similar nonsevere pressures with no proteinuria or qualifying organ findings fit gestational hypertension.

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A patient discharged after birth reports a worsening headache and flashing lights. Treat the combination as an urgent maternal warning sign and direct immediate assessment rather than suggesting sleep and routine follow-up.

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During an infusion, urine output falls to 20 mL/hour, tendon reflexes disappear, and respirations become slow and shallow. Stop magnesium, activate urgent assistance, support breathing, and prepare prescribed calcium gluconate while magnesium concentration and renal function are evaluated.

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A large newborn whose mother had gestational diabetes becomes unusually sleepy and feeds poorly. Recognize hypoglycemia as a concern and obtain prompt glucose assessment while arranging feeding and further treatment appropriate to the findings.

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Before discharge, help a patient whose glucose has normalized arrange the fasting 75-g oral glucose tolerance test for eight weeks postpartum. Explain that the test includes fasting and 2-hour blood samples and uses different diagnostic criteria from pregnancy testing. If the result is normal, document the next screening interval within 1–3 years and connect the patient with continuing primary care.

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At 30 weeks 2 days, a patient with no previous corticosteroid course has regular contractions and cervical dilation progressing from 2 to 4 cm. Delivery within seven days is sufficiently likely to support a standard course; twin gestation or ruptured membranes would not automatically exclude treatment. Compare a patient at the same gestational age whose contractions resolve, whose cervix remains closed, and whose assessment gives no reason to anticipate delivery within seven days: symptoms alone do not establish eligibility.

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A patient with insulin-treated gestational diabetes is scheduled for antenatal corticosteroids. Anticipate additional glucose checks and coordinated treatment adjustment rather than assuming that the usual pregnancy regimen will remain sufficient throughout treatment.

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At 31 weeks, regular contractions with an initially 1-cm cervix require assessment for subsequent cervical change; progression to 2 cm supports labor. A separate patient arriving with regular contractions and an initially 3-cm cervix already meets the alternative presentation criterion without waiting to demonstrate further dilation.

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A patient at 30 weeks reports persistent watery leakage without contractions. Recognize possible PPROM and arrange assessment of membrane status, maternal temperature and symptoms, and fetal condition rather than waiting for labor to begin.

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A patient under observation for PPROM develops fever, uterine discomfort, and a rising fetal baseline. Communicate the combined findings promptly and prepare for evaluation of infection and a possible change in the birth plan.

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A monochorionic diamniotic pregnancy develops marked fluid discordance, with little fluid around one twin and excess around the other. Escalate for specialist assessment of possible transfusion syndrome. Separate sacs do not remove the placental vascular connection; monoamniotic twins additionally need assessment addressing shared-sac cord risks.

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A patient at 34 weeks presents with painless vaginal bleeding and an unknown placental location. Begin maternal-fetal assessment and arrange placental localization before proceeding with a digital cervical examination to investigate possible labor.

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After abdominal trauma, a patient has persistent uterine pain, a firm uterus, and fetal decelerations with little visible bleeding. Recognize possible concealed abruption and initiate urgent maternal-fetal evaluation and hemorrhage preparation.

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A patient with two previous cesarean births has placenta previa on imaging. Recognize the combined risk for accreta spectrum and anticipate specialist assessment and a planned hemorrhage-capable birth setting rather than routine placental management.

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Immediately after membrane rupture, vaginal bleeding appears and the fetal heart rate falls sharply while maternal blood pressure remains stable. Treat possible fetal-vessel bleeding as an emergency requiring immediate obstetric assessment and expedited birth preparation.

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A growth-restricted fetus develops recurrent late decelerations despite fewer than six contractions in ten minutes. Consider limited placental reserve and assess maternal perfusion instead of dismissing the tracing because tachysystole is absent.

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A patient reports recent cocaine use and now has abdominal pain, frequent contractions, and fetal abnormalities. Integrate vasoconstriction and excessive uterine activity into urgent assessment while also evaluating placental separation and maternal condition.

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A tracing spends most of a ten-minute window near 145 beats per minute with brief accelerations to 175. Identify the baseline from the stable segments rather than averaging the acceleration peaks into the resting rate.

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A fetus has moderate variability with recurrent variable decelerations. Recognize evidence against current metabolic acidemia while addressing the likely compression mechanism and following the tracing for worsening depth, duration, or loss of variability.

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At 30 weeks, a tracing shows abrupt rises of 12 beats per minute lasting 12 seconds. Recognize that these meet the gestational-age acceleration definition rather than rejecting them for failing the later-pregnancy 15-by-15 criteria.

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A gradual fetal heart rate decrease reaches its lowest point after the contraction has peaked and returns after the contraction ends. Describe it as late and assess perfusion, uterine activity, and associated variability.

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A tracing repeatedly drops 35 beats per minute within 15 seconds and recovers after 50 seconds, with varying relationships to contractions. Identify variable decelerations and evaluate compression-related causes and the fetal response between episodes.

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A tracing has a baseline of 135, moderate variability, occasional early decelerations, and no accelerations. Classify it as Category I because accelerations are optional and early decelerations do not exclude this category.

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A tracing changes from recurrent late decelerations with moderate variability to recurrent late decelerations with absent variability. Recognize progression from Category II to Category III and communicate the change and urgency immediately.

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During auscultation, a nurse hears slowing after a contraction in a previously reassuring labor. Reassess the fetal rate and maternal-uterine context and seek further evaluation rather than documenting moderate variability from the audible rate alone.

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Use Abbott's i-STAT CG8+ equations at 37°C: HCO3 = 10^(pH + log10(PCO2) − 7.608), and BEecf = HCO3 − 24.8 + 16.2 × (pH − 7.4). Enter PCO2 in mm Hg; bicarbonate and base excess are expressed in mmol/L. For one infant's arterial sample, pH 7.10 and PCO2 80 produce calculated bicarbonate approximately 24.8 and extracellular-fluid base deficit approximately 4.8. This is predominantly respiratory acidemia with a smaller metabolic contribution. For another infant, pH 7.10 and PCO2 40 produce bicarbonate approximately 12.4 and extracellular-fluid base deficit approximately 17.2, demonstrating a substantial metabolic component. Calculate with unrounded intermediate values, then round the results. These are separate infants, not an arterial–venous pair.

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At 34 weeks, a baseline of 140 with moderate variability, no decelerations, and rises to 158 for 18 seconds and 160 for 20 seconds during 20 minutes meets reactive criteria. A rise of only 12 beats for 12 seconds would not qualify at this gestation. If fewer than two qualifying responses remain after 40 minutes, communicate nonreactivity and arrange further assessment.

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A patient reports tolerable contractions but progresses from 3 to 5 centimeters during observation. Recognize established progression even though the patient is comfortable and the contractions do not appear dramatic on the external monitor.

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Contractions become nearly continuous during augmentation, and late decelerations appear. Recognize reduced recovery time as a plausible mechanism and act to reduce excessive uterine stimulation while assessing maternal perfusion and fetal response.

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A contraction begins at 10:00 and ends at 10:01; the next begins at 10:03. Record a three-minute frequency, a one-minute duration, and two minutes of relaxation rather than calling all three measurements frequency.

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An induced patient remains at 4 centimeters for several hours with reassuring maternal and fetal findings. Recognize that active-phase arrest criteria do not yet apply and review the induction course without prematurely labeling active arrest.

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A patient at 7 centimeters with ruptured membranes has no change after four hours of inadequate contractions. Recognize that the adequate-activity pathway is unmet and review the duration and effectiveness of augmentation before diagnosing arrest.

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A nulliparous patient has pushed beyond three hours but continues to demonstrate descent with reassuring assessments. Review progress, risks, options, and preferences with the team instead of treating the elapsed time alone as an automatic cesarean indication.

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Oxytocin begins at 08:00, membranes rupture at 14:00, and reassessment occurs at 20:00 with reassuring findings. Only six hours of oxytocin after rupture have elapsed. Continue evaluating the induction rather than declaring failure from the twelve hours since oxytocin began.

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A healthy first-time parent at 39 weeks asks whether induction guarantees a better neonatal outcome. Explain the lower cesarean rate observed in ARRIVE, the primary-outcome limitation, longer labor-unit time, and the option of expectant management.

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Using the original score, a cervix dilated 2 cm receives 1 point; 50% effacement, station −2, medium consistency, and midposition each receive 1 point, totaling 5. Explain why ripening may precede oxytocin and lengthen induction. For a term patient with a previous low-transverse cesarean who is otherwise eligible for labor, a balloon may be considered; misoprostol is contraindicated because of uterine-rupture risk. The uterine incision history therefore changes method selection even when the cervical assessment is identical.

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A thirty-minute record contains six, six, and seven contractions in successive ten-minute segments. Identify tachysystole even if variability remains moderate, and assess the need to reduce stimulation and improve recovery between contractions.

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During augmentation, contractions increase to seven in ten minutes and recurrent late decelerations develop. Stop oxytocin, reposition laterally, assess maternal circulation, summon appropriate assistance, and evaluate the tracing’s response rather than continuing routine dose escalation.

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Soon after an epidural dose, a patient becomes lightheaded, blood pressure falls, and late decelerations appear. Position laterally, obtain immediate maternal-fetal reassessment, and coordinate treatment of hypotension with the anesthesia and obstetric teams.

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A patient in early labor requests neuraxial pain relief and asks whether the effect can be adjusted later. Explain catheter-based titration and arrange anesthesia assessment while discussing the monitoring and assistance needed after placement.

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Before planned amniotomy, the fetal head remains ballotable above the pelvis. Communicate the increased prolapse risk and seek reassessment of the procedure plan rather than treating membrane rupture as an equivalent risk at every station.

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After membrane rupture, a prolapsed cord is palpated with sustained fetal bradycardia. Call for emergency assistance, elevate the presenting part to relieve compression, and maintain decompression while the team prepares the fastest appropriate birth.

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The fetal head delivers, but the shoulders remain impacted. Activate the emergency response and assist with McRoberts positioning and directed suprapubic pressure while supporting coordinated maneuvers rather than applying pressure over the uterine fundus.

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After shoulder dystocia, one newborn arm moves less than the other while the mother has increasing bleeding. Arrange neonatal assessment of possible injury and simultaneous maternal evaluation rather than ending surveillance once the shoulders have delivered.

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During second stage, deep decelerations accompany every pushing effort but recover between contractions. Reassess the tracing and descent, and coordinate a temporary reduction in pushing frequency while observing whether fetal recovery improves.

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After membrane rupture, recurrent variable decelerations persist despite repositioning, while maternal blood pressure is stable. Discuss whether amnioinfusion is appropriate for suspected cord compression rather than selecting it as treatment for an unrelated maternal perfusion problem.

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A stable patient is being considered for cesarean solely for slow dilation before active labor. Review the labor-phase definition and available support, then discuss both current safety and the consequences of a primary cesarean for future pregnancies.

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After cesarean birth under neuraxial anesthesia, blood pressure continues falling while bleeding increases. Assess circulation and hemorrhage urgently with the obstetric and anesthesia teams instead of assuming that the entire change is an expected block effect.

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Soon after birth, heavy bleeding accompanies a soft, enlarged uterus. Call for assistance and begin the immediate atony response, including uterine massage and coordinated uterotonic treatment, while the team assesses blood loss and maternal circulation.

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A patient continues to bleed briskly despite a well-contracted uterus after a difficult vaginal birth. Communicate the persistent bleeding and firm tone, and prepare for evaluation of lacerations and other sources while supporting the hemorrhage response.

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Four days after birth, a patient reports the worst headache of the week with blurred vision. Arrange immediate assessment and communicate the postpartum timing and neurological symptoms rather than advising routine analgesia until the scheduled visit.

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A recently postpartum patient calls about new breathlessness and chest discomfort. Direct urgent medical evaluation and emphasize the recent pregnancy rather than suggesting that reduced fitness or interrupted sleep adequately explains the symptoms.

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After warming, positioning, drying, and stimulation, a newborn remains gasping with a heart rate of 80. Initiate assisted ventilation and evaluate its effectiveness rather than waiting for the one-minute Apgar or giving oxygen alone.

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A newborn receives mask ventilation, but the heart rate remains low and chest movement is minimal. Reassess mask seal, airway position, and ventilation delivery, then evaluate whether corrective steps produce chest movement and a rising heart rate.

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A vigorous term newborn is breathing comfortably after birth. Dry the infant, support warm skin-to-skin care, and continue observing breathing and temperature rather than leaving the infant wet while completing nonurgent routine measurements.

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A newborn appears jaundiced at 14 hours of age. Notify the responsible clinician and obtain timely bilirubin assessment rather than planning to reassess color after the next day’s routine feeding and weight checks.

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A jaundiced infant has few audible swallows and poor output despite long feeds. Observe and improve attachment, assess weight and bilirubin, and arrange an intake plan. If supplementation is needed, pair it with regular expression to protect supply and return to effective breastfeeding as the infant’s condition allows.

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A patient can repeat “seek care for severe headache” but has no transport and is unsure whom to call overnight. Build a specific emergency access plan and confirm understanding before considering the teaching complete.

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A nurse reports recurrent late decelerations and requests immediate bedside review. The clinician repeats the request and plan, and the nurse confirms the details, creating a shared understanding rather than assuming that a brief acknowledgment guarantees action.

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Before elective induction, a patient has signed a form but says birth is guaranteed within three hours and requests explanation in another language. Arrange interpretation and renewed discussion before proceeding. Document the clarified expectations and choice. If later decelerations occur, record their features, oxytocin changes, maternal assessment, response, and escalation rather than only “provider aware.”