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CNM > ACNM Review Session > Flashcards

ACNM Review Session Flashcards

1
Q

Pyrosis is caused by

A

Reflux of the acidic secretions into lower esophagus

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2
Q

a function of progesterone in pregnancy is to

A

suppress maternal immunologic response to fetal antigens

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3
Q

the softness and compressibility of the uterine isthmus is called

A

Heagar’s sign

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4
Q

the disproportion of erythrocytes to plasma results in which type of anemia

A

physiologic anemia

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5
Q

the end of the eight postferilization week also marks the end of which period

A

embryonic period

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6
Q

oxygenated blood enters the placental intervillous space by way of the

A

spiral arteries

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7
Q

this pelvis type has an inlet which is characteristically oval with an AP diameter much larger then the transverse diameter

A

anthropoid

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8
Q

Naegele’s rule is calculated by

A

first day of LMP minus 3 months,plus 7 days

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9
Q

CVS testing screens for all the following EXCEPT

A

neutral tube defects

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10
Q

women who do a lot of gardening are at an increased risk for

A

toxoplasmosis

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11
Q

Auscultation with a fetoscope should be possible at which gestion

A

18-20 weeks

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12
Q

exercise in pregnancy may help to prevent/treat which condition

A

gestational diabetes

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13
Q

when is the fetus seen as a separate object it’s own identity

A

third trimester

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14
Q

a 25 yo G2P0101 at 8 weeks gestation reports her first baby was born at 33 weeks after going into spontaneous labor. what should she be offered

A

progesterone injections

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15
Q

a 36 yo at 36 weeks gestation reports having young some moderate bright red vaginal bleeding. Which is the best method to asses the bleeding

A

sterile speculum exam to evaluate at cervical os

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16
Q

a 33 yo G2P1001 at 34 weeks gestation is at her routine prenatal visit. her internal history to date has been bening. today her fundal height is measuring 31 cm. which is the best action at this visit

A

order an an abdominal ultrasound

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17
Q

what best describes growth of the uterus in the 2nd half of pregnancy

A

hypertrophy results in increased oxygen receptors and expression of those receptors

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18
Q

which medications will relax the uterus

A

calcium channel blockers, beta agonists, magnesium suflate

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19
Q

terutaline

A

is contraindicated beyond 48-72 hours of use for treatment of PTL

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20
Q

what is true concerning induction of labor

A

safety issues are a concern with elective induction prior to 39 completed weeks

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21
Q

what hormone initiates labor

A

prostaglandins

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22
Q

what may prevent a successful IOL for jennifer

A

nulliparity and unfavorable cervix

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23
Q

what is your treatment approach for GBS in this situation

A

obtain a GBS culture. start antibiotics. if the culture is negative, you may discontinue antibiotic prophylaxis

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24
Q

what is the appropriate treatment regimen

A

start vancomycin 1 g IV q 12 hours until delivery

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25
Q

engagement in cephalic presentation

A

involves the widest portion of the presenting part

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26
Q

what is the result of flexion

A

the presenting diameter changes from occipitofrontal to sboccipiotbregmatic

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27
Q

how would you appropriately monitor this patient

A

intermittent auscultation is acceptable

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28
Q

how frequently and when will you auscultation Cindy’s FHR

A

Q 15-30 minutes, before and after interventions

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29
Q

what is true about electronic teal monitoring (EFM) and FHR patterns in a low-risk labor

A

reassuring FHR patterns indicate normal fetal acid-base balance

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30
Q

how would you classify the FHR

A

category ll

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31
Q

what management is needed for category ll

A

continued monitoring and further assesment

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32
Q

what describes a normal LOA position

A

longitudinal lie, attitude = flexed, denominator = occipit

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33
Q

in the same position (LOA), where is the ceohalic prominence

A

on the opposite side of the back

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34
Q

in the same position as (LOA), where is the cephalic prominence

A

on the same side of the back

35
Q

how will you asses or diagnose he r progress

A

according to the friedman curve, this is a 1st stage protraction disorter

36
Q

the patient is 9/100/+1 and you palpate the posterior fontanelle roughly in the 2:00 position. you cannot palpate the anterior fontanelle

A

the head is in LOA

37
Q

Jeanine, a 41 y.o. G5 P4004 at 39.4 weeks is in active labor. BP upon admission was 120/70 and is consistent with her prenatal course. The nurse is concerned about her current readings: 130/75, 134/74. What do you tell the nurse?

A

A slight elevation is normal, especially duing contractions. Let’s make sure she’s as comfortable as possible.

38
Q

What other changes in vital signs will you anticipate wit ha normal course of labor?

A

Slight elevation of pulse, temp and respiratory rate.

39
Q

In LOA, during internal rotation:

A

the occiput rotates right toward the midline, the sagittal suture from the oblique to the AP diameter

40
Q

Internal rotation

A

May be delayed with epidural anesthesia, fetopelvic disproportion, rigid perineum or maternal exhaustion

41
Q

concerning uterine rupture:

A

Risk increases with use of pitocin
FHR abnormalitites are a positive sign
Risk increases with prior uterine surgery

42
Q

what’s the most common sign of uterine rupture?

A

fetal distress

43
Q

considered a later maneuver in management for shoulder dystocia

A

Wood’s Screw, Rubin

44
Q

If effective, McRobert’s maneuver:

A

flattens out sacrum and rotates symphysis pubis superiorly

45
Q

Associated factors for shoulder dystocia

A

Large baby
Length of 2nd stage
Post-dates induction

46
Q

What might be done to predict and prevent SD?

A

highly unpredictable and unpreventable

47
Q

Most common cause of postpartum hemorrhage

A

uterine atony

48
Q

Contributes to uterine atony

A

Myometrium
Smooth muscle
uterine fibers

49
Q

Lidocaine is effective…

A

peaks at 5 minutes

duration 30 min- 2hr

50
Q

After infiltration of the perineum, which signs or symptom is most concerning and why?

A

Metallic taste in mouth & dizziness.

Hypotension - rapid systemic effects

51
Q

what complication may be encountered if a placenta is deliverd by the Duncan mechanism

A

increased bleeding

52
Q

Involutional changes

A 
Uterus:
immediately after delivery is between symphisis and umbilicus
At 12 hours rises to umbilicus
Decreases height by 1 cm/day
3 days pp = U/3
7 days pp = U/3-5
2 weeks pp = pelvic organ
53
Q

placental eschar passage

A

10-14 days pp is NORMAL
not a period
will have small clots
may last 2-3 days

54
Q

process of involution takes place over which of the following pp time frames

A

first 6 weeks

55
Q

endometrium regenerates in…

A

3 weeks

56
Q

placental site regenerates in…

A

6 weeks

57
Q

hematological changes: interstitial fluid

A

3-4 days mobilizes, increases plasma volume

58
Q

H/H & plasma protein end of 2nd week pp

A

decreased.

Normal by 6-8 weeks pp WITH or WITHOUT iron supplementation (unless already low and taking iron)

59
Q

Hemodynamic changes during initial pp period include:

A

elevated cardiac output for up to 48 hours after birth
BP is stable
increase in WBC during first 72 hrs pp (then falls to 6-10K…normal by 6 days pp)

60
Q

Hgb v blood loss

A

q 500 ml blood loss = 1 g reduction Hgb

61
Q

Hgb first 24 hrs

A

slight decrease, plateaus for 4 days, slowly increases; normal by day 14

62
Q

increased thromboembolism risk pp due to

A

changes in diameter and velocity of deep veins

63
Q

Diuresis pp

A

most begins by days 2-5

64
Q

systolic murmur

A

20% of all women will have persistent SM beyond 4 weeks pp

65
Q

Pregnancy-associated proteinuria should be resolved by…

A

6 weeks

pre-e/eclampsia/HELLP

66
Q

Pre-e pp

A

check pre-e labs daily postpartum to be sure stabilizing before d/c

67
Q

fluid and electrolytes normal by…

A

21 days pp

68
Q

temp pp

A

may have slight increase to 99.6 immediately pp; resolves spontaneously within 24 hours. May also elevate slightly with engorgement

69
Q

Rubella <1:10 ratio

A

non-immune

70
Q

infant with negative coombs/direct autoagglutination test

A

administer Rhogam

71
Q

300 mg Rhogam covers…

A

30 ml fetal cells in maternal system

72
Q

ex: 150 Kleinhauer -Betke from auto accident + major bleed= how many doses Rhogam?

A

5 doses at 300 mg each

73
Q

how many women will have some fetal-maternal transplacental exchange of blood during pregnancy or at delivery?

A

75%

74
Q

timing of Rhogam at end of pregnancy

A

does not have to be given pp if given within 3 weeks prior to delivery

75
Q

rubella vaccine contraindicated if..

A

mom allergic to neomycin

76
Q

reliable contraception for how long after administering Rubella vax?

A

1 month

77
Q

pp hemorrhage

A

blood loss in excess of 500 ml or more after the 3rd stage of labor

78
Q

risk factors for pp hemorrhage

A

hx of pp hemorrhage
overdistention
prolonged, induced or augmented labor
uterine or placental abnormalities (previa, fibroids)

79
Q

early pp hemorrhage

A

> 500 ml in 1st 24 hrs, or a 10% drop in Hct from admission

80
Q

Late pp hemorrhage

A

> 500 ml between 1st 24 hrs and 6 wks pp

81
Q

reasons for late pp hemorrhage

A

lacerations, infection, placental fragments

Most often occurs in 2nd week when placental eschar sloughs off

82
Q

s/s late pp hemorrhage

A

persistent lochia, subinvolution, painless bright red bleeding

83
Q

early pp hemorrhage rx tx

A

oxytocin 10 U/500 ml IV
Methergine 0.2 mg IM (contraindicated with HTN, preeclampsia, eclampsia)
Hemabate 250 mcg IM (C/I with PID, renal/cardiac/hepatic dz or asthma)
Cytotec 800 mcg per rectum (not FDA approved)

84
Q

Late pp hemorrhage rx tx

A

Methergine 0.2 mg PO q 4 hr x 24-48 hrs

may require abx if infxn is causative agent

CNM (15 decks)

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