Obstetric & Gynecological Emergencies review !@#$%%^

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when should the apgar score be calculated

1 minute and 5 min after birth

obtain apgar score

1-5 min

when to begin cpr

10- 15 seconds

compression per min

120

A mother who is pregnant with her first baby is typically in the first stage of labor for approximately

16 HRS

bloody show

1st stage of labor

meconium

1st stool passed, greenish-black, tarry appearance. Formed as a fetus, consists of shed skin cells & lanugo hair that was swallowed.

the umbilical cord has?

2 arteries 1 vien

OVULATION begins______ before mestration

2 weeks

a prig increases blood by

20%

the shedding of the endometrium occurs on the

28 th day

an infant is considered premature if born b4

36 weeks

egg must be fertilized within

36-48 hrs

when assisting ventilations the rate is

40-60

how much fluid does the amniotic sac carry

500 to 1000ml of fluid

If a baby is born at 7:52 the second apgar score should be calculated at

7:57 (5 min later)

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

Bacterial vaginosis is a condition that occurs when: A. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. B. numerous bacteria enter the uterus through the cervix and cause severe tissue damage. C. abnormal bacteria enter the vagina and cause damage without causing any symptoms. D. harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes.

EMTs treating a patient of a sexual assault may not only be dealing with medical issues, but with _____ issues as well. A. psychological B. physiological C. educational D. sociological

Each ovary produces an ovum in alternating months and releases it into the: A. fallopian tube. B. vagina. C. cervix. D. uterus.

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer: A. may be relatively painless. B. is typically not as severe. C. can be controlled in the field. D. often presents with acute pain.

In rare cases, _____ causes arthritis that may be accompanied with skin lesions and inflammation of the eyes and urethra. A. chlamydia B. gonorrhea C. PID D. vaginal bleeding

It is not uncommon for young females who experience their first menstrual period to: A. experience abdominal cramping, which may be misinterpreted. B. become so emotionally distraught that they contemplate suicide. C. have a falsely positive home pregnancy test result. D. lose up to 500 mL of blood within the first 24 hours.

Often the most important intervention for sexual assault patient is _____ and transport to a facility with staff specially trained to deal with this scenario. A. comforting reassurance B. excellent assessment skills C. bandaging skills D. emotional sympathy

The "PID Shuffle" refers to: A. a distinctive gait when the patient walks. B. rotation of the microorganisms that cause PID. C. symptoms that come and go. D. a structural that come and go.

When a female has reached menarche: A. she is capable of becoming pregnant. B. she can no longer produce an ovum. C. she usually requires hormone therapy. D. menstrual periods become less frequent.

Which of the following statements regarding rape is correct? A. Rape is a legal diagnosis, not a medical diagnosis. B. Only a licensed physician can make a diagnosis of rape. C. The EMT should try to determine if rape occurred. D. Rape causes more physical harm than emotional harm.

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. Your first course of action should be to: A. determine whether the patient is physically injured. B. establish the exact events of what took place. C. allow the patient to use the restroom. D. let the police question the patient before conducting a primary assessment.

multigravida

A WOMAN WHO HAS BEEN PREGNANT MORE THAN ONCE

vernix caseosa

A white cheese-like protective material that covers the skin of a fetus.

46. An abortion occurs when the fetus and placenta deliver before: A. 20 weeks. B. 24 weeks. C. 26 weeks. D. 28 weeks.

A. 20 weeks.

25. Which of the following statements regarding a breech presentation is MOST correct? A. A breech presentation occurs when the buttocks are the presenting part. 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. Breech deliveries occur rapidly, so the EMT should deliver at the scene.

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

29. During your visual inspection of a 19-year-old woman in labor, you see the baby's head crowning at the vaginal opening. What should you do? A. Apply gentle pressure to the baby's head as it delivers. B. Tell the mother not to push and transport her immediately. C. Place your fingers in the vagina to assess for a nuchal cord. D. Maintain firm pressure to the head until it completely delivers.

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

10. Which of the following statements regarding the placenta is correct? A. 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. 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, 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. 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.

A. 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.

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

A. belly button.

22. The ONLY indications for placing your gloved fingers in the vagina during delivery are: 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.

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

A. ensure that it is thoroughly dried and warmed.

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

A. has an even proportionately larger head.

18. Signs and symptoms of preeclampsia include: A. headache and edema. B. marked hypoglycemia. C. dyspnea and bradycardia. D. dysuria and constipation.

A. headache and edema.

40. 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. keep him warm and provide ventilatory assistance. B. begin chest compressions and reassess in 30 seconds. C. clamp and cut the umbilical cord and keep him warm. D. assess his skin color and give free-flow oxygen as needed.

A. keep him warm and provide ventilatory assistance.

27. A 33-year-old woman who is 36 weeks pregnant is experiencing scant vaginal bleeding. During transport, you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. In addition to administering 100% oxygen, you should: A. place her in a left lateral recumbent position. B. position her supine and elevate her legs 12″. C. carefully place sterile gauze into her vagina. D. assist her ventilations with a bag-mask device.

A. place her in a left lateral recumbent position.

43. Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's 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. gently pulling on the infant's leg in an attempt to facilitate delivery. C. placing the mother in a recumbent position and rapidly transporting. 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.

13. During delivery of the baby's head, you should suction the mouth before the nose because: A. suctioning the nose first may cause the baby to gasp and aspirate fluid. B. it is easier to suction larger volumes of fluid from the baby's oropharynx. C. babies are primarily mouth breathers and do not breathe through their nose. D. the mucosa of the nose is fragile and is easily damaged by vigorous suctioning.

A. suctioning the nose first may cause the baby to gasp and aspirate fluid.

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

A. the mother may become nauseated and vomit.

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

A. the placenta prematurely separates from the uterine wall.

11. 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. mild vaginal bleeding that occurs within the first 30 minutes after the onset of the second stage of the labor process. C. the normal amount of vaginal bleeding that occurs within the first 24 hours following delivery of the baby and placenta. D. any volume of blood that is expelled from the vagina after the amniotic sac has ruptured and contractions have begun.

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

Traditionally an APGAR score is taken at what time intervals after birth? A. 1 and 5 minutes B. 1 and 6 minutes C. 2 and 7 minutes D. 5 and 10 minutes

A. 1 and 5 minutes

When clamping the umbilical cord, the clamp closest to the baby should be approximately ________ inch(es) from the infant's body. A. 10 B. 1 C. 3 D. 12

A. 10

By definition, a premature infant is one who is born before how many weeks of the pregnancy? A. 37 B. 40 C. 34 D. 28

A. 37

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

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

The condition in which the placenta separates from the uterine wall is known as which of the following? A. Abruptio placentae B. Ectopic pregnancy C. Preeclampsia D. Placenta previa

A. Abruptio placentae

Which of the following describes the normal appearance of amniotic fluid? A. Clear and colorless fluid Your answer is correct. B. Thin fluid, greenish-yellow in color C. Thick fluid, greenish-black in color D. A fluid containing blood and mucus

A. Clear and colorless fluid

The greatest danger to the pregnant woman and her fetus involved in trauma is which of the following? A. Hemorrhagic shock B. Distributive shock C. Neurogenic shock D. Supine hypotensive shock

A. Hemorrhagic shock

If assisting in a prehospital delivery while off-duty, which of the following would be the BEST choice for tying or clamping the umbilical cord? A. Pair of shoelaces B. Clothespin C. Section of wire coat hanger D. White cotton thread

A. Pair of shoelaces

Which of the following is NOT relevant in determining whether or not delivery is imminent for a woman in labor? A. Phoning the patient's obstetrician for advice B. Asking how long ago the contractions began C. Determining if the patient feels as if she needs to move her bowels D. Finding out how many pregnancies the patient has had

A. Phoning the patient's obstetrician for advice

Which of the following is indicated in the prehospital management of a prolapsed umbilical cord? A. Place the mother in a head-down position with pillows under her hips. B. Encourage the mother to push forcefully in order to speed delivery. C. Immediately clamp the cord in two places and cut it between the clamps. D. Use your gloved hand to push the umbilical cord back up through the cervix.

A. Place the mother in a head-down position with pillows under her hips.

What is the temporary organ of pregnancy, which functions to supply the developing fetus with oxygen and nutrients? A. Placenta B. Uterus C. Amnion D. Cervix

A. Placenta

Which of the following is true concerning trauma in the pregnant woman? A. She may lose up to 35% of her blood volume before exhibiting signs of shock. B. The mother's body will preferentially protect the life of the fetus over that of the mother. C. She may lose up to 15% of her blood volume before exhibiting signs of shock. D. The increase in blood volume during pregnancy makes shock an unlikely cause of death.

A. She may lose up to 35% of her blood volume before exhibiting signs of shock.

You have just delivered a full-term baby girl and she is doing well. You have dried her off and wrapped her in a warm blanket. You are preparing to cut the umbilical cord. Which of the following is normally true regarding cutting the umbilical cord? A. The infant must be breathing on his or her own before you cut the cord. B. You must try to cut the cord before it stops pulsating. C. The cord should be cut immediately following delivery. D. You should hold the baby above the level of the mother when cutting the cord.

A. The infant must be breathing on his or her own before you cut the cord.

If the baby's head is delivered with the amniotic sac still intact, which of the following should be done first? A. Use your fingers to tear the sac away from the baby's face. B. Use the scissors in the obstetrics kit to cut the sac away from the baby's head. C. Call medical control before taking action. D. Leave the sac intact until the entire body is delivered.

A. Use your fingers to tear the sac away from the baby's face.

Which of the following is appropriate when caring for a premature baby? A. Wrapping the infant in a blanket, covering his head, and keeping the temperature in the ambulance between 90 degrees°F and 100 degrees°F B. Deeply suctioning the airway with a rigid tonsil-tip C. Applying high-concentration oxygen with a neonatal nonrebreather mask D. Encouraging family members to hold the infant

A. Wrapping the infant in a blanket, covering his head, and keeping the temperature in the ambulance between 90 degrees°F and 100 degrees°F

You are called for a possible imminent delivery. Your patient is a 15-year-old girl who is in your estimation about 8 months pregnant. She tells you that she has been hiding her pregnancy. You are especially concerned about problems she might have during the delivery. Which of the following are findings that may indicate the need for neonatal resuscitation? A. Young mother who has not had prenatal care B. Patient whose water has already broken C. Patient with a blood pressure of 130/82 D. Mother who has had five previous births

A. Young mother who has not had prenatal care

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

A. alleviation of pain with movement or changing positions.

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

A. ensure that it is thoroughly dried and warmed.

The term for a baby developing inside the mother's womb after week 8 is: A. fetus. B. infant. C. neonate. D. chorion.

A. fetus.

Signs and symptoms of preeclampsia include: Choose one answer. A. headache and edema. B. marked hypoglycemia. C. dyspnea and bradycardia. D. dysuria and constipation.

A. headache and edema.

A nuchal cord is defined as an umbilical cord that: Choose one answer. A. is wrapped around the baby's neck. B. has abnormally developed blood vessels. C. has separated from the placenta. D. is lacerated due to a traumatic delivery.

A. is wrapped around the baby's neck.

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. keep him warm and provide ventilatory assistance. B. begin chest compressions and reassess in 30 seconds. C. clamp and cut the umbilical cord and keep him warm. D. assess his skin color and give free-flow oxygen as needed.

A. keep him warm and provide ventilatory assistance.

You respond for an imminent delivery of a baby in the breech position. As you examine the mother, you see that the umbilical cord is protruding from the opening of the cervix. You realize that the most important care you can provide for this baby is to: A. keep the baby off of the cord. B. provide oxygen to the mother. C. wrap the cord to prevent heat loss. D. gently push the cord back into the vaginal space.

A. keep the baby off of the cord.

When preparing a pregnant patient for delivery, you should position her: Choose one answer. A. on a firm surface with her hips elevated 2″ to 4″. B. in a supine position with her legs spread. C. in a sitting position with her hips elevated 12″. D. on her left side with the right leg elevated.

A. on a firm surface with her hips elevated 2" to 4".

Your pregnant patient is in active labor. She has been lying on her back throughout her labor and is experiencing signs and symptoms of shock. Her vital signs are pulse rate 118, respirations 22, blood pressure 96/62, and skin cool and diaphoretic. The BEST way to treat her is to: A. place a rolled blanket under her left hip to displace the uterus. B. give her some fluids to drink to help elevate her blood pressure. C. elevate her legs to increase the blood return to the heart. D. cover her up with a blanket to maintain body heat.

A. place a rolled blanket under her left hip to displace the uterus.

A 33-year-old woman who is 36 weeks pregnant is experiencing scant vaginal bleeding. During transport, you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. In addition to administering 100% oxygen, you should: A. place her in a left lateral recumbent position. B. position her supine and elevate her legs 12″. C. carefully place sterile gauze into her vagina. D. assist her ventilations with a bag-mask device.

A. place her in a left lateral recumbent position.

You are assessing a pregnant woman whose chief complaint is vaginal bleeding. She is 8 months pregnant and has moderate, bright red bleeding. She says that her doctor was concerned about the location of the placenta. This condition is known as: A. placenta previa. B. unstable placenta. C. abruptio placenta. D. placenta disruption

A. placenta previa.

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's 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. gently pulling on the infant's leg in an attempt to facilitate delivery. C. placing the mother in a recumbent position and rapidly transporting. 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.

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

A. the placenta prematurely separates from the uterine wall.

Supine hypotensive syndrome occurs when: Choose one answer. A. the pregnant uterus compresses the inferior vena cava. B. blood pressure decreases as a result of hypovolemia. C. the superior vena cava is compressed by the uterus. D. a supine position kinks the ascending aorta.

A. the pregnant uterus compresses the inferior vena cava.

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. mild vaginal bleeding that occurs within the first 30 minutes after the onset of the second stage of the labor process. C. the normal amount of vaginal bleeding that occurs within the first 24 hours following delivery of the baby and placenta. D. any volume of blood that is expelled from the vagina after the amniotic sac has ruptured and contractions have begun.

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

Vigorous suctioning of a newborn's airway is indicated if: A. there is meconium in the amniotic fluid. B. positive-pressure ventilations are indicated. C. the newborn presents with labored breathing. D. his or her heart rate is less than 60 beats/min.

A. there is meconium in the amniotic fluid.

Vigorous suctioning of a newborn's airway is indicated if: Choose one answer. A. there is meconium in the amniotic fluid. B. his or her heart rate is less than 60 beats/min. C. positive-pressure ventilations are indicated. D. the newborn presents with labored breathing.

A. there is meconium in the amniotic fluid.

General treatment guidelines when caring for a woman with traumatic vaginal bleeding include: Choose one answer. A. transporting to an appropriate facility. B. cleaning external wounds with sterile water. C. packing the vagina with sterile dressings. D. carefully removing impaled objects.

A. transporting to an appropriate facility.

You are assessing a 25-year-old woman who is 39 weeks' pregnant. She is experiencing regular contractions that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the appropriate BSI precautions, you should

ASSES FOR CROWNING

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: A. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. B. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. C. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. D. assist her ventilations with a bag-mask device, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

As a woman approaches menopause: A. she usually experiences abdominal cramping without vaginal bleeding. B. her menstrual periods may become irregular and vary in severity. C. her risk of developing PID lowers significantly. D. she cannot become pregnant because of fluctuating hormone levels.

If a patient with vaginal bleeding present with a rapid pulse and pale or cool skin, you should: A. attempt to locate the source of bleeding and correct it. B. place the patient in a supine position with her legs elevated. C. consider this to be a normal sign in a menstruating woman. D. inquire about recent problems with urination.

Painful urination associated with burning and a yellowish discharge is assocated with: A. chlamydia. B. gonorrhea. C. endometriosis. D. syphilis.

Potentially life-threatening consequences of PID include: A. bacterial vaginosis and chlamydia. B. ovarian abscess and ectopic pregnancy. C. ovarian cysts and gonorrhea. D. uterine rupture with severe bleeding.

The onset of menstruation usually occurs between the ages of: A. 8 and 10 years. B. 11 and 16 years. C. 16 and 18 years. D. 17 and 20 years.

When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she: A. has obtained a complete set of vital signs. B. has gathered patient history information. C. ascertains if the patient was ever pregnant. D. has formed a general impression of the patient.

Which of the following conditions does NOT typically present with vaginal discharge? A. PID B. genital herpes C. chlamydia D. gonorrhea

Which of the following statements is FALSE regarding assessment and treatment of a woman who was the victim of sexual assault? A. You may be called to testify in court regarding the incident B. You should question the victim thoroughly about the assaulter in case the police missed any details C. The patient should be given the option of being treated by a female responder D. The patient should be discouraged from urinating or changing her clothes prior to examination at the hospital

You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings would increase your index of suspicion for PID? A. a history of ectopic pregnancy B. a shuffling gait when walking C. bright red blood in the urine D. vaginal passage of blood clots

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

B. 7:57.

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

B. alleviation of pain with movement or changing positions.

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

B. crowning of the baby's head

12. If a pregnant patient requires spinal immobilization, you should secure her to the backboard and then: A. tilt the board 30° to the right to prevent hypotension. B. elevate the right side of the board with rolled towels or blankets. C. raise the foot of the board 12″ in order to maintain blood pressure. D. elevate the head of the board 6″ to prevent breathing impairment.

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

24. 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. elevate her legs 6″ to 8″ and cover her with a blanket. B. firmly massage the uterine fundus with a circular motion. C. carefully insert a sterile trauma dressing into her vagina. D. place her legs together and position her on her left side.

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

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

B. increased respiratory rate and decreased respiratory reserve

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

B. insulate and protect the fetus.

45. A nuchal cord is defined as an umbilical cord that: A. has separated from the placenta. B. is wrapped around the baby's neck. C. is lacerated due to a traumatic delivery. D. has abnormally developed blood vessels.

B. is wrapped around the baby's neck.

33. Upon delivery of the baby's head, you note that its face is encased in the unruptured amniotic sac. You should: A. give the mother 100% oxygen and transport at once. B. puncture the sac and suction the baby's mouth and nose. C. leave the amniotic sac intact until arrival at the hospital. D. note the color of the amniotic fluid before breaking the sac.

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

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

B. push the infant's head away from the cord.

8. The presence of thick meconium in the amniotic fluid indicates: A. an expected finding in full-term infants. B. that the baby's airway may be obstructed. C. that the fetus is at least 4 weeks premature. D. that full newborn resuscitation will be needed.

B. that the baby's airway may be obstructed.

54. Supine hypotensive syndrome occurs when: A. a supine position kinks 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.

14. From what internal female organ is the fetus expelled during delivery? A. vagina B. uterus C. cervix D. perineum

B. uterus

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

B. 15 to 30

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

B. 16 hours.

Normal maternal blood loss during delivery of an infant usually does not exceed how much? A. 250 cc B. 500 cc C. 1,000 cc D. 100 cc

B. 500 cc

Your patient is an infant who has just been delivered 3 weeks before her due date. She is breathing adequately, has a heart rate of 140 beats per minute, and has cyanosis of her face and chest. Which of the following interventions should be done first? A. Place a neonatal nonrebreather mask on the infant's face. B. Administer blow-by oxygen. C. Begin CPR with a compression rate of 120/minute. D. Perform ventilations with a bag-valve-mask device and supplemental oxygen.

B. Administer blow-by oxygen.

When assisting with a delivery in the field, which of the following should be done as the head begins to emerge from the vagina? A. Advise the mother not to push or strain. B. Apply gentle pressure to the head with your gloved hand. C. Check for crowning. D. Pull on the baby.

B. Apply gentle pressure to the head with your gloved hand.

Which of the following is the highest priority to the EMT in delivery of an infant with meconium-stained amniotic fluid? A. Checking for fever B. Being prepared to suction the infant immediately before he takes a breath C. Vigorously rubbing the infant's back immediately upon delivery to stimulate breathing D. None of the above

B. Being prepared to suction the infant immediately before he takes a breath

Which of the following is the correct technique to check for crowning in the assessment of a woman in labor? A. Ask the woman to "push" or "bear down" as you inspect the vaginal opening. B. Cover her with a sheet, have her remove her underwear, wait for a contraction, and then visualize the vaginal opening. C. Place your hand on the woman's abdomen, just above the umbilicus, and check for the firmness of the uterus during contractions. D. None of the above

B. Cover her with a sheet, have her remove her underwear, wait for a contraction, and then visualize the vaginal opening.

You are called to assess a pregnant woman who is approximately 7 months pregnant. She states that her pregnancy has been uneventful but she is experiencing intermittent headaches. Her vital signs are pulse 118, respirations 22, blood pressure 138/88, and blood sugar 148. Which of the following is true regarding a pregnant woman? A. Her pulse rate should be lower than normal. B. Diabetes may be made worse during pregnancy. C. Her blood pressure is usually higher during pregnancy. D. Her respirations usually remain the same during pregnancy.

B. Diabetes may be made worse during pregnancy.

Which of the following is the correct way to time the frequency of contractions in the pregnant woman? A. After counting the number of contractions in a 15-minute period, multiply by 4 B. From the beginning of one contraction to the beginning of the next C. From the end of one contraction to the beginning of the next D. From the beginning of a contraction to the end of the same contraction

B. From the beginning of one contraction to the beginning of the next

Which of the following is NOT advisable following complete birth of the infant? A. Keep the infant at the level of the mother's vagina until the cord is clamped and cut. B. Hold the infant by the ankles to allow the airway to drain. C. Place the infant on his side with his head slightly lower than his body. D. Dry the infant and wrap him in a blanket.

B. Hold the infant by the ankles to allow the airway to drain.

Which of the following is an appropriate question to ask while evaluating a woman in labor? A. Do you know who the father is and what is his medical history? B. Is this your first pregnancy? C. When was the last time you were sexually active? D. None of the above

B. Is this your first pregnancy?

Which of the following is NOT part of a basic obstetrics kit? A. Surgical scissors B. Packet of suture material C. Umbilical cord clamps D. Baby blanket

B. Packet of suture material

Which of the following BEST describes the term crowning? A. Discharge of bloody mucus B. Presenting part of the baby being visible at the vaginal opening C. Complete dilation of the cervix D. Delivery of the head during a breech birth, completing delivery

B. Presenting part of the baby being visible at the vaginal opening

What is the term for when the fetus and placenta deliver before the 28th week of pregnancy? A. Eclampsia B. Spontaneous abortion C. Stillbirth D. Induced abortion

B. Spontaneous abortion

Which of the following is true concerning a stillborn baby? A. Resuscitation must always be attempted. B. The death may occur weeks before delivery. C. The parents should never be allowed to see the baby, especially if it has begun to deteriorate. D. Infants born in cardiopulmonary arrest should not be resuscitated.

B. The death may occur weeks before delivery.

Which of the following BEST describes placenta previa? A. The umbilical cord is the presenting part. B. The placenta is implanted over the opening of the cervix. C. The placenta prematurely separates from the uterine wall. D. The pregnancy is lost before the 20th week of gestation.

B. The placenta is implanted over the opening of the cervix.

If the baby's umbilical cord is noted to be wrapped around his neck after the head is delivered, which of the following should be done? A. Clamp the cord in two places, but do not cut it until the baby is delivered. B. Try to slip the cord over the baby's head and shoulder. C. Immediately cut the cord before delivering the baby. D. Transport emergently without further intervention.

B. Try to slip the cord over the baby's head and shoulder.

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

B. belly button.

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

B. crowning of the baby's head

You are called for a woman with severe abdominal pain. During your assessment and interview, she tells you that she is sexually active and there is a chance she could be pregnant. Her vital signs are pulse 122, respirations 22, blood pressure 96/62, and skin cool and pale. You should immediately suspect: A. appendicitis. B. ectopic pregnancy. C. placenta previa. D. internal bleeding.

B. ectopic pregnancy.

You have been called for a 32-year-old female who is in active labor. During your assessment and interview, you note that she is 37 weeks along, this is her first child, and her contractions are 5 minutes apart. She also tells you that her pregnancy is considered "high risk." Your first concern should be: A. assembling your delivery kit. B. getting to the hospital. C. completing a thorough secondary exam. D. calling for a back-up unit.

B. getting to the hospital.

A nuchal cord is defined as an umbilical cord that: A. has separated from the placenta. B. is wrapped around the baby's neck. C. is lacerated due to a traumatic delivery. D. has abnormally developed blood vessels.

B. is wrapped around the baby's neck.

You respond to a call for a patient in active labor with her second child. Your interview with the patient shows that she is 40 weeks pregnant and has been in active labor for several hours. You determine that her vital signs are all within normal limits. After your physical exam, you determine the baby is crowning. You should next: A. delay delivery until arrival at the hospital. B. prepare to deliver the baby on-scene. C. contact medical direction for orders. D. begin transport and plan to deliver in the ambulance.

B. prepare to deliver the baby on-scene.

The presence of thick meconium in the amniotic fluid indicates: A. an expected finding in full-term infants. B. that the baby's airway may be obstructed. C. that the fetus is at least 4 weeks premature. D. that full newborn resuscitation will be needed.

B. that the baby's airway may be obstructed.

aspiration

Breathing fluid, food, vomitus, or an object into the lungs

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: A. refraining from placing any dressings into the vagina. B. treating external lacerations with moist, sterile compresses. C. carefully removing any foreign bodies from the vagina. D. supplemental oxygen and lower extremity elevation.

If a woman with vaginal bleeding reports syncope, the EMT must assume that she: A. is pregnant. B. has an infection. C. is in shock. D. has an ectopic pregnancy.

In anticipation of receiving a fertilized ovum, the lining of the uterine wall: A. sheds and is expelled externally. B. diverts blood flow to the vagina. C. becomes engorged with blood. D. thins and begins to separate.

Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should: A. advise her that she cannot clean herself up because this will destroy evidence. B. perform a limited hands-on assessment to detect life-threatening injuries. C. provide emotional support and visually assess her for obvious trauma. D. ask her if there is anyone you can contact, such as a friend or relative.

Left untreated, _____ can lead to premature birth or low birth weight in pregnant women. A. chlamydia B. gonorrhea C. bacterial vaginosis D. vaginal bleeding

When taking a history on a patient experiencing a gynecologic emergency, you should consider asking all of the following EXCEPT: A. Are you taking birth control? B. When was your last menstrual period? C. How many sexual partners have you has in the past? D. Do you have any history of sexually transmitted diseases?

Whenever possible, a female sexual assault victim should be: A. thoroughly assessed, even if no signs of injury exist. B. encouraged to take a shower and change her clothes. C. given the option of being treated by a female EMT. D. asked to provide a brief description of the perpetrator.

Which of the following clinical presentations is MOST consistent with PID? A. left lower quadrant pain, referred pain to the left shoulder, and fever B. upper abdominal cramping, severe headache, and heavy vaginal bleeding C. lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge D. pain around the umbilicus, low-grade fever, and generalized weakness

Which of the following statements regarding gonorrhea is correct? A. Mild infections with gonorrhea cause abdominal pain, vomiting, and fever. B. Symptoms of gonorrhea usually appear within 3 months after being infected. C. Painful urination is a common symptom of gonorrhea in men and women. D. Most men who are infected with gonorrhea do not experience symptoms.

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The second course of action involves the psychological care of the patient. You should avoid: A. making attempts to get a female EMT to examine the patient. B. examination of the vaginal canal, even if active bleeding is taking place. C. attempting to gather information to assist the police. D. granting the patient's wishes for refusing care and transport.

Your _____ is the best tool to gain the patient's confidence to seek medical help. A. professionalism B. content knowledge C. compassion D. empathy

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

C. "Have you had a sonogram?"

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

C. 15 to 30

39. 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. 6 B. 7 C. 8 D. 9

C. 8

53. 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? A. Allow the mother to hold her baby. B. Clamp and cut the umbilical cord. C. Assess the brachial or umbilical pulse. D. Begin assisting the newborn's breathing.

C. Assess the brachial or umbilical pulse.

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

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

19. Which of the following statements regarding twins is correct? A. Twins are typically larger than single infants. B. Identical twins are typically of different gender. C. Most twins are born within 45 minutes of each other. D. Fraternal twins have two cords coming from one placenta.

C. Most twins are born within 45 minutes of each other.

41. Which of the following processes occurs during ovulation? A. Certain female hormone levels decrease significantly in quantity. B. The endometrium sheds its lining and is expelled from the vagina. C. The inner lining of the uterus thickens in preparation for implantation. D. Numerous follicles mature and release eggs into the fallopian tubes.

C. The inner lining of the uterus thickens in preparation for implantation.

42. You are assessing a 25-year-old woman who is 39 weeks pregnant. She is experiencing regular contractions that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the standard precautions, you should: A. apply 100% oxygen. B. place her on her left side. C. assess her for crowning. D. transport her immediately.

C. assess her for crowning.

16. The umbilical cord: A. separates from the placenta shortly after birth. B. carries blood away from the baby via the artery. 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.

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

C. have delivered a baby before.

59. 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. internal bleeding caused by a ruptured ectopic pregnancy. D. blunt trauma to the abdomen during a motor vehicle crash.

C. internal bleeding caused by a ruptured ectopic pregnancy.

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

C. is pregnant for the first time.

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

C. positive-pressure ventilations.

48. A pregnant trauma patient may 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.

51. Following 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. provide emotional support to the mother. D. dry the infant off to stimulate breathing.

C. provide emotional support to the mother.

44. 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 mm Hg.

C. seizures that result from severe hypertension.

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

C. take quick short breaths.

When performing chest compressions on a pregnant patient that has gone into cardiac arrest, what change do you need to make in the placement of your hands? A. 1 to 2 inches lower on the sternum B. .5 to 1 inch lower on the sternum C. 1 to 2 inches higher on the sternum D. 0.5 to 1 inch higher on the sternum

C. 1 to 2 inches higher on the sternum

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

C. 15 to 30

An infant's birth weight is considered low if it is less than ________ pounds. A. 4.5 B. 2.5 C. 5.5 D. 3.5

C. 5.5

C. 8

You are assessing a newborn patient 1 minute after delivery. You notice the patient has blue extremities with a pink trunk, a pulse of 120, and strong crying with good movement of all extremities. What is the newborn's APGAR score? A. 7 B. 8 C. 9 D. 10

C. 9

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? A. Allow the mother to hold her baby. B. Clamp and cut the umbilical cord. C. Assess the brachial or umbilical pulse. D. Begin assisting the newborn's breathing.

C. Assess the brachial or umbilical pulse.

By which of the following means does the fetus's blood pick up nourishment from the mother? A. Direct circulation B. Indirect circulation C. Diffusion D. Osmosis

C. Diffusion

You are assessing a patient in labor. Her contractions are 2 minutes apart lasting 30 seconds with increasing pain. The patient states that she feels the urge to push. These signs indicate which stage of delivery? A. Third stage B. Fourth stage C. First and second stage D. Second stage

C. First and second stage

Seizures due to complications of pregnancy generally occur during which of the following time periods? A. In the first trimester B. Before the mother even knows she is pregnant C. Late in pregnancy D. In the second trimester

C. Late in pregnancy

While treating a patient of sexual assault, your treatment should follow which of the following sequences? A. Maintain scene safety, treat immediate life threats, allow the patient to shower if the patient is capable to help treat psychological needs, and transport. B. Maintain scene safety, treat immediate life threats, and treat only the secondary injuries that may become life threats to protect criminal evidence. C. Maintain scene safety, treat immediate life threats, treat medical and psychological needs, and protect criminal evidence. D. Treat immediate life threats, treat psychological needs, and protect criminal evidence.

C. Maintain scene safety, treat immediate life threats, treat medical and psychological needs, and protect criminal evidence.

Which of the following is of greatest concern for the EMT in the prehospital care of a woman with vaginal bleeding? A. Preventing infection B. Obtaining a thorough gynecological history C. Monitoring for hypovolemic shock D. Finding out if the patient is currently sexually active

C. Monitoring for hypovolemic shock

Which of the following BEST describes the events that occur during the first stage of labor? A. Expulsion of the fetus through the birth canal B. Expulsion of the placenta C. Thinning and dilation of the cervix D. Rupture of the amniotic sac

C. Thinning and dilation of the cervix

You are assessing a 25-year-old woman who is 39 weeks pregnant. She is experiencing regular contractions that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the standard precautions, you should: A. apply 100% oxygen. B. place her on her left side. C. assess her for crowning. D. transport her immediately.

C. assess her for crowning.

Upon delivery of an infant's head, you note that the umbilical cord is wrapped around its neck. You should: Choose one answer. A. provide free-flow oxygen to the infant and transport. B. give 100% oxygen to the mother and transport at once. C. attempt to slip the cord gently over the infant's head. D. immediately clamp and cut the umbilical cord.

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

You have delivered a newborn and wrapped the baby in a dry blanket. During your reassessment of the mother, you note continued moderate vaginal bleeding. Care for this bleeding may involve all of the following EXCEPT: A. Transport the mother has a high-priority patient. B. elevating the mother's feet. C. encourage the mother to use the bathroom if possible. D. massaging the uterus to control bleeding.

C. encourage the mother to use the bathroom if possible.

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

C. has an even proportionately larger head.

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

C. have delivered a baby before.

A 33-year-old woman who is 36 weeks pregnant is experiencing scant vaginal bleeding. During transport, you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. In addition to administering 100% oxygen, you should: Choose one answer. A. position her supine and elevate her legs 12″. B. assist her ventilations with a bag-mask device. C. place her in a left lateral recumbent position. D. carefully place sterile gauze into her vagina.

C. place her in a left lateral recumbent position.

When delivering a baby, you should do all of the following except: A. position your gloved hands at the vaginal opening. B. have someone stay at the mother's head if possible. C. place your fingers in the armpit to assist with delivery of the shoulders. D. suction the mouth first, then the nose.

C. place your fingers in the armpit to assist with delivery of the shoulders.

A pregnant trauma patient may 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.

You have responded to a woman who has possible premature labor. She is 8 months pregnant and is experiencing labor pains. During your assessment, you note that the baby is not yet crowning. You need to determine whether delivery is imminent or not. You should next: A. check the level of the fundus. B. complete a set of vital signs. C. time her contractions. D. check for cervix dilation.

C. time her contractions.

An infant is considered to be premature if it: Choose one answer. A. is born before 40 weeks' gestation or weighs less than 7 lb. B. weighs less than 5.5 lb or is born before 37 weeks' gestation. C. weighs less than 5 lb or is born before 36 weeks' gestation. D. is born before 38 weeks' gestation or weighs less than 6 lb.

C. weights less than 5 lb or is born before 36 weeks' gestation.

Elcampsia

Coma or convulsions in a patient with preeclampsia, occurring in late pregnancy, during labor, or within 24 hours after parturition.- move Patient on her left

hyperglycemia

Condition of increased blood sugar.

cervix

Connects the Uterus to the Vagina.`

During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse is rapid and weak. You should: A. perform a rapid secondary assessment. B. perform a visual assessment of her vaginal area. C. assess her blood pressure and elevate her legs. D. assist her ventilations with a bag-mask device.

PID typically does NOT affect the: A. ovaries. B. uterus. C. fallopian tubes. D. urinary bladder.

Possible causes of vaginal bleeding include all of the following EXCEPT: A. ectopic pregnancy. B. cervical polyps. C. vaginal trauma. D. peptic ulcer.

Rape is considered to be a _____ diagnosis, not a medical diagnosis. A. psychological B surgical C. sociological D. legal

The most common presenting sign of PID is: A. vaginal discharge. B. fever. C. nausea and vomiting. D. lower abdominal pain.

The onset of menstruation is called menarche and usually occurs in women who are: A. between 25 and 35 years of age. B. between 12 and 14 years of age. C. between 45 and 50 years of age. D. between 11 and 16 years of age.

The physical examination of a sexual assault victim should be: A. deferred until the patient can be evaluated by a physician. B. as detailed as possible so all injuries can be documented. C. performed in the presence of at least two police officers. D. limited to a brief survey for life-threatening injuries.

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to: A. determine the underlying cause of her problem. B. ask questions related to her gynecologic history. C. keep assessment and treatment to a minimum. D. maintain her ABCs and transport without delay.

When documenting a call in which a female was sexually assaulted, you should: A. only use quotation marks when recording any statements made by witnesses. B. translate the patient's words or statements using proper medical C. record your opinion only if you have reasonable proof to justify the statement. D. keep the report concise and record only what the patient stated in her own words.

When performing a physical exam on a victim of sexual assault, you should: A. expose and evaluate the patient's vaginal area regardless of whether there is bleeding. B. allow multiple people to observe the examination in case you have to testify. C. limit your examination to a brief survey for life-threatening injuries. D. place the patient's clothes into a paper bag.

Which of the following conditions would MOST likely lead to PID if left untreated? A. genital herpes B. ovarian cysts C. ectopic pregnancy D. chlamydia

Which of the following statements regarding pelvic inflammatory disease (PID) is correct? A. The most common presenting symptom of PID is generalized upper abdominal pain. B. PID most commonly affects women who have had an ectopic pregnancy in the past. C. The most severe cases of PID occur in women who are not sexually active. D. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The patient tells you that she would really like to be transported to the hospital but refuses a physical examination. You should: A. explain to her that she cannot be transported without a physical exam. B. have the police take the patient into custody in order to legally force a physical exam. C. explain to her that this is a criminal case and that she must be examined. D. follow your system's refusal of treatment policy and respect the patient's wishes without judgement.

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

D. 16 hours.

9. Spina bifida is a developmental defect in which: A. an excessive amount of cerebrospinal fluid damages the spinal cord. B. nerve fibers that arise from the spinal cord do not function properly. C. the spinal column is severely deformed, resulting in permanent paralysis. D. a portion of the spinal cord or meninges protrudes outside of the vertebrae.

D. a portion of the spinal cord or meninges protrudes outside of the vertebrae.

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

D. an ectopic pregnancy.

35. 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. give 100% oxygen to the mother and transport at once. C. provide free-flow oxygen to the infant and transport. D. attempt to slip the cord gently over the infant's head.

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

60. 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.

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

D. birth canal.

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

D. body size

17. The onset of labor begins with: A. thinning of the uterus. B. full dilation of the cervix. C. increased fetal movement. D. contractions of the uterus.

D. contractions of the uterus.

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

D. easier breathing.

4. When preparing a pregnant patient for delivery, you should position her: A. in a supine position with her legs spread. B. on her left side with the right leg elevated. C. in a sitting position with her hips elevated 12″. D. on a firm surface with her hips elevated 2″ to 4″.

D. on a firm surface with her hips elevated 2″ to 4″.

49. 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.

5. If a newborn's heart rate is less than 60 beats/min following delivery, you should: A. flick the soles of its feet. B. begin chest compressions. C. resuction the mouth only. D. provide ventilations for 30 seconds.

D. provide ventilations for 30 seconds.

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

D. start of one to the start of the next.

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

D. weighs less than 5 lb 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. 4 hours. B. 8 hours. C. 10 hours. D. 16 hours.

D. 16 hours.

You are assessing a 27-year-old female who is 9 months pregnant with her first child. She has been having contractions for the past 6 hours. As you are about to assist her to your cot, she asks you to wait because she feels the need to use the bathroom first. Which of the following is the BEST course of action? A.Advise the patient that this could be a sign of a serious complication, have her lie on her left side, apply high-concentration oxygen, and transport immediately. B. Tell the patient she needs to be transported immediately and using the bathroom will have to wait until she arrives at the hospital. C. Allow the patient to use the bathroom as it will make transport, and also delivery, more comfortable. D. Advise the patient that this could be an indication that the baby is ready to be born and you need to check to see if the baby's head is visible.

D. Advise the patient that this could be an indication that the baby is ready to be born and you need to check to see if the baby's head is visible.

In which of the following situations should the mother be transported immediately? A. The infant's arm is the presenting part. B. The mother experiences a severe, tearing sensation in her abdomen during labor and the outline of the fetus can be felt through the abdominal wall. C. Delivery is not imminent and there is about 500 cc of painless, bright red bleeding. D. All of the above

D. All of the above

Which of the following conditions should be present before the umbilical cord is cut? A. The infant is breathing on his or her own. B. The cord is clamped in two places. C. The cord is no longer pulsating. D. All of the above

D. All of the above

Which of the following is a cause of gynecological emergencies? A. Soft-tissue trauma to the external genitalia B. Disorders of the female reproductive organs C. Sexual assault D. All of the above

D. All of the above

Which of the following is true of premature infants? A. They are more susceptible to infection. B. They can easily develop hypothermia. C. They are at risk for respiratory difficulty. D. All of the above

D. All of the above

Which of the following may result from a woman in her third trimester of pregnancy lying in a supine position? A. Fetal compromise B. Compression of the inferior vena cava C. Supine hypotensive syndrome D. All of the above

D. All of the above

Which of the following should be done when the infant's head has been delivered? A. Suction the mouth. B. Check to see if the umbilical cord is around the neck. C. Suction the nose. D. All of the above

D. All of the above

Which of the following should the EMT do to control maternal bleeding after delivery of the baby? A. Massage the uterus until it is firm and grapefruit-sized. B. Allow the infant to nurse, if possible. C. Apply direct pressure with a sanitary napkin over any perineal lacerations. D. All of the above

D. All of the above

You are called for a women who is about to deliver. During the labor process, your patient's water breaks. She experiences a rush of warm water and an increase in uterine contractions. The purpose of the amniotic fluid is to: A. provide lubrication during the delivery of the baby. B. help maintain a constant fetal body temperature. C. allow the fetus to float during development. D. All of the above

D. All of the above

During your visual inspection of a 19-year-old woman in labor, you see the baby's head crowning at the vaginal opening. What should you do? Choose one answer. A. Maintain firm pressure to the head until it completely delivers. B. Tell the mother not to push and transport her immediately. C. Place your fingers in the vagina to assess for a nuchal cord. D. Apply gentle pressure to the baby's head as it delivers.

D. Apply gentle pressure to the baby's head as it delievers.

Which of the following describes a breech presentation? A. The infant presents buttocks first. B. The infant presents with both feet first. C. The infant presents face first. D. Both A and B

D. Both A and B

Supine hypotensive syndrome is easily prevented by transporting the pregnant female into which of the following positions? A. On her hands and knees with her hips elevated B. Tilted slightly onto the right side C. Supine, with the head lower than the hips D. Lying on her left side

D. Lying on her left side

You have assisted in the delivery of a full-term infant by suctioning the mouth and nose as the head was delivered and again following complete delivery. The infant is not yet breathing. Which of the following is the correct sequence of interventions? A. Perform a series of back blows and chest thrusts interposed with mouth-to-mouth ventilation. B. Begin bag-valve-mask ventilations, suction the airway with a rigid tonsil tip, and begin CPR. C. Transport without further intervention. D. Rub the infant's back, tap the bottom of his foot, begin bag-valve-mask ventilations, and check the pulse.

D. Rub the infant's back, tap the bottom of his foot, begin bag-valve-mask ventilations, and check the pulse.

During which stage of labor is the baby born? A. Primary B. Third C. First D. Second

D. Second

Your patient is a 26-year-old female with a history of ectopic pregnancies. She has called 911 for extreme abdominal pain and she is concerned that she has another ectopic pregnancy. Her vital signs are pulse 118, respirations 20, and blood pressure 100/76. Which of the following is true regarding ectopic pregnancies? A. The fertilized egg usually implants in the wall of the uterus. B. It may cause painless bright red bleeding. C. It usually occurs during the second trimester. D. The fallopian tubes cannot stretch to accommodate a fetus.

D. The fallopian tubes cannot stretch to accommodate a fetus.

Which of the following is true concerning prehospital delivery of twins? A. The umbilical cord of the first infant must not be cut until the second infant is born. B. This is a true emergency and cannot be managed outside the hospital setting without additional help. Your answer is not correct. C. There are always two placentas. D. The infants will probably be smaller than a single infant and need attention in keeping them warm.

D. The infants will probably be smaller than a single infant and need attention in keeping them warm.

Which of the following is a common sign of a pre-delivery emergency? A. The placenta fails to deliver within 20 minutes of the infant's birth. B. Contractions become more intense and closer together. C. The amniotic sac ruptures. D. There is profuse vaginal bleeding.

D. There is profuse vaginal bleeding.

While treating a pregnant trauma patient, which of the following is the BEST way to keep the fetus alive? A. Transport the patient to the closest pediatric center. B. Do an emergency cesarean section of the fetus. C. Do not put the patient on a spine board to prevent supine hypotensive syndrome. D. Treat the patient as any other trauma patient.

D. Treat the patient as any other trauma patient.

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

D. an ectopic pregnancy.

The onset of labor begins with: A. thinning of the uterus. B. full dilation of the cervix. C. increased fetal movement. D. contractions of the uterus.

D. contractions of the uterus.

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

D. easier breathing.

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

D. easier breathing.

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

D. ensure that it is thoroughly dried and warmed.

Your pregnant patient is in active labor. You note that her contractions are getting closer together and much stronger as the baby moves deeper into the birth canal. The muscle contraction mechanism that moves the baby toward birth is the same mechanism that moves: A. fluid into and out of the cell. B. air down the bronchial tubes to the alveoli. C. sweat to the surface of the skin. D. food from the esophagus to the stomach.

D. food from the esophagus to the stomach.

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

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

All of the following are signs of adequate breathing and circulation in the newborn except: A. heart rate greater than 100. B. cyanosis of only the hands and feet. C. vigorous crying. D. relaxation of the extremities.

D. relaxation of the extremities.

You have been called for a young female in labor. She is lying on the floor in obvious distress from the labor pains. While you are assessing her for crowning, your partner is getting a set of vital signs. She tells you that she is getting dizzy and nauseated. Vital signs are pulse rate 120, respiratory rate 22, and blood pressure 98/62. You should be concerned that she has: A. Braxton-Hicks contractions. B. contracted food poisoning. C. placenta previa. D. supine hypotensive syndrome.

D. supine hypotensive syndrome.

The muscular organ in which a baby develops during pregnancy is called the: A. fetal membrane. B. placenta. C. amniotic sac. D. uterus.

D. uterus.

gestational diabetes

Develops during pregnancy and usually goes away after the baby is born; At rish for type 2 diabetes later in life

primigravida

First pregnancy

hypoxic

Having low oxygen levels in the water; organisms may find survival in a hypoxic environment difficult or impossible.

THE AMNIOTIC SAC

INSULATES THE BABY

placenta previa

Implantation of the placenta over the cervical opening or in the lower region of the uterus

endometrium

Inner lining of the uterus

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

MASAGE THE BELLY

Which of the following statements regarding pelvic inflammatory disease (PID) is correct?

PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.

Fetal complications associated with drug- or alcohol-addicted mothers include all of the following, EXCEPT: a) profound tachycardia b) premature delivery c) low birth weight d) respiratory depression

PROFOUD TACHYCARDIA

Which of the following statements regarding gonorrhea is correct?

Painful urination is a common symptom of gonorrhea in men and women

abruptio placenta

Premature separation of the implanted placenta

Which of the following statements regarding rape is correct?

Rape is a legal diagnosis, not a medical diagnosis

When the cervix begins to dilate

THE MUCUS PLUG EXPELLS

crowning

The point during labor at which the baby's head first bulges from the perineum

nuchal cord

Umbilical cord around the fetal neck.

Which of the following occurs during true labor?

Uterine contractions become more regular

Which of the following statements regarding a breech presentation is MOST correct?

WHEN THE BUtt comes out 1st

amniotic sac

a fluid-filled sac that cushions and protects a developing embryo and fetus in the uterus (500-1,000)ml

spina bifida is a developmental defect in which

a portion of the spinal cord or meninges protrudes outside of the vertebrae

a shuffling gait when walking

Multigravida

a woman who has experienced multiple pregnancies

Primigravida

a woman who is experiencing her first pregnancy

preclampsia

abnormal condition encountered during pregnancy or shortly after delivery characterized by high blood pressure, edema, and proteinuria, but with no convulsions or coma headache seeing spots swelling of feet and hands (edema) anxiety high Blood pressure

passage of fetus and placenta

abortion

Braxton-Hicks contractions are characterized by

alleviation of pain with movement or changing positions

apgar score

aperance pulse grimance-crying activity resp. A PERFECT SCORE IS 10

what is the apgar score based on

appearance, pulse, irritability or grimace, activity or muscle tone, and respirations

When does ovulation occur

approx 2 weeks prior to menstruation

assist her ventilations with a bag-mask device.

In anticipation of receiving a fertilized ovum, the lining of the uterine wall:

becomes engorged with blood

The onset of menstruation is called menarche and usually occurs in women who are

between 11 and 16 years of age.

what is the normal respiratory rate response and heart rate of a newborn

breathing within 15-30 sec after birth at a hr of 120 beats/min or higher

why is it hard for pregnant women to show signs of shock

by the third semester of the pregnancy pregnant women have an increased amount of overall total blood volume and approx 20% increase in their heart rate, therefore she may have a significant amount of blood loss before any signs appear

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT:

carefully removing any foreign bodies from the vagina

what are the three stages of labor

cervix dilation, infant delivery, and placenta delivery

Which of the following conditions would MOST likely lead to PID if left untreated?

chlamydia

the onset of labor begins with

contractions of the uterus

Umbilical arteries carry what

deoxgenated blood from the heart of the fetus to the woman

placenta previa is MOST accurately defined as

development of the placenta over the cervical opening

3 stages of labor

dilation of the cervix delivery of baby delivery of placenta

early stage of of the fetus

embryo

It is not uncommon for young females who experience their first menstrual period to:

experience abdominal cramping, which may be misinterpreted.

Each ovary produces an ovum in alternating months and releases it into the:

fallopian tube.

fertilization occurs in the

falopian tube

Which of the following conditions does NOT typically present with vaginal discharge?

genital herpes

Whenever possible, a female sexual assault victim should be:

given the option of being treated by a female EMT

When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she:

has gathered patient history information.

A precipitous labor and deliver is MOST common in women who

have had children before

As a woman approaches menopause:

her menstrual periods may become irregular and vary in severity

what questions to ask during history taking to determine whats goin on

how long have you been pregnant, when are you due, is this your 1st, are you having contractions and how far apart, any spotting or bleeding, water broken, have you had a c section, do you feel like you need to have a bowel movement

What to do with newly delivered infant

immediately dry off and wrap in blanket or towel and place on one side with head lower than rest of body, wrap body so only face is exposed, use sterile gauze to wipe out mouth and suction mouth and nose

resp. for a prego

incresed shallow breaths

If a woman with vaginal bleeding reports syncope, the EMT must assume that she:

is in shock

When documenting a call in which a female was sexually assaulted, you should:

keep the report concise and record only what the patient stated in her own words

When documenting a call in which a female was sexually assaulted, you should

keep the report concise and record only what the patient stated in her own words.

how do you calculate a due date in pregnancy

know the last date of the woman's menstrual period and add 40 weeks from that date

how should a pregnant women wear her seatbelt

lap belt should be laced under the abdomen and over the hip bones, shoulder belt should be positioned between the breasts

How to treat for eclampsia

lie pt on her side, preferably her left, maintain an airway and provide supplemental o2

when the fetus positions itself to the pelvis

lightening

The physical examination of a sexual assault victim should be:

limited to a brief survey for life-threatening injuries.

Which of the following clinical presentations is MOST consistent with PID?

lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

fluids of the amniotic sac

lub and disenfect the cervix

how to treat a trauma pregnant pt

maintain an open airway, apply high flow 02 with non rebreather, ensure adequate ventilation, assess circulation, and transport

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to:

maintain her ABCs and transport without delay.

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer:

may be relatively painless

Bacterial vaginosis is a condition that occurs when:

normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms

when preparing a pregnant patient for delivery you should position her

on a firm surface with her hips elevated 2" to 4"

what is the first stage begin with

onset of contractions, which is usually the longest

Potentially life-threatening consequences of PID include:

ovarian abscess and ectopic pregnancy

Umbilical veins carry what

oxygenated blood from the woman to the heart of the fetus

how to treat mother after delivery for bleeding

place a sterile pad or sanitary napkin over the vagina and straighten the mothers legs, help slow bleeding by massaging the abdomen with firm kneading motion

When caring for a female patient who has been sexually assaulted, you should:

place any bloodstained clothing or other articles in separate paper bags

how to position a pt about to deliver

place her on a firm surface padded with blankets beneath her hips to elevate them about 2 to 4 inches

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's leg is protruding from the vagina. Appropriate management of this situation includes

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

Most common complication in first time pregnancy

preeclampsia (headache, seeing spots, swelling, hypertension)

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because

pregnant patients have an overall increase in blood volume.

provide emotional support and visually assess her for obvious trauma

the uterus is

responsible for contractions and helps push the baby out

eclampsia is MOST accurately defined as

seizures that result from hypertension

When a female has reached menarche

she is capable of becoming pregnant

headache and edema

signs and symptoms of preeclampsia

how to deliver infant

support bony parts of the head suction fluid from the mouth then the nostrils, when upper shoulder appears guide the head down, supposrt the head and upper body as the lower should delivers, handle the infant firmly but gently keeping the neck in a neutral position to maintain airway, keep the infant approx at the level until umbilical cord is cut, place the cord clamps 2-4" apart and cut in b/w them

second stage begins when

the baby enters the canal and ends wen the baby is born

what is a fundus

the dome shaped top of the uterus

During delivery, it is MOST important to position your partner at the mother's head because

the mother may become nauseated and vomit.

what is ovulation

the process the follicle goes through and the actual release of the egg is stimulated by the release of specific hormones in the female body

where is the uterus located at 20weeks along

the uterus is located at or above the belly button

PID typically does NOT affect the:

urinary bladder

8-12 cm in legnth

vagina

birth canal is made of the

vagina and neck of the uterus

what structures make up the birth canal

vagina and the lower third or neck of the uterus called the cervix

when should you consider delivering in the field

when delivery can be expected within a few min, or when a natural disaster, inclement weather or other environmental factors make it impossible to reach the hospital

what is lightening

when the baby decends into the pelvis

what is a bloody show

when the cervix begins to dilate the mucous plug is discharged into the vagina as pink tinged mucous, beginning the labor

what is a nuchal cord

when the umbilical cord is wound tightly around the neck which could strangle the infant

uterine contractions become more regular

which of the following occurs during true labor

apply 100% oxygen

you are assessing a 25 year woman who is 39 weeks pregnant. She is experiencing regular contractions that are approx 3 min apart and states that her amniotic sac broke 2 hrs ago. After taking standard precautions you should

Obstetric & Gynecological Emergencies review !@#$%%^

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