Chapter 34 Obstetrics and Neonatal Care

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. "Is this your first baby?" C. "Do you feel the need to push?" D. "When are you due?"

A. "Have you had a sonogram?"

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

A. 15 to 30

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

A. 7:57.

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

A. In some cases, women with gestational diabetes require insulin injections.

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

A. Increased respiratory rate and decreased respiratory reserve

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

A. baby is expelled from the vagina.

The only indications for placing your gloved fingers in the vagina during delivery are: Select one: 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. breech presentation and prolapsed umbilical cord.

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

A. have delivered a baby before.

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

A. is pregnant for the first time.

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. insert an oral airway and ventilate her with a bag-valve mask. D. elevate her legs to improve brain perfusion and keep her warm.

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

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

A. positive-pressure ventilations.

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

A. 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. profound tachycardia. B. low birth weight. C. respiratory depression. 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: Select one: A. pulmonary embolism. B. intrauterine bleeding. C. acute pulmonary edema. D. spontaneous pneumothorax.

A. pulmonary embolism.

Eclampsia is most accurately defined as: Select one: 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 presence of meconium in the amniotic fluid indicates: Select one: A. that the baby's airway might be obstructed. B. that full newborn resuscitation will be needed. C. that the fetus is at least four weeks premature. D. an expected finding in full- term intants.

A. that the baby's airway might be obstructed.

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

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

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 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. C. 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. 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.

B. 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.

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

B. Uterine contractions become more regular.

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

B. alleviation of pain with movement or changing positions.

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. belly button. C. xiphoid process. D. pubic bone.

B. belly button.

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. firmly massage the uterine funds with a circular motion. C. place her legs together and position her on her left side. D. elevate her legs six to eight inches and cover her with a blanket. See Normal Delivery

B. firmly massage the uterine funds with a circular motion.

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

B. insulate and protect the 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? Select one: A. Tell the mother not to push and transport her immediately. 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. Maintain firm pressure to the head until it completely delivers.

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

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

C. Body size

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

C. Crowning of the baby's head

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

C. ensure that it is thoroughly dried and warmed.

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: Select one: A. clamp and cut the umbilical cord and keep him warm. B. begin chest compressions and reassess in 30 seconds. C. keep him warm and ventilate with a bag-mask device. D. assess his skin color and give free-flow oxygen as needed.

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

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

C. on the first day of her last menstrual cycle.

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

C. start of one to the start of the next.

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

D. 16 hours.

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? Select one: A. Clamp and cut the umbilical cord. B. Begin assisting the newborn's breathing. C. Allow the mother to hold her baby. D. Check the pulse rate at the brachial artery.

D. Check the pulse rate at the brachial artery.

Which of the following statements regarding suctioning of a newborn's mouth and oropharynx is correct? Select one: A. Newborns rapidly expel fluid from their lungs and do not require suctioning. B. Suctioning should be performed on all newborns immediately following delivery. C. If the head delivers face- down, the mouth and nose should be suctioned at once. D. Suctioning is indicated prior to cutting the cord if respiratory distress is present.

D. Suctioning is indicated prior to cutting the cord if respiratory distress is present.

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

D. carries oxygen to the baby via the umbilical vein.

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

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

D. has an even proportionately larger head.

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

D. internal bleeding caused by a ruptured ectopic pregnancy.

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

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

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

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

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