EMT Chapter 33 - Obstetrics and Neonatal Care

*Which of the following statements is NOT true? Select one: A. Gestational diabetes will clear up in most women after delivery. B. The leading cause of abruptio placenta is an ectopic pregnancy. C. As pregnancy progresses, the uterus enlarges and rises out of the pelvis. D. Some cultures may not permit male EMTs to examine a female patient.

B

*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: Select one: 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

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

B

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 amniotic fluid serves to: Select one: A. assist in fetal development. B. insulate and protect the fetus. C. remove viruses from the fetus. D. transfer oxygen to the fetus.

B

Vigorous suctioning of a newborn's airway is indicated if: Select one: A. positive-pressure ventilations are indicated. B. there is meconium in the amniotic fluid. C. the newborn presents with labored breathing. D. his or her heart rate is less than 60 beats/min.

B

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

B

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

B

Which of the following statements regarding twins is correct? Select one: A. Twins are typically larger than single infants. B. Most twins are born within 45 minutes of each other. C. Identical twins are typically of different gender. D. Fraternal twins have two cords coming from one placenta.

B

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

C

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

C

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

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

C

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? Select one: A. Maintain firm pressure to the head until it completely delivers. B. Place your fingers in the vagina to assess for a nuchal cord. C. Apply gentle pressure to the baby's head as it delivers. D. Tell the mother not to push and transport her immediately.

C

Eclampsia is MOST accurately defined as: A.high levels of protein in the patient's urine. B.hypertension in the 20th week of pregnancy. C.seizures that result from severe hypertension. D.a blood pressure greater than 140/90 mm Hg.

C

Once the infant's head has been delivered: Select one: A. suction the infant's nose, and then the mouth. B. apply oxygen over the mother's vagina. C. suction the infant's mouth, then the nose. D. apply a nasal cannula at 3 L/min to the infant.

C

The leading cause of maternal death during the first trimester of pregnancy is: Select one: A. blunt trauma to the abdomen during a motor vehicle crash. B. massive brain damage secondary to a prolonged seizure. C. internal bleeding caused by a ruptured ectopic pregnancy. D. unrecognized or untreated supine hypotensive syndrome.

C

The term primigravida refers to a woman who: A.has never been pregnant. B.has had only one live birth. C.is pregnant for the first time. D.has had more than one live baby.

C

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

C

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: Select one: A. intrauterine bleeding. B. spontaneous pneumothorax. C. pulmonary embolism. D. acute pulmonary edema.

C

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

C

When the mother is experiencing a contraction, you should instruct her to: Select one: A. rest and breathe deeply. B. hold her breath. C. take quick short breaths. D. push for 30 seconds.

C

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

Which of the following statements regarding a breech presentation is MOST correct? Select one: A. It is impossible to deliver a breech presentation in the prehospital setting. B. There is minimal risk of trauma to the infant with a breech presentation. C. A breech presentation occurs when the buttocks are the presenting part. D. Breech deliveries occur rapidly, so the EMT should deliver at the scene.

C

Which of the following statements regarding the placenta is correct? Select one: A. 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. B. 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. C. 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. D. 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

While examining a woman in labor, you see the umbilical cord protruding from the vagina. You should: Select one: A. gently pull on the cord to facilitate delivery. B. cover the umbilical cord with a dry dressing. C. push the infant's head away from the cord. D. carefully push the cord back into the vagina.

C

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: Select one: 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

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

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: A.6 B.7 C.8 D.9

C

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

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

D

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

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

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

D

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: Select one: A. carefully insert a sterile trauma dressing into her vagina. B. place her legs together and position her on her left side. C. elevate her legs 6 to 8 inches and cover her with a blanket. D. firmly massage the uterine fundus with a circular motion.

D

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

D

If a pregnant patient requires spinal immobilization, you should secure her to the backboard and then: Select one: A. tilt the board 30° to the right to prevent hypotension. B. elevate the head of the board 6″ to prevent breathing impairment. C. raise the foot of the board 12″ in order to maintain blood pressure. D. elevate the right side of the board with rolled towels or blankets.

D

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

D

The third stage of labor begins when the: A.placenta is fully delivered. B.cervix is completely dilated. C.umbilical cord has been clamped. D.baby is expelled from the vagina.

D

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

D

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

D

Which of the following is NOT performed immediately following delivery of the infant? Select one: 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

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: Select one: A. 7 B. 6 C. 9 D. 8

D

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: Select one: A. placing the mother in a recumbent position and rapidly transporting. B. gently pulling on the infant's leg in an attempt to facilitate delivery. C. carefully attempting to push the infant's leg off of the umbilical cord. D. placing the mother supine with her head down and pelvis elevated.

D

What would the Apgar score be for a newborn whose body is pink but whose hands and feet are cyanotic, has a pulse rate of 98 bpm, cries but does not recoil from stimulus, resists attempts to straighten hips and knees, and has slow respirations? - 4 - 6 - 8 - 10

- 6

If a newborn's heart rate is 75 bpm, what should you do? - Keep the newborn warm and assess him/her continuously. - Begin assisted ventilation with a BVM and room air. - Begin assisted ventilation with a BVM and 100% oxygen. - Begin chest compressions.

- Begin assisted ventilation with a BVM and room air.

Which of the following is a sign that delivery is imminent? - Crowning - Lightening - Contractions - Bloody stool

- Crowning

The answer to which of the following questions will help you determine whether delivery for this patient is imminent? - Have you had a previous complicated pregnancy? - Do you know if there is a chance of multiple deliveries? - Is this your first baby? - Do you use drugs or drink alcohol?

- Is this your first baby?

When transporting a pregnant patient in her third trimester, how should you position her? - Supine - On her left side - On her right side - Fowler position

- On her left side

*In which of the following instances should you insert your fingers into the pregnant patient's vagina? - When there is limb presentation instead of the normal head presentation - Prolapse of the umbilical cord - In a breech birth - In a vertex presentation

- Prolapse of the umbilical cord - In a breech birth

What is a primary characteristic of eclampsia? - Severe, persistent headache - Hypotension - Seizures - Bleeding

- Seizures

If amniotic fluid is green, what does this signify? - Premature rupture of the placenta - The presence of meconium - Prolonged gestation - Maternal infection

- The presence of meconium

As you are delivering the head during birth, you observe the umbilical cord is wrapped once around the neck. What should you do? - Ask the patient not to push, and prepare for immediate transport. - Clamp and cut the cord, and remove the cord from around the neck. - Pull on the cord to speed the delivery. - Try to slip the cord gently over the head.

- Try to slip the cord gently over the head.

*When does the onset of labor begin? - When the amniotic sac ruptures - When the fetus enters the birth canal - When uterine contractions begin - When the woman has the urge to push

- When uterine contractions begin

The amniotic fluid serves to: - transfer oxygen to the fetus. - insulate and protect the fetus. - remove viruses from the fetus. - assist in fetal development.

- insulate and protect the fetus.

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

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

Fetal complications associated with drug- or alcohol-addicted mothers include all of the following, EXCEPT: Select one: A. profound tachycardia. B. respiratory depression. C. premature delivery. D. low birth weight.

A

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

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

A

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

The term "bloody show" is defined as: Select one: A. the small amount of pink-tinged mucus that is discharged from the vagina after expulsion of the mucous plug. B. mild vaginal bleeding that occurs within the first 30 minutes after the onset of the second stage of the labor process. C. any volume of blood that is expelled from the vagina after the amniotic sac has ruptured and contractions have begun. D. the normal amount of vaginal bleeding that occurs within the first 24 hours following delivery of the baby and placenta

A

Upon delivery of the baby's head, you note that its face is encased in the unruptured amniotic sac. You should: Select one: A. puncture the sac and suction the baby's mouth and nose. B. leave the amniotic sac intact until arrival at the hospital. C. note the color of the amniotic fluid before breaking the sac. D. give the mother 100% oxygen and transport at once.

A

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

A

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

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

a

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

c

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because: Select one: A. pregnant patients have an overall increase in blood volume. B. blood is shunted to the uterus and fetus during major trauma. C. pregnant patients can dramatically increase their heart rate. D. pregnancy causes vasodilation and a lower blood pressure.

A

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

A

Braxton-Hicks contractions are characterized by: Select one: A. alleviation of pain with movement or changing positions. B. pink or red bloody show in conjunction with the contractions. C. regular contractions of progressively increasing intensity. D. a rupture of the amniotic sac just before the contractions begin

A

Determine the Apgar score in the following scenario: You arrive at the scene of a home delivery. Upon entering the scene, the father appears upset and hands you a limp baby. The child has a weak cry, is completely cyanotic, and has a pulse of 70 beats/min. Respirations are slow. Select one: A. 3 B. 9 C. 2 D. 7

A

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: Select one: A. place her on her side, administer high-flow oxygen, and transport. B. administer oral glucose for presumed hypoglycemia and transport. C. elevate her legs to improve brain perfusion and keep her warm. D. insert an oral airway and ventilate her with a bag-valve mask.

A

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