2. General healthcare skills (16-30) Flashcards
16 . Ekaterina is a 37 year old multiparous client with borderline high blood pressure and borderline low hemoglobin and hematocrit levels. Her baby has just been born and you’re waiting on the placenta, mentally preparing for a postpartum hemorrhage. Which of these is correct?
a) Misoprostol is not an ideal medication choice for Ekaterina because of her high blood pressure. It may also close the os to an extent. 10 units of Pitocin IM in the thigh should be your first option of medication if indicated, or 0.2 mg methergine PO, IM or IV if this is not an option. Pitocin’s onset of action is 3-7 minutes, and methergine’s onset of action is 2-10 minutes, depending on route.
b) Methergine is not an ideal medication choice for Ekaterina because of her hypertension. It may also close the os to an extent. 10 units of Pitocin IM in the thigh should be your first option of medication if indicated, or 800 mcg misoprostol sublingually if this is not an option. Pitocin’s onset of action is 3-7 minutes, and misoprostol’s onset of action is 3-5 minutes.
c) Methergine is not an ideal medication choice for Ekaterina because of her low H/H. It may also close the os to an extent. 10 units of Pitocin IM in the thigh should be your first option of medication if indicated, or 800 mcg misoprostol sublingually if this is not an option. Pitocin’s onset of action is 15-30 minutes, and misoprostol’s onset of action is 30 minutes when given sublingually.
d) Methergine is not an ideal medication choice for Ekaterina because of her high blood pressure. It may also close the os to an extent. 10 units of Pitocin IM in the thigh should be your first option of medication if indicated, or 800 mcg misoprostol sublingually if this is not an option. Pitocin’s onset of action is 15-30 minutes, and misoprostol’s onset of action is 30 minutes when given sublingually.
B
17 . Emre and Frank have stated that they would prefer not to have their newborn be given Vitamin K intramuscularly unless there is a risk factor for Vitamin K Deficiency Bleeding. What are risk factors for which they might want to consider IM administration?
a) The newborn’s Vitamin K level is extremely high, the birthing person had gestational diabetes or preexisting diabetes, or they were anemic.
b) The newborn’s Vitamin K level was outside the normal range, the birthing person was hypertensive or, conversely, hypotensive, or they had a known febrile episode in the first trimester.
c) The newborn is known to have low levels of Vitamin K, labor was traumatic, labor was prolonged or, conversely, labor was rapid.
d) The newborn’s Vitamin K levels are outside the normal range, the birthing person had polyhydramnios or, conversely, oligohydramnios, or is a grand multipara.
C
18 . Gayle’s blood contains A antigens but no B or Rh-D antigens, but it does contain antibodies against Rh antigens. What does this mean?
a) Gayle has type A- blood and is Rh isoimmunized, which could cause significant negative impacts on the fetus if it is Rh-positive.
b) Gayle has type B+ blood and so the Rh factor of the baby is irrelevant.
c) Gayle has type A+ blood and so the Rh factor of the baby is irrelevant.
d) Gayle has type B- blood and is Rh isoimmunized, which could cause significant negative impacts on the fetus if it is Rh-positive.
A
19 . Today is Elle’s first appointment with you, and you’re reviewing the medications and supplements she takes. You discover she’s taking 400 mcg of folate, which is the ACOG recommended dose, she’s not taking DHA, and she has a total daily intake of Vitamin A over all supplements of 35,000 IU, which is three times the ACOG-recommended dose. What counseling do you give Elle?
a) Her folate intake is good, and it’s great that she’s taking folate rather than folic acid. You recommend that Elle add a DHA supplement and suggest a couple of good brands, as DHA has many benefits, including in the development of the baby’s eyes, brain and nervous system, it may help reduce the risk of preterm labor, and it supports the birthing parent’s mood in the postpartum period. Vitamin A is a teratogen in high doses, and Elle should reduce her intake immediately.
b) Her folate intake is good. You recommend that Elle add a DHA supplement and suggest a couple of good brands. Vitamin A is essential during pregnancy, as it helps reduce the risk of childhood infections in the fetus. Elle should continue taking Vitamin A as she is, and may want to add Vitamin D.
c) Her folate intake is good. You recommend that Elle add a DHA supplement and suggest a couple of good brands, as DHA has many benefits, including supporting placental perfusion, bone growth and fetal circulation. Vitamin A is a teratogen in high doses, and Elle should reduce her intake immediately.
d) Her folate intake is good, but if would be better if she was taking the natural form, folic acid. You recommend that Elle add a DHA supplement and suggest a couple of good brands, as DHA has many benefits, including in the development of the baby’s eyes, brain and nervous system, it may help reduce the risk of preterm labor, and it supports the birthing parent’s mood in the postpartum period. Vitamin A is a teratogen in high doses, and Elle should reduce her intake immediately.
A
20 . Normally produced by the corpus luteum for the first few weeks of pregnancy before the placenta takes over, which hormone might you want to test in a client with a history of early miscarriages?
a) Progestin
b) Estradiol
c) Estrogen
d) Progesterone
D
21 . The Rapid Plasma Reagin and Venereal Disease Research Laboratory are both used to test for what?
a) HSV, which can lead to premature delivery, spontaneous abortion, microcephaly, intracranial calcifications, encephalitis, CNS impairment, meningitis and neonatal death.
b) Chlamydia, which can cause spontaneous abortion, UTI leading to premature labor, life-threatening pneumonia, and ophthalmia neonatorum.
c) Syphilis, which can cause miscarriage, prematurity, neonatal infection, fetal malformation or death.
d) Gonorrhea, which can lead to spontaneous abortion, chorioamnionitis, PROM, very low birth weight and ophthalmia neonatorum.
C
22 . Fiona is 41.0 weeks, and thinks she’s felt reduced fetal movement today. You refer her for a biophysical profile, and explain to her what will be assessed. What do you tell her?
a) 1. Fetal heart rate and reactivity, where they will look for episodes of acceleration. 2. Fetal breathing movements. 3. Amniotic fluid volume. 4. Fetal movements. 5. Fetal muscle tone. Each is given a score of 0-2 points, and a total of 8 or more is reassuring.
b) 1. Fetal heart rate and reactivity, where they will look for periodic accelerations. 2. Fetal breathing movements. 3. Amniotic fluid volume. 4. Fetal movements. 5. Fetal muscle tone. Each is given a score of 0-2 points, and a total of 8 or more is reassuring.
c) 1. Fetal heart rate and reactivity, where they will be looking for accelerations associated with fetal movement. 2. Fetal breathing movements. 3. Cervical length. 4. Fetal movements. 5. Fetal muscle tone. Each is given a score of 0-2 points, and a total of 8 or more is reassuring.
d) 1. Fetal heart rate and reactivity, where they will look at variability in the heart rate. 2. Fetal breathing movements. 3. Amniotic fluid volume. 4. Cord loops around the fetal neck (nuchal cord). 5. Fetal muscle tone. Each is given a score of 0-2 points, and a total of 8 or more is reassuring.
A
23 . Elizabeth is Rh negative and her husband is known to be Rh positive. You’ve just explained the action of RhoGAM to her, but have not yet described risks and benefits of it when she tells you that her religion does not allow her to have RhoGAM because it is a blood product. How might you accurately counsel her?
a) RhoGAM is a plasma derivative, and so she is correct that it is a blood product. If she changes her mind at any stage, you are happy to revisit the topic with her without any judgement. If she does not have RhoGAM administered, your recommendation is that she be tested for isoimmunization prior to any pregnancies so that she can make an informed choice over the risks involved.
b) RhoGAM is indeed a blood product. While you respect her decision, you do still want to tell her the risks and benefits so she fully understands the risks involved. When administered correctly, It reduces the risk of isoimmunization to 1-2%. It does carry the theoretical risk of transmission of a virus.
c) Since Elizabeth is Rh negative, she is not at risk of isoimmunization, and hence RhoGAM is not an appropriate medication to be offering her.
d) RhoGAM is a plasma derivative, not a blood product, and so she does not need to decline it on religious grounds. You explain this to her and then tell her of the risks and benefits of RhoGAM and of refusing it.
A
24 . What is one reason the platelet count might be significant?
a) A high count is one part of HELLP, a life-threatening complication.
b) A high count due to reduced aggregation raises the risk of PPH.
c) Thrombocytopenia raises the risk of hemorrhage.
d) There is a physiologic slight reduction in platelet count during pregnancy.
C
25 . Your new client, Gboyega, is vegan and is of Nigerian descent. She wears clothing that covers most of her skin year-round. Given this information, which Vitamin might you want to check with a view to potentially recommending supplementation?
a) Vitamin C
b) Vitamin A
c) Vitamin E
d) Vitamin D
D
26 . Which of the following correctly describes macrocytic (megaloblastic) anemia, microcytic anemia and normocytic anemia?
a) In all, the total hemoglobin is low. In macrocytic anemia, MCV is high. In microcytic anemia, it is low, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by an iron deficiency. Microcytic anemia is normally caused by acute blood loss. Normocytic anemia normally reflects low folate or B12.
b) In all, the total hemoglobin is high. In macrocytic anemia, MCV is low. In microcytic anemia, it is high, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by an iron deficiency. Microcytic anemia is normally caused by acute blood loss. Normocytic anemia normally reflects low folate or B12.
c) In all, the total hemoglobin is high. In macrocytic anemia, MCV is low. In microcytic anemia, it is high, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by low folate or B12. Microcytic anemia is normally caused by an iron deficiency. Normocytic anemia normally reflects acute blood loss.
d) In all, the total hemoglobin is low. In macrocytic anemia, MCV is high. In microcytic anemia, it is low, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by low folate or B12. Microcytic anemia is normally caused by an iron deficiency. Normocytic anemia normally reflects acute blood loss.
D
27 . Which are normal readings for hematocrit and hemoglobin during pregnancy?
a) Early pregnancy: hematocrit over 10.5 g/dL, hemoglobin over 31%. Later in pregnancy: hematocrit >13 g/dL, hemoglobin >39%.
b) Early pregnancy: hematocrit over 31%, hemoglobin over 10.5 g/dL. Later in pregnancy: hematocrit >39%, hemoglobin >13 g/dL.
c) Early pregnancy: hematocrit >13 g/dL, hemoglobin >39%. Later in pregnancy: hematocrit over 10.5 g/dL, hemoglobin over 31%.
d) Early pregnancy: hematocrit >39%, hemoglobin >13 g/dL. Later in pregnancy: hematocrit over 31%, hemoglobin over 10.5 g/dL.
D
28 . Which of the following cannot be tested for using a vaginal culture?
a) Candidiasis
b) Trichomonas
c) Chlamydia
d) Gonorrhea
C
29 . Which of the following lists appropriate use of instruments and equipment?
a) Bag and mask resuscitator: neonatal heart rate is below 100bpm. Hemostats: To clamp an avulsed cord. Lancet: to assess neonatal glucose levels when hypoglycemia is suspected. Straight, in and out catheter: with sterile technique when client cannot empty their bladder. Sphygmomanometer: correctly sized to measure blood pressure.
b) Amnihook: fetus is not engaged and amniotic fluid levels are high. Bulb syringe: Extra stimulation or suspected meconium aspiration, ensuring vagal response is not elicited. Delee tube: Not recommended for routine use. Use if there is excess fluid in the lungs. Lancets: For assessing hemoglobin level. Thermometer: Rectal is not recommended in a neonate because it may trigger a vagal response.
c) Thermometer: Axillary temperatures are approximately 1F cooler than oral temperatures, and temporal temperatures are approximately 1F higher than oral temperatures. Urinalysis strips: Ensure these are stored within the correct range of temperatures and not left in a very hot or cold car. Doppler and fetoscope: Used to detect fetal heartbeat, with Doppler picking it up approximately 8 weeks earlier but a fetoscope giving a more accurate sound of the heart beating. Pulse oximeter: Used to detect CCHD in neonates. Normally done within an hour of birth. To pass, neonate must have over 95% on left hand and foot, with less than 3% difference between the two.
d) Bulb syringe: Ensure you do not elicit a vagal response. Used as standard on the perineum. Hemostats: For clamping the cord prior to cutting. Nitrazine paper: To test for suspected ROM. Turns from yellow to deep blue in the presence of amniotic fluid. Scissors: Blunt-blunt are used for the emergency cutting of a nuchal cord. Suturing equipment: Sterile technique. Dissolvable sutures must be used.
A
30 . What are some of the indications for ultrasound in the three trimesters?
a) First trimester: Suspected ectopic pregnancy, to rule out multiples, to confirm viability of the embryo, to confirm EDD when LMP history is known. Second trimester: Monitor location of the placenta, monitor amniotic fluid levels, identify the lie of the fetus, investigate possible fetal demise. Third trimester: Look for a cord loop around the neck, investigate pelvic dimensions to assess for CPD, estimate fetal weight, assess amniotic fluid volume.
b) First trimester: Suspected placenta previa, pregnancy suspected outside the uterine cavity, possible fetal demise, to investigate suspected IUGR. Second trimester: To confirm a suspected multiple gestation, full anatomy scan, suspected incarceration of the uterus, to confirm position and lie of fetus. Third trimester: Suspected placental abruption, suspected uterine rupture, to confirm EDD, to investigate suspected fetal demise.
c) First trimester: To identify sex of the embryo, to confirm EDD, suspected ectopic pregnancy, suspected incarceration of the uterus. Second trimester: to monitor the location of the placenta, to investigate a possible missed abortion, to confirm multiple gestation, full anatomy scan. Third trimester: Assess the health of the placenta, investigate suspected IUGR, assess cervical length with risk for premature labor, 3D ‘fun’ ultrasound.
d) First trimester: Suspected ectopic pregnancy, suspected hydatidiform mole, to confirm dates, to confirm a multiple gestation. Second trimester: Investigate possible fetal demise, assess cervical length with risk for premature labor, to identify source of bleeding. Third trimester: Suspected placenta previa, to assess amniotic fluid levels, to assess the health of the placenta, to confirm fetal lie.
D
