Chapter 33 Obstetrics and Neonatal Care
2.Which of the following questions is of LEAST pertinence when determining whether a mother will deliver her baby within the next few minutes?
"Have you had a sonogram?"
131.Traditionally an APGAR score is taken at what time intervals after birth?
1 and 5 minutes
89.When performing chest compressions on a pregnant patient, position your hands
1-2 inches higher on the sternum to make up for shifting of the heart by the large uterus
132.When clamping the umbilical cord, the clamp closest to the baby should be approximately ________ inch(es) from the infant's body
10 (7 actually)
64.A newborn infant will usually begin breathing spontaneously within _______ seconds following birth.
15 to 30
17.A mother who is pregnant with her first baby is typically in the first stage of labor for approximately
16 hours.
67.An abortion occurs when the fetus and placenta deliver before
20 weeks.
77.During 3rd trimester, additional weight is
20-24 pounds
150.Preeclampsia MOST commonly occurs after the ____ week of gestation.
30th
92.What is the CORRECT chest compression-to-ventilation ratio for CPR in a newborn?
3:1
96.What is the typical duration of pregnancy
40 weeks
93.By what percentage does the maternal blood volume increase by the end of pregnancy?
50%
130.Normal maternal blood loss during delivery of an infant usually does not exceed how much?
500 cc
1.If a baby is born at 7:52, the second Apgar score should be calculated at
7:57.
51.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
66.Which of the following statements regarding a breech presentation is correct?
A breech presentation occurs when the buttocks are the presenting part.
122.If assisting in a prehospital delivery while off-duty, which of the following would be the BEST choice for tying or clamping the umbilical cord?
A pair of shoelaces
25.Braxton-Hicks contractions are characterized by
Alleviation of pain with movement or changing positions
5.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?
Apply gentle pressure to the baby's head as it delivers.
125.When assisting with a delivery in the field, which of the following should be done as the head begins to emerge from the vagina?
Apply gentle pressure to the head with your gloved hand
135.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
40.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 infants head
113.What is the highest priority to the EMT in delivery of an infant with meconium-stained amniotic fluid?
Being prepared to suction the infant immediately before he takes a breath
39.The vagina and the neck of the uterus comprise the
Birth canal
104.What is MOST likely when a woman who is experiencing labor pain states that she needs to go to the bathroom to move her bowels?
Birth is imminent
43.Which of the following is NOT a component of the Apgar score
Body size
102.What is recommended for suctioning the newborn's mouth and nose?
Bulb syringe
101.If a patient is in labor, what is the MOST reliable indication that delivery will happen imminently?
Bulging perineum
65.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?
Check the pulse rate at the brachial artery. (Assess the brachial or umbilical pulse)
110.What should be done when the infant's head has been delivered?
Check to see if the umbilical cord is around the neck, suction the mouth, suction the nose
121.Which of the following describes the normal appearance of amniotic fluid?
Clear & colorless fluid
124.What is the correct technique to check for crowning in the assessment of a woman in labor?
Cover her with a sheet, have her remove her underwear, wait for a contraction, and then visualize the vaginal opening.
61.Which of the following is an indication of imminent birth?
Crowning of the baby's head
32.Placenta previa is defined as
Development of the placenta over the cervical opening
123.You are called to assess a pregnant woman who is approximately 7 months pregnant. She states that her pregnancy has been uneventful but she is experiencing intermittent headaches. Her vital signs are pulse 118, respirations 22, blood pressure 138/88, and blood sugar 148. Which of the following is true regarding a pregnant woman?
Diabetes may be made worse during pregnancy
128.How does the fetus's blood pick up nourishment from the mother?
Diffusion
23.After the fetus has descended into the pelvis at the end of the third trimester, many mothers experience
Easier breathing
129.What is the correct way to time the frequency of contractions in the pregnant woman?
From the beginning of one contraction to the beginning of the next
21.A precipitous labor and delivery is MOST common in women who
Have delivered a baby before
33.Signs and symptoms of preeclampsia include
Headache and edema
109.The greatest danger to the pregnant woman and her fetus involved in trauma is which of the following?
Hemorrhagic shock
46.Which of the following statements regarding gestational diabetes is correct?
In some cases women with gestational diabetes require insulin injections.
42.Which of the following are normal physiologic changes that occur in the mother's respiratory system during pregnancy?
Increased respiratory rate and decreased respiratory reserve
97.You are assisting a woman in the delivery of her infant when you note that a segment of the umbilical cord is sticking out of her birth canal. What is the prehospital treatment of this condition?
Instruct the patient not to push. Place the mother in knee-chest position or elevate the hips with pillows, push the baby's head several inches upward into the birth canal, and cover the exposed cord with wet sterile dressings.
52.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 ventilate with a BVM
119.Seizures due to complications of pregnancy generally occur during which of the following time periods?
Late in pregnancy
116.While treating a patient of sexual assault, your treatment should follow which of the following sequences?
Maintain scene safety, treat immediate life threats, treat medical and psychological needs, and protect criminal evidence.
118.What should the EMT do to control maternal bleeding after delivery of the baby?
Massage the uterus until it is firm/grapefruit-sized, apply direct pressure with a sanitary napkin over any perineal lacerations, allow the infant to nurse if possible
49.Which of the following statements regarding twins is correct?
Most twins are born within 45 minutes of each other
94.What is the MOST common cause of blunt trauma in pregnant patients?
Motor vehicle accidents
100.As an infant's head emerges during a normal delivery, few secretions are present. As the infant's body is delivered, the infant begins to cry normally. Which of the following statements BEST describes the proper care of the infant's airway?
No intervention is needed for the airway. Clamp and cut the cord, and warm and dry the infant.
126.What is indicated in the prehospital management of a prolapsed umbilical cord?
Place the mother in a head-down position with pillows under her hips
134.What is the temporary organ of pregnancy, which functions to supply the developing fetus with oxygen and nutrients?
Placenta
26.Fetal complications associated with drug- or alcohol-addicted mothers include all of the following, EXCEPT
Profound tachycardia
95.Which of the following interventions is required in a newborn who has spontaneous breathing and a heart rate greater than 100 per minute but who still has cyanotic skin?
Provide blow-by oxygen
27.Following delivery of a pulseless and apneic infant who has a foul odor, skin sloughing, and diffuse blistering, you should
Provide emotional support to the mother
29.If a newborn's heart rate is less than 60 beats/min following delivery, you should
Provide ventilations for 30 seconds
44.Which of the following is NOT generally considered an obstetrical emergency
Return of contractions following delivery of the baby
47.Which of the following statements regarding suctioning of a newborn's mouth and oropharynx is correct
Suctioning is indicated prior to cutting the cord if respiratory distress is present
112.What may result from a woman in her third trimester of pregnancy lying in a supine position?
Supine hypotensive syndrome, fetal compromise, compression of the inferior vena cava
41.When the mother is experiencing a contraction, you should instruct her to
Take quick short breaths
111.What conditions should be present before the umbilical cord is cut?
The cord is no longer pulsating, clamped in 2 places, and the infant is breathing on their own
106.You have just delivered a full-term baby girl and she is doing well. You have dried her off and wrapped her in a warm blanket. You are preparing to cut the umbilical cord. Which of the following is normally true regarding cutting the umbilical cord?
The infant must be breathing on their own before you cut the cord
53.Which of the following processes occurs immediately following ovulation?
The inner lining of the uterus thickens in preparation for implantation.
48.Which of the following statements regarding the placenta is correct?
The placenta allows oxygen, carbon dioxide, and other products to transfer between the mother and the fetus but does not allow blood to mix the mother and fetus
22.Abruptio placenta occurs when
The placenta prematurely separates from the uterine wall
98.Which of the following mechanisms accounts for supine hypotensive syndrome?
The weight of the enlarged uterus and fetus presses on the INFERIOR vena cava, causing inadequate blood return to the heart.
28.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
These actions simulate the production of oxytocin and cause uterine contraction
120.What BEST describes the events that occur during the first stage of labor?
Thinning and dilation of the cervix
127.While treating a pregnant trauma patient, which of the following is the BEST way to keep the fetus alive?
Treat the patient as any other trauma patient
45.Which of the following occurs during true labor?
Uterine contractions become more regular
4.From what internal female organ is the fetus expelled during delivery?
Uterus
114.If the mother experiences a severe, tearing sensation in her abdomen during labor and the outline of the fetus can be felt through the abdominal wall, should the mother be transported immediately?
Yes
115.If the infant's arm is the presenting part, should the mother be transported immediately?
Yes
91.Sometimes in a pregnant patient in cardiac arrest and if the arrest is witnessed/has happened less than 5 minutes prior to arrival of EMS,
a C-section could save the baby
140.When the cervix begins to dilate
a mucus plug is expelled from the vagina
149.Spina bifida is a developmental defect in which
a portion of the spinal cord or meninges protrudes outside of the vertebrae
34.Spina bifida is a development defect in which
a portion of the spinal cord or meninges protudes outside of the vertebrae
90.Although in most cases you will not be immediately transporting a cardiac-arrest patient, pregnancy is
a special exception
82.If the baby has a blue coloration to the torso
administer blow-by oxygen
144.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.
81.Meconium staining is when
amniotic fluid is green/brown/yellow and is an indication of possible maternal or fetal distress during labor
139.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
15.A history of pelvic inflammatory disease or tubal ligations increases a woman's risk for
an ectopic pregnancy.
57.The third stage of labor begins when the
baby is expelled from the vagina.
74.The amniotic sac is and does
bag of waters that contains almost one quart of liquid that allows the fetus to float, protects it, and helps maintain a constant fetal body temp
14.By the 20th week of pregnancy, the uterus is typically at or above the level of the mother's
belly button.
145.Signs and symptoms of pregnancy-induced hypertension (preeclampsia) include all of the following, EXCEPT
blood in the urine
36.The ONLY indications for placing your gloved fingers in the vagina during delivery are
breech presentation and prolapsed umbilical cord
38.The umbilical cord
carries oxygen to the baby via the umbilical vein
72.You are attending to a 28-year-old female patient in labor. Her newborn baby boy has just been delivered, and you have dried and wrapped the newborn in a clean blanket. The umbilical cord has stopped pulsating. Based on this information, you should now
clamp the cord utilizing two clamps, placed approximately 6 inches from the newborn and 2 to 4 inches apart.
12.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
continue your care in a private area, document any details regarding the scene and the incident, and reassure her as you provide care.
37.The onset of labor begins with
contractions of the uterus
76.The blood pressure of a pregnant woman is usually slightly
decreased, but high BP can occur as well
151.Placenta previa is MOST accurately defined as
devolpment of the placenta over the cervical opening
133.You are called for a woman with severe abdominal pain. During your assessment and interview, she tells you that she is sexually active and there is a chance she could be pregnant. Her vital signs are pulse 122, respirations 22, blood pressure 96/62, and skin cool and pale. You should immediately suspect
ectopic pregnancy
60.If a pregnant patient requires spinal immobilization, you should secure her to the backboard and then
elevate the right side of the board with rolled towels or blankets.
141.After a baby is born, it is important to
ensure it is thoroughly dried and warm
103.Your patient is 39 weeks pregnant and complaining of contractions that are 2 minutes apart. She tells you that she needs to use the bathroom before transport. You should
explain that the sensation might indicate that she is close to delivery and you need to check to see whether the baby's head is in the birth canal.
9.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.
108.Your pregnant patient is in active labor. You note that her contractions are getting closer together and much stronger as the baby moves deeper into the birth canal. The muscle contraction mechanism that moves the baby toward birth is the same mechanism that moves
food from the esophagus to the stomach
137.If a newborn has gasping respirations after being dried and suctioned
further stimulation is not likely to improve ventilation.
148.A 30-year-old pregnant female is gravida-3 and para-2. This means that she has
given birth to 2 live babies
69.In contrast to a full-term infant, a premature infant
has an even proportionately larger head.
143.The term primipara refers to a woman who
has had only one live birth.
99.Obtaining a thorough history from your pregnant patient will
help you to anticipate possible complications
86.Care for the mother after birth includes
helping her deliver the placenta, controlling her vaginal bleeding, and making her as comfortable as possible
107.When delivering a baby, you should not place your fingers
in the armpit to assist with delivery of the shoulders
147.Compared to full-term infants, premature infants are at a higher risk for
infection
84.If heart rate is less than 60 bpm,
initiate chest compressions at a rate of 120/min. 90 compressions & 30 ventilations per minute
154.You have delivered an infant with gasping respirations. After suctioning and physical stimulation, there is no improvement. You should
initiate ventilatory assistance.
8.The amniotic fluid serves to
insulate and protect the fetus.
59.The leading cause of maternal death during the first trimester of pregnancy is
internal bleeding caused by a ruptured ectopic pregnancy.
79.Braxton-Hicks contractions are
irregular & unsustained contractions that begin days/weeks before birth and do not typically indicate impending delivery
56.The term primigravida refers to a woman who
is pregnant for the first time.
7.A nuchal cord is defined as an umbilical cord that
is wrapped around the baby's neck.
73.As the fetus grows, the uterus becomes more vulnerable to injury because
it becomes thinner-walled & less protected by the abdominal cavity
155.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.
117.You respond for an imminent delivery of a baby in the breech position. As you examine the mother, you see that the umbilical cord is protruding from the opening of the cervix. You realize that the most important care you can provide for this baby is to
keep the baby off the cord
68.CPR is in progress on a pulseless and apneic 29-year-old woman who is 37 weeks pregnant. When treating this patient, the EMT should
manually displace the patient's uterus to the left.
30.In contrast to abruptio placenta, placenta previa
may not present with heavy vaginal bleeding
153.When preparing a pregnant patient for delivery, you should position her
on a firm surface in a semi-Fowler's position.
10.When preparing a pregnant patient for delivery, you should position her
on a firm surface with her hips elevated 2 to 4 inches.
31.Most medical models base a pregnant woman's due date
on the first day of her last menstural cycle
78.To take the weight off the vena cava during the 3rd trimester, the patient should be transported
on their left sides
71.You are attending to a 26-year-old female patient who is at 37 weeks' gestation with her second pregnancy. The patient is in labor and delivery is imminent. The patient is on your stretcher. You should now
open the OB kit and continue to prepare for the delivery.
105.Your pregnant patient is in active labor. She has been lying on her back throughout her labor and is experiencing signs and symptoms of shock. Her vital signs are pulse rate 118, respirations 22, blood pressure 96/62, and skin cool and diaphoretic. The BEST way to treat her is to
place a rolled blanket under her left hip to displace the uterus
146.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.
3.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
place her on her side, administer high-flow oxygen, and transport.
11.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.
20.Common interventions used to stimulate spontaneous respirations in the newborn include all of the following, EXCEPT
positive-pressure ventilations.
55.Pregnant women are advised to take iron supplements, such as prenatal vitamins, because
pregnancy causes an increased number of red blood cells, which predisposes the mother to anemia.
19.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.
83.If infant's breathing is shallow,
provide positive pressure ventilation at 40-60/min
18.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
pulmonary embolism.
70.You are attending to a 34-year-old female patient in labor. The pregnancy was a difficult one, and she spent much of the third trimester on bed rest. The delivery is uneventful, and as you are preparing for transport, the patient tells you that she is feeling short of breath. Based on this information, you should suspect
pulmonary embolism.
63.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.
50.While examining a woman in labor, you see the umbilical cord protruding from the vagina. You should
push the infants head away from the cord
6.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
respect the patient's wishes, ensure that the appropriate documentation is completed, and transport the patient.
58.Eclampsia is MOST accurately defined as
seizures that result from severe hypertension.
85.A mother who has just delivered a baby is at risk for
serious bleeding, infection, and emboli
13.When determining the frequency of contractions, you should time the contractions from the
start of one to the start of the next.
138.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.
16.The presence of meconium in the amniotic fluid indicates
that the baby's airway may be obstructed.
62.During delivery, it is MOST important to position your partner at the mother's head because
the mother may become nauseated and vomit.
75.In pregnancy, blood volume increases but
the number of red blood cells remains the same and oxygen-carrying capacity is decreased
152.In contrast to a placenta previa, a placenta abruptio occurs when
the placenta prematurely separates from the uterine wall.
142.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
35.Supine hypotensive syndrome occurs when
the pregnant uterus compresses the inferior vena cava
54.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.
88.If a women is in cardiac arrest and estimated to be more than 20 weeks pregnant,
the uterus must be displaced manually during CPR by placing 2 hands on the side of the abdomen and pulling toward the patient's left side or tilt the backboard to a left lateral angle of 27-30 degrees
87.Sometimes EMS systems recommend transport without waiting for delivery of the placenta because
there may be a condition where the placenta does not separate from the uterine wall
136.General treatment guidelines when caring for a woman with traumatic vaginal bleeding includes
transporting to an appropriate facility
24.An infant is considered to be premature if it
weighs less than 5 lbs or is born before 36 weeks' gestation
80.Lightening is
when a fetus moves from high in the abdomen down toward the birth canal