Ch. 34: Obstetrics and Neonatal Care

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

B. 7:57

You are assessing a 25-year-old woman who is 39 weeks pregnant. She is experiencing regular contractions that are approximately three minutes apart and states that her amniotic sac broke two hours ago. After taking the standard precautions, you should: A. place her on her left side B. assess her for crowning C. apply high-flow oxygen D. transport her immediately

B. assess her for crowning

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

B. birth canal

You have just delivered a full-term infant. His respirations are rapid and irregular, and he has a strong cry. What should you do enxt? A. clamp and cut the umbilical cord B. check the pulse rate at the brachial artery C. allow the mother to hold her baby D. begin assisting the newborn's breathing

B. check the pulse rate at the brachial artery

Which of the following is an indication of imminent birth? A. expulsion of the mucus plug from the vagina B. crowning of the baby's head C. rupture of the amniotic sac D. irregular contractions lasting 10 minutes

B. crowning of the baby's head

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

B. ensure that it is thoroughly dried and warmed

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

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

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

B. is pregnant for the first time

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. keep him arm and ventilate with a bag-mask device C. begin chest compressions and reassess in 30 seconds D. clamp and cut the umbilical cord and keep him warm

B. keep him warm and ventilate with a bag-mask device

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. ventilate her with a bag-mask device B. place her in a left lateral recumbent position C. carefully place sterile gauze into her vagina D. position her supine and elevate her legs 12 inches

B. place her in a left lateral recumbent position

During delivery, it is MOST important to position your partner at the mother's head because: A. mothers often need assisted ventilation during delivery B. the mother might become nauseated and vomit C. the mother needs to be apprised of the situation D. she might need emotional support during the delivery

B. the mother might become nauseated and vomit

Supine hypotensive syndrome occurs when: A. a supine position kinds 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 pregnant uterus compresses the inferior vena cava

After 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. uterine massage increases blood flow to the uterus B. the production of oxytocin caused uterine contraction C. a portion of the placenta was retained in the uterus D. breastfeeding causes uterine blood vessels to dilate

B. the production of oxytocin caused uterine contraction

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

B. uterine contractions become more regular

Which of the following statements regarding the placenta is correct? 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 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. 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 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

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? A. place your fingers in the vagina to assess for a nuchal cord B. maintain firm pressure to the head until it completely delivers C. apply gentle pressure to the baby's head as it delivers D. tell the mother not to push and transport her immediately

C. apply gentle pressure to the baby's head as it delivers

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

C. belly button

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

C. carries oxygen to the baby via the umbilical vein

In contrast to a full-term infant, a premature infant: A. is often covered with excess vernix material B. retains heat better because of excess body hair 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 precipitous labor and delivery is MOST common in women who: A. have gestational diabetes B. are pregnant for the first time C. have delivered a baby before D. are younger than 30 years of age

C. have delivered a baby before

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

C. might present without significant abdominal pain

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

C. place her on her side, administer high-flow oxygen, and transport

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 mmHg

C. seizures that result from severe hypertension

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. newborns rapidly expel fluid from their lungs and do not require suctining C. suctioning is indicated prior to cutting the cord if respiratory distress is present D. If the head delivers face-down, the mouth and nose should be suctioned at once

C. suctioning is indicated prior to cutting the cord if respiratory distress is present

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

D. "Have you had a sonogram?"

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

D. 15 to 30

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. baby is expelled from the vagina

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

D. breech presentation and prolapsed umbilical cord

If a pregnant patient must be placed onto a backboard, you should: A. place a folded towel behind her head to make it easier to breathe B. raise the foot of the board 12 inches in order to maintain blood pressure C. elevate the head of the board six inches to prevent breathing impairment D. elevate the right side of the board with rolled towels or blankets

D. elevate the right side of the board with rolled towels or blankets

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. cover the umbilical cord with a dry dressing C. gently pull on the cord to facilitate delivery D. gently push the infants head away from the cord

D. gently push the infant's head away from the cord

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

D. in some cases, women with gestational diabetes require insulin injections

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

D. internal bleeding caused by a ruptured ectopic pregnancy

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: A. Avoid defibrillation because it might harm the fetus B. perform compressions slightly lower on the sternum C. deliver a compression rate of 120 to 140 per minute D. manually displace the patient's uterus to the left

D. manually displace the patient's uterus to the left

Most medical models base a pregnant woman's due date: A. two weeks after her last menstrual cycle B. on the last day of her last menstrual cycle C. two weeks before her last menstrual cycle D. on the first day of her last menstrual cycle

D. on the first day of her last menstrual cycle

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

D. positive-pressure ventilations

After delivery of a pulseless and apneic infant who has a foul odor, skin sloughing, and diffuse blistering, you should: A. begin full resuscitation and transport B. report the case to the medical examiner C. dry the infant off to stimulate breathing D. provide emotional support to the mother

D. provide emotional support to the mother

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

D. take quick short breaths

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

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

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

A. 16 hours

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. 8 B. 6 C. 9 D. 7

A. 8

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

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

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

A. alleviation of pain with movement or changing positions

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

A. an ectopic pregnancy

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

A. body size

After the fetus has descended into the pelvis at the end of the third trimester, many mothers experience: A. easier breathing B. a bloated feeling C. mid-back pain D. an urge to push

A. easier breathing

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

A. firmly massage the uterine fundus with a circular motion

Which of the following is a normal physiologic change that occurs in the mother's respiratory system during pregnancy? A. increased respiratory rate and decreased respiratory reserve B. increased respiratory depth and decreased respiratory rate C. increased respiratory reserve and decreased oxygen demand D. decreased respiratory rate and increased minute volume

A. increased respiratory rate and decreased respiratory reserve

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

A. insulate and protect the fetus

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infants leg is protruding from the vagina. Appropriate management of this situation includes: A. placing the mother supine with her head down and pelvis elevated B. placing the mother in a recumbent position and rapidly transporting C. gently pulling on the infant's leg to facilitate delivery D. carefully attempting to push the infant's leg off of the umbilical cord

A. placing the mother supine with her head down and pelvis elevated

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

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

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

A. pregnant patients have an overall increase in blood volume

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

A. profound tachycardia

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

A. pulmonary embolism

Upon delivery of the baby's head, you note that its face is encased in the unruptured amniotic sac. You should: 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 high-flow oxygen and transport at once

A. puncture the sac and suction the baby's mouth and nose

Which of the following is NOT generally considered an obstetrical emergency? A. Return of contractions following delivery of the baby B. failure of the placenta to deliver after 30 minutes C. more than 500 mL of blood loss before placental delivery D. significant bleeding after delivery of the placenta

A. return of contractions following delivery of the baby

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

A. start of one to the start of the next

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

A. that the baby's airway might be obstructed

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

A. the placenta prematurely separates from the uterine wall

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

A. the small amount of pink-tinged mucus that is discharged from the vagina after expulsion of the mucous plug