Chapter 34: Obstetrics and Neonatal Care

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

A. 20 weeks.

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

From what internal female organ is the fetus expelled during delivery? A. Perineum B. Uterus C. Vagina D. Cervix

B. Uterus

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

B. 7:57.

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.

B. alleviation of pain with movement or changing positions.

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

B. birth canal.

You are attending to a 23-year-old female patient who is 16 weeks pregnant with her second child. The patient has apparently fallen and sustained an injury to her upper right arm. When you ask about the incident history, the patient is reluctant to explain what happened and becomes very quiet. Based on this information, you should: A. contact police and remain at the scene until they arrive and escort you to the hospital. B. continue your care in a private area, document any details regarding the scene and the incident, and reassure her as you provide care. C. ask more detailed questions and press the issue until you have a more detailed understanding of the incident. D. immediately remove the patient from the environment and transport.

B. continue your care in a private area, document any details regarding the scene and the incident, and reassure her as you provide care.

A common cause of shock in an infant is: A. a cardiac dysrhythmia. B. dehydration from vomiting and diarrhea. C. cardiovascular disease. D. excessive tachycardia.

B. dehydration from vomiting and diarrhea.

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.

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

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

B. increased respiratory rate and decreased respiratory reserve

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.

B. insulate and protect the fetus.

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.

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

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

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.

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.

B. profound tachycardia.

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.

B. push the infant's head away from the cord.

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.

B. the pregnant uterus compresses the inferior vena cava.

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.

B. transporting to an appropriate facility.

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

C. 16 hours.

The 1-minute Apgar score of a newborn reveals that the baby has a heart rate of 90 beats/min, a pink body but blue hands and feet, and rapid respirations. The baby cries when the soles of its feet are flicked and resists attempts to straighten its legs. You should assign an Apgar score of: A. 4. B. 6. C. 8. D. 9.

C. 8.

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.

C. Assess the brachial or umbilical pulse.

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.

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

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.

C. Most twins are born within 45 minutes of each other.

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.

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

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.

C. Uterine contractions become more regular.

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.

C. assess her for crowning.

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.

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.

C. have delivered a baby before.

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

C. positive-pressure ventilations.

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. blood is shunted to the uterus and fetus during major trauma. C. pregnant patients have an overall increase in blood volume. D. pregnancy causes vasodilation and a lower blood pressure.

C. pregnant patients have an overall increase in blood volume.

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.

C. provide emotional support to the mother.

You and your partner are both male and are attending to a 28-year-old female patient complaining of diffuse abdominal pain. The patient is 34 weeks pregnant with her first child. The patient refuses to allow you to examine her, and her husband informs you that their culture does not allow males to examine or care for pregnant women. You should: A. call for the police to ensure that patient assessment is carried out. B. insist that the patient requires proper care and that requires an adequate physical assessment and that you cannot be responsible for the outcome. C. respect the patient's wishes, ensure that the appropriate documentation is completed, and transport the patient. D. inform the patient that by calling for an ambulance, she is agreeing to the care provided and continue with your assessment and management.

C. respect the patient's wishes, ensure that the appropriate documentation is completed, and transport the patient.

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

C. return of contractions following delivery of the baby

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.

C. take quick short breaths.

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

D. "Have you had a sonogram?"

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

D. 15 to 30

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

D. 30th

When assisting ventilations in a newborn with a bag-mask device, the rate is ________ breaths/min. A. 20-30 B. 30-50 C. 35-45 D. 40-60

D. 40-60

You are transporting a woman who is 8 months' pregnant. To prevent supine hypotensive syndrome, how should you position this patient? A. On her right side B. Supine C. Semi-Fowler D. On her left side

D. On her left side

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.

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

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

D. an ectopic pregnancy.

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

D. belly button.

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.

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.

D. contractions of the uterus.

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.

D. easier breathing.

Before assessing the respiratory adequacy of a semiconscious infant or child, you must: A. ensure that his or her head is in a hyperextended position. B. routinely suction the mouth to remove oral secretions. C. insert a nasopharyngeal or oropharyngeal airway adjunct. D. ensure that the airway is patent and clear of obstructions.

D. ensure that the airway is patent and clear of obstructions.

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 inches and cover her with a blanket. B. carefully insert a sterile trauma dressing into her vagina. C. place her legs together and position her on her left side. D. firmly massage the uterine fundus with a circular motion.

D. firmly massage the uterine fundus with a circular motion.

Which of the following is not performed immediately following delivery of the infant? A. wrap the infant in a towel and place it on one side with head lowered B. be sure the head is covered and keep the neck in a neutral position C. use a sterile gauze pad to wipe the infant's mouth, then suction again D. obtain an Apgar score

D. obtain an Apgar score

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.

D. on the first day of her last menstrual cycle.

A 26-year-old female who is 34 weeks pregnant is experiencing a seizure. Her husband tells you that her blood pressure has been high and that she had been complaining of a headache for the past few days. You should: A. administer oral glucose for presumed hypoglycemia and transport. B. insert an oral airway and ventilate her with a bag-valve mask. C. elevate her legs to improve brain perfusion and keep her warm. D. place her on her side, administer high-flow oxygen, and transport.

D. place her on her side, administer high-flow oxygen, and transport.

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.

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

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.

D. provide ventilations for 30 seconds.

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.

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

D. start of one to the start of the next.

Following delivery of the placenta, the mother is experiencing vaginal bleeding. After massaging the uterine fundus and allowing the mother to breastfeed, the bleeding stops. This occurred because: A. uterine massage increases blood flow to the uterus. B. a portion of the placenta was retained in the uterus. C. breastfeeding causes uterine blood vessels to dilate. D. these actions simulate the production of oxytocin and cause uterine contraction.

D. these actions simulate the production of oxytocin and cause uterine contraction.

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.

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

During your visual inspection of a 25-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. Place your fingers in the vagina to assess for a nuchal cord. C. Maintain firm pressure to the head until it completely delivers. D. Tell the mother not to push and transport her immediately.

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

Which of the following statements regarding suctioning of a newborn's mouth and oropharynx is correct? A. Suctioning is indicated prior to cutting the cord if respiratory distress is present. B. If the head delivers facedown, the mouth and nose should be suctioned at once. C. Suctioning should be performed on all newborns immediately following delivery. D. Newborns rapidly expel fluid from their lungs and do not require suctioning.

A. Suctioning is indicated prior to cutting the cord if respiratory distress is present.

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.

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.

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.

A. breech presentation and prolapsed umbilical cord.

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

A. carries oxygen to the baby via the umbilical vein.

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.

___________ is heralded by the onset of convulsions, or seizures, resulting from severe hypertension in the pregnant woman. A. eclampsia B. placenta previa C. placenta abruptio D. supine hypotensive syndrome

A. eclampsia

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.

A. has an even proportionately larger head.

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

A. headache and edema.

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

A. is wrapped around the baby's neck.

You have just delivered a premature baby. Your assessment reveals that he is breathing adequately. However, 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.

A. keep him warm and provide ventilatory assistance.

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

A. may not present with heavy vaginal bleeding.

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.

A. place her in a left lateral recumbent position.

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.

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

Three days after delivering her baby, a 30-year-old woman complains of a sudden onset of difficulty breathing. Her level of consciousness is decreased and she is tachycardic. The EMT should suspect: A. pulmonary embolism. B. spontaneous pneumothorax. C. intrauterine bleeding. D. acute pulmonary edema.

A. pulmonary embolism.

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.

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

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

A. that the baby's airway may be obstructed.

Which of the following statements is not true? A. the leading cause of abruptly placenta is in an ectopic pregnancy B. as pregnancy progresses the uterus and larges and rises out of the pelvis C. some cultures may not permit male EMTs to examine a female patient D. gestational diabetes will clear up in most woman after delivery

A. the leading cause of abruptly placenta is in an ectopic pregnancy

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.

A. the mother may become nauseated and vomit.

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.

_________ _________ is a developmental defect in which a portion of the spinal cord protrudes outside the vertebrae.

Spina bifida

The leading cause of maternal death in the first trimester is internal hemorrhage into the abdomen following rupture of a(n) ___________ _________.

ectopic pregnancy

By the end of pregnancy, the pregnant patient's heart rate increases up to 20%, or about __________ beats more per minute.

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