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RNC-NIC Questions Ch 1-4 General Assessment and Management Questions and Answers 100% Solved
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RNC-NIC Questions Ch 1-4 General Assessment and Management
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RNC-NIC Questions Ch 1-4 GeneralAssessment and Management
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. –
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 – 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 - answerB. 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 -
answerA. 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 - answerC. 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 - answerB. 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
blood flow to the uterus and intervillous space. Upright and lateral positions during labor
result in fewer nonreassuring characteristics of the FHR, higher pH, and PO2 levels. A
normal pH, PO2, and PCO2 should reflect a normal base excess.
What is the physiologic cause of late decelerations?
A. Fetal distress
B. Sympathetic response to fetal activity
C. Rapid fetal descent through the pelvis
D. Transient interruption in fetal oxygenation - answerD. A late deceleration is a reflex
fetal response to transient hypoxia during uterine contractions. Fetal distress is an
imprecise term, and the National Institute of Child Health and Human Development
Task Force has recommended that this term be abandoned. Accelerations reflect a
sympathetic nervous system response and results in an increase in the FHR. Rapid
decent through the pelvis may cause a parasympathetic response that results in
prolonged deceleration or fetal bradycardia.
An intrauterine pressure catheter, placed for the monitoring of uterine pressure,
amnioinfusion, and fluid sampling, is useful in the treatment of:
A. Polyhydramnios
B. late decelerations
C. variable decelerations
D. decreased FHR variability - answerC. Amnioinfusion is used to attempt to resolve
variable FHR decelerations by correcting umbilical cord compression as a result of
oligohydramnios. When amnioinfusion is used during labor to treat recurrent severe
decelerations, it has been proven to reduce the incidence of C/S deliveries.
Amnioinfusion may assist with oligohydramnios (AFI<5cm) to provide additional fluid to
cushion the umbilical cord and prevent variable decelerations from occurring.
Amnioinfusion was once used during labor in the presence of meconium-stained fluid to
decrease the incidence of meconium aspiration. However, studies have since shown no
benefit with the treatment of amnioinfusion to prevent MAS. Careful monitoring and
documentation of fluid infused are important to avoid iatrogenic polyhydramnios.
Amnioifusion does not affect late decelerations or decreased fetal heart variability
because these patterns are not a result of cord compression. Polyhydramnios is the
condition of too much amniotic fluid. The most effective treatments for polyhydramnios
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