ALSO Pre test
In discriminating between a viable and non-viable early intrauterine pregnancy, which one of the following criteria can be used to reliably diagnose pregnancy failure?
Mean gestational sac diameter of > 25 mm and no embryo Correct
You are attending the delivery of a 36-year-old gravida 6 para 5 female at term. Her pregnancy has been uncomplicated, with the exception of chronic hypertension treated with Labetalol 100 mg po BID. After a normal spontaneous vaginal delivery, you note a large gush of blood, prompt delivery of the placenta, and brisk vaginal bleeding. In addition to uterine massage, which of the following uterotonic agents should not be used to treat postpartum hemorrhage in this patient?
Methylergonovine 0.2 mg IM Correct
The intrapartum use of continuous electronic fetal monitoring has resulted in a reduction of which outcome?
Neonatal seizures Correct
Which one of the following is the single most important identifiable risk factor for recurrent spontaneous preterm delivery?
Prior preterm delivery Correct
Pregnant women beyond 20 weeks' gestation experiencing minor trauma (such as a fall, minor MVC, or blunt abdominal trauma) should be monitored by cardiotocograph for a minimum of how many hours?
4 hours Correct
In considering placental abruption, which of the following is correct?
Vaginal bleeding may not reflect the amount of blood loss Correct
A 22-year-old multiparous female presents to Labor and Delivery at 28 weeks' gestation after having an episode of vaginal bleeding. Initially, she noticed a small amount of blood-tinged mucus, but 1-hour before admission, she experienced a gush of bright red blood. Her first delivery was a cesarean delivery at term for failure to progress, and her second was an elective repeat cesarean delivery at 38 weeks' gestation. In evaluating and managing her vaginal bleeding, which of the following statements is true?
. A sterile speculum examination can be safely performed in women with second or third trimester vaginal bleeding before ultrasonographic evaluation of placental location Correct
In managing an early postpartum hemorrhage, what threshold volume of blood loss requires immediate maternal resuscitation measures using an interdisciplinary team approach including anesthesia, laboratory, nursing, surgery, and blood bank staff?
1500 mL Correct
An intrauterine gestational sac is typically first visible using transvaginal sonographic scanning when the maternal quantitative serum hCG reaches what level?
1500-2000 mIU/mL Correct
A 26-year-old gravida 2 para 1 female presents for her initial obstetric evaluation at 15 3/7 weeks' estimated gestational age by last normal menstrual period. In obtaining her history, you discover she had a spontaneous preterm delivery at 30 6/7 weeks' gestational age three years ago. Given her history of preterm delivery, you advise an endovaginal ultrasound as part of her intake assessment. The ultrasound is completed in the office and the cervical length is noted to be 35 mm. In counseling her about the increased risk of repeat preterm delivery, what do you recommend?
17-alpha hydroxyprogesterone caproate - 250 mg IM weekly until 36 weeks' gestation Correct
Magnesium sulfate helps prevent seizures in women with preeclampsia. According to the 2013 ACOG Hypertension in Pregnancy Task Force Guidelines, which of the following women should receive magnesium sulfate prophylaxis?
21 year-old gravida 2 para 1 female at 41 6/7 weeks' estimated gestational age, with a blood pressure of 156/98, and four hours later a blood pressure of 152/92, complaining of a headache Correct c
You are called stat to a pregnant patient's bedside on Labor and Delivery who is having a tonic-clonic seizure. She becomes pulseless and is confirmed to be in cardiac arrest. Cardiopulmonary resuscitation is immediately initiated. Her primary nurse reports the patient is full term, and was admitted two hours ago for labor management. In the face of maternal cardiopulmonary arrest after 4 minutes of adequate cardiopulmonary resuscitation, you recall the American Heart Association's goal is to achieve delivery of the fetus via emergency hysterotomy by no more than how many minutes after the mother's heart has stopped beating?
5 minutes Correct
In utilizing intrapartum continuous electronic fetal monitoring, which one of the following fetal heart rate pattern interpretations is most strongly associated with fetal acidemia?
Absent fetal heart rate baseline variability, accompanied by recurrent late decelerations Correct
Which of the following is the best strategy to prevent a postpartum hemorrhage?
Active management of the third stage of labor Correct
A 19-yo primigravida at approximately 40 weeks' estimated gestational age comes to the hospital with painful contractions. She has received no prenatal care. Examination: Cervix is 4 cm dilated and 80% effaced at station -1. Blood pressure is 164/111 mm Hg, and a urine dipstick shows 3+ protein. She reports having had severe headaches for three days and has noticed swelling in her hands and feet. Moments after her blood is drawn and IV access is obtained, she has a generalized tonic-clonic seizure. Which of the following is the most appropriate immediate course of action?
Administer magnesium sulfate six grams IV over 15-20 minutes Correct
A cesarean delivery may be considered due to failed induction after arrest of labor in which of the following primiparous labor scenarios?
After maximum oxytocin dosing for six hours with ruptured membranes, there is failure to generate adequate contractions or progress at 7 cm Correct
Which of the following is NOT typically indicated in the assessment of the patient presenting with premature contractions?
Amnioinfusion of indigo carmine Correct
In providing a practical approach to mitigate normal grief after early pregnancy loss, the clinician may include which one of the following principles in the conversation
Assess the level of grief, and adjust counseling as appropriate Correct
Postpartum hemorrhage is a common maternal morbidity in high resource countries and is on the rise. Which one of the following is the most common cause of postpartum hemorrhage?
Atonic uterus Correct
In considering an external cephalic version (ECV) for breech presentation, which of the following statements is true?
Betamimetics (e.g., terbutaline) increase the likelihood of a successful ECV Correct
According to the NICHD Fetal Heart Rate Classification System, which category tracing requires prompt evaluation and expedient interventions to address the pattern (as the tracing in this category is considered abnormal and predictive of abnormal fetal acid-base status at the time of observation)?
Category III electronic fetal monitoring tracing Correct
A 31-year-old gravida 2 para 1 female presents to Labor and Delivery in spontaneous labor at 38 6/7 weeks' gestation. She reports no rupture of membranes, vaginal bleeding, or vaginal discharge. Upon cervical exam, you discover she is 4 cm dilated, 100% effaced, and -2 station. A review of her medical record reveals a vaginal-rectal swab was positive for group B streptococcus colonization two weeks ago. She reports an allergy to penicillin but no report of anaphylaxis, angioedema, respiratory distress, or urticaria. Which of the following is the recommended regimen for intrapartum antibiotic prophylaxis for prevention of early onset group B streptococcal disease?
Cefazolin 2 g IV initial dose, then 1 g IV every 8 hours until delivery Correct
A period of continuous electronic fetal monitoring for low risk women performed upon admission for labor, compared to immediate initiation of structured intermittent auscultation results in an increase of:
Cesarean delivery Correct
A 26 year-old gravida 2 para 1 female presents to the Emergency Department at 36 2/7 weeks' estimated gestational age complaining of sudden onset chest pain, shortness of breath, and feeling very anxious. Her vital signs are: blood pressure 138/88, pulse 122, respirations 24, temperature 98.8F, and oxygen saturation 91% on room air. You suspect a pulmonary embolus. Venous Doppler studies of the lower extremities are negative for a deep venous thrombosis, but the clinical presentation makes you highly suspicious. PA and lateral chest x-rays reveal right lower lobe opacity. What would be the next step in evaluating this patient for a definitive diagnosis of pulmonary embolus?
Computed tomographic pulmonary angiogram (CTPA) Correct
Which one of the following is the most important treatment for acute fatty liver of pregnancy?
Delivery of infant
Which of the following is a major risk factor for considering assisted vaginal delivery?
Drug-induced analgesia (epidural anesthesia) Correct
In major obstetric trauma, which one of the following is evaluated as part of the primary maternal survey?
Effective circulatory volume Correct
You are attending the delivery of a term 32-year-old gravida 3 para 2 patient with gestational diabetes. The estimated fetal weight of 3800 grams. After pushing for only 20 minutes, the head spontaneously delivers but fails to restitute; the anterior shoulder does not deliver. An attempt to facilitate delivery of the anterior shoulder with gentle assistance is unsuccessful. The infant's head is retracted against the perineum. The anterior shoulder is stuck, impeded by the pubic bone of the mother's pelvis. You realize you are dealing with a shoulder dystocia. Which of the following statements is TRUE regarding this condition?
Either "enter" (rotational) maneuvers or removal of the posterior arm should be considered following unsuccessful McRoberts maneuver and suprapubic pressure Correct
You are preparing a presentation on assisted vaginal deliveries for a group of students. Upon review of your notes, you notice an error. Which one of the following statements is in accurate (or false)?
Epidural anesthesia is associated with a decreased need for an assisted vaginal delivery Correct
You are discussing prevention of shoulder dystocia with a nurse midwife student. Which of the following statements is true?
Episiotomy performed at the time of an assisted vaginal delivery does not reduce the incidence of shoulder dystocia Correct
In counseling a mother prior to an elective vacuum assisted delivery for a prolonged second stage of labor, all of the following should be discussed as potential neonatal risks associated with the procedure EXCEPT:
Facial nerve palsy Correct
Which of the following defines an occiput posterior position?
Fetal occiput toward the maternal spine Correct
Which of the following is not a part of the active management of the third stage of labor?
Fundal massage to promote placental separation. Correct
Which of the following intrapartum strategies may help to PREVENT labor dystocia?
Having a trained labor support companion (doula) present with the laboring patient Correct
Which of the following is an intrauterine resuscitative measure that can be undertaken for any fetal heart rate tracing that is concerning?
IVF bolus Correct
In the face of a shoulder dystocia, injury to the infant can produce both serious short-term and long-term consequences. Which of the following statements is true?
In utero positioning of the infant has been identified as a potential cause of brachial plexus palsy, even without the occurrence of a shoulder dystocia Correct
In discussing obstetric emergencies with a new registered nurse on Labor and Delivery, you initiate a conversation reviewing the common risk factors for postpartum hemorrhage. Which of the following is considered a risk factor?
Induction or augmentation of labor Correct
Which of the following conditions is contraindicated when planning for a vaginal breech delivery?
Intrauterine growth restriction Correct
A 32-year-old gravida 2 para 1 female at 40 6/7 weeks' estimated gestational age has been fully dilated for four hours, and has now been pushing for two hours. She is physically and emotionally exhausted, so you have a discussion with her regarding assisted vaginal delivery. Which of the following are prerequisites to an instrumented delivery?
Lack of suspicion of severe cephalopelvic disproportion Correct
A 29 year-old gravida 3 para 2 female at 28 weeks' estimated gestational age is found to have a pulmonary embolus. She is hemodynamically stable and you are discussing therapeutic anticoagulation with her. According to the 2012 American College of Chest Physicians Guidelines, the treatment of choice for venous thromboembolism in pregnancy is which one of the following?
Low-molecular weight heparin Correct
Which one of the following drugs administered to a patient in preterm labor, both immediately before and at the time of delivery, decreases the rate of cerebral palsy in a premature infant?
Magnesium Sulfate Correct
Which one of the following drugs administered to a patient in preterm labor, both immediately before and at the time of delivery, decreases the rate of cerebral palsy in a premature infant?
Magnesium sulfate Correct
Which of the following is an antenatal risk factor for shoulder dystocia?
Maternal obesity Correct
Pregnancy is associated with numerous maternal physiologic changes. In which of the following is a physiologic increase typically seen?
Oxygen consumption Correct
Clinical labor dystocia can be defined as the 95th percentile of dilatation rate at different points depending on how dilated a female is. As part of making this diagnosis, the clinician needs to address several questions, considering the "Mnemonic of P's." Which one of the following factors is NOT included for consideration in this mnemonic?
Pharmacology Correct
Which of the following is a contraindication for medical management of an ectopic pregnancy with methotrexate?
Presence of embryonic cardiac activity Correct
An experienced nurse who has just done a cervical exam on your patient calls you to Labor and Delivery. She reports that she believes the vertex is not presenting. You perform a vaginal examination and confirm the presenting part is not the vertex. In considering malpresentations, which of the following portions of the fetus that is foremost, or presenting, in the birth canal is not compatible with a vaginal delivery?
Shoulder Correct
The majority of uterine ruptures present with which one of the following clinical presentations?
Sudden deterioration of the fetal heart rate pattern Correct
Documentation in the medical record after a delivery with a shoulder dystocia is an essential risk management tool. Which of the following should be documented in the medical record pertaining to the circumstances that took place during the shoulder dystocia?
The elapsed amount of time from delivery of the fetal head until complete delivery of the baby Correct
According to the American College of Obstetricians and Gynecologists classification of instrumented deliveries, which of the following attributes is part of the definition of outlet forceps?
The fetal scalp is visible between contractions Correct
Which of the following statements regarding latent or prodromal labor is true?
The latent phase of labor begins with the maternal perception of painful uterine contractions Correct
You are caring for a 19 year old nulliparous female who is admitted secondary to regular painful contractions. Her cervix is 4 cm dilated, 100% effaced, and station 0 upon admission. You confirm no rupture of membranes. A repeat examination four hours later demonstrates little to no progress. In considering strategies to avoid labor dystocia and active-phase arrest, which of the following statements is true?
The overall duration of labor may shorten in women who receive oxytocin early in labor for slow labor progression Correct
All of the following are true statements regarding multiple gestation pregnancies EXCEPT:
There is a decreased incidence of congenital anomalies Correct
In a patient with a known placenta previa, which of the following agents may be used safely in the gravid female to prolong the gestation if preterm contractions occur WITH vaginal bleeding?
Tocolytic agents Correct
A 30-year-old nulliparous female is undergoing oxytocin augmentation at 38 weeks' estimated gestational age for chronic hypertension. Her cervix has been dilated to 6 cm for one hour. A large amount of vaginal bleeding follows her next cervical exam. The fetal heart rate tracing is a Category 2. You are concerned about a vasa previa. Assuming available resources, which of the following tests would most quickly determine if the vaginal bleeding is maternal or fetal?
Wright stain Correct
A 26 year-old gravida 2 para 1 female at 9 weeks' estimated gestational age (by last normal menstrual period) presents to the Emergency Department complaining of heavy vaginal bleeding which began two hours earlier. She denies having any sexual intercourse in the past seven days. Her vital signs are stable. A quantitative serum hCG returns at a value of 3200 mIU/mL and a transvaginal ultrasound reveals a mean gestational sac diameter of 30mm and no embryo. She reports passing no tissue and a speculum examination reveals the cervix is visually closed. In counseling the patient about her options, which of the following statements is true?
Medical management with misoprostol is more effective than expectant management Correct