Chapter 34 Obstetrics and Neonatal Care

10.A newborn is considered to be "term" if it is born after ____ weeks and before ____ weeks. A.34; 37 B.37; 42 C.38; 44 D.39; 43

B.37; 42 Rationale: A term gestation ranges between 37 and 42 weeks. An infant who is born before 37 weeks' gestation (or weighs less than 5 lb, regardless of gestational age) is considered premature. An infant born after 42 weeks is considered past due.

5.Upon delivery of the baby's head, you note that the umbilical cord is wrapped around its neck. You should: A.immediately clamp and cut the cord. B.make one attempt to slide the cord over the head. C.keep the cord moist and transport as soon as possible. D.give the mother high-flow oxygen and transport rapidly.

B.make one attempt to slide the cord over the head. Rationale: If the umbilical cord is wrapped around the baby's neck (nuchal cord), you should make one attempt to gently remove the cord from around the baby's neck. If this is not possible, the cord should be clamped and cut. Keep the cord moist, administer high-flow oxygen to the mother, and transport at once.

2.A 23-year-old woman, who is 24 weeks pregnant with her first baby, complains of edema to her hands, a headache, and visual disturbances. When you assess her vital signs, you note that her blood pressure is 160/94 mm Hg. She is MOST likely experiencing: A.eclampsia. B.preeclampsia. C.a hypertensive crisis. D.chronic water retention.

B.preeclampsia. Rationale: Preeclampsia—also called pregnancy-induced hypertension—usually develops after the 20th week of gestation and most commonly affects primigravida (first pregnancy) patients. It is characterized by a headache, visual disturbances, edema of the hands and feet, anxiety, and high blood pressure. Preeclampsia can lead to eclampsia, a life-threatening condition that is characterized by seizures.

If a newborn's heart rate is 75 beats/min, what should you do? Keep the newborn warm and assess him or her continuously. Begin assisted ventilation with a bag-mask device and room air. Begin assisted ventilation with a bag-mask device and 100% oxygen. Begin chest compressions.

Begin assisted ventilation with a bag-mask device and room air.

8.The MOST effective way to prevent cardiopulmonary arrest in a newborn is to: A.rapidly increase its body temperature. B.allow it to remain slightly hypothermic. C.ensure adequate oxygenation and ventilation. D.start CPR if the heart rate is less than 100 beats/min.

C.ensure adequate oxygenation and ventilation. Rationale: Cardiopulmonary arrest in infants and children (including newborns) is most often the result of respiratory arrest. Therefore, ensuring adequate oxygenation and ventilation at all times is critical. It is also important to maintain the infant's body temperature and to prevent hypothermia.

4.Immediately after delivery of the infant's head, you should: A.suction the baby's mouth and then nose. B.suction the baby's nose and then mouth. C.assess the baby's breathing effort and skin color. D.check the position of the umbilical cord.

D.check the position of the umbilical cord. Rationale: Immediately following delivery of the infant's head, you should check the position of the umbilical cord to make sure it is not wrapped around the baby's neck (nuchal cord). If a nuchal cord is not present, suction the infant's mouth and nose.

6.The need for and extent of newborn resuscitation is based on: A.the 1-minute Apgar score. B.the gestational age of the newborn. C.the newborn's response to oxygen. D.respiratory effort, heart rate, and color.

D.respiratory effort, heart rate, and color. Rationale: The need for and extent of newborn resuscitation is based on respiratory effort, heart rate, and skin color. The Apgar score is not used to determine if resuscitation is needed; the first score is not assigned until the newborn is 1 minute of age. Resuscitation, if needed, should commence immediately.

Labor is usually longer in a multigravida and shorter in a primigravida. True/False

False

9.While assisting a woman in labor, you visualize her vaginal area and see an arm protruding from her vagina. She tells you that she feels the urge to push. You should: A.cover the arm with a sterile towel and transport immediately. B.encourage her to keep pushing as you prepare for rapid transport. C.insert your gloved fingers into the vagina and try to turn the baby. D.instruct the mother to keep pushing and give her high-flow oxygen.

A.cover the arm with a sterile towel and transport immediately. Rationale: Limb presentations do not deliver in the field—period! If the mother feels the urge to push, instruct her to stop; she should pant instead. Cover the protruding limb with a sterile towel, administer high-flow oxygen to the mother, and transport immediately. Delivery must take place in the hospital.

1.The first stage of labor ends when: A.the presenting part of the baby is visible. B.contractions are less than 10 minutes apart. C.the mother experiences her first contraction. D.the amniotic sac ruptures and labor pains begin.

A.the presenting part of the baby is visible.

Which of the following is a normal change in pregnancy? Decreased blood volume Tightening of joints Increased respiratory rates and decreased minute volumes Decreased ability of blood to clot

Increased respiratory rates and decreased minute volumes

The answer to which of the following questions will help you determine whether delivery for this patient is imminent? Have you had a previous complicated pregnancy? Do you know if there is a chance of multiple deliveries? Is this your first baby? Do you use drugs or drink alcohol?

Is this your first baby?

In which of the following instances should you insert your fingers into the pregnant patient's vagina? When there is limb presentation instead of the normal head presentation Prolapse of the umbilical cord In a breech birth In a vertex presentation

Prolapse of the umbilical cord In a breech birth

What is a primary characteristic of eclampsia? Severe, persistent headache Hypotension Seizures Bleeding

Seizures

What event marks the onset of labor? When the amniotic sac ruptures When the fetus enters the birth canal When uterine contractions begin When the woman has the urge to push

When uterine contractions begin

Which of the following statements regarding a breech presentation is correct? Select one: A. There is minimal risk of trauma to the infant with a breech presentation. B. A breech presentation occurs when the buttocks are the presenting part. 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.

a breech presentation occurs when the buttocks are the presenting part

In ____________, the placenta separates prematurely from the wall of the uterus. - abruptio placenta - placenta previa - preeclampsia - vertex presentation

abruptio placenta

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

belly button

Which of the following is not a component of the Apgar score? Select one: A. Pulse B. Grimace C. Body size D. Activity

body size

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

carries oxygen to the baby via the umbilical vein

Which of the following is an indication of imminent birth? Select one: A. Crowning of the baby's head B. Irregular contractions lasting 10 minutes C. Rupture of the amniotic sac D. Expulsion of the mucus plug from the vagina

crowing of the baby's head

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

ensure that it is thoroughly dried and warmed

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

has an even proportionately larger head

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

have delivered a baby before

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

insulate and protect the fetus

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

is pregnant for the first time

In contrast to abruptio placenta, placenta previa: Select one: A. is caused by hypertension or abdominal trauma. B. might present without significant abdominal pain. C. might not present with heavy vaginal bleeding. D. is typically associated with severe abdominal pain.

might present without significant abdominal pain

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

positive - pressure ventilations

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

pregnancy causes an increased number in red blood cells, which predisposes the mother to anemia

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

pregnant patients have an overall increase in blood volume

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

profound tachycardia

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

seizures that result from severe hypertension

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

start of one to the start of the next

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

weights less than 5 pounds or is born before 36 weeks' gestation

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

15 to 30

What would the Apgar score be for a newborn whose body is pink but whose hands and feet are cyanotic, has a pulse rate of 98 beats/min, cries but does not recoil from stimulus, resists attempts to straighten hips and knees, and has slow respirations? 4 6 8 10

6

If amniotic fluid is green, what does this signify? Premature rupture of the placenta The presence of meconium Prolonged gestation Maternal infection

The presence of meconium

Lightening occurs when the head of the fetus descends into the woman's pelvis as the fetus positions for delivery. True/False

True

Meconium in the amniotic fluid may result in respiratory distress or an airway obstruction in the newborn. True/False

True

The risk of perineal tearing during labor can be reduced by applying gentle pressure across the perineum with a sterile gauze pad. True/False

True

As you are delivering the head during birth, you observe the umbilical cord is wrapped once around the neck. What should you do? Ask the patient not to push, and prepare for immediate transport. Clamp and cut the cord, and remove the cord from around the neck. Pull on the cord to speed the delivery. Try to slip the cord gently over the head.

Try to slip the cord gently over the head.

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

Uterine contractions become more regular