ch 37
Five minutes after delivering a baby, the mother feels the sudden urge to push and a gush of blood comes from the vagina. Given that the mother is not delivering twins, which stage of labor should the EMT recognize?
Placental
Prior to delivery, the EMT prepares to create a sterile field around the patient's vaginal opening. This is best accomplished by:
Placing a sheet from the OB kit under the patient's hips and another over her abdomen and legs
After successfully delivering a baby, the EMT notes that the protruding umbilical cord is lengthening and a small gush of blood came out of the vagina. The appropriate action would be to:
Prepare for delivery of the placenta
According to the neonatal resuscitation pyramid, which level of care will most newborns require?
Tactile stimulation and drying
An EMT is presenting a continuing education class on the care of the pregnant female. When discussing the amniotic sac, he is correct to emphasize which point?
The amniotic sac protects and insulates the baby during gestation
While delivering a baby in the field, the EMT notices that the baby is covered with a green-brown liquid. The EMT should immediately recognize that:
The baby was distressed and may be hypoxic
Which statement regarding the role and function of the cervix during pregnancy is true?
The cervix becomes plugged with mucus to prevent contamination of the uterus during gestation
When faced with the possibility of delivering twins, the EMT must remember that:
The second infant may be born breech
The EMT would use the sterile scissors found in the OB kit to cut:
The umbilical cord
You have been called to a crisis shelter for a patient possibly having a baby. On scene, you find an older female patient who is developmentally challenged and cannot communicate normally. Staff states that the patient just came to the shelter and they know nothing about her, other than that she is pregnant. Assessment reveals crowning, and you proceed to deliver what appears to be a healthy baby boy. When assessing the mother after delivery, which finding should increase your suspicion that the woman may be carrying twins?
The mother's abdomen remains large after delivery of the first baby
The Apgar scoring system is useful in determining:
The newborn's overall condition
A 31-year-old female in her third trimester of pregnancy lost her balance and fell down a flight of stairs. Treatment included spinal motion precautions and oxygen therapy. When transporting her, the EMT should:
Tilt the long spine board to the left
Which finding is of greatest concern when assessing a 33-year-old female who is eight months pregnant?
Vaginal bleeding not associated with pain
The EMT shows that he understands the seriousness of a prolapsed umbilical cord when he states:
"A prolapsed cord that is pinched can stop the flow of oxygen to the baby and must be addressed immediately."
The EMT shows that he understands care of the post-delivery mother when he states:
"Allowing the baby to nurse immediately after delivery can help to control uterine bleeding."
The EMT shows that he can accurately differentiate placenta previa from abruptio placentae when he states:
"Bleeding associated with abruptio placentae is typically associated with abdominal pain; bleeding associated with placenta previa is painless."
A woman informs you that she is eight months pregnant and fatigues easily. She is apprehensive because when she lies down, she gets dizzy and feels as though she is going to vomit. What is the EMT's best response?
"Check with your obstetrician, but you may want to rest and sleep on your left or right side."
You have been called for a 16-year-old female with vaginal bleeding. On scene, you determine the patient to be pregnant and bleeding for 3 hours. Which statement would indicate proper care of the patient?
"I am going to put this sanitary napkin between your legs to collect the blood."
You are transporting a female patient who is seven months pregnant. She has been diagnosed with preeclampsia and is currently hypertensive. Which statement made by the patient indicates she may be transitioning from preeclampsia to eclampsia?
"I feel like I am going to have a seizure."
Which statement by the patient best indicates that the patient is in the second stage of labor?
"I feel like I have to move my bowels."
When assessing a 27-year-old patient who is eight months pregnant, which statement made by the patient should the EMT be most concerned about?
"I have not been able to see the doctor this pregnancy at all."
You are caring for an emotionally distraught female who just suffered a miscarriage. During transport, which statement would be the most appropriate one for the EMT to make to the patient?
"I really do not know what to say, but let me know how I can help you."
The EMT shows an understanding of newborn resuscitation when she states:
"Interventions in a newborn should be performed for 30 seconds followed by reassessment."
A 25-year-old female presents with abdominal pain. She appears thin and healthy, but in obvious distress. Of the many questions the EMT may ask, which one should the EMT ask early during the patient interview?
"Is there any possibility you are pregnant?"
You are transporting a young female who just had a miscarriage at home. During the transport the woman weeps continually. Which statement is most appropriate given the situation?
"Is there anything that I can do to help you right now?"
Which statement made by a pregnant patient in labor should be of most concern to the EMT?
"My water broke two days ago."
You have determined that you will need to perform a field delivery. Which instructions to the patient show that the EMT is properly positioning her?
"Please lie on your back, draw your knees upward, and spread your legs apart."
Which statement made by the EMT indicates an understanding of the relationship between seizures and pregnancy?
"Prolonged seizures can easily cause the mother and baby to become hypoxic."
Which statement regarding the placenta, made by your EMT partner while reviewing the OB/GYN protocols, is most accurate?
"The placenta typically delivers itself within 20 minutes of the birth of the baby."
The EMT shows she has a proper understanding of Braxton-Hicks contractions when he says:
"They are often irregular and less painful than labor contractions, but they should still be evaluated by the hospital."
When asked, a young female with abdominal pain replies that she is not sure if she is pregnant. Given this response, which question would provide the best information to determine if the patient may be pregnant?
"When was your last normal menstrual period?"
What would the minimum expected preductal SpO2 reading be at one minute after birth?
60%
What are the stages of labor in the order in which they occur?
Dilation, expulsion, and placental delivery
You are assessing a 29-year-old pregnant female who has signs of imminent delivery. Her past medical history includes HIV infection. Compared to a patient with no infectious disease, how will standard precautions differ for this patient?
Gloves, a gown, and eye protection should be worn for both the patient with HIV and the noninfectious patient
When do most women experience a decrease in the nausea and vomiting associated with hyperemesis gravidarum?
Between 14 and 20 weeks
A female patient is 34 weeks pregnant, and you are delivering the baby. As soon as the baby is completely delivered, you should immediately:
Dry the baby with a warm towel
A young female complains of sharp pain to the left lower quadrant of her abdomen. She states that her last period was seven weeks ago. With this information, the EMT should be suspicious of:
Ectopic pregnancy
A 32-year-old female complains of the sudden onset of sharp pain to the left side of her abdomen. She denies any medical history and when asked, admits to being sexually active. Her last menstrual period was two months ago. As an EMT, you should immediately suspect:
Ectopic pregnancy
In a normal fertilization, the egg and the sperm meet in which structure?
Fallopian tube
Upon arrival at the home of a woman in labor, a midwife on scene tells you the patient is 7 cm dilated and is complaining of painful contractions. Which stage of labor should the EMT identify?
First stage
When should the EMT instruct his partner to cut the umbilical cord?
Following delivery and after the baby has been dried off
You are assessing a female patient who informs you that she has been pregnant four times before but delivered only once. What would be a correct way to document that information on the prehospital care report?
Gravida IV; para I
After the EMT observes that secretions are interfering with the baby's breathing, which action indicates that the EMT is properly suctioning the newborn?
He squeezes the bulb syringe prior to placing it in the baby's nose
Which single assessment finding is most consistent with a stable newborn?
Heart rate of 140 beats per minute
The components of the Apgar scoring system include:
Heart rate, spontaneous activity, and respirations
When treating a patient whom you believe has an ectopic pregnancy, you know that the primary threat to the patient's life is:
Hemorrhage
You arrive at the residence of a physician who informs you that his pregnant wife requires immediate transport to the hospital because she is bleeding and has a history of abruptio placentae. As a knowledgeable EMT, you should recognize that the greatest threat to the baby is:
Hypoxia
A newborn's first Apgar score was 6. His second Apgar score is 9. What does this information mean to the EMT?
Improvement
As soon as the baby is delivered from the vaginal canal, it is critical that the EMT immediately:
Initiate drying and warming of the newborn
You have completed the assessment of a 32-year-old patient who is starting her seventh month of pregnancy. During your assessment, which finding should you be most concerned about?
Intermittent vaginal bleeding
During a continuing education session on OB/GYN topics, the EMT would recognize which statement about the umbilical cord as true?
It contains one vein and two arteries
Why is the uterus essential to a healthy pregnancy and childbirth?
It powerfully contracts to force the fetus from the mother's body following gestation
Assessment of a newborn indicates that she has slow and irregular respirations with a weak cry. You should award her how many points according to the Apgar scoring system?
1
Assessment of a newborn indicates that his heart rate is 120 beats per minute. How many points should he be awarded according to the Apgar scoring system?
2
How many newborns will require a level of care that falls below the top tier of the neonatal resuscitation pyramid?
20 percent
While examining a pregnant patient who has not received prenatal medical care, you note that you can palpate the uterine fundus at the level of the umbilicus. What is the approximate gestational age of the fetus?
20 weeks
The EMT is performing CPR on a neonate. What is the correct compression-to-ventilation ratio?
3 compressions to every 1 ventilation
By the time a fetus reaches full term, the tidal volume of the female has increased by:
40 percent
When asked by a concerned newborn parent, the EMT should indicate that an acceptable respiratory rate for the newborn is:
52 breaths per minute
The EMT would recognize which neonate as premature?
A baby weighing 7 pounds 4 ounces born at 36 weeks
Which statement regarding limb presentation is true during childbirth?
A cesarean section birth will likely be required
You have been called for a 35-year-old female who is experiencing vaginal spotting. The patient states that she has noted the discharge of blood from her vagina and is concerned because she is 36 weeks pregnant. She has also experienced some abdominal pain, which she describes as "sharp." Your assessment reveals bleeding as noted and tenderness on palpation just right to the midline of her abdomen. Her pulse is 122 beats/min, respirations are 22 breaths/min, blood pressure is 118/82 mmHg, SpO2 is 96%, and oral temperature is 97.3degreesF. Based on this presentation, you would:
Administer high-concentration oxygen and immediately transport the patient
Despite the increase in maternal blood volume, the pregnant patient is typically:
Anemic
What would the expected preductal SpO2 reading be at 5 minutes after birth?
At least 80%
A female patient tells you that she is 38 weeks pregnant. Where would you expect to palpate the top of the uterus during your exam?
At the level of the xiphoid process
While delivering a baby, you note that the umbilical cord is wrapped around the baby's neck. You would:
Attempt to slip the cord over the baby's shoulders or head
The EMT should recognize a full-term pregnancy has occurred in which patient?
A 21-year-old woman who is 39 weeks pregnant and feeling dizzy
Which patient should the EMT be most suspicious of having a spontaneous abortion?
A 21-year-old woman, 6 weeks pregnant, passing vaginal blood clots
Which action shows that the EMT is properly caring for the umbilical cord after delivery?
A 6-inch segment of cord is still connected to the baby
You have been called to a residence for a 21-year-old female in labor. On arrival, you immediately see that the head of the baby is out of the vagina. While delivering the head, the mother tells you that she is having twins. The EMT should immediately:
Call for another EMS crew
You are in the process of performing a field delivery and have just delivered the baby's head. What should you do next?
Check the neck for the umbilical cord
You arrive at the side of a pregnant patient in her third trimester who has had vaginal bleeding for several hours. Observation reveals several blood-soaked towels on the bed. She is alert and oriented with a patent airway and adequate breathing. Her pulse is 88 beats per minute and her blood pressure is 104/66 mmHg. In caring for this patient you would:
Collect all towels with blood and transport them with the patient
It has been 30 minutes and the placenta has yet to deliver. The EMT should:
Continue to monitor the mother and baby
A female patient has acute onset of right-sided abdominal pain, describes it as sharp, and rates it as 9/10. The primary survey reveals no life threats, but her skin is cool and diaphoretic. She states that she has been going to the bathroom more and is worried because her father has diabetes. Her last period was nine weeks ago, and she has a history of irregular periods. Her heart rate is 122 beats/min, respirations are 20 breaths/min, blood pressure is 138/68 mmHg, and SaO2 is 97%. In this scenario, which bit of information is of most concern to the EMT?
Last period nine weeks ago
When cutting the umbilical cord, how should the baby be positioned?
Level with the mother's uterus
The EMT recognizes the underlying pathophysiology associated with the most common type of ectopic pregnancy is a fertilized egg that is:
Lodged in a fallopian tube
When should the EMT use the Apgar scoring system on a newborn?
One and five minutes after the baby has been delivered
Which action demonstrates that the EMT is correctly performing uterine massage?
One hand cups the top of the uterus, with one of the hands positioned just above the symphysis pubis
A female patient who is eight and a half months pregnant states that she does not feel well and is weak with clammy skin. She denies chest pain, shortness of breath, and dizziness. She states that she did vomit earlier in the morning and still feels somewhat nauseated. She is alert and oriented and has a patent airway. She is breathing 18 times per minute and has a heart rate of 88 beats per minute. Her blood pressure is 116/70 mmHg and her SpO2 reading is 95% on room air. The most appropriate care for this patient should include:
Oxygen at 15 lpm via a nonrebreather face mask
After delivery, you note blood still escaping from the mother's vagina. The sanitary pads that you placed earlier between her legs continue to become soaked. Your next action would be to:
Perform a uterine massage
You have been called to assist another crew with the birth of a baby. On scene, another EMT informs you that the mother's perineum tore and is bleeding heavily. You would:
Place a sterile dressing between the mother's vagina and rectum
You have been dispatched for a young female in labor. On arrival, you find an arm protruding from the vagina. What should you do next?
Place the mother in a knee-chest position
A 31-year-old female is in labor. After ensuring her airway, breathing, and circulation, you assess her perineum and observe the umbilical cord protruding from the vagina. However, the baby is not visible. Your next action would be to:
Place the patient in a knee-chest position
Assessment of a pregnant patient in labor reveals what appears to be the baby's buttocks presenting at the vaginal opening. The EMT would immediately:
Place the patient in supine, head-down position, with hips elevated, and administer supplemental oxygen
You have arrived at the side of a 35-year-old female who is 37 weeks pregnant and in labor. Your exam reveals crowning with contractions 60 seconds apart. Your immediate action would be to:
Place the patient on her back, and then open and prepare the OB kit
A 22-year-old female, who is eight months pregnant, calls 911 for vaginal bleeding. Your primary assessment reveals no acute life threats, but the patient does have some evidence of blood in her underwear. The patient denies abdominal pain. Her vital signs are normal. Given these findings, the EMT should be suspicious of:
Placenta previa
If the placenta attaches over the cervix, the patient and fetus would be at risk for which condition?
Placenta previa
You have been called for a 27-year-old female who is 32 weeks pregnant. She states that she is experiencing uterine contractions but feels no pain with them, just a tightening in her abdomen. The contractions began three days ago and seem to be increasing in frequency today. She denies discharge or rupture of her membranes. Given this presentation, you should recognize:
Probable false labor, but have the patient transported to the hospital for evaluation
During which abnormal birth presentation is it permissible for the EMT to place a gloved hand into the vaginal canal?
Prolapsed umbilical cord
While en route for a call involving a pregnant patient, an Emergency Medical Responder (EMR) on scene contacts you and reports that the patient is actively seizing. The EMR reports that she is seven months pregnant and has not been feeling well for the past three days (per family). Which instruction is critical for you to relay to the EMR?
Provide oxygen at 15 liters per minute
You are completing the delivery of a near term baby boy when you notice that the fluid expelled with the baby is greenish-brown. At this point you should:
Quickly suction the nose and mouth only if the newborn's condition is depressed
You are delivering a baby in the patient's house. As the baby's head appears at the opening of the vagina, you notice that the amniotic membrane is still intact. You would:
Rip open the amniotic sac with your fingers
You have been dispatched to a residence for a female patient who is dizzy and "passing out." An Emergency Medical Responder meets you at the door and reports that the patient is lying in bed and is nine months pregnant. Her pulse rate is 112 beats per minute and her blood pressure is 84/50 mmHg. Respirations are 24 breaths per minute and she has a room air pulse oximetry reading of 97%. What should you do as soon as you reach the patient's side?
Roll her onto her left side
You are by the side of a 19-year-old female who is 36 weeks pregnant. When assessing this patient, which finding best indicates that she is in preterm labor?
Rupture of the amniotic sac
You have been called to a home for a female in labor. On scene, the family tells you that the 37-year-old patient is 42 weeks pregnant and wanted to have her baby at home naturally. The patient has been in labor for more than 24 hours, but suddenly began complaining of severe and tearing abdominal pain. Which condition should the EMT suspect?
Ruptured uterus
A female patient is described as primigravida. Consequently, the EMT would recognize that:
She is pregnant for the first time
You are responding to a low-income apartment complex for a 16-year-old female who is five weeks pregnant with vaginal bleeding. When mentally reviewing possible causes of hemorrhage for this patient, which condition are you most likely to encounter given the information provided thus far?
Spontaneous abortion
Despite positive pressure ventilation, a term newborn's heart rate has decreased from 80 beats per minute to 40 beats per minute. He is breathing spontaneously but shallowly at 40 breaths per minute and has a mottled appearance. Your next action would be to:
Start external chest compressions
Assessment indicates that a term newborn's respiratory rate is 38 breaths per minute and his heart rate is 80 beats per minute after administration of supplemental blow-by oxygen. The EMT should:
Start positive pressure ventilation with supplemental oxygen
After positive pressure ventilation, a newborn's heart rate increases from 80 to 120 beats per minute. The EMT should:
Stop positive pressure ventilation and provide blow-by oxygen
