Vol 5 Chapter 2 Obstetrics

A 38-year-old pregnant woman called 911 after she developed a "splitting headache" unrelieved by over-the-counter analgesics. She states that she has a previous diagnosis of diabetes that is typically well controlled with insulin injections. This patient's history of diabetes makes her more likely to develop which of the following pregnancy-related conditions? A) Preeclampsia B) Cerebral aneurysm C) Congestive heart failure D) Stroke

A) Preeclampsia Page Ref: 26 Diabetics are at increased risk of developing preeclampsia and hypertension

A newborn is listless and has a heart rate of 50 beats per minute after 30 seconds of stimulation. You should FIRST: A) initiate positive pressure ventilation. B) begin chest compressions. C) obtain IV access. D) apply the AED.

A) initiate positive pressure ventilation.' Page Ref: 41

The second stage of labor begins: A) with the complete dilation of the cervix. B) at the onset of contractions. C) when the baby is delivered. D) at the rupture of membranes.

A) with the complete dilation of the cervix. Page Ref: 36 Stage one (dilation stage) Begins with onset of true labor contractions; ends with complete dilation and effacement of cervix. Stage two (expulsion stage) Begins with complete dilation of cervix; ends withdelivery of fetus Stage three (placental stage) Begins immediately after birth of infant; ends withdelivery of placenta

When is the ideal time to assess a neonate for the APGAR score? A) 2 to 3 minutes after delivery B) 1 minute and 5 minutes after delivery C) 5 to 10 minutes after delivery D) 2 minutes and 10 minutes after delivery

B) 1 minute and 5 minutes after delivery Page Ref: 40

What is the appropriate sequence of care for a newborn following a normal delivery? A) Suction the nose, dry the infant, and cut the cord. B) Dry the infant, cut the cord, and place infant on mother's stomach. C) Suction the mouth, deliver the placenta, and cut the cord. D) Apply oxygen, dry the infant, and give the infant to the mother.

B) Dry the infant, cut the cord, and place infant on mother's stomach. Page Ref: 39, 40

You have just delivered an infant at 33 weeks gestation. The infant is blue and limp and has a brachial pulse of 70 beats per minute. What is the appropriate sequence of care for this infant? A) Keep warm and dry, chest compressions, clamp and cut the cord. B) Keep warm and dry, clamp and cut the cord, positive pressure ventilations. C) Clamp and cut the cord, positive pressure ventilations, keep warm and dry. D) Clamp and cut the cord, chest compressions, positive pressure ventilations.

B) Keep warm and dry, clamp and cut the cord, positive pressure ventilations. Page Ref: 41

When assessing the vital signs of a pregnant patient, it is generally most appropriate to have the patient in which position? A) Supine B) Left lateral recumbent C) Semi-Fowler's D) Standing

B) Left lateral recumbent Page Ref: 27 left lateral recumbent position is preferred after the 24th week.

You are caring for a woman who is 32 weeks pregnant. While assessing her breathing, you notice that her rib cage expands visibly with each breath and that her tidal volume appears to be deep. You recognize: A) signs of a severe respiratory condition requiring immediate intervention. B) an increase in tidal volume that is normal during pregnancy. C) signs of obstructive shock. D) an increase in oxygen demand due to an obstetrical emergency.

B) an increase in tidal volume that is normal during pregnancy. Page Ref: 21 The diaphragm is pushed up by the enlarging uterus, resulting in flaring of the rib margins to maintain intrathoracic volume.

You are caring for a 19-year-old woman who states that she is 32 weeks pregnant. She is experiencing cramping abdominal pain every six to seven minutes and reports a brief period of fluid discharge from her vagina approximately 15 minutes ago. You should: A) provide routine BLS care and transport. B) begin a fluid bolus and transport code 3. C) administer ondansetron and reassess vital signs. D) apply oxygen and perform a physical exam.

B) begin a fluid bolus and transport code 3. Page Ref: 35-36

A 29-year-old woman is 28 weeks pregnant. She complains of nausea, abdominal pain, and right shoulder pain. She states she vomited once, which caused temporary relief; however, the pain returned shortly afterward. She has no pertinent medical history or allergies, has stable vital signs, and states that she ate a cheeseburger about 20 minutes prior to the start of her pain. The most likely cause of this patient's presentation is: A) food poisoning. B) cholecystitis. C) hyperemesis gravidarum. D) appendicitis.

B) cholecystitis. Page Ref: 29 Cholecystitis - gallstones Severe pain in your upper right or center abdomen. Pain that spreads to your right shoulder or back. Appendicitis appendicitis may complain of right lower quadrant pain or even back pain

Just before an infant is delivered, the fetal scalp can be seen at the vaginal opening during each contraction. This is referred to as: A) effacement. B) crowning. C) dilation. D) presentation.

B) crowning. Page Ref: 28 Crowning is the bulging of the fetal head past the opening of the vagina during a contraction. Crowning is an indication of impending delivery.

You are assisting a mother with an out-of-hospital delivery. After the head delivers, it immediately retracts back into the perineum. You should: A) transport in the knee-chest position. B) instruct the mother to drop her buttocks off the end of the bed. C) gently pull downward on the infant's head. D) instruct the mother to avoid pushing if possible.

B) instruct the mother to drop her buttocks off the end of the bed. Page Ref: 43

You are caring for a patient who is 36 weeks pregnant. She states that she has been experiencing vaginal bleeding after intercourse, and denies any associated pain. Vital signs are: heart rate 84, respirations 18, blood pressure 102/72 mmHg, and warm, dry skin. The most likely cause of this patient's vaginal bleeding is: A) spontaneous abortion. B) placenta previa. C) abruptio placentae. D) false labor.

B) placenta previa. Page Ref: 31 Painless bleeding indicates placenta previa until proven otherwise placenta lies -placenta is low covering the cervix

You are caring for a woman in labor. She has had three previous deliveries and states that her contractions are approximately 3 minutes apart. Physical exam reveals a bulging of tissue at the vaginal opening with each contraction; however, the baby's head is not yet visible. You should: A) encourage the mother to breathe and ready her for transport. B) prepare for imminent delivery. C) place the mother in the knee-chest position. D) perform an internal exam to see how much the cervix is dilated.

B) prepare for imminent delivery. Page Ref: 38

You have just delivered a healthy newborn to a 35-year-old woman. There is a steady flow of blood from the vagina and her uterus feels soft upon palpation. Her vital signs are: heart rate 122, respirations 20, blood pressure 90/60 mmHg. Appropriate management of this patient includes: A) sanitary pads placed over the vagina and continued monitoring. B) two large-bore IVs and oxytocin administration. C) Trendelenberg position and administration of magnesium sulfate. D) low-flow oxygen and position of comfort.

B) two large-bore IVs and oxytocin administration. Page Ref: 45 confronted by a patient with postpartum hemorrhage Medical direction may request the administration of oxytocin (Pitocin). The usual dose is 10 to 20 USP units oxytocin in 1 liter of normal saline to run at 125 mL/hour titrated to response

During which period of development is the fetus most susceptible to damage from maternal exposure to toxins, such as alcohol and tobacco? A) 1-8 weeks B) 16-20 weeks C) 8-12 weeks D) 20-40 weeks

C) 8-12 weeks Page Ref: 24 fetus is most vulnerable to the development of birth defects in the first trimester

Which of the following techniques is an appropriate method of estimating the gestational age? A) Measuring the circumference of the woman's abdomen; each inch corresponds to one week of pregnancy. B) Palpate the abdomen and estimate gestational age based on the size of the developing fetus. C) Measure the height of the fundus; each centimeter corresponds to one week of pregnancy. D) Palpate the abdomen; if fetal movement is felt then the pregnancy is at least 14 weeks.

C) Measure the height of the fundus; each centimeter corresponds to one week of pregnancy. Page Ref: 47

Which structure allows oxygenated maternal blood to bypass the uninflated lungs of the developing fetus? A) Ductus venosus B) Foramen ovale C) Umbilical artery D) Ductus arteriosus

A) Ductus venosus Page Ref: 25 This enriched blood flows through the umbilical vein toward the baby's liver. There it moves through a shunt called the ductus venosus.

A 27-year-old pregnant woman was the restrained driver of a vehicle that hit the guardrail at a high rate of speed. She sustained a large laceration to the upper thigh and has lost a significant amount of blood. Vital signs are: heart rate 102, blood pressure 118/78 mmHg, respirations 18, and her skin is pale and clammy. Which of the following BEST explains this patient's presentation? A) Maternal blood volume increases during pregnancy, allowing vital signs to remain normal despite significant blood loss. B) Fetal oxygen demand increases after trauma, causing maternal blood pressure and heart rate to increase immediately after injury. C) Maternal blood volume decreases during pregnancy, amplifying the effects of epinephrine and allowing for the maintenance of blood pressure. D) Maternal vital signs remain normal following trauma to ensure the survival of the developing fetus.

A) Maternal blood volume increases during pregnancy, allowing vital signs to remain normal despite significant blood loss. Page Ref: 22 Pregnancy cardiac output increases by 30 to 50 percent throughout pregnancy, peaking at 6 to 7 liters/minute by the time the fetus is fully developed

A 30-year-old woman complains of swelling in both of her legs. She is 32 weeks pregnant, and states that she has also developed varicose veins over the past few weeks. Which of the following BEST explains the cause of this patient's signs and symptoms? A) The gravid uterus compresses the superior vena cava, decreasing venous return to the heart. B) Changes in the endocrine system cause peripheral edema during the late stages of pregnancy. C) The gravid uterus compresses the pelvic and femoral vessels, decreasing venous return and causing venous stasis. D) Changes in kidney function alter the normal electrolyte balance, causing tissue edema in the legs and feet.

C) The gravid uterus compresses the pelvic and femoral vessels, decreasing venous return and causing venous stasis. Page Ref: 22 Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior vena cava when the mother lies in a supine position, causing decreased venous return to the right atrium

During delivery, you notice a yellowish-green fluid on the baby's head and face. You recognize: A) a normal side effect of delivery. B) that emergency transport is required. C) a sign of fetal hypoxia. D) that the infant will require resuscitation.

C) a sign of fetal hypoxia. Page Ref: 45

A 37-year-old, obviously pregnant woman complains of sharp, tearing abdominal pain. She reports that she is pregnant with her fifth child, but states she cannot remember the exact due date. The patient has a history of drug use and states that she last smoked crack cocaine approximately 30 minutes ago. You suspect: A) spontaneous abortion. B) placenta previa. C) abruptio placentae. D) false labor.

C) abruptio placentae. Page Ref: 31-32 predisposing factors multiparity, maternal hypertension trauma cocaine use increasing maternal age history of abruption in a previous pregnancy

A 24-year-old pregnant woman is actively seizing. Her partner reports that she complained of abdominal pain approximately 10 minutes ago, and then began seizing. He reports that the seizure activity has been consistent for the past 10 minutes, and that she has no significant medical history. You should: A) apply a nasal cannula, assess blood glucose level, and transport in the left lateral position. B) insert a nasal airway, administer midazolam, and obtain vital signs. C) apply high-flow oxygen, administer magnesium sulfate, and transport emergently. D) suction the airway, obtain IV access, and assess blood pressure.

C) apply high-flow oxygen, administer magnesium sulfate, and transport emergently. Page Ref: 32-33 Administer a bolus dose of magnesium sulfate (2 to 5 g diluted in 50 to 100 mL slow IV push) to control the seizures

A woman late in her pregnancy is in cardiac arrest. When resuscitating this patient, it is appropriate to: A) compress at a rate of at least 120 per minute. B) use a mechanical compression device. C) lift and push the gravid uterus to the left. D) assess for imminent delivery.

C) lift and push the gravid uterus to the left. Page Ref: 47-48

The blood-rich structure that serves as a lifeline for the developing fetus is called the: A) uterus. B) cervix. C) placenta. D) amniotic sac.

C) placenta. Page Ref: 20

The term "puerperium" refers to: A) the delivery of the afterbirth. B) a specific fertility treatment. C) the time surrounding delivery. D) a technique used to delay contractions.

C) the time surrounding delivery. Page Ref: 36 The puerperium is the time period surrounding the birth of the fetus. the period of about six weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition.

A 32-year-old woman was the restrained passenger of a vehicle that hit a tree at a high rate of speed. She is 34 weeks pregnant and complains of excruciating abdominal pain. She is cool and diaphoretic and has a faint and rapid radial pulse. You suspect: A) traumatic onset of labor. B) uterine inversion. C) uterine rupture. D) premature rupture of membranes.

C) uterine rupture. Page Ref: 46

A pregnant woman is complaining of a severe headache and "feeling ill." Her vital signs are: heart rate 92, blood pressure 120/82 mmHg, and respiratory rate of 16. Which of the following questions would be most helpful in identifying a possible pregnancy-related emergency? A) "Do you have a history of migraine headaches?" B) "Have you been experiencing morning sickness or excessive vomiting today?" C) "When was the last time you saw your doctor?" D) "What has been a typical blood pressure for you during this pregnancy?"

D) "What has been a typical blood pressure for you during this pregnancy?" Page Ref: 33

A newborn has just been delivered. He is centrally pink with pale extremities, has a heart rate of 110, and is actively crying and moving. The appropriate APGAR score for this infant is: A) 6. B) 7. C) 8. D) 9.

D) 9. Page Ref: 41

The medically appropriate term for the projected birth date of a baby is: A) probable date of delivery. B) expected date of labor. C) predicted delivery date. D) estimated date of confinement.

D) estimated date of confinement. Page Ref: 23 Medically, it is known as the estimated date of confinement (EDC) or estimated date of delivery (EDD). Generally, pregnancy is divided into trimesters. Each trimester is approximately 13 weeks, or 3 calendar months, long.

A 42-year-old woman is 38 weeks pregnant and in active labor. While assessing for crowning, you notice that although the top of the baby's head is visible, a loop of the umbilical cord is protruding from the vagina. You should: A) gently attempt to reinsert the cord into the vaginal canal. B) encourage the mother to push while gently pulling traction. C) clamp and cut the presenting section of the umbilical cord. D) insert two fingers to raise the head of the baby off the cord.

D) insert two fingers to raise the head of the baby off the cord. Page Ref: 43

You are caring for a 42-year-old woman who is 32 weeks pregnant with twins. She is complaining of a severe headache and blurred vision, and lives in a rural area approximately 30 miles from the nearest ED. Your physical exam reveals significant peripheral edema and the following vital signs: heart rate 98, blood pressure 156/98 mmHg, respirations 18. The patient states she has a history of hypertension, but has not taken her prescribed medications because "they aren't safe for the babies." Appropriate treatment for this patient includes: A) administration of nitroglycerine and delayed transport. B) intravenous calcium chloride and 12-lead ECG.C) administration of aspirin and a prehospital stroke assessment. D) intravenous magnesium sulfate and rapid transport.

D) intravenous magnesium sulfate and rapid transport. Page Ref: 32-33 preeclampsia hypertension, edema, headaches, and visual disturbances

A 21-year-old woman is complaining of abdominal pain. She says she is 25 weeks pregnant and has been actively trying to stop using methamphetamines, but slipped and used earlier today. Her abdominal pain comes every 8 to 10 minutes and is described as sharp and cramping. You suspect: A) hypertensive disorder of pregnancy. B) abruptio placentae. C) toxic shock syndrome. D) preterm labor.

D) preterm labor. Page Ref: 35 True labor that begins before the 38th week of gestation is called preterm labor

Umbilical Cord - a flexible cordlike structure containing blood vessels and attaching a human or other mammalian fetus to the placenta during gestation.

Ductus Arteriosus - Connects the pulmonary artery and the aorta, again bypassing the lungs of the fetus. Foramen Ovale - Shunts blood from the right atrium directly into the left atrium. Bypassing the developing lungs.