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NM 706 Adv Midwifery Care-Perinatal & Neonatal > Module 5 and 6 Practice Questions > Flashcards

Module 5 and 6 Practice Questions Flashcards

1
Q

A 22-year-old at 28 weeks gestation had a 1-hour 50 g glucose screen of 148 mg/dL followed by a 3-hour 100 g glucose tolerance test (GTT) with the following values:
fasting 106 mg/dL
1 hour 185 mg/dL
2 hour 172 mg/dL
3 hour 136 mg/dL
This result indicates …

A

indicates gestational diabetes (GDM) by national diabetes data groups’ (NDDG) criteria

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2
Q

A 29-year-old Hispanic G1P0 with a body mass index (BMI) of 30.5 returns for her 2nd visit at 12 weeks gestation. She had a normal 1-hour 50 g glucose screen at her first visit. How should we follow up?

A

advise a repeat 1-hour 50 g glucose screen at 24 -28 weeks gestation.

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3
Q

A 27-year-old South Asian (India) G2P1001 arrives for her first visit at 11 weeks gestation. Her body mass index (BMI) is 25 and she has gained 4 lbs so far. Her OB history discloses a vaginal delivery of a 7 lb 8 oz baby boy 2 years ago. Her family history reveals a paternal aunt with diabetes. According to American College of Obstetricians and Gynecologists (ACOG) early screening criteria a 1-hour 50 g glucose screen is indicated because of her..

A

Ethnicity
BMI

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4
Q

A gestational diabetic mother gives birth to a 9 lb infant. The initial breastfeeding is delayed. The infant’s first blood sugar taken within 2 hours after delivery is 30 mg/dL. The infant is then successfully breastfed and the blood sugar repeated 30 minutes later with a result of 38 mg/dL. An appropriate assessment (A) and management plan (P) includes

A

A: hypoglycemia; P: confirm with venous sample, refer to pediatrician

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5
Q

A 36-year-old Asian G3P2002 at 32 weeks gestation with diet controlled gestational diabetes has a fundal height measurement of 35 centimeters. Fetal parts are difficult to palpate with Leopold’s. At what measurement of amniotic fluid index (AFI)/ largest vertical pocket would hydramnios be diagnosed?

A

≥ 24 cm/8 cm

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6
Q

A 29-year-old G2P1001 who has been diagnosed with GDM is at 26 weeks gestation. When discussing treatment and monitoring of her diabetes, the nurse-midwife counsels her that …. can help control her blood sugars.

A

that daily exercise of 30 minutes/day can help to control her blood sugars.

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7
Q

A 36-year-old G3P2002 is diagnosed with gestational diabetes at 26 weeks gestation. Her fasting blood sugars are less than 95 mg/dL and 2 hours postprandial are less than 120 mg/dL on diet and exercise. Each prenatal visit should include

A

Fundal Height
BP
Review blood sugars and diet sheet

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8
Q

A 24-year-old Caucasian G1P0 at 24 weeks gestation does not want to do gestational diabetes mellitus (GDM) screening. Her history includes a paternal aunt with diabetes mellitus and a BMI of 23. Shared decision making information should include

A

“Although professional organizations recommend the universal use of laboratory GDM testing, an alternative selective screening strategy is also evidence-based”.

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9
Q

The results of an ultrasound of a G2P1001 non-diabetic mother at 37-weeks gestation reveals

-estimated fetal weight (EFW): 97th percentile, 4,500 g
-amniotic fluid index/deepest vertical pocket: 15 cm/6 cm
-vertex presentation

What is an appropriate assessment (A) and management plan (P)?

A

A: fetal macrosomia; P: evaluate gestational diabetic testing, expectant management.

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10
Q

What risk factors are associated with polyhydramnios? (choose all that apply)
-omphalocele
-preeeclampsia
-Diabetes
-viral infections (parvo virus, CMV)
-tracheoesophageal fistula
-renal agenesis
-Hypothyroidism
-Rh isoimmunization

A

-omphalocele
-Diabetes
-viral infections (parvo virus, CMV)
-tracheoesophageal fistula
-Rh isoimmunization

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11
Q

A patient on Methadone treatment for a prior history of substance abuse has just given birth. Her last Methadone dose was 8 hours prior to birth. The nurse-midwife’s immediate delivery room preparations are based on the knowledge that:

A

Methadone dependent neonates are at risk for respiratory depression.

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12
Q

Match the drug to its neonatal effects: Nicotine
-Cleft lip
-craniofacial abnormalities
-autonomic instability
-neuroteratogen
-NAS
-Microcephaly

A

-neuroteratogen

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13
Q

Match the drug to its neonatal effects: Alcohol
-Cleft lip
-craniofacial abnormalities
-autonomic instability
-neuroteratogen
-NAS
-Microcephaly

A

-craniofacial abnormalities

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14
Q

Match the drug to its neonatal effects: Cocaine
-Cleft lip
-craniofacial abnormalities
-autonomic instability
-neuroteratogen
-NAS
-Microcephaly

A

-autonomic instability

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15
Q

Match the drug to its neonatal effects: Opiods
-Cleft lip
-craniofacial abnormalities
-autonomic instability
-neuroteratogen
-NAS
-Microcephaly

A

-NAS

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16
Q

Pregnant women abusing substances may be more willing to disclose their substance use if

A

they are routinely screened using a screening tool like Audit-C.

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17
Q

A G2P1 at 15 weeks gestation is complaining of new onset insomnia, palpitations, excessive sweating, and weight loss. Physical exam reveals an enlarged, soft thyroid without nodules. Based on these findings, what should the nurse-midwife order?

A

thyroid stimulating hormone (TSH), free T4 and total T3

18
Q

Oligohydramnios is associated with
-gestational diabetes.
-fetal growth restriction.
-cord compression.
-postmaturity syndrome.
-Rh isoimmunization.
-maternal bacterial infection.
-uteroplacental insufficiency.
-substance abuse
-dehydration.

A

-fetal growth restriction.
-cord compression.
-uteroplacental insufficiency.
-substance abuse
-dehydration.

19
Q

An ultrasound done on a 36 week G2P1001 for size less than dates reveals an estimated fetal weight (EFW) in the 25th percentile, amniotic fluid index of 5 cm with the largest vertical pocket of 2 cm. Based on these findings, what should the nurse-midwife include in the management plan?

A

Home with activity modified, increase oral fluids, order bi-weekly fetal surveillance testing, collaborate with obstetrician

20
Q

During her 6 week postpartum visit a G2P2002 is concerned with fatigue, insomnia, palpitations and anxiety. Review of her history reveals diet controlled gestational diabetes (GDM) and hypothyroidism treated with levothyroxine. The nurse-midwife is concerned she may have

A

postpartum thyroiditis (hypertensive phase).

21
Q

A G1P0 at 34 weeks gestation fundal height measures 31 centimeters. At her last visit, 2 weeks ago, she measured 30 centimeters. Based on these findings, how should the nurse-midwife proceed?

A

Order an U/S

22
Q

The midwife is evaluating ultrasound reports on a 35 week G3P2002 whose fundal height has consistently measured 3 centimeters less than dates since 27 weeks gestation. The 27 week, 30 week, and 33 week ultrasound estimated fetal weights (EFW) are consistently in the 9th percentile showing continued growth despite a 3 week delay in gestational age, amniotic fluid index (AFI) 10-16 centimeters, and normal doppler flow studies. Review of the woman’s history reveals:

maternal birth weight 6 lbs 4 oz at term
BMI 21
pregnancy weight gain 20 pounds
2014 delivered 6 lb baby girl
2011 delivered 6 lb 8 oz baby boy

The nurse-midwife’s assessment is:

A

Small for gestational age (SGA), probably constitutionally small fetus.

23
Q

Maternal thyroxine (T4) is important for fetal brain development at what stage of pregnancy?

A

throughout the entire pregnancy.

24
Q

During the physical exam of a 32-year-old G4P2013 at 10 weeks gestation, a slight enlargement of a smooth thyroid is noted. Upon questioning she admits to feeling fatigued and constipated but denies cold or heat intolerance, muscle cramps, unusual weight gain, hair loss, or palpitations. Based on these findings what would the nurse-midwives include in the assessment (A) and management plan (P)?

A

A: normal thyroid variation; thyroid disorder risk factors ; P: order thyroid stimulating hormone (TSH).

25
Q

Changes in thyroid hormone levels during pregnancy include

A

decreasing thyroid stimulating hormone (TSH) levels during the first trimester when human chorionic gonadotrophin (HCG) levels are high.

26
Q

How does fasting blood glucose change in a healthy pregnant patient compared to a healthy non-pregnant person?

A

It is LOWER (15-20 mg/dL lower)

27
Q

T/F: The purpse of early DM screening is to identify undiagnosed pre-gestational DM.

A

True (For example DM II)

28
Q

What practice cut-off values do you use for 50g, 1-hour GTT test?

A

Either 130, 135, or 140.

Lower cut off will have higher false positive and higher cut off will have higher false negative.

29
Q

What education should be provided to a patient when ordering a 3h GTT?

A

It will be fasting test. Do not eat after midnight and eat high protein diet the day before. You will have your blood drawn when you arrive, drink the glucola and then your blood drawn every hour for the following three hours. It can make you nauseous and eating high protein foods the day before can help. If your blood sugar comes back elevated, you will be diagnosed with diabetes.

30
Q

When does the 3h GTT not need to be done to diagnose GDM?

A

When the screening results in a blood sugar >200

31
Q

How many elevated values of the 3h GTT is required to diagnose a patien with GDM when using either the C/C or NDDG?

A

Two or more elevated values is diagnostic fo GDM

32
Q

What is an appropriate timeframe for diet and lifestyle management before initiation of pharm intervention with elevated blood sugars?

A

3-5 weeks after diagnosis

33
Q

What is considered first-line pharm treatment for GDM?

A

Insulin
Note: if a patient has concerns about insulin or cannot give it to themselves safety then metformin is a good 2nd choice

34
Q

Does insulin cross the placenta?

A

No

35
Q

Do metformin and glyburide cross the placenta?

A

Yes

36
Q

What is a normal AFI?

A

6-24

37
Q

What is a normal SDP level?

A

2-8

38
Q

Based on ACOG’s recommendations, when should the timing of delivery occur for pregnant clients with GDM that is managed with diet and exercise?

A

Up to 40 6/7

39
Q

T/F: According to ACOG, a client WITH GDM should be offered a C/S if the EFW is 4,500g+

A

True

40
Q

What is the EFW where patient WITHOUT GDM should be offered a C/S?

A

5,000g+

41
Q

What should be done PP to ensure GDM has resolved PP?

A

A 2h GTT and repeat testing every 1-3 years

NM 706 Adv Midwifery Care-Perinatal & Neonatal (11 decks)

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