NM 704 EXAM 4 2026 EXAMINATION TEST
COMPLETE QUESTIONS AND ANSWERS
◉ Ultiva (remifentanil). Answer: Shortest-active opioid, no active
metabolites, fewer side effects and neonatal effects, can cause
significant maternal respirtory depression, use is controversial, dose
at beginning of uterine ctx to maximize peak effect; used only in PCA
infusions
◉ Traditional 2nd Stage. Answer: Begins with complete dilation of
the cervix and ends with the birth of the baby
Stage of expulsion
Push only when complete
Requires vaginal exam for diagnosis, provider focuses
◉ Alternative 2nd stage. Answer: Begins with onset of involuntary,
expulsive efforts (urge to push) and ends with birth of baby
Cervical dilation is not relevant, woman follows her body's cues and
pushes when she must, with an urge
◉ Ferguson's reflex. Answer: Stimulation of the nerve plexus that
generates an urge to push via a surge of oxytocin, occurs as
presenting part descends and applies pressure on the pelvic floor;
usually occurs at +1 station
, ◉ Coached (directive) pushing. Answer: Instruction on breath
holding, positioning and duration of each push, found women had
decreased bladder capacity, decreased first urge to void volume and
more pelvic floor descent at 3 months PP
◉ Spontaneous (supportive) pushing. Answer: Woman pushes
according to urge, pushing is spontaneous, in response to natural
urges and sensations, usually results in 5-6 bearing down efforts per
contraction of 3-10 seconds each
◉ Closed glottis pushing. Answer: Use of breath holding combined
with prolonged bearing down results in a Valsalva maneuver that
can decrease cardiac output and subsequent blood flow to the
uterus; causes more FHR decels, more perineal trauma, maternal
exhaustion and risk for cystocele and urinary stress incontinence
◉ Open glottis pushing. Answer: Similar to semi-voluntary grunting
and pushing associated with defecation, does not increase
intrathoracic pressure and doesn't affect cardiac output
◉ Hands on/guarding. Answer: Hands are used to support the
perineum and/or fetal head manually and encourage baby to come
out in an unhurried way
COMPLETE QUESTIONS AND ANSWERS
◉ Ultiva (remifentanil). Answer: Shortest-active opioid, no active
metabolites, fewer side effects and neonatal effects, can cause
significant maternal respirtory depression, use is controversial, dose
at beginning of uterine ctx to maximize peak effect; used only in PCA
infusions
◉ Traditional 2nd Stage. Answer: Begins with complete dilation of
the cervix and ends with the birth of the baby
Stage of expulsion
Push only when complete
Requires vaginal exam for diagnosis, provider focuses
◉ Alternative 2nd stage. Answer: Begins with onset of involuntary,
expulsive efforts (urge to push) and ends with birth of baby
Cervical dilation is not relevant, woman follows her body's cues and
pushes when she must, with an urge
◉ Ferguson's reflex. Answer: Stimulation of the nerve plexus that
generates an urge to push via a surge of oxytocin, occurs as
presenting part descends and applies pressure on the pelvic floor;
usually occurs at +1 station
, ◉ Coached (directive) pushing. Answer: Instruction on breath
holding, positioning and duration of each push, found women had
decreased bladder capacity, decreased first urge to void volume and
more pelvic floor descent at 3 months PP
◉ Spontaneous (supportive) pushing. Answer: Woman pushes
according to urge, pushing is spontaneous, in response to natural
urges and sensations, usually results in 5-6 bearing down efforts per
contraction of 3-10 seconds each
◉ Closed glottis pushing. Answer: Use of breath holding combined
with prolonged bearing down results in a Valsalva maneuver that
can decrease cardiac output and subsequent blood flow to the
uterus; causes more FHR decels, more perineal trauma, maternal
exhaustion and risk for cystocele and urinary stress incontinence
◉ Open glottis pushing. Answer: Similar to semi-voluntary grunting
and pushing associated with defecation, does not increase
intrathoracic pressure and doesn't affect cardiac output
◉ Hands on/guarding. Answer: Hands are used to support the
perineum and/or fetal head manually and encourage baby to come
out in an unhurried way
