Chapter 33: Obstetrics and Neonatal Care

You have just delivered a baby boy. His body is pink, but his hands and feet are blue. His heart rate 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: a. 8 b. 6 c. 7 d. 9

a. 8

Which of the following are normal physiologic changes that occur in the mother's respiratory system during pregnancy? a. Increased respiratory rate and decreased respiratory reserve b. Decreased respiratory rate and increased minute volume c. Increased respiratory reserve and decreased oxygen demand d. Increased respiratory depth and decreased respiratory rate

a. Increased respiratory rate and decreased respiratory reserve

Which of the following statements regarding twins is correct? a. Most twins are born within 45 minutes of each other. b. Fraternal twins have two cords coming from one placenta. c. Twins are typically larger than single infants. d. Identical twins are typically of different gender.

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

Upon delivery of an infant's head, you note that the umbilical cord is wrapped around its neck. You should: a. attempt to slip the cord gently over the infant's head. b. immediately clamp and cut the umbilical cord. c. provide free-flow oxygen to the infant and transport. d. give high-flow oxygen to the mother and transport.

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

Signs and symptoms of preeclampsia include: a. headache and edema. b. dysuria and constipation. c. marked hypoglycemia. d. dyspnea and bradycardia.

a. headache and edema.

Which of the following statements regarding gestational diabetes is correct? a. Diet and exercise are typically ineffective in controlling gestational diabetes. b. In some cases, women with gestational diabetes require insulin injections. c. The onset of gestational diabetes typically manifests with hypoglycemia. d. Gestational diabetes results in permanent diabetes mellitus after delivery.

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

Which of the following statements regarding the placenta is correct? a. 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. b. 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. c. 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. d. The placenta provides oxygen and nutrients to the fetus and is expelled from the vagina about 30 minutes before the baby is bom.

b. 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? a. Uterine contractions last about 10 seconds. b. Uterine contractions become more regular. c. Uterine contractions decrease in intensity. d. The uterus becomes very soft and movable.

b. Uterine contractions become more regular.

The umbilical cord: a. contains two veins and one large umbilical artery. b. carries oxygen to the baby via the umbilical vein. c. separates from the placenta shortly after birth. d. carries blood away from the baby via the artery.

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

If a newborn's heart rate is less than 60 beats/min following delivery, you should: a. flick the soles of his or her feet. b. provide ventilations for 30 seconds. c. resuscitation the mouth only. d. begin chest compressions.

b. provide ventilations for 30 seconds.

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.

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. breastfeeding causes uterine blood vessels to dilate. b. these actions simulate the production of oxytocin and cause uterine contraction. c. a portion of the placenta was retained in the uterus. d. uterine massage increases blood flow to the uterus.

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

Which of the following is NOT generally considered an obstetrical emergency? a. More than 500 mL of blood loss before placental delivery b. Significant bleeding after delivery of the placenta c. Return of contractions following delivery of the baby d. Failure of the placenta to deliver after 30 minutes

c. Return of contractions following delivery of the baby

Spina bifida is a developmental defect in which: a. an excessive amount of cerebrospinal fluid damages the spinal cord. b. the spinal column is severely deformed, resulting in permanent paralysis. c. a portion of the spinal cord or meninges protrudes outside of the vertebrae. d. nerve fibers that arise from the spinal cord do not function properly.

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

The ONLY indications for placing your gloved fingers in the vagina during delivery are: a. nuchal cord and presentation of an arm or leg. b. vertex presentation and delivery of the placenta. c. breech presentation and prolapsed umbilical cord. d. limb presentation and severe vaginal hemorrhage.

c. breech presentation and prolapsed umbilical cord.

Placenta previa is defined as: a. premature placental separation from the uterine wall. b. abnormal development and functioning of the placenta. c. development of the placenta over the cervical opening. d. delivery of a portion of the placenta before the baby.

c. development of the placenta over the cervical opening.

A 33-year-old woman who is 36 weeks pregnant is experiencing vaginal bleeding. During transport, you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. You should: a. carefully place sterile gauze into her vagina. b. ventilate her with a bag-valve mask. c. place her in a left lateral recumbent position. d. position her supine and elevate her legs 12 inches.

c. place her in a left lateral recumbent position.

Abruptio placenta occurs when: a. the placenta affixes itself to the outer layer of the uterus. b. a tear in the placenta causes severe internal hemorrhage. c. the placenta prematurely separates from the uterine wall. d. the placenta develops over and covers the cervical opening.

c. the placenta prematurely separates from the uterine wall.

Supine hypotensive syndrome occurs when: a. blood pressure decreases as a result of hypovolemia. b. the superior vena cava is compressed by the uterus. c. the pregnant utems compresses the inferior vena cava. d. a supine position kinks the ascending aorta.

c. the pregnant utems compresses the inferior vena cava.

An infant is considered to be premature if it: a. is born before 40 weeks' gestation or weighs less than 7 lb. b. is born before 38 weeks' gestation or weighs less than 6 lb. c. weighs less than 5 lbs or is born before 36 weeks' gestation. d. weighs less than 5.5 lbs or is born before 37 weeks' gestation,

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

Which of the following is NOT a component of the Apgar score? a. Pulse b. Activity c. Grimace d. Body size

d. Body size

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

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

The onset of labor begins with: a. thinning of the uterus. b. increased fetal movement. c. full dilation of the cervix. 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. an urge to push. b. a bloated feeling. c. mid-back pain. d. easier breathing.

d. easier breathing.

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. assess his skin color and give free-flow oxygen as needed. b. clamp and cut the umbilical cord and keep him warm. c. begin chest compressions and reassess in 30 seconds. d. keep him warm and ventilate with a BVM.

d. keep him warm and ventilate with a BVM.