TEST BANK FOR RNC-OB Exam 2023/24 LATEST UPDATE

TEST BANK FOR RNC-OB Exam 2023/24 LATEST UPDATE 1. Late in pregnancy, a patient often develops supine hypotension because of a. partial occlusion of the vena cava and aorta. b. decreased peripheral collateral circulation. c. increased blood flow to the placenta. - A because of partial occlusion of the vena cava and aorta from the weight of the uterus. This impedes venous return from the lower extremities although increased collateral circulation during pregnancy helps to compensate. Remaining in the supine position for long periods of time could decrease fetal oxygenation as well. The lateral recumbent position relieves the pressure on the vena cava and aorta, allowing the blood pressure to increase and symptoms to decrease. The nurse must educate the new mother that a contraindication to breast feeding is a. fetal macrosomia. b. type II diabetes. c. infection with HIV/AIDS. - C Some maternal contraindications to breastfeeding include: -Infection with HIV/AIDS -Use of antiretroviral medications -Active TB not treated -Infection with human T-cell lymphotropic virus -Illicit drug use -Use of chemotherapeutic agents -Radiation therapy (may require only interruption during treatment) -Use of other medications that pass into the breast milk and may harm the child -Presence of herpes on the breast -Presence of varicella lesions on the breast (may resume after lesions crust) The initial postpartal intervention indicated for a soft boggy uterus is to a. apply an ice compress. b. massage the fundus until firm. c. apply a warm compress. - B ...with the dominant hand while supporting the inferior uterus with the non-dominant hand to prevent trauma. If the fundus does not contract with massage, then further evaluation is indicated to determine if placental fragments remain. After the fundus becomes contracted, the nurse should push firmly downward on the fundus to expel clots that may have pooled. With the vibroacoustic stimulation test, stimulus with an artificial larynx or other device is applied to the maternal abdomen for a. 1 to 3 seconds. b. 5 to 10 seconds. c. 1 to 2 minutes. - A Usually, stimulus is applied for 1-2 seconds and repeated up to 3 times with time extending to 3 seconds in order to stimulate fetal movement. A positive or reactive finding is an increased fetal heart rate of 15 bpm or more for at least 15 seconds; however, a nonreactive result does not always indicate fetal abnormality but indicates the need for further testing. Absence of the Moro reflex on one side only in a neonate may indicate a. fractured scapula. b. cerebral palsy. c. fractured clavicle. - C a fractured clavicle or brachial plexus injury. Damage to the central nervous system, such as may occur with cerebral palsy, often results in bilateral absence of the reflex. The Moro reflex is elicited by allowing the infant's head and trunk to fall slightly backward when the infant is raised. A positive Moro reflex includes immediate extension and abduction of the arms(and sometimes the legs) with fingers fanning and forming a C-shape with a return of the limbs to the flexed states In a multiparous woman, what is the lowest Bishop score that predicts labor induction will be successful? a. 5 b. 7 c. 9 - A In a multiparous woman, the Bishop score that predicts that labor induction will be successful is 5 or more while it is a 9 or more for a nulliparous woman. The Bishop score is a rating system to determine readiness for induction based on scores of 0-3 in four different measures: dilation (cm), effacement (percentage), station (cm), and cervical consistency (firm, medium, soft), and cervical position (posterior, mid position, anterior). The fifth measure, cervical position, is scored only 0-2. When cervical laceration occur during delivery, they are most common at what position? a. 3 and 9 o'clock b. 12 and 6 o'clock c. 10 and 4 o'clock - A Cervical lacerations are most often identified with vaginal retractors when bleeding is persistent after delivery. The lacerations are sutured with absorbable sutures, so no further treatment is usually indicated. Minor lacerations often occur during delivery, but they usually require no treatment. Tears are more common after forceps assisted and vacuum assisted deliveries than normal vaginal births If using fetal pulse oximetry, what is normal oxygen saturation? a. 30% to 65% b. 65% to 90% c. 90% to 100% - A because of the fetus's high hemoglobin and hematocrit. A value below 30% may be associated with hypoxia and metabolic acidosis. For fetal pulse oximetry, which may be used to determine whether immediate intervention is needed for non-reassuring fetal heart rate, a special single-use sensor is placed internally along the fetal cheek, temple, or forehead. However, fetal pulse oximetry has not been found to reduce overall rates of Caesarean. A decrease of fetal heart rate of at least 15 bpm for at least 10 minutes is classified as a. recurrent deceleration. b. prolonged deceleration. c. baseline change. - C If it persists more than 2 minutes but less than 10 minutes, it is classified as a prolonged deceleration. Recurrent decelerations are classified as occurring with half or more of uterine contractions in a 20 minute period. Intermittent decelerations occur with fewer than half of uterine contractions in a 20 minute period. With suspected fetal hypoxia, a cord blood gas specimen is obtained during delivery by a. withdrawing blood from the vein/artery before the cord is clamped or cut and before placental expulsion. b. placing one clamp and withdrawing blood above the clamp before cutting the cord. c. double clamping a 10 to 20 cm segment, cutting it out, and then withdrawing blood from the segment. - C The segment can be placed on ice temporarily as cord blood gas can be accurately assessed for 60 minutes. An arterial sample is preferred over venous, but paired sampling is recommended. A pH of 7.24 or less is associated with neurological compromise. A base excess of 12 mmol/L or more is predictive of motor or cognitive impairment. When eliciting the scarf sign in a neonate, the infant's elbow crosses the midline of the chest, probably indicating a a. preterm infant. b. term infant. c. postterm infant. - A At fullterm, the elbow should not cross the midline. For the scarf test, the neonate should be placed supine. One arm is grasped and the hand pulled toward the opposite shoulder and then the position of the elbow is assessed in relation to the midline of the chest. Following birth, which hormone stimulates the alveolar cells of the breast, promoting production of milk? a. Estrogen b. Prolactin c. Progesterone - B which increases in response to the neonate's suckling. Suckling also promotes release of oxytocin, which promotes the letdown reflex by increasing contractibility of the muscles of the mammary ducts. After milk production is well established, prolactin levels decrease, and most milk production is then facilitated by oxytocin. During pregnancy, estrogen promotes proliferation of breast ducts and progesterone the development of lobules and alveoli Which anesthetic technique provides the best relief of pain during labor and delivery? a. Epidural b. Spinal c. Pudendal block - A The epidural can provide continuous relief during both labor and delivery and does not pose the risk of spinal headache and provides less motor blockade. Additionally, there is a deceased risk of hypotension because of reduced risk of sympathetic blockade. Spinal is now usually reserved for Cesareans. The pudendal block provides relief primarily during delivery. A patient with lupus erythematosus places the fetus at risk if she takes which medication during pregnancy? a. Prednisone b. Methotrexate c. Plaquenil® (hydroxychloroquine) - B ...methotrexate or cyclophosphamide. Both of these medications should be discontinued at least 30 days prior to the patient becoming pregnant. Plaquenil and prednisone may be continued during pregnancy. A patient with lupus should be stabilized for at least 6 months before attempting to become pregnant because pregnancy may exacerbate symptoms, and the patient may have antibodies that increase risk of miscarriage or stillbirth in late pregnancy. A series of ultrasound scans after the 20th week show that the fetal head is growing normally but the abdominal circumference is lower than expected. This may indicated which of the following? a. Down syndrome b. Neural tube defect c. Placental insufficiency - C ...common in patients who are diabetic, hypertensive, or anemic. With placental insufficiency, the supply of oxygen and nutrients to the fetus is impaired, so the fetus responds by sending the nutrients to the most critical organs (heart, brain, lungs) and the other abdominal organs receive less, so they develop more slowly Idiopathic cardiomyopathy of pregnancy is a condition that a. precedes pregnancy and exacerbates due to the stress of pregnancy. b. develops in the last month of pregnancy or soon after birth without preexisting cardiac disease. c. develops in the first trimester of pregnancy and must be monitored throughout the pregnancy and delivery. - B Develops in the last month of pregnancy or the first 5-6 postpartal months and is not associated with pre-existing myocarditis, endocarditis, or cardiac disease. It is characterized by left ventricular systolic dysfunction. Typical symptoms are similar to heart failure and include dyspnea (the most common symptom), orthopnea, cough, palpitations, and chest pain. The heart is markedly enlarged, and the ejection fraction is less than 45%. It increases risk of thromboembolia, so the woman is often treated with heparin. Treatment is similar to that for heart failure although if it occurs prior to delivery, ACE inhibitors are withheld because of adverse effects to the fetus. Management includes bedrest, diuretics, and digoxin. If 10% to 20% of the placental surface is detached but the mother and fetus are not in distress, the placental abruption is classified as a. grade 1, mild. b. grade 2, moderate. c. grade 3, severe. - A Grade 1: 10-20% of the placental surface is detached o the mother and fetus are not in distress. Uterus may be tender and mild tetany evident Grade 2: 20-50% is detached with or without external bleeding. Uterine tenderness and tetany are evident. While the mother is not in shock, the fetus shows distress. Grade 3: over 50% detached with severe uterine tetany, maternal shock, and frequently coagulopathy. The fetus is dead. If vaginal fluid contains blood, the nitrazine test for the presence of amniotic fluid a. may show a false positive. b. may show a false negative. c. is unaffected by blood. - A because the pH of blood ranges from 7.35-7.45 and the pH of amniotic fluid ranges from 7.0-7.5, so they may react similarly. A pH in the range of 6.57.5 is considered positive for amniotic fluid in the absence of other factors (blood, semen, urine) that may affect results. The test sample should include vaginal secretions from the posterior vagina but not the mucous plug To reduce the risk of hemorrhagic disease after birth, a neonate should receive a. vitamin B9 (folic acid). b. vitamin C. c. vitamin K. - C Neonates are born with low levels of vitamin K, which is necessary to activate clotting factors. Additionally, while platelet levels are near adult level, the platelets do not respond effectively to stimuli for several days after birth. Combined, these factors increase the risk of hemorrhage, but the risk is markedly reduced if the neonate receives an IM injection of vitamin K. A patient is in active labor and has contractions every 8 minutes lasting for 45 seconds and increasing in intensity by 25 mm Hg during contractions. This patient is likely experiencing a. hypertonic labor. b. hypotonic labor. c. normal labor. - B The average amplitude is 40-50 mmHG. Because the contractions are often irregular and have low amplitude, cervical dilation is usually slowed or may arrest so that labor becomes prolonged without interventions. Treatment may include ROM and/or oxytocin to strengthen the contractions A pregnant patient who presents with sudden onset of severe uterine pain with slow increase in fundal height but no vaginal bleeding should be assessed for a. abruptio placentae. b. bladder retention. c. fecal impaction. - A Up to 80% of patients with abruptio placentae exhibit vaginal bleeding, but bleeding may be contained between the uterine wall and the placenta, resulting in maternal shock without obvious bleeding. If the fetus is at term, bleeding is severe, or the mother or fetus is in jeopardy, immediate delivery is indicated. During the second stage of labor, when does external rotation occur? a. As the fetus descends from station 2+ to 4+ b. Before delivery of the head c. After delivery of the head - C The head is delivered face down but then externally rotates so that the face is toward the right or left (facing maternal inner thighs) in order to allow passage of the shoulders and body. If shoulder dystocia occurs, delivery may halt at this time. McRoberts technique, in which the patient elevates the knees to the chest position, may reduce the angle and allow expulsion. Supporting a patient's request that she receive an opioid and an epidural during labor is an example of the ethical principle of a. autonomy. b. beneficence. c. justice. - A ...which recognizes that people have the right to make their own decisions about care. Beneficence is taking action that benefits another, such as providing pain relief immediately when needed. Justice requires fair and equal treatment of all, making sure that resources and health care are distributed in a fair manner. What is a contraindication of oxytocin infusion? a. Eclampsia b. Non-reassuring fetal heart rate c. Dystocia - B Other contraindications include cephalopelvic disproportion, transverse lie, placenta previa, vasa previa, previous classic uterine incision or uterine surgery, and invasive carcinoma of the cervix. Oxytocin is used to stimulate uterine contractions, thus inducing or augmenting labor, and may be indicated for suspected fetal jeopardy, dystocia, postterm pregnancy, eclampsia, fetal death, chorioamnionitis, and multiple maternal medical problems, such as renal disease or uncontrolled diabetes mellitus If the biophysical profile shows a score of 8 with normal amniotic fluid volume, what is the required intervention? a. No intervention needed b. Induction of labor c. Repeat test the same day - A A normal BPP is 10 (score of 2 on 5 different measures). A score of 8 with normal AFI suggests very little risk to the fetus and no intervention is required. If however, the amniotic fluid volume were abnormal, this would suggest chronic asphyxia and increased rate of perinatal mortality within a week, so birth should be induced. A score of 6 indicated possible asphyxia, 4 probably asphyxia, 2 almost certain asphyxia, and 0 certain asphyxia For an elective Caesarean, the most important preoperative measure is to a. determine the method of anesthesia. b. position the patient correctly. c. confirm fetal maturity. - C ...is at least 39 weeks. Confirmation may be done by (1) finding documentation of fetal heart sounds for 30 weeks by Doppler ultrasound/20 weeks by auscultation, (2) noting a 36 wk internal since positive pregnancy test by lab, (3) supporting gestation of at least 39 weeks by ultrasound completed between 6-11 wks, and (4) noting clinical history and later ultrasound that supports at least 39 weeks gestation A cordocentesis can be performed after how many weeks' gestation? a. 16 b. 18 c. 20 - B aka percutaneous umbilical cord blood sampling (PUBS), guided by ultrasound, can be performed after 18 wks of pregnancy, as risks are higher at earlier gestation. If the placenta is located on the posterior wall of the uterus, the needle is inserted through the amniotic fluid to the umbilical cord near attachment to the placenta, but if the placenta is located on the anterior or lateral walls, the needle must first go through the placenta. Cordocentesis can be used to identify fetal abnormalities, infections, anemia, and congenital alloimmune thrombocytopenia. Velamentous insertion of the umbilical cord is commonly associated with a. singleton gestations. b. abruptio placentae. c. placenta previa. - C associated with placenta previa, vasa previa, and multiple gestations. With velamentous insertion, the umbilical cord vessels divide at a distance from the placenta, protected only by the thin placental membranes, which may become compressed or injured during pregnancy, labor, and delivery. Because the vessels lack the protection of Wharton's jelly, they are especially susceptible to tearing, resulting in fetal hemorrhage. If the vessels precede the fetus at the internal os, this is termed vasa previa. During the fourth stage of labor, lochia should generally not exceed a. one saturated pad per hour. b. one saturated pad per 2 hours. c. two saturated pads per hour. - A ...as excessive drainage may indicate hemorrhage. Small clots are common in the lochia rubra, but large clots may indicate excessive bleeding. When changing the pad, it's important to examine the buttocks and back to determine if overflow drainage has pooled. If the uterus is firm but there is a continuous trickle of bright red blood, this may be an indication of laceration. When determining the baseline fetal heart rate, the fetal heart must be monitored for at least a. 2 minutes. b. 5 minutes. c. 10 minutes. - C The baseline rate is the average rate during that time period, rounded to the nearest 5 bpm. The normal fetal heart rate is 110-160 bpm at term with a slightly increased rate for the preterm fetus. Fetal tachycardia is defined as either over 150 bpm or over 160 bpm for at least 10 minutes, while bradycardia is defined as either under 110 bpm or under 120 bpm for at least 10 minutes The most common visual complaint during pregnancy is a. myopia. b. blurred vision. c. hyperopia. - B The pregnancy woman tends to retain fluid, and this retention along with decreased intraocular pressure causes some thickening of the cornea and change of shape during the first trimester, resulting in blurring of vision. However, these changes usually resolve within the first 8 weeks of pregnancy, so the visual changes should not be causes for changing prescriptions for corrective lenses. Pregnant women also commonly complain of dry eyes, which may be relieved by the use of artificial tears. With battledore placenta, the greatest maternal risks are for a. preterm labor and bleeding. b. postpartal hemorrhage. c. late abortion and pre-term labor. - A The umbilical cord inserts into the placenta at or near the placental margin. Maternal risks include preterm labor and bleeding. Risks to the fetus include prematurity and fetal stress. Succenturiate placenta is at least 1 accessory lobe of fetal villi develops on the placenta. Maternal risk includes postpartal hemorrhage although there are few fetal risks Circumvallate placenta is a ring of chorion and amnion that surround the umbilical cord on the fetal side of the placenta. Maternal risks include late abortion, antepartal hemorrhage, and pre-term labor. Fetal risks include IUGR, preterm birth and mortality. When a woman is using paced breathing during labor, the rate of breathing should be no more than a. one and a half times normal rate. b. two times normal rate. c. three times normal rate. - B ...because a faster rate may result in hyperventilation. If using slow-placed breathing, the rate should be no slower than half the normal rate (usually 6-9 breaths per minute) to ensure that oxygenation remains adequate. Breathing during the first stage of labor may include cleansing breaths, slow-paced, modified paced, and pattern paced ("hee hoo") breathing. Breathing in short puffs may help control the urge to push. The cervix is considered uneffaced at a. 2 cm. b. 3 cm. c. 4 cm. - C The cervix is considered uneffaced at 4 cm (0% effacement). Effacement refers to thinning of the cervix, with the length of the cervix expressed in numbers of centimeters, and the degree of effacement in percentages. Complete effacement (100%) occurs when the cervix has completely thinned. Some patients efface slowly over the weeks prior to labor, especially if the fetal head is in the pelvis and applying pressure to the cervix, but others efface after onset of labor. During pregnancy, where are vascular spiders most common? a. Face, arms, and upper torso b. Abdomen, breasts, and thighs c. Palms of the hands - A spider like vessels from dilated arterioles and small veins surrounding the arteriole filled with blood. They are most common on the face, arms, and upper torso and may occur in pregnant women because of increased levels of estrogen, so they recede after delivery. Palmar erythema (redness of the palms) is also caused by increased estrogen levels. Striae gravidarum (stretch marks) occur on the abdomen, breasts, and thighs and are caused by stretching of the skin Edema of the fetal scalp resulting from pressure of the head against the cervix is called a. cephalohematoma. b. caput succedaneum. c. molding. - B ...or from suction of vacuum-assisted delivery. The swelling crosses suture lines and is usually soft and resolves within the first 12 hours after delivery. Cephalohematoma is bleeding between the periosteum and the skull. The welling is usually firm, most commonly over parietal areas and does not cross suture lines. Molding is an overlappling of cranial bones at suture lines. This condition usually resolves within a week. An extra-long umbilical cord often results in a. fetal death. b. transient decelerations. c. umbilical cord rupture. - B ...because of knots that have formed. The average length of the umbilical cord is 55 cm. A longer cord rarely results in fetal death, but knots can form in the cord if the fetus is active and, although these are rarely pulled tight enough to completely restrict blood flow, they may tighten during contractions, resulting in decelerations. Knots are more likely to form in identical-twin pregnancies than singleton. The fetal head is considered engaged at which station? a. -1 b. 0 c. +1 - B ..., the level of the ischial spines. Station refers to the position of the presenting part in relation to the ischial spines. If the presenting part is above station zero, then the station is expressed in negative numbers with each number referring to a centimeter (-1, -2, -3). If the presenting part is below the ischial spines, the station is expressed in positive numbers (+1, +2, +3). The fundal height is no longer an accurate estimate of gestation after how many weeks? a. 30 b. 34 c. 36 - C The fundal height, the measure from the pubic bone to the top of the uterus, is no longer an accurate estimate of gestation after 36 weeks because the fetus usually changes position in preparation for delivery, and the uterus changes shape. However, between weeks 16-36, the fundal height is a good estimate of weeks of gestation in a normal singleton pregnancy with each cm of height equal to a week of gestation, so 22 cm height equals 22 weeks gestation. Fetal bradycardia with variable decelerations during uterine contractions may indicate a. placenta previa. b. abruptio placentae. c. prolapsed cord. - C In some cases, the cord may be seen protruding from the vagina, especially after rupture of the membranes if the presenting part is high, or felt on digital exam. Immediate action is required to prevent fetal hypoxia. The patient is placed in modified Sims' or knee chest position and the examiner inserts fingers into the vagina to hold the presenting cord off the cord while awaiting emergent treatment, such as a Cesarean. The nonstress test (NST) measures the a. fetal heart rate. b. fetal movement. c. fetal breathing movement. - A NST measures the feta heart rate in relation to fetal movement. Normally, the heart rate should increase during activity and decrease at rest. A reactive (normal) NST shows that, for a fetus at 32 or more weeks gestation, the fetal heart rate increases by at least 15 bpm for at least 15 seconds after a fetal movement. A reactive NST on a fetus under 32 weeks should show increase of at least 10 bpm for at least 10 seconds. Following birth, fetal characteristics during the first period of reactivity include a. sleepiness and/or prolonged sleeping. b. alert state and movement of limbs. c. periods of apnea and regurgitation. - B Following birth, fetal characteristics during the first period of reactivity, which begins at birth and lasts for 30 min to 2 hours, include an alert state and movement of limbs. The neonate appears wide-awake and may appear hungry and begin rooting. The neonate will begin nursing if offered a breast. Respirations may be quite rapid, up to 80 per minute, and the heart rate may be elevated to 180 bpm although the respiratory rate and heart rate gradually slow as the infant enters a period of sleep. When being assessed for the biophysical profile, what is the normal fetal breathing movement (FBM)? a. 1 FBM lasting ³30 seconds in 30 minutes b. 2 FBM lasting ³30 seconds in 30 minutes c. 3 FBM lasting ³30 seconds in 30 minutes - A ...which is scored as a 2. If there is no FBM of at least 30 seconds in a 30 minute period, it is a score of 0. FBMs are often irregular with periods of apnea and can be detected on ultrasound by about 10-11 weeks of gestation. Although FBM does not actually exchange air, the thorax rises and falls, and this helps prepare the fetus for breathing after birth. With acute respiratory distress syndrome (ARDS) in the neonate, the goal of therapy is to maintain oxygen saturation greater than a. 85%. b. 90%. c. 95%. - B If ARDS is mild, oxygen administration per nasal prongs or mask may be adequate, but if levels fall under 90% then endotracheal incubation with mechanical ventilation or high- frequency oscillatory ventilation may be indicated. ARDS is characterized by tachypnea, crackling rales, decreased lung volume, cyanosis, hypotension, and tachycardia. In the early stages, respiratory alkalosis is common but later develops into hypercarbia and respiratory acidosis. A maternal indication of amniotic fluid embolism is a. respiratory distress. b. hypertension. c. hypertonic uterus. - A Amniotic fluid embolism occurs when a bolus of amniotic fluid with particles of debris, such as hair or meconium, enters the maternal blood and travels to the lungs, most commonly after rupture of the membranes. Thick meconium, which can clog the pulmonary vein, poses the most risk. Patients may develop coagulopathy with DIC. The amniotic fluid may also cause maternal venospasm and pulmonary hypertension, leading to left ventricular failure. The first stage of labor is the time period between onset of labor and a. cervical dilation of 8 cm. b. cervical dilation of 10 cm. c. delivery of infant - B Phases: -Latent: may vary widely in duration but is commonly 10-12 hours in multiparas and about 20 hours in primigravidas. The cervix begins effacement and contractions increase in frequency and intensity. -Active: The cervix dilation is 3-4 cm at onset and 8-9 cm at the end with this phase lasting about 5 hours for primigravidas and 2 hours for multiparas. -Deceleration phase: Dilation completes and delivery is imminent. Fetal tone evaluates a. extension and return to flexion. b. gross body movements. c. fetal resting position. - A To be scored as normal tone (2) in a BPP, the fetus should exhibit at least one episode of extension with return to flexion of limbs/trunk or lands. Fetal tone is scored as absent (0) if there is no movement or if there is slow extension with partial return flexion or movement of a limb in full extension. If the mother is Rh- and the father Rh+, what are the odds that the fetus will be Rh+? a. 25% b. 50% c. 100% - C ...because every fetus will receive the Rh+ antigen from the father who provides half of the genetic makeup. With a first pregnancy, typically the fetus develops no problems because antibodies have not yet formed against the Rh+ antigen, but subsequent pregnancies are at high risk for the development of erythroblastosis fetalis, a hemolytic disease, unless the mother receives RhoGAM (Rh immune globulin) during the first pregnancy at 28 weeks gestation and within 3 days after delivery. The purpose of the Leopold maneuvers is to determine fetal a. movement, size, and presentation. b. lie, presentation, and position. c. size, lie, and presentation. - B -Lie: long axis of fetus in relation to long axis of mother, typically longitudinal (99%), although may be transverse or on rare occasions oblique -Presentation: refers to the presenting part, usually cephalic or breech with longitudinal lie Position: refers to the relation of the presenting part to the maternal pelvis, typically left or right. If the presenting part faces anteriorly or posteriorly, this is referred as anterior or posterior asynclitism. The last fetal system to mature functionally is the a. cardiovascular. b. renal. c. respiratory. - C ....so assessment of the respiratory system is especially important for preterm births under 36 weeks. If the respiratory system is immature, the neonate is unable to adequately ventilate the lungs and lacks adequate surfactant (phospholipids), which lower surface tension in alveolar sacs and facilitate ventilation This condition is referred to as respiratory distress syndrome (RDS). With RDS, the neonate may exhibit chest retraction, nasal flaring, grunting respirations, and hypoxia. A common problem in the mouth during pregnancy is a. gingivitis. b. tooth demineralization. c. decreased saliva. - A ....because of hyperemia of the mouth and gum tissues resulting from increased levels of estrogen. Some patients may develop red, swollen, bleeding gums because of vascular hypertrophy, but these conditions recede after delivery of the fetus. Excessive salivation (ptyalism) is also common, although the cause is unknown. Demineralization of the teeth is not associated pregnancy although it is a common belief. The most frequent cause of postpartal hemorrhage is a. vaginal laceration. b. uterine atony. c. retained placental fragments. - B 90%. Following delivery, uterine contractions are needed to compress vessels and prevent bleeding from the placenta attachment site, but with uterine atony, the contractions are absent or ineffective. Predisposing factors induce distended uterus (multiple gestations and hydramnios), precipitous and prolonged labor, and administration of magnesium sulfate. The uterus may respond to massage, oxytocin, or Methergine (methylergonovine maleate), but surgical intervention (ligation of vessels, repair of lacerations, selective arterial embolization, or hysterectomy) may be required. Cervical effacement often begins a. before the onset of true labor. b. at the onset of true labor. c. after the onset of true labor. - A ...especially in the multiparous patient. As the cervix begins to efface, bloody show (blood-tinged mucous plug), which has served as a barrier to the cervical canal, is passed, sometimes all at once but at other times over a number of days. This usually occurs late in pregnancy and indicates cervical effacement is occurring. Effacement usually increases as lightening occurs with resultant increased pressure on the cervix and as Braxton Hicks contractions occur more frequently. Patients in labor are usually advised to come to the hospital when a. contractions occur every 10 minutes for at least an hour. b. the membranes rupture. c. bloody show occurs. - B Other indications include contractions that are occurring every 5 min for at least an hour, significant vaginal bleeding (always a warning sign), or decreased fetal movement. On admission, both a focused review of systems to determine if possible complications of pregnancy are present and a limited general physical examination are completed. Contractions should be assessed for intensity and duration and fetal heart tones auscultated immediately after a contraction. If massaging the uterus is ineffective for uterine atony, the next treatment is usually a. oxytocin infusion. b. hysterectomy. c. uterine artery embolization. - A ...which is often given routinely after delivery of the infant and after delivery of the placenta as a preventive measure. If the oxytocin is ineffective, bimanual massage may be tried and/or other medications, such as Methergine (methylergonovine maleate) or Hemabate (prostaglandin F-@-alpha). If the atony persists and bleeding cannot be controlled, then surgical intervention is indicated with hysterectomy a last resort. The cardinal movements of vertex presentation labor include engagement, flexion, descent, internal rotation, extension, a. external rotation, and recovery. b. external rotation, and restitution. c. external rotation, and expulsion. - C The cardinal movements of vertex presentation labor include: -Engagement: biparietal diameter of head descends below pelvic inlet to zero station -Flexion: head flexes to decrease diameter -Descent: fetus descends birth canal -Internal rotation: again decreases head diameter to allow passage through bony pelvis -Extension: head and neck extend to correspond with curve of birth canal -External rotation: head rotates after delivery to allow delivery of shoulders and body -Expulsion: delivery of shoulders and body During labor, the fetal descent causes the bladder to a. descend. b. ascend. c. move laterally. - B ....relative tot he lower portion of the uterus and the cervix. Because of this and resultant pressure, the patient may experience difficulty urinating and may develop urinary retention. The patient should be assisted to urinate frequently, sitting upright in the bathroom if possible, because urinating on a bedpan is usually more difficult. In some cases, patients may require straight catheterization to reduce a distended bladder. During contractions in the second stage of labor, the patient should be encouraged to a. relax muscles. b. push. c. avoid pushing. - B ...as the patient is fully dilated. Pushing at this stage aids the contractile force of the uterus in facilitating delivery. The mother should be instructed to carry out an extended Valsalva maneuver as each contraction starts, inhaling, holding her breath, and bearing down to help increase intra-abdominal pressure. The patient usually feels the urge to bear down and push. The maneuver that is used to avoid laceration or episiotomy during delivery is a. modified Ritgen. b. Leopold. c. Valsalva. - A ...which involves applying upward pressure from the coccygeal region beneath the fetal head to apply pressure on the fetal chin with one hand while the other hand is on the vertex. This maneuver helps to extend the fetal head, ensuring that the chin delivers slowly and the head follows the curve of the birth canal so that the musculature of the perineum does not tear during delivery. A vaginal pH of 7.2 probably indicates the presence of a. inconclusive results. b. vaginal fluid. c. amniotic fluid. - C Normal vaginal fluid is more acidic with pH ranging from 4.5-5.5 while amniotic fluid is more alkaline with pH ranging from 7.0-7.5. However, blood has a pH that is similar to that of amniotic fluid and semen is highly alkaline, so the presence of either of these two substances may produce a pH that is suggestive of amniotic fluid. Following birth of an infant, signs of placental separation usually begin within a. 5 minutes. b. 15 minutes. c. 30 minutes. - A ....but it may take up to 30 min to expel the placenta and membranes. Signs include globular shaped uterus, rise in fundus, sudden expelling of a gush of blood or a trickle of blood, and extended length of the umbilical cord as it is pushed exteriorly by the descending placenta. The placenta may separate from the middle to the edges and be expelled with the fetal side presenting (Schultze mechanism) or may separate from the outer edges, rolling and present with the maternal side (Duncan mechanism). A tocotransducer detects a. intensity of uterine contractions. b. frequency and duration of uterine contractions. c. resting tone of the uterus between contractions. - B The toco has a pressure sensitive area that detects changes in the contour of the abdomen that occur with contractions. The sensor may also detect other movements, such as those associated with maternal respirations and fetal movements. The toco cannot provide a reliable estimate of the intensity of uterine contractions or the resting tone, and different maternal positions may affect the pressure against the toco. Prior to induction, it is most essential to assess for a. cephalopelvic disproportion. b. psychological status. c. macrosomia. - A ....(CPD) and fetal malpresentation because vaginal birth may not be possible and Cesarean may be required rather than induction. CPD may result from increased size of the fetus or from abnormally shaped or small pelvis. Both (vaginal assessment of pelvic bones to determine pelvic size) and ultrasound may be used to assess for CPD, but examination is often inaccurate before labor because fetal molding may alter the proportions. A patient who has hypertonic labor and is not progressing but experiencing a prolonged latent phase, increasing pain, and fatigue is likely a candidate for a. Caesarean. b. increased sedation. c. induction. - C ...unless contraindications, such as extreme fatigue or cephalopelvic disproportion (CPD), are present. With hypertonic labor, the uterus does not adequately relax following contractions, and contractions are painful and ineffective so that effacement and dilation do not occur adequately. Induction with oxytocin is often used to strengthen the contractions. A multiparous patient who is in active labor and dilating 0.8 cm per hour is likely experiencing a. prolonged labor. b. normal labor. c. precipitous labor. - A ....because the multiparous patient usually dilates approximately 1.5 cm per hour and the nulliparous patient 1.2 cm per hour. The patient should be assessed for hypertonic and hypotonic labor patterns as well as other complications, such as abnormalities in fetal presentation or size, to determine the cause of the prolonged labor. Following precipitous labor and birth, the mother is most as risk for a. hypertension. b. hemorrhage. c. retained placenta. - B ...which is defined as at least 500 mL of blood loss after vaginal delivery or more than 1000 mL of blood loss after Cesarean. The hematocrit may show greater than 10% change from admission values. With hemorrhage, the patient is at increased risk for hypovolemic shock. Immediate treatment includes providing increased intravenous fluids, elevated feet and legs, and exploring the cause of bleeding, such as vaginal lacerations or retained placental fragments. Post-term pregnancy extends more than how many weeks? a. 40 b. 41 c. 42 - C ...or 294 days after last menstrual period. Increased risks for both the mother and the fetus occur during labor and delivery. Labor is often induced, and delivery is more likely to include the use of forceps or vacuum-assisted delivery because the fetus is large for gestation age (LGA) or macrosomic. Cesarean may be indicated for cephalopelvic disproportion (CPD) or malpresentation. The minimum anesthesia usually needed for forceps-assisted delivery is a. spinal block. b. pudendal block. c. general anesthesia. - B Although forceps-assisted delivery is sometimes carried out with only local anesthetic, most patients cannot tolerate the use of forceps well without a minimum of a pudendal block. Regional anesthesia may be used in some circumstances and general anesthesia poses increased risk to the fetus. The criteria for forceps application, including the fetus's position, station, and presentation, should be reviewed to ensure that the patient is a candidate prior to forceps-assisted delivery. What is an indication for vacuum-assisted delivery of a fetus? a. Extended second stage of labor b. Advanced cranial molding c. Uncertain fetal station - A ...because longer duration correlates with increased maternal risk from trauma (hemorrhage, lacerations, and chorioamnionitis). Vacuum-assisted delivery may also be utilized if the mother's health or state of exhaustion precludes normal delivery and if there is suspected fetal compromise. Contraindications include advanced cranial molding, uncertain fetal station or position, and malpresentation. Relative contraindications include preterm fetus, overlapping cranial bones, cephalopelvic disproportion, and probable macrosomia. A pregnant woman with pre-eclampsia who develops petechiae, hematuria, and oozing of blood at IV insertions site, likely has a. sepsis. b. coagulopathy. c. anemia. - B ...such as disseminated intravascular coagulation (DIC). DIC is an emergent condition that occurs secondary to another disorder, so immediate assessment should include coagulation studies. The patient should be tilted toward the left to increase blood flow to the uterus and should receive oxygen and blood products. Urinary output must be monitored carefully for signs of renal failure. Prior to administration of a narcotic to relieve labor pain, a nullipara should generally be dilated to how many centimeters? a. 3 to 4 b. 4 to 5 c. 6 to 7 - A ...and a multipara to 4-5 cm. However, the patient should have stable vital signs and be without drug allergy, drug dependency, or respiratory compromise; and the fetus should be at term and have FHR of 110-160 bpm with a reactive NST and no evidence of meconium staining. Additionally, the pattern of contractions should be well established and the presenting part engaged with progressive descent. Prior to the induction phase of Subutex® (buprenorphine) administration, the patient should abstain from drug use for how many hours? a. 6 to 12 b. 12 to 24 c. 24 to 48 - B ...in order to avoid abrupt withdrawal symptoms when the drug is administered. Induction may be controlled through administration of morphine to stabilize blood levels in the pregnant woman. During the stabilization phase, the patient should discontinue use of other drugs, and the drug dosage may require adjustment. During the maintenance phase, the patient's dose is stable and the patient should be progressing well. Which substance poses the highest risk for birth defects if used during pregnancy? a. Marijuana b. Cocaine c. Alcohol - C ...which can cause fetal alcohol syndrome and a wide range of defects, including impairment of the CNS with intellectual disability and hyperactivity, facial abnormalities, and growth retardation. Marijuana poses fewer risks but may be associated with learning disabilities and behavioral problems. Cocaine has a low risk of birth defects but does impair fetal growth resulting in low birth weight, smaller head, and shorter length. If the partner of a woman in labor and delivery begins shouting at her and hitting her, the best response is to a. call security immediately. b. restrain the partner and call for help. c. stand between the patient and the partner. - A While the initial inclination may be to intervene and restrain the partner, this places the healthcare worker at risk of injury as well as the patient, so the best response is to immediately call security. Any interventions, such as calling out to the person to stop, should be done from a safe distance and preferable with additional staff members present. It's important to bear in mind that a person who is violent may carry a weapon, putting everyone in the vicinity at risk. A pregnant woman with organic mercury poisoning (methyl mercury) but few symptoms places the fetus at a. virtually no risk of impairment. b. slight risk of impairment. c. high risk of impairment. - C Even though the mother may have few symptoms of organic mercury poisoning, the fetus may be profoundly affected because the fetus is more sensitive to mercury than the adult. Mercury impairs the development of the central nervous system, so the child may have severe neurological abnormalities, including impaired memory, thinking abilities, visuospatial skills, and attention span as well as impaired motor skills. If signals from a fetal scalp electrode suddenly become completely erratic and stop, what is the most likely reason? a. Fetal distress b. Electrode dislodgement c. Equipment malfunction - B When applied to the scalp, the electrode only penetrates approximately 1 mm, so the electrode can easily become dislodged with fetal movement, and attachment is more difficult if the fetus has a lot of hair. Once an electrode is secured to the scalp, the lead wire extends through the patients' vagina and is attached to a leg plate for grounding. The unit beeps with each fetal heartbeat. A mother's smoking during pregnancy places the fetus at increased risk of a. low birth weight. b. renal abnormalities. c. bradycardia. - A ...and preterm birth. In addition, miscarriages and stillbirths are more common, and the fetus may exhibit tachycardia, respiratory problems, and birth defects. After birth, the child of a smoker is at increased risk of sudden infant death syndrome. The more that a pregnant woman smokes, the greater the risk, so all pregnant women should be advised to stop smoking during pregnancy. Second-hand smoke after delivery continues to pose risks to the infant. Prior to delivery, a patient with immune thrombocytopenia (ITP) should have what minimum platelet count? a. 30,000 mm3 b. 50,000 mm3 c. 100,000 mm3 - B ...because of the risk of bleeding if a Cesarean is required. With a platelet count of at least 30,000 mm3, treatment is usually withheld until 36 weeks gestation or earlier if birth is expected. The initial treatment is oral corticosteroids, usually started 10 days before anticipated due date or intravenous immunoglobulin. Transfusions are used only in emergent situations. Hypertension without proteinuria that develops after 20 or more weeks' gestation and persists 6 weeks into the postpartum period is classified as a. chronic hypertension. b. preeclampsia. c. gestational hypertension. - C AKA transient hypertension and pregnancy induced hypertension. If the hypertension persists more than 12 weeks PP, without any development of Pre-E, or if it began prior to 20 weeks, then the hypertension is classified as chronic rather than gestational. Therefore, the final diagnosis of hypertension may only be determined in the postpartal period When using the deep tendon reflex rating scale to assess CNS irritability secondary to preeclampsia, a low normal but diminished response is rated as what? a. 1+ b. 2+ c. 3+ - A Assessment for hyperreflexia is done in the brachial, wrist, patellar, or Achilles tendons. Deep tendon reflex rating scale: 4+: Abnormal hyperactive, jerky, or clonic response 3+: More brisk than usual response but may be normal 2+: Normal 1+: Low normal response, diminished 0: Abnormal finding, no response Which cardiac abnormality poses the least maternal risk during pregnancy? a. Atrial septal defect b. Moderate aortic stenosis c. Marfan syndrome with aortic root involvement - A ...are the most common cardiac abnormality in pregnant women. With previous surgical repair, there is little increased increased risk to the patient. Without previous surgical repair, the patient is at increased risk for deep vein thrombosis and may also be at risk for bacterial endocarditis. A pregnant patient 40 years has increased risk of developing atrial flutter or atrial fibrillation. Moderate aortic stenosis poses an intermediate risk to the patient, and Marfan syndrome with aortic root involvement poses a high risk. What is the treatment of choice for a pregnant patient with Graves' disease? a. Methimazole b. Radioactive iodine c. Propylthiouracil - C The lowest possible dose is administered because the drug may cause hypoparathyroidism in the fetus. Methimazole may also be used, but it is usually avoided because it causes aplasia cutis (scalp disorder) in the fetus. Radioactive iodine is contraindicated during pregnancy because it may result in damage to the fetal thyroid. If surgery is necessary, the thyroid gland can be removed in the second trimester. Iron deficiency anemia during pregnancy is usually treated with a. blood transfusion. b. ferrous sulfate, 325 mg orally daily. c. iron dextran, intramuscular. - B Iron deficiency anemia during pregnancy, accounts for approximately 95% of cases of anemia, is usually treated with oral ferrous sulfate, 325 mg orally daily. Higher or more frequent doses may result in GI upset and constipation and decreased absorption. If patients are unable to adequately absorb oral iron, then iron dextran 100 mg every other day for about 3 weeks may be administered IM. Transfusions are only indicated if severe symptoms, such as dyspnea, tachycardia, dizziness, are present. On day one of birth for a term infant, what is a normal blood glucose level? a. 40 to 60 mg/dL (2.2 to 3.3 mmol/L) b. 50 to 80 mg/dL (2.8 to 4.4 mmol/L) c. 60 to 100 mg/dL (3.3 to 5.6 mmol/L) - A ...increasing to 50-80 by day 2. Because capillary screening is less accurate than blood glucose, a low value should be verified by laboratory analysis. Typically, an infant is fed if values are 40-45 or less, especially with signs of hypoglycemia, and then the value rechecked 30-60 min after feedings until it remains above 50 twice. During pregnancy, a patient who is receiving hemodialysis for end-stage kidney disease should generally receive hemodialysis how often? a. 3 days a week b. 4 days a week c. 6 days a week - C ...instead of 3 days a week that is most common in non-pregnant patients in order to protect the fetus and because waste products from the fetus enter the maternal circulatory system. Only up to 7% of women receiving dialysis are able to conceive and 1:5 have spontaneous abortions, so pregnancies are high risk. Preterm birth, usually at about 32 weeks is common. Poor control of blood glucose levels during the third trimester in a patient with gestational diabetes increases the risk of a. preeclampsia. b. spontaneous abortion. c. congenital malformations. - A ...as well as fetal macrosomia, which may occur even with normal levels. Poor control of blood glucose levels in the first 10 weeks of pregnancy, when organs are being formed, may result in congenital malformations and spontaneous abortion. Gestational diabetes type A1 is usually controlled with diet while type A2 requires oral medications or insulin At birth, a neonate infected with hepatitis C usually exhibits a. generalized edema. b. jaundice. c. no symptoms. - C About 10% of infants born to infected mothers develop hepatitis C and most require no treatment to clear the virus or have very slow progression of liver disease. The fetus of a woman with hepatitis C is at risk for being small for gestational age and having a low birth weight as well as preterm birth. Any pregnant woman at high risk, such as those with a history of injection drug use, should be tested during pregnancy for hepatitis C virus. A pregnant patient with asymptomatic bacteriuria should a. receive antibiotics. b. have repeated monitoring. c. be advised to increase fluid intake. - A ...as though the patient has acute urinary tract infection because asymptomatic bacteriuria poses a risk to the pregnancy and may evolve to active cystitis or pyelonephritis, further increasing the risk of premature rupture of membranes and preterm birth. Following treatment, a culture should be done to ensure that the bacteria have cleared. If not, prophylactic suppressive treatment is indicated for the duration of the pregnancy. If a pregnant woman has chlamydia, vaginal delivery of the neonate may result in a. skin infection. b. eye and lung infections. c. genitourinary infection. - B ...such as pneumonia. The antibiotic prophylaxis used to prevent eye infections from gonorrhea is ineffective for chlamydia infections, which are usually treated with systemic erythromycin. If the pregnant woman is untreated, there is increased risk of premature rupture of membranes, preterm labor, and low birth weight. A presumptive diagnosis of vasa previa is usually confirmed with a. abdominal CT scan. b. transabdominal ultrasound. c. transvaginal ultrasound. - C Condition in which fetal blood vessels cross or run near the internal cervix. Vasa previa is generally characterized by painless vaginal bleeding, fetal bradycardia, and rupture of the membranes. With vasa previa, the umbilical vein and arteries are not protected with Wharton's jelly or supportive tissue, so they are at risk of laceration, especially during rupture of the membranes. Treatment varies but often includes NST twice weekly until about 30-32 weeks when the patient is hospitalized for continuous monitoring. Cesarean may be emergent or scheduled after fetal lung maturity. An amniotic fluid index (AFI) of 28 cm a. indicates hydramnios (polyhydramnios). b. indicates oligohydramnios. c. is a normal AFI. - A Normal AFI ranges from 5-25 cm. Oligohydramnios is 5 cm. While some pregnant patients with hydramnios may complain of difficulty breathing, most are asymptomatic and the condition is identified on ultrasound. It may occur with multiple gestations, maternal diabetes, and fetal abnormalities. It increases the risk of preterm labor and birth, premature rupture of membranes, uterine atony, abruptio placentae, prolapse of umbilical cord, and death of the fetus. The primary sign or symptom of oligohydramnios is often a. lower abdominal pain. b. increased Braxton-Hicks contractions. c. decreased fetal movements. - C ....with no other maternal symptoms although in some cases the uterus may seem smaller than expected. Numerous causes include some medications (NSAIDS and ACE Inhibitors), uteroplacental insufficiency, fetal abnormalities, and premature rupture of membranes. If it occurs early in pregnancy, the fetus may develop contractures of the limbs, because of restricted movement, and impaired maturation of the lungs. With a first episode of mild bleeding before 36 weeks associated with placenta previa, what is the usual treatment? a. Hospitalization until bleeding stops and modified bedrest b. Hospitalization on bedrest until delivery of the child c. Caesarean section - A ...with the patient spending most of the time in bed and avoiding strain and sexual intercourse, which may trigger contractions and bleeding. With a second episode of bleeding, the patient is usually hospitalized until delivery of the child. Corticosteroids may be administered to help mature fetal lungs if delivery is necessary prior to 34 weeks. If severe bleeding occurs, Cesarean is indicated. For a preterm fetus at 31 weeks' gestation, what is considered an acceleration? a. Increase of at least 5 bpm for at least 5 seconds b. Increase of at least 10 bpm for at least 10 seconds c. Increase of at least 15 bpm for at least 15 seconds - B Accelerations is a temporary increase in fetal heart rate. Less than 32 weeks, a preterm infants' heart rate increases at least 10 bpm for at least 10 seconds. If the fetus is under 28 weeks, there is usually very little variability because the autonomic nervous system is still immature. If accelerations persist for more than 2 minutes, they are classified as prolonged. If the accelerations persist for more than 10 minutes, they are considered a change in the baseline rate. The most common cause of uterine inversion is a. multiple gestations. b. excessive cord traction. c. abruptio placentae. - B ...during expulsion of the placenta. The inversion may be partial or complete. The inverted uterus may be obvious if it protrudes from the cervical os or vaginal orifice, but other indications may be inability to palpate the fundus, maternal hypotension, and excessive vaginal bleeding. Initial treatment includes stopping oxytocic medications and reinserting the uterus manually (Johnson maneuver) after administration of medications, such as magnesium sulfate, to relax the uterine muscle. The primary complications related to multiple gestations are a. preterm birth and uterine inversion. b. preterm birth and uterine rupture. c. preterm birth and intrauterine growth restriction. - C On average, twins are delivered at about 37 weeks gestation and triplets at 33 weeks, so they almost always have low birth weight, increasing risk of postnatal complications. Multiple fetuses tend to be smaller than singletons because the rate of growth slows earlier than with singletons: at 30-32 weeks for twins and 27-28 weeks for triplets. If retained placental fragments are suspected, the best method of to confirm the diagnosis is a. manual exploration b. ultrasound c. hysteroscopy - B In some cases, manual exploration may identify fragments, which can be loosened manually and removed. After expulsion of the placenta, it should be carefully examined for missing cotyledons to ensure it is intact. Retained fragments may occur if the placenta is forcefully separated during fundal massage prior to spontaneous separation. Retained fragments can prevent the uterus from contracting and compressing vessels, resulting in hemorrhage. What antimicrobial agent is contraindicated for treatment of bacterial infections during pregnancy? a. Fluoroquinolones b. Macrolides c. Penicillins - A ...as they may affect the musculoskeletal system of the fetus. Nitrofurantoin should be avoided in late stages of pregnancy as it may cause hemolytic anemia in the newborn. Tetracycline impairs development of fetal bones and teeth so it should only be used during the first trimester. Macrolides and penicillins are generally considered safe for pregnant women. The most common cause of fever greater than 38C/100.4F in the postpartal period is a. urinary tract infection b. respiratory infection c. genital tract infection - C ...usually of the uterine cavity and adjacent tissues (endometritis, metritis with pelvic cellulitis). Fever usually develops on the first or second day after delivery and persists. Manual removal of the placenta, membrane rupture, prolonged labor, internal fetal monitoring, and Cesarean increase risk of infection. Multiple digital vaginal examinations are also a risk factor. Mortality rates are especially high for both mother (90%) and fetus (50%) with infection caused by group A-hemolytic streptococcus. If a mother suffers from severe postpartum depression and expresses intense dislike of her infant, the initial intervention should be to a. provide treatment for depression b. ask the mother if she plans to hurt her infant c. ensure safety of the infant - C The mother should not be left alone with the infant at any time until her condition improves. While treatment for maternal depression is appropriate, the condition may persist for weeks or months after treatment is initiated, and if the mother is experiencing some psychosis or inappropriate thoughts, she may not be forthcoming if asked about harming her infant If a neonate is bobbing his head and holding his hands in fists, this probably indicates a. neurological impairment b. hunger c. pain - B Signs of hunger may be subtle with crying (squawking) typically the last sign. Once an infant begins crying and acting frantic, the child may have difficulty latching on. Other signs of hunger include licking, sucking motions, rooting, bringing hands to mouth or face, and trying to suck a finger stroking the infant's cheek or lower lip. If the neonate is consistently underfed, the infant may become listless and show less interest in nursing. The type of breast milk that provides passive immunity to the neonate is a. colostrum b. transitional c. mature foremilk - A Colostrum, which is produced by the breast for the first 2-4 days, serves to provide passive immunity to the neonate through high levels of immunoglobulins (antibodies). Although colostrum, which is thick and buttery in appearance, is produced in low volume (teaspoons), it is three times higher in protein, because of antibodies, than mature milk and lower in fats and carbohydrates and is adequate for the small stomach of the neonate. Colostrum also has laxative action and promotes passage of meconium. Folic acid/folate deficiency in the mother places the fetus at risk for a. hypoxic encephalopathy b. IUGR c. neural tube defects - C ...., cleft lip, and cleft palate and is more common with multiple gestations than singleton. With folate deficiency, red blood cells enlarge (macrocytic) instead of divide so the number of circulating blood cells decreases. Pregnant women should take 0.4 mg daily and those at high risk 1-4 mg daily along with an iron supplement. Women with a previous infant born with neural tube defect should take 4 mg daily for the month preceding pregnancy and for the first trimester. Following an amniocentesis, the pregnant patient should be advised to avoid strenuous activities for at least how long? a. 24 hours b. 36 hours c. 48 hours - A ....in order to prevent bleeding. After the needle is removed, the insertion site should be reexamined with ultrasound to note movement of fluid that may indicate bleeding. Additionally, the patient should remain under observation for vital signs and fetal assessment for at least an hour after the procedure. Some mild cramping is normal, but dizziness, hypotension, severe cramping, and fever or chills may indicate complications. A neonate born at 36 or more weeks gestation with moderate hypoxemic-ischemic encephalopathy should be treated with hypothermia for how long? a. 24 hours b. 48 hours c. 72 hours - C ....with induced temperatures of 33.5C/92.3F to 34.5C/94.1F for 72 hours, with the treatment initiated within 6 hours and the neonate slowly warmed over a 4 hour period at the conclusion of the therapy. Studies show that neonates treated with hypothermia had lower rates of neurological impairment and lower rates of mortality than those who received alternative treatments. On the maternal serum screen, a high level of alpha-fetoprotein indicates a possibility of a. trisomy 21 (Down syndrome) b. neural tube defect c. trisomy 18 (Edwards syndrome) - B However, levels may also be high with multiple gestations, other fetal abnormalities (gastroschisis), and fetal death. Many false positives occur because of inaccuracy in gestation age because the test is most accurate if done between 16-18 weeks, although it can be done anytime between 14-22 weeks. The alpha-fetoprotein level identifies about 85% of fetuses with neural tube defects. Breast self-stimulation is often done to facilitate the a. nonstress test b. vibroacoustic stimulation test c. contraction stimulation test - C (CST), which evaluates the fetal heart rate response to contractions. The test requires contractions lasting at least 40 seconds in a 10 minute period of time. In order to stimulate contractions, the patient may be administered oxytocin or asked to carry out self-stimulation of the breasts because nipple stimulation results in increased production of endogenous oxytocin. Baseline measurements are taken for the first 15-20 minutes before the CST is carried out. If a fetal scalp sampling shows pH of 7.23 with non-reassuring fetal heart rate, the response should be to a. monitor and repeat sampling in 2-3 hours b. monitor and repeat sampling in 15-20 minutes c. immediately repeat sampling and, if no improvement, immediate delivery - B The normal fetal blood pH is 7.25-7.35. If the pH falls to a pH of 7.2 or less, then immediate delivery is indicated because acidosis is present and presenting a risk to the fetus. The sample is taken transvaginally with a special lancet that punctures the fetal scalp rather than cuts in order to prevent bleeding. The Doppler scan is used to a. determine the size and shape of the placenta b. determine the implantation site of the placenta in the uterus c. measure the flow of blood from the uterine arteries to the placenta - C aka uterine artery Doppler used to determine if placental insufficiency is present. The probe emits high-frequency sound waves, which are echoed back, and the frequency at which this occurs is translated into images and graphs that show blood flow. Doppler is used in conjunction with a placental ultrasound, which is done to determine the size and shape of the placenta as well as the placental location, umbilical cord insertion, and number of umbilical blood vessels. Fetal heart rate patterns are categorized as baseline, a. periodic, and episodic