Inpatient OB Certification Exam 840 Questions with Verified Answers
Pain during the first stage of labor is caused by
a. cervical and lower uterine
... [Show More] segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments.
b. pressure on the urethra, bladder, and rectum by the descending fetal presenting part
c. uterine muscle hypoxia, lactic acid accumulation, and distention of the pelvic floor muscles. - CORRECT ANSWER a. cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments.
A class of antihypertensive drugs that should be avoided in pregnancy is:
a. ACE inhibitors
b. adrenergic blocking agents
c. calcium channel blockers - CORRECT ANSWER a. ACE inhibitors
Gestational diabetes places a woman at increased risk of:
a. a birth with a congenital defect
b. oligohydramnios with resultant fetal growth restriction
c. overt diabetes in later life - CORRECT ANSWER Overt diabetes in later life
A sign of symptom that indicates a progression of preeclampsia to eclampsia and warrants a consideration for delivery is:
a. epigastric pain
b. nausea or vomiting
c. persistent proteinuria - CORRECT ANSWER epigastric pain
A predisposing factor for preeclampsia is:
a. nulliparity
b. obesity prior to pregnancy
c. previous history of preeclampsia - CORRECT ANSWER A, B, and C
A women is receiving magnesium sulfate. A sign that the magnesium sulfate is reaching a toxic level is:
a. decreased appetite
b. difficulty in swallowing
c. slurring of speech - CORRECT ANSWER Slurring of the speech
A positive ankle clonus that occurs with preeclampsia is usually a result of
a. cerebral edema
b. decreased colloid osmotic pressure
c. dependent edema - CORRECT ANSWER cerebral edema
A potentially life saving measure for a fetus that is exposed to chicken pox just prior to delivery is for the mother to receive:
a. acyclovir (Zovirax)
b. the chicken pox vaccine
c. varicella immune globulin (VZIG) - CORRECT ANSWER Varicella immune globulin (VZIG)
Following cesarean delivery for abrupt placenta, a clot observation test is initiated. Placing a small amount of blood in a test tube for 20 minutes yields a soft clot that dissolves easily. This is consistent with:
a. hypofibriongenemia
b. normal coagulation process
c. presence of antithrombin III - CORRECT ANSWER Hypofibriongenemia
A finding that would indicate a pregnant diabetic patient is at increased risk for giving birth to an infant with a congenital defect is:
a. a history of macrosomia in her previous pregnancy
b. an elevated hemoglobin A1C levels during the first trimester
c. glucose levels above 140 mg/dL in the third trimester - CORRECT ANSWER b. an elevated hemoglobin A1C levels during the first trimeter
(A1C) — Hemoglobin A1C levels are monitored during pregnancy because they correlate with a woman's blood glucose concentration over the prior 8 to 12 weeks and are predictive of the risk for congenital malformations and neonatal birth weight [9]. Lower values have been associated with better outcomes. (<6)
When a pregnant woman experiences a cardiac arrest, the nurse should:
a. first focus on assessing fetal status
b. if the mother dies, discontinue resuscitative efforts
c. treat the patient as the same as a non-pregnant patient - CORRECT ANSWER c. Treat the patient as the same as a non-pregnant patient
At term, a woman is labor is found to have severe condylomata which has obstructed the vaginal canal. The appropriate disposition is.
a. cesarean delivery
b. cryotherapy removal
c. immediate removal with podophyllin - CORRECT ANSWER a. cesarean delivery
A hematologic change in pregnancy that predisposes to venous thrombosis is
a. depressed fibrinolytic activity
b. increased white blood cell count
c. reduced erythrocyte production - CORRECT ANSWER a. depressed fibrinolytic activity
A women is admitted to labor and delivery at 32 weeks gestation with vaginal bleeding. Her hematocrit is falling and she is tachycardic. A Kleihauer-Betketest is ordered. This is done to:
a. detect fetal red blood cells in the maternal circulation
b. detect hemolysis of fetal red blood ells
c. rule out Rh isoimmunization - CORRECT ANSWER a. detect fetal red blood cells in the maternal circulation
A pregnant woman at 33 weeks gestation experiences an eclamptic seizure. The medication of choice for this patient is immediate, intravenous administration of:
a. diazepam (Valium)
b. magnesium sulfate
c. phenytoin (Dilantin) - CORRECT ANSWER b. magnesium sulfate
A pregnant woman has a hemoglobin level of 9 g/dL and is stable, afebrile, and can ambulate without adverse symptoms. The indicated treatment is
a. oral iron preparation
b. parenteral iron therapy
c. whole blood transfusions - CORRECT ANSWER a. oral iron preparation
The Centers for Disease Control and Prevention (CDC) has defined anemia as hemoglobin levels of less than 11 g/dL (hematocrit less than 33 percent) in the first and third trimesters and less than 10.5 g/dL (hematocrit less than 32 percent) in the second trimester [21]. Since hemoglobin and hematocrit levels are lower in African-American adults, the Institute of Medicine recommends lowering the hemoglobin cut-off level by 0.8 g/dL in this population
A women at 34 weeks gestation is admitted to the antepartum unit for influenza type symptoms and lymphadenopathy. A culture shows an infection caused by T. gondii. The most likely transmission route for this infection is.
a. ingestion of raw meat
b. rectal transfer
c. sexual intercourse - CORRECT ANSWER ingestion of raw meat
Toxoplasma gondii is a ubiquitous protozoan parasite that infects humans in various settings.
Acute infection in the mother is usually asymptomatic. When symptoms of infection occur, they are nonspecific, such as fatigue, fever, headache, malaise, and myalgia. Lymphadenopathy is a more specific sign of the disease.
A pregnant woman who is HIV positive is on combination antiviral therapy comes to the hospital for delivery. Drug therapy should be:
a. continued on the prenatal dosing regimen throughout labor and delivery
b. discontinued until after delivery where combination therapy should be resumed postpartum
c. switched to zidovudine IV for one hour and followed by continuous infusion until delivery - CORRECT ANSWER a. continued on the prenatal dosing regimen throughout labor and delivery.
Women should continue taking their ART regimen during labor and delivery or scheduled cesarean delivery. For women who have HIV RNA ≥1000 copies/mL or unknown viral levels in late pregnancy and around the time of delivery, we recommend intrapartum intravenous zidovudine to further reduce the risk of perinatal transmission (table 2) (Grade 1B). For women who have had HIV RNA <1000 copies/mL consistently in late pregnancy and around the time of delivery and have no concerns related to adherence or resistance to the regimen, intrapartum intravenous zidovudine is not associated with further reduction of HIV transmission.
A diagnostic test used in the diagnosis of HELLP syndrome is.
a. decreased liver function studies
b. increased creatinine clearance
c. presence of burr cells - CORRECT ANSWER c. decreased liver function studies
During labor, women on full dose prophylactic unfractionated heparin anticoagulation should have the heparin dose.
a. increased
b, maintained
c. withheld - CORRECT ANSWER c. withheld
An alternative regimen to hydrazine when treating severe maternal hypertension is
a. diazoxide
b. labetalol
c. sodium nitroprusside - CORRECT ANSWER b. labetalol
The vascular manifestation of pregnant women with Class F diabetes is
a. atherosclerotic heart disease
b. nephropathy
c. proliferative retinopathy - CORRECT ANSWER b. nephropathy
Which class of antidepressants is most safe for use by pregnant woman?
a. MAO inhibitors
b. SSRIs
c. Tricyclic - CORRECT ANSWER b. SSRIs
Selective Serotonin reuptake inhibitors
A woman who previously had an infant with anencephaly is planning another pregnancy. She should be advised to supplement her diet with folic acid in the dosage of
a. 0.04 mg
b. 0.4 mg
c. 4.0 mg - CORRECT ANSWER c. 4.0 mg - recommendation from ACOG.
The dose is decreased to 0.4 mg per day after the first trimester. For most women of reproductive potential, we suggest one multivitamin containing 0.4 mg of folic acid once per day beginning at least one month prior to conception and continuing through the first trimester
A woman at 31 weeks gestation is admitted to labor and delivery for cuts and bruises on her stomach and torso. When asked how she acquired the bruise, she admits that her partner beat her after she told him she was leaving him due to repeated abusive episodes. The nurse would recognize that the utmost priority is the woman's
a. need for social support
b. physical safety
c. risk for fetal loss - CORRECT ANSWER b. physical safety
Because of potential fetal risks for pregnant woman with chronic hypertension, an antepartum fetal assessment that is recommended is
a. amniocentesis
b. serial ultrasound
c. urinary estriols - CORRECT ANSWER b. serial ultrasound
Compared to alphafetoprotein testing, triple screen testing improves the ability to detect.
a. metabolic disorders
b. open neural tube defects
c. trisomies - CORRECT ANSWER c. trisomies
When comparing the non stress over the contraction stress test, the clinician should understand that the non-stress test
a. has a low false negative rate
b. is more sensitive to fetal oxygen reserve
c. Requires more repeat testing. - CORRECT ANSWER a. has a low false negative rate
A negative contraction stress test is characterized by
a. accelerations with onset of contractions
b. maintenance of beat to beat variability
c. no decelerations in response to contractions - CORRECT ANSWER c. no decelerations in response to contractions
Failure to elicit a relative pattern with a non stress test after one hour of monitoring warrants
a. initiation of a biophysical profile
b. repeat testing after administration of orange juice
c. retesting in 24 hours. - CORRECT ANSWER a. initiation of a biophysical profile
A diagnosis of severe preeclampsia is consistent with a 24 hour urine showing protein excreting of?
a. 1 g/L
b. 3g/L
c. 5g/L - CORRECT ANSWER c. 5g/L
An indication of impending magnesium sulfate toxicity in the patient being treated for preeclampsia is the absence of?
a. deep tendon reflexes
b. fetal movement
c. urine output - CORRECT ANSWER a. deep tendon reflexes
The therapeutic range of serum magnesium during magnesium sulfate therapy to prevent eclampsia seizures is
a. 1 to 4 mg/dL
b. 5 to 8 mg/dL
c. 9 to 12 mg/dL - CORRECT ANSWER b. 5 to 8 mg/dL
The first priority in the care of a patient during an eclamptic seizure is to?
a. administer an anticonvulsant agent
b. ensure a patent airway
c. establish IV access - CORRECT ANSWER b. ensure a patent airway
Diagnosis of preeclampsia requires the presence of hypertension and?
a. edema
b. headaches
c. proteinuria - CORRECT ANSWER c. proteinuria
Severe preeclampsia can be diagnosis in the presence of?
a. excretion of 4500 g protein in a 24 hour urine
b. serial diastolic bp of at least 110 mm Hg
c. serum blood urea nitrogen of 10mg/dL with a serum creatinine of 1mg/dL - CORRECT ANSWER b. serial diastolic bp of at least 110mm Hg
______________ disorders are the most common medical complication of pregnancy. - CORRECT ANSWER hypertensive
A diastolic blood pressure of _________ mm Hg on two occasions at least 6 hours apart is necessary for the diagnosis of severe preeclampsia. - CORRECT ANSWER 110 mm Hg
The blood pressure should be recorded with the pregnant woman in the ______________ position. - CORRECT ANSWER Semi-Fowler's
___________ is the drug of choice to prevent seizure activity in the patient with preeclampsia. - CORRECT ANSWER Magnesium Sulfate
Material morbidity from hypertension in pregnancy results from?
1.
2.
3.
4 - CORRECT ANSWER Abruption placentae
DIC
hepatic failure
acute renal failure
The goals of antihypertensive therapy in the woman with preeclampsia are to _________ and to ___________. - CORRECT ANSWER prevent maternal CVA
maintain uteroplacental perfusion
Laboratory markers for HELLP syndrome are __________, ___________ and ___________ - CORRECT ANSWER Hemolysis, Elevated Liver Enzymes, Low Platelet count
The leading cause of maternal morbidity following an eclamptic seizure is ______________. - CORRECT ANSWER aspiration
Invasion of the trophoblastic cells into the uterine myometrium is termed placenta
a. accreta
b. increta
c. percreta - CORRECT ANSWER b. increta
The incidence of placenta previa is increasing likely due to
a. better diagnostic tools such as transvaginal ultrasound
b. increased rate of cesarean birth
c. more women delaying childbirth until they are older - CORRECT ANSWER b. increased rate of cesarean birth
Painless, bright red vaginal bleeding at 28 weeks gestation is most likely due to
a. abruptio placentae
b. placenta previa
c. uterine rupture - CORRECT ANSWER b. placenta previa
A clinical finding associated with a dehiscence of a uterine scar during a trial of labor after cesarean birth (TOLAC) is:
a. cessation of uterine contractions
b. fetal heart rate (FHR) with variable decelerations
c. sudden decrease of intrauterine pressure - CORRECT ANSWER b. fetal heart rate (FHR) with variable decelerations
The initial drug of choice for excessive bleeding in the immediate postpartum period is
a. Methergine IM
b. Oxytocin IV infusion
c. Prostaglandin 15-MF suppository - CORRECT ANSWER b. Oxytocin IV infusion
The most common cause of postpartum hemorrhage is?
a. an atonic uterus
b. a cervical laceration
c. a placenta accrete - CORRECT ANSWER a. an atonic uterus
In the last 10 years in the United States, the maternal mortality rate has
a. decreased
b. stabilized
c. increased - CORRECT ANSWER c. increased
Which group has the highest maternal mortality
a. African American Women
b. Hispanic Women
c. Native American Women - CORRECT ANSWER a. African American Women
Approximately two thirds of maternal trauma seen in the ED is related to
a. domestic violence/intimate partner violence
b. falls at home or in the workplace
c. motor vehicle accidents - CORRECT ANSWER c. motor vehicle accidents
The risk of uterine inversion is increased with
a. a prior uterine scar
b. suprapubic pressure
c. traction applied to the cord - CORRECT ANSWER c. traction applied to the cord
Cervical lacerations after birth should be suspected if
a. estimated blood loss exceeds 500mL
b. the mother reports severe cramping pain
c. the uterus is well contracted but frank bleeding continues - CORRECT ANSWER c. the uterus is well contracted but frank bleeding continues.
Vasa previa is the result of a ____________ insertion of the cord - CORRECT ANSWER Velamentous
For the fetus to maintain adequate oxygenation, the maternal oxygen saturation must be at least _______% - CORRECT ANSWER 95%
_______ is a late sign of hypovolemia in the woman experiencing bleeding during pregnancy - CORRECT ANSWER hypotension
Active Management of the third state of labor involves
1.
2.
3.
4. - CORRECT ANSWER 1. Administer oxytocin with delivery of the anterior shoulder
2. Clamping/cutting the umbilical cord by 2 to 3 minutes of birth
3. Controlling traction of the umbilical cord, with the provider's hand supporting the uterus to prevent uterine inversion
4. Preforming vigorous fundal massage for at least 15 seconds.
Based on 28 day cycles, when using the first day of the last menstrual period, the estimated date of confinement is calculated by adding
a. 220 days
b. 240 days
c. 280 days - CORRECT ANSWER c. 280 days
What does EDC stand for? - CORRECT ANSWER Estimated day of Confinement
The most accurate method for determining gestational age is?
a. crown-rump length by ultrasound at 6-12 weeks
b. multiple biometric measurements by ultrasound between 12 and 20 weeks
c. stated date for the first day of the last menstrual period. - CORRECT ANSWER a. crown-rump length by ultrasound at 6-12 weeks.
By 28 to 34 weeks gestation in a normal pregnancy, blood volume has increased by approximately
a. 10-20%
b. 30-50%
c. 60-80% - CORRECT ANSWER b. 30-50%
During pregnancy, the position for optimum maternal cardiac output is.
a. lateral
b. semi-Fowler's
c. supine - CORRECT ANSWER a. lateral
During labor, maternal cardiac output
a. decreased slightly
b. increases progressively
c. remains the same - CORRECT ANSWER b. increases progressively
An intravenous (IV) fluid bolus is given before epidural anesthesia to prevent.
a. hypotension
b. renal hypoperfusion
c. sympathetic blockade - CORRECT ANSWER a. hypotension
Normally during pregnancy, maternal sitting and standing diastolic blood pressure readings
a. decrease, then increase
b. increase progressively
c. remain unchanged. - CORRECT ANSWER a. decrease, then increase
The volume of the maternal auto transfusion immediately after birth is approximately
a. 600mL
b. 800mL
c. 1000mL - CORRECT ANSWER c. 1000mL
What happens to maternal PaO2 and PaCo2 levels during pregnancy?
a. Both decrease
b. Both increase
c PaO2 increased and PaCO2 decreases - CORRECT ANSWER c. PaO2 increases and PaCO2 decreases
The slight increase in pH that occurs during pregnancy is due to
a. a decrease in hemoglobin and hematocrit
b. a decrease in renal excretion of bicarbonate
c. an increase in ventilatory rate - CORRECT ANSWER c. an increase in ventilatory rate
During pregnancy serum urea and creatine levels
a. decrease
b. increase
c. remain constant - CORRECT ANSWER a. decrease
Heartburn is common during pregnancy due primarily to
a. decreased gastric motility
b. increased secretion of hydrochloric acid
c. relaxation of the lower esophageal sphincter - CORRECT ANSWER c. relaxation of the lower esophageal sphincter
A physical finding that may occur during pregnancy in response to normal cardiovascular changes is
a. decreased heart rate
b. dependent edema
c. elevated blood pressure - CORRECT ANSWER b. dependent edema
The average blood loss during vaginal birth is less than
a. 300mL
b. 500mL
c. 700mL - CORRECT ANSWER b. 500mL
The average blood loss during a cesarean birth is less than
a. 600mL
b. 800mL
c. 1000mL - CORRECT ANSWER c. 1000mL
During pregnancy, cardiac output increases approximately
a. 10-25%
b. 30-50%
c. 60-70% - CORRECT ANSWER b. 30-50%
Cardiac output is greatest during which period of birth process?
a. First stage, active phase
b. Immediately after birth
c. second stage - CORRECT ANSWER b. immediately after birth
A cardiovascular parameter which normally decreases during pregnancy is
a. heart rate
b. stroke volume
c. systemic vascular resistance - CORRECT ANSWER c. systemic vascular resistance
An expected white blood cell count during labor and the early postpartum is
a. 8,000-10,000 mm
b. 13,000-15,000 mm
c. 20,000-22,000 mm - CORRECT ANSWER c. 20,000-22,000 mm
Which of the following coagulation factors does not increase during pregnancy?
a. Fibrin
b. Platelets
c. Fibriogen - CORRECT ANSWER b. Platelets
Which of the following increases during pregnancy?
a. Colloid oncotic pressure
b. Glomerular filtration rate
C. Serum osmolality - CORRECT ANSWER b. Glomerular filtration rate
Colloid oncotic (osmotic) pressure (movement of solutions pressure) Increased pressure pushes protein out of capillary carried away by lymphatics. Reduction in oncotic pressure and increase in filtration across the capillary, resulting in excess fluid build up in the tissue (EDEMA)
By term, blood flow to the uterus is approximately
a. 200mL/min
b. 500mL/min
c. 800mL/min - CORRECT ANSWER b. 500mL/min
During pregnancy, the pigmented line in the skin that traverses the abdomen longitudinally from the sternum to the symphysis is called the
a. linea nigra
b. spider nevus
c. striae gravidarum - CORRECT ANSWER a. linea nigra
Which of the following is a change occurring in the respiratory system during pregnancy?
a. Oxygen consumption increases
b. Respiratory rate decreases
c. Tidal volume decreases - CORRECT ANSWER a. Oxygen consumption increases
A normal finding during pregnancy is
a. glycosuria
b. hematuria
c. proteinuria - CORRECT ANSWER a. glycosuria
The respiratory system parameter that decreases during pregnancy is the
a. functional residual capacity
b. minute ventilation
c. vital capacity - CORRECT ANSWER a. functional residual capacity
A metabolic change characteristic of late pregnancy is decreased
a. blood free fatty acid levels
b. insulin sensitivity
c. serum glucose levels after meals - CORRECT ANSWER b. insulin sensitivity
What is the most common complication of early pregnancy? - CORRECT ANSWER Spontaneous Abortion
What accounts for a large percentage of all spontaneous abortions? - CORRECT ANSWER Chromosome abnormalities
What type of abortion is defined as having three documented (by pathology or ultrasound with heart beat) consecutive spontaneous abortions?
a. Habitual abortion
b. Threatened Abortion
c. Complete Abortion - CORRECT ANSWER a. Habitual abortion
What type of abortion is rare but potentially has lethal complication?
a. Habitual Abortion
b. Incomplete abortion
c. Septic abortion - CORRECT ANSWER c. Septic Abortion
Define abortion? - CORRECT ANSWER Termination of pregnancy by any means, resulting in the expulsion of an immature, nonviable fetus.
What is the actual terminology for any gestation 10 weeks or less? - CORRECT ANSWER Embryo
Which risk factors are known to increase the risk for spontaneous abortion?
a. Advanced Maternal Age
b. alcohol and cigarette smoking
c. previous spontaneous abortion
d. uterine anomalies - CORRECT ANSWER A,B,C,D
Fetal cardiac activity is normally identifiable by ultrasonography at ______ to ______ weeks gestation by crown-rump length measurement. - CORRECT ANSWER 6 to 7
What are 2 disorders of pregnancy that are classified as a threatened abortion? - CORRECT ANSWER Hydatidiform Mole
Ectopic Pregnancy
What should be considered in every patient who has vaginal bleeding and pain in the first trimester?
a. Hydatidiform Mole
b. Ectopic Pregnancy
c. Placenta Previa
d. Complete miscarriage - CORRECT ANSWER b. Ectopic Pregnancy
What is the most common site the fertilized ovum implants during an ectopic pregnancy?
a. cervix
b. abdominal cavity
c. fallopian tube
d. ovary - CORRECT ANSWER c. fallopian tube
What are 5 signs of septic shock that usually follow chills and fevers? - CORRECT ANSWER oliguria
hypotension
tachypnea and tachycardia
mental confusion
warmth & dryness of the extremities (low peripheral resistance)
OR
cold and cyanotic extremities (increased resistance)
Define preterm labor? - CORRECT ANSWER Regular uterine contractions associated with cervical change occurring from 20 - 36 6/7 weeks of gestational age.
What statements about Corticosteriods are true?
a. Reduce the incidence of neonatal respiratory distress and necrotizing enterocolitis
b. Inhibits smooth muscle contraction by inhibiting calcium uptake
c. Repeat rescue dosing in not recommended.
d. Use is limited to 48-72 hours to avoid complications. - CORRECT ANSWER a and c
What statements are true for Indomethacin?
a. Use is limited to 48 -72 hours to avoid complications
b. Pulmonary edema can be a complication
c. It should be avoided or used with caution in patients with diabetes.
d. When given to a woman with a history of preterm birth, it can effetely decrease the incidence in a subsequent pregnancy - CORRECT ANSWER a. Use is limited to 48 - 72 hours to avoid complications.
NSAID - Analgesic
Because NSAIDs may cause premature closure of the ductus arteriosus, product labeling for indomethacin specifically states use should be avoided starting at 30-weeks gestation.
Pulmonary edema can be a complication for this medication?
a. Magnesium Sulfate
b. Nifedipine
c. Progesterone
d. Prostaglandin synthase inhibitors - CORRECT ANSWER a. Magnesium Sulfate
Which medication when given to a woman with a history of preterm birth, it can effectively decrease the incidence in a subsequent pregnancy?
a. Corticosteroids
b. Indomethacin
c. Nifedipine
d. Progesterone - CORRECT ANSWER d. Progesterone
Which B-Sympathominetic is approved by the FDA?
a. Ritodrine
b. Terbutaline - CORRECT ANSWER a. Ritodrine
Which is the most common B-Sympathominetic and is B2 selective?
a. Ritodrine
b. Terbutaline - CORRECT ANSWER b. Terbutaline
Identify the Prostaglandin syntheses inhibitors?
a. aspirin
b. ibuprofen
c. indomethacin
d. ketorolac
e. sulindac - CORRECT ANSWER All listed - NSAIDS
What is the most common calcium channel blocker for tocolysis?
a. Nifedipine
b. Magnesium Sulfate - CORRECT ANSWER a. Nifedipine
What is not a side effect of calcium channel blockers?
a. Headache
b. Dizziness
c. Excessive Thirst
d. Hypotension - CORRECT ANSWER c. Excessive Thirst
What is the gestational age ranges for administration of a corticosteroid to accelerate fetal lung maturity?
a. 24-34
b. 25-33
c. 26-34 - CORRECT ANSWER a. 24-34
True or False - Prophylactic antibiotic therapy in preterm labor is recommended? - CORRECT ANSWER False
Why are prophylactic antibiotics used in labor? - CORRECT ANSWER To prevent GBS sepsis in a postive cultured mom.
Rupture of amniotic membranes before 37 weeks?
a. Prolonged rupture of membranes
b. preterm rupture of membranes
c. premature rupture of membranes - CORRECT ANSWER b. preterm rupture of membranes
Rupture of amniotic membranes before the onset of labor, regardless of gestational age?
a. Prolonged rupture of membranes
b. preterm rupture membranes
c. premature rupture of membranes - CORRECT ANSWER c. premature rupture of membranes
Rupture of amniotic membranes for more that 18 hours?
a. prolonged rupture of membranes
b. preterm rupture membranes
c. premature rupture of membranes - CORRECT ANSWER a. prolonged rupture of membranes
(PAMG-1) placental alpha microglobulin-1 is a protein found at high levels within amniotic fluid. Which test is it measured?
a. Nitrazine Test
b. Ferning Test
c. AmniSure Test - CORRECT ANSWER c. AmniSure Test
Nitrazine Testing relies on the pH of amniotic fluid. What is the pH range that would indicate positive for rupture of membranes?
a. 5.0 - 5.5
b. 5.5 - 6.5
c. 6.5 - 7.0 - CORRECT ANSWER c. 6.5 - 7.0
What 4 substances can give a false positive test?
a. blood
b. semen
c. urine
d. discharge
e. antiseptic cleaning agents - CORRECT ANSWER a, b, c, e
What is the primary factor in the decision to continue conservative management of premature rupture of membranes?
a. LMP
b. Gestational Age
c. AFI
d. Crown Rump Measurement - CORRECT ANSWER b. Gestational Age
After 34 weeks gestation, conservative management of premature rupture of membranes increases the risk for what major concern?
a. DIC
b. Pyelonephritis
c. Chorioamnionits
d. IUGR - CORRECT ANSWER c. Chorioamnionitis
What is the correct dose for Dexamethasone?
a. 12 mg IM x 1
b. 6 mg IM x 2 (q 24 hours)
c. 6 mg IM x 4 (q 12 hours)
d. 12 mg IM x 4 (q 12 hours) - CORRECT ANSWER c. 6 mg IM x 4 (q 12 hours)
What test needs to be confirmed before a digital examination can be done of a patient with vaginal bleeding in the third trimester?
a. Ultrasound
b. BPP
c. Reative NST
d. KB - CORRECT ANSWER a. Ultrasound to confirm no placenta previa
In an Rh negative woman with vaginal bleeding, what media should be administered to protect against sensitization? - CORRECT ANSWER Rhogam - Anti-D Immunoglobulin
Why would a Kleihauer-Betke test be ordered? - CORRECT ANSWER This test is used to quantify fetal to maternal hemorrhage
What characteristics is not associated with placental abruption?
a. Vaginal Bleeding
b. Abnormal implantation
c. Pain
d. Fetal Malpresentation - CORRECT ANSWER b. Abnormal implantation
True or False - Vaginal bleeding is always a noticeable clinical symptom of placental abruptions? - CORRECT ANSWER False - 20% of placental abruptions can be concealed
An Apt test is done a woman at 32 weeks gestation with vaginal bleeding. The blood turns brown. This means the blood is:
a. Fetal
b. Maternal - CORRECT ANSWER b. Maternal
The risk of placental abruption is higher in women with a history of:
a. hypertension
b. nulliparity
c. previous cesarean delivery - CORRECT ANSWER a. hypertension
A women has a mild placental abruption and preterm labor. The tocolytic of choice is:
a. Nifedipine
b. Magnesium Sulfate
c. Terbutaline - CORRECT ANSWER a. Nifedipine
Define the categories of placenta previa?
Total (Complete)
Partial (Incomplete)
Marginial - CORRECT ANSWER Total - entire internal cervical os is covered by placenta
Partial - part of internal cervical os is covered by placenta
Marginal - placental edge extends w/in 2 cm of the internal cervical os.
Describe the clinical presentation of vasa previa? - CORRECT ANSWER Catastrophic fetal bleeding occurs when the cervix starts to dilate. Vaginal bleeding noted and fetal distress witnessed.
Vasa previa occurs when fetal blood vessels travel within the membranes, usually as a velametous insertion, and in so doing , cross the region of the internal cervical os.
In the presence of hemorrhagic shock due to bleeding from a placental abruption, fluid replacement should be quickly administered in the form of.
a. crystalloid
b. normal saline
c. packed red blood cells - CORRECT ANSWER a. crystalloid
3ml for every mL of blood lost while waiting for blood products.
G2P1001 who is 1-2 cm with contractions q 5-10 minutes; 18 hours later exam is unchanged.
a. Prolonged latent phase
b. Prolonged second stage
c. Protraction disorder of the active phase
d. Secondary arrest of labor - CORRECT ANSWER a. Prolonged latent phase
Multiparous greater than 14 hours
Nullipara who is C/C/+1 at 0300; then C/C/+2 at 0530 - no epidural
a. prolonged latent phase
b. prolonged second stage
c. protraction disorder of the active phase
d. secondary arrest of labor - CORRECT ANSWER b. prolonged second stage
Nullipara without epidural greater than 1 hour
G3P2002 who is 6 cm at 0500 at 6 cm at 0715
a. prolonged latent phase
b. prolonged second stage
c. protraction disorder of the active phase
d. secondary arrest of labor - CORRECT ANSWER d. secondary arrest of labor
No cervical dilation after 2 hours in active labor with adequate contractions.
Primigravida at 5 cm dilated at 0800; then 6 cm dilated at 1000
a. prolonged latent phase
b. prolonged second stage
c. protraction disorder of the active phase
d. secondary arrest of labor - CORRECT ANSWER c. protraction disorder of the active phase
Slow progression of labor
What are the 3 P's? - CORRECT ANSWER Power - uterine contractions and maternal effort
Passenger - fetal size, presentation and position
Passage - Pelvis size and soft tissues
List 3 benefits of amniotomy in the event of uterine disfunction? - CORRECT ANSWER 1. Reduction in labor duration
2. Reduction in abnormal 5 minute apgars
3. Decreased need of oxytocin
When a fetus has a partially deflexed vertex presentation the presentation is called:
a. asynclitism
b. brow
c. face - CORRECT ANSWER b. brow
After what week is external version attempted?
a. 34 wks
b. 36 weeks
c. 37 weeks
d. 38 weeks - CORRECT ANSWER c. 37 weeks
What are 2 maternal criteria that must be met before external version for breech presentation should be attempted?
a. Normal AFI
b. Reactive BPP
c. Normal Liver enzymes
d. Reactive NST - CORRECT ANSWER a. Normal AFI
d. Reactive NST
What are 3 contraindication to external version?
a. Placenta previa, fetal anomalies, non reassuring NST
b. breech presentation, fetal anomalies, reactive NST
c. vaginal bleeding, GBS positive, Category 3 tracing
d. Uterine contractions, rectal pressure, flu like symptoms. - CORRECT ANSWER a. Placental previa, fetal anomalies, non reassuring NST
What maternal or fetal complications are associated with vacuum extraction?
a. skull fracture, cervical lacerations, hemorrhage
b. recurrent UTI, intracranial or retinal hemorrhage
c. scalp or facial lacerations, perineal laceration, leg drop
d. urinary retention, pelvic hematoma, small gestation age infant - CORRECT ANSWER a. skull fracture, cervical laceration, hemorrhage
What are some common maternal complications of cesarean birth? - CORRECT ANSWER 1. hemorrhage
2. injury to bladder, bowel, ureters, blood vessels, nerves, cervix
3. infection
4. Thromboembolic event
5. Anes complications
6. Post OP illness or bowel obstruction
7. Wound complication
8. Placenta Accreta/ or previa in subsequent pregnancies
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What are some common fetal complication of cesarean birth? - CORRECT ANSWER a. iatrogenic prematurity
b. transient tachypnea of the newborn
c. fetal laceration
Define Gestational Hypertension - CORRECT ANSWER New onset elevated BP > or = to 140/90 on 2 separate occasions at least 4 hours apart after 20 weeks gestation in a patient with previously normal blood pressures. BP returns to normal postpartum. [Show Less]