Module 7 Practice Questions

Question 1

T/F: It is unsafe for prenatal patients with asthma to be treated with
asthma medications.

Answer 1

False

Note: it is safer to use the meds than risk hypoxic episodes of asthma

Question 2

How can asthma in pregnancy be differentiated from dyspnea in
pregnancy?
A. Dyspnea involves shortness of breath while asthma does not.
B. Asthma does not affect the peak expiratory flow rate (PEFR), while dyspnea does.
C. Dyspnea does not traditionally include wheezing and coughing, but asthma does.
D. All dyspnea in pregnancy is caused by underlying asthma.

Answer 2

C. Dyspnea does not traditionally include wheezing and coughing, but asthma does.

Question 3

Prenatal patients with asthma are at risk for which of the following
conditions? (Select all that apply.)
A. Polyhydramnios
B. Fetal growth restriction
C. Small for gestational age
D. Preeclampsia
E. Preterm delivery

Answer 3

B. Fetal growth restriction
D. Preeclampsia
E. Preterm delivery

Question 4

Ashley is a G1P0 at 28 weeks gestation. She has a history of mild
persistent asthma controlled via medication. What components will you include in your PE today? What laboratory tests will you order?

Answer 4

Peek flow/PFT, cardiac and pulmonary assessment, fundal height, FHR

Labs: H/H, GTT, Rhogam?

Question 5

Pregnancy affects the body in many ways. What effect does pregnancy have on asthma?
A. Traditionally, asthma gets worse during pregnancy.
B. Pregnancy typically causes asthma to improve.
C. Pregnancy tends to be worse in overweight/obese patients with
asthma than normal weight patients with asthma.
D. Pregnancy typically causes ⅓ of asthma cases to improve,
another third to worsen, and another third to remain unchanged.

Answer 5

D. Pregnancy typically causes ⅓ of asthma cases to improve,
another third to worsen, and another third to remain unchanged.

Question 6

A patient reports asthma symptoms more than two days a week (but not daily) that wakes her up at night at least once a week. These symptoms are beginning to mildly interfere with her activity; however, the peak expiratory flow is still greater than 80% of her personal best. According to the asthma classification system, to which category does this patient belong?
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent

Answer 6

B. Mild persistent

Question 7

A patient with intermittent asthma has an acute exacerbation of
wheezing. What is the recommended first-line treatment?
A. A short-acting β-agonist (Albuterol)
B. Theophylline
C. A low-dose inhaled corticosteroid (Pulmicort)
D. A long-acting β-agonist (Symbicort)

Answer 7

A. A short-acting β-agonist (Albuterol)

Question 8

What is the recommended treatment for a patient with mild persistent
asthma?
A. A short-acting β-agonist (Albuterol)
B. A low-dose inhaled corticosteroid (Pulmicort)
C. A short-acting β-agonist (Albuterol) + A low-dose inhaled
corticosteroid (Pulmicort)
D. A long-acting β-agonist (Symbicort)

Answer 8

C. A short-acting β-agonist (Albuterol) + A low-dose inhaled
corticosteroid (Pulmicort)

Question 9

What is the recommended treatment for a patient with moderate
persistent asthma?
A. A low-dose inhaled corticosteroid
B. A short-acting β-agonist + A low-dose inhaled corticosteroid
C. A short-acting β-agonist + A low-dose inhaled corticosteroid + A
long-acting β-agonist
D. A low-dose inhaled corticosteroid + A long-acting β-agonist

Answer 9

C. A short-acting β-agonist + A low-dose inhaled corticosteroid + A
long-acting β-agonist

Question 10

Karen is 32 weeks pregnant. She calls complaining of sudden increasing left lower extremity edema, erythema, and pain while walking. Her symptoms began 2 days ago, and elevation and warm compresses have not helped. Physical exam is significant for left lower extremity edema, and erythema of the leg, T 98.7 °F, BP 110/60, P105, R 18. What action(s) should the CNM take next?
A. Order a D-dimer test
B. Elicit Homan’s sign
C. Initiate Warfarin therapy
D. Order compression ultrasonography

Answer 10

D. Order compression ultrasonography

D-dimer could be false positive because of pregnancy. A negative d-dimer is reassuring. Homan’s sign is no longer recommended

Question 11

A pregnant patient calls today reporting difficulty breathing, chest pain, and a productive, bloody cough. She denies any lower extremity pain but has an overwhelming sense of doom. What is the most likely diagnosis?
A. Acute asthma exacerbation
B. Pulmonary embolism
C. Dyspnea of pregnancy

Answer 11

B. Pulmonary embolism

Question 12

A pregnant patient calls today reporting difficulty breathing, chest pain, and a productive, bloody cough. She denies any lower extremity pain but has an overwhelming sense of doom. What is the first method used to aid in diagnosis?
A. Chest X-Ray
B. Compression ultrasonography
C. Computed-tomographic pulmonary angiography (CTPA)
D. Ventilation-perfusion scintigraphy (V/Q)

Answer 12

A. Chest X-Ray

Question 13

Once a pulmonary embolism (PE) or deep vein thrombosis (DVT) have been confirmed, what is the most appropriate plan of care?
A. Consult with physician
B. Collaborate with physician
C. Refer to physician

Answer 13

C. Refer to physician

Question 14

Which of the following clinical scenarios is an appropriate indication for suctioning? (Select all that apply.)
A. Suctioning a neonate with a bulb syringe after delivery when the
airway is obstructed
B. Suctioning the nasopharynx and oropharynx of all neonates
following delivery of the head
C. Suctioning the oropharynx and nasopharynx on the perineum
after delivery of the head when meconium stained amniotic fluid
(MSAF) is present
D. Suctioning an apneic neonate prior to initiating positive pressure
ventilation
E. Suctioning the trachea routinely during intubation in a non-
vigorous neonate with MSAF

Answer 14

A. Suctioning a neonate with a bulb syringe after delivery when the
airway is obstructed
D. Suctioning an apneic neonate prior to initiating positive pressure
ventilation

Question 15

What is the risk of unnecessary suctioning and endotrachial intubation to the neonate?
A. Tachycardia
B. Bradycardia
C. Tachypnea
D. Apnea

Answer 15

B. Bradycardia

Question 16

What three questions should be asked to assess the need for neonatal resuscitation?

Answer 16

-Is the infant term
-Is the infant breathing/crying
-Does the infant have muscle tone

Question 17

A newborn baby born at 39 5/7 weeks in an alongside birth center is not crying, has poor color and minimal tone. What initial action should the midwife take?
A. Initiate positive pressure ventilation
B. Dry, warm, stimulate, and position in a sniffing position
C. Begin compressions
D. Allow delayed cord clamping

Answer 17

B. Dry, warm, stimulate, and position in a sniffing position

Question 18

A newly born baby at 41 2/7 weeks was born with meconium stained fluid. Which of the following statements is true?
A. Oropharyngeal suctioning should be routinely performed at the
perineum
B. Oropharyngeal suctioning is not required if the infant is vigorous
with good breathing effort
C. A NRP certified professional trained in tracheal intubation should
be present.
D. A and C
E. B and C

Answer 18

E. B and C

Question 19

A midwife has just performed a community birth at a freestanding birth center. What physical symptoms does the CNM expect to see in a newborn exhibiting respiratory distress?

Answer 19

1. Tachypnea (RR>60)
2. Grunting
3. Nasal flaring
4. Retractions
5. Cyanosis

Question 20

While completing a newborn exam, the CNM notes that the newborn’s breathing is irregular with 15-20 second pauses between breaths. The heart rate is not affected by these respiratory pauses and color remains pink with a SpO2 > 95%. This is an example of:
A. Central Apnea
B. Obstructive Apnea
C. Mixed Apnea
D. Periodic Breathing

Answer 20

D. Periodic Breathing

Question 21

Following a precipitous birth in a community birth center, a newborn’s respiratory rate is 120 breaths/minute with grunting and intermittent retractions. Breath sounds are clear to auscultation, skin color is pink, and the SpO2 is 97%. What is the best management plan by the nurse-midwife?
A. Consult with a pediatrician and administer 100% oxygen
B. Initiate PPV and order a CBC
C. Perform intubation
D. Refer to pediatrician while closely monitoring

Answer 21

D. Refer to pediatrician while closely monitoring

Question 22

What maternal conditions can cause neonatal seizures?

Answer 22

-Substance abuse
-Pre-E
-Uncontrolled DM
-Maternal infection (including untreated GBS)
-Maternal antidepressants

Question 23

What newborn conditions can cause neonatal seizures?

Answer 23

-Hypoxia-ischemia
-Infections
-Hypoglycemia
-Intracranial hemorrhage
-Electrolyte imbalances

Question 24

While completing 35-week baby Gayle’s newborn exam, you note rapid, lightening-like jerks in the upper extremities. You are most suspicious for which type of newborn seizure?
A. Subtle
B. Tonic
C. Clonic
D. Myoclonic

Answer 24

D. Myoclonic

Question 25

A newborn exhibits eye fluttering, sucking, apnea, and tongue thrusting. The nurse-midwife is most suspicious for which type of newborn seizure?
A. Subtle
B. Tonic
C. Clonic
D. Myoclonic

Answer 25

A. Subtle

Question 26

What management steps should be taken when the CNM notices a
neonatal seizure?

Answer 26

-Ensure adequate ventilation and perfusion
-Order glucose screen and begin D10%
-Correct electrolyte imbalances
-Detailed physical exam
-Pediatric referral
-Begin anticonvulsants
-Treat underlying causes

Question 27

A 38-year-old G2P1001 is induced at 40 weeks gestation for oligohydramnios with oxytocin. Her membranes are artificially ruptured with meconium fluid. Two hours into a rapidly progressing labor she begins to grasp for air and frantically cries out that she can’t breathe. Her BP drops to 65/45 and she begins to have tonic-clonic seizures. What factors increased her risk for this complication?
-late term pregnancy
-olioghydramnios
-meconium fluid
-rapid labor
-advanced maternal age
-multiparous
- induction of labor
-artifical ruputure of membranes

Answer 27

-meconium fluid
-rapid labor
-advanced maternal age
- induction of labor

Question 28

While examining a 38 week newborn the nurse-midwife notes 40 to 50 second pauses in the breathing pattern with the heart rate dropping to 70 beats/minute. During the pauses no breathing effort or airflow is perceived. Appropriate assessment (A) and management plan (P) include

Answer 28

A: Central apnea; P: pediatric referral

Question 29

A 25-year-old G2P1001 at 10 weeks gestation has a history of mild persistent asthma controlled with a beta agonist (albuterol) inhaler and inhaled corticosteroid (Pulmicort). She is worried about the potential effects of the medication on her pregnancy. The nurse-midwife explains

Answer 29

the risks of uncontrolled asthma are greater than the risks of the medications.

Question 30

Asthma severity is classified by:

Answer 30

-symptom frequency.
-frequency of nighttime awakenings.
-interference with normal activity.
-peak flow rate.

Question 31

A woman calls at 2 weeks postpartum with complaints of increasing left lower leg swelling, redness and pain on ambulation. On examination the left lower leg is noted to be swollen with calf tenderness and erythema. Suspicious of a deep vein thrombosis (DVT) the nurse-midwife orders a compression ultrasonography and D-dimer. The nurse-midwife is aware that a D-dimer

Answer 31

is reassuring that a deep vein thrombosis (DVT) is not present when the result is negative.

Question 32

The nurse-midwife’s labor and delivery management for a newborn with meconium fluid includes

Answer 32

monitoring fetal heart rate patterns.

Question 33

It takes __________minutes for an uncompromised newborn to reach 85-95% oxygen saturation levels after birth. This supports why skin color is a poor indicator of the state of oxygenation in an uncompromised newborn at birth.

Answer 33

10

Question 34

At 3 weeks postpartum a G3P3003 calls to tell the nurse-midwife that she has an overwhelming sense of doom and is feeling short of breath. Suspicious for a pulmonary embolism the nurse-midwife looks for additional signs and symptoms including
-bradypnea
-tachypnea
-bradycardia
-respiratory rales
-chest pain
-tachycardia
-bloody cough

Answer 34

-tachypnea
-respiratory rales
-chest pain
-tachycardia
-bloody cough

Question 35

What is the implication of tachypnea?

Answer 35

> 60 breaths/minute

Question 36

What is the implication of grunting?

Answer 36

stints the alveoli to maintain functional residual capcity

Question 37

What is the implication of nasal flaring?

Answer 37

decreases the work of breathing

Question 38

What is the implication of retractions?

Answer 38

occurs with airway obstruction

Question 39

What is the implication of central cyanosis?

Answer 39

apparent when 5g/100 mL of hemoglogin is unsaturated

Question 40

A newborn is born after a long labor that ended with shoulder dystocia. He has been dried, stimulated, and his airway is clear. He is apneic with a heart rate of 84. Your next action is to

Answer 40

begin positive pressure ventilation.

Question 41

An emergency cesarean delivery is done for abruptio placenta with category 3 fetal heart tones. Full neonatal resuscitation is needed with Apgars of 0, 2 (heart rate), 4, and 6. To improve perinatal outcomes, after resuscitative measures have established the heart rate at 100 beats per minute and the airway is secure the infants core temperature should be maintained between

Answer 41

32.5° C and 34°C (90.5 -93.2° F).

Question 42

An infant has been crying, inconsolably with periods of apnea, rowing arm movements, and fluttering of eyelids. Choose those behaviors that may indicate seizure activity.

Answer 42

-rowing arm movements
-fluttering of eyelids
-periods of apnea.

Question 43

What is the physiologic respiratory state of pregnancy?

Answer 43

Hyperventilatory state: chronic respiratory alkalosis. This promotes more efficient gas exchange from maternal lungs to the fetus