Unit 3 Module 1 Maternal Phys(Exam 2) Flashcards
Its a numbers game for this one
At what gestational age is a pregnancy considered “term gestation”?
a) 32-34 weeks
b) 34-36 weeks
c) 37-40 weeks
d) 40-42 weeks
c) 37-40 weeks
Slide 3
True or False
Anything before 40weeks is considered “pre-term”
False
Anything before 37 weeks is considered “pre-term”
How many trimesters are there in a full-term pregnancy?
a) 2
b) 3
c) 4
d) 5
b) 3
Slide 3
What is the definition of “parturient”?
a) A woman who has never been pregnant
b) A woman who has had multiple pregnancies
c) One who is pregnant or in labor
d) One who has given birth to more than two children
c) One who is pregnant or in labor
Slide 4
What does “gravida” refer to?
a) Number of pregnancies
b) Number of live births
c) Number of miscarriages
d) Number of gestational weeks
a) Number of pregnancies
Slide 4
The term “para” refers to the number of ___.
a) Pregnancies a woman has had
b) Births that occur at ≥20 weeks gestation
c) Miscarriages before 20 weeks
d) Fertility treatments
b) Births that occur at ≥20 weeks gestation
slide 4
True or False
Still-Births are considered “para” if they happen >/20 weeks of gestation
True
Live or still-births >/20weeks are considered “para”
Slide 4
A woman who has never been pregnant is referred to as ___.
a) Nulliparous
b) Primigravida
c) Multiparous
d) Nulligravida
d) Nulligravida
G0P0 = nulligravida/nulliparous
Slide 4
A woman who is G1P0 is considered:
a) Nulligravida and nulliparous
b) Primigravida and multiparous
c) Primigravida and nulliparous
d) Multigravida and multiparous
c) Primigravida and nulliparous
AKA - “Primip” - Pregnant but not yet had the baby
Slide 4
True or False
A G1P0 can mean a patient is pregnant and has had a miscarriage prior to 20weeks.
True
Slide 4
If a woman is currently pregnant for the fourth time and has had one miscarriage and two live births, her obstetric history would be recorded as G___P___.
a) G3P2
b) G4P2
c) G3P3
d) G4P3
b) G4P2 - Multigravida/Multiparous “Multip”
This also could mean she has been pregnant 4 times and had two miscarriages prior to 20weeks..
Slide 4
A woman who has had three pregnancies and two live births would be classified as:
a) G2P2
b) G2P3
c) G3P2
d) G3P3
c) G3P2
Also can mean she has has one miscarriage prior to 20weeks..
Slide 4
True or False
A “multip” could have more complications as in bleeding or a fast birth?
True
Slide 4
What is considered a normal and healthy minimum weight gain during pregnancy?
a) 8 kg
b) 10 kg
c) 12 kg
d) 15 kg
c) 12 kg
Slide 5
True or False
It is normal for a pregnant person to lose weight in the first trimester
True - d/t food aversion, nausea and vomiting.
Slide 5
Which of the following contributes approximately 2 kg to total pregnancy weight gain?
a) Increased blood volume
b) Placental weight
c) Amniotic fluid
d) Uterine growth
a) Increased blood volume
Slide 5
How much weight gain is attributed to uterus and amniotic fluid combined?
a) 1 kg
b) 2 kg
c) 3 kg
d) 4 kg
b) 2 kg
(1 kg each for uterus and amniotic fluid)
Slide 5
During pregnancy, new fat and protein stores contribute to an approximate weight gain of ___ kg.
a) 1 kg
b) 2 kg
c) 3 kg
d) 4 kg
d) 4 kg
Which of the following correctly matches a pregnancy weight component to its approximate weight gain?
a) Fetal weight + placenta = 4 kg
b) Blood volume increase = 3 kg
c) New fat and protein stores = 2 kg
d) Uterus and amniotic fluid combined = 3 kg
a) New fat and protein stores = 4kg
Slide 5
Matching
1 → D → IV (Underweight: 28-40 lb, 1 lb/wk)
2 → B → III (Normal weight: 25-35 lb, 1 lb/wk)
3 → A → II (Overweight: 15-25 lb, 0.6 lb/wk)
4 → C → I (Obese: 11-20 lb, 0.5 lb/wk)
Slide 6
By how much does blood volume increase during pregnancy?
a) 10-15%
b) 20-25%
c) 30-35%
d) 40-45%
c) 30-35%
Slide 7
Between which weeks of pregnancy does blood volume expansion occur?
a) 4-20 weeks
b) 8-32 weeks
c) 12-36 weeks
d) 20-40 weeks
b) 8-32 weeks
Slide 7
By what gestational age does the majority of blood volume increase occur?
a) 16 weeks
b) 20 weeks
c) 24 weeks
d) 28 weeks
c) 24 weeks
“front loaded”
Slide 7
During pregnancy, which component of blood increases more significantly?
a) Red blood cells (RBCs)
b) Plasma
c) Platelets
d) Hematocrit
b) Plasma
Expansion of both plasma & red blood cell volume (Plasma > RBC)
aka - dilutional anemia
Slide 8
The primary reason for blood volume expansion during pregnancy is:
a) To improve maternal oxygen uptake
b) To increase metabolic rate
c) To compensate for anticipated blood loss during delivery
d) To prevent blood clot formation
c) To compensate for anticipated blood loss during delivery
Slide 8
Approximately how much blood loss occurs during a vaginal delivery?
a) 250 mL
b) 500 mL
c) 750 mL
d) 800 mL
b) 500 mL
Slide 8
How much blood loss is expected during a cesarean section (C/S)?
a) 500 mL
b) 600 mL
c) 800 mL
d) 1000 mL
c) 800 mL
Slide 8
After delivery, blood volume returns to pre-pregnancy levels within:
a) 6 weeks
b) 8 weeks
c) 10 weeks
d) 12 weeks
a) 6 weeks
Slide 8
What is the approximate blood volume (BV) in a non-pregnant individual?
a) 45 ml/kg
b) 55 ml/kg
c) 65 ml/kg
d) 75 ml/kg
c) 65 ml/kg
Slide 9
What is the approximate blood volume (BV) in a pregnant individual?
a) 80-85 ml/kg
b) 85-90 ml/kg
c) 85-100 ml/kg
d) 90-95 ml/kg
b) 85-90 ml/kg
*…remember 30-35% blood volume increase
65ml x (0.30 to 0.35) = 84.5 - 87.75mL*
Slide 9
By how much does cardiac output increase at term during pregnancy?
a) 10%
b) 25%
c) 35%
d) 40%
d) 40%
Slide 10
What physiological factor contributes to the increase in cardiac output by 6 weeks of pregnancy?
a) Increase in maternal stroke volume
b) Increase in maternal heart rate
c) Decrease in maternal oxygen demand
d) Decrease in systemic vascular resistance
b) Increase in maternal heart rate
Slide 10
What additional factor contributes to increased cardiac output by 8-10 weeks of pregnancy?
a) Increased stroke volume
b) Decreased stroke volume
c) Decreased maternal heart rate
d) Increased systemic vascular resistance
a) Increased stroke volume
Slide 10
Increased plasma renin activity during pregnancy is primarily responsible for:
a) Decreased plasma volume
b) Decreased sodium and water retention
c) Increased aldosterone production
d) Increased systemic vascular resistance
c) Increased aldosterone production
This is due to pregnancy hormones like progesterone and estrogen.
slide 11
Rearrange the following physiological changes in the correct order leading to increased cardiac output during pregnancy:
A. Increased plasma volume
B. Increased stroke volume
C. Increased sodium (Na⁺) reabsorption in the kidneys
D. Increased preload (venous return to the heart)
E. Increased aldosterone secretion
F. Increased cardiac output
G. Increased water retention
E → Increased aldosterone secretion
C → Increased sodium (Na⁺) reabsorption in the kidneys
G → Increased water retention
A → Increased plasma volume
D → Increased preload (venous return to the heart)
B → Increased stroke volume
F → Increased cardiac output
slide 11
How much does uterine blood flow (UBF) increase by term gestation?
a) 2-5 times
b) 5-10 times
c) 10-20 times
d) 20-30 times
c) 10-20 times
Slide 12
What is the baseline uterine blood flow in a non-pregnant individual?
a) 30 ml/min
b) 50 ml/min
c) 100 ml/min
d) 150 ml/min
b) 50 ml/min
Slide 12
What is the approximate uterine blood flow at term gestation?
a) 100 ml/min
b) 250 ml/min
c) 500 ml/min
d) 700 ml/min
d) 700 ml/min
Slide 12
How much does skin blood flow increase during pregnancy?
a) 3-4x
b) 5-6x
c) 6-7x
d) 8-9x
a) 3-4x
Slide 12
Which of the following are effects of increased skin blood flow during pregnancy? (Select three)
A. Increased skin temperature
B. Flushing
C. Decreased cardiac output
D. Itching
E. Reduced blood volume
A. Increased skin temperature
B. Flushing
D. Itching
slide 12
During pregnancy, systemic vascular resistance (SVR) ____________
a) Increases by 20%
b) Decreases by 20%
c) Remains the same
d) Increases due to higher blood volume
b) Decreases by 20% lower than pre-pregnant values
Slide 13
Which of the following contribute to the decrease in systemic vascular resistance (SVR) during pregnancy? (Select four)
A. Increased progesterone levels
B. Decreased relaxin levels
C. Increased prostacyclin
D. Increased systemic vasoconstriction
E. Increased relaxin levels
F. Increased estrogen
A. Increased progesterone levels
C. Increased prostacyclin
E. Increased relaxin levels
F. Increased estrogen
slide 13
Which best describes the vascular state of normal pregnancy?
a) High flow, high resistance
b) Low flow, high resistance
c) High flow, low resistance
d) Low flow, low resistance
c) High flow, low resistance
Slide 14
Which two physiological changes contribute to decreased systemic vascular resistance (SVR) during pregnancy?
select 2
A. Decreased maternal vasodilation
B. Low-resistance placental circulation
C. Increased renal vasculature resistance
D. Increased maternal vasodilation
B. Low-resistance placental circulation
C. Increased maternal vasodilation
Maximal arterial dilation in the uterus!
Slide 14
Which of the following are consequences of decreased SVR in pregnancy?
A. Maternal vasoconstriction
B. Decreased renal vascular resistance
C. High-resistance placental circulation
D. Increased renal vascular resistance
B. Decreased renal vascular resistance
Slide 14
Systemic vascular resistance ___ during pregnancy, leading to a decrease in ___.
a) Increases; cardiac output
b) Increases; venous return
c) Decreases; preload
d) Decreases; afterload
d) Decreases; afterload
Slide 15
By how much does left ventricular (LV) mass increase by term during pregnancy?
a) 10%
b) 25%
c) 50%
d) 75%
c) 50%
slide 16
Which type of ventricular hypertrophy is referred to as the “Athlete’s Heart”?
A. Concentric hypertrophy
B. Eccentric hypertrophy
C. Hypertrophic cardiomyopathy
D. Dilated cardiomyopathy
B. Eccentric hypertrophy
slide 16
Eccentric hypertrophy primarily occurs due to:
A. Increased afterload and decreased blokd volume
B. Increased systemic vascular resistance
C. Decreased myocardial oxygen demand
D. Increased preload and blood volume
D. Increased preload and blood volume
Slide 16
During pregnancy, the heart shifts _________ and _________ due to diaphragmatic elevation from the growing uterus.
A. Posterior, right
B. Inferior, right
C. Anterior, left
D. Superior, left
C. Anterior, left
slide 17
The PMI (point of maximal impulse) shifts _________ and to the _________, typically to the 4th intercostal space, midclavicular line
A. Downward, right
B. Upward, left
C. Downward, left
D. Upward, right
B. Upward, left
Slide 17
On a chest radiograph, the heart may appear _________ due to its shift anteriorly.
A. larger
B. smaller
C. compressed
D. inverted
A. larger
Lungs also apprear shifted upward as well
Slide 17
During pregnancy, the QRS axis shifts:
A. Rightward in the 3rd trimester
B. Inferiorly throughout pregnancy
C. Leftward in the 3rd trimester
D. Anteriorly in the 2nd trimester
C. Leftward in the 3rd trimester
Slide 19
Which of the following EKG changes are commonly observed in pregnancy?
(Select 3)
A. Leftward QRS axis shift
B. T wave inversions
C. ST-segment elevation
D. QT interval increased
E. Prolonged PR interval
A. Leftward QRS axis shift
B. T wave inversions (Lead III)
D. QT interval increased (but often WNL)
Slide 19
What factors contribute to a shortened PR interval in the 3rd trimester of pregnancy? (Select 2)
A. Decreased sympathetic activity
B. Decreased AV node conduction velocity
C. Accelerated AV node conduction velocity
D. Increased sympathetic activity
C. Accelerated AV node conduction velocity
D. Increased sympathetic activity (In 3rd trimester)
Slide 19
Which of the following EKG findings are consistent with left axis deviation (LAD)? (Select 4)
A. Positive QRS in Lead I
B. Negative QRS in Lead I
C. Positive QRS in aVL
D. Positive QRS in aVR
E. Negative QRS in aVF
F. Negative QRS in aVL
G Negative QRS in Lead II
A. Positive QRS in Lead I
C. Positive QRS in aVL
E. Negative QRS in aVF
G Negative QRS in Lead II
Slide 20
Increased cardiac size contribute to tachydysrhythmias in pregnancy.
True
These are the most common EKG “abnormalities”
Which of the following arrhythmias are commonly seen in pregnancy?
Select 2
A. PACs
B. Atrial flutter
C. PVCs
D. Third-degree heart block
A. PACs
C. PVCs
Slide 21
Pregnancy-related tachydysrhythmias are caused by _________ in cardiac ion channel conduction and _________ in cardiac size.
A. Change, increase
B. Stasis, decrease
C. Stabilization, decrease
D. Enervation, increase
A. Change, increase
Slide 21
What are common causes of tachydysrhythmias in pregnancy? (Select 2)
A. Decreased sympathetic activity
B. Anorexia
C. Changes in autonomic tone
D. Hormonal influences
C. Changes in autonomic tone
D. Hormonal influences
Slide 21
Which valvular abnormalities occur in more than 90% of pregnant patients by the end of the third trimester?
A. Aortic and mitral regurgitation
B. Tricuspid and pulmonic regurgitation
C. Mitral stenosis and tricuspid stenosis
D. Aortic stenosis and pulmonic stenosis
:B. Tricuspid and pulmonic regurgitation
Freeman - d/t all the extra fluid ‘sloshing around’
Slide 22
What percentage of pregnant patients experience mitral regurgitation?
A. 10-15%
B. 20-25%
C. 25-30%
D. 40-50%
C. 25-30%
Slide 22
The valvular changes in pregnancy are often severe and require long-term management postpartum.
False
These are reversible changes that will
return to normal in postpartum period
Slide 22
The third heart sound (S3), often heard in pregnancy, is also referred to as a _________ and is commonly heard in the _________ trimester.
A. Atrial gallop, first
B. Diastolic gallop, second
C. Systolic murmur, third
D. Ventricular gallop, third
D. Ventricular gallop, third
Freeman - d/t mitral opening and large amounts of fluid filling the very compliant left ventricle
Slide 23
The fourth heart sound (S4) in pregnancy:
A. Becomes more pronounced at term
B. Disappears at term
C. Indicates heart failure in all cases
D. Is best heard over the pulmonic area
B. Disappears at term
Freeman - low pitch sound, d/t late diastolic filling d/t atrial contraction
Slide 23
A Grade II systolic ejection murmur (SEM) due to Cardiac Enlargement in pregnancy is best heard:
A. At the right sternal border
B. Over the left axilla
C. At the apex of the heart
D. Over the carotid arteries
A. At the right sternal border
Slide 23
Which factors can contribute to lower than normal blood pressure changes? (Select 3)
A. Fetal sex
B. Pregnancy complications
C. Gestational age
D. Maternal diet
E. Pre-existing conditions
B. Pregnancy complications
C. Gestational age
E. Pre-existing conditions
Slide 24
Which factors influence lower than normal blood pressure during pregnancy? (Select two)
A. Parity
B. Amount of fetal movement
C. Maternal age
D. Hair growth during pregnancy
A. Parity
C. Maternal age
Slide 24
_________ compression occurs when the enlarged uterus compresses the inferior vena cava and aorta, which can lead to a drop in blood pressure.
A. Carotid
B. Aortocaval
C. Jugular
D. Venous
B. Aortocaval
Supine position causes the gravid uterus to compress inferior vena cava and aorta
Slide 24
Anesthetic drugs that cause _________ can exacerbate aortocaval compression, leading to decreased venous return and hypotension.
A. Vasoconstriction
B. Tachycardia
C. Bradycardia
D. Vasodilation
D. Vasodilation
Freeman - For example - spinals/epidurals that can cause sympathectomy and cause vasodilation
Slide 25
Aortocaval compression can begin as early as _________ weeks gestation due to the increasing size of the gravid uterus.
A. 8–10
B. 13–16
C. 20–24
D. 30–34
B. 13–16
Slide 25
Put the following events of aortocaval compression in the correct order:
1. Decreased cardiac output
2. Decreased perfusion to the fetus
3. Decreased venous return to the right atrium
4. Decreased uterine blood flow
5. Hypotension
3 → 1 → 5 → 4 → 2
Slide 26
The initial cardiovascular response to aortocaval compression is _________, which is later followed by _________.
A. Tachycardia, bradycardia
B. Bradycardia, tachycardia
C. Hypertension, hypotension
D. Increased venous return, decreased cardiac output
A. Tachycardia, bradycardia
Slide 27
Which of the following symptoms may indicate aortocaval compression? (Select 4)
A. Nausea/Vomiting
B. Flushing
C. Loss of consciousness
D. Fetal distress
E. Hypertension
F. Pallor
A. Nausea/Vomiting
C. Loss of consciousness
D. Fetal distress
F. Pallor
Slide 27
To relieve aortocaval compression, the patient should be tilted to which side?
A. Left
B. Trendelenburg
C. Supine
D. Right
A. Left - LUD = Left Uterine Displacement
Displace uterus off vena cava and aorta
Slide 28
Which cardiovascular changes occur during the first stage of labor between and during contractions? (Select 3)
A. Increased cardiac output
B. Decreased blood volume
C. Increased heart rate
D. Autotransfusion of blood from the uterus
E. Decreased systemic circulation
A. Increased cardiac output
C. Increased heart rate
D. Autotransfusion of blood from the uterus
Slide 29
How much blood is autotransfused into the general circulation with each contraction?
A. 100–200 mL
B. 300–500 mL
C. 600–800 mL
D. 50–100 mL
B. 300–500 mL
Slide 29
During the second stage of labor, cardiac output increases by approximately _________%, primarily due to _________ efforts.
A. 25, breathing
B. 45, relaxation
C. 50, pushing
D. 10, reduced stroke volume
C. 50, pushing
Therefore the heart rate also increases
Slide 30
What percentage increase in cardiac output occurs immediately after delivery?
A. 30–50%
B. 50–70%
C. 60–80%
D. 90–100%
C. 60–80%
Slide 31
Which factors contribute to the increased cardiac output immediately postpartum? (Select 2)
A. Increased pressure on the vena cava
B. Uterine continuing to contract
C. Relief of pressure on the vena cava
D. Increased systemic vascular resistance
E. Decreased circulating blood volume
B. Uterine continuing to contract -releasing blood into systemic circulation
C. Relief of pressure on the vena cava
Slide 31
Cardiac output begins to decline within _________ minutes of delivery and returns to normal by _________ hours postpartum.
A. 10, 24
B. 20, 12
C. 5, 48
D. 15, 36
A. 10, 24
Slide 31
Pregnancy leads to vascular engorgement of the airway, resulting in _________ tissue and a potential for a _________ airway.
A. Friable, difficult
B. Thickened, narrowed
C. Stiff, restricted
D. Inelastic, obstructed
A. Friable, difficult
Edemetous as well
Slide 32
One common symptom of increased airway vascularity in pregnancy is _________, which may present as nasal congestion or _________.
A. Bronchospasm, wheezing
B. Rhinitis, nosebleeds
C. Hypoxia, coughing
D. Tracheomalacia, respiratory failure
B. Rhinitis, nosebleeds
Freeman - First thing pregnant patients should do if they feel like they can’t breath through her nose is blow their nose!
Slide 32
True or False
If a pregnant patient is having trouble breathing through their nose you can place a nasal trumpet to open their airway.
False
This can cause nose bleeds
Hyperemia Anesthetic implications include (select 3)
A. ETT 6.0-0.6
B. use nasal trumpets
C.increased risk for airway obstruction
D.Mallampati class improvement
E.airway difficulties
A. ETT 6.0-6.5
C. increased risk for airway obstruction
E. airway difficulties
mallampati class may worsen, keep a bougie on hand
avoid nasal tube. trumpet/NGT
Slide 34
Progesterone can cause what 3 things:
A. decrease sensitivity to CO2
B. bronchodilation
C. hyperemia
D. increase respiratory sensitivity to CO2
B.bronchodilation
C.hyperemia
D. increase respiratory sensitivity to CO2
slide 35
true or false
Estrogen will cause a decrease number and sensitivity of progesterone receptors in respiratory center in brain
false
increase number and sensitivity
so then will increase sensitvity to CO2
bronchodilation and hypermia/edema of respiratory passages
slide 35
Relaxin causes hormonal and mechanical changes including (select 3)
A. ligamentous attachments to lower ribs to relax
B. sunken chest
C.subcoastal angle increase
D. ligamentous attachemets to upper ribs relax
E. widened AP and transverse diameter of chest wall
A. ligamentous attachments to lower ribs to relax
C. subcoastal angles increase
E. WIdened AP and transverse diameter of chest wall (barrel chest)
slide 36
true or false
Pulmonary changes includes preservation of total lung capacity
true
slide 37
terminology review Matching
- FRC
- ERV
- RV
A. extra volumbe of air that can be expired with maximum effort beyond the level reached at the end of a normal expiration
B. volume of air that revents complete emptying of lungs and keeps small airways open
C. the volume of air that remains in the lungs after the ERV is expired
- FRC: B
- ERV: A
- RV: C
FRC=ERV + RV
slide 38
What will the decrease in FRC be at term?
A. 20%
B. 30%
C. 15%
D. 25%
A. 20%
slide 39
Decreased FRC results from decreased ____ and ____ (select 2)
A. RV
B. ERV
C. IC
D. IRV
A. RV
B. ERV
slide 39
With an elevated diaphragm negative pleural pressure is increased causing
A. delayed closure of small airways
B. decreased surfactant in large airways
C. earlier closure of small airway
D. increased surfactant in large airways
C. earlier closure of small airways
slide 40
FRC decrease is more profound in _____ position
A. supine
B. lateral
C. Prone
D. sitting
A. supine 30%
diaphragm elevated even more
increased alveolar atelectasis
slide 41
The ________ may exceed FRC causing small airway closure, v/q mismatch, and decreased O2 saturation
A. expiratory reserve volume
B. tidal volume
C. closing capacity
D. Inspiratory reserve volume
C. closing capacity
slide 41
Which 2 respiratory volumes are increased in pregnancy
A. expiratory reserve volume
B. tidal volume
C. inspiratory capacity
D. functional reserve capacity
B. Tidal volume
C. inspiratory capacity
slide 43
Increased metabolic CO2 production and respiratory drive related to high progesterone level is related to
A. expiratory reserve volume
B. tidal volume
C. inspiratory capacity
D. functional reserve capacity
B. Tidal volume
slide 43
Which 2 respiratory volumes are unchanged in pregnancy
A. total lung capacity
B. functional reserve capacity
C. expiratory reserve volume
D. vital capacity
A. total lung capacity - same d/t rib expansion from relaxin
D. vital capacity
slide 44
True or false
Pregnancy makes patient vulnerable to hypoxia
true
d/t elevated diaphragm (decreased FRC) and decreased oxygen reserves
will desat faster!!
slide 45
What is an extremely important factor for the pregnant population regarding anesthesia
A. pain control
B. supine position
C. maintain neutrality
D. preoxygenation
D. preoxygenation
may need supplemental O2 during labor and in times or distress
slide 46
What is the goal for preoxygenation?
A. bringing O2 to 98%
B. denitrogenate and oxygenate
C. nitrogenate and deoxygenate
D.so they can smell the balloon and you have time to get your life together
D. denitrogenate and oxygenate the bloodstream to a maximal level
* bring O2 sat as near as possible to 100%
* denitrogenate the **residual lung capacity **
* maximize the storage of oxygen in the lungs
slide 47
What are the 2 ways to preoxygenate
A. 3-5 vital capacity breaths with a tight face mask seal delivering 100% O2
B. 8 deep breaths of an oxygen flow rate of 10L /min within a time period of 60 seconds
C. 10 vital capacity breaths with a tight face mask seal delivering 100% O2
D. 3 deep breaths of an oxygen flow rate of 5L/min within 30 seconds
A. 3-5 vital capacity breaths with a tight face mask seal delivering 100% O2
B. 8 deep breaths of an oxygen flow rate of 10L /min within a time period of 60 seconds
slide 48
Not a question just read the card for tips you deserve a break
Preoxygenation tips: tight mask seal (can use mask straps), watch for an increase in FeO2 (0.9 is ideal), 20 degree reverse trendelenburg shown to be helpful in Pre O2
you’re welcome.. now back to work
slide 49
What is the ideal fraction expired O2 while preoxygenating
A.0.6
B.0.8
C.0.3
D.0.9
D. 0.9
I literally just gave a free one hope you didn’t disappoint
slide 49
How much does Oxygen consumption increase during pregnancy at term
A. 23%
B. 30%
C. 17%
D. 20%
D. 20%
can cause increase work of breathing and increased cardiac workload
increased metabloic need of fetus, uterus, and placenta
slide 50
When does dyspnea begin in pregnancy?
A.first trimester
B. second trimester
C. third trimester
A. first trimester
slide 51
What is dyspnea caused by in pregnancy (select 3)
A. decreased respiratory drive
B. increased O2 consumption
C. decreased PaCO2
D. lower pulmonary blood volume
E. increase RBC
F. nasal congestion
B. increased O2 consumption
C. decreased PaCO2
F. nasal congestion
also increased respiratpory drive, larger pulmonary blood volume, and anemia
slide 51
During pregnancy your minute ventilation increases due to and increase in tidal volume and respiration. By how much does your respiration increase per minute while pregnant?
A. 1-4 breaths
B. 3-4 breaths
C. 2-4 breaths
D.1-2 breaths
D. 1-2 breaths
hormone mediated increase neural drive to breath
slide 52
Alveolar ventilation _________ during pregnancy.
A. increase
B. decrease
C. is unchanged
A. increase
slide 52
Due to increased ventilation caused by pregnancy, you can expect PaCO2 to _____ by _______.
A. increase; 8-10mmHg
B.decrease; 8-10mmHg
C. decrease; 4-6mmHg
D.Increase; 4-6mmHg
B. decrease; 8-10mmHg
30-32 vs 40
respiratory alkolosis (pH 7.41-7.44)
slide 53/54
Due to increased ventilation caused by pregnancy, you can expect PaO2 to _____ by _______.
A. decrease; 10 mmhg
B. decrease 5mmHg
C. increase; 5mmHg
D. increase; 10mmHg
C. increase; 5mmHg
100-105 vs 100
slide 53/54
During pregnancy you can expect your HCO3 to be around
A.25mEq
B. 20mEq
C.22mEq
D. 15mEq
B. 20mEq
vs 24-26
slide 54
During pregnancy you can expect your base excess to be
A. 1-5mEq/L
B. 4-6mEq/L
C. 3-6mEq/L
D. 2-3mEq/L
D. 2-3mEq/L
slide 54
During the first stage of labor your minute ventilation will be up
A. 20%
B. 200%
C. 140%
D. 157%
C. 140%
slide 55
Maternal CO2 will decrease by_____ during the second stage of labor
A. 5-10mmHg
B. 1-3mmHg
C. 4-6mmHg
D. 10-15mmHg
D. 10-15mmHg
slide 55
During second stage of labor you can expect minute ventilation to be up
A. 40%
B.200%
C. 140%
D. 157%
B. 200%
slide 55
During second stage of labor you can expect the following changes to occur. (select 3)
A. CO2 increase
B.O2 consumption increase
C. anaerobic requirements increase
D.aerobic requirments increase
E. maternal lactate level increase
B. O2 consumption increase (may need supplemental O2)
D. aerobic requirements increase
E. maternal lactate level increase
slide 55
What is the primary cause of dilutional anemia during pregnancy?
a) Decreased red blood cell production
b) Increased red blood cell destruction
c) Plasma volume increase exceeding red cell mass increase
d) Iron deficiency
C. plasma volume increase exceeding red cell mass increase
slide 57
By approximately 36 weeks’ gestation, how much does hemoglobin typically drop from pre-pregnancy levels?
a) 1.2 g/dL
b) 2.4 g/dL
c) 3.6 g/dL
d) 4.8 g/dL
B. 2.4g/dL
slide 57
A pregnant woman’s hematocrit decreases by approximately what percentage during pregnancy?
a) 3.25%
b) 5.0%
c) 6.5%
d) 8.0%
C. 6.5%
slide 57
What maternal hemoglobin concentration is considered abnormal during pregnancy?
a) Less than 9 g/dL
b) Less than 15 g/dL
c) Less than 13 g/dL
d) Less than 11 g/dL
D. less than 11g/dL
slide 57
If a pregnant woman’s hemoglobin is greater than 13 g/dL, what condition should she be monitored for?
a) Hemoconcentration and pre-eclampsia
b) Iron deficiency anemia
c) Dilutional anemia
d) Gestational diabetes
A. hemoconcentration and pre-eclampsia
slide 57
Iron is needed to make RBC’s. During pregnancy how do you treat iron deficiency anemia.
A. oral iron formulations
B. PRBCs
C. Albumin
D. fluid
A. oral iron formulations
slide 58
What is a normal platelet count for a non pregnant patient?
A. 130,000-300,000mm3
B. 200,000-350,000mm3
C. 150,000-500,000 mm3
D. 165,000-415,000mm3
D. 165,000-415,000mm3
slide 59
What can you expect to see regarding the platelet count in a pregnant patient
A. no change
B. profound decrease
C. increase
A. no change (to moderate decrease)
slide 59
What is considered thrombocytopenia
A. <150,000
B.<100,000
C. <200,000
D. <250,000
A. <150,000
for gestational <150k, no abnormal platelet function or bleeding seen
slide 59
Thrombocytopenia is considered (select 2)
A. normal
B. psychopathic
C. idiopathic
D. hypertensive disorder of pregnancy
C. idiopathic
D. hypertensive disorder of pregnancy
slide 59
What is the incidence of epidural hematoma
A. 1: 100,000-150,000
B. 1:300,000-350,000
C.1:150-000-250,000
D. 1:200,000 - 1:250,000
D. 1:200,000-1:250,000
slide 60
What is the big concern with epidural hematoma formation?
A. cause temporary or permanent neurological damage
B. cause headache and n/v
C. cause increase in difficuly breathing
D. can cause mom to be really really mad at you
A. cause temporary or permanent neurological damage
slide 60
If an emergency delivery comes in and a c-section is needed, the patient has no labs… what if anesthetic plan?
A. combined spinal/epidural
B.GETA
C. epidrual
D. spinal
B. GETA
can be dependent on hopsital/anesthesia group policies
slide 60
For a plt count of_____ you would cancel surgery/procedure
A. 17,000mm3
B. 15,000mm3
C. 50,000mm3
D. 10,000mm3
D. 10,000mm3
slide 61
Before major surgery plt count needs to be
A. 25,000mm3
B. 10,000mm3
C. 50,000mm3
D. 80,000mm3
C. 50,000mm3
slide 61
Before an epidural plt count needs to be
A. 25,000mm3
B. 10,000mm3
C. 50,000mm3
D. 80,000mm3
D. 80,000mm3
slide 61
True or false
Pregnancy produces a hypocoagulable state.
False
pregnancy produces a hypercoagulable state
slide 62
All factors except___ (choose 4) increase in concentration
A. II
B. III
C.IV
D.V
E.XI
F.XII
G.XIII
A. II
D. V
E. XI
G. XIII
slide 62
Which factor has a siginificant increase during pregnancy
A. I
B. II
C. III
D. IV
A. I (fibrinogen)
>400mg/dL at term (slide 63)
slide 62
Hyperfibrinogenemia leads to (select 2)
A. hemorrhage
B. increased clotting efficiency
C. impaired fibrinolysis
D. bleeding
B. increased clotting efficiency
C. impaired fibrinolysis
protects against hemorrhage… but risk for blood clots increase
slide 63
What factors are increased at term gestation (select 6) … sorry i know it sucks
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
A. I
G. VII
H. VIII
I. IX
J. X
L. XII
slide 64
Which factors are unchanged at term gestation (select 2)
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
B. II
E. V
slide 65
Which factors are decreased at term gestation (select 2)
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
M. XIII
K. XI
M. XIII
also PT &PTT decreased by 20%
fibrinolytic activity decrease in third trimester
slide 65
What decreased by 20% at term gestation (select 2)
A. PT
B.PTT
C.INR
D. Plt
A. PT
B. PTT
slide 65
What decreased in the third trimester
A. sanity
B. fibrinolytic activity
C. clotting
D. blood pressure
B. fibrinolytic activity
slide 65
