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CNM > CNM Varney's Review Book Part C > Flashcards

CNM Varney's Review Book Part C Flashcards

1
Q

A woman come sto see you because she received a rubella vax 2 wks ago and has just found out that she is approximately 4 wks preg. What is your response?

A

Explain there is theoretical risk from the vax but that there is no demonstrated evidence of teratogenicity from the vax.

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2
Q

What are ways to avoid toxoplasmosis?

A

avoid contact with cat feces, wear gloves while gardening, and avoid eating raw or undercooked meat.

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3
Q

In which stage of pregnancy is maternal infection with varicella most likely to cause congenital varicella syndrome in the fetus?

A

the first 20 weeks

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4
Q

What is the most common cause of maternal mortality r/t varicella?

A

varicella pneumonia

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5
Q

G1P0 at 39 wks GA exposed to varicella two weeks ago (not immune). You administered 1 dose varicella zoster immune globulin (VZIG) at that time. She calls today c/o fever, chills, muscle pain x 2 days. Appt to see you later today. What is best course of action?

A

have her come into your office after ovvice hours for PE and counseling/education.

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6
Q

About 16 days after being exposed to varicella (and not being priorly immune), a G1P0 at 39 wks develops vesicular rash on head and neck with occasional vesicle on abdomen. Goes into labor on foruth day after eruption of the vesicles and delivers 7 lb 12 oz male with no signs of distress or varicella infection. How do you manage woman and infant?

A

Give VZIG to infant immediately and consider isolation of infant from mother.

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7
Q

What physiological change of pregnancy makes pregnant women more susceptible to UTIs?

A

Hydronephrosis, which causes urinary stasis

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8
Q

A black woman with recurrent UTIs should first be screened for what?

A

sickle cell trait/dz

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9
Q

G3P1 at 29 wks with hx of recurrent UTIs in previous pregnancy leading to PTL/PTB at 30 wks had a repeat urine culture at 28 wks = +. Gave 10-day course ampicillin. TOC is positive. What is best course of action?

A

obtain careful hx of compliance with tx regime and prescribe another course of tx with different drug based on sensitivity testing.

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10
Q

When would it be most appropriate to initiate suppressive therapy for asymptomatic bacteriuria?

A

when 2 complete courses of tx have been completed without a cure

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11
Q

Who should nOT receive nitrofuantoin to tx asymptomatic bacteriuria?

A

Woman with G6PD deficiency

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12
Q

What are some expected findings from microsopic u/a of woman with cystitis?

A

bacteriuria, hematuria, pyuria

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13
Q

What is the most common cause of true anemia during pregnancy?

A

iron deficiency

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14
Q

What is hemodilution of pregnancy?

A

normal increase in plasma volume that outpaces increase in erythrocyte production

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15
Q

What is the generally accepted, working definitiaon of anemia in pregnant women?

A

Hgb <10 g/dL

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16
Q

G1P0 at 8 wks has Hgb 10g/dL. Bulimia age 14. Currently asympotmatic for anemia; denies any bingeing and purging . Nl weight for height. What is best management option for her?

A

Iron, folic acid, PNV, nutrition counseling

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17
Q

Iron supplements causing G1P0 to become constipated. Solution?

A

continue iron supplementation, provide advice on relief measures for constipation, reevaluate Hgb level at 28 wks.

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18
Q

What is daily recommended amt of elemental iron supplementation in pregnancy?

A

30 ml

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19
Q 
Anemia labs results at 20 wk GA:
Hgb 9.8
low reticulocyte count
MCV of 98
What kind of anemia does this suggest?
A

Macrocytic anemia

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20
Q

Hgb electrophoresis reveals woman has Hb AS. What does this result mean?

A

Shows that she has sickle cell trait

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21
Q

Woman with sickle cell dz wants to know how pregnancy will affect course of dz.

A

Pregnancy increases both intensity and frequency of sickle cell crises

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22
Q

Which group of women is most likely to have G6PD?

A

Woman of Turkish descent

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23
Q

When does cardiac output peak in pregnancy, making it most likely for a woman with cardiac dz to decompensate?

A

20-24 wks

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24
Q

How will pregnancy affect asthma?

A

The clinical course of asthma in pregnancy cannot be predicted.

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25
Q

What pregnancy complications/outcomes is asthma associated with?

A

hyperemesis gravidarum
preeclampsia
LBW

26
Q

Why should a fasting blood sugar not be used as the sole screening crieteria in pregnancy

A

because the fasting bs in gestational diabetics may be normal

27
Q 
3hr GTT results:
fasting: 100
1 hr: 200 
2 hr: 150
3 hr: 130
What is the best interpretation and management?
A 
This client is gestational diabetic.  Refer to nutritionist; comanage with MD.
ADA/ACOG cutoff values:
fasting: 95
1 hr: 180
2 hr: 155
3 hr: 140
28
Q

50g, 1-hour glucose screen value which indicates need for the 3hr GTT

A

130-140mg/dL

29
Q

when is a glucose challenge test not necessary for the dx of DM?

A

fasting plasma glucose >126 mg/dL

casual plasma glucose >200 mg/dL on 2 separate days

30
Q

what is a casual plasma glucose?

A

randomly taken during the day.

Normally functioning system does not have wide glucose range throughout day.

31
Q

HgbA1c levels

A

Normal in non-diabetic: 4.5-6
5.7-6.4 = prediabetes
>6.5 on two separate occasions = diabetes
If dx with previous DM, target is ve been taught?)

32
Q

Tocolytic of choice to treat preterm labor in multiple prenancy

A

magnesium sulfate

33
Q

What are some things associated with development of oligohydramnios?

A

congenital anomalies
IUGR
postmature syndrome

34
Q

describe the normal changes in amniotic fluid volume during pregnancy

A

gradual increase through 33-35 weeks, then a decrease until term

35
Q

what are some complications associated with polyhydramnios?

A

cord prolapse
placental abruption
pp hemorrhage

36
Q

what is a known cause of polyhydramnios?

A

DM

37
Q

Following IUFD, onset of labor usually occurs within 2-3 week due to?

A

cessation of placental function

38
Q

what is a risk of expectant management of iufd?

A

DIC

39
Q

IUFD at 34 wks. Mother asks you reason.

A

even after a thorough autopsy, most intrauterine deaths have no known cause

40
Q 
In the absence of a baseline blood pressure, which would be considered HTN?
130/80
135/88
128/90
138/78
A

128/90

41
Q

What is an accurate definition of proteinuria?

A

protein in the urine in excess of 1 g/dL

42
Q

what things predispose a woman to develop preeclampsia?

A

trophoblastic dz
maternal age >35
multiple pregnancy

43
Q

If a woman develops preeclapsia before 36 wks gestation, midwife should monitor for development of which associated condition?

A

IUGR

44
Q

Eclamptic seizures are usually which type of sz?

A

tonic-clonic

45
Q

You admit pt to hosptial for preeclampsia, to initiate magnesium sulfate therapy, but she begins seizing before you can start an IV. What is MOST appropriate action at this time?

A

Call for help!
notify the physician
try to stop the sz with mag (apparently port was in)

46
Q

what is your top priority following an eclamptic sz?

A

maintain patent airway and administer O2

47
Q

G4P2 at 28 wk GA present with vaginal bleeding without contractions. U/S reveals total placenta previa. birth hx: 1 c/s for fetal distress, 2 VBAC. What is most appropriate course of action now?

A

Admit to hospital for maternal blood studies and fetal assessment.

48
Q

A woman with placenta previa and prior c/s is at increased risk for what?

A

placenta accreta

highest with pp&c/s, but generally is increased just with hx of c/s

49
Q

placenta accreta

A

placenta attached to myometrium

50
Q

placenta increta

A

placenta extends into myometrium

51
Q

placenta percreta

A

placenta extends through entire myometrium and uterine serosa

52
Q

what is the most common cause for S>D?

A

large fetus

53
Q

what are some other causes of S>D?

A

GDM
Myomata
trophoblastic dz

54
Q

What would be most helpful in confirming a clinical suspicion of IUGR in a pregnancy that is high risk based on hx of previous IUGR or complications arising this pregnancy?

A

two U/S measurements of abdomoinal circumference at least four weeks apart

55
Q

birthweight for LGA

A

4000 gm or more

56
Q

ACOG birthweight for macrosomia

A

4500 gm

57
Q

what percentage of pregnancies labeled postdates are ACTUALLY postdates?

A

50%

58
Q

When should you initiate and how often should you conduct NST in a postdates pregnancy when there are normal fetal movement coutns?

A

initiate at 41-42 weeks and twice weekly thereafter

59
Q

When in pregnancy do BH contractions begin?

A

approximately 6 weeks at the earliest
(so my thought is: if frequent flyer comes in repeatedly for BH preterm, and it is likely due to a sub-level infection which the body is trying to get rid of by getting rid of the pregnancy…is that why they can start as soon as 6 weeks, bc there is underlying infection?)

60
Q

Waht percentage of women at or near term will start labor spontaneously within 24 hours of PROM?

A

80%

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