Quiz 18 - OB Flashcards Preview

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Flashcards in Quiz 18 - OB Deck (25):
1

Uterine rupture MOST commonly occurs:

A. after the placenta delivers.

B. in primiparous women.

C. during the third trimester.

D. during active labor

D. during active labor

2

The dome-shaped top of the uterus is called the:

A. cervix.

B. os.

C. body.

D. fundus.

D. fundus.

3

Women who have had a cesarean section:

A. can have a normal vaginal delivery.

B. are precluded from having a vaginal delivery.

C. usually have a vertical scar on the abdomen.

D. most likely delivered two or more babies.

A. can have a normal vaginal delivery.

4

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 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 22 breaths/min and regular. After loading the woman in the ambulance and placing her on her left side, you should:

A. 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.

B. 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.

C. 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 her.

D. 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.

B. 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.

5

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

A. Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm Hg.

B. An increase in blood bicarbonate levels causes a slight decrease in the pH level of the blood.

C. Oxygen consumption decreases by approximately 20%, causing a 40% decrease in tidal volume.

D. Progesterone increases the threshold of the medullary respiratory center to carbon dioxide.

A. Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm Hg.

6

A 30-year-old woman presents with bright red 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. This patient is MOST likely experiencing:

A. a ruptured uterus.

B. placenta previa.

C. abruptio placenta.

D. a threatened abortion.

C. abruptio placenta.

7

Common signs and symptoms of preeclampsia include:

A. weight loss, blurred vision, and diarrhea.

B. ketones in the urine and rapid weight gain.

C. edema, hypertension, and headache.

D. facial swelling, dysuria, and chest pain.

C. edema, hypertension, and headache.

8

Women who experience hyperemesis gravid arum:

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

B. have been pregnant at least two times and are commonly underweight.

C. vomit once or twice a day, usually during the morning hours, and often develop hyperglycemia as a result.

D. develop the condition secondary to increased progesterone and decreased human chorionic gonadotropin levels.

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

9

You are in the process of assisting a woman in labor. She is 38 weeks pregnant with her second child, and her contractions are 3 minutes apart and are strong and regular. Her first baby was delivered by cesarean section. As you prepare for imminent delivery, the woman tells you that her contractions have decreased significantly and that she is very dizzy. Assessment of her vaginal area reveals moderate vaginal bleeding. You quickly assess her and note that she is diaphoretic, tachycardic, and hypotensive. You should be MOST suspicious for:

A. uterine rupture.

B. placenta previa.

C. abruptio placenta.

D. threatened abortion.

A. uterine rupture.

10

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. trichomoniasis.

B. toxoplasmosis.

C. a septic abortion.

D. bacterial vaginosis

C. a septic abortion.

11

Which of the following is NOT a function of the placenta?

A. Antibody production that protects the fetus

B. Excretion of wastes in the maternal circulation

C. Synthesis of glycogen and cholesterol

D. Fetal protection against all harmful substances

D. Fetal protection against all harmful substances

12

A spontaneous abortion:

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

B. is generally performed by a physician to prevent maternal death.

C. is most often the result of a congenital abnormality of the placenta.

D. affects one out of every three pregnancies and is typically idiopathic.

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

13

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 98/58 mm Hg, pulse rate is 108 beats/min and regular, and respirations are 22 breaths/min with adequate depth. In addition to bringing the fetus to the hospital for inspection, the MOST appropriate treatment for this patient involves:

A. 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.

B. 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.

C. 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.

D. 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.

C. 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.

14

When caring for a woman with an inevitable or incomplete abortion, you should be MOST concerned with:

A. severe maternal infection.

B. maternal emotional trauma.

C. the risk of airway compromise.

D. bleeding and shock.

D. bleeding and shock.

15

The leading cause of life-threatening infections in newborns is:

A. bacterial vaginosis.

B. candidiasis.

C. human immunodeficiency virus.

D. group B streptococcus.

D. group B streptococcus.

16

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:

A. lowering her blood pressure.

B. the possibility of a seizure.

C. the risk of fetal compromise.

D. her current blood sugar level

B. the possibility of a seizure.

17

Which of the following statements regarding the amniotic sac and fluid is correct?

A. In the latter stages of pregnancy, the fetus swallows amniotic fluid and passes wastes out into the fluid.

B. The amniotic sac is composed of a tough, fibrous membrane that generally does not rupture until birth.

C. Amniotic fluid serves no real physiologic purpose and the fetus could easily survive in utero without it.

D. The volume of amniotic fluid reaches about 500 mL by the end of pregnancy and nourishes the fetus.

A. In the latter stages of pregnancy, the fetus swallows amniotic fluid and passes wastes out into the fluid.

18

Pneumonia can be especially virulent during pregnancy because:

A. the mother's cough reflex markedly diminishes.

B. pregnancy causes an increased risk of bronchospasm.

C. pregnancy causes a reduction in tidal volume.

D. the mother's immune system is already depressed.

D. the mother's immune system is already depressed.

19

During your visual exam of a woman in active labor, you see a loop of the umbilical cord protruding from her vagina. She is in the middle of a strong contraction, and you can see the baby's head just beyond the cord. You should immediately:

A. instruct her to pant during the contraction.

B. push the baby's head back into the vagina.

C. place her on 100% supplemental oxygen.

D. apply sterile, moist dressings over the cord.

A. instruct her to pant during the contraction.

20

Gestational diabetes is caused by:

A. decreased cellular utilization of insulin secondary to increased estrogen.

B. increased insulin production and decreased cellular sensitivity to insulin.

C. a decreased production of insulin secondary to excess estrogen levels.

D. ketones that are excreted in the urine during the course of the pregnancy.

B. increased insulin production and decreased cellular sensitivity to insulin.

21

A woman who does not take prenatal vitamins during the course of her pregnancy is at greatest risk for:

A. anemia.

B. abnormal bleeding.

C. leukopenia.

D. post-term labor.

A. anemia.

22

In pregnancy, magnesium sulfate is used principally for:

A. tocolytic therapy.

B. ventricular dysrhythmias.

C. eclamptic seizures.

D. hyperemesis gravidarum.

C. eclamptic seizures.

23

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?

A. The normal flow of bile from the liver has been interrupted.

B. High levels of estrogen are affecting the gastrointestinal system.

C. The placenta has prematurely detached from the uterine wall.

D. A fertilized ovum is implanted somewhere other than the uterus.

D. A fertilized ovum is implanted somewhere other than the uterus.

24

Which of the following statements regarding Rh disease during pregnancy is correct?

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

B. If the fetus inherits Rh-positive blood, it will create antibodies that can result in maternal hemolysis.

C. Rh disease is a problem during the first pregnancy and occurs when the mother's blood is Rh positive.

D. Isoimmunization occurs when an Rh-positive woman becomes pregnant by an Rh-negative man.

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

25

You are caring for a 33-year-old woman who is 35 weeks pregnant and fell down a flight of stairs. Full spinal precautions have been taken, the patient is receiving high-flow oxygen, and a patent IV line is in place. During transport, you reassess her and note that she has become diaphoretic, tachycardic, and tachypneic. You should:

A. administer a rapid fluid bolus.

B. reassess her blood pressure.

C. cover her with warm blankets.

D. tilt the backboard to the left side.

D. tilt the backboard to the left side.