Chapter 31

place her in a left lateral recumbent position.

A 33-year-old woman who is 36 weeks pregnant is experiencing scant vaginal bleeding. During transport, you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. In addition to administering 100% oxygen, you should: A. place her in a left lateral recumbent position. B. position her supine and elevate her legs 12″. C. carefully place sterile gauze into her vagina. D. assist her ventilations with a bag-mask device.

an ectopic pregnancy.

A history of pelvic inflammatory disease or tubal ligations increases a woman's risk for: A. preeclampsia. B. placenta previa. C. gestational diabetes. D. an ectopic pregnancy.

16 hours.

A mother who is pregnant with her first baby is typically in the first stage of labor for approximately: A. 4 hours. B. 8 hours. C. 10 hours. D. 16 hours.

15 to 30

A newborn infant will usually begin breathing spontaneously within _______ seconds following birth. A. 3 to 5 B. 5 to 10 C. 15 to 30 D. 30 to 60

is wrapped around the baby's neck.

A nuchal cord is defined as an umbilical cord that: A. has separated from the placenta. B. is wrapped around the baby's neck. C. is lacerated due to a traumatic delivery. D. has abnormally developed blood vessels.

have delivered a baby before.

A precipitous labor and delivery is MOST common in women who: A. have gestational diabetes. B. are younger than 30 years of age. C. have delivered a baby before. D. are pregnant for the first time.

pregnant patients have an overall increase in blood volume.

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because: A. pregnant patients can dramatically increase their heart rate. B. pregnancy causes vasodilation and a lower blood pressure. C. pregnant patients have an overall increase in blood volume. D. blood is shunted to the uterus and fetus during major trauma.

the placenta prematurely separates from the uterine wall.

Abruptio placenta occurs when: A. the placenta prematurely separates from the uterine wall. B. a tear in the placenta causes severe internal hemorrhage. C. the placenta affixes itself to the outer layer of the uterus. D. the placenta develops over and covers the cervical opening.

ensure that it is thoroughly dried and warmed.

After a baby is born, it is important to: A. ensure that it is thoroughly dried and warmed. B. position it so that its head is higher than its body. C. cool the infant to stimulate effective breathing. D. immediately clamp and cut the umbilical cord.

easier breathing.

After the fetus has descended into the pelvis at the end of the third trimester, many mothers experience: A. midback pain. B. a bloated feeling. C. an urge to push. D. easier breathing.

20 weeks.

An abortion occurs when the fetus and placenta deliver before: A. 20 weeks. B. 24 weeks. C. 26 weeks. D. 28 weeks.

weighs less than 5 lb or is born before 36 weeks' gestation.

An infant is considered to be premature if it: A. is born before 38 weeks' gestation or weighs less than 6 lb. B. weighs less than 5.5 lb or is born before 37 weeks' gestation. C. is born before 40 weeks' gestation or weighs less than 7 lb. D. weighs less than 5 lb or is born before 36 weeks' gestation.

alleviation of pain with movement or changing positions.

Braxton-Hicks contractions are characterized by: A. regular contractions of progressively increasing intensity. B. alleviation of pain with movement or changing positions. C. pink or red bloody show in conjunction with the contractions. D. a rupture of the amniotic sac just before the contractions begin.

belly button.

By the 20th week of pregnancy, the uterus is typically at or above the level of the mother's: A. belly button. B. pubic bone. C. xiphoid process. D. superior diaphragm.

positive-pressure ventilations.

Common interventions used to stimulate spontaneous respirations in the newborn include all of the following, EXCEPT: A. suctioning of the upper airway. B. thorough drying with a towel. C. positive-pressure ventilations. D. some form of tactile stimulation.

is pregnant for the first time.

The term primigravida refers to a woman who: A. has never been pregnant. B. has had only one live birth. C. is pregnant for the first time. D. has had more than one live baby.

suctioning the nose first may cause the baby to gasp and aspirate fluid.

During delivery of the baby's head, you should suction the mouth before the nose because: A. suctioning the nose first may cause the baby to gasp and aspirate fluid. B. it is easier to suction larger volumes of fluid from the baby's oropharynx. C. babies are primarily mouth breathers and do not breathe through their nose. D. the mucosa of the nose is fragile and is easily damaged by vigorous suctioning.

the mother may become nauseated and vomit.

During delivery, it is MOST important to position your partner at the mother's head because: A. the mother may become nauseated and vomit. B. the mother needs to be apprised of the situation. C. she may need emotional support during the delivery. D. mothers often need assisted ventilation during delivery.

Apply gentle pressure to the baby's head as it delivers.

During your visual inspection of a 19-year-old woman in labor, you see the baby's head crowning at the vaginal opening. What should you do? A. Apply gentle pressure to the baby's head as it delivers. B. Tell the mother not to push and transport her immediately. C. Place your fingers in the vagina to assess for a nuchal cord. D. Maintain firm pressure to the head until it completely delivers.

seizures that result from severe hypertension.

Eclampsia is MOST accurately defined as: A. high levels of protein in the patient's urine. B. hypertension in the 20th week of pregnancy. C. seizures that result from severe hypertension. D. a blood pressure greater than 140/90 mm Hg.

profound tachycardia.

Fetal complications associated with drug- or alcohol-addicted mothers include all of the following, EXCEPT: A. low birth weight. B. profound tachycardia. C. premature delivery. D. respiratory depression.

firmly massage the uterine fundus with a circular motion.

Following delivery of a full-term baby, you have properly cared for the baby and have clamped and cut the umbilical cord. During transport, you note that the mother is experiencing moderate vaginal bleeding. You should: A. elevate her legs 6″ to 8″ and cover her with a blanket. B. firmly massage the uterine fundus with a circular motion. C. carefully insert a sterile trauma dressing into her vagina. D. place her legs together and position her on her left side.

provide emotional support to the mother.

Following delivery of a pulseless and apneic infant who has a foul odor, skin sloughing, and diffuse blistering, you should: A. begin full resuscitation and transport. B. report the case to the medical examiner. C. provide emotional support to the mother. D. dry the infant off to stimulate breathing.

Uterus

From what internal female organ is the fetus expelled during delivery? A. vagina B. uterus C. cervix D. perineum

transporting to an appropriate facility.

General treatment guidelines when caring for a woman with traumatic vaginal bleeding include: A. carefully removing impaled objects. B. transporting to an appropriate facility. C. packing the vagina with sterile dressings. D. cleaning external wounds with sterile water.

7:57.

If a baby is born at 7:52, the second Apgar score should be calculated at: A. 7:53. B. 7:57. C. 7:59. D. 8:00.

provide ventilations for 30 seconds.

If a newborn's heart rate is less than 60 beats/min following delivery, you should: A. flick the soles of its feet. B. begin chest compressions. C. resuction the mouth only. D. provide ventilations for 30 seconds.

elevate the right side of the board with rolled towels or blankets.

If a pregnant patient requires spinal immobilization, you should secure her to the backboard and then: A. tilt the board 30° to the right to prevent hypotension. B. elevate the right side of the board with rolled towels or blankets. C. raise the foot of the board 12″ in order to maintain blood pressure. D. elevate the head of the board 6″ to prevent breathing impairment.

has an even proportionately larger head.

In contrast to a full-term infant, a premature infant: A. has an even proportionately larger head. B. is often covered with excess vernix material. C. is one who is born before 38 weeks' gestation. D. retains heat better because of excess body hair.

on the first day of her last menstrual cycle.

Most medical models base a pregnant woman's due date: A. two weeks after her last menstrual cycle. B. on the last day of her last menstrual cycle. C. two weeks before her last menstrual cycle. D. on the first day of her last menstrual cycle.

development of the placenta over the cervical opening.

Placenta previa is MOST accurately defined as: A. delivery of a portion of the placenta before the baby. B. premature placental separation from the uterine wall. C. abnormal development and functioning of the placenta. D. development of the placenta over the cervical opening.

30th

Preeclampsia MOST commonly occurs after the ____ week of gestation. A. 12th B. 20th C. 24th D. 30th

pregnancy causes a decreased number of red blood cells, which predisposes the mother to anemia.

Pregnant women are advised to take iron supplements, such as prenatal vitamins, because: A. iron makes the blood clot faster, which protects the mother from excessive bleeding during delivery. B. the blood naturally thins during pregnancy, which predisposes the mother to severe bleeding. C. white blood cells decrease during pregnancy, which increases the mother's risk of an infection. D. pregnancy causes a decreased number of red blood cells, which predisposes the mother to anemia.

headache and edema.

Signs and symptoms of preeclampsia include: A. headache and edema. B. marked hypoglycemia. C. dyspnea and bradycardia. D. dysuria and constipation.

a portion of the spinal cord or meninges protrudes outside of the vertebrae.

Spina bifida is a developmental defect in which: A. an excessive amount of cerebrospinal fluid damages the spinal cord. B. nerve fibers that arise from the spinal cord do not function properly. C. the spinal column is severely deformed, resulting in permanent paralysis. D. a portion of the spinal cord or meninges protrudes outside of the vertebrae.

the pregnant uterus compresses the inferior vena cava.

Supine hypotensive syndrome occurs when: A. a supine position kinks the ascending aorta. B. the pregnant uterus compresses the inferior vena cava. C. the superior vena cava is compressed by the uterus. D. blood pressure decreases as a result of hypovolemia.

breech presentation and prolapsed umbilical cord.

The ONLY indications for placing your gloved fingers in the vagina during delivery are: A. breech presentation and prolapsed umbilical cord. B. limb presentation and severe vaginal hemorrhage. C. vertex presentation and delivery of the placenta. D. nuchal cord and presentation of an arm or leg.

insulate and protect the fetus.

The amniotic fluid serves to: A. transfer oxygen to the fetus. B. insulate and protect the fetus. C. remove viruses from the fetus. D. assist in fetal development.

internal bleeding caused by a ruptured ectopic pregnancy.

The leading cause of maternal death during the first trimester of pregnancy is: A. massive brain damage secondary to a prolonged seizure. B. unrecognized or untreated supine hypotensive syndrome. C. internal bleeding caused by a ruptured ectopic pregnancy. D. blunt trauma to the abdomen during a motor vehicle crash.

contractions of the uterus.

The onset of labor begins with: A. thinning of the uterus. B. full dilation of the cervix. C. increased fetal movement. D. contractions of the uterus.

that the baby's airway may be obstructed.

The presence of thick meconium in the amniotic fluid indicates: A. an expected finding in full-term infants. B. that the baby's airway may be obstructed. C. that the fetus is at least 4 weeks premature. D. that full newborn resuscitation will be needed.

the small amount of pink-tinged mucus that is discharged from the vagina after expulsion of the mucous plug.

The term "bloody show" is defined as: A. the small amount of pink-tinged mucus that is discharged from the vagina after expulsion of the mucous plug. B. mild vaginal bleeding that occurs within the first 30 minutes after the onset of the second stage of the labor process. C. the normal amount of vaginal bleeding that occurs within the first 24 hours following delivery of the baby and placenta. D. any volume of blood that is expelled from the vagina after the amniotic sac has ruptured and contractions have begun.

baby is expelled from the vagina.

The third stage of labor begins when the: A. placenta is fully delivered. B. cervix is completely dilated. C. umbilical cord has been clamped. D. baby is expelled from the vagina.

carries oxygen to the baby via the umbilical vein.

The umbilical cord: A. separates from the placenta shortly after birth. B. carries blood away from the baby via the artery. C. carries oxygen to the baby via the umbilical vein. D. contains two veins and one large umbilical artery.

birth canal.

The vagina and the neck of the uterus comprise the: A. womb. B. cervix. C. fundus. D. birth canal.

attempt to slip the cord gently over the infant's head.

Upon delivery of an infant's head, you note that the umbilical cord is wrapped around its neck. You should: A. immediately clamp and cut the umbilical cord. B. give 100% oxygen to the mother and transport at once. C. provide free-flow oxygen to the infant and transport. D. attempt to slip the cord gently over the infant's head.

Puncture the sac and suction the baby's mouth and nose.

Upon delivery of the baby's head, you note that its face is encased in the unruptured amniotic sac. You should: A. give the mother 100% oxygen and transport at once. B. puncture the sac and suction the baby's mouth and nose. C. leave the amniotic sac intact until arrival at the hospital. D. note the color of the amniotic fluid before breaking the sac.

there is meconium in the amniotic fluid.

Vigorous suctioning of a newborn's airway is indicated if: A. there is meconium in the amniotic fluid. B. positive-pressure ventilations are indicated. C. the newborn presents with labored breathing. D. his or her heart rate is less than 60 beats/min.

start of one to the start of the next.

When determining the frequency of contractions, you should time the contractions from the: A. end of one to the start of the next. B. start of one to the end of the next. C. end of one to the end of the next. D. start of one to the start of the next.

on a firm surface with her hips elevated 2″ to 4″.

When preparing a pregnant patient for delivery, you should position her: A. in a supine position with her legs spread. B. on her left side with the right leg elevated. C. in a sitting position with her hips elevated 12″. D. on a firm surface with her hips elevated 2″ to 4″.

take quick short breaths.

When the mother is experiencing a contraction, you should instruct her to: A. hold her breath. B. push for 30 seconds. C. take quick short breaths. D. rest and breathe deeply.

body size

Which of the following is NOT a component of the Apgar score? A. pulse B. activity C. grimace D. body size

return of contractions following delivery of the baby

Which of the following is NOT generally considered an obstetrical emergency? A. failure of the placenta to deliver after 30 minutes B. significant bleeding after delivery of the placenta C. return of contractions following delivery of the baby D. more than 500 mL of blood loss before placental delivery

increased respiratory rate and decreased respiratory reserve

Which of the following is a normal physiologic change that occurs in the mother's respiratory system during pregnancy? A. decreased respiratory rate and increased minute volume B. increased respiratory rate and decreased respiratory reserve C. increased respiratory reserve and decreased oxygen demand D. increased respiratory depth and decreased respiratory rate

crowning of the baby's head

Which of the following is an indication of imminent birth? A. rupture of the amniotic sac B. crowning of the baby's head C. irregular contractions lasting 10 minutes D. expulsion of the mucus plug from the vagina

Uterine contractions become more regular.

Which of the following occurs during true labor? A. Uterine contractions decrease in intensity. B. The uterus becomes very soft and movable. C. Uterine contractions become more regular. D. Uterine contractions last about 10 seconds.

The inner lining of the uterus thickens in preparation for implantation.

Which of the following processes occurs during ovulation? A. Certain female hormone levels decrease significantly in quantity. B. The endometrium sheds its lining and is expelled from the vagina. C. The inner lining of the uterus thickens in preparation for implantation. D. Numerous follicles mature and release eggs into the fallopian tubes.

"Have you had a sonogram?"

Which of the following questions is of LEAST pertinence when determining whether a mother will deliver her baby within the next few minutes? A. "When are you due?" B. "Is this your first baby?" C. "Have you had a sonogram?" D. "Do you feel the urge to push?"

A breech presentation occurs when the buttocks are the presenting part.

Which of the following statements regarding a breech presentation is MOST correct? A. A breech presentation occurs when the buttocks are the presenting part. B. There is minimal risk of trauma to the infant with a breech presentation. C. It is impossible to deliver a breech presentation in the prehospital setting. D. Breech deliveries occur rapidly, so the EMT should deliver at the scene.

In some cases, women with gestational diabetes require insulin injections.

Which of the following statements regarding gestational diabetes is correct? A. Gestational diabetes results in permanent diabetes mellitus after delivery. B. The onset of gestational diabetes typically manifests with hypoglycemia. C. In some cases, women with gestational diabetes require insulin injections. D. Diet and exercise are typically ineffective in controlling gestational diabetes.

The placenta allows oxygen, carbon dioxide, and other products to transfer between the mother and fetus but does not allow blood to mix between the mother and fetus.

Which of the following statements regarding the placenta is correct? A. The placenta allows oxygen, carbon dioxide, and other products to transfer between the mother and fetus but does not allow blood to mix between the mother and fetus. B. The placental barrier consists of two layers of cells and allows the mother's blood that contains high concentrations of oxygen to directly mix with the blood of the fetus. C. The placenta, also referred to as the afterbirth, provides oxygen and nutrients to the fetus and is expelled from the vagina about 30 minutes before the baby is born. D. The placenta allows for the transfer of oxygen and carbon dioxide between the mother and fetus but prevents most medications from passing between the mother and fetus.

Most twins are born within 45 minutes of each other.

Which of the following statements regarding twins is correct? A. Twins are typically larger than single infants. B. Identical twins are typically of different gender. C. Most twins are born within 45 minutes of each other. D. Fraternal twins have two cords coming from one placenta.

push the infant's head away from the cord.

While examining a woman in labor, you see the umbilical cord protruding from the vagina. You should: A. carefully push the cord back into the vagina. B. push the infant's head away from the cord. C. cover the umbilical cord with a dry dressing. D. gently pull on the cord to facilitate delivery.

assess her for crowning.

You are assessing a 25-year-old woman who is 39 weeks pregnant. She is experiencing regular contractions that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the standard precautions, you should: A. apply 100% oxygen. B. place her on her left side. C. assess her for crowning. D. transport her immediately.

8

You have just delivered a baby boy. His body is pink, but his hands and feet are blue. His heart rate is approximately 110 beats/min and his respirations are rapid and irregular. He has a weak cry when stimulated and resists attempts to straighten his legs. His Apgar score is: A. 6 B. 7 C. 8 D. 9

Assess the brachial or umbilical pulse.

You have just delivered a full-term infant. His respirations are rapid and irregular, and he has a strong cry. What should you do next? A. Allow the mother to hold her baby. B. Clamp and cut the umbilical cord. C. Assess the brachial or umbilical pulse. D. Begin assisting the newborn's breathing.

keep him warm and provide ventilatory assistance.

You have just delivered a premature baby. Your assessment reveals that he is breathing adequatelyhowever, his heart rate is 90 beats/min. You should: A. keep him warm and provide ventilatory assistance. B. begin chest compressions and reassess in 30 seconds. C. clamp and cut the umbilical cord and keep him warm. D. assess his skin color and give free-flow oxygen as needed.

placing the mother supine with her head down and pelvis elevated.

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's leg is protruding from the vagina. Appropriate management of this situation includes: A. placing the mother supine with her head down and pelvis elevated. B. gently pulling on the infant's leg in an attempt to facilitate delivery. C. placing the mother in a recumbent position and rapidly transporting. D. carefully attempting to push the infant's leg off of the umbilical cord.