CNM Varney's Review Book Part E

Question 1

desultory labor

Answer 1

uterine inertia

Question 2

what is the average duration of the third stage of labor?

Answer 2

5-10 minutes

Question 3

once you are sure that the placenta has separated, waht is the next step you sould take in managing the deliver of the placenta?

Answer 3

assess whether the uterus is contracted

Question 4

after the placenta separates and moves into the lower uterine segment or the upper vaginal vault, what change in the uterus would hou expect?

Answer 4

it would be displaced upward and thus rise in the abdomen

http://library.med.utah.edu/nmw/mod2/Tutorial2/fig13-williams.html

Question 5

what is the modified Brandt-andrews maneuver?

Answer 5

bringing the fingertips of your abdominal hand straight down above the symphysis into the lower abdomen while holding the umbilical cord taut to check for placental separation (but it is not the same as counterpressure on uterus while pulling on cord/placenta to remove it)

Question 6

what is the fourth stage of labor?

Answer 6

the period beginning with the birth of the lacenta and ending one hour later

Question 7

a woman’s blood pressure, pulse and respirations should be monitored how often during normal fourth stage of labor?

Answer 7

q 15 min until stable at prelabor levels

Question 8

woman just delivered 4200 gm infant following prolonged first stage of labor for which you initiated pitocin. Second stage unremarkable except for fact that you preformed an episitomy to expedite birth of infant’s head. This woman is most at risk for what?

Answer 8

uterine relaxation/atony

Question 9

what would be indications for postpartum inspection of cervix?

Answer 9

Well-contracted uterus accompanied by steady trickle of blood from the vagina
Presence of anterior lip that had to be pushed back manually
Forceps or vacuum extraction delivery

Question 10

As you try to tease out trailing membranes during third stage, you feel that there is some tearing of the membranes. You inspect the placenta and the membranes and it appears that parts of the memebranes are indeed missing and therefore, probably retained within the uterus. What is appropriate mgmt of this situation?

Answer 10

Order a methergine series for teh woman to achiever rapid expulsion of the retained membrane fragments.

Question 11

What is the most common cause of third stage hemorrhage?

Answer 11

mismanagement of third stage

Question 12

as you examine a placenta during the postpartum period you notice approximately four small, hard, nodular whitish areas on both the maternal and fetal side of the placenta. Wha tis the term used to describe these nodules?

Answer 12

infarcts

Question 13

what is teh most appropriate mgmt of finding infarcts?

Answer 13

note it as a normal degenerative change of the placenta

Question 14

Approximately what percentage of infants born with only one umbilical artery will have multiple, severe malformations?

Answer 14

30%

Question 15

Third stage hemorrhage due to partial placetal separation. You immediately put a STAT call in to the consulting physician, and as you come into the room, you notice that there is an IV line running with LR. What is the best action to take to manage the hemorrhage?

Answer 15

masage uterus to attempt to cmplete placental separation adn then apply controlled cord traction to facilitate delivery of the pacenta.

Question 16

partial placental separation leading to 3rd stage hemorrhage is most likely caused by

Answer 16

uterine massage prior to placental separation

Question 17

when should manual repositioning of the uterus be performed following uterine inversion?

Answer 17

should be performed with the placeta still attached to the uterine wall

Question 18

what is the last step in manual removal of the placenta?

Answer 18

administration of oxytocin

Question 19

what is the most common cause of immediate postpartum hemorrhage?

Answer 19

uterine atony

Question 20

What is the proper dosage and freuqency for a methylergonovine (Methergine) series?

Answer 20

0.2mg every 4 hours for 6 doses

Question 21

As you examine a placenta, you note that there appear to be several cotyledons missing. What is most appropriate management of this situation?

Answer 21

perform a manual uterine examinationa dn removal of the retained placental fragments to ensure that a hemorrhage does not ensue.

Question 22

What is the drug of choice for a normotensive woman who is experiencing excessive postpartum bleeding due to uterine atony?

Answer 22

Methergine

Question 23

which pelvic muscle comprises the largest portion of the pelvic floor?

Answer 23

levator ani

Question 24

What muscle would NOT be cut in a midline episiotomy?
bulbocavernosus
pubococcygeus
superficial transverse perineal
deep transverse perineal

Answer 24

pubococcygeus muscle

Question 25

When are mediolateral episiotomies indicated?

Answer 25

they are indicated if there is an increased risk of a sevre laceration or cut that will extend into the rectal sphincter and rectum

Question 26

what gauge suture should you use to repair a tear/incision of the vaginal mucosa?

Answer 26

3-0

Question 27

what gauge suture should you use to repair a clitoral tear?

Answer 27

4-0

Question 28

a sulcus tear is what degree of laceration?

Answer 28

second degree

Question 29

Which of the following has the potential to inhibit respirations in the newborn?
rubbing on newborn's back
flicking sole of newborn's foot
exposure of newborn to cold
exposure of newborn to light and noise

Answer 29

exposure of newborn to cold

Question 30

what neonatal heat-crating mechanism is most efficient?

Answer 30

non-shivering thermogenesis

Question 31

You are trying to rewarm a newborn who has been stressed by hypothermia by placing her under a radiant warmer. What would be most helpful in the rewarming process?

Answer 31

uncover the newborn’s head prior to placing her under the warmer

Question 32

what is the mean glucose level for newborns from 4-72 hours after birth?

Answer 32

60-70 mg/dL

in our hospital as long as its above 40, we’re ok with it

Question 33

what is the approximate maximum capacity of the stomach of the term newborn?

Answer 33

30 cc

Question 34

What characteristic of the newborn GI system predisposes the newborn to water loss complications?

Answer 34

immaturity of the lining of the colon

Question 35

What is “gut closure”?

Answer 35

process by which the epithelial surfaces of the intestine become impermeable to antigens

Question 36

What findings would suggest that the fetus of a mother exposed to CMV in pregnancy has actively responded to a CMV infxn in utero?

Answer 36

Positive IgM antibodies to CMV

Question 37

metabolic acidosis caused by cold stress has what effect on the pulmonary vasculature?

Answer 37

vasoconstriction

Question 38

fetal lungs require waht for the production of surfactant?

Answer 38

oxygen
glucose
lung perfusion

Question 39

How is brown adipose used for thermoregulation?

Answer 39

its utilization is under the control of the hypothalamus and is triggered by cold sstimulus

Question 40

At 1 minute following birth:
HR 88 bpm
slow, irregular breathing with grunting
limp extremities
grimace in response to stimulus
pale color

Answer 40

3
1 for HR
1 for breathing
0 for extremities
1 for grimace
0 for color

Question 41

what is the maximum amount of time after birth that a newborn can go without voiding before referral to a pediatric provider is warranted?

Answer 41

24 hrs

but I thought we learned 36 or 48 was when to call peds

Question 42

when is the best time to apply eye prophylaxis against opthalmic infection by GC/Ct?

Answer 42

at approximately 1-2 hours after birth

Question 43

of the follwoing situations leading to the need for resuscitation, which is the most common?
birth trauma
fetal asphyxia
maternal medication
fetal malformations

Answer 43

fetal asphyxia

Question 44

what step in newborn resuscitation whould always be undertaken first?

Answer 44

clear the airway

ABC) (provide warmth, clear airway, dry, stimulate

Question 45

a newborn has no respiratory effort. Stim and clearing airway does not initiate spontaneous respirations. Now what?

Answer 45

Positive-pressure ventilation

Question 46

Waht is the pressure needed for the first newborn breath?

Answer 46

40-50 cm H2O

Question 47

When shoudl you do ET intubation of newborn?

Answer 47

when diaphragmatic hernia is suspected
when newborn needs prolonged ventilation
when adequate exygenation cannot be achieved with bag/mask