WC EMT CH 34 Obstetrics and Neonatal Care

A newborn infant will usually begin breathing spontaneously within _______ seconds following birth. A. 3 to 5 B. 15 to 20 C. 30 to 60 D. 5 to 10

B. 15 to 20

A newborn is considered to be "term" if it is born after ____ weeks and before ____ weeks. A. 34, 37 B. 37, 42 C.38, 44 D. 39, 43

B. 37, 42 Rationale: A term gestation ranges between 37 and 42 weeks. An infant who is born before 37 weeks gestation (or weighs less than 5 lb, regardless of gestational age) is considered premature. An infant born after 42 weeks is considered past due.

Which of the following occurs during true labor? A. Uterine contractions decrease in intensity B. Uterine contractions become more regular C. Uterine contractions last about 10 seconds D. The uterus becomes very soft and movable

B. Uterine contractions become more regular

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

B. belly button

Upon delivery of the baby's head, you note that the umbilical cord is wrapped around its neck. You should: A. immediately clamp and cut the cord. B. make one attempt to slide the cord over the head. C. keep the cord moist and transport as soon as possible. D. give the mother high-flow oxygen and transport rapidly.

B. make one attempt to slide the cord over the head. Rationale: If the umbilical cord is wrapped around the baby's neck (nuchal cord), you should make one attempt to gently remove the cord from around the baby's neck. If this is not possible, the cord should be clamped and cut. Keep the cord moist, administer high-flow oxygen to the mother, and transport at once.

In contrast to abruptio placenta, placenta previa: A. is typically associated with severe abdominal pain. B. might present without significant abdominal pain C. is caused by hypertension or abdominal trauma D. might not present with heavy vaginal bleeding

B. might present without significant abdominal pain

A 23-year-old woman, who is 24 weeks pregnant with her first baby, complains of edema to her hands, a headache, and visual disturbances. When you assess her vital signs, you note that her blood pressure is 160/94 mm Hg. She is MOST likely experiencing: A. eclampsia. B. preeclampsia. C. a hypertensive crisis. D. chronic water retention.

B. preeclampsia. Rationale: Preeclampsia—also called pregnancy-induced hypertension—usually develops after the 20th week of gestation and most commonly affects primagravida (first pregnancy) patients. It is characterized by a headache, visual disturbances, edema of the hands and feet, anxiety, and high blood pressure. Preeclampsia can lead to eclampsia, a life-threatening condition that is characterized by seizures.

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

B. start of one to the start of the next

The 1-minute Apgar score of a newborn reveals that the baby has a heart rate of 90 beats/min, a pink body but blue hands and feet, and rapid respirations. The baby cries when the soles of its feet are flicked and resists attempts to straighten its legs. You should assign an Apgar score of: A. 4. B. 6. C. 8. D. 9.

C. 8. Rationale: The Apgar score, which is obtained at 1 and 5 minutes after birth, assigns a numeric value to the following five areas: appearance, pulse, grimace, activity, and respirations. A heart rate below 100 beats/min is assigned a 1; a pink body with blue hands and feet is a 1; rapid respirations is a 2; a strong cry in reaction to a painful stimulus is a 2; and resistance against an attempt to straighten the hips and knees is a 2. Added together, the Apgar score for this infant is 8.

The MOST effective way to prevent cardiopulmonary arrest in a newborn is to: A. rapidly increase its body temperature. B. allow it to remain slightly hypothermic. C. ensure adequate oxygenation and ventilation. D. start CPR if the heart rate is less than 100 beats/min.

C. ensure adequate oxygenation and ventilation. Rationale: Cardiopulmonary arrest in infants and children (including newborns) is most often the result of respiratory arrest. Therefore, ensuring adequate oxygenation and ventilation at all times is critical. It is also important to maintain the infant's body temperature and to prevent hypothermia.

In contrast to a full-term infant, a premature infant: A. retains heat better because of excess body hair B. is often covered with excess vernix material C. has an even proportionately larger head D. is one who is born before 38 weeks' gestation

C. has an even proportionately larger head

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

C. pregnant patients have an overall increase in blood volume.

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

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

Which of the following is not a component of the Apgar score? A. Grimace B. Pulse C. Activity D. Body size

D. Body size

Which of the following is an indication of imminent birth? A. Rupture of the amniotic sac B. Expulsion of the mucus plug from the vagina C. Irregular contractions lasting 10 mins D. Crowning of the baby's head

D. Crowning of the baby's head

You are transporting a woman who is 8 months pregnant. To prevent supine hypotensive syndrome, how should you position this patient? A. On her right side B. Supine C. Semi-Fowler's D. On her left side

D. On her left side Rationale: To prevent supine hypotensive syndrome, the patient must be positioned on her left side. This stops the weight of the baby from compressing the inferior vena cava, which can cause low blood pressure.

Immediately after delivery of the infant's head, you should: A. suction the baby's mouth and then nose. B. suction the baby's nose and then mouth. C. assess the baby's breathing effort and skin color. D. check the position of the umbilical cord.

D. check the position of the umbilical cord. Rationale: Immediately following delivery of the infant's head, you should check the position of the umbilical cord to make sure it is not wrapped around the baby's neck (nuchal cord). If a nuchal cord is not present, suction the infant's mouth and nose.

After a baby is born, it is important t: A. position it so that its head is higher than its body. B. immediately clamp and cut the umbilical cord. C. cool the infant to stimulate effective breathing D. ensure that it is thoroughly dried and warmed

D. ensure that it is thoroughly dried and warmed

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

D. is pregnant for the first time.

Pregnant women are advised to take iron supplements, such as prenatal vitamins because: A. iron makes the blood clot faster, which protects the mother from excessive bleeding during delivery B. white blood cells decrease during pregnancy, which increases the mother's risk of an infection C. the blood naturally thins during pregnancy, which predisposes the mother to severe bleeding. D. pregnancy causes an increased number of red blood cells, which predisposes the mother to anemia

D. pregnancy causes an increased number of red blood cells, which predisposes the mother to anemia

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

D. profound tachycardia

The need for and extent of newborn resuscitation is based on: A. the 1-minute Apgar score. B. the gestational age of the newborn. C. the newborn's response to oxygen. D. respiratory effort, heart rate, and color.

D. respiratory effort, heart rate, and color. Rationale: The need for and extent of newborn resuscitation is based on respiratory effort, heart rate, and skin color. The Apgar score is not used to determine if resuscitation is needed; the first score is not assigned until the newborn is 1 minute of age. Resuscitation, if needed, should commence immediately.

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

A. carries oxygen to the baby via the umbilical vein

While assisting a woman in labor, you visualize her vaginal area and see an arm protruding from her vagina. She tells you that she feels the urge to push. You should: A. cover the arm with a sterile towel and transport immediately. B. encourage her to keep pushing as you prepare for rapid transport. C. insert your gloved fingers into the vagina and try to turn the baby. D. instruct the mother to keep pushing and give her high-flow oxygen.

A. cover the arm with a sterile towel and transport immediately. Rationale: Limb presentations do not deliver in the field—period! If the mother feels the urge to push, instruct her to stop; she should pant instead. Cover the protruding limb with a sterile towel, administer high-flow oxygen to the mother, and transport immediately. Delivery must take place in the hospital.

A precipitous labor and delivery is most common in women who: A. have delivered a baby before B. have gestational diabetes C. are pregnant for the first time D. are younger than 30 years of age

A. have delivered a baby before

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

A. insulate and protect the fetus

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

A. positive - pressure ventilations

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

A. seizures that result from severe hypertension

The first stage of labor ends when: A. the presenting part of the baby is visible. B. contractions are less than 10 minutes apart. C. the mother experiences her first contraction. D. the amniotic sac ruptures and labor pains begin.

A. the presenting part of the baby is visible. Rationale: The first stage of labor begins with the onset of contractions and ends when the cervix is fully dilated. However, since cervical dilation cannot be assessed in the field, the first stage of labor is considered over when the presenting part of the baby is visible at the vaginal opening (crowning).

An infant is premature if it: A. weighs less than 5 pounds or is born before 36 weeks' gestation B. weighs less than 5.5 pounds or is born before 37 weeks' gestation. C. is born before 38 weeks' gestation or weighs less than 6 pounds D. is born before 40 weeks' gestation or weighs less than 7 pounds.

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