Module 3 Practice Questions Flashcards
The nurse midwife is seeing a pregnant patient who is suspected of having a UTI. Which laboratory test is the most accurate in diagnosing this condition?
Urine Culture
Latoya is a 23-year-old G2P1001 at 36 weeks gestation who presents to the clinic for right sided abdominal pain radiating to the right flank. She feels feverish, has chills, and is vomiting. Her chart review reveals that she was treated for an asymptomatic bacteriuria infection at 22 weeks with a negative TOC culture following treatment. Her exam reveals: T 102° F, P 108. Which diagnoses should the CNM consider as differentials? Select all that apply.
A. Acute Cystitis
B. Appendicitis
C. Pyelonephritis
D. Pancreatitis
B. Appendicitis
C. Pyelonephritis
Latoya is a 23-year-old G2P1001 at 36 weeks gestation who presents to the clinic for right sided abdominal pain radiating to the right flank. She feels feverish, has chills, and is vomiting. Her chart review reveals that she was treated for an asymptomatic bacteriuria infection at 22 weeks with a negative TOC culture following treatment. Her exam reveals: T 102° F, P 108.
Upon further investigation, the midwife’s physical exam notes marked CVA tenderness. Urinalysis is positive for nitrites, ↑WBCs and WBC casts, ↑ RBCs, positive hematuria, and ↑protein. Urine culture still pending. Which is the most appropriate course of action by the midwife?
Recommend hospital admission and notify on-call physician for
collaborative care
Latoya has now arrived at the hospital where your collaborating MD is waiting for her. Dr. Walters will begin treatment, and you intend to follow-up tomorrow morning when you assume call. What next steps do you anticipate that the MD will take?
IV hydration, broad-spectrum antibiotic, monitor urinary output
and VS, order anti-emetic and Tylenol
The CNM is seeing a 28 week patient for routine prenatal care. Urinalysis shows proteinuria and elevated WBCs. Urine culture shows 100,000 colonies per mL. The patient denies dysuria, urinary frequency, or urinary urgency. How should the CNM best manage care?
Prescribe macrobid 100 mg po BID x 7 days
100,000 ml indicates UTI and should be treated
A G1P0 at 37 weeks gestation reports mild burning on urination that began two days ago with urgency. She denies increased frequency. Urinalysis results show WBCs +1, positive nitrites, pH 8.0, protein +2. The nurse midwife obtains a urine culture. What is the appropriate prophylactic medication that should be prescribed.
Cephalexin (Keflex)
Macrobid and Pyridium is not appropriate at 37 weeks. Note: Pyridium treats symptoms but not infection.
Alicia presents for her 36 week routine visit. As part of the visit, you obtain a vaginal chlamydia and gonorrhea culture. She has a history of being treated for Group B Streptococcus bacteriuria at 22 weeks gestation. What is the most appropriate statement by the nurse midwife?
“Since you were already tested and treated for GBS earlier in
pregnancy, it is not necessary to screen you for GBS again. We will
treat you prophylactically while you are in labor.”
GBS was found in the urine, so she does not need a rescreen. This suggests heavy vaginal colinization and rescreening is not needed.
What is the most significant risk factor for preterm birth?
Prior preterm birth
Other risk factors: smoking, multifetal gestation, AA ethnicity
Tonya is a 17-year-old G2P0101 @ 12 weeks. Review of her prenatal record reveals: SVD@32 weeks in 2019 to 2 lb 8 oz female, smokes ½ ppd, denies ETOH or recreational drug use, BMI 18. What should the midwife recommend?
Injections of 17 P beginning at 16 weeks
See module 3 Review PPTX for SMFM Recommendation Algorithim for PTL prophylaxis in singleton
Gina is a 32 y/o G3P0101 at 18 weeks gestation carrying twins. She has a prior history of PTB @ 35 weeks during her 1st pregnancy. Both you and Gina are concerned about her risk of recurrent PTB. Which of the following steps should be taken by the nurse midwife?
Notify OB and discuss PTL precautions
Key: She is pregnant with twins
See module 3 Review PPTX for ACOG Recommendation Algorithim for PTL prophylaxis
Tonya is a G1P000. On her 20-week US, the transvaginal cervical length (CL) is 24 mm. How should the CNM manage Tonya’s care at this point?
Continue routine OB care
Note: Cerviclal length >20 mm needs no changes
See module 3 Review PPTX for SMFM Recommendation Algorithim for PTL prophylaxis in singleton
A CL of 20mm is found on a 20 week US for a G3P1102. What is the best management plan for this patient?
Continue 17 a-hydroxyprogesterone caproate weekly injection
and refer for cerclage placement
Key: her CL is 20 and she has a prior PTB
See module 3 Review PPTX for SMFM Recommendation Algorithim for PTL prophylaxis in singleton
What is the gold standard for testing for pPROM?
Sterile speculum with ferning and nitrazine
At 29 weeks, a G1P0 calls reporting contractions q 5-10 min with lower abdominal cramping, increased pelvic pressure and lower back discomfort that coincide with the contractions. She also feels like her panties are extremely wet. She denies vaginal bleeding, recent sexual intercouse, or recent vaginal exam. What should the nurse midwife include in his/her physical exam? (Select all that apply.)
A. Palpate and monitor uterine contractions
B. Electronic fetal monitoring
C. Sterile speculum exam
D. Digital cervical exam
E. Assess for CVA tenderness
All of them
Avoid cx exam until PPROM is ruled out
At 29 weeks, a G1P0 calls reporting contractions q 5-10 min with lower abdominal cramping, increased pelvic pressure and lower back discomfort that coincide with the contractions. She also feels like her panties are extremely wet. She denies vaginal bleeding, recent sexual intercouse, or recent vaginal exam. What should the nurse midwife include in his/her lab assessment?
- U/A
- CBC
- Fetal fibronectin
- TVUS for AFI/CL/presenting part (shouldn’t be used alone)
- NAAT testing for CT/NG
- Wet prep for BV/Yeast/Trich
- GBS cultures
At what gestation can an FFN be done?
22-33.6w
What could cause a false positive on an FFN?
Anything in the vagina in the previous 24 hours
Vaginal bleeding
What does an FFN predict?
If labor will NOT occur in the next 2 weeks. A Negative is reassuring, a positive is not definitive that the patient will deliver in the next two weeks
The patient’s results are negative for vaginal pooling, vaginal bleeding, ferning, or nitrazine. Wet prep was negative for BV, yeast and trichomonas. U/A clear. fFN was also collected and pending. Abdomen NT, no CVA tenderness. FHTs 140s, Cat 1 tracing. You also note regular UCs every 5 minutes, moderate, lasting 45 sec. What is the next step for the nurse midwife?
Digital cervical exam
No PPROM noted and we want to assess if there is cx change
The patient’s (29 weeks) cervical exam: 3cm/75%/-2. Vertex
presentation palpated and confirmed by US. AFI WNL, and TV CL = 18 mm. fFN returns positive. CBC normal and patient is afebrile. What is the midwife’s next step?
Refer for OB care
Due to her GA and PTL
A GBS negative patient has been laboring for 20 hours. She has made slow labor progress and had several cervical exams. Pitocin was initiated and, shortly after, she requested an epidural. An IUPC was later inserted. Five hours later, the nurse calls you to her room to evaluate a category 2 strip with fetal tachycardia. The patient also has a temperature of 102°F. The CNM is most suspicious for which of the following:
Intraamniotic infection
A GBS negative patient has been laboring for 20 hours. She has made slow labor progress and had several cervical exams. Pitocin was initiated and, shortly after, she requested an epidural. An IUPC was later inserted. Five hours later, the nurse calls you to her room to evaluate a category 2 strip with fetal tachycardia. The patient also has a temperature of 102°F. What is the most appropriate plan of action at this point by the nurse midwife?
A. Administer acetaminophen
C. Administer antibiotics
D. Physician notification
A patient with suspected intraamniotic fever has NKDA. What
medications should the CNM order to treat the infection? (Select all that apply.)
Gentamycin
Ampicillin
What presentation of maternal fever would lead us to believe it is epidural related?
Onset within 1-<4 hours after epidural
What presentation of maternal fever would lead us to believe it is epidural related?
Onset within 1-<4 hours after epidural
When would intraamniotic infection be suspected vs. confirmed?
Suspected: During Labor
Confirmed: Post pathology report
