Module 1 Practice Questions Flashcards
A G1P000 @ 32 4/7 weeks has been seeing the nurse midwife. She calls the office shortly after her vehicle was hit from behind and asks to speak to you because she doesn’t know what she should do next. She notifies you that she was in the passenger seat, and that she did not hit the dashboard. Her seatbelt was on. She is a little sore, but “nothing too serious right now”, and she doesn’t want to go to the hospital unnecessarily. What are you most concerned about:
Her risk of abruption
As the nurse midwife, what is the best advice to a prenatal patient who has just suffered abdominal trauma?
“It is important that you be evaluated at the hospital. I will order an ultrasound to evaluate your baby and the placenta.”
A nurse-midwife is reading an ultrasound report and notices that the vessels within the umbilical cord lie across the cervical os?
Vasa Previa
A patient at 22 2/7 weeks gestation has had an uncomplicated prenatal course up until this point. She recently had her anatomy ultrasound performed, and today, she presents for routine prenatal care and follow-up. She is very concerned about her results because, “The technician said that I had placenta previa. I heard that is bad! What does that mean?” How should the CNM describe placenta previa?
“Placenta previa occurs when the placenta either partially or completely covers the cervical opening.”
After reviewing the ultrasound report, the CNM discovers that there is actually a low-lying placenta. The patient is relieved that she does not have a previa, but is still unsure of how these results affect the pregnancy. How should the CNM counsel a patient with placenta previa?
“You are at low risk risk for a placenta previa, and I suggest we repeat the ultrasound at 28 weeks to reassess the placental placement.”
What is the difference between:
Consultation
Collaboration
Referral
Consultation - communication with the physician where the CNM retains primary care of the individual
Collaboration - the CNM and MD care for the individual together
Referral - the CNM transfers the individual’s care to the MD
A individual at 36 0/7 weeks gestation arrives via ambulance to the L&D triage unit reporting sudden onset of severe abdominal pain and heavy vaginal bleeding. The EMT reports that her initial vitals were 140/92 and HR 105. On examination, her BP is now 100/50 with a HR of 115. Her abdomen is very tender and hard. Contractions are noted every 2min that last 60 sec. FHT’s are Category II with minimal variability and recurrent late decelerations. What is the nurse-midwife’s assessment?
Placental abruption
A G4P3003 at 36 weeks gestation, arrives via ambulance reporting sudden onset of severe abdominal pain and heavy vaginal bleeding. The EMT reports that initially her BP was 180/100, P 110. On examination, her BP is 90/50, HR 120. She is writhing in pain and will not allow you to touch her abdomen. Her contractions are q 2min x 60 sec. FHT’s are Category II with minimal variability and recurrent late decelerations. What is the CNM’s initial management?
Begin fluid resuscitation, continuous fetal monitoring, and notify physician
A patient presents to the office concerned about low milk supply, and she is returning to work soon. The nurse-midwife feels that Peggy needs a lactation consultant; however, the next available appointment is not for another 2 weeks. The nurse-midwife decide to speak with the physician. This is an example of:
Physician consultation
An individual’s 28 week lab results reveal a platelet count of 115,000/μL with no other abnormalities. Today, her BP is 110/60, urine protein negative. She denies any family history of low platelets and denies a history of easy bruising or bleeding. What is the most likely diagnosis?
Gestational Thrombocytopenia
T/F: A diagnosis of gestational thrombocytopenia may possibly result in adverse outcomes for the patient and her baby.
True
An exhausted patient arrives to the hospital in labor after several days of prodromal labor. Her cervical exam is 5 cm/90%/ -1 with intact membranes, vertex presentation, and contractions are every 2 min. FHTs are Category I. Two hours after admission, the RN reports that her cervix has not changed. She is visibly exhausted and in pain, and the CNM is concerned that this is hindering her dilatation. She requests something for pain. What is the best response from the nurse-midwife?
“There are several pain management options that are available at this point in your labor. Let me describe the different options with their advantages and disadvantages for you to choose from, depending on your preference.”
A complete blood count (CBC) reveals a hemoglobin of 10.4 g/dL, hematocrit of 31%, platelet count of 115,000/L. Vital signs are BP 116/78, HR 84, R 16. Urine has trace protein and negative glucose. Physical exam shows her skin intact and free of bruises. She denies a history of gum bleeding. As the nurse midwife, what is the best diagnosis (Dx) and management plan (P)?
Dx: Gestational thrombocytopenia and anemia; P: draw ferritin and RBC indices for additional evaluation.
Tiffany is a 24 year old G2P1001 who was diagnosed with G6PD after the birth of her first son who suffered from hyperbilirubinemia within the first 24 hours of birth. Her 20 week US indicates that she is carrying a baby girl.
She asks how she got G6PD. How would you counsel her?
What ethnic groups are at risk for G6PD?
What is the treatment for G6PD?
Cause: X-Linked genetic disease. Rarely symptomatic in women
Ethnic Groups: Mediterranean descent and African descent
Treatment: Avoid oxidative agents (sulfa, macrobid, NSAIDs, methylene blue, legumes)
Four weeks later at her follow-up OB visit, you diagnose Tiffany with a urinary tract infection. She has G6PD deficiency and no known drug allergies. What medication is most appropriate to treat Tiffany?
Keflex (Cephalexin)
Avoid Sulfa (like bactrim) and macrobid
