ch 37

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Five minutes after delivering a​ baby, the mother feels the sudden urge to push and a gush of blood comes from the vagina. Given that the mother is not delivering​ twins, which stage of labor should the EMT​ recognize?

Placental

Prior to​ delivery, the EMT prepares to create a sterile field around the​ patient's vaginal opening. This is best accomplished​ by:

Placing a sheet from the OB kit under the​ patient's hips and another over her abdomen and legs

After successfully delivering a​ baby, the EMT notes that the protruding umbilical cord is lengthening and a small gush of blood came out of the vagina. The appropriate action would be​ to:

Prepare for delivery of the placenta

According to the neonatal resuscitation​ pyramid, which level of care will most newborns​ require?

Tactile stimulation and drying

An EMT is presenting a continuing education class on the care of the pregnant female. When discussing the amniotic​ sac, he is correct to emphasize which​ point?

The amniotic sac protects and insulates the baby during gestation

While delivering a baby in the​ field, the EMT notices that the baby is covered with a​ green-brown liquid. The EMT should immediately recognize​ that:

The baby was distressed and may be hypoxic

Which statement regarding the role and function of the cervix during pregnancy is​ true?

The cervix becomes plugged with mucus to prevent contamination of the uterus during gestation

When faced with the possibility of delivering​ twins, the EMT must remember​ that:

The second infant may be born breech

The EMT would use the sterile scissors found in the OB kit to​ cut:

The umbilical cord

You have been called to a crisis shelter for a patient possibly having a baby. On​ scene, you find an older female patient who is developmentally challenged and cannot communicate normally. Staff states that the patient just came to the shelter and they know nothing about​ her, other than that she is pregnant. Assessment reveals​ crowning, and you proceed to deliver what appears to be a healthy baby boy. When assessing the mother after​ delivery, which finding should increase your suspicion that the woman may be carrying​ twins?

The​ mother's abdomen remains large after delivery of the first baby

The Apgar scoring system is useful in​ determining:

The​ newborn's overall condition

A​ 31-year-old female in her third trimester of pregnancy lost her balance and fell down a flight of stairs. Treatment included spinal motion precautions and oxygen therapy. When transporting​ her, the EMT​ should:

Tilt the long spine board to the left

Which finding is of greatest concern when assessing a​ 33-year-old female who is eight months​ pregnant?

Vaginal bleeding not associated with pain

The EMT shows that he understands the seriousness of a prolapsed umbilical cord when he​ states:

​"A prolapsed cord that is pinched can stop the flow of oxygen to the baby and must be addressed​ immediately."

The EMT shows that he understands care of the​ post-delivery mother when he​ states:

​"Allowing the baby to nurse immediately after delivery can help to control uterine​ bleeding."

The EMT shows that he can accurately differentiate placenta previa from abruptio placentae when he​ states:

​"Bleeding associated with abruptio placentae is typically associated with abdominal​ pain; bleeding associated with placenta previa is​ painless."

A woman informs you that she is eight months pregnant and fatigues easily. She is apprehensive because when she lies​ down, she gets dizzy and feels as though she is going to vomit. What is the​ EMT's best​ response?

​"Check with your​ obstetrician, but you may want to rest and sleep on your left or right​ side."

You have been called for a​ 16-year-old female with vaginal bleeding. On​ scene, you determine the patient to be pregnant and bleeding for 3 hours. Which statement would indicate proper care of the​ patient?

​"I am going to put this sanitary napkin between your legs to collect the​ blood."

You are transporting a female patient who is seven months pregnant. She has been diagnosed with preeclampsia and is currently hypertensive. Which statement made by the patient indicates she may be transitioning from preeclampsia to​ eclampsia?

​"I feel like I am going to have a​ seizure."

Which statement by the patient best indicates that the patient is in the second stage of​ labor?

​"I feel like I have to move my​ bowels."

When assessing a​ 27-year-old patient who is eight months​ pregnant, which statement made by the patient should the EMT be most concerned​ about?

​"I have not been able to see the doctor this pregnancy at​ all."

You are caring for an emotionally distraught female who just suffered a miscarriage. During​ transport, which statement would be the most appropriate one for the EMT to make to the​ patient?

​"I really do not know what to​ say, but let me know how I can help​ you."

The EMT shows an understanding of newborn resuscitation when she​ states:

​"Interventions in a newborn should be performed for 30 seconds followed by​ reassessment."

A​ 25-year-old female presents with abdominal pain. She appears thin and​ healthy, but in obvious distress. Of the many questions the EMT may​ ask, which one should the EMT ask early during the patient​ interview?

​"Is there any possibility you are​ pregnant?"

You are transporting a young female who just had a miscarriage at home. During the transport the woman weeps continually. Which statement is most appropriate given the​ situation?

​"Is there anything that I can do to help you right​ now?"

Which statement made by a pregnant patient in labor should be of most concern to the​ EMT?

​"My water broke two days​ ago."

You have determined that you will need to perform a field delivery. Which instructions to the patient show that the EMT is properly positioning​ her?

​"Please lie on your​ back, draw your knees​ upward, and spread your legs​ apart."

Which statement made by the EMT indicates an understanding of the relationship between seizures and​ pregnancy?

​"Prolonged seizures can easily cause the mother and baby to become​ hypoxic."

Which statement regarding the​ placenta, made by your EMT partner while reviewing the​ OB/GYN protocols, is most​ accurate?

​"The placenta typically delivers itself within 20 minutes of the birth of the​ baby."

The EMT shows she has a proper understanding of​ Braxton-Hicks contractions when he​ says:

​"They are often irregular and less painful than labor​ contractions, but they should still be evaluated by the​ hospital."

When​ asked, a young female with abdominal pain replies that she is not sure if she is pregnant. Given this​ response, which question would provide the best information to determine if the patient may be​ pregnant?

​"When was your last normal menstrual​ period?"

What would the minimum expected preductal SpO2 reading be at one minute after​ birth?

​60%

What are the stages of labor in the order in which they​ occur?

​Dilation, expulsion, and placental delivery

You are assessing a​ 29-year-old pregnant female who has signs of imminent delivery. Her past medical history includes HIV infection. Compared to a patient with no infectious​ disease, how will standard precautions differ for this​ patient?

​Gloves, a​ gown, and eye protection should be worn for both the patient with HIV and the noninfectious patient

When do most women experience a decrease in the nausea and vomiting associated with hyperemesis​ gravidarum?

Between 14 and 20 weeks

A female patient is 34 weeks​ pregnant, and you are delivering the baby. As soon as the baby is completely​ delivered, you should​ immediately:

Dry the baby with a warm towel

A young female complains of sharp pain to the left lower quadrant of her abdomen. She states that her last period was seven weeks ago. With this​ information, the EMT should be suspicious​ of:

Ectopic pregnancy

A​ 32-year-old female complains of the sudden onset of sharp pain to the left side of her abdomen. She denies any medical history and when​ asked, admits to being sexually active. Her last menstrual period was two months ago. As an​ EMT, you should immediately​ suspect:

Ectopic pregnancy

In a normal​ fertilization, the egg and the sperm meet in which​ structure?

Fallopian tube

Upon arrival at the home of a woman in​ labor, a midwife on scene tells you the patient is 7 cm dilated and is complaining of painful contractions. Which stage of labor should the EMT​ identify?

First stage

When should the EMT instruct his partner to cut the umbilical​ cord?

Following delivery and after the baby has been dried off

You are assessing a female patient who informs you that she has been pregnant four times before but delivered only once. What would be a correct way to document that information on the prehospital care​ report?

Gravida​ IV; para I

After the EMT observes that secretions are interfering with the​ baby's breathing, which action indicates that the EMT is properly suctioning the​ newborn?

He squeezes the bulb syringe prior to placing it in the​ baby's nose

Which single assessment finding is most consistent with a stable​ newborn?

Heart rate of 140 beats per minute

The components of the Apgar scoring system​ include:

Heart​ rate, spontaneous​ activity, and respirations

When treating a patient whom you believe has an ectopic​ pregnancy, you know that the primary threat to the​ patient's life​ is:

Hemorrhage

You arrive at the residence of a physician who informs you that his pregnant wife requires immediate transport to the hospital because she is bleeding and has a history of abruptio placentae. As a knowledgeable​ EMT, you should recognize that the greatest threat to the baby​ is:

Hypoxia

A​ newborn's first Apgar score was 6. His second Apgar score is 9. What does this information mean to the​ EMT?

Improvement

As soon as the baby is delivered from the vaginal​ canal, it is critical that the EMT​ immediately:

Initiate drying and warming of the newborn

You have completed the assessment of a​ 32-year-old patient who is starting her seventh month of pregnancy. During your​ assessment, which finding should you be most concerned​ about?

Intermittent vaginal bleeding

During a continuing education session on​ OB/GYN topics, the EMT would recognize which statement about the umbilical cord as​ true?

It contains one vein and two arteries

Why is the uterus essential to a healthy pregnancy and​ childbirth?

It powerfully contracts to force the fetus from the​ mother's body following gestation

Assessment of a newborn indicates that she has slow and irregular respirations with a weak cry. You should award her how many points according to the Apgar scoring​ system?

1

Assessment of a newborn indicates that his heart rate is 120 beats per minute. How many points should he be awarded according to the Apgar scoring​ system?

2

How many newborns will require a level of care that falls below the top tier of the neonatal resuscitation​ pyramid?

20 percent

While examining a pregnant patient who has not received prenatal medical​ care, you note that you can palpate the uterine fundus at the level of the umbilicus. What is the approximate gestational age of the​ fetus?

20 weeks

The EMT is performing CPR on a neonate. What is the correct​ compression-to-ventilation ratio?

3 compressions to every 1 ventilation

By the time a fetus reaches full​ term, the tidal volume of the female has increased​ by:

40 percent

When asked by a concerned newborn​ parent, the EMT should indicate that an acceptable respiratory rate for the newborn​ is:

52 breaths per minute

The EMT would recognize which neonate as​ premature?

A baby weighing 7 pounds 4 ounces born at 36 weeks

Which statement regarding limb presentation is true during​ childbirth?

A cesarean section birth will likely be required

You have been called for a​ 35-year-old female who is experiencing vaginal spotting. The patient states that she has noted the discharge of blood from her vagina and is concerned because she is 36 weeks pregnant. She has also experienced some abdominal​ pain, which she describes as​ "sharp." Your assessment reveals bleeding as noted and tenderness on palpation just right to the midline of her abdomen. Her pulse is 122​ beats/min, respirations are 22​ breaths/min, blood pressure is​ 118/82 mmHg, SpO2 is​ 96%, and oral temperature is 97.3degreesF. Based on this​ presentation, you​ would:

Administer​ high-concentration oxygen and immediately transport the patient

Despite the increase in maternal blood​ volume, the pregnant patient is​ typically:

Anemic

What would the expected preductal SpO2 reading be at 5 minutes after​ birth?

At least​ 80%

A female patient tells you that she is 38 weeks pregnant. Where would you expect to palpate the top of the uterus during your​ exam?

At the level of the xiphoid process

While delivering a​ baby, you note that the umbilical cord is wrapped around the​ baby's neck. You​ would:

Attempt to slip the cord over the​ baby's shoulders or head

The EMT should recognize a​ full-term pregnancy has occurred in which​ patient?

A​ 21-year-old woman who is 39 weeks pregnant and feeling dizzy

Which patient should the EMT be most suspicious of having a spontaneous​ abortion?

A​ 21-year-old woman, 6 weeks​ pregnant, passing vaginal blood clots

Which action shows that the EMT is properly caring for the umbilical cord after​ delivery?

A​ 6-inch segment of cord is still connected to the baby

You have been called to a residence for a​ 21-year-old female in labor. On​ arrival, you immediately see that the head of the baby is out of the vagina. While delivering the​ head, the mother tells you that she is having twins. The EMT should​ immediately:

Call for another EMS crew

You are in the process of performing a field delivery and have just delivered the​ baby's head. What should you do​ next?

Check the neck for the umbilical cord

You arrive at the side of a pregnant patient in her third trimester who has had vaginal bleeding for several hours. Observation reveals several​ blood-soaked towels on the bed. She is alert and oriented with a patent airway and adequate breathing. Her pulse is 88 beats per minute and her blood pressure is​ 104/66 mmHg. In caring for this patient you​ would:

Collect all towels with blood and transport them with the patient

It has been 30 minutes and the placenta has yet to deliver. The EMT​ should:

Continue to monitor the mother and baby

A female patient has acute onset of​ right-sided abdominal​ pain, describes it as​ sharp, and rates it as​ 9/10. The primary survey reveals no life​ threats, but her skin is cool and diaphoretic. She states that she has been going to the bathroom more and is worried because her father has diabetes. Her last period was nine weeks​ ago, and she has a history of irregular periods. Her heart rate is 122​ beats/min, respirations are 20​ breaths/min, blood pressure is​ 138/68 mmHg, and SaO2 is​ 97%. In this​ scenario, which bit of information is of most concern to the​ EMT?

Last period nine weeks ago

When cutting the umbilical​ cord, how should the baby be​ positioned?

Level with the​ mother's uterus

The EMT recognizes the underlying pathophysiology associated with the most common type of ectopic pregnancy is a fertilized egg that​ is:

Lodged in a fallopian tube

When should the EMT use the Apgar scoring system on a​ newborn?

One and five minutes after the baby has been delivered

Which action demonstrates that the EMT is correctly performing uterine​ massage?

One hand cups the top of the​ uterus, with one of the hands positioned just above the symphysis pubis

A female patient who is eight and a half months pregnant states that she does not feel well and is weak with clammy skin. She denies chest​ pain, shortness of​ breath, and dizziness. She states that she did vomit earlier in the morning and still feels somewhat nauseated. She is alert and oriented and has a patent airway. She is breathing 18 times per minute and has a heart rate of 88 beats per minute. Her blood pressure is​ 116/70 mmHg and her SpO2 reading is​ 95% on room air. The most appropriate care for this patient should​ include:

Oxygen at 15 lpm via a nonrebreather face mask

After​ delivery, you note blood still escaping from the​ mother's vagina. The sanitary pads that you placed earlier between her legs continue to become soaked. Your next action would be​ to:

Perform a uterine massage

You have been called to assist another crew with the birth of a baby. On​ scene, another EMT informs you that the​ mother's perineum tore and is bleeding heavily. You​ would:

Place a sterile dressing between the​ mother's vagina and rectum

You have been dispatched for a young female in labor. On​ arrival, you find an arm protruding from the vagina. What should you do​ next?

Place the mother in a​ knee-chest position

A​ 31-year-old female is in labor. After ensuring her​ airway, breathing, and​ circulation, you assess her perineum and observe the umbilical cord protruding from the vagina.​ However, the baby is not visible. Your next action would be​ to:

Place the patient in a​ knee-chest position

Assessment of a pregnant patient in labor reveals what appears to be the​ baby's buttocks presenting at the vaginal opening. The EMT would​ immediately:

Place the patient in​ supine, head-down​ position, with hips​ elevated, and administer supplemental oxygen

You have arrived at the side of a​ 35-year-old female who is 37 weeks pregnant and in labor. Your exam reveals crowning with contractions 60 seconds apart. Your immediate action would be​ to:

Place the patient on her​ back, and then open and prepare the OB kit

A​ 22-year-old female, who is eight months​ pregnant, calls 911 for vaginal bleeding. Your primary assessment reveals no acute life​ threats, but the patient does have some evidence of blood in her underwear. The patient denies abdominal pain. Her vital signs are normal. Given these​ findings, the EMT should be suspicious​ of:

Placenta previa

If the placenta attaches over the​ cervix, the patient and fetus would be at risk for which​ condition?

Placenta previa

You have been called for a​ 27-year-old female who is 32 weeks pregnant. She states that she is experiencing uterine contractions but feels no pain with​ them, just a tightening in her abdomen. The contractions began three days ago and seem to be increasing in frequency today. She denies discharge or rupture of her membranes. Given this​ presentation, you should​ recognize:

Probable false​ labor, but have the patient transported to the hospital for evaluation

During which abnormal birth presentation is it permissible for the EMT to place a gloved hand into the vaginal​ canal?

Prolapsed umbilical cord

While en route for a call involving a pregnant​ patient, an Emergency Medical Responder​ (EMR) on scene contacts you and reports that the patient is actively seizing. The EMR reports that she is seven months pregnant and has not been feeling well for the past three days​ (per family). Which instruction is critical for you to relay to the​ EMR?

Provide oxygen at 15 liters per minute

You are completing the delivery of a near term baby boy when you notice that the fluid expelled with the baby is​ greenish-brown. At this point you​ should:

Quickly suction the nose and mouth only if the​ newborn's condition is depressed

You are delivering a baby in the​ patient's house. As the​ baby's head appears at the opening of the​ vagina, you notice that the amniotic membrane is still intact. You​ would:

Rip open the amniotic sac with your fingers

You have been dispatched to a residence for a female patient who is dizzy and​ "passing out." An Emergency Medical Responder meets you at the door and reports that the patient is lying in bed and is nine months pregnant. Her pulse rate is 112 beats per minute and her blood pressure is​ 84/50 mmHg. Respirations are 24 breaths per minute and she has a room air pulse oximetry reading of​ 97%. What should you do as soon as you reach the​ patient's side?

Roll her onto her left side

You are by the side of a​ 19-year-old female who is 36 weeks pregnant. When assessing this​ patient, which finding best indicates that she is in preterm​ labor?

Rupture of the amniotic sac

You have been called to a home for a female in labor. On​ scene, the family tells you that the​ 37-year-old patient is 42 weeks pregnant and wanted to have her baby at home naturally. The patient has been in labor for more than 24​ hours, but suddenly began complaining of severe and tearing abdominal pain. Which condition should the EMT​ suspect?

Ruptured uterus

A female patient is described as primigravida.​ Consequently, the EMT would recognize​ that:

She is pregnant for the first time

You are responding to a​ low-income apartment complex for a​ 16-year-old female who is five weeks pregnant with vaginal bleeding. When mentally reviewing possible causes of hemorrhage for this​ patient, which condition are you most likely to encounter given the information provided thus​ far?

Spontaneous abortion

Despite positive pressure​ ventilation, a term​ newborn's heart rate has decreased from 80 beats per minute to 40 beats per minute. He is breathing spontaneously but shallowly at 40 breaths per minute and has a mottled appearance. Your next action would be​ to:

Start external chest compressions

Assessment indicates that a term​ newborn's respiratory rate is 38 breaths per minute and his heart rate is 80 beats per minute after administration of supplemental​ blow-by oxygen. The EMT​ should:

Start positive pressure ventilation with supplemental oxygen

After positive pressure​ ventilation, a​ newborn's heart rate increases from 80 to 120 beats per minute. The EMT​ should:

Stop positive pressure ventilation and provide​ blow-by oxygen


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