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The fundus reaches the umbilicus at approximately how many weeks' gestation? A. 8 weeksB. 12 weeksC. 20 weeksD. 28 weeks
Your correct answer: C The fundus generally reaches the umbilicus around 20 weeks' gestation.
Which mechanism of injury results in the most maternal deaths? A. Motor vehicle crashes B. Gunshot wounds C. Assaults D. Suicide
Your correct answer: A Head trauma after ejection from a motor vehicle accounts for the greatest number of maternal deaths. Intimate partner violence that leads to assaults or penetrating trauma (such as gunshot wounds) is common during pregnancy, and the incidence increases as the pregnancy progresses. Although suicide is possible, it is not a common cause of mortality in pregnant women.
Which assessment finding is the best indicator of a viable fetus? A. Fundal height of 26 cm above the symphysis pubis B. Four kicks over 2 hours in a term fetus. C. Fetal heart rate greater than 160 beats per minute D. Maternal report of contractions every 3 minutes
A. Fundal height of 26 cm above the symphysis pubis Your correct answer: A A fundal height of 26 cm or more above the symphysis pubis indicates a fetus at 26 weeks' gestation, which is considered viable. About ten (not four) kicks in 2 hours indicate fetal well-being. Should this read normal or abnormal: Although a fetal heart rate greater than 160 beats per minute is considered abnormal, it does not provide an indication of fetal viability. Contractions may indicate active labor, but they do not indicate fetal viability.
When resuscitating a neonate after emergency delivery, which interventions are the priorities? A. Providing tactile stimulation and obtaining an Apgar score B. Suctioning and administering oxygen C. Positioning and initiating chest compressions D. Drying and warming
D. Drying and warming Your correct answer: D Drying and warming are the first interventions to perform after every delivery. Airway clearance and tactile stimulation may or may not be needed. If the neonate does not respond to these initial resuscitation interventions, perform additional interventions, such as administering positive pressure ventilation and initiating chest compressions. Obtain an Apgar score at 1 minute after delivery and again at 5 minutes after delivery. Do not delay resuscitation while waiting for the 1-minute Apgar score.
Which assessment provides the best information about possible fetal distress? A. Inspecting for fetal movement B. Noting the abdominal shape and contour C. Palpating for abdominal tenderness D. Determining the gestational age
Your correct answer: A Lack of fetal movement or excessive fetal movement may indicate fetal distress. Irregularity or deformity of the abdominal shape and contour and abdominal tenderness on palpation may indicate uterine rupture and signs of intra-abdominal injury, which are indications of need for immediate further maternal and fetal assessment because these can be fatal to both mother and fetus, but they do not provide direct information on fetal distress. Determining the gestational age is an important factor in caring for a pregnant trauma patient, but it provides no data on fetal distress.
Why may nitrazine paper be used? A. To differentiate amniotic fluid from vaginal fluid B. To detect fetomaternal hemorrhageC. To establish gestational ageD. To rule out abruptio placentae
Your correct answer: A Nitrazine paper is one way to test for amniotic fluid. It is not used to detect fetomaternal hemorrhage, establish gestational age, or rule out abruptio placentae.
After a minor motor vehicle crash, a woman who is 7 months pregnant arrives at the emergency department supine and in complete spinal stabilization. Assessment reveals that her skin is slightly pale, cool, and dry; her heart rate is 112 beats per minute; and her blood pressure is 72/50 mm Hg. She is awake and alert. Which of these interventions has the highest priority? A. Tilt the backboard 15 degrees to the left. B. Rapidly infuse an additional liter of intravenous fluid. C. Administer a unit of type O-negative blood. D. Monitor serial vital signs.
Your correct answer: A Tilt the backboard to shift the weight of the gravid uterus off her great vessels. Aortocaval compression may decrease cardiac output by 28% and systolic blood pressure by 30 mm Hg. This patient may require additional intravenous fluid. However, at this point, tilting the backboard takes a higher priority. The backboard should be tilted at least 15 degrees, and the patient's response to this positioning should be assessed before her decreased blood pressure is treated with blood replacement. Monitoring serial vital signs is important for ongoing care, but is not the priority at this time.
Which resuscitative intervention can cause uteroplacental vasoconstriction and adverse fetal effects? A. DefibrillationB. Vasopressor administrationC. Aggressive management of ventilationD. Lateral displacement of the uterus during compressions
Your correct answer: B Although all of these interventions may be used for resuscitation, only vasopressor administration causes uteroplacental vasoconstriction.
What information does fundal height measurement provide? A. It approximates the length of the fetus in inches. B. It estimates the gestational age of a single fetus. C. It estimates the weight of the fetus in pounds when divided by 2. D. It estimates the fetal heart rate after 8 weeks' gestation.
Your correct answer: B Fundal height measurement can estimate the gestational age of a single fetus. Measure the fundal height at the midline from the symphysis pubis to the top of the uterus. This measurement (in centimeters) correlates to the gestational age. For example, a fundal height of 25 cm corresponds to gestational age of 25 weeks. Fundal height measurement provides no information about the length, weight, or heart rate of the fetus
Along with motor vehicle crashes, what are the most common causes of blunt abdominal trauma in pregnant patients? A. Pedestrian incidents and assaultsB. Falls and assaultsC. Bicycle incidents and fallsD. Pedestrian and bicycle incidents
Your correct answer: B Motor vehicle crashes, falls, and assaults are the most common causes of blunt abdominal trauma in pregnant patients. Pedestrian and bicycle incidents are not common causes of blunt abdominal trauma in pregnant patients.
Which cardiotocographic findings indicate fetal distress? A. More than ten uterine contractions per hour and varying levels of fetal movement B. A fetal heart rate of less than 100 beats per minute and decreased variability in the fetal heart rate C. Regular fetal movement and a fetal heart rate of 110 to 160 beats per minute D. Regular variability in the heart rate and more than ten uterine contractions per hour
Your correct answer: B Signs of fetal distress include a fetal heart rate below 100 beats per minute in a term or postterm fetus, a fetal heart rate consistently below 120 beats per minute in a preterm fetus, a fetal heart rate consistently above 160 beats per minute, decreased variability in the fetal heart rate, and no fetal movement. More than ten uterine contractions per hour is a sign of labor, not fetal distress.
Which age-related consideration applies to pregnant adolescents? A. Pre-existing medical conditions may complicate the pregnancy. B. The risk of fetal chromosomal abnormalities is increased. C. Preterm labor is more common. D. Bone loss is a complication as the pregnancy progresses.
Your correct answer: C Preterm labor is more common in adolescents. Adolescent mothers frequently lack prenatal care and are less likely to be able to provide information about gestational age. Among older women, pre-existing medical conditions may complicate pregnancy and trauma. The risk of fetal chromosomal abnormalities and the incidence of osteoporosis and bone loss are increased in pregnant older women, not adolescents, which increases the risks related to maternal trauma.
You are assigned to care for a pregnant patient who, at 16 weeks' gestation, fell at home but sustained no obvious injuries. Her heart rate is 102 beats per minute. Based on the information provided, what should be your next step? A. Initiate two large-bore intravenous catheters.B. Prepare to administer two units of packed red blood cells.C. Reassess the patient in 15 minutes.D. Position the patient on her side.
Your correct answer: C A heart rate of 102 beats per minute may be normal for a pregnant patient, but it should not be dismissed. Instead, it should be rechecked and documented so that trends can be detected. The scenario does not provide enough information to indicate that volume resuscitation with crystalloids or blood is indicated. Aortocaval compression is not a concern at 16 weeks' gestation.
Which mechanism of injury is most common in pregnant women? A. Penetrating injury B. Drowning C. Blunt trauma D. Burns
Your correct answer: C Blunt trauma is the most common mechanism of injury among pregnant patients and usually results from motor vehicle crashes, falls, and assaults. Penetrating injury, typically from a gunshot or knife wound, is the second most common mechanism. Drowning and burns can also occur, but are not as common.
For a pregnant trauma patient, which intervention is performed during the focused obstetric assessment? A. Prepare for insertion of an arterial line or central venous line. B. Initiate blood replacement with Rh-compatible blood. C. Perform cardiotocography. D. Use foam wedges or pillows to tilt patient on her side.
Your correct answer: C Continuous fetal monitoring, or cardiotocography, is part of a focused obstetric assessment of a pregnant trauma patient and may be indicated for patients beyond 20 weeks' gestation. Tilting the patient to avoid aortocaval compression is performed during the circulation portion of the primary survey. Blood replacement and insertion of an arterial line or central venous line may be required during ongoing assessment and evaluation, not the focused obstetric assessment.
What is the most common cause of fetal injury from penetrating trauma? A. Burns involving the maternal abdomenB. Stab wounds to the maternal abdomenC. Gunshot wounds to the maternal lower abdomenD. Gunshot wounds to the maternal upper abdomen
Your correct answer: C Gunshot wounds are more common than stab wounds or burns in the obstetric population. Fetal injury is most likely to result from a wound to the mother's lower abdomen.
Which finding is associated with abruptio placentae? A. Blood or meconium in the urine B. Acute pain initially, followed by no pain C. Port-wine colored vaginal bleeding D. Palpation of fetal limbs outside the uterine borders
Your correct answer: C In abruptio placentae, port-wine colored vaginal bleeding occurs when blood mixes with amniotic fluid. Blood or meconium in the urine may signal uterine rupture associated with bladder injury. Acute pain initially, followed by no pain, is associated with uterine rupture. Fetal limb palpation outside the uterine borders is also associated with uterine rupture.
Which heart rate is normal for a term fetus? A. 95 beats per minuteB. 106 beats per minuteC. 127 beats per minuteD. 175 beats per minute
Your correct answer: C The normal heart rate for a term fetus ranges from 110 to 160 beats per minute. A heart rate of 127 beats per minute is within the normal range. The other heart rates are outside the normal range.
Which condition should prompt the emergency nurse to observe for signs and symptoms of disseminated intravascular coagulation? A. Spontaneous abortion B. Preterm labor C. Pregnancy-induced hypertension D. Abruptio placentae
Your correct answer: D Disseminated intravascular coagulation is a potentially fatal complication of abruptio placentae. Disseminated intravascular coagulation is not usually associated with preterm labor, pregnancy-induced hypertension, or spontaneous abortion.
You are caring for a young pregnant woman who is the victim of intimate partner abuse. She states that she is 38 weeks pregnant and expresses concern that she may lose the baby. Which of these findings is the best indicator of a potentially viable fetus? A. Two kicks in 1 hourB. Palpable fetal limbs outside the uterine borderC. A fetal heart rate that is consistently above 160 beats per minuteD. A fetal heart rate that varies from 110 to 140 beats per minute
Your correct answer: D A fetal heart rate of 110 to 140 beats per minute falls within the normal range, which is 100 to 160 beats per minute in a term fetus or 120 to 160 beats per minute in a preterm fetus. Minimal fetal movement (such as two kicks in 1 hour) and palpable fetal limbs outside the uterine border are not indications of viability.
A pregnant trauma patient is in her third trimester. Why should you place this patient in the left lateral position? A. To make her more comfortableB. To facilitate airway maneuversC. To provide easier access for fetal evaluationD. To decrease the chance of supine hypotensive syndrome
Your correct answer: D Although it may make the patient more comfortable, the goal of using the left lateral position is to relieve supine hypotensive syndrome. Also known as inferior vena cava syndrome or aortocaval compression, this syndrome can occur after about 20 weeks' gestation. Cardiac output can decrease when the mother is in a supine position because the uterus and fetus compress the vena cava and aorta. The left lateral position does not facilitate airway maneuvers or make it easier to evaluate the fetus.
When caring for an unresponsive pregnant trauma patient, which assessment is the priority? A. Observe the abdomen for fetal movement. B. Perform a brief neurologic examination. C. Check the perineum for vaginal bleeding. D. Open the mouth to look for vomitus or blood.
Your correct answer: D As with all trauma patients, the primary survey focuses on airway, breathing, circulation, disability, and exposure or environmental control. Therefore, assessing for a patent airway by opening the mouth to look for vomitus or blood is the priority. Conducting a brief neurologic examination is completed during the disability portion of the assessment, which follows assessment and intervention for airway, breathing, and circulation concerns. Checking the perineum for vaginal bleeding and observing the abdomen for fetal movement are completed during the secondary assessment
A woman, 7 months pregnant, presents to the emergency department after escaping from a house fire. Her carboxyhemoglobin level is elevated. Why is this finding significant? A. The fetus's carboxyhemoglobin level is lower than the mother's. B. The mother's risk of aspiration is increased. C. The mother is likely to develop abruptio placentae. D. The fetus's carboxyhemoglobin level is higher than the mother's.
Your correct answer: D Fetal hemoglobin has a higher (not lower) affinity for carbon monoxide than maternal hemoglobin. When measuring maternal carboxyhemoglobin, keep in mind that the fetus's level is higher. An elevated maternal carboxyhemoglobin level does not increase the mother's risk for aspiration or abruptio placenta.
When caring for a pregnant trauma patient, which intervention is the priority? A. Expose the patient to reveal life-threatening injuries. B. Initiate venous access with two large-bore catheters. C. Tilt the pregnant patient in spinal protection to the left side. D. Apply a nonrebreather mask.
Your correct answer: D Nonrebreather mask application is an intervention that addresses the breathing (B) component of the primary survey. The primary survey should be systematic and focus on recognizing and treating life-threatening conditions sequentially: airway, breathing, circulation, disability, and exposure or environmental control. Initiating venous access with two large-bore catheters belongs to the circulation (C) phase of the primary survey. Preventing uterine compression of the vena cava by tilting the spine board is also part of the circulation (C) phase of the primary survey. Exposing the patient to reveal life-threatening injuries falls within the exposure (E) component of the primary survey.
Surgical exploration is usually required for which injury? A. Bloody or meconium-stained amniotic fluid B. Coup-contrecoup injury of the uterus C. Evidence of fetal death or distress D. Penetrating injury of the abdomen
Your correct answer: D Surgical exploration is usually required in penetrating abdominal trauma caused by a gunshot or stab wound. Bloody or meconium-stained amniotic fluid is a sign of fetal distress. Although its treatment varies with maternal status, surgical exploration is not indicated. A patient with a coup-contrecoup injury of the uterus requires serial monitoring. Treatment varies based on the injuries sustained and maternal and fetal status, and surgical exploration is not always required. Surgical exploration is not indicated for evidence of fetal death or distress. Stabilization of the mother takes priority, and then the decision to deliver the fetus is made.
You are caring for a pregnant trauma patient who was involved in a motor vehicle crash. She is experiencing uterine contractions and reports severe abdominal and back pain. You note abdominal rigidity even between her contractions. Her uterus feels firm and symmetrical. What should you suspect? A. Fetal demiseB. Uterine ruptureC. Abruptio placentaeD. Supine hypotensive syndrome
Your incorrect answer: A In a pregnant trauma patient, abdominal pain and rigidity should prompt investigation for abruptio placentae. One of the first signs of fetal demise is lack of fetal movement, which is not indicated in this scenario. Uterine rupture may involve pain and rigidity, but probably not uterine symmetry. Supine hypotensive syndrome does not result in abdominal and back pain, abdominal rigidity, and uterine contractions.
For a pregnant woman, cardiopulmonary resuscitation requires which adjustment? A. Place defibrillator pads one rib interspace lower than usual. B. Perform compressions slightly lower on the maternal sternum. C. Manually displace the uterus laterally. D. Begin vasopressors as soon as possible.
Your incorrect answer: B Manual displacement of the uterus during chest compressions minimizes aortocaval compression and can increase cardiac output. It may be all that is needed to restore maternal pulses. Defibrillator pads should be placed one rib interspace higher than usual because the enlarged term uterus normally displaces the heart. Compressions should be performed slightly higher on the maternal sternum because the maternal heart is located higher and laterally rotated in pregnancy. Vasopressors should be used cautiously because they cause uteroplacental vasoconstriction, which can harm the fetus.
In which situation is an emergency cesarean section most likely to result in a favorable outcome for the mother and the fetus? A. A patient who is 34 weeks pregnant and has fetal limbs palpable outside the uterine bordersB. A patient who is 36 weeks pregnant and has been in cardiac arrest for 30 minutes before arrivalC. A patient who is 22 weeks pregnant and has cardiac arrest on arrival in the emergency departmentD. A patient who is 30 weeks pregnant and presents with shock and signs of fetal distress
Your incorrect answer: C The patient who is 30 weeks pregnant and presents with shock and signs of fetal distress describes a compromised mother and a compromised—but potentially viable—fetus. Emergency cesarean section may result in maternal recovery and a good fetal outcome. Fetal limb palpation outside the uterine borders indicates a complete uterine rupture. This catastrophic injury is associated with almost 100% fetal mortality. Although a fetus at 36 weeks' gestation is viable, the best maternal and fetal outcomes occur when emergency surgical delivery occurs within 5 minutes of maternal arrest. At 22 weeks' gestation, the fetus is not viable so even if an emergency cesarean section were performed within 5 minutes of the patient's arrival, the fetus would not have a favorable outcome.
Which description provides the best definition of tocolysis? A. Continuous electronic monitoring of the fetal heart rate, patterns, and uterine contractions B. Pharmacologic suppression of contractions, usually to halt preterm labor C. Compression of the vena cava, causing decreased maternal cardiac output D. Laboratory study that identifies the mixing of fetal blood in the maternal circulation
Your incorrect answer: D Tocolysis refers to pharmacologic suppression of contractions, usually to halt preterm labor. Cardiotocography is the continuous electronic monitoring of the fetal heart rate, fetal heart rate patterns, and uterine contractions. Aortocaval compression is the compression of the vena cava, which decreases cardiac output by 28% and systolic blood pressure by 30 mm Hg. A Kleihauer-Betke test is a laboratory study that may be used to identify the mixing of fetal blood in the maternal circulation.
During the perineal assessment of a pregnant patient, the physician obtains a sample of vaginal fluid for examination. Which finding indicates amniotic fluid in the sample? A. A fern pattern appears on the slide sample. B. The pH of the sample is 4.5. C. The sample separates into two distinct rings of fluid. D. Nitrazine paper turns yellow.
Your incorrect answer: D When vaginal fluid is placed on a slide and allowed to air dry, a fern pattern appears if amniotic fluid is present. The pH of 4.5 and yellow nitrazine paper indicate vaginal fluid because amniotic fluid has a pH of 7.0 to 7.5, which turns nitrazine paper blue. Vaginal fluid mixed with amniotic fluid does not separate into two distinct rings.