Chapter 21- Gynecologic Emergencies & Chapter 31- Obstetrics and Neonatal Care

A newborn infant will usually begin breathing spontaneously within _____ seconds following birth.

15-30

A mother who is pregnant with her first baby is typically in the first stage of labor for approximately

16 hours

An abortion occurs when the fetus and placenta deliver before

20 weeks

Preeclampsia MOST commonly occurs after the ___ week of gestation.

30th

If a baby is born at 7:52 p.m., the second APGAR score should be calculated at

7:57 p.m.

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

8

Which of the following statements regarding a breech presentation is MOST correct?

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

D"Do you feel the urge to push?"

A"Have you had a sonogram?"

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:

Assess her for crowning

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?

Assess the brachial or umbilical pulse.

Which of the following is an indication of imminent birth?

Crowning of the baby's head

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

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

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

D. body size

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

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

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

D.positive-pressure ventilations

After the fetus has descended into the pelvis at the end of the third trimester, many mother experience:

Easier breathing

All of the following questions are pertinent to ask a mother when determining whether or not her baby will deliver within the next few minutes, EXCEP

Have you had a sonogram?

Signs and symptoms of preeclampsia include:

Headache and edema

Which of the following statements regarding twins is MOST correct?

Most twins are born within 45 minutes of each other.

Which of the following statements regarding pelvic inflammatory disease (PID) is correct? a) The most common presenting symptom of PID is generalized upper abdominal pain. b) PID most commonly affects women who have had an ectopic pregnancy in the past. c) The most severe cases of PID occur in women who are not sexually active. d) PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.

PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.

Which of the following statements regarding gonorrhea is correct? a) Mild infections with gonorrhea cause abdominal pain, vomiting, and fever. b) Symptoms of gonorrhea usually appear within 3 months after being infected. c) Painful urination is a common symptom of gonorrhea in men and women. d) Most men who are infected with gonorrhea do not experience symptoms.

Painful urination is a common symptom of gonorrhea in men and women.

Which of the following statements regarding rape is correct? a) Rape is a legal diagnosis, not a medical diagnosis. b) Only a licensed physician can make a diagnosis of rape. c) The EMT should try to determine if rape occurred. d) Rape causes more physical harm than emotional harm.

Rape is a legal diagnosis, not a medical diagnosis.

Eclampsia is MOST accurately defined as

Seizures that result from severe hypertension

APGAR

Summarizes the health of a newborn.

Which of the following processes occurs during ovulation?

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

Which of the following statements regarding the placenta is MOST correct?

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 occurs during true labor?

Uterine contractions become more regular

When the cervix begins to dilate

a mucus plug is expelled from the vagina

Spina bifida is a developmental defect in which:

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

You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings would increase your index of suspicion for PID? a) a history of ectopic pregnancy b) a shuffling gait when walking c) bright red blood in the urine d) vaginal passage of blood clots

a shuffling gait when walking

Fetal complications associated with drug- or alcohol-addicted mothers include all of the following, EXCEPT: a) profound tachycardia b) premature delivery c) low birth weight d) respiratory depression

a) profound tachycardia

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: a) administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. b) administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. c) administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. d) assist her ventilations with a bag-mask device, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

You are assessing a 30-year-old woman who is 35 weeks' pregnant. She tells you that her amniotic sac has not ruptured, but she is experiencing irregular contractions that "come and go." Upon visual inspection, you note a small amount of brown mucus draining from her vagina. You should

administer oxygen and transport.

Braxton-Hicks contractions are characterized by

alleviation of pain with movement or changing positions

A 26-year-old woman complains of a stabbing pain in the right lower quadrant of her abdomen. She states that her last menstrual period was 7 weeks ago and that she had pelvic inflammatory disease approximately 3 months ago. You should be MOST suspicious that this patient is experiencing

an ectopic pregnancy

A history of pelvic inflammatory disease or tubal ligations increases a woman's risk for

an ectopic pregnancy

During your visual inspection of a 19-year-old patient in labor, you see the baby's head crowning at the vaginal opening. What should you do?

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

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 appropriate BSI precautions, you should

assess her for crowning.

During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse is rapid and weak. You should: a) perform a rapid secondary assessment. b) perform a visual assessment of her vaginal area. c) assess her blood pressure and elevate her legs. d) assist her ventilations with a bag-mask device.

assist her ventilations with a bag-mask device.

Upon delivery of an infant's head, you note that the umbilical cord is wrapped around its neck. You should

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

In anticipation of receiving a fertilized ovum, the lining of the uterine wall: a) sheds and is expelled externally. b) diverts blood flow to the vagina. c) becomes engorged with blood. d) thins and begins to separate.

becomes engorged with blood.

By the 20th week of pregnancy, the uterus is typically at or above the level of the mother's

belly button

The onset of menstruation is called menarche and usually occurs in women who are: a) between 25 and 35 years of age. b) between 12 and 14 years of age. c) between 45 and 50 years of age. d) between 11 and 16 years of age.

between 11 and 16 years of age.

The vagina and the neck of the uterus comprise the

birth canal

Signs and symptoms of pregnancy-induced hypertension (preeclampsia) include all of the following, EXCEPT

blood in the urine

The ONLY indications for placing your gloved fingers in the vagina during delivery are:

breech presentation and prolapsed umbilical cord

The ONLY indications for placing your gloved fingers in the vagina during delivery are

breeched presentation and prolapsed umbilical cord

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: a) refraining from placing any dressings into the vagina. b) treating external lacerations with moist, sterile compresses. c) carefully removing any foreign bodies from the vagina. d) supplemental oxygen and lower extremity elevation.

carefully removing any foreign bodies from the vagina.

The umbilical cord

carries oxygen to the baby via the umbilical vein.

Which of the following conditions would MOST likely lead to PID if left untreated? a) genital herpes b) ovarian cysts c) ectopic pregnancy d) chlamydia

chlamydia

The onset of labor begins with

contractions of the uterus

A placenta previa is MOST accurately defined as

development of the placenta over the cervical opening

After a baby is born, it is important to

ensure it is thoroughly dried and warm

It is not uncommon for young females who experience their first menstrual period to: a) experience abdominal cramping, which may be misinterpreted. b) become so emotionally distraught that they contemplate suicide. c) have a falsely positive home pregnancy test result. d) lose up to 500 mL of blood within the first 24 hours.

experience abdominal cramping, which may be misinterpreted.

Each ovary produces an ovum in alternating months and releases it into the: a) fallopian tube. b) vagina. c) cervix. d) uterus.

fallopian tube.

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

firmly massage the uterine fundus with a circular motion

If a newborn has gasping respirations after being dried and suctioned

further stimulation is not likely to improve ventilation.

Which of the following conditions does NOT typically present with vaginal discharge? a) PID b) genital herpes c) chlamydia d) gonorrhea

genital herpes

A 30-year-old pregnant female is gravida-3 and para-2. This means that she has

given birth to 2 live babies

Whenever possible, a female sexual assault victim should be: a) thoroughly assessed, even if no signs of injury exist. b) encouraged to take a shower and change her clothes. c) given the option of being treated by a female EMT. d) asked to provide a brief description of the perpetrator.

given the option of being treated by a female EMT.

When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she: a) has obtained a complete set of vital signs. b) has gathered patient history information. c) ascertains if the patient was ever pregnant. d) has formed a general impression of the patient.

has gathered patient history information.

The term primipara refers to a woman who

has had only one live birth.

A precipitous labor and delivery is MOST common in women who

have delivered a baby before

As a woman approaches menopause: a) she usually experiences abdominal cramping without vaginal bleeding. b) her menstrual periods may become irregular and vary in severity. c) her risk of developing PID lowers significantly. d) she cannot become pregnant because of fluctuating hormone levels.

her menstrual periods may become irregular and vary in severity.

Which of the following is a normal physiologic change that occurs in the mother's respiratory system during pregnancy?

increased respiratory rate and decreased respiratory reserve

Compared to full-term infants, premature infants are at a higher risk for

infection

The amniotic fluid serves to

insulate and protect the fetus.

The leading cause of maternal death during the first trimester of pregnancy is

internal bleeding caused by a ruptured ectopic pregnancy

If a woman with vaginal bleeding reports syncope, the EMT must assume that she: a) is pregnant. b) has an infection. c) is in shock. d) has an ectopic pregnancy.

is in shock.

A nuchal cord is defined as an umbilical cord that

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

keep him warm and provide ventilatory assistance.

When documenting a call in which a female was sexually assaulted, you should: a) record your opinion only if you have reasonable proof to justify the statement. b) keep the report concise and record only what the patient stated in her own words. c) only use quotation marks when recording any statements made by witnesses. d) translate the patient's words or statements using proper medical terminology.

keep the report concise and record only what the patient stated in her own words.

The physical examination of a sexual assault victim should be: a) deferred until the patient can be evaluated by a physician. b) as detailed as possible so all injuries can be documented. c) performed in the presence of at least two police officers. d) limited to a brief survey for life-threatening injuries.

limited to a brief survey for life-threatening injuries.

Which of the following clinical presentations is MOST consistent with PID? a) left lower quadrant pain, referred pain to the left shoulder, and fever b) upper abdominal cramping, severe headache, and heavy vaginal bleeding c) lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge d) pain around the umbilicus, low-grade fever, and generalized weakness

lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to: a) determine the underlying cause of her problem. b) ask questions related to her gynecologic history. c) keep assessment and treatment to a minimum. d) maintain her ABCs and transport without delay.

maintain her ABCs and transport without delay.

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer: a) may be relatively painless. b) is typically not as severe. c) can be controlled in the field. d) often presents with acute pain.

may be relatively painless.

Bacterial vaginosis is a condition that occurs when: a) normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. b) numerous bacteria enter the uterus through the cervix and cause severe tissue damage. c) abnormal bacteria enter the vagina and cause damage without causing any symptoms. d) harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes.

normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.

When preparing a pregnant patient for delivery, you should position her

on a firm surface with her hips elevated 2" to 4"

Potentially life-threatening consequences of PID include: a) bacterial vaginosis and chlamydia. b) ovarian abscess and ectopic pregnancy. c) ovarian cysts and gonorrhea. d) uterine rupture with severe bleeding.

ovarian abscess and ectopic pregnancy.

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

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

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

pregnant women are advised to take iron supplements, such as prenatal vitamins, because:

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

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because

pregnant patients have an overall increase in blood volume.

Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should: a) advise her that she cannot clean herself up because this will destroy evidence. b) perform a limited hands-on assessment to detect life-threatening injuries. c) provide emotional support and visually assess her for obvious trauma. d) ask her if there is anyone you can contact, such as a friend or relative.

provide emotional support and visually assess her for obvious trauma.

Following delivery of a pulseless and apneic infant that has a foul odor, skin sloughing, and diffuse blistering, you should

provide emotional support to the mother

If a newborn's heart rate is less than 60 beats/mins following delivery, you should:

provide ventilations for 30 seconds

Upon delivery of the baby's head, you note that its face is encased in the unruptured amniotic sac. You should

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

While examining a woman in labor, you see the umbilical cord protruding from the vagina. You should

push the infant's head away from the cord

During delivery of the baby's head, you should suction the mouth before the nose because

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

When the mother is experiencing a contraction, you should instruct her to:

take quick short breaths

The presence of thick meconium in the amniotic fluid indicates

that the baby's airway may be obstructed.

The third stage of labor begins when the

the baby is expelled from the vagina

During delivery, it is MOST important to position your partner at the mother's head because

the mother may become nauseated and vomit.

Abruprio placenta occurs when:

the placenta prematurely separates from the uterine wall

In contrast to a placenta previa, a placenta abruptio occurs when

the placenta prematurely separates from the uterine wall.

A 35-year-old woman who is 30 weeks' pregnant presents with a severe headache and swelling in her hands and feet. She is conscious and alert with a blood pressure of 148/94 mm Hg, a pulse of 100 beats/min, and respirations of 24 breaths/min. During transport, you should be MOST concerned with

the possibility that she may experience a seizure

Supine hypotensive syndrome occurs when

the pregnant uterus compresses the inferior vena cava

The term "bloody show" is defined as:

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

Vigorous suctioning of a newborn's airway is indicated if:

there is meconium in the amniotic fluid

When determining the frequency of contractions, you should

time the contractions from the start of one to the start of the next

General treatment guidelines when caring for a woman with traumatic vaginal bleeding includes

transporting to an appropriate facility

PID typically does NOT affect the: a) ovaries. b) uterus. c) fallopian tubes. d) urinary bladder.

urinary bladder.

From what internal female organ is the fetus expelled during delivery?

uterus

An infant is considered to be premature if it

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