ALSO PRE TEST QUESTIONS AND ANSWERS
A 26 year-old gravida 2 para 1 female at 9 weeks' estimated gestational age (by last
normal menstrual period) presents to the Emergency Department complaining of heavy
vaginal bleeding which began two hours earlier. She denies having any sexual
intercourse in the past seven days. Her vital signs are stable. A quantitative serum hCG
returns at a value of 3200 mIU/mL and a transvaginal ultrasound reveals a mean
gestational sac diameter of 30mm and no embryo. She reports passing no tissue and a
speculum examination reveals the cervix is visually closed. In counseling the patient
about her options, which of the following statements is true? - Answers- Medical
management with misoprostol is more effective than expectant management Correct
Which of the following is a contraindication for medical management of an ectopic
pregnancy with methotrexate? - Answers- Presence of embryonic cardiac activity
Correct
A 19-yo primigravida at approximately 40 weeks' estimated gestational age comes to
the hospital with painful contractions. She has received no prenatal care. Examination:
Cervix is 4 cm dilated and 80% effaced at station -1. Blood pressure is 164/111 mm Hg,
and a urine dipstick shows 3+ protein. She reports having had severe headaches for
three days and has noticed swelling in her hands and feet. Moments after her blood is
drawn and IV access is obtained, she has a generalized tonic-clonic seizure. Which of
the following is the most appropriate immediate course of action? - Answers-
Administer magnesium sulfate six grams IV over 15-20 minutes Correct
A 29 year-old gravida 3 para 2 female at 28 weeks' estimated gestational age is found
to have a pulmonary embolus. She is hemodynamically stable and you are discussing
therapeutic anticoagulation with her. According to the 2012 American College of Chest
Physicians Guidelines, the treatment of choice for venous thromboembolism in
pregnancy is which one of the following? - Answers- Low-molecular weight heparin
Correct
A 32-year-old gravida 2 para 1 female at 40 6/7 weeks' estimated gestational age has
been fully dilated for four hours, and has now been pushing for two hours. She is
physically and emotionally exhausted, so you have a discussion with her regarding
assisted vaginal delivery. Which of the following are prerequisites to an instrumented
delivery? - Answers- Lack of suspicion of severe cephalopelvic disproportion Correct
Which of the following is an antenatal risk factor for shoulder dystocia? - Answers-
Maternal obesity Correct
Documentation in the medical record after a delivery with a shoulder dystocia is an
essential risk management tool. Which of the following should be documented in the
medical record pertaining to the circumstances that took place during the shoulder
dystocia? - Answers- The elapsed amount of time from delivery of the fetal head until
complete delivery of the baby Correct
, Postpartum hemorrhage is a common maternal morbidity in high resource countries and
is on the rise. Which one of the following is the most common cause of postpartum
hemorrhage? - Answers- Atonic uterus Correct
You are attending the delivery of a 36-year-old gravida 6 para 5 female at term. Her
pregnancy has been uncomplicated, with the exception of chronic hypertension treated
with Labetalol 100 mg po BID. After a normal spontaneous vaginal delivery, you note a
large gush of blood, prompt delivery of the placenta, and brisk vaginal bleeding. In
addition to uterine massage, which of the following uterotonic agents should not be
used to treat postpartum hemorrhage in this patient? - Answers- Methylergonovine 0.2
mg IM Correct
In managing an early postpartum hemorrhage, what threshold volume of blood loss
requires immediate maternal resuscitation measures using an interdisciplinary team
approach including anesthesia, laboratory, nursing, surgery, and blood bank staff? -
Answers- 1500 mL Correct
You are called stat to a pregnant patient's bedside on Labor and Delivery who is having
a tonic-clonic seizure. She becomes pulseless and is confirmed to be in cardiac arrest.
Cardiopulmonary resuscitation is immediately initiated. Her primary nurse reports the
patient is full term, and was admitted two hours ago for labor management. In the face
of maternal cardiopulmonary arrest after 4 minutes of adequate cardiopulmonary
resuscitation, you recall the American Heart Association's goal is to achieve delivery of
the fetus via emergency hysterotomy by no more than how many minutes after the
mother's heart has stopped beating? - Answers- 5 minutes Correct
Pregnant women beyond 20 weeks' gestation experiencing minor trauma (such as a fall,
minor MVC, or blunt abdominal trauma) should be monitored by cardiotocograph for a
minimum of how many hours? - Answers- 4 hours Correct
In discussing obstetric emergencies with a new registered nurse on Labor and Delivery,
you initiate a conversation reviewing the common risk factors for postpartum
hemorrhage. Which of the following is considered a risk factor? - Answers- Induction or
augmentation of labor Correct
You are discussing prevention of shoulder dystocia with a nurse midwife student. Which
of the following statements is true? - Answers- Episiotomy performed at the time of an
assisted vaginal delivery does not reduce the incidence of shoulder dystocia Correct
According to the NICHD Fetal Heart Rate Classification System, which category tracing
requires prompt evaluation and expedient interventions to address the pattern (as the
tracing in this category is considered abnormal and predictive of abnormal fetal acid-
base status at the time of observation)? - Answers- Category III electronic fetal
monitoring tracing Correct
A 26 year-old gravida 2 para 1 female at 9 weeks' estimated gestational age (by last
normal menstrual period) presents to the Emergency Department complaining of heavy
vaginal bleeding which began two hours earlier. She denies having any sexual
intercourse in the past seven days. Her vital signs are stable. A quantitative serum hCG
returns at a value of 3200 mIU/mL and a transvaginal ultrasound reveals a mean
gestational sac diameter of 30mm and no embryo. She reports passing no tissue and a
speculum examination reveals the cervix is visually closed. In counseling the patient
about her options, which of the following statements is true? - Answers- Medical
management with misoprostol is more effective than expectant management Correct
Which of the following is a contraindication for medical management of an ectopic
pregnancy with methotrexate? - Answers- Presence of embryonic cardiac activity
Correct
A 19-yo primigravida at approximately 40 weeks' estimated gestational age comes to
the hospital with painful contractions. She has received no prenatal care. Examination:
Cervix is 4 cm dilated and 80% effaced at station -1. Blood pressure is 164/111 mm Hg,
and a urine dipstick shows 3+ protein. She reports having had severe headaches for
three days and has noticed swelling in her hands and feet. Moments after her blood is
drawn and IV access is obtained, she has a generalized tonic-clonic seizure. Which of
the following is the most appropriate immediate course of action? - Answers-
Administer magnesium sulfate six grams IV over 15-20 minutes Correct
A 29 year-old gravida 3 para 2 female at 28 weeks' estimated gestational age is found
to have a pulmonary embolus. She is hemodynamically stable and you are discussing
therapeutic anticoagulation with her. According to the 2012 American College of Chest
Physicians Guidelines, the treatment of choice for venous thromboembolism in
pregnancy is which one of the following? - Answers- Low-molecular weight heparin
Correct
A 32-year-old gravida 2 para 1 female at 40 6/7 weeks' estimated gestational age has
been fully dilated for four hours, and has now been pushing for two hours. She is
physically and emotionally exhausted, so you have a discussion with her regarding
assisted vaginal delivery. Which of the following are prerequisites to an instrumented
delivery? - Answers- Lack of suspicion of severe cephalopelvic disproportion Correct
Which of the following is an antenatal risk factor for shoulder dystocia? - Answers-
Maternal obesity Correct
Documentation in the medical record after a delivery with a shoulder dystocia is an
essential risk management tool. Which of the following should be documented in the
medical record pertaining to the circumstances that took place during the shoulder
dystocia? - Answers- The elapsed amount of time from delivery of the fetal head until
complete delivery of the baby Correct
, Postpartum hemorrhage is a common maternal morbidity in high resource countries and
is on the rise. Which one of the following is the most common cause of postpartum
hemorrhage? - Answers- Atonic uterus Correct
You are attending the delivery of a 36-year-old gravida 6 para 5 female at term. Her
pregnancy has been uncomplicated, with the exception of chronic hypertension treated
with Labetalol 100 mg po BID. After a normal spontaneous vaginal delivery, you note a
large gush of blood, prompt delivery of the placenta, and brisk vaginal bleeding. In
addition to uterine massage, which of the following uterotonic agents should not be
used to treat postpartum hemorrhage in this patient? - Answers- Methylergonovine 0.2
mg IM Correct
In managing an early postpartum hemorrhage, what threshold volume of blood loss
requires immediate maternal resuscitation measures using an interdisciplinary team
approach including anesthesia, laboratory, nursing, surgery, and blood bank staff? -
Answers- 1500 mL Correct
You are called stat to a pregnant patient's bedside on Labor and Delivery who is having
a tonic-clonic seizure. She becomes pulseless and is confirmed to be in cardiac arrest.
Cardiopulmonary resuscitation is immediately initiated. Her primary nurse reports the
patient is full term, and was admitted two hours ago for labor management. In the face
of maternal cardiopulmonary arrest after 4 minutes of adequate cardiopulmonary
resuscitation, you recall the American Heart Association's goal is to achieve delivery of
the fetus via emergency hysterotomy by no more than how many minutes after the
mother's heart has stopped beating? - Answers- 5 minutes Correct
Pregnant women beyond 20 weeks' gestation experiencing minor trauma (such as a fall,
minor MVC, or blunt abdominal trauma) should be monitored by cardiotocograph for a
minimum of how many hours? - Answers- 4 hours Correct
In discussing obstetric emergencies with a new registered nurse on Labor and Delivery,
you initiate a conversation reviewing the common risk factors for postpartum
hemorrhage. Which of the following is considered a risk factor? - Answers- Induction or
augmentation of labor Correct
You are discussing prevention of shoulder dystocia with a nurse midwife student. Which
of the following statements is true? - Answers- Episiotomy performed at the time of an
assisted vaginal delivery does not reduce the incidence of shoulder dystocia Correct
According to the NICHD Fetal Heart Rate Classification System, which category tracing
requires prompt evaluation and expedient interventions to address the pattern (as the
tracing in this category is considered abnormal and predictive of abnormal fetal acid-
base status at the time of observation)? - Answers- Category III electronic fetal
monitoring tracing Correct
