CCPR - OB EXAM 1 100% CORRECT ANSWERS | VERIFIED

1. A gravida 2, para 1 in active labor just reported spontaneous rupture of membranes. Ten minutes later, she suddenly complains of severe shortness of breath and lightheadedness. The nurse should suspect a. anaphylactoid syndrome b. extreme anxiety c. hyperventilation - correct answer anaphylactoid syndrome 2. Betamethasone given to the mother can transiently affect the fetal heart rate by a. decreasing the variability b. increasing the variability c. lowering the baseline - correct answer decreasing the variability 3. When Cervidil is used for induction of labor, at what point can oxytocin be initiated after removal of the Cervidil? a. 1 hour b. 2 hours c. 4 hours - correct answer 1 hour 5. When fundal pressure is used during a shoulder dystocia, the nurse is aware that it will potentially a. abrupt the placenta b. assist the provider with delivery of the shoulders c. impact the fetal shoulder - correct answer c. impact the fetal shoulder 6. A postpartum mother who would like to breastfeed her baby is diagnosed with Hepatitis B surface-antigen positive. What is the recommendation regarding breastfeeding for this mother? a. Administer HBIG and hepatitis B vaccine to the newborn and then allow breastfeeding b. Breastfeeding is absolutely contraindicated c. Pump and discard milk for 1 week following vaccine administration to the newborn - correct answer a. Administer HBIG and hepatitis B vaccine to the newborn and then allow breastfeeding 7. Stimulation of the sympathetic nervous system causes the fetal heart rate to a. decrease b. increase c. remain the same - correct answer increase 8. A patient at 37 weeks gestation arrives to labor and delivery from the emergency room after admission for severe gastric discomfort with nausea and vomiting. Her blood pressure is 156/100 mmHg. She complains of blurred vision. These findings are consistent with a diagnosis of a. gestational hypertension b. preeclampsia c. preeclampsia with severe features - correct answer preeclampsia with severe features 9. What maternal disease results in damage to the fetal heart conduction system? a. Alpha thalassemia major b. Rh isoimmunization c. Systemic lupus erythematosus - correct answer Systemic lupus erythematosus 10. The most appropriate instruction to give parents about what breastfeeding frequency to expect during the first few weeks after birth is a. cluster feedings with 8 to 12 feedings in 24 hours b. regularly spaced feedings every 2 to 3 hours c. six to eight feedings in 24 hours with a longer stretch of sleep during the night - correct answer a. cluster feedings with 8 to 12 feedings in 24 hours 11. A woman at 28 weeks gestation reports to the labor and delivery with painless vaginal bleeding that started this morning. The nurse's first step in caring for this woman is to determine a. cervical dilation b. placental location c. rupture of membranes - correct answer b. placental location 12. A series of sine waves with similar duration and amplitude develop on the electronic fetal monitor 10 minutes after stadol (butorphanol) is administered to a patient with previously normal tracings. The appropriate response to this fetal heart rate pattern would be to a. administer oxygen b. continue to observe c. prepare for cesarean delivery - correct answer b. continue to observe 13. Increased perfusion of the newborn liver is initiated by closure of the a. ductus arteriosus. b. ductus venosus. c. foramen ovale. - correct answer b. ductus venosus. 14. Following premature rupture of membranes, a woman at 33 weeks gestation is placed on a fetal heart rate monitor. The fetal heart rate is persistently 175 bpm. This is most likely consistent with a. immature fetal CNS integrity b. maternal anxiety c. uterine infection - correct answer c. uterine infection 15. A patient is examined and found to have a tender, red area in one breast that feels small and hard, similar to a pea just under the skin. The expected management for this patient is a. antibiotics for 7 days b. cabbage leaves applied to the breast c. gentle massage to relieve the lump - correct answer c. gentle massage to relieve the lump 16. According to the gate control theory relieving pain with massage, heat and cold acts by a. blocking the capacity of nerve pathways to transmit pain b. diverting the pathways to areas of spinal cord decreasing sensation c. stimulation of mu and kappa receptors - correct answer a. blocking the capacity of nerve pathways to transmit pain 17. The phase of labor that distraction techniques are most likely to be effective is a. active b. latent c. transition - correct answer b. latent 18. A gravida 1 para 0 is in spontaneous labor at 40 weeks after an uncomplicated pregnancy. She is 5 centimeters dilated, completely effaced with the vertex at -2 station. The above tracing is obtained following the artificial rupture of the membranes (AROM). -- After maternal repositioning, the next step in management is to: a. Administer terbutaline b. Initiate an amnioinfusion c. Perform a vaginal exam - correct answer c. Perform a vaginal exam 19. The recommended method to reduce the incidence of nonreactive nonstress tests is a. fetal manipulation b. ingestion of orange juice c. vibroacoustic stimulation - correct answer c. vibroacoustic stimulation 20. A woman is 12 hours postpartum and has a white blood cell count of 25,000μL. This indicates a. dehydration and a need to force fluids b. in the expected range at this time c. infection and a need for antibiotics - correct answer b. in the expected range at this time 21. The cardinal symptom of cholestasis of pregnancy is a. diaphoresis b. nausea and vomiting c. pruritus - correct answer c. pruritus 22. When the chorionic villi attach directly to the myometrium of the uterus, this represents a. early stage placenta previa b. placenta accreta c. retained placenta - correct answer b. placenta accreta 23. After the last dose of misoprostol (Cytotec), oxytocin administration should be delayed for at least a. 30-60 minutes b. 4 hours c. 6-12 hours - correct answer b. 4 hours 24. The pushing technique that a woman in second stage should be encouraged to use is a. Alternating between open and closed-glottis pushing b. Closed glottis pushing while holding her breath to the count of 10 c. Open-glottis pushing for 6-8 seconds with 3 to 4 pushes per contraction - correct answer c. Open-glottis pushing for 6-8 seconds with 3 to 4 pushes per contraction 25. To avoid a precipitous drop in intra-abdominal pressure, during catheterization of a postpartum patient's bladder, what is the maximum amount of urine that should be removed at one time? a. 500 ml b. 800 ml c. 1000 ml - correct answer b. 800 ml 26. A prolonged second stage in a primigravida with regional anesthesia is defined as a lack of continuing progress and a second stage duration of greater than a. 1 hour b. 2 hours c. 3 hours - correct answer c. 3 hours 27. Dinoprostone (Cervidil) is being utilized for cervical ripening. The nurse should know the Cervidil should be removed a. in 12 hours or the onset of uterine contractions b. in 24 hours after insertion c. when it is time to administer oxytocin - correct answer a. in 12 hours or the onset of uterine contractions 28. In 2006 when the Centers for Disease Control revised HIV testing and counseling guidelines, which of the following reflects the change for pregnant women? a. Formal pretest education and counseling for any pregnant women before the HIV test is performed b. Routine testing for each pregnant woman unless she specifically declines c. Uniform HIV testing requirements for a pregnant woman in any state - correct answer b. Routine testing for each pregnant woman unless she specifically declines 29. Fluid balance should be monitored in the preeclamptic woman on magnesium sulfate therapy because there is an increased risk for a. acute renal failure b. congestive heart failure c. pulmonary edema - correct answer c. pulmonary edema 30. The relation of the fetal body parts to one another is called fetal a. attitude b. lie c. presentation - correct answer a. attitude 31. A woman is admitted to labor and delivery with moderate uterine pain without bleeding. On examination, the uterus has high tonicity and the uterine contraction tracing shows increased resting tone. The most likely cause is a. placental abruption b. placenta previa c. uterine rupture - correct answer a. placental abruption 32. When differentiating false labor from true labor, a finding that would suggest a woman is in true labor is if after 1-2 hours of walking which of the following occurs? a. Back pain radiating to the abdomen b. Cervix is soft and closed c. Contractions lessen some with walking - correct answer a. Back pain radiating to the abdomen 33. A woman is pregnant with twins and had an ultrasound diagnosis of monochorionicity. Compared to dichorionicity, risk of an adverse outcome is a. higher b. lower c. similar - correct answer a. higher 34. A newly pregnant woman who is morbidly obese has a strong family history of type 2 diabetes. The recommended time for this woman's initial glucose screen is a. as soon as possible b. at 36 weeks gestation c. between 24 and 28 weeks gestation - correct answer a. as soon as possible 35. A Bishop score of 4 indicates a. a favorable cervix b. an intermediate cervix c. an unfavorable cervix - correct answer c. an unfavorable cervix 36. During auscultation of the fetal heart rate, the nurse notes a gradual decrease in the fetal heart rate after a contraction that lasts 60 seconds. The appropriate documentation of this finding is that after a contraction, there is a a. decrease in the fetal heart rate after a contraction b. late deceleration c. variable deceleration - correct answer a. decrease in the fetal heart rate after a contraction 37. Which one of the following women is the best candidate for a vaginal birth after cesarean? a. A gravida 2 para 1 who had a cesarean for labor dystocia prior to 5 centimeters dilation b. A gravida 3, para 2 who had a cesarean for fetal heart rate issues with her first baby and a cesarean for breech presentation with her second baby c. A gravida 3, para 2 who had a vaginal delivery with her first pregnancy and a cesarean for breech with her second baby - correct answer c. A gravida 3, para 2 who had a vaginal delivery with her first pregnancy and a cesarean for breech with her second baby 38. What is the pattern in the above fetal heart rate tracing? a. acceleration b. late deceleration c. prolonged acceleration - correct answer c. prolonged acceleration 39. A predisposing factor to breech presentation is a. android pelvis b. multifetal pregnancy c. primiparity - correct answer b. multifetal pregnancy 40. A maternal contraindication to breastfeeding is a. hepatitis A b. group B streptococcus c. HTLV-1(human T-cell leukemia virus, type 1) - correct answer c. HTLV-1(human T-cell leukemia virus, type 1) 41. An Rh negative woman at 36 weeks has an external version. She should a. not receive Rh D immunoglobulin (Rhogam) b. receive Rh D immunoglobulin (Rhogam) c. only receive Rh D immunoglobulin (Rhogam) if spotting after procedure - correct answer b. receive Rh D immunoglobulin (Rhogam) 42. Fentanyl requires more frequent dosing for management of labor pain because a. it has a shorter duration of action b. multiple smaller doses over time decrease the incidence of side effects c. the peak effect time lengthens with subsequent doses - correct answer a. it has a shorter duration of action 43. Which one of the following tachyarrhythmias can result in fetal hydrops? a. Persistent supraventricular tachycardia b. Premature atrial contractions c. Sinus tachycardia - correct answer a. Persistent supraventricular tachycardia 44. A pregnant woman at 24 weeks gestation is an elementary school teacher. She states there is an episode of Fifth Disease in the school. This patient is at risk for acquiring a. Cytomegalovirus b. Parvovirus B19 c. Varicella Zoster - correct answer b. Parvovirus B19 45. Guidelines from the Centers for Disease Control (CDC) regarding tetanus toxoid, reduced diphtheria toxoid, and a-cellular pertussis (Tdap) for a postpartum patient who had a tetanus booster 2 years ago would be to a. administer before discharge b. administer in 2 years. c. needs no further boosters - correct answer a. administer before discharge 46. Therapeutic touch is based on the theory that a. application of pressure to extremities will direct the body b. natural endorphin release will be induced by massaging the body c. well-being can be promoted by uniting the energy fields of the care giver and the patient - correct answer c. well-being can be promoted by uniting the energy fields of the care giver and the patient 47. A cause of physiological jaundice can be a result of a. decreased amounts of bilirubin delivered to the liver b. delayed cord clamping c. increased intestinal motility - correct answer b. delayed cord clamping 48. The color of nitrazine paper most indicative of ruptured membranes is a. blue b. green c. yellow - correct answer a. blue 49. The above tracing is that of a 39½ week gestation gravida 3, para 2 who is currently 6 cm, 90%, -1, who received an epidural test dose 10 minutes ago. FHR baseline is 150. — The most likely cause of these decelerations is a. a short umbilical cord b. fetal metabolic acidosis c. maternal hypotension - correct answer c. maternal hypotension 50. A fetal heart rate baseline of 140 with moderate variability, no accelerations and no decelerations is a NICHD category a. I b. II c. III - correct answer a. I 51. The fetal heart tones of a baby in the ROP position, would best be heard over which area of the mothers abdomen? a. A (low midline) b. B (low right) c. C (low left) - correct answer b. B (low right) 52. Compared to non-pregnant values, the maternal arterial carbon dioxide (pCO₂) during pregnancy is a. decreased b. increased c. the same - correct answer a. decreased 53. A 39 week gestation primigravida has had regular contractions for the past 48 hours. She has remained 1 centimeter dilated since the onset of contractions. She is exhausted, uncomfortable and unable to sleep. Which medication is recommended for therapeutic rest? a. Fentanyl b. Morphine c. Stadol - correct answer b. Morphine 54. pH 7.0 pCO2 80 mmHg pO2 21 mmHg HCO3 21.3 mm/L B.D. 6 mm/L The umbilical cord blood values above reflect a. metabolic acidemia b. normal values c. respiratory acidemia - correct answer c. respiratory acidemia 55. Which statement describes normal uterine activity? a. Frequency of 1-1/2 to 2 minutes b. Intensity of 90 mmHg early in labor c. Resting tone less than 20-25 mmHg - correct answer c. Resting tone less than 20-25 mmHg 56. A negative fetal fibronectin test at 30 weeks indicates a. a need for further testing b. increased risk for delivery c. risk of delivery is very low for the next 7-14 days - correct answer c. risk of delivery is very low for the next 7-14 days 57. The uterine incision which has the highest risk of heavy blood loss and repair difficulty is a. lower uterine segment transverse (Kerr) b. lower uterine segment vertical (Sellheim) c. upper uterine segment vertical (Classic) - correct answer c. upper uterine segment vertical (Classic) 58. A patient diagnosed with a postpartum infection states she does not have any pain but seems confused and agitated. Her vital signs are as follows: Temperature 99.9°F; BP 98/50; Pulse 125, urinary output is decreased. The most likely diagnosis is a. pulmonary embolism b. septic shock c. thromboembolism - correct answer b. septic shock 59. The cervical dilation in the above multigravida labor cure is interpreted as a. Arrest of dilation b. Normal labor progress c. Protracted active phase - correct answer c. Protracted active phase 60. Following delivery the insulin requirement for most diabetic breastfeeding women is a. decreased b. increased c. the same as for bottlefeeding diabetics - correct answer a. decreased 61. Pitocin dosages during labor induction should be documented in a. mU/per minute b. ml/min c. cc/hour - correct answer a. mU/per minute 62. Cordocentesis is more commonly used to detect fetal a. anemia b. metabolic disorders c. pH and PO2 - correct answer a. anemia Cordocentesis is usually done when diagnostic information can not be obtained through amniocentesis, CVS, or ultrasound, or if the results of these tests were inconclusive. Cordocentesis is performed after 17 weeks into pregnancy Cordocentesis detects chromosome abnormalities (i.e. Down syndrome) and blood disorders (i.e. fetal hemolytic disease.) Malformations of the fetus Fetal infection (i.e. toxoplasmosis or rubella) Fetal platelet count in the mother Fetal anemia Isoimmunisation 63. A postpartum patient has a spinal headache. The nurse knows that this can occur as a consequence of epidural anesthesia due to a. injured nerve pathways b. leakage of fluid at the puncture site c. too rapid administration - correct answer b. leakage of fluid at the puncture site 64. Ten minutes after placement of an epidural, maternal blood pressure decreases by 20%. After performing IV hydration and lateral positioning, what should be the nurses next intervention? a. Administer ephedrine b. Discontinue the epidural c. Prepare for a cesarean section - correct answer a. Administer ephedrine 65. Forty-eight hours after a woman's cesarean birth, the nurse notes that the woman's left calf and foot are cool and pale. The left pedal pulse is diminished and there is decreased capillary refill. The Homan's sign is negative bilaterally. She reports some tenderness in the left calf. The most appropriate initial response to these findings would be to a. administer pain Warfarin b. apply elastic stockings c. place on bedrest with elevation of left leg - correct answer c. place on bedrest with elevation of left leg 66. Which maternal age is at greatest risk of a labor dystocia a. 16 b. 28 c. 36 - correct answer c. 36 68. A sign of deteriorating status in a pregnancy complicated by hypertension is increased a. albumin b. plasma colloid pressure c. serum creatinine - correct answer c. serum creatinine 69. A woman is receiving steroids at 36 weeks gestation for immune thrombocytopenia (ITP). She needs to be followed closely for a. increased risk of infection b. hypoglycemia c. hypertension - correct answer Priority is c. hypertension! Early detection of HELLP NOT a. increased risk of infection, though perhaps this is a SE of steroids. 70. The lochia that is pink or brown in color and occurs between 3 and 10 days postpartum is a. alba b. rubra c. serousa - correct answer c. serousa 71. A primigravida admitted for induction at 39 weeks gestation for preclampsia. She is not receiving any medication. On admission, her blood pressure is 157/91 and the FHR tracing is above. -- The decelerations in this tracing are (somewhat abrupt, but >30 sec onset to nadir, nadir after peak of ctx): a. early b. late c. variable - correct answer b. late 67. Continued increases in oxytocin rates over a prolonged period of time have what effect on oxytocin receptor sites? a. desensitization b. multiplication c. up-regulation - correct answer a. desensitization 73. During a shoulder dystocia, the provider has the nurse place the patient on all fours to facilitate delivery. Which of the following maneuvers would the provider request? a. Gaskin b. Woods c. Zavanelli - correct answer a. Gaskin 72. The Ferguson reflex is the result of a. cytokine release b. prostaglandin release from the membranes c. stretching of pelvic floor muscles - correct answer c. stretching of pelvic floor muscles 75. A young woman at 38 weeks gestation is brought to the hospital via ambulance after having seizures at home. She has been given phenobarbital, labetelol and magnesium sulfate. -- Fetal scalp stimulation is performed in panel 28345. The response of the fetus indicates. a. indeterminate acid-base status b. metabolic acidemia c. respiratory acidosis - correct answer a. indeterminate acid-base status 76. At 39 weeks gestation, a gravida 1, para 0 is admitted for an elective induction of labor. Her vaginal exam shows her to be 2 cm dilated, 50% effaced and a -3 station. The provider performs an artificial rupture of membranes and goes back to the office. Two minutes later, there is a prolonged fetal heart rate deceleration. The nurse's initial response to this situation is to a. call the provider b. initiate an IV fluid bolus c. perform a vaginal exam - correct answer c. perform a vaginal exam 77. The tracing above is a gravida 2, para 1 at 39 weeks gestation with internal monitoring. Her last cervical exam 30 minutes ago showed that she was 6 cm, 100%, and -1 station. — Given the patient's phase of labor, the peak pressure of these contractions is a. normal b. too high c. too low - correct answer b. too high 74. The release of catecholamines during labor can result in a a. longer dysfunctional labor b. more rapid second stage c. stronger contraction pattern - correct answer a. longer dysfunctional labor 78. Halogenated agents used for general anesthesia can result in a uterine tone that is a. decreased b. increased c. tetanic - correct answer a. decreased 79. Which finding of this tracing rules out fetal metabolic acidemia at this time? a. Baseline FHR b. Decelerations c. Variability - correct answer c. Variability 81. When a fetus is in the occiput posterior position, the position that is most helpful in facilitating rotation is a. hands and knees b. lithotomy c. semi-fowlers - correct answer a. hands and knees 80. According to the ACOG guidelines for continuous electronic fetal monitoring, a patient without complications in the active phase of labor should have the fetal heart rate assessed every a. 15 minutes b. 30 minutes c. 60 minutes - correct answer b. 30 minutes 83. Group B streptococcus (GBS) and what other organism are currently the most common