Inpatient OB Certification Exam 840 Questions with Verified Answers,100% CORRECT

Inpatient OB Certification Exam 840 Questions with Verified Answers Pain during the first stage of labor is caused by a. cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments. b. pressure on the urethra, bladder, and rectum by the descending fetal presenting part c. uterine muscle hypoxia, lactic acid accumulation, and distention of the pelvic floor muscles. - CORRECT ANSWER a. cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments. A class of antihypertensive drugs that should be avoided in pregnancy is: a. ACE inhibitors b. adrenergic blocking agents c. calcium channel blockers - CORRECT ANSWER a. ACE inhibitors Gestational diabetes places a woman at increased risk of: a. a birth with a congenital defect b. oligohydramnios with resultant fetal growth restriction c. overt diabetes in later life - CORRECT ANSWER Overt diabetes in later life A sign of symptom that indicates a progression of preeclampsia to eclampsia and warrants a consideration for delivery is: a. epigastric pain b. nausea or vomiting c. persistent proteinuria - CORRECT ANSWER epigastric pain A predisposing factor for preeclampsia is: a. nulliparity b. obesity prior to pregnancy c. previous history of preeclampsia - CORRECT ANSWER A, B, and C A women is receiving magnesium sulfate. A sign that the magnesium sulfate is reaching a toxic level is: a. decreased appetite b. difficulty in swallowing c. slurring of speech - CORRECT ANSWER Slurring of the speech A positive ankle clonus that occurs with preeclampsia is usually a result of a. cerebral edema b. decreased colloid osmotic pressure c. dependent edema - CORRECT ANSWER cerebral edema A potentially life saving measure for a fetus that is exposed to chicken pox just prior to delivery is for the mother to receive: a. acyclovir (Zovirax) b. the chicken pox vaccine c. varicella immune globulin (VZIG) - CORRECT ANSWER Varicella immune globulin (VZIG) Following cesarean delivery for abrupt placenta, a clot observation test is initiated. Placing a small amount of blood in a test tube for 20 minutes yields a soft clot that dissolves easily. This is consistent with: a. hypofibriongenemia b. normal coagulation process c. presence of antithrombin III - CORRECT ANSWER Hypofibriongenemia A finding that would indicate a pregnant diabetic patient is at increased risk for giving birth to an infant with a congenital defect is: a. a history of macrosomia in her previous pregnancy b. an elevated hemoglobin A1C levels during the first trimester c. glucose levels above 140 mg/dL in the third trimester - CORRECT ANSWER b. an elevated hemoglobin A1C levels during the first trimeter (A1C) — Hemoglobin A1C levels are monitored during pregnancy because they correlate with a woman's blood glucose concentration over the prior 8 to 12 weeks and are predictive of the risk for congenital malformations and neonatal birth weight [9]. Lower values have been associated with better outcomes. (<6) When a pregnant woman experiences a cardiac arrest, the nurse should: a. first focus on assessing fetal status b. if the mother dies, discontinue resuscitative efforts c. treat the patient as the same as a non-pregnant patient - CORRECT ANSWER c. Treat the patient as the same as a non-pregnant patient At term, a woman is labor is found to have severe condylomata which has obstructed the vaginal canal. The appropriate disposition is. a. cesarean delivery b. cryotherapy removal c. immediate removal with podophyllin - CORRECT ANSWER a. cesarean delivery A hematologic change in pregnancy that predisposes to venous thrombosis is a. depressed fibrinolytic activity b. increased white blood cell count c. reduced erythrocyte production - CORRECT ANSWER a. depressed fibrinolytic activity A women is admitted to labor and delivery at 32 weeks gestation with vaginal bleeding. Her hematocrit is falling and she is tachycardic. A Kleihauer-Betketest is ordered. This is done to: a. detect fetal red blood cells in the maternal circulation b. detect hemolysis of fetal red blood ells c. rule out Rh isoimmunization - CORRECT ANSWER a. detect fetal red blood cells in the maternal circulation A pregnant woman at 33 weeks gestation experiences an eclamptic seizure. The medication of choice for this patient is immediate, intravenous administration of: a. diazepam (Valium) b. magnesium sulfate c. phenytoin (Dilantin) - CORRECT ANSWER b. magnesium sulfate A pregnant woman has a hemoglobin level of 9 g/dL and is stable, afebrile, and can ambulate without adverse symptoms. The indicated treatment is a. oral iron preparation b. parenteral iron therapy c. whole blood transfusions - CORRECT ANSWER a. oral iron preparation The Centers for Disease Control and Prevention (CDC) has defined anemia as hemoglobin levels of less than 11 g/dL (hematocrit less than 33 percent) in the first and third trimesters and less than 10.5 g/dL (hematocrit less than 32 percent) in the second trimester [21]. Since hemoglobin and hematocrit levels are lower in African-American adults, the Institute of Medicine recommends lowering the hemoglobin cut-off level by 0.8 g/dL in this population A women at 34 weeks gestation is admitted to the antepartum unit for influenza type symptoms and lymphadenopathy. A culture shows an infection caused by T. gondii. The most likely transmission route for this infection is. a. ingestion of raw meat b. rectal transfer c. sexual intercourse - CORRECT ANSWER ingestion of raw meat Toxoplasma gondii is a ubiquitous protozoan parasite that infects humans in various settings. Acute infection in the mother is usually asymptomatic. When symptoms of infection occur, they are nonspecific, such as fatigue, fever, headache, malaise, and myalgia. Lymphadenopathy is a more specific sign of the disease. A pregnant woman who is HIV positive is on combination antiviral therapy comes to the hospital for delivery. Drug therapy should be: a. continued on the prenatal dosing regimen throughout labor and delivery b. discontinued until after delivery where combination therapy should be resumed postpartum c. switched to zidovudine IV for one hour and followed by continuous infusion until delivery - CORRECT ANSWER a. continued on the prenatal dosing regimen throughout labor and delivery. Women should continue taking their ART regimen during labor and delivery or scheduled cesarean delivery. For women who have HIV RNA ≥1000 copies/mL or unknown viral levels in late pregnancy and around the time of delivery, we recommend intrapartum intravenous zidovudine to further reduce the risk of perinatal transmission (table 2) (Grade 1B). For women who have had HIV RNA <1000 copies/mL consistently in late pregnancy and around the time of delivery and have no concerns related to adherence or resistance to the regimen, intrapartum intravenous zidovudine is not associated with further reduction of HIV transmission. A diagnostic test used in the diagnosis of HELLP syndrome is. a. decreased liver function studies b. increased creatinine clearance c. presence of burr cells - CORRECT ANSWER c. decreased liver function studies During labor, women on full dose prophylactic unfractionated heparin anticoagulation should have the heparin dose. a. increased b, maintained c. withheld - CORRECT ANSWER c. withheld An alternative regimen to hydrazine when treating severe maternal hypertension is a. diazoxide b. labetalol c. sodium nitroprusside - CORRECT ANSWER b. labetalol The vascular manifestation of pregnant women with Class F diabetes is a. atherosclerotic heart disease b. nephropathy c. proliferative retinopathy - CORRECT ANSWER b. nephropathy Which class of antidepressants is most safe for use by pregnant woman? a. MAO inhibitors b. SSRIs c. Tricyclic - CORRECT ANSWER b. SSRIs Selective Serotonin reuptake inhibitors A woman who previously had an infant with anencephaly is planning another pregnancy. She should be advised to supplement her diet with folic acid in the dosage of a. 0.04 mg b. 0.4 mg c. 4.0 mg - CORRECT ANSWER c. 4.0 mg - recommendation from ACOG. The dose is decreased to 0.4 mg per day after the first trimester. For most women of reproductive potential, we suggest one multivitamin containing 0.4 mg of folic acid once per day beginning at least one month prior to conception and continuing through the first trimester A woman at 31 weeks gestation is admitted to labor and delivery for cuts and bruises on her stomach and torso. When asked how she acquired the bruise, she admits that her partner beat her after she told him she was leaving him due to repeated abusive episodes. The nurse would recognize that the utmost priority is the woman's a. need for social support b. physical safety c. risk for fetal loss - CORRECT ANSWER b. physical safety Because of potential fetal risks for pregnant woman with chronic hypertension, an antepartum fetal assessment that is recommended is a. amniocentesis b. serial ultrasound c. urinary estriols - CORRECT ANSWER b. serial ultrasound Compared to alphafetoprotein testing, triple screen testing improves the ability to detect. a. metabolic disorders b. open neural tube defects c. trisomies - CORRECT ANSWER c. trisomies When comparing the non stress over the contraction stress test, the clinician should understand that the non-stress test a. has a low false negative rate b. is more sensitive to fetal oxygen reserve c. Requires more repeat testing. - CORRECT ANSWER a. has a low false negative rate A negative contraction stress test is characterized by a. accelerations with onset of contractions b. maintenance of beat to beat variability c. no decelerations in response to contractions - CORRECT ANSWER c. no decelerations in response to contractions Failure to elicit a relative pattern with a non stress test after one hour of monitoring warrants a. initiation of a biophysical profile b. repeat testing after administration of orange juice c. retesting in 24 hours. - CORRECT ANSWER a. initiation of a biophysical profile A diagnosis of severe preeclampsia is consistent with a 24 hour urine showing protein excreting of? a. 1 g/L b. 3g/L c. 5g/L - CORRECT ANSWER c. 5g/L An indication of impending magnesium sulfate toxicity in the patient being treated for preeclampsia is the absence of? a. deep tendon reflexes b. fetal movement c. urine output - CORRECT ANSWER a. deep tendon reflexes The therapeutic range of serum magnesium during magnesium sulfate therapy to prevent eclampsia seizures is a. 1 to 4 mg/dL b. 5 to 8 mg/dL c. 9 to 12 mg/dL - CORRECT ANSWER b. 5 to 8 mg/dL The first priority in the care of a patient during an eclamptic seizure is to? a. administer an anticonvulsant agent b. ensure a patent airway c. establish IV access - CORRECT ANSWER b. ensure a patent airway Diagnosis of preeclampsia requires the presence of hypertension and? a. edema b. headaches c. proteinuria - CORRECT ANSWER c. proteinuria Severe preeclampsia can be diagnosis in the presence of? a. excretion of 4500 g protein in a 24 hour urine b. serial diastolic bp of at least 110 mm Hg c. serum blood urea nitrogen of 10mg/dL with a serum creatinine of 1mg/dL - CORRECT ANSWER b. serial diastolic bp of at least 110mm Hg ______________ disorders are the most common medical complication of pregnancy. - CORRECT ANSWER hypertensive A diastolic blood pressure of _________ mm Hg on two occasions at least 6 hours apart is necessary for the diagnosis of severe preeclampsia. - CORRECT ANSWER 110 mm Hg The blood pressure should be recorded with the pregnant woman in the ______________ position. - CORRECT ANSWER Semi-Fowler's ___________ is the drug of choice to prevent seizure activity in the patient with preeclampsia. - CORRECT ANSWER Magnesium Sulfate Material morbidity from hypertension in pregnancy results from? 1. 2. 3. 4 - CORRECT ANSWER Abruption placentae DIC hepatic failure acute renal failure The goals of antihypertensive therapy in the woman with preeclampsia are to _________ and to ___________. - CORRECT ANSWER prevent maternal CVA maintain uteroplacental perfusion Laboratory markers for HELLP syndrome are __________, ___________ and ___________ - CORRECT ANSWER Hemolysis, Elevated Liver Enzymes, Low Platelet count The leading cause of maternal morbidity following an eclamptic seizure is ______________. - CORRECT ANSWER aspiration Invasion of the trophoblastic cells into the uterine myometrium is termed placenta a. accreta b. increta c. percreta - CORRECT ANSWER b. increta The incidence of placenta previa is increasing likely due to a. better diagnostic tools such as transvaginal ultrasound b. increased rate of cesarean birth c. more women delaying childbirth until they are older - CORRECT ANSWER b. increased rate of cesarean birth Painless, bright red vaginal bleeding at 28 weeks gestation is most likely due to a. abruptio placentae b. placenta previa c. uterine rupture - CORRECT ANSWER b. placenta previa A clinical finding associated with a dehiscence of a uterine scar during a trial of labor after cesarean birth (TOLAC) is: a. cessation of uterine contractions b. fetal heart rate (FHR) with variable decelerations c. sudden decrease of intrauterine pressure - CORRECT ANSWER b. fetal heart rate (FHR) with variable decelerations The initial drug of choice for excessive bleeding in the immediate postpartum period is a. Methergine IM b. Oxytocin IV infusion c. Prostaglandin 15-MF suppository - CORRECT ANSWER b. Oxytocin IV infusion The most common cause of postpartum hemorrhage is? a. an atonic uterus b. a cervical laceration c. a placenta accrete - CORRECT ANSWER a. an atonic uterus In the last 10 years in the United States, the maternal mortality rate has a. decreased b. stabilized c. increased - CORRECT ANSWER c. increased Which group has the highest maternal mortality a. African American Women b. Hispanic Women c. Native American Women - CORRECT ANSWER a. African American Women Approximately two thirds of maternal trauma seen in the ED is related to a. domestic violence/intimate partner violence b. falls at home or in the workplace c. motor vehicle accidents - CORRECT ANSWER c. motor vehicle accidents The risk of uterine inversion is increased with a. a prior uterine scar b. suprapubic pressure c. traction applied to the cord - CORRECT ANSWER c. traction applied to the cord Cervical lacerations after birth should be suspected if a. estimated blood loss exceeds 500mL b. the mother reports severe cramping pain c. the uterus is well contracted but frank bleeding continues - CORRECT ANSWER c. the uterus is well contracted but frank bleeding continues. Vasa previa is the result of a ____________ insertion of the cord - CORRECT ANSWER Velamentous For the fetus to maintain adequate oxygenation, the maternal oxygen saturation must be at least _______% - CORRECT ANSWER 95% _______ is a late sign of hypovolemia in the woman experiencing bleeding during pregnancy - CORRECT ANSWER hypotension Active Management of the third state of labor involves 1. 2. 3. 4. - CORRECT ANSWER 1. Administer oxytocin with delivery of the anterior shoulder 2. Clamping/cutting the umbilical cord by 2 to 3 minutes of birth 3. Controlling traction of the umbilical cord, with the provider's hand supporting the uterus to prevent uterine inversion 4. Preforming vigorous fundal massage for at least 15 seconds. Based on 28 day cycles, when using the first day of the last menstrual period, the estimated date of confinement is calculated by adding a. 220 days b. 240 days c. 280 days - CORRECT ANSWER c. 280 days What does EDC stand for? - CORRECT ANSWER Estimated day of Confinement The most accurate method for determining gestational age is? a. crown-rump length by ultrasound at 6-12 weeks b. multiple biometric measurements by ultrasound between 12 and 20 weeks c. stated date for the first day of the last menstrual period. - CORRECT ANSWER a. crown-rump length by ultrasound at 6-12 weeks. By 28 to 34 weeks gestation in a normal pregnancy, blood volume has increased by approximately a. 10-20% b. 30-50% c. 60-80% - CORRECT ANSWER b. 30-50% During pregnancy, the position for optimum maternal cardiac output is. a. lateral b. semi-Fowler's c. supine - CORRECT ANSWER a. lateral During labor, maternal cardiac output a. decreased slightly b. increases progressively c. remains the same - CORRECT ANSWER b. increases progressively An intravenous (IV) fluid bolus is given before epidural anesthesia to prevent. a. hypotension b. renal hypoperfusion c. sympathetic blockade - CORRECT ANSWER a. hypotension Normally during pregnancy, maternal sitting and standing diastolic blood pressure readings a. decrease, then increase b. increase progressively c. remain unchanged. - CORRECT ANSWER a. decrease, then increase The volume of the maternal auto transfusion immediately after birth is approximately a. 600mL b. 800mL c. 1000mL - CORRECT ANSWER c. 1000mL What happens to maternal PaO2 and PaCo2 levels during pregnancy? a. Both decrease b. Both increase c PaO2 increased and PaCO2 decreases - CORRECT ANSWER c. PaO2 increases and PaCO2 decreases The slight increase in pH that occurs during pregnancy is due to a. a decrease in hemoglobin and hematocrit b. a decrease in renal excretion of bicarbonate c. an increase in ventilatory rate - CORRECT ANSWER c. an increase in ventilatory rate During pregnancy serum urea and creatine levels a. decrease b. increase c. remain constant - CORRECT ANSWER a. decrease Heartburn is common during pregnancy due primarily to a. decreased gastric motility b. increased secretion of hydrochloric acid c. relaxation of the lower esophageal sphincter - CORRECT ANSWER c. relaxation of the lower esophageal sphincter A physical finding that may occur during pregnancy in response to normal cardiovascular changes is a. decreased heart rate b. dependent edema c. elevated blood pressure - CORRECT ANSWER b. dependent edema The average blood loss during vaginal birth is less than a. 300mL b. 500mL c. 700mL - CORRECT ANSWER b. 500mL The average blood loss during a cesarean birth is less than a. 600mL b. 800mL c. 1000mL - CORRECT ANSWER c. 1000mL During pregnancy, cardiac output increases approximately a. 10-25% b. 30-50% c. 60-70% - CORRECT ANSWER b. 30-50% Cardiac output is greatest during which period of birth process? a. First stage, active phase b. Immediately after birth c. second stage - CORRECT ANSWER b. immediately after birth A cardiovascular parameter which normally decreases during pregnancy is a. heart rate b. stroke volume c. systemic vascular resistance - CORRECT ANSWER c. systemic vascular resistance An expected white blood cell count during labor and the early postpartum is a. 8,000-10,000 mm b. 13,000-15,000 mm c. 20,000-22,000 mm - CORRECT ANSWER c. 20,000-22,000 mm Which of the following coagulation factors does not increase during pregnancy? a. Fibrin b. Platelets c. Fibriogen - CORRECT ANSWER b. Platelets Which of the following increases during pregnancy? a. Colloid oncotic pressure b. Glomerular filtration rate C. Serum osmolality - CORRECT ANSWER b. Glomerular filtration rate Colloid oncotic (osmotic) pressure (movement of solutions pressure) Increased pressure pushes protein out of capillary carried away by lymphatics. Reduction in oncotic pressure and increase in filtration across the capillary, resulting in excess fluid build up in the tissue (EDEMA) By term, blood flow to the uterus is approximately a. 200mL/min b. 500mL/min c. 800mL/min - CORRECT ANSWER b. 500mL/min During pregnancy, the pigmented line in the skin that traverses the abdomen longitudinally from the sternum to the symphysis is called the a. linea nigra b. spider nevus c. striae gravidarum - CORRECT ANSWER a. linea nigra Which of the following is a change occurring in the respiratory system during pregnancy? a. Oxygen consumption increases b. Respiratory rate decreases c. Tidal volume decreases - CORRECT ANSWER a. Oxygen consumption increases A normal finding during pregnancy is a. glycosuria b. hematuria c. proteinuria - CORRECT ANSWER a. glycosuria The respiratory system parameter that decreases during pregnancy is the a. functional residual capacity b. minute ventilation c. vital capacity - CORRECT ANSWER a. functional residual capacity A metabolic change characteristic of late pregnancy is decreased a. blood free fatty acid levels b. insulin sensitivity c. serum glucose levels after meals - CORRECT ANSWER b. insulin sensitivity What is the most common complication of early pregnancy? - CORRECT ANSWER Spontaneous Abortion What accounts for a large percentage of all spontaneous abortions? - CORRECT ANSWER Chromosome abnormalities What type of abortion is defined as having three documented (by pathology or ultrasound with heart beat) consecutive spontaneous abortions? a. Habitual abortion b. Threatened Abortion c. Complete Abortion - CORRECT ANSWER a. Habitual abortion What type of abortion is rare but potentially has lethal complication? a. Habitual Abortion b. Incomplete abortion c. Septic abortion - CORRECT ANSWER c. Septic Abortion Define abortion? - CORRECT ANSWER Termination of pregnancy by any means, resulting in the expulsion of an immature, nonviable fetus. What is the actual terminology for any gestation 10 weeks or less? - CORRECT ANSWER Embryo Which risk factors are known to increase the risk for spontaneous abortion? a. Advanced Maternal Age b. alcohol and cigarette smoking c. previous spontaneous abortion d. uterine anomalies - CORRECT ANSWER A,B,C,D Fetal cardiac activity is normally identifiable by ultrasonography at ______ to ______ weeks gestation by crown-rump length measurement. - CORRECT ANSWER 6 to 7 What are 2 disorders of pregnancy that are classified as a threatened abortion? - CORRECT ANSWER Hydatidiform Mole Ectopic Pregnancy What should be considered in every patient who has vaginal bleeding and pain in the first trimester? a. Hydatidiform Mole b. Ectopic Pregnancy c. Placenta Previa d. Complete miscarriage - CORRECT ANSWER b. Ectopic Pregnancy What is the most common site the fertilized ovum implants during an ectopic pregnancy? a. cervix b. abdominal cavity c. fallopian tube d. ovary - CORRECT ANSWER c. fallopian tube What are 5 signs of septic shock that usually follow chills and fevers? - CORRECT ANSWER oliguria hypotension tachypnea and tachycardia mental confusion warmth & dryness of the extremities (low peripheral resistance) OR cold and cyanotic extremities (increased resistance) Define preterm labor? - CORRECT ANSWER Regular uterine contractions associated with cervical change occurring from 20 - 36 6/7 weeks of gestational age. What statements about Corticosteriods are true? a. Reduce the incidence of neonatal respiratory distress and necrotizing enterocolitis b. Inhibits smooth muscle contraction by inhibiting calcium uptake c. Repeat rescue dosing in not recommended. d. Use is limited to 48-72 hours to avoid complications. - CORRECT ANSWER a and c What statements are true for Indomethacin? a. Use is limited to 48 -72 hours to avoid complications b. Pulmonary edema can be a complication c. It should be avoided or used with caution in patients with diabetes. d. When given to a woman with a history of preterm birth, it can effetely decrease the incidence in a subsequent pregnancy - CORRECT ANSWER a. Use is limited to 48 - 72 hours to avoid complications. NSAID - Analgesic Because NSAIDs may cause premature closure of the ductus arteriosus, product labeling for indomethacin specifically states use should be avoided starting at 30-weeks gestation. Pulmonary edema can be a complication for this medication? a. Magnesium Sulfate b. Nifedipine c. Progesterone d. Prostaglandin synthase inhibitors - CORRECT ANSWER a. Magnesium Sulfate Which medication when given to a woman with a history of preterm birth, it can effectively decrease the incidence in a subsequent pregnancy? a. Corticosteroids b. Indomethacin c. Nifedipine d. Progesterone - CORRECT ANSWER d. Progesterone Which B-Sympathominetic is approved by the FDA? a. Ritodrine b. Terbutaline - CORRECT ANSWER a. Ritodrine Which is the most common B-Sympathominetic and is B2 selective? a. Ritodrine b. Terbutaline - CORRECT ANSWER b. Terbutaline Identify the Prostaglandin syntheses inhibitors? a. aspirin b. ibuprofen c. indomethacin d. ketorolac e. sulindac - CORRECT ANSWER All listed - NSAIDS What is the most common calcium channel blocker for tocolysis? a. Nifedipine b. Magnesium Sulfate - CORRECT ANSWER a. Nifedipine What is not a side effect of calcium channel blockers? a. Headache b. Dizziness c. Excessive Thirst d. Hypotension - CORRECT ANSWER c. Excessive Thirst What is the gestational age ranges for administration of a corticosteroid to accelerate fetal lung maturity? a. 24-34 b. 25-33 c. 26-34 - CORRECT ANSWER a. 24-34 True or False - Prophylactic antibiotic therapy in preterm labor is recommended? - CORRECT ANSWER False Why are prophylactic antibiotics used in labor? - CORRECT ANSWER To prevent GBS sepsis in a postive cultured mom. Rupture of amniotic membranes before 37 weeks? a. Prolonged rupture of membranes b. preterm rupture of membranes c. premature rupture of membranes - CORRECT ANSWER b. preterm rupture of membranes Rupture of amniotic membranes before the onset of labor, regardless of gestational age? a. Prolonged rupture of membranes b. preterm rupture membranes c. premature rupture of membranes - CORRECT ANSWER c. premature rupture of membranes Rupture of amniotic membranes for more that 18 hours? a. prolonged rupture of membranes b. preterm rupture membranes c. premature rupture of membranes - CORRECT ANSWER a. prolonged rupture of membranes (PAMG-1) placental alpha microglobulin-1 is a protein found at high levels within amniotic fluid. Which test is it measured? a. Nitrazine Test b. Ferning Test c. AmniSure Test - CORRECT ANSWER c. AmniSure Test Nitrazine Testing relies on the pH of amniotic fluid. What is the pH range that would indicate positive for rupture of membranes? a. 5.0 - 5.5 b. 5.5 - 6.5 c. 6.5 - 7.0 - CORRECT ANSWER c. 6.5 - 7.0 What 4 substances can give a false positive test? a. blood b. semen c. urine d. discharge e. antiseptic cleaning agents - CORRECT ANSWER a, b, c, e What is the primary factor in the decision to continue conservative management of premature rupture of membranes? a. LMP b. Gestational Age c. AFI d. Crown Rump Measurement - CORRECT ANSWER b. Gestational Age After 34 weeks gestation, conservative management of premature rupture of membranes increases the risk for what major concern? a. DIC b. Pyelonephritis c. Chorioamnionits d. IUGR - CORRECT ANSWER c. Chorioamnionitis What is the correct dose for Dexamethasone? a. 12 mg IM x 1 b. 6 mg IM x 2 (q 24 hours) c. 6 mg IM x 4 (q 12 hours) d. 12 mg IM x 4 (q 12 hours) - CORRECT ANSWER c. 6 mg IM x 4 (q 12 hours) What test needs to be confirmed before a digital examination can be done of a patient with vaginal bleeding in the third trimester? a. Ultrasound b. BPP c. Reative NST d. KB - CORRECT ANSWER a. Ultrasound to confirm no placenta previa In an Rh negative woman with vaginal bleeding, what media should be administered to protect against sensitization? - CORRECT ANSWER Rhogam - Anti-D Immunoglobulin Why would a Kleihauer-Betke test be ordered? - CORRECT ANSWER This test is used to quantify fetal to maternal hemorrhage What characteristics is not associated with placental abruption? a. Vaginal Bleeding b. Abnormal implantation c. Pain d. Fetal Malpresentation - CORRECT ANSWER b. Abnormal implantation True or False - Vaginal bleeding is always a noticeable clinical symptom of placental abruptions? - CORRECT ANSWER False - 20% of placental abruptions can be concealed An Apt test is done a woman at 32 weeks gestation with vaginal bleeding. The blood turns brown. This means the blood is: a. Fetal b. Maternal - CORRECT ANSWER b. Maternal The risk of placental abruption is higher in women with a history of: a. hypertension b. nulliparity c. previous cesarean delivery - CORRECT ANSWER a. hypertension A women has a mild placental abruption and preterm labor. The tocolytic of choice is: a. Nifedipine b. Magnesium Sulfate c. Terbutaline - CORRECT ANSWER a. Nifedipine Define the categories of placenta previa? Total (Complete) Partial (Incomplete) Marginial - CORRECT ANSWER Total - entire internal cervical os is covered by placenta Partial - part of internal cervical os is covered by placenta Marginal - placental edge extends w/in 2 cm of the internal cervical os. Describe the clinical presentation of vasa previa? - CORRECT ANSWER Catastrophic fetal bleeding occurs when the cervix starts to dilate. Vaginal bleeding noted and fetal distress witnessed. Vasa previa occurs when fetal blood vessels travel within the membranes, usually as a velametous insertion, and in so doing , cross the region of the internal cervical os. In the presence of hemorrhagic shock due to bleeding from a placental abruption, fluid replacement should be quickly administered in the form of. a. crystalloid b. normal saline c. packed red blood cells - CORRECT ANSWER a. crystalloid 3ml for every mL of blood lost while waiting for blood products. G2P1001 who is 1-2 cm with contractions q 5-10 minutes; 18 hours later exam is unchanged. a. Prolonged latent phase b. Prolonged second stage c. Protraction disorder of the active phase d. Secondary arrest of labor - CORRECT ANSWER a. Prolonged latent phase Multiparous greater than 14 hours Nullipara who is C/C/+1 at 0300; then C/C/+2 at 0530 - no epidural a. prolonged latent phase b. prolonged second stage c. protraction disorder of the active phase d. secondary arrest of labor - CORRECT ANSWER b. prolonged second stage Nullipara without epidural greater than 1 hour G3P2002 who is 6 cm at 0500 at 6 cm at 0715 a. prolonged latent phase b. prolonged second stage c. protraction disorder of the active phase d. secondary arrest of labor - CORRECT ANSWER d. secondary arrest of labor No cervical dilation after 2 hours in active labor with adequate contractions. Primigravida at 5 cm dilated at 0800; then 6 cm dilated at 1000 a. prolonged latent phase b. prolonged second stage c. protraction disorder of the active phase d. secondary arrest of labor - CORRECT ANSWER c. protraction disorder of the active phase Slow progression of labor What are the 3 P's? - CORRECT ANSWER Power - uterine contractions and maternal effort Passenger - fetal size, presentation and position Passage - Pelvis size and soft tissues List 3 benefits of amniotomy in the event of uterine disfunction? - CORRECT ANSWER 1. Reduction in labor duration 2. Reduction in abnormal 5 minute apgars 3. Decreased need of oxytocin When a fetus has a partially deflexed vertex presentation the presentation is called: a. asynclitism b. brow c. face - CORRECT ANSWER b. brow After what week is external version attempted? a. 34 wks b. 36 weeks c. 37 weeks d. 38 weeks - CORRECT ANSWER c. 37 weeks What are 2 maternal criteria that must be met before external version for breech presentation should be attempted? a. Normal AFI b. Reactive BPP c. Normal Liver enzymes d. Reactive NST - CORRECT ANSWER a. Normal AFI d. Reactive NST What are 3 contraindication to external version? a. Placenta previa, fetal anomalies, non reassuring NST b. breech presentation, fetal anomalies, reactive NST c. vaginal bleeding, GBS positive, Category 3 tracing d. Uterine contractions, rectal pressure, flu like symptoms. - CORRECT ANSWER a. Placental previa, fetal anomalies, non reassuring NST What maternal or fetal complications are associated with vacuum extraction? a. skull fracture, cervical lacerations, hemorrhage b. recurrent UTI, intracranial or retinal hemorrhage c. scalp or facial lacerations, perineal laceration, leg drop d. urinary retention, pelvic hematoma, small gestation age infant - CORRECT ANSWER a. skull fracture, cervical laceration, hemorrhage What are some common maternal complications of cesarean birth? - CORRECT ANSWER 1. hemorrhage 2. injury to bladder, bowel, ureters, blood vessels, nerves, cervix 3. infection 4. Thromboembolic event 5. Anes complications 6. Post OP illness or bowel obstruction 7. Wound complication 8. Placenta Accreta/ or previa in subsequent pregnancies 9 What are some common fetal complication of cesarean birth? - CORRECT ANSWER a. iatrogenic prematurity b. transient tachypnea of the newborn c. fetal laceration Define Gestational Hypertension - CORRECT ANSWER New onset elevated BP > or = to 140/90 on 2 separate occasions at least 4 hours apart after 20 weeks gestation in a patient with previously normal blood pressures. BP returns to normal postpartum. Define Mild and severe preeclampsia - CORRECT ANSWER New onset of elevated BP > or = 140/90 (160/110) on 2 separate occasion at least 4 hours apart after 20 weeks gestation plus end- organ manifestations> (proteinuria 0.3grams/24 hour urine or >= 0.3mg/dL protein creatine ration) Thrombocytopenia (<100,000) Renal insufficiency(Creatine > 1.1 mg/dL) Impaired liver functions (transaminases twice the upper limits of normal) Define HELLP syndrome? - CORRECT ANSWER Hemolysis, abnormal liver function tests, and thrombocytopenia Define Chronic Hypertension? - CORRECT ANSWER BP >= 140-90 on 2 occasions before 20 weeks and persists for more than 6 weeks pp. Define Superimposed preeclampsia or eclampsia? - CORRECT ANSWER Development of either preeclampsia or eclampsia in patients previously diagnosed with chronic hypertension A 32 week prenatal patient is diagnosed with severe preeclampsia and is admitted to labor and delivery with no evidence of maternal or fetal distress. Which of the following would be the appropriate course of action? a. amniocentesis, steroids and delivery within 48 hours b. Immediate delivery c. Steroids and antihypertensive drugs - CORRECT ANSWER c. steroids and antihypertensive drugs Which drug is classified as calcium-channel antagonist? a. Hydralazine b. Labetalol c. Nifedipine d. Nitroprusside - CORRECT ANSWER c. Nifedipine The initial dose is 5 mg? a. Hydralazine b. Labetalol c. Nifedipine d. Nitroprusside - CORRECT ANSWER a. Hydralazine (5-10mg) - antihypertensive Direct vasodilation of arterioles (with little effect on veins) with decreased systemic resistance Onset of action is immediate and duration is very short. a. Hydralazine b. Labetalol c. Nifedipine d. Nitroprusside - CORRECT ANSWER d. Nitroprusside - antihypertensive Hypotensive effect: <2 minutes Blood pressure via arterial line and heart rate (cardiac monitor and blood pressure monitor required) Profound drops in blood pressure can be reversed by calcium gluconate? a. Hydralazine b. Labetalol c. Nifedipine d. Nitroprusside - CORRECT ANSWER c. Nifedipine Cyanide is a product of metabolism of this drug with potential deleterious effects for the fetus. a. Hydralazine b. Labetalol c. Nifedipine d. Nitroprusside - CORRECT ANSWER d. Nitroprusside What are 4 major complications of eclampsia? - CORRECT ANSWER 1. Abruptio Placentae 2. Pulmonary Edema 3. Acute Renal Failure 4. Aspiration Pneumonia Which of the following is not a common symptom of preterm labor? a. Headache b. Menstrual-like cramps c. Pelvic pressure - CORRECT ANSWER a. Headache One of the three most common risk factors predictive of preterm birth is? a. low pre pregnancy weight b. smoking during pregnancy c. history of preterm birth - CORRECT ANSWER c. history of preterm birth When considering nursing care of the woman in preterm labor, which of the following is true? a. Maternal transport to a high-risk center has improved outcome over neonatal transport to a special care nursery. b. The effect of antenatal glucocorticoid treatment is immediate. c. Tocolysis has great effectiveness in delaying preterm birth by 7 days. - CORRECT ANSWER a. Maternal transport to a high-risk center has improved outcome over neonatal transport to a special care nursery. A drug that is used for tocolysis but is not classified as a beta-mimetic is? a. Procardia b. Ritodrine c. Terbutaline - CORRECT ANSWER a. Procardia To accurately be considered preterm, an infant must be a. born at gestational age < 37 weeks b. < 10th percentile in weight c. small for gestational age - CORRECT ANSWER a. born at gestational age < 37 weeks Teaching pregnant women about the symptoms of preterm labor? a. has been shown to prevent preterm birth b. should be ongoing throughout pregnancy c. should only be done on a one-to-one basis - CORRECT ANSWER b. should be ongoing throughout pregnancy When administering IV fluids for a woman with preterm contractions, it is important to consider that a. IV hydration has not been shown to be an effective preventative measure for preterm birth. b. preterm labor contractions usually diminish within 1 hour of initiation of IV hydration c. The first liter of IV fluid should be administered within the first hour of the admission. - CORRECT ANSWER a. IV hydration has not been shown to be an effective preventative measure for preterm birth. Antenatal glucocorticoid administration for acceleration of fetal lung maturation is appropriate a. for all women who could give birth preterm before 37 weeks gestation b. for woman at 24-34 weeks gestation at risk for preterm birth within 7 days c. once a week from the time of significant preterm symptoms until birth or 34 weeks gestation, whichever comes first. - CORRECT ANSWER b. for woman at 24-34 weeks gestation at risk for preterm birth within 7 days Research has shown that bed rest a. allows the pregnant woman to gain appropriate amounts of weight b. causes bone demineralization c. inhibits preterm labor contractions. - CORRECT ANSWER b. causes bone demineralization Smoking during pregnancy a. has been shown to decrease if cessation programs are offered b. is best eradicated using the 2As program c. is not a factor in risk of preterm birth. - CORRECT ANSWER a. has been shown to decrease if cessation programs are offered Preterm birth in the US is ____________ among African Americans the among whites. - CORRECT ANSWER higher During the past several years, rates of preterm births have __________. - CORRECT ANSWER stabilized We now know that the term Braxton-Hicks contractions should be __________ from prenatal care teaching. - CORRECT ANSWER eliminated Signs and symptoms of preterm labor include? - CORRECT ANSWER Uterine contractions every 10-15 minutes or more frequently, uterine cramping (menstrual-like cramps, intermittent or constant), low abdominal pressure (pelvic pressure), dull, low backache (intermittent or constant): increase or change in vaginal discharge; feeling that the baby is "pushing down", abdominal cramping with or without diarrhea. Invasion of the trophoblastic cells into the uterine myometrium is termed placenta a. accrete b. increta c. percreta - CORRECT ANSWER b. increta The incidence of placenta previa is increasing likely due to? a. better diagnostic tools such as transvaginal ultrasound b. increased rate of cesarean birth c. more women delaying childbirth until they are older - CORRECT ANSWER b. increased rate of cesarean birth Painless, bright red vaginal bleeding at 28 weeks gestation is most likely due to a. abruption placentae b. placenta previa c. uterine rupture - CORRECT ANSWER b. placenta previa A clinical finding associated with a dehiscence of a uterine scar during a trial of labor after cesarean birth (TOLAC) is a. cessation of uterine contractions b. fetal heart rate (FHR) with variable decelerations c. sudden decrease of intrauterine pressure - CORRECT ANSWER b. fetal heart rate (FHR) with variable decelerations The initial drug of choice for excessive bleeding in the immediate postpartum period is? a. Methergine IM b. Oxytocin IV infusion c. Prostaglandin 15-MF2@ suppository - CORRECT ANSWER b. Oxytocin IV infusion The most common cause of postpartum hemorrhage is? a. an atonic uterus b. a cervical laceration c. a placenta accreta - CORRECT ANSWER a. an atonic uterus In the last 10 years in the United States, the maternal mortality rate has a. decreased b. stabilized c. increased - CORRECT ANSWER c. increased Approximately two thirds of maternal trauma seen in the emergency department is related to a. domestic violence/intimate partner violence b. falls at home or in the workplace c. motor vehicle accidents - CORRECT ANSWER a. domestic violence/intimate partner violence The risk of uterine inversion is increased with a. a prior uterine scar b. suprapubic pressure c. traction applied to the cord - CORRECT ANSWER c. traction applied to the cord Cervical lacerations after birth should be suspected if a. estimated blood loss exceeds 500mL b. the mother reports severe cramping pain c. the uterus is well contracted but frank bleeding continues - CORRECT ANSWER c. the uterus is well contracted but frank bleeding continues Vasa previa is the result of a __________________ insertion of the cord - CORRECT ANSWER valamentous For the fetus to maintain adequate oxygenation, the maternal oxygen saturation must be at least ______ % - CORRECT ANSWER 95 ___________ is a late sign of hypovolemia i the woman experiencing bleeding during pregnancy - CORRECT ANSWER Hypotension Active Management of the third stage of labor involves: 1. 2. 3. 4. - CORRECT ANSWER 1. Administering oxytocin with delivery of the anterior shoulder 2. Clamping/cutting the umbilical cord by 2-3 minutes of birth 3. Controlling traction of the umbilical cord, with the provider's hand supporting the uterus to prevent uterine inversion 4. Performing vigorous fundal massage for at least 15 seconds. What is the purpose of the cardiovascular system? - CORRECT ANSWER To deliver nutrient-rich oxygenated blood and remove waste products in response to the metabolic needs of the body. What are the 3 components of the cardiovascular system? - CORRECT ANSWER 1. The heart 2. An electrical conduction system 3. A vascular distribution network What are the three layers of the chamber wall? - CORRECT ANSWER 1. The pericardium or sac that surrounds the heart 2. The myocardium or the muscular layer 3. The endocardium or inner lining of the chambers, which forms the valves of the heart. What side of the heart pumps the deoxygenated blood to the lungs from the venous circulation. - CORRECT ANSWER The right side (venous return->right atrium->right ventricle->pulmonary artery-> pulmonary capillaries->pulmonary vein) What side of the heart receives oxygenated blood from the lungs and pumps it back to the systemic circulation. - CORRECT ANSWER The left side (pulmonary vein->left atrium->left ventricle->aorta->systemic circulation) Is the Mitral valve located on the left or right side of the heart? - CORRECT ANSWER left Is the Tricuspid Valve located on the left or right side of the heart? - CORRECT ANSWER right How do veins attempt to redistribute volume if there is a low circulating blood volume - CORRECT ANSWER The veins constrict Where is the primary pacemaker of the heart located? - CORRECT ANSWER The SA node is located in the right atria. What stimulates nerve receptors in the heart? - CORRECT ANSWER The release of epinephrine and norepinephrine from the sympathetic nervous system. What happens to the tissue of the heart during pregnancy? - CORRECT ANSWER A remodeling process results in a enlargement or hypertrophy and expansion of the capillary bed to supply adequate oxygenation for the increased workload. Define cardiac output? - CORRECT ANSWER The amount of blood pumped throughout the heart and is measured in liters per minute. What are the 4 variables determined by Cardiac Output? - CORRECT ANSWER 1. Preload - Volume of blood in the ventricles. Influenced by available blood volume. If blood volume is diminished (hypotension) the reduction in preload reduces cardiac output. 2. Afterload - Resistance the ventricles has to overcome to eject blood during systole. Systemic Vascular Resistance or the patient's blood pressure provides afterload to the left ventricle. 3. Contractility - measured indirectly by the left ventricle stroke work index. 4. Heart rate - The speed at which the cardiac muscle pumps can influence output either positively or negatively. Rapid heart rates lead to decrease filling time of the ventricle and reduction in output. What does the influence of progesterone do to peripheral vascular resistance? - CORRECT ANSWER Decreases therefore decreasing after load In the cases of severe hypovolemia, the _______ may rise appreciable before changes in the peripheral vascular resistance are evident. - CORRECT ANSWER heart rate Typically the left or right side of the heart under higher pressure? - CORRECT ANSWER The left side because it has the task of pumping blood to the large systemic circulation against the pressure of the systemic vascular resistance. What can happen if the systemic vascular resistance drops in pregnancy? - CORRECT ANSWER The blood could shunt from the right side to the left. In this case deoxygenated blood is contributing to cardiac output, ultimately resulting in decreased oxygen content in arterial blood. What does the hyper coagulable state of pregnancy increase the risk of? - CORRECT ANSWER Clot formation for women with artificial hart valves and some forms of arrhythmias. How much blood returns to the maternal vascular compartment in the first 15 minutes after evacuation of the uterus at birth? - CORRECT ANSWER 600-800 mL What is a BNP level? - CORRECT ANSWER B-type natriuretic peptide. Levels increase in conjunction with worsening heart failure in non-pregnant cardiac patients that are similar to pregnancy. Congenital cardiac disease occurs in what approximate percentage of live births? a. 0.8% b. 1.5% c. 2.0% - CORRECT ANSWER a.0.8% Maternal outcomes in pregnancies of women with Marfan syndrome are related to a. cardiac dysrhythmias b. degree of aortic root dilation c. hypervolemia of pregnancy - CORRECT ANSWER b. degree of aortic root dilation Symptoms indicative of heart disease in pregnancy include? a. jugular venous distention, tachycardia, pedal edema, Grade II/VI systolic murmur b. palpitations, exertion dyspnea, irregular syncope, third heart sound c. severe dyspnea, diastolic murmurs, syncope with exertion chest pain with exertion. - CORRECT ANSWER c. severe dyspnea, diastolic murmurs, syncope with exertion , chest pain with exertion In a review of hospitalization in the United States from , steady increases were seen in what conditions? a. Congenital heart disease, valvular disease from pneumatic fever, cardiomyopathy, and cardiac arrhythmias b. Acute myocardial infarction and permpartum cardiomyopathy c. Mitral valve prolapse, mitral stenosis, and acute myocardial infarction. - CORRECT ANSWER a. Congenital heart disease, Valvular disease from rheumatic fever, cardiomyopathy, and cardiac arrhythmias The peak incidence of peripartum cardiomyopathy is during a. the third trimester of pregnancy b. labor and birth c. the second month postpartum - CORRECT ANSWER c. the second month postpartum A pregnant woman with New York Heart Association (NYHA) class II cardiac disease is symptomatic with a. bed rest b. mild exertion c. heavy exertion - CORRECT ANSWER c. heavy exertion The drug of choice to treat epidural analgesia-related hypotension for a pregnant woman with a cardiac disorder would be? a. dopamine b. ephedrine c. phenylephrine - CORRECT ANSWER b. ephedrine (book says phenylephrine) The time during labor and birth when cardiac output increases the most is during? a. second stage with fetal descent b. birth c. the immediate postpartum period - CORRECT ANSWER b. birth The physiologic changes of pregnancy that tend to be problematic for women with cardiac disease include? a. decreased functional residual lung capacity, relaxation of the cardiac sphincter, and hypotension b. increase in blood volume, decrease in systemic vascular resistance, the hypercoagulable state of pregnancy, and fluctuations in cardiac output. - CORRECT ANSWER b. increase in blood volume, decrease in systemic vascular resistance, the hyper coagulable state of pregnancy An initial sign of inadequate cerebral perfusion is a. low pulse oximeter reading b. restlessness c. unequal pupil dilation - CORRECT ANSWER b. restlessness ____________ regulate the distribution of extracellular fluid - CORRECT ANSWER capillaries Mitral and aortic stenosis are examples of cardiac disease caused by ___________________. - CORRECT ANSWER Rheumatic fever A diagnosis test often used for diagnosis of myocardial infarction is _____________. - CORRECT ANSWER Cardiac Troponin 1 Current risk counseling for pregnant women with cardiac disease is based on the ___________ and the ______________. - CORRECT ANSWER type of cardiac disorder, secondary complications The NYHA classification system for cardiac disease categorizes patient by _________________. - CORRECT ANSWER functional ability Regional analgesia/anesthesia lengthens the active phase of labor by approximately 60-90 minutes. True or False - CORRECT ANSWER True The admission Bishop score is less than 6, elective induction for nulliparous women significantly increase the risk of cesarean birth? True or False - CORRECT ANSWER True What is the leading cause of for primary cesarean births in the United States? - CORRECT ANSWER Labor Dystocia A latent phase as long as _______ hours during labor induction for nulliparous women is not unusual, and most of these women will give birth vaginally if time is allowed to achieve active labor. - CORRECT ANSWER 18 hours Labor progression for nulliparous and multiparous women appears to be at similar phase before ______ cm: however after _____ cm, labor accelerates much _______ in multiparous compared to nulliparous women - CORRECT ANSWER 6, 6, faster ACOG recommends consideration of operative vaginal birth for nulliparous women when there is lack of continuing progress for ____ hours with regional anesthesia or for ___ hours without regional anesthesia. For multiparous women, operative vaginal birth should be considered after lack of continuous progress for ____ hours with regional anesthesia or for _____ hour without regional anesthesia. - CORRECT ANSWER 3 hours, 2 hours, 2 hours ,1 hour When does the second stage of labor begin? a. 0-3 cm b. 4-7 cm c. 8-10 cm d. 10cm - birth - CORRECT ANSWER d. 10cm - birth Match the First stage of Labor phases with dilatation : a. 0-3 cm ______ Latent b. 4-7 cm ______ Transition c. 8-10 cm ______ Active - CORRECT ANSWER a c b The second stage of labor is divided into 2 parts? - CORRECT ANSWER initial latent phase (passive fetal descent) active pushing phase What begins and ends the 3rd stage of labor? - CORRECT ANSWER Begins with the birth of the baby and ends with the delivery of the placenta . What begins the 4th stage of labor? - CORRECT ANSWER The delivery of the placenta until mother is stable usually 1- 2 hours after. Any pregnant woman presenting to a hospital for care should, at a minimum, be assessed for the following 3 things? - CORRECT ANSWER FHR Contractions Maternal Vital Signs When should the primary provider promptly be notified? a. Vaginal bleeding, acute abdominal pain, temp 100.4 or higher, preterm labor, pprom, hypertension, and Category II or III b. Vaginal discharge, back pain, urinary frequency c. Pedal Edema, headache, decreased fetal movments - CORRECT ANSWER a. vaginal bleeding, acute abdominal pain, temp 100.4 or higher, preterm labor, pprom, hypertension and Category 11 or 111. According to the ACOG, in the absence of risk factors, FHR should be assessed during second stage labor every a. 5 minutes b. 15 minutes c. 30 minutes - CORRECT ANSWER b. 15 minutes An appropriate lubricant to use for vaginal examinations during labor is a. povidone-iodine gel b. sterile water c. water-soluble jelly - CORRECT ANSWER c. water- soluble jelly According to the American Society of Anesthesiologists (ASA) Guidelines for Obstetrical Anesthesia, and elective cesarean could be done when the women has been NPO for at least? a. 4 hours b. 5 hours c. 6 hours - CORRECT ANSWER c. 6 hours An involuntary urge to push is most likely a sign of a. low fetal station b. occiput posterior fetal positon c. transition - CORRECT ANSWER a. low fetal station An appropriate solution to use for amnioinfusion is a. 5% dextrose in LR (D5L/R) b. 5% dextrose in water (D5W) c. lactated Ringer's solution - CORRECT ANSWER c. lactated Ringer's solution An increased risk for shoulder dystocia is associated with a. maternal diabetes b. post-date pregnancy c. TOLAC - CORRECT ANSWER a. maternal diabetes The primary factor that would allow second stage labor to continue beyond 2 hours is that a. epidural anesthesia is in place with level <T10 b. the FHR, as the presenting part descends, does not suggest fetal compromise c. maternal pushing efforts result in progress - CORRECT ANSWER b the FHR, as the presenting part descends, does not suggest fetal compromise Using the Zavanelli maneuver to resolve should dystocia involves? a. assisting the woman to a knee-chest position b. elevating the fetal head back through the vagina c. sweeping an arm to deliver the posterior shoulder - CORRECT ANSWER b. elevated the fetal head back through the vagina Included in ACOG (2009) definition of tachysystole is? a. contraction duration of > 60 seconds b. contraction frequency of every 2-3 minutes c. more than 5 contractions in 10 minutes - CORRECT ANSWER c. more than 5 contractions in 10 minutes A high probability of successful induction of labor is associated with a Bishop score of a. > 4 b. > 6 c. > 8 - CORRECT ANSWER c. 8 Appropriate treatment of tachysystole after dinoprostone administration is? a. IV bolus of D5W b. terbutaline 0.25 mg SQ c. vaginal irrigation with normal saline - CORRECT ANSWER b. terbutaline 0.25mg SQ In the absence of complications, immediate postpartum maternal vital signs should be assessed every a. 5 minutes for 30 minutes b. 15 minutes for 2 hours c. 30 minutes for 2 hours - CORRECT ANSWER b. 15 minutes for 2 hours ACOG recommends a dosing interval for Misoprostol of every a. 1 to 2 hours b. 3 to 6 hours c. 7 to 12 hours - CORRECT ANSWER b. 3 to 6 hours The most common reason for hospital readmission following operative birth is a. endometritis b. hemorrhage c. wound infection - CORRECT ANSWER c. wound infection Vacuum extractor cup placement on the fetal head should not exceed a. 5 minutes b. 10-15 minutes c. 20-30 minutes - CORRECT ANSWER c. 20-30 minutes Anesthesia personnel are required to remain with a post anesthesia care unit (PACU) patient until the a. monitoring equipment has been applied b. PACU nurse accepts responsibility for the patient. c. patient is alert and oriented - CORRECT ANSWER b. PACU nurse accepts responsibility for the patient The normal length of the pregravid cervix is a. 2.5 to 3.0 cm b. 3.5 to 4.0 cm c. 4.5 to 5.0 cm - CORRECT ANSWER b. 3.5 to 4.0 cm True labor is characterized by a. effacement and/or dilation of the cervix b. painful uterine contractions c. suprapubic discomfort at regular intervals - CORRECT ANSWER a. effacement and/or dilation of the cervix One liter of D5L/R provides a. 150 calories b. 180 calories c. 250 calories - CORRECT ANSWER b. 180 calories Facilitating a family-centered birth experience involves a. allowing immediate family members to participate b. providing a waiting area for siblings c. supporting family as defined by the childbearing woman - CORRECT ANSWER c. supporting family as defined by the childbearing woman Diastolic blood pressure measurements taken from an automatic blood pressure device are typically __________ than diastolic measurements utilizing a stethoscope and a mercury cuff. - CORRECT ANSWER lower The enzyme oxytocinase facilitates plasm clearance of oxytocin via the maternal _____________ and _____________. - CORRECT ANSWER kidneys and liver During the second stage of labor, an alternative to squatting that provides the same benefits is __________________________. - CORRECT ANSWER sitting on the toilet Bearing down efforts accompanied by prolonged breath-holding typifies __________________ pushing, which has associated negative maternal and fetal _________________ effects. - CORRECT ANSWER closed glottis, hemodynamics AWHONN's second-stage labor nursing management protocol for a woman with epidural anesthesia encourages rest until the occurrence of ___________________. - CORRECT ANSWER urge to push The McRoberts maneuver is used to facilitate birth when there is an occurrence of __________________. - CORRECT ANSWER Shoulder dystocia Adverse outcomes associated with episiotomy include? 1. 2. 3. - CORRECT ANSWER 1. 3rd and 4th degree lacerations (pain) 2. infection 3. hemorrhage (blood loss) Measure to aide perineal stretching and aide in the goal to avoid episiotomy include? 1. 2. 3. - CORRECT ANSWER 1. open glottis pushing - gentle pushing 2. spontaneous rather than directed pushing 3. upright position in second stage Women who have a support person with them in labor have been found to have? 1. 2. 3. - CORRECT ANSWER 1. Fewer perinatal complications 2. Shorter labors 3. Fewer NICU admissions Before the use of a cervical ripening or labor induction agent, the following should be assessed? 1. 2. 3. - CORRECT ANSWER 1. Maternal status 2. Fetal well-being 3. cervical status Normal latent phase labor of nulliparous women can last up to ________hours - CORRECT ANSWER 18 An interval of ________hours is recommended between the final dose of dinoprostone gel and oxytocin administration. - CORRECT ANSWER 6 to 12 Nursing documentation following amniotomy should include? 1. 2. 3. - CORRECT ANSWER 1. Color and amount of amniotic fluid 2. FHR before procedure 3. Fetal response to procedure A ____________ degree laceration extends into the rectal lumen - CORRECT ANSWER 4th The maternal landmarks that must be identified to determine fetal station are the ______________ - CORRECT ANSWER ischial spines With a physician or certified nurse midwife order, nurses with appropriate training may administer the cervical ripening agents_________________ and ________________. - CORRECT ANSWER Cytotec (Misoprostol) and cervidil _______________ is a contraindication for the use of Misoprostol and Cervidil - CORRECT ANSWER Previous uterine surgery (TOLAC) prior cesarean birth or uterine scar A nursing measure to use before forceps application to help prevent maternal trauma is _________________. - CORRECT ANSWER emptying the maternal bladder The recommendation for use of the vacuum extractor device states that the pressure should not exceed _________mmHg - CORRECT ANSWER 500-600 Requirements for post anesthesia recovery care include availability of. 1. 2. 3. 4. 5. 6. 7. - CORRECT ANSWER 1. oxygen delivery system 2. cardiac monitoring (ECG monitoring equipment) 3. continuous and intermittent suction 4. adjustable lighting 5. blood pressure monitoring equipment 6. means to ensure patient privacy 7. pulse ox According to ACOG, selection criteria for women who are candidates for vaginal birth after cesarean (VBAC) includes 1. 2. 3. 4. 5. - CORRECT ANSWER 1. one or 2 prior low transverse c/s 2. no prior uterine surgery or rupture 3. clinically adequate pelvis 4. physician immediately available and capable of preforming emergent cesarean birth 5. surgical team and anesthesia personal available for emergent cesarean birth _______________ is a sign of impending uterine rupture in women experiencing a trial of labor after prior cesarean delivery. - CORRECT ANSWER pain at the prior incision site Four maternal factors proposed as being responsible for initiation of labor are 1. 2. 3. 4. - CORRECT ANSWER 1. Stretching of the uterine muscles 2. Pressure on the cervix 3. Endogenous oxytocin 4. Change in estrogen:progesterone ratio If any of the following findings are present in a pregnant women, the perinatal provider should be notified promptly? 1. 2. 3. 4. 5. 6. - CORRECT ANSWER 1. Hypertension 2. Vaginal bleeding 3. Acute Abdominal Pain 4. Premature Rupture of membranes 5. Temp > 100.4 6. Preterm Labor The Bishop score evaluates these five parameters: 1. 2. 3. 4. 5. - CORRECT ANSWER 1. Cervical dilatation 2. Cervical consistency 3. Cervical position 4. Fetal station 5. Cervical Effacement Unnecessary interventions during labor increase the risk of _________. - CORRECT ANSWER Iatrogenic injuries to the mother and/or fetus Informed consent for VBAC correctly includes discussion about 1. 2. 3. - CORRECT ANSWER 1. Risks 2. Benefits 3. Alternative approaches Labor is a clinical diagnosis which includes? 1. 2. 3. - CORRECT ANSWER 1. Regular uterine contractions 2. Resulting in progressive cervical effacement and dilation 3. Accompanied by fetal descent into the maternal pelvis When is Fetal Fibronectin "the protein that acts like a glue" present in vaginal discharge? a. before 22 weeks of pregnancy b. after 22 weeks of pregnancy c. after 32 weeks of pregnancy - CORRECT ANSWER a. before 22 weeks of pregnancy The presence of fetal fibronectin would be abnormal if it was found in vaginal fluid? a. 32 weeks b. 10 weeks c. 36 weeks - CORRECT ANSWER a. and c the presence of this protein means that the cervical matrix is disturbed. (many causes for this) A patient at 33 weeks is being evaluated for preterm labor. Which test is likely to predict delivery will not occur in the next 7-10 days. a. Cervical length b. Fetal fibronectin assay c. Routine ultrasound - CORRECT ANSWER b. Fetal fibronectin assay What are the 4 powers that affect the progress of labor? a. b c d - CORRECT ANSWER a. The Powers (contractions) b. The Passageway (pelvis, uterine/cervical changes) c. The Passenger (fetus and placenta) d. The Psyche (culture, experience, preparedness) What are the two types of oxytocin receptors? a. b. - CORRECT ANSWER a. Myometrial b. Decimal When do the oxytocin receptors steadily increase? a. 32 weeks b. 38 weeks c. 40 weeks - CORRECT ANSWER a. 32 weeks When do women perceive contractions? - CORRECT ANSWER 30mmHg True or False - Preterm labor contractions may not reach significant pressure, but can lead to dilatation. - CORRECT ANSWER True Define Station? - CORRECT ANSWER The relationship of the presenting part to the ischial spines What does AGOG define as Fetal Macrosomia? a. infant 4,000 g b. infant 3500 g c. infant 4500 g - CORRECT ANSWER c. infant 4500 g What shape is the Anterior fontanel? - CORRECT ANSWER Diamond shaped What shape is the Posterior fontanel? - CORRECT ANSWER Triangular shaped True of False - Sutures are intersections of bones? - CORRECT ANSWER True True or False - Fontanels are intersections of bones? - CORRECT ANSWER False They are intersections of sutures The nurse performs a vaginal exam on a labor patient for the purpose of determining station. When the head is at the ischial spines, the station is a. -1 b. 0 c. +1 - CORRECT ANSWER b. 0 Define Fetal Lie - Lie refers to the _______________________ axis of the fetus relative to the ________________________ axis of the uterus. - CORRECT ANSWER Longitudinal, Longitudinal (Longitudinal, transverse, or oblique) Fetal Presentation is the fetal part that directly overlies the pelvic inlet. True or False - CORRECT ANSWER True List the 2 types of longitudinal lie? - CORRECT ANSWER Cephalic (Vertex) Breech What is a type of transverse lie? - CORRECT ANSWER Shoulder What does compound presentation mean? - CORRECT ANSWER The presence of more than one fetal part overlying the pelvic inlet (hand, head) What is the most common breech presentation? a. Frank (pike position) b. Footling or incomplete c. Comple