CH 42

Question 1

Hydramnios is a condition in which:

there is too little amniotic fluid.

the amniotic fluid is infected.

there is too much amniotic fluid.

the amniotic sac has not ruptured.

Answer 1

there is too much amniotic fluid.

Question 2

A pregnant woman with a past history of a cesarean section is at greatest risk for:
breech birth.
uterine rupture.
preeclampsia.
prolapsed cord

Answer 2

uterine rupture.

Question 3

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

Answer 3

Polydipsia

Question 4

During true labor:

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

Answer 4

the interval between contractions gradually shortens.

Question 5

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

Answer 5

blood flow will be diverted away from the uterus.

Question 6

Which of the following processes takes place in the uterus?
Fertilization
Lactation
Fetal development
Release of luteinizing hormone

Answer 6

Fetal development

Question 7

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.
carefully dry its face.
thoroughly suction its airway.
gently guide the head upward.

Answer 7

assess for a nuchal cord.

Question 8

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

Answer 8

edema, hypertension, and headache.

Question 9

When caring for a woman with an incomplete abortion, you should be most concerned with:
maternal emotional trauma.
bleeding and shock.
the risk of airway compromise.
severe maternal infection.

Answer 9

bleeding and shock.

Question 10

The most important prehospital intervention for a footling breech or transverse presentation of the baby is:
keeping the mother warm.
rapid transport to the hospital.
delivery of high-flow oxygen.
maternal vascular access.

Answer 10

rapid transport to the hospital.

Question 11

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

Answer 11

the presenting of the baby at the vaginal opening.

Question 12

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 fertilized ovum is implanted somewhere other than the uterus.

The placenta has prematurely detached from the uterine wall.

High levels of estrogen are affecting the gastrointestinal system.

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

Answer 12

A fertilized ovum is implanted somewhere other than the uterus.

Question 13

Which of the following statements regarding uterine fundus measurement is correct?

If the fundus is longer than expected, it could indicate uterine growth problems.

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

A uterine fundus measurement that is shorter than expected is suggestive of a breech position.

If the fundus measures 36 cm, the woman is between 32 and 34 weeks pregnant.

Answer 13

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

Question 14

Which of the following events occur during the third stage of labor?
Delivery of the baby
Crowning
Delivery of the placenta
Expulsion of the mucous plug

Answer 14

Delivery of the placenta

Question 15

Fertilization of an egg usually occurs in the:
ovary.
infundibulum.
uterus.
fallopian tube.

Answer 15

fallopian tube.

Question 16

The risk of aspiration in the pregnant woman is increased significantly because:

pregnancy hormones often cause nausea and vomiting.

the gastric lining is extremely irritable during pregnancy.

decreased digestion causes a delay in gastric emptying.

increased tidal volume causes air to enter the stomach.

Answer 16

decreased digestion causes a delay in gastric emptying.

Question 17

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

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.

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

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

Answer 17

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

Question 18

Abruptio placenta is most accurately defined as:

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.

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

Answer 18

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

Question 19

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:

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.

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.

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.

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.

Answer 19

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 20

A spontaneous abortion:

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

is generally performed by a physician to prevent maternal death.

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

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

Answer 20

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

Question 21

In pregnancy, magnesium sulfate is used primarily for:

hyperemesis gravidarum.

ventricular dysrhythmias.

tocolytic therapy.

eclamptic seizures.

Answer 21

eclamptic seizures.

Question 22

When assessing the abdomen of a woman who is 36 weeks pregnant, you should expect it to be:

distended and guarded.

firm and nontender.

enlarged and tender.

rigid and distended

Answer 22

firm and nontender.

Question 23

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

Mental status

Pulse rate

Blood glucose

Pupils

Answer 23

Pulse rate

Question 24

If the uterine fundus is palpable at the level of the umbilicus, then the gestational age is:

16 weeks.

24 weeks.

12 weeks.

20 weeks

Answer 24

20 week

Question 25

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

Answer 25

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

Question 26

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: bacterial vaginosis. trichomoniasis. toxoplasmosis. a septic abortion.

Answer 26

A septic abortion

Question 27

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? Audible fetal heart tones The age of the patient Bright red vaginal bleeding Absence of abdominal pain

Answer 27

Absence of abdominal pain

Question 28

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? Threatened abortion Abruptio placenta Placenta previa Ruptured uterus

Answer 28

Abruptio placenta

Question 29

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

Answer 29

Magnesium sulfate

Question 30

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? 75 to 85 beats/min 85 to 90 beats/min 90 to 100 beats/min 100 to 110 beats/min

Answer 30

85 to 90 beats/min

Question 31

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: 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. 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.

Answer 31

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

Question 32

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

Answer 32

Jaundice

Question 33

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

Answer 33

Remnants of the follicle after the egg has been released

Question 34

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

Answer 34

she feels a strong urge to move her bowels

Question 35

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. administer 1 to 2 L of isotonic crystalloid solution. manually displace the gravid uterus to the right side. place the woman in a left lateral recumbent position.

Answer 35

place the woman in a left lateral recumbent position.

Question 36

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: pinch the distal end of the cord with your finger and assess the baby. cannulate the baby's umbilical vein and infuse normal saline. tie or clamp the cord proximal to the first clamp and reexamine it. cut the cord proximal to the first clamp and apply another clamp.

Answer 36

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

Question 37

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

Answer 37

Anemia

Question 38

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: apply sterile, moist dressings over the cord. place her on 100% supplemental oxygen. instruct her to pant during the contraction. push the baby's head back into the vagina.

Answer 38

instruct her to pant during the contraction.

Question 39

In contrast to an abruptio placenta, a placenta previa: - is associated with an absence of fetal heart tones. - usually presents with painless vaginal bleeding. - typically presents with tearing abdominal pain. - is usually caused by maternal abdominal trauma.

Answer 39

Usually presents with painless vaginal bleeding.

Question 40

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

Answer 40

decrease in expiratory reserve volume.

Question 41

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

Answer 41

the embryonic process of forming specialized body systems has started.

Question 42

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

Answer 42

manually displace her uterus to the left

Question 43

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

Answer 43

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

Question 44

Which of the following statements regarding the amniotic sac and fluid is correct? The amniotic sac is composed of a tough, fibrous membrane that generally does not rupture until birth. In the latter stages of pregnancy, the fetus swallows amniotic fluid and passes wastes out into the fluid. Amniotic fluid serves no real physiologic purpose and the fetus could easily survive in utero without it. The volume of amniotic fluid reaches about 500 mL by the end of pregnancy and nourishes the fetus.

Answer 44

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

Question 45

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

Answer 45

She has delivered two babies

Question 46

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

Answer 46

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

Question 47

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

Answer 47

contractions become more intense and more frequent.

Question 48

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

Answer 48

An increase in pressure in the pelvic area.

Question 49

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

Answer 49

Menstrual-like cramps.

Question 50

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

Answer 50

Antibody production that protects the fetus.

Question 51

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

Answer 51

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

Question 52

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

Answer 52

Myometrium

Question 53

When caring for a prolapsed umbilical cord, you should: • keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital. • instruct the mother to push during each contraction to facilitate passage of the baby past the cord. • have your partner cover the exposed portion of the umbilical cord with dry, sterile dressings. • position the mother in a left lateral recumbent position with her knees flexed into her abdomen.

Answer 53

keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital.

Question 54

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

Answer 54

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

Question 55

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

Answer 55

The possibility of a seizure.

Question 56

When delivering multiple babies, you should clamp and cut the umbilical cord: • after all the babies have delivered. • after the placenta has delivered. • following delivery of each baby. • only after the first baby delivers.

Answer 56

Following the delivery of each baby.

Question 57

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: • G5A2P1. • G1A2P3. • G1A2P5. • G3A2P1.

Answer 57

G3A2P1

Question 58

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

Answer 58

Administering IV fluids to maintain perfusion.

Question 59

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: • 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. • 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.

Answer 59

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 60

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? • Bronchitis • Asthma • Pneumonia • COPD

Answer 60

Asthma

Question 61

There is a higher incidence of abdominal injuries in association with chest trauma in pregnant women because: • the diaphragm is elevated nearly 2 inches. • seat belts are usually not worn. • the peritoneum is maximally stretched. • the abdomen is large and protuberant.

Answer 61

The diaphragm is elevated nearly 2 inches.

Question 62

Human chorionic gonadotropin hormone sends signals to the corpus luteum, which, in turn: • produces cells that clump together and ultimately form the main tissues of the placenta. • produces hormones designed to support the pregnancy until the placenta has developed. • causes the developing placenta to produce projections that tap into the external tissue of the blastocyst. • facilitates transition of the blastocyst into an embryo and causes further maturation of the placenta.

Answer 62

Produces hormones designed to support the pregnancy until the placenta has developed.

Question 63

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

Answer 63

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

Question 64

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

Answer 64

Group B streptococcus.

Question 65

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 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. - 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 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.

Answer 65

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 66

Seizures during pregnancy should be treated with: - magnesium sulfate. - valproic acid. - phenobarbital. - diazepam.

Answer 66

Magnesium sulfate

Question 67

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

Answer 67

Magnesium sulfate.

Question 68

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

Answer 68

Atrial preload may be reduced markedly