CNM Varney's Review Book Part D

Question 1

What describes the cervix of the average primigravida on the verge of true labor?

Answer 1

50-100% effacement with fingertip to 1cm dilation

Question 2

how do uterine contractions differentiate the uterus into two segments?

Answer 2

upper zone of uterus shortens and thickens, while lower zone legnthens and thins

Question 3

What is the definition of fetal engagement?

Answer 3

when the widest diameter of fetal presenting part has passed through pelvic inlet

Question 4

Which landmark of the fetal head would you use to determine station in a well-flexed, cephalic presentation?

Answer 4

occipital bone

Question 5

What are some characteristics of true labor contractions?

Answer 5

regular; increase in freuquency, duration, intenstiy; radiate from fundus to back

Question 6

Which of the following findings would be LEAST likely to give a false positive result when confirming ROM?
+nitrazine test
+ferning
being unable to visualize or feel membranes bulging over presenting part
visualizing amniotic fluid escaping from cervical os

Answer 6

visualizing aminiotic fluid escaping from cervical os

Question 7

G1P0 at 39 wks. Calls at 10 pm; has been having ctxn since 11 am, is exhuasted and unable to sleep. No signs of ROM, neg bleeding. Ctxn q 10-30 min, lasting 20-30 sec. Have not changed in character, but most comfortable ambulating, least comfortable sitting/laying. Normal fetal movement. You suspect she is experiencing what?

Answer 7

false labor

Question 8

What is your management of this person in false labor?

Answer 8

Take a warm bath and have a hot drink with sugar and call you back if unable to sleep.

Question 9

At 2 am, woman comes in who had false labor since 11am previous morning. 2/90/-1 contractions moderate intensity q 7-10 min, lasing 20-40 sec. FHR 130, neg decels. She has had no sleep, is tired and frustrated. What is she experiencing, and what should you do?

Answer 9

Latent phase of labor

send her home with sedatives and encourage her to rest

Question 10

during what stage of labor does majority of progressive descent of fetal presenting part occur?

Answer 10

During deceleration phase and second stage

Question 11

what are some traditional s/s of transitional phase/impending second stage?

Answer 11

uncontrollable desire to bear down
expulsive grunt upon exhalation
ROM

Question 12

What is the most common position, lie, presentation and variety of the fetus at onset of labor?

Answer 12

LOT

Question 13

Waht is the term used to describe changes in fetal heart rate associated with uterine contractions?

Answer 13

periodic changes

Question 14

what is considered teh cut-off lower limit for marked tachycardia?

Answer 14

180 bpm

Question 15

What method of FH evaluation provides the most reliable, comprehensive data?

Answer 15

internal continuous monitoring with FSE

Question 16

What is considered the critical level of fetal scalp pH at which immediate deliver becomes necessary?

Answer 16

a second reading of a pH <7.20

Question 17

normal arterial and venous cord blood pH levels

Answer 17

arterial: 7.11-7.36
venous: 7.25-7.45
fetal scalp capillary: 7.25-7.35

Question 18

What represents a normal rise of BP during contractions for a woman in labor?

Answer 18

systolic rise of 10-20 mm Hg

diastolic rise of 5-10 mm Hg

Question 19

Which position will be helpful in facilitating the long arc rotation of a fetus in ROP?

Answer 19

Right-lateral position

Question 20

second stage is also known as what stage?

Answer 20

expulsion stage

Question 21

according to friedman, what is the avg length of second stage for primigravidas?

Answer 21

60 minutes

Question 22

G3P2 in active labor turns to you and cires, “the baby is coming!” You checked her 15 min ago and she was 8cm, 0 station. Waht do you do?

Answer 22

Ask her to start panting respirations and while you keep an eye on her perineum, put on your gloves.

Question 23

what mechanism of labor occurs thorughout labor?

Answer 23

descent

Question 24

birth of the head occurs throgh which mechanism for an OA delivery?

Answer 24

extension

Question 25

External rotation accomplishes what in a birth with cephalic presentation?

Answer 25

brings the bisacromial diameter of the fetus into alignment with the AP diameter of the pelvic outlet

Question 26

what is the bisacromial diameter?

Answer 26

the distance between the outermost parts of the fetal shoulders

Question 27

internal rotation accomplishes what in a birth with cephalic presentation?

Answer 27

brings A-P diameter of fetal head into alignment with A-P diameter of maternal pelvis

Question 28

If engagement took place in ROP, how many degrees does the fetal head rotate during internal rotation for OA delivery?

Answer 28

135 degrees ??? shouldn't it be 180?

Question 29

If engagement was in ROT, how many degrees for birth in OA?

Answer 29

90

Question 30

birth in OA from RO, head will restitute to what position?

Answer 30

ROA

Question 31

head restitutes to ROA, where will it be after external rotation?

Answer 31

ROT

Question 32

If on abdominal exam you feel the fetal back on the maternal left side and on vag exam you feel sagittal suture in right oblique diameter, what is osition of fetus?

Answer 32

LOA

Question 33

What physiologic change is abnormal in second stage?

Answer 33

persistent, constant vomiting

Question 34

what are some NORMAL physiologic maternal changes in second stage?

Answer 34

increase in BP of 20 mm Hg during ctxn tachycardia at time of delivery maternal temp elevation of 2 degrees F

Question 35

Generally accepted frequency of BP checks in second stage is how often?

Answer 35

q 15 min

Question 36

When is the lithotomy position contraindicated?

Answer 36

``` severe varicosities (of course, in general it's not what we want to do, but there are exceptions..shoulder dystocia, etc) ```

Question 37

what is the usual concentration of lidocaine used for a pudendal block?

Answer 37

1%

Question 38

what is the best gauge to use for local infiltration of the perineal body?

Answer 38

22 gauge

Question 39

VBAC most likely contraindicated for which one of the following: previous c/s for CPD 2 PLTCS for failure to progress previous c/s with vertical incision of lower uterine segment previous emergency c/s at 26 wks before onset of labor

Answer 39

book says D, but I say C I guess because it's in the lower uterine segment, it remains a slim option. I don't understand why an emergent section before labor in a second trimester would mean risking out of VBAC, unless it implies a high vertical incision.

Question 40

How does management of a woman laboring for VBAC (good candidate) differ from women without previous c/s?

Answer 40

Manage the same as any woman in labor

Question 41

In someone with a classical uterine incision, what is the best option for the next delivery?

Answer 41

scheduled RLTCS without labor

Question 42

``` For which of the following women would a dx of preterm labor be accurate? 18 wks, contractions, ROM 24 wks, ctxn q 6 min 20 wks, ctxn q 8 min, ROM 34 wks, ctxn q 10, 1 cm dilation ```

Answer 42

20 wks, ctxn q 8, ROM

Question 43

Antenatal corticosteroid therapy has been shown to be most effective at improving neonatal oucome when administered at what GA to women at risk for preterm birth?

Answer 43

24-34 wks

Question 44

What are some sequelae of PTB?

Answer 44

RDS intraventricular hemorrhage LBW

Question 45

reserach has demonstrated that what is associated with prevention of PTL among women with multiple gestation or a hx of PTL/PTB?

Answer 45

daily contact with a nurse

Question 46

Waht percentage of women with PROM will go into spontaneous labor within 24 hours?

Answer 46

80-85%

Question 47

What s/s are associated with intrauterine infection?

Answer 47

fetal tachycardia BPP 6 or less white blood cell count with a shift to the left

Question 48

In a client with PROM at 32 weeks with no curren tsigns of infection, what is the most appropriate mgmt plan?

Answer 48

watchful waiting and allowing pregnancy to continue for as long as possible because the risks of prematurity outweight reisks of sepsis (or thats what the 2002 book said)

Question 49

s/s: 38 wk GA, temp 102, leaking some liqid that "smells really bad". uterus tender, HR 100 bpm, FHR 180. What is your dx?

Answer 49

chorioamnionitis

Question 50

What is the most appropriate first step to take if you suspect chorio in antepartum?

Answer 50

admit to hospital for induced vaginal birth or c/s within 24 hours

Question 51

Calculate Montevideo units for a woman who iin the last twenty minutes has had four contractions, each 5 minutes apart, lasting 45 seconds, and with a baseline of 10 mm Hg, amplitude of 55 mm Hg. 90,110,135, 165

Answer 51

90

Question 52

Why should oxyocin only be administered with a physiologic electrolyte solution such as LR and not with an aqueous fluid such as dextrose in water?

Answer 52

to avoid water intoxication

Question 53

dduring which decel pattern is the FHR most likely to dip befow 100 bpm?

Answer 53

variable decels

Question 54

Can late decels occur within normal HR range and be as shalow as 10 bpm?

Answer 54

yes

Question 55

in the absence of administration of any medications, a sinusoidal pattern of the FHR is associated with what?

Answer 55

severe fetal hypoxia

Question 56

what is teh definition of hypoxia?

Answer 56

decreased oxygen in the tissue

Question 57

what is the definition of asphyxia?

Answer 57

decreased oxygen in the tissue and metabolic acidosis

Question 58

deep transverse arrest is associated with what?

Answer 58

android pelvis

Question 59

upon vag exam of woman in second stage labor with hypotonic uterine dysfunction, you determine that the saggital suture is in the transverse diameter of the mother's pelvis and that there is considerable molding and formation of caput succadeneum. What is most likely dx?

Answer 59

deep transverse arrest

Question 60

What might you do to remedy deep transverse arrest?

Answer 60

change maternal position pitocin instument or cesarean delivery if condition is not overcome

Question 61

what is the usual mangement for hypertonic uterine dysfunction in early labor?

Answer 61

administration of morphine and/or barbiturate

Question 62

Multip in 1st stage has had no change in dilation in 3 hours. You have ensured maternal hydration, encouraged ambulation, performed an amniotomy which reealed clear amnitic fluid. What next?

Answer 62

Pitocin stimulation

Question 63

woman with uterine rupture. In addition to alerting the physician STAT, what is the most important action for the midwife to take next in this situation?

Answer 63

order blood for a transfusion and ensure that there is appropriate venous access

Question 64

the fetal shoulders normally enter the true pelvis with the bisaccromial diameter in which diameter?

Answer 64

oblique

Question 65

what is Varney's predictive factor for shoulder dystocia?

Answer 65

an estimated fetal weight 1 pound or more greater than the woman's largest previous baby

Question 66

it is believed that the exaggerated lithotomy position (McRobert's maneuber) facilitates delivery of the fetal shoulders through what mechanism?

Answer 66

rotating the symphysis pubis to free the impacted shoulder

Question 67

during a breech delicery, a hands-off approach is recommended until the baby is born spontaneously up to which body part?

Answer 67

the umbilicus

Question 68

during breech deliery, suprapubic pressure is applied for what reason?

Answer 68

to maintain flexion of the fetal head

Question 69

waht is the reasoning behind clamping and cutting the cord of the first-born twin?

Answer 69

to avoid having the second twin exsanguinate through the cord

Question 70

what finding on its own does not signal fetal hypoxemia?

Answer 70

meconium-stained amniotic fluid