CH 42

Question 1

Which of the following is a common sign of gestational diabetes?
Polydipsia
Confusion
Diaphoresis
Tachycardia

Answer 1

Polydipsia

Question 2

Which part of the uterus is composed of three layers of muscle fibers that contract and help expel the fetus during childbirth?

Myometrium
Endometrium
Cervix
Perimetrium

Answer 2

Myometrium

Question 3

During pregnancy, which of the following respiratory conditions can occur due to the effects of stress or respiratory irritants on an already-sensitized respiratory system?
Asthma
Pneumonia
COPD
Bronchitis

Answer 3

Asthma

Question 4

A 19-year-old diabetic woman who is 22 weeks pregnant presents with an occipital headache, blurred vision, and edema to her hands and feet. Her blood pressure is 152/94 mm Hg, pulse rate is 108 beats/min, and respirations are 20 breaths/min. The patient is conscious and alert, and states that she is “retaining a lot of water.” Your most immediate concern should be:

the risk of fetal compromise.
her current blood sugar level.
the possibility of a seizure.
lowering her blood pressure.

Answer 4

the possibility of a seizure.

Question 5

When delivering multiple babies, you should clamp and cut the umbilical cord:

after the placenta has delivered.
following delivery of each baby.
after all the babies have delivered.
only after the first baby delivers.

Answer 5

following delivery of each baby.

Question 6

The most immediate treatment to prevent placental hypoperfusion in a pregnant woman who is lying on her back is to:

keep the woman supine and elevate her legs 12 inches.
place the woman in a left lateral recumbent position.
administer 1 to 2 L of isotonic crystalloid solution.
manually displace the gravid uterus to the right side.

Answer 6

place the woman in a left lateral recumbent position.

Question 7

There is a higher incidence of abdominal injuries in association with chest trauma in pregnant women because:

the diaphragm is elevated nearly 2 inches.
the abdomen is large and protuberant.
the peritoneum is maximally stretched.
seat belts are usually not worn.

Answer 7

the diaphragm is elevated nearly 2 inches.

Question 8

Hydramnios is a condition in which:
there is too much amniotic fluid.
there is too little amniotic fluid.
the amniotic sac has not ruptured.
the amniotic fluid is infected.

Answer 8

there is too much amniotic fluid.

Question 9

Uterine inversion occurs when:
postpartum bleeding is improperly managed with inadequate massage of the uterine fundus.
the placenta fails to detach properly and adheres to the uterine wall when it is expelled.
the musculature of the uterine fundus is inherently weak, causing the uterus to prolapse.
excessive postpartum hemorrhage causes uterine ischemia and subsequent expulsion from the vagina.

Answer 9

the placenta fails to detach properly and adheres to the uterine wall when it is expelled.

Question 10

Seizures during pregnancy should be treated with:

phenobarbital.
magnesium sulfate.
valproic acid.
diazepam.

Answer 10

magnesium sulfate.

Question 11

When caring for a woman with an incomplete abortion, you should be most concerned with:

bleeding and shock.
maternal emotional trauma.
severe maternal infection.
the risk of airway compromise.

Answer 11

bleeding and shock.

Question 12

Which of the following statements regarding abdominal trauma during pregnancy is correct?

Uterine trauma is common during the first trimester.
Deceleration injuries often result in placenta previa.
The pubic bone protects the bladder in late pregnancy.
Use of a lap belt increases the risk of uterine injury.

Answer 12

Use of a lap belt increases the risk of uterine injury.

Question 13

Crowning is defined as:

passage of the baby through the fully dilated cervix.
the presenting of the baby at the vaginal opening.
the thinning and shortening of the cervix during labor.
bulging of the baby’s head from the vaginal opening.

Answer 13

the presenting of the baby at the vaginal opening.

Question 14

Which of the following assessment parameters is most difficult to interpret when a pregnant woman is injured?

Pulse rate
Blood glucose
Pupils
Mental status

Answer 14

Pulse rate

Question 15

You are assisting in the delivery of a baby. As the infant’s head begins to emerge from the vagina, you should support the head as it turns and then:

assess for a nuchal cord.
thoroughly suction its airway.
gently guide the head upward.
carefully dry its face.

Answer 15

assess for a nuchal cord.

Question 16

Which of the following changes occurs in the respiratory system of a pregnant woman?

Oxygen consumption decreases by approximately 20%, causing a 40% decrease in tidal volume.
Minute ventilation increases by as much as 50%, which causes the partial pressure of carbon dioxide to drop by about 5 mm Hg.
An increase in blood bicarbonate levels causes a slight decrease in the pH level of the blood.
Progesterone increases the threshold of the medullary respiratory center to carbon dioxide.

Answer 16

Minute ventilation increases by as much as 50%, which causes the partial pressure of carbon dioxide to drop by about 5 mm Hg.

Question 17

During the second stage of labor:
amniotic fluid typically gushes out of the vagina.
contractions become more intense and more frequent.
the baby’s head begins to bulge through the cervix.
delivery in a multiparous woman occurs in a few hours.

Answer 17

contractions become more intense and more frequent.

Question 18

Which of the following would you most likely observe in a newborn with hemolytic disease?
Splenomegaly
Hot flushed skin
Jaundice
Polycythemia

Answer 18

Jaundice

Question 19

A spontaneous abortion:

affects one out of every three pregnancies and is typically idiopathic.
is most often the result of a congenital abnormality of the placenta.
occurs naturally and may or may not have an identifiable cause.
is generally performed by a physician to prevent maternal death.

Answer 19

occurs naturally and may or may not have an identifiable cause.

Question 20

A 30-year-old woman who is 35 weeks pregnant is pulseless and apneic. As CPR is initiated, you or another team member should:

tilt her entire body slightly to the left.
ventilate her at a slightly faster rate.
manually displace her uterus to the left.
start and IV line and give epinephrine.

Answer 20

manually displace her uterus to the left.

Question 21

In contrast to an abruptio placenta, a placenta previa:

usually presents with painless vaginal bleeding.
typically presents with tearing abdominal pain.
is associated with an absence of fetal heart tones.
is usually caused by maternal abdominal trauma.

Answer 21

usually presents with painless vaginal bleeding.

Question 22

Which of the following events occur during the third stage of labor?

Delivery of the baby
Expulsion of the mucous plug
Delivery of the placenta
Crowning

Answer 22

Delivery of the placenta

Question 23

A pregnant woman with a past history of a cesarean section is at greatest risk for:

prolapsed cord.
preeclampsia.
uterine rupture.
breech birth.

Answer 23

uterine rupture.

Question 24

Which of the following processes takes place in the uterus?

Fertilization
Release of luteinizing hormone
Lactation
Fetal development

Answer 24

Fetal development

Question 25

The leading cause of life-threatening infections in newborns is: bacterial vaginosis. human immunodeficiency virus. candidiasis. group B Streptococcus.

Answer 25

group B Streptococcus.

Question 26

A woman who does not take prenatal vitamins during the course of her pregnancy is at greatest risk for: post-term labor. leukopenia. anemia. abnormal bleeding.

Answer 26

anemia

Question 27

If a woman is gravida 3 and para 2: she has delivered two babies. she has delivered three babies. she has been pregnant five times. she has been pregnant two times.

Answer 27

she has delivered two babies.

Question 28

When assessing the abdomen of a woman who is 36 weeks pregnant, you should expect it to be: enlarged and tender. firm and nontender. distended and guarded. rigid and distended.

Answer 28

firm and nontender.

Question 29

A woman has been pregnant three times, has had two spontaneous abortions, and has carried one baby to term. You should document her obstetric history as: G1A2P3. G5A2P1. G3A2P1. G1A2P5.

Answer 29

G3A2P1

Question 30

Women who experience hyperemesis gravidarum: develop the condition secondary to increased progesterone and decreased human chorionic gonadotropin levels. have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition. have been pregnant at least two times and are commonly underweight. vomit once or twice a day, usually during the morning hours, and often develop hyperglycemia as a result.

Answer 30

have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition.

Question 31

What is the corpus luteum? The by-product of the release of progesterone The thickened inner lining of the uterine wall A hormone that is excreted throughout the ovarian cycle Remnants of the follicle after the egg has been released

Answer 31

Remnants of the follicle after the egg has been released

Question 32

By the end of the third week after conception: the embryonic process of forming specialized body systems has started. the embryo is officially referred to as the fetus. the volume of the amniotic fluid is approximately 500 mL. the placenta is sufficiently developed to assume responsibility for the production of hCG.

Answer 32

the embryonic process of forming specialized body systems has started.

Question 33

The risk of aspiration in the pregnant woman is increased significantly because: the gastric lining is extremely irritable during pregnancy. pregnancy hormones often cause nausea and vomiting. decreased digestion causes a delay in gastric emptying. increased tidal volume causes air to enter the stomach.

Answer 33

decreased digestion causes a delay in gastric emptying.

Question 34

Which of the following is the initial drug of choice for a pregnant patient who is experiencing seizures? Oxytocin Ativan Valium Magnesium sulfate

Answer 34

Magnesium sulfate

Question 35

Following delivery of a stillborn baby at 16 weeks, the mother presents with fever, abdominal tenderness, and a foul-smelling vaginal discharge. This clinical presentation is consistent with: a septic abortion. bacterial vaginosis. toxoplasmosis. trichomoniasis.

Answer 35

a septic abortion.

Question 36

You are dispatched to the parking lot of a shopping mall for a pregnant woman with severe vomiting. When you arrive and assess the patient, she tells you that she is 26 weeks pregnant and that this is her first child. She further tells you that her normal morning sickness nausea became worse 3 days ago and that she has vomited numerous times since then; she has also noticed small amounts of blood in her vomitus. Her blood pressure is 94/60 mm Hg, pulse rate is 124 beats/min and weak, and respirations are 24 breaths/min and regular. After loading the woman in the ambulance and placing her on her left side, you should: be suspicious that she has acute gastritis, apply oxygen via nasal cannula at 4 L/min, start an IV line and give a 20-mL/kg normal saline bolus, administer an antiemetic if she continues to vomit, obtain a 12-lead ECG tracing, and transport her promptly. suspect upper gastrointestinal bleeding, administer oxygen via nonrebreathing mask, start two large-bore IV lines and give 2 L of normal saline, apply the cardiac monitor, insert a nasogastric tube to evacuate blood from her stomach, and transport at once. conclude that increased hormone levels are causing a transient worsening of her morning sickness, start an IV of normal saline and set it to keep the vein open, administer 12.5 mg of promethazine to control the vomiting, and transport. suspect hyperemesis gravidarum, administer high-flow oxygen, start a large-bore IV and give a 250-mL normal saline bolus, assess her blood sugar and cardiac rhythm, consider administering diphenhydramine if protocols allow, and transport promptly.

Answer 36

suspect hyperemesis gravidarum, administer high-flow oxygen, start a large-bore IV and give a 250-mL normal saline bolus, assess her blood sugar and cardiac rhythm, consider administering diphenhydramine if protocols allow, and transport promptly.

Question 37

Abruptio placenta is most accurately defined as: premature separation of a normally implanted placenta from the uterine wall. a condition in which the placenta progressively detaches from the uterine wall. separation of the placenta secondary to blunt maternal abdominal trauma. a placenta that implants low in the uterus and partially or fully covers the cervix.

Answer 37

premature separation of a normally implanted placenta from the uterine wall.

Question 38

In pregnancy, magnesium sulfate is used primarily for: eclamptic seizures. tocolytic therapy. hyperemesis gravidarum. ventricular dysrhythmias.

Answer 38

eclamptic seizures.

Question 39

During true labor: the interval between contractions gradually shortens. contractions are irregularly spaced from one to the next. the intensity of uterine contractions remains constant. analgesics often abolish the pain from contractions.

Answer 39

the interval between contractions gradually shortens.

Question 40

You are assessing a 36-year-old woman who is 33 weeks pregnant. The patient complains of bright red vaginal bleeding, but denies abdominal pain or cramping. She tells you that she last felt her baby move about 5 or 10 minutes ago. Fetal heart tones are audible at a rate of 130 beats/min. Gentle palpation of her abdomen reveals that it is soft and nontender. Which of your assessment findings is most suggestive of placenta previa? Bright red vaginal bleeding Audible fetal heart tones The age of the patient Absence of abdominal pain

Answer 40

Absence of abdominal pain

Question 41

Premonitory signs of labor include: contractions at 5- to 15-minute intervals. an increase in pressure in the pelvic area. crowning. effacement of the cervix.

Answer 41

an increase in pressure in the pelvic area.

Question 42

Cholestasis occurs when: hormone levels drop after pregnancy, resulting in gallbladder disease. hormones slow or block the normal flow of bile from the liver. pressure on the gallbladder prevents normal contraction and relaxation. progesterone and estrogen block the production of bile in the liver.

Answer 42

hormones slow or block the normal flow of bile from the liver.

Question 43

Common signs and symptoms of preeclampsia include: weight loss, blurred vision, and diarrhea. edema, hypertension, and headache. ketones in the urine and rapid weight gain. facial swelling, dysuria, and chest pain.

Answer 43

edema, hypertension, and headache.

Question 44

If the uterine fundus is palpable at the level of the umbilicus, then the gestational age is: 12 weeks. 24 weeks. 20 weeks. 16 weeks.

Answer 44

20 weeks.

Question 45

Signs of a threatened abortion include: strong uterine contractions. menstrual-like cramps. massive vaginal bleeding. severe abdominal pain.

Answer 45

menstrual-like cramps.

Question 46

Which of the following statements regarding uterine fundus measurement is correct? Measurement of the fundus in centimeters corresponds to the number of gestational weeks. If the fundus is longer than expected, it could indicate uterine growth problems. If the fundus measures 36 cm, the woman is between 32 and 34 weeks pregnant. A uterine fundus measurement that is shorter than expected is suggestive of a breech position.

Answer 46

Measurement of the fundus in centimeters corresponds to the number of gestational weeks.

Question 47

Cervical effacement occurs when: the cervix becomes fully dilated and the baby exits the uterus and enters the birth canal. the opening of the cervix stretches enough to accommodate passage of the entire baby's body. the less muscular lower part of the uterus is pulled upward over the presenting part of the baby. the uterine wall thickens during the wavelike contractions that cause progressive cervical dilation.

Answer 47

the less muscular lower part of the uterus is pulled upward over the presenting part of the baby.

Question 48

At term, displacement of the diaphragm by the uterus causes a(n): decrease in inspiratory reserve volume. marked increase in residual volume. decrease in expiratory reserve volume. increase in functional reserve capacity.

Answer 48

decrease in expiratory reserve volume.

Question 49

Which of the following is a function of the placenta? Synthesis of glucose Transfer of heat from the fetus to the woman Fetal protection against all harmful substances Antibody production that protects the fetus

Answer 49

Antibody production that protects the fetus

Question 50

Appropriate care for postpartum bleeding in the prehospital setting includes: infusing oxytocin at a rate of 0.5 to 0.8 units/min. performing an internal examination of the vagina. administering IV fluids to maintain perfusion. carefully placing sanitary pads in the vagina.

Answer 50

administering IV fluids to maintain perfusion.

Question 51

If a woman who is 35 weeks pregnant is placed in a supine position: If a woman who is 35 weeks pregnant is placed in a supine position: atrial preload may be reduced markedly. aortic compression will cause hypotension. uterine circulation will increase exponentially. a paradoxical bradycardia will occur.

Answer 51

atrial preload may be reduced markedly.

Question 52

A 30-year-old woman presents with vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has high blood pressure and admits to using cocaine throughout her pregnancy. What should you suspect? Placenta previa Ruptured uterus Abruptio placenta Threatened abortion

Answer 52

Abruptio Placenta

Question 53

A 29-year-old woman complains of abdominal cramping and vaginal bleeding. The patient is 22 weeks pregnant and tells you that she passed several large clots of blood while using the toilet. Your partner confirms that she can clearly recognize a small fetus in the toilet. The patient is conscious and alert, but her skin is diaphoretic. Her blood pressure is 92/56 mm Hg, pulse rate is 114 beats/min and regular, and respirations are 24 breaths/min. The most appropriate treatment for this patient involves: oxygen by face mask at 8 L/min, placing her in a left lateral recumbent position, a sanitary pad over her vagina, emotional support, and transport to the hospital. supplemental oxygen, careful packing of the vagina to control the bleeding, an IV line set to keep the vein open, emotional support as needed, and transport. oxygen via nasal cannula at 2 L/min, two large-bore IV lines, a 20-mL/kg normal saline bolus, emotional support, and rapid transport to the hospital. high-flow oxygen, a sanitary pad over her vagina, a large-bore IV, crystalloid boluses as needed to maintain adequate perfusion, emotional support, and prompt transport.

Answer 53

high-flow oxygen, a sanitary pad over her vagina, a large-bore IV, crystalloid boluses as needed to maintain adequate perfusion, emotional support, and prompt transport.

Question 54

Which of the following statements regarding Rh disease during pregnancy is correct? Rh disease is a problem during the first pregnancy and occurs when the mother's blood is Rh positive. Isoimmunization occurs when an Rh-positive woman becomes pregnant by an Rh-negative man. If the fetus inherits Rh-positive blood, it will create antibodies that can result in maternal hemolysis. During subsequent pregnancies, the Rh antibody will cross the placental barrier and attack the fetal red blood cells.

Answer 54

During subsequent pregnancies, the Rh antibody will cross the placental barrier and attack the fetal red blood cells.

Question 55

If a woman's prepregnancy resting heart rate is 70 beats/min, you would expect her heart rate to range between which values at term? 90 to 100 beats/min 75 to 85 beats/min 100 to 110 beats/min 85 to 90 beats/min

Answer 55

85-90 beats/min

Question 56

You are delivering a baby who was in a breech presentation. The baby's body has delivered, and you are attempting to deliver its head by lifting its body upward. After about 3 minutes, the baby's head has not delivered. You should: elevate the mother's hips with pillows, administer high-flow oxygen, and transport immediately. support the baby's body, carefully turn the mother on her left side, and transport expeditiously. place your gloved hand in the vagina and gently lift the baby's face away from the vaginal wall. elevate the mother's hips and apply gentle traction to the baby's body until the head has delivered.

Answer 56

place your gloved hand in the vagina and gently lift the baby's face away from the vaginal wall.

Question 57

A 20-year-old female presents with severe lower abdominal pain. She does not believe that she is pregnant, but states that her breasts have been unusually tender and that she has been nauseated. What is the pathophysiology of this patient's suspected condition? The placenta has prematurely detached from the uterine wall. A fertilized ovum is implanted somewhere other than the uterus. The normal flow of bile from the liver has been interrupted. High levels of estrogen are affecting the gastrointestinal system.

Answer 57

A fertilized ovum is implanted somewhere other than the uterus.

Question 58

A 25-year-old woman was involved in a motor vehicle accident in which she struck the rear end of another car at a low speed. When you arrive at the scene and exit the ambulance, you immediately hear the patient screaming, “My baby, my baby!” After calming the patient down, she tells you that she is 10 weeks pregnant and that she is afraid that the car accident injured her child. She confirms that she was properly restrained at the time of impact. She is conscious and alert, denies abdominal pain, and has stable vital signs. She refuses spinal motion restriction precautions but does consent to EMS transport. You should: reassure her that her baby was not injured, offer her oxygen via nasal cannula, defer IV therapy, and transport her to the closest hospital with continuous emotional support en route. be concerned that the traumatic injury may have caused an abruptio placenta, administer high-flow oxygen, establish a large-bore IV, and transport her to a trauma center. provide emotional support, administer diazepam to prevent her from becoming frantic, administer oxygen via nasal cannula at 6 L/min, and transport her to a minor emergency clinic. administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.

Answer 58

administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.

Question 59

A woman is in the second stage of labor when: the cervix is fully effaced and partially dilated. contractions occur in 5- to 10-minute intervals. she feels a strong urge to move her bowels. a gush of amniotic fluid pours from the vagina.

Answer 59

she feels a strong urge to move her bowels.

Question 60

If a pregnant woman is injured and is bleeding severely: her body will automatically shunt blood to the fetus. signs of shock will appear earlier than expected. her blood pressure will fall after a 70% loss of blood. blood flow will be diverted away from the uterus.

Answer 60

blood flow will be diverted away from the uterus.

Question 61

After delivering a baby and clamping and cutting the umbilical cord, you note that the end of the umbilical cord attached to the baby is bleeding. You should: cut the cord proximal to the first clamp and apply another clamp. tie or clamp the cord proximal to the first clamp and reexamine it. cannulate the baby's umbilical vein and infuse normal saline. pinch the distal end of the cord with your finger and assess the baby.

Answer 61

tie or clamp the cord proximal to the first clamp and reexamine it.