NSG 504 Exam 2 Questions with Correct
Answers
1. why is there such a high rate of C-sections in the US - ANSWER indicated,
"defensive medicine", elective cesareans without indication, more medical
interventions during labor, fewer vacuum/forceps births, fewer VBACs
2. indications for c-section - ANSWER maternal: dystocia, severe
preeclampsia, heart disease, active HSV, placenta previa, increased ICP,
obstruction of vaginal opening, previous uterine surgery with vertical
incision (classical), placental abruption or previa, elective repeat cesarean
fetal: abnormal FHR pattern, fetal malpresentation, congenital anomalies
maternal-fetal: CPD
3. benefits of cesarean - ANSWER less chance of fetal birth injury, less risk for
maternal perineal lacerations, less maternal urinary/fecal incontinence for
the 1st 6 months pp, convenience, absence of labor pains
4. cesarean risks - ANSWER mom: surgery, increased risk in future
pregnancies, longer recovery, higher cost, pain post-op, perceived maternal
poor birth experience/postpartum depression newborn: inadvertent late-
preterm birth (wait until 39 weeks in case the calculations were off), injury
(laceration), temporary respiratory problems, admission to NICU, risk of
delayed breastfeeding
,5. c-section incision - ANSWER low transverse (lowest risk of uterine rupture
for next pregnancy), low vertical, or classic (highest risk of uterine rupture
but better visualization and quicker)
6. c-section post op assessments - ANSWER routine post-op care plus 4th
stage of labor assessments q 15 minutes for the 1st hour then q 30 minutes
for the 2nd hour then q hour
7. recommended folic acid intake - ANSWER low-risk - 0.5 mg
8. high-risk (e.g. taking antiepileptics) - 4 mg
9. advanced maternal age and risk for down syndrome - ANSWER 35-40: 4x
risk
40-48: 10x risk
10.edward's syndrome - ANSWER trisomy 18, 2nd most common
chromosomal abnormality; most die
11.fetal kick counts - ANSWER fetal alarm system - directly reflects the health
of the CNS & stopping or slowing of movement may be in response to
hypoxia
healthy = 10 kicks in <2 hours
begin kick counts at 28 weeks
12.ultrasound-doppler flow studies - ANSWER used to study the circulation
between the fetus, placenta and uterus; flow in umbilical arteries should be
in the forward direction in normal circumstances; absent and reverse end-
diastolic flow represent a worsening environment for the fetus
,13.MRI - ANSWER good for observing the quantity of amniotic fluid, size of
baby, soft-tissue anomalies
14.amniotic fluid - ANSWER average is 1000 mL at term with a peak at 34
weeks; mostly water, 1-2% electrolytes, glucose, hormones, fetal cells,
lanugo, vernix; it's basically fetal pee and is absorbed into the fetal lungs or
digestive tract with swallowing (200 cc/day at term); promotes symmetric
development and keeps membranes from adhering to the developing parts;
cushions against impact, provides a stable temperature, contains antibacterial
factors
15.oligohydramnios - ANSWER AFI < 5; associated with poor fetal lung
development, malformations, fetal variable decels, IUGR, prolonged
pregnancy, chronic hypoxia or reduced placental blood flow
16.polyhydramnios - ANSWER AFI > 15; neural tube defects, cardiac, GI tract,
or Down syndrome; also associated with maternal diabetes --> fetal polyuria
17.coombs test - ANSWER screening test for Rh incompatibility performed at
28 weeks
18.1st trimester screening - ANSWER combined maternal serum blood test and
ultrasound performed between 11-13 weeks so parents can decide if they
want to terminate the pregnancy
19.alpha-fetoprotein - ANSWER done between 15-20 weeks and may detect
trisomy 21 and 18
, 20.quad/penta screen - ANSWER 15-20 weeks gestation; increases detection of
trisomy 21 or 18; includes MSAFP, alpha-hCG, unconjugated estriol,
inhibin A, h-hCG
21.cell-free DNA analysis - ANSWER most accurate (sensitive and specific)
test for trisomy 21, 18, and 13 and sex chromosome aneuploidies; very
expensive and most insurance does not cover
22.chorionic villus sampling - ANSWER invasive - tissue is taken from the
fetal side of the placenta either transcervically or transabdominally;
performed between 9-12 weeks
23.amniocentesis - ANSWER performed at 16 weeks gestation; can detect open
ntd's, degree of Rh isoimmunization, presence/type of intrauterine infection,
can relieve polyhydramnios, determine fetal lung maturity; may also be
performed in 2nd or 3rd trimester
indications: advanced maternal age, history of chromosomal abnormalities, sex
determination for an X-linked disorder, maternal Rh sensitization, r/o
chorioamnionitis, recurrent pregnancy loss
24.percutaneous umbilical sampling (pubs) - ANSWER cordocentesis;
performed in the second to third trimesters; most widely used method for
fetal blood sampling and transfusion; high risk to fetus
25.non-stress test (NST) - ANSWER tests pH and fetal neurological status;
indirect measure of utero-placental function; non-invasive, rapid results;
high rate of false positives, fetal sleep most common reason, need to
consider age of fetus when interpreting tracing, expensive
26.a reassuring NST - ANSWER reactive; 2 accelerations of 15 beats above
baseline for at least 15 seconds over a 20-minute period
Answers
1. why is there such a high rate of C-sections in the US - ANSWER indicated,
"defensive medicine", elective cesareans without indication, more medical
interventions during labor, fewer vacuum/forceps births, fewer VBACs
2. indications for c-section - ANSWER maternal: dystocia, severe
preeclampsia, heart disease, active HSV, placenta previa, increased ICP,
obstruction of vaginal opening, previous uterine surgery with vertical
incision (classical), placental abruption or previa, elective repeat cesarean
fetal: abnormal FHR pattern, fetal malpresentation, congenital anomalies
maternal-fetal: CPD
3. benefits of cesarean - ANSWER less chance of fetal birth injury, less risk for
maternal perineal lacerations, less maternal urinary/fecal incontinence for
the 1st 6 months pp, convenience, absence of labor pains
4. cesarean risks - ANSWER mom: surgery, increased risk in future
pregnancies, longer recovery, higher cost, pain post-op, perceived maternal
poor birth experience/postpartum depression newborn: inadvertent late-
preterm birth (wait until 39 weeks in case the calculations were off), injury
(laceration), temporary respiratory problems, admission to NICU, risk of
delayed breastfeeding
,5. c-section incision - ANSWER low transverse (lowest risk of uterine rupture
for next pregnancy), low vertical, or classic (highest risk of uterine rupture
but better visualization and quicker)
6. c-section post op assessments - ANSWER routine post-op care plus 4th
stage of labor assessments q 15 minutes for the 1st hour then q 30 minutes
for the 2nd hour then q hour
7. recommended folic acid intake - ANSWER low-risk - 0.5 mg
8. high-risk (e.g. taking antiepileptics) - 4 mg
9. advanced maternal age and risk for down syndrome - ANSWER 35-40: 4x
risk
40-48: 10x risk
10.edward's syndrome - ANSWER trisomy 18, 2nd most common
chromosomal abnormality; most die
11.fetal kick counts - ANSWER fetal alarm system - directly reflects the health
of the CNS & stopping or slowing of movement may be in response to
hypoxia
healthy = 10 kicks in <2 hours
begin kick counts at 28 weeks
12.ultrasound-doppler flow studies - ANSWER used to study the circulation
between the fetus, placenta and uterus; flow in umbilical arteries should be
in the forward direction in normal circumstances; absent and reverse end-
diastolic flow represent a worsening environment for the fetus
,13.MRI - ANSWER good for observing the quantity of amniotic fluid, size of
baby, soft-tissue anomalies
14.amniotic fluid - ANSWER average is 1000 mL at term with a peak at 34
weeks; mostly water, 1-2% electrolytes, glucose, hormones, fetal cells,
lanugo, vernix; it's basically fetal pee and is absorbed into the fetal lungs or
digestive tract with swallowing (200 cc/day at term); promotes symmetric
development and keeps membranes from adhering to the developing parts;
cushions against impact, provides a stable temperature, contains antibacterial
factors
15.oligohydramnios - ANSWER AFI < 5; associated with poor fetal lung
development, malformations, fetal variable decels, IUGR, prolonged
pregnancy, chronic hypoxia or reduced placental blood flow
16.polyhydramnios - ANSWER AFI > 15; neural tube defects, cardiac, GI tract,
or Down syndrome; also associated with maternal diabetes --> fetal polyuria
17.coombs test - ANSWER screening test for Rh incompatibility performed at
28 weeks
18.1st trimester screening - ANSWER combined maternal serum blood test and
ultrasound performed between 11-13 weeks so parents can decide if they
want to terminate the pregnancy
19.alpha-fetoprotein - ANSWER done between 15-20 weeks and may detect
trisomy 21 and 18
, 20.quad/penta screen - ANSWER 15-20 weeks gestation; increases detection of
trisomy 21 or 18; includes MSAFP, alpha-hCG, unconjugated estriol,
inhibin A, h-hCG
21.cell-free DNA analysis - ANSWER most accurate (sensitive and specific)
test for trisomy 21, 18, and 13 and sex chromosome aneuploidies; very
expensive and most insurance does not cover
22.chorionic villus sampling - ANSWER invasive - tissue is taken from the
fetal side of the placenta either transcervically or transabdominally;
performed between 9-12 weeks
23.amniocentesis - ANSWER performed at 16 weeks gestation; can detect open
ntd's, degree of Rh isoimmunization, presence/type of intrauterine infection,
can relieve polyhydramnios, determine fetal lung maturity; may also be
performed in 2nd or 3rd trimester
indications: advanced maternal age, history of chromosomal abnormalities, sex
determination for an X-linked disorder, maternal Rh sensitization, r/o
chorioamnionitis, recurrent pregnancy loss
24.percutaneous umbilical sampling (pubs) - ANSWER cordocentesis;
performed in the second to third trimesters; most widely used method for
fetal blood sampling and transfusion; high risk to fetus
25.non-stress test (NST) - ANSWER tests pH and fetal neurological status;
indirect measure of utero-placental function; non-invasive, rapid results;
high rate of false positives, fetal sleep most common reason, need to
consider age of fetus when interpreting tracing, expensive
26.a reassuring NST - ANSWER reactive; 2 accelerations of 15 beats above
baseline for at least 15 seconds over a 20-minute period
