OB Inpatient Certification Test 123 Questions with Verified Answers
The [_____] is considered the pathogenic focus for all manifestations of pre-e -
... [Show More] CORRECT ANSWER Placenta
(Regarding Pre-e): Increased sensitivity to Angiotensin II leads to [-------] and [------] - CORRECT ANSWER Vascular damage & arteriolar vasoconstriction and systemic vasospasm
A [---------] measurement is recommended for all pregnant women with HTN - CORRECT ANSWER 24-hr urinary protein measurement
Thrombocytopenia is present when platelets are low: [-------], and severe: [------] - CORRECT ANSWER Low platelets: less than 100,000/mm3, severe platelets: less than 50,000/mm3
In severe pre-e, urine output decreases to less than [---]ml in 24hrs - CORRECT ANSWER 400ml
(Regarding pre-e): Arteriolar vasospasms damage the [-----] layer of small blood vessels, causing lesions --> [-----] accumulate at lesions sites and fibrin network forms--> RBCs are forced through the network under high pressure, resulting in [------] - CORRECT ANSWER Arteriolar vasospasms damage the endothelial layer..... platelets accumulate at lesions..... resulting in hemolysis
With regards to HELLP, Hemolysis can be identified by looking for (4): - CORRECT ANSWER 1) falling hematocrit
2) hyperbilirubinemia (>1.2mg/dl)
3) Increased LDH
4) Jaundice including sclerae
With regards to HELLP, Elevated Liver Enzymes can be identified by looking for (5): - CORRECT ANSWER 1) Increased LDH
2) Increased AST/ALT
3) Feeling Malaise
4) Viral-like symptoms
5) RUQ pain
With regards to HELLP, Low Platelets can be identified by looking for (2): - CORRECT ANSWER 1) falling platelet count (low: <100,000, severe: <50,000)
2) Abnormal coagulation and fibrinolytic values
You do not need to diagnose [-------] in order to diagnose HELLP - CORRECT ANSWER Preeclampsia
The definitive treatment of for preeclampsia is .... - CORRECT ANSWER delivery
The primary goals of management of pre-e are: (4) - CORRECT ANSWER 1) Prevent convulsions through use of Mag Sulfate
2) Ensure adequate kidney functions
3) Monitor fetal status continuously for signs of uteroplacental insufficiency
4) To stabilize the women so vaginal/cesarean birth can be accomplished
A women with preeclampsia might experience a reduced plasma volume, and a [--------] diet can worsen the situation - CORRECT ANSWER a salt-restricted diet
In nursing management of a women with preeclampsia, BPs should be ..... - CORRECT ANSWER taken in the same position on the left arm, horizontal with the heart
In nursing management of a women with preeclampsia, oliguria is [-------] and is an [-----] sign - CORRECT ANSWER oliguria is output less than 30ml/hr for 2hrs.... and is an ominous sign
In nursing management of a women with preeclampsia, limit fluid administration to no more than [-----] or [--]ml/kr/hr - CORRECT ANSWER no more than 150ml/hr, or 1ml/kg/hr
Magnesium sulfate is given for [-------] therapy, it is note given to treat [------] - CORRECT ANSWER Magnesium sulfate is given for anticonvulsant therapy, not to treat hypertension
The therapeutic range of magnesium sulfate is between [-------] - CORRECT ANSWER between 4 to 7 mEq/L
The antidote to Magnesium toxicity is [-----] - CORRECT ANSWER Calcium gluconate
Current recommendations for antihypertensive therapy include these 3 medications: - CORRECT ANSWER 1) Hydralazine (Apresoline- arteriolar dilator)
2) Labetalol (Adrenergic blocker)
3) Nifedipine (Calcium entry blocker)
The preeclamptic women maintained on therapeutic levels of Mag Sulfate is at risk for [-------] after delivery, this is of great concern because she is already experiencing reduced [----] and [-----] - CORRECT ANSWER At risk for postpartum hemorrhage after delivery... she is already experiencing reduced blood volume and hemoconcentration
HTN during the last 20weeks of pregnancy or in the first 24hrs postpartum without other signs of preeclampsia - CORRECT ANSWER Transient Hypertension
A term sometimes used to designate expectant women who have elevated BP after 20 weeks but without accompanying proteinuria - CORRECT ANSWER Gestational Hypertension
A subset of preeclampsia - CORRECT ANSWER HELLP syndrome
Sometimes seen in normotensive women within the first hours after delivery but with a subsequent return to baseline BP levels within 24 hrs. - CORRECT ANSWER Transient Hypertension
The development of a BP higher than 140/90 mmHG or higher after the 20th week of pregnancy and accompanied by proteunuria - CORRECT ANSWER Preeclampsia
Occurs before the 20th week of gestation in the presence of pathologic changes in the placenta - CORRECT ANSWER Preeclampsia
A disorder that can begin with implantation, but has no overt signs or symptoms for weeks or even months - CORRECT ANSWER Preeclampsia
Exists in a severe form when BP reaches 160/110 mmHg or higher - CORRECT ANSWER Preeclampsia
Can occur in women who enter pregnancy with preexisting HTN - CORRECT ANSWER Superimposed Preeclampsia
Has as its underlying pathophysiology arterial vasospasm leading to microangiopathic hemolytic anemia - CORRECT ANSWER HELLP Syndrome
Is accompanied by convulsions nots caused by neurologic disease - CORRECT ANSWER Eclampsia
Is diagnosed with a history of persistent BP elevation of at least 140/90 mmHG before the 20th week of gestations - CORRECT ANSWER Chronic hypertension
Convulsions can occur in the presence of mildly elevated BP or mild preteinuria - CORRECT ANSWER Ecplamsia
The presence of this hypertensive disorder, together with DM, renal disease, or a cardiac condition, increases the mother's risk - CORRECT ANSWER Chronic hypertension
[--]% of all adolescent and adult HIV infections worldwide are the result of heterosexual transmission - CORRECT ANSWER 90%
HIV-1 is predominate in [----] and HIV-2 is predominate in [-----]. - CORRECT ANSWER HIV-1 in American, HIV-2 in West Africa
The impact of the HIV infection is related to its effect on the normal function of [-----] cells. These cells play an essential role in orchestrating the body's [-----]. - CORRECT ANSWER The normal function of CD4+T cells, which play an important role in the body's immune function.
The standard algorithm for HIV testing consists of:
1) an initial screening with a sensitive [--------]
2) followed by confirmation with the [------] - CORRECT ANSWER 1) An initial screening with the EIA (enzyme immunosorbent assay)
2) Followed by confirmation with the Western blot test
The average time to develop detectable HIV antibodies to provide results with the EIA test is [----] - CORRECT ANSWER 25 days
Western blot tests are reported as,
1) Unequivocal positive: [---]
or 2) Indeterminate: [----] - CORRECT ANSWER 1) Unequivocal positive: HIV infected-- the antibody-positive serum reacts with all nine viral antigens
2) Indeterminate: not enough detectable antibodies, recommended to retest in 1 month, until 6mos-- indeterminate for >6mo = not HIV positive
When used together, the EIA and Western blot test are greater than [--]% accurate - CORRECT ANSWER >99% accurate
The OraQuick HIV-1 Antibody test and the SUDS HIV-1 test are [---------] when compared to the EIA and the sensitivity and specificity are higher than [--]%. - CORRECT ANSWER OraQuick and SUDS are easier to perform and results can be obtained within a few hours.... the sensitivity and specificity are higher than 99%.
Examples of Horizontal transmission of HIV: (4) - CORRECT ANSWER - sexual contact
- sharing drug needles
- blood transfusion of HIV+ blood
- inadvertent contamination of mucous membranes/breaks in skin
Examples of Vertical transmission of HIV: - CORRECT ANSWER vertical transmission occurs when the virus is passed from the mother to her infant during the perinatal period--- generally believed to occur most often in late pregnancy
Treatment with [----] and a cesarean section have reduce vertical transmission rates to less than [--]% - CORRECT ANSWER Treatment with ZDV and a cesarean section have reduced vertical transmission to less than 2%.
The viral load is a measurement of the magnitude of active HIV replication and correlates with... - CORRECT ANSWER The viral load correlates with the risk of perinatal transmission
Reducing exposure of the fetus to HIV during intrapartum period by: (4) - CORRECT ANSWER 1) Do NOT use FSE
2) Do NOT perform fetal pH scalp sampling
3) Do NOT give injections/eye prophylaxis until maternal body fluids have been removed
4) Do NOT cut the cord using maternal-contaminated instruments
HIV [---] be transmitted through breastfeeding - CORRECT ANSWER HIV CAN be transmitted through breastfeeding-- 44% of infections are the result of breastfeeding
HIV exposed infants should be tested [----] and HIV infection can be diagnosed in most infants by [--] month, and virtually all by [--] months. - CORRECT ANSWER HIV exposed infants should be exposed between birth and 14 days of life... month can be diagnosed by 1mo, virtually all can be diagnosed by 6mo.
In an HIV infected women, as long as mother and infant are stable, the primary focus in the postpartum period should be [-----] - CORRECT ANSWER on the promotion of bonding
During pregnancy, [--]% of all cases of diabetes are women with gestational diabetes - CORRECT ANSWER 90%
If glycemia control is poor during the first trimester during organogenesis, [----] or [----] can occur. - CORRECT ANSWER congenital anomalies or miscarriage can occur
If glycemia control is poor during the 2nd and 3rd trimester, [--------] occur - CORRECT ANSWER metabolic consequences occur
Type 1 DM occurs in [--]-[--]% of the population and type 2 DM accounts for [--]-[--]% - CORRECT ANSWER Type 1: 5-10%; Type 2: 90-95%
Gestational DM: glucose tolerance is [---------------], and the occurrence of GDM [---] the future risk of DM2. - CORRECT ANSWER Gestational DM- glucose tolerance is first discovered/developed during pregnancy, and the occurrence of GDM INCREASES the future risk of DM2.
Gestational Diabetes is a result of .... - CORRECT ANSWER result of the combination of insulin resistance and a diminished insulin secretion.
Pregnancy hormones, such as (5) [-----------] are responsible for the [---insulin----] that is found later in pregnancy as the fetal-placental unit grow - CORRECT ANSWER Pregnancy hormones, such as HPL, estrogen, progesterone, cortisol, and prolactin are responsible for the INCREASE IN INSULIN RESISTANCE that is found....
In women with preexisting DM, near the end of the first trimester insulin needs [----], and then [-----] during the 2nd and 3rd trimester, eventually [-------]. - CORRECT ANSWER ...near the end of the first trimester, insulin needs may slightly decrease, then STEADILY INCREASE during the 2nd and 3rd trimester, eventually INCREASING 2-3x pre-pregnancy needs.
[-----------] complicated with diabetes is a potential contraindication to pregnancy - CORRECT ANSWER Coronary Artery Disease
The most common cause of DKA is [---] - CORRECT ANSWER The most common cause of DKA is infection
Hyperglycemia is the 2d/3d trimester causes an increase in fetal [-------], leading to LGA [> ----gm] and [-----]. - CORRECT ANSWER ...causes an increase in fetal insulin production, leading to LGA (>4000gm) and Macrosomia.
In a nondiabetic patient, by 37weeks infant have mature pulmonary profiles, but in diabetic patients this occurs at [--]. - CORRECT ANSWER 39 weeks
Hypoglycemia is a term infant is [----] and in a preterm infant is [-----]. - CORRECT ANSWER Hypoglycemia in a term infant is plasma glucose level of less than 35mg/dl, and less than 25mg/dl in a preterm infant
The peak incidence of hypoglycemia is [--] to [----] after birth - CORRECT ANSWER 6-12hrs
In DM mothers, HbA1C should be done... - CORRECT ANSWER every 4-6 weeks to monitor glucose control
The three hallmarks in the treatment of DM during pregnancy include: - CORRECT ANSWER - Medical Nutritional Therapy
- Exercise
- Insulin Therapy
As a general rule, diabetic women should be delivered between [--]- [--]weeks. - CORRECT ANSWER 39-40weeks
If a diabetic women is being delivered before [--] an amniocentesis should be performed to determine [---------] - CORRECT ANSWER before 39weeks, an amniocentesis should be performed to determine fetal lung maturity
A cesarean delivery is recommended if the estimated fetal weight is... - CORRECT ANSWER ...greater than 4,500 gm
GDM patients are at risk for (4): - CORRECT ANSWER - Preeclampsia and HTN disorders
- Polyhydramnios
- Cesarean section because of fetal macrosomia
- Excessive weight gain
Long term complication for offspring of GDM pregnancies include.. - CORRECT ANSWER ... increased risk for obesity and impaired glucose tolerance (DM later in life)
Results of a 1hr Glucose Challenge Test (GCT) greater than [---] requires further testing; greater than [---] requires immediate tx for GDM - CORRECT ANSWER >140mg/dl requires a 3hr-GCT; > 200mg/dl requires immediate tx for GDM
The 1hr- GCT should be performed... - CORRECT ANSWER ...between 24-28 weeks gestation
Recommended blood glucose levels are:
- fasting: [--]
- 1hr postprandial: [--] - [--]
- 2hr posprandial: [--] - [--] - CORRECT ANSWER - fasting: <95mg/dl
- 1hr PP: < 130-140mg/dl
- 2hr PP: <140mg/dl
Glyburide can be used an alternative to .... - CORRECT ANSWER ...insulin therapy
The starting dose of glyburide is [--]mg, with a max dose of [--]mg. - CORRECT ANSWER starting is 2.5mg, max dose is 10mg
GDM should begin fetal kick counts at... - CORRECT ANSWER ... 28weeks.
"Count to 10" Technique - CORRECT ANSWER Time how long it takes to feel 10 fetal movements. If more than 2hrs, call your doctor.
A major risk factor during delivery of all DM patients is.. - CORRECT ANSWER ... shoulder dystocia
Indications of shoulder dystocia include: (4) - CORRECT ANSWER - fetal weight >4,000gm
- a dysfunctional labor curve
- a prolonged second stage
- the "turtle sign" during the delivery of the head
The hbA1C reflects glucose control over the past [--] - [--] weeks. A normal HbA1C is [--] - [--]% - CORRECT ANSWER the past 4-6 weeks, and normal values are 4-6%
During a delivery in the absence of a Provider, why do you ask the woman to feather blow? - CORRECT ANSWER Feather blowing helps control the urge to push and helps with a controlled delivery with gradual stretching of perineal tissue
When delivering a placenta in a absnce of a provider, you should... - CORRECT ANSWER ... not manipulate in any way. Do not tug on the cord or massage the uterus.
In a provider absent delivery, if suprapubic pressure is needed, the RN should push down on the side the fetal [----] is facing - CORRECT ANSWER fetal back
In a provider absent delivery, if the infant has mec stained the fluid, the RN should suction... - CORRECT ANSWER ... Once the fetal head is delivered with a bulb syringe
In a provider absent delivery, if there is uterine atony or retained pieces of placenta, the RN can (4) - CORRECT ANSWER 1) Massage the top of the uterus
2) Give Oxygen
3) Increase IV fluids rate
4) Record BP and pulse
In a provider absent BREECH delivery, the RN should use a towel to [----------], and to be sure to avoid [-------] - CORRECT ANSWER The RN should use a towel to lift the baby to delivery the shoulder, lower the body until the hairline is visible, and then raise the body once the hairline is visible. And be sure to avoid excessive handing of the baby and cord.
The first step to help the newborn transition to life out the womb is: - CORRECT ANSWER preventing heat loss
The 5 components of an APGAR score - CORRECT ANSWER Heart rate, respiratory rate, muscle tone, reflex irritability, and color
How do these factors cause variations in APGAR scores?
- Gestational Age
- Intubation/cord visualization
- Congenital defects
- Infection - CORRECT ANSWER - GA: Apgar are not appropriate for infants less than 31-34wk due to expected lack of tone and irritability
- Intubation: causes stimulation of the vagus nerve, which lowers heartrate-- should return to WNL on its own
- Congenital defects: The low apgars might not indicated need for resuscitation (expected palsy, etc)
- Infection: infection can affent tone, color, and reflexes.
In cord gases, the arterial values reflect [------] and the venous values reflect [--------] - CORRECT ANSWER Arterial values reflect fetal well-being, and venous values reflect placental function.
The term "Asphyxia" should only be applied to infant who:
- Have [----] or [------] acidemia (pH<7.0)
- Have an APGAR score < [-----] for 5+min
- Neonatal neurologic manifestations, such as [-------------] - CORRECT ANSWER - Have METABOLIC or MIXED acidemia
- Have apgar less than 3 for 5+min
- Neurologic manifestations: SEIZURES, COMA, POOR TONE, MULTISYSTEM ORGAN FAILURE
In the immediate pospartum period, the fundus should be - CORRECT ANSWER 2cm below the umbilicus
Within 12hr PP, the fundus should be approx. [---] the umbilicus, and by 24hrs PP the fundus should be approx. [----] the umbilicus - CORRECT ANSWER 12hrs: +1 cm
24hrs: at umbulicus
Involution: - CORRECT ANSWER The descent of the fundus in the PP period, approx. 1cm Q24hrs
Common cause of PP fever: - CORRECT ANSWER dehydration after lengthy labor with inadequate fluid intake
Clinical situations that predispose a newly PP woman to atony: (5) - CORRECT ANSWER - prolonged labor
- induction/augmentation
- Mag. Sulfate use
- Large infant/multiples
- C/S under general anesthesia
In most cases, PP hemorrhage related to uterine atony [--------] be predicted before delivery - CORRECT ANSWER uterine atony CANNOT be predicted
When massaging a boggy uterus, position the women... - CORRECT ANSWER ...with her head supine and her knees flexed
Malpractice - CORRECT ANSWER is PROFESSIONAL negligence, improper discharge of professional duties, or failure to meet the standard of care
Neligence - CORRECT ANSWER is the failure to act as a reasonable and prudent person
What are the four key elements of professional negligence suits? - CORRECT ANSWER - duty
- breach of duty
- damages
- causation
When documenting telephone triage, be sure to document the patients... - CORRECT ANSWER RESPONSE to the instructions (ex: will not comply)
The three components of informed consent: - CORRECT ANSWER capacity, information, voluntariness
Regarding informed consent, "capacity" means.. - CORRECT ANSWER refers to the person's age and competence
Regarding informed consent, "information" means... - CORRECT ANSWER The content of the explanation given to the patient
Regarding informed consent, "voluntariness" means... - CORRECT ANSWER refers to the circumstances surrounding the individual giving consent. There can not be force, fraud, duress, or collusion present.
Consent must be obtained whenever you [------].. Your failure to obtain consent constitutes battery. - CORRECT ANSWER Consent must be obtained whenever you TOUCH THE PATIENT. Your failure to obtain consent constitutes battery
Define, addendum - CORRECT ANSWER The accurate information entered when an error is fixed in the chart
JCAHO has identified [----------] as the primary cause of infant death and injury - CORRECT ANSWER Miscommunication among caregivers
"Outborn neonates" vs "Inborn neonates" - CORRECT ANSWER outborn infants are infant born at a Level I or II hospital that are transfered into a Level III hospital for further/more extensive care.
Transfer of patients in early labor is recommended in the following circumstances: - CORRECT ANSWER - Transport will take <2hr
- Mother is stable
- Delivery is not anticipated for 4-6hrs
- A professional attendant (flight nurse, Dr., experience EMT) can accompany her
During a cord prolapse, why should you not handle the cord? - CORRECT ANSWER It can cause the cord to spasm and shut off fetal blood supply
Shoulder dystocia occurs when fetal head is delivered, but the anterior shoulder is stuck in the... - CORRECT ANSWER PUBIC ARCH
The fetal pH drops by an estimated [------] during delivery of the trunk (shoulder dystocia) - CORRECT ANSWER fetal pH drops by an estimated 0.14 per minute
The first two interventions in the event of a shoulder dystocia - CORRECT ANSWER McRoberts and Suprapubic pressure
Can an amniotic fluid embolism be predicted or prevented? - CORRECT ANSWER AFE is considered an unpredictable and unpreventable event and the cause it unknown
One unit of packed red blood cells is expected to raise the hematocrit by - CORRECT ANSWER 3% per unit
One unit of platelets is expected to raise the platelet count - CORRECT ANSWER by 5,000-10,000 per unit
Definitive diagnosis of placental abruptions comes - CORRECT ANSWER with inspection of the placenta after delivery
When there is more than [--]% separation of the placenta, the risk for fetal death is high. - CORRECT ANSWER 50%
There is significant risk for coagulopathy, such as [----], if the infant is dead - CORRECT ANSWER such as DIC [Show Less]