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NM 706 Adv Midwifery Care-Perinatal & Neonatal > Module 2 Practice Questions > Flashcards

Module 2 Practice Questions Flashcards

1
Q

A G1P0 at 27 weeks gestation reports epigastric pain and increased
nausea and vomiting. She hasn’t eaten since yesterday.
❏ T 99.2°F, HR 90, R 20, BP 120/80
❏ Diffuse abdominal pain with pinpoint tenderness to the right
❏ Upper quadrant (RUQ) and no guarding
These signs and symptoms are most suggestive of which condition?

A

Appendicitis

Uterine enlargement moves the appendix up and to the right flank

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2
Q

The nurse-midwife’s management of appendicitis should include which
of the following:
A. CBC w/o diff
B. Abdominal Ultrasound
C. CBC w/diff
D. Urinalysis
E. Physician notification
F. Liver enzyme tests

A

B. Abdominal Ultrasound
C. CBC w/diff
D. Urinalysis
E. Physician notification
F. Liver enzyme tests

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3
Q

What is the most common cause of acute abdominal pain in pregnancy?

A

Appendicitis

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4
Q

A baby boy was born in your birth center 4 hours ago. He is doing well
and is being exclusively breastfed. You perform your newborn
assessment and, upon inspection, notice the urethral meatus on the
ventral surface of the penis. Is this a normal or abnormal finding?

A

Abnormal

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5
Q

What is the best diagnosis of the urethral meatus on the
ventral surface of the penis in a newborn?

A

Penile hypospadias

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6
Q

What is the nurse-midwife’s management plan of penile hypospadias?

A

Refer to pediatrician

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7
Q

A G3P2002 presents at 32 weeks reporting sudden onset of acute
epigastric pain that radiates into her right shoulder. She is nauseated without vomiting. She ate fried chicken, coleslaw, and a brownie for dinner 2 hours ago. T 100.2, P 90, BP 120/80. The nurse-midwife is most concerned for:

A

Cholecystitis

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8
Q

What will the nurse midwife include within his/her physical
examination fo cholecystitis?
A. Palpate McBurney’s point
B. Palpate under right costal margin while patient inhales
C. Fetal heart tones
D. Auscultate lung sounds
E. Inspect the abdomen
F. Auscultate bowel sounds
G. Assess for CVA tenderness

A

A. Palpate McBurney’s point
B. Palpate under right costal margin while patient inhales
C. Fetal heart tones
D. Auscultate lung sounds
E. Inspect the abdomen
F. Auscultate bowel sounds
G. Assess for CVA tenderness

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9
Q

What diagnostic labs and management steps should the nurse-midwife for cholecystitis?
A. Liver function tests
B. Urinalysis
C. CBC w/diff
D. Physician consultation
E. US or MRI
F. All of the above

A

F. All of the above

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10
Q

Potential treatment options for a patient 32-week patient with cholecystitis include which of the following:
A. Surgical intervention
B. Low or non-fat diet
C. Pain medication(s)
D. Anti-spasmodic(s)
E. Antibiotics
F. All of the above

A

F. All of the above

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11
Q

How may a patient with cholecystitis present?

A

Colicky or stabbing RUQ pain or epigastric pain radiating to right
flank, shoulder, or scapula can be indicative of GB disease.

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12
Q

A patient at 31 weeks gestation arrives in OB triage reporting sudden onset of severe mid-gastric pain radiating to the LUQ and left flank area. She is actively vomiting on admission. Her VS are T 100.3° F, HR 110, R 20, BP 105/70. The lab values return showing: ↑LFTs, ↑ serum amylase/lipase, ↑WBCs, normal triglycerides, normal serum calcium. US report shows enlarged pancreas, presence of gallstones and sludge. Based on the presentation and these results, what’s the nurse-midwife’s diagnosis (Dx) and plan (P)?

A

Dx: Cholethiasis and pancreatitis; P: Refer to OB on-call

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13
Q

What is the key lab that should be drawn when pancreatitis in pregnancy is suspected? Aka: what is the diagnostic lab of choice?

A

Serum lipase

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14
Q

A patient is 28 weeks gestation with dichorionic/diamniotic twins. Her medical history is positive for chronic Hepatitis C. She reports intense generalized itching that is noticeably worse on her soles and palms and at night. She awakens herself clawing at her skin. The nurse-midwife is mosts suspicious for:

A

Intrahepatic cholestasis of pregnancy

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15
Q

Which of the following statements is NOT true regarding ICP?
A. ICP has the potential to reoccur during subsequent pregnancies.
B. Stillborn is a serious potential adverse outcome of ICP
C. Antenatal fetal surveillance is not recommended in women with ICP.
D. Ursodiol is the recommended treatment for ICP.

A

C. Antenatal fetal surveillance is not recommended in women with ICP.

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16
Q

What is the first line treatment for ICP?

A

– Ursodiol (lowers bile salts and treats pruritus)
– Hydroxyzine (Vistaril) to treat pruritus

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17
Q

While doing a newborn physical, the CNM notices that the urethral
meatus is on the dorsal side of the penis. What is the best assessment?

A

Epispadias

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18
Q

What preventative measures should the midwife advise in order to
prevent neural tube defects?

A

Folic acid 400 mcg po daily

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19
Q

A 20 week anatomy US reveals a pouch of fluid on the baby’s back;
however, the spinal cord is not exposed. The CNM most likely suspects:

A

Meningocele

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20
Q

Which class of medications in pregnancy is most likely to increase the risk the cleft lip or palate?

A

Anticonvulsants

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21
Q

A G1P0 at 34 weeks gestation reports a rash with intense itching that began in her stretch marks and has spread to her abdomen, arms, and legs. She has otherwise had an uncomplicated course. She denies any itching on her palms and soles. You note that the rash is not on her umbilicus. The nurse-midwife suspects which condition?

A

PUPPP

22
Q

The patient asks you how PUPP will affect her baby. How can you respond?

A

“This rash can be common in pregnancy. It will not cause any
harmful effects to your baby and typically resolves after
pregnancy.”

23
Q

What are your treatment options for PUPP?
A. IV methylprednisolone
B. Topical hydrocortisone (low-potency)
C. Topical Aveeno lotion
D. Topical Calamine lotion
E. Topical triamcinolone (medium-potency)
F. Oral diphenhydramine
E. Physician collaboration

A

B. Topical hydrocortisone (low-potency)
C. Topical Aveeno lotion
D. Topical Calamine lotion
E. Topical triamcinolone (medium-potency)
F. Oral diphenhydramine

24
Q

A G1P0 at 24 weeks gestation reports a rash that developed on her abdomen and has spread to her trunk, arms and legs, palms, and soles. The rash is accompanied by intense itching. Recently she has noticed vesicles. You suspect which condition?

A

Pemphigoid gestationis

25
Q

What are the maternal and fetal effects of pemphigoid gestationis (PG)?

A

Maternal risk of recurrence during subsequent pregnancies
Fetal risk of prematurity and low birth weight

26
Q

How should the nurse-midwife proceed with management of pemphigoid gestationis (PG)?

A

Begin fetal surveillance testing in the third trimester

27
Q

Which dermatologic conditions of pregnancy discussed in this module are benign?

A

PEP/PUPP and AEP

28
Q

What is the goal of treatment for benign dermatologic conditions of pregnancy?

A

Symptom relief

29
Q

Grace is a 41 year old caucasian female presenting for routine PNV. She is 33.4weeks G1 without prior complications. She is married and unemployed. She reports a rash with intense itching starting 2 days ago. She reports the rash started in her abdomen within stretch marks and extends slightly to her thighs. She denies any new meds, foods, products, or exposures. She took one benadryl that provided some relief byt stoped taking it because it mader her sleepy. She denies VB, LOF, and CTXs. Reports good FM. Her SMI is 32.5.

What is the most likely diagnosis?

A

PEP/PUPP

30
Q

Describe what you may chart for a physical exam of a patient with PEP/PUPP.

A

Urticarial plaque, papules, erythema, and raised surrounded by a pale halo. Periumbilical sparing

31
Q

How could the father be a potential contributor for PEP/PUPP?

A

It is a condition that only begins with first pregnancies unless there is a new father. When determining the origin of a rash in a multip, it is essential to know if the patient has had the rash before. If they have not, is this a new father?

32
Q

In PUPPs, what is a common characteristic found during the physical exam?

A

Involvement of striae. Often starts in the abdomen and spreads to the trunk, extremities and thighs. Spares the palms, soles, face, and mucus membranes

33
Q

What type of diagnostic testing is done for PEP/PUPP?

A

None! Diagnosis based on H&P only

34
Q

How is PUPP managed?

A

Symptom management with topical steroids, 1st gen. antihistamines. No referral is needed.

For SEVERE cases ONLY: systemic steroids

35
Q

What education should be done with PEP/PUPP?

A

It is benign, non-infectious, nonscarring, resolves 1-6 weeks PP, meds should provide relief in 24-72 hours, and risks and benefits of steroids.

36
Q

Karen is a 35-year-old G3P1 caucasian female at 27 weeks. She presents for a problem visit with a rash on her face neck, arms, and thighs that started seven days ago. She has not tried anything to relieve her symptoms and denies any new exposures. She reports a similar rash years ago in 2013. She is engaged, employed with TSA, and smokes 3-4 cigs per day. She has has one previous NSVD in 2012. She takes PNV daily.

What is the most likely diagnosis?

A

AEP- Atopic Eruption of Pregnancy

Key: She has experienced this before

37
Q

How will you educate a patient with AEP that is concerned about their baby?

A

AEP will not harm their baby, but they may develop their own atopic skin conditions.

38
Q

What causes AEP?

A

Unknown: Involves other pruritic inflammatory responses during pregnancy

39
Q

How is AEP managed?

A

Symptom relief: topical steroids, 1st gen antihistamines, phototherapy, short course systemic steroids.

Referral is no improvement/worsening

40
Q

Mia is a 23 year old G1P1 Asian female. She had an uncomplicated NSVD of a 4# 3oz baby at 36 weeks 48 hours ago. She complains of intense itching since delivery, and has a rash with blisters appearing this morning. She had a rash in 1st trimester and was told it was dermatitis. She used oatmeal to skin with minimal relief. She denies any new exposures. She has no PmHx or FHx. She is married and employed as a nail tech. She takes PNV daily.

What is the most likely diagnosis?

A

PG- pemphigoid gestationis

Note: PTB and IUGR (fetal growth restriction)

41
Q

What is the cause of PG? When does it occur?

A

Rare autoimmune blistering disease. Starts in the 2nd-3rd trimester but can worsen or erupt PP.

42
Q

Describe the presentation of PG.

A

Pruritic papules and vesicles/bullae with 50% of cases involving the umbilicus.

43
Q

What is the next best step in diagnosing a patient who presents with probable PG?

A

Skin biopsy for immunoflourescence

Note: Key is to have a sure diagnosis due to risk of harm to fetus

44
Q

What is the best treatment for a patient diagnosed with severe PG?

A

Oral steroids!! Derm. referral

45
Q

What type of complications are associated with PG?

A

Mother: pain, lack of sleep, Graves/autoimmune disorder
Baby: PTB, IUGR, SGA

46
Q

What education should be given to someone with PG?

A

It may take weeks to clear and could return with menses, COC, and pregnancy.
Rash can spread to extremities (not Face)
10% of NB may develop skin lesions that resolve spontaneously

47
Q

Annaline is a 22-year-old G2P1 Scandinavian female at 38 weeks gestation presenting for routine PNV. 10 days ago, she started itching on the palms of her hands and soles of her feet. For the last several days, her abdomen has been itching. She reports it is intense without lesions. Itching is worse after a hot shower. She had a similar rash in her last pregnancy but this is worse. She used topical steroid cream from her last pregnancy that helped some at first but now is not. Her mother had a 39 week IUFD and had similar symptoms. She reports CTXs q5m since last night and decreased FM.

What is her most likely diagnosis?

A

ICP- Intrahepatic cholelstasis of pregnancy

48
Q

Annaline is a 22-year-old G2P1 Scandinavian female at 38 weeks gestation presenting for routine PNV. 10 days ago, she started itching on the palms of her hands and soles of her feet. For the last several days, her abdomen has been itching. She reports it is intense without lesions. Itching is worse after a hot shower. She had a similar rash in her last pregnancy but this is worse. She used topical steroid cream from her last pregnancy that helped some at first but now is not. Her mother had a 39 week IUFD and had similar symptoms. She reports CTXs q5m since last night and decreased FM.

What should you be immediate first steps with this patient?

A

Assess fetal wellbeing, draw labs to assess LFTs, bile acids. Prompt IOL

49
Q

What is the most important abnormal lab finding in ICP?

A

Elevated bile acids

50
Q

What is the goal of treatment with ICP?

A

Reduce symptoms and prevent maternal and fetal complications.

Immediate referal/collaboration with OB/MD
IOL at 35-38weeks
Ursidiol (Ursodeoxycholic acid)

51
Q

What complications are associated with ICP?

A

Maternal: Bleeding, intestinal malabsorption, cholelithiasis
Fetal: PTB, fetal distress, IUFD

NM 706 Adv Midwifery Care-Perinatal & Neonatal (11 decks)

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