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A set of practice questions and answers related to inpatient obstetric care and certification. It covers a wide range of topics including placenta previa, antihypertensive drugs, maternal trauma, uterine inversion, cervical lacerations, maternal mortality, fetal monitoring, labor stages, medication administration, and more. The questions and answers provide valuable insights into the knowledge and skills required for inpatient obstetric nursing practice and certification. The document could be useful for students, nurses, and healthcare professionals preparing for exams, studying for certification, or reviewing obstetric care protocols.
Typology: Exams
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The incidence of placenta previa is increasing likely due to a. better diagnostic tools such as transvaginal ultrasound b. increased rate of cesarean birth
cesarean birth A class of antihypertensive drugs that should be avoided in pregnancy is: a. ACE inhibitors b. adrenergic blocking agents
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Pain during the first stage of labor is caused by a. cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments. b. pressure on the urethra, bladder, and rectum by the descending fetal presenting part c. uterine muscle hypoxia, lactic acid accumulation, and distention of the pelvic floor muscles. -
fallopian tubes, and uterine ligaments. Gestational diabetes places a woman at increased risk of: a. a birth with a congenital defect b. oligohydramnios with resultant fetal growth restriction
A sign of symptom that indicates a progression of preeclampsia to eclampsia and warrants a consideration for delivery is:
a. epigastric pain b. nausea or vomiting
A predisposing factor for preeclampsia is: a. nulliparity b. obesity prior to pregnancy
A women is receiving magnesium sulfate. A sign that the magnesium sulfate is reaching a toxic level is: a. decreased appetite b. difficulty in swallowing
A positive ankle clonus that occurs with preeclampsia is usually a result of a. cerebral edema b. decreased colloid osmotic pressure
A potentially life saving measure for a fetus that is exposed to chicken pox just prior to delivery is for the mother to receive: a. acyclovir (Zovirax) b. the chicken pox vaccine
Following cesarean delivery for abrupt placenta, a clot observation test is initiated. Placing a small amount of blood in a test tube for 20 minutes yields a soft clot that dissolves easily. This is consistent with: a. hypofibriongenemia b. normal coagulation process
A finding that would indicate a pregnant diabetic patient is at increased risk for giving birth to an infant with a congenital defect is: a. a history of macrosomia in her previous pregnancy b. an elevated hemoglobin A1C levels during the first trimester
hemoglobin A1C levels during the first trimeter (A1C) — Hemoglobin A1C levels are monitored during pregnancy because they correlate with a woman's blood glucose concentration over the prior 8 to 12 weeks and are predictive of the risk for congenital malformations and neonatal birth weight [9]. Lower values have been associated with better outcomes. (<6) When a pregnant woman experiences a cardiac arrest, the nurse should: a. first focus on assessing fetal status b. if the mother dies, discontinue resuscitative efforts
as the same as a non-pregnant patient At term, a woman is labor is found to have severe condylomata which has obstructed the vaginal canal. The appropriate disposition is. a. cesarean delivery b. cryotherapy removal
A hematologic change in pregnancy that predisposes to venous thrombosis is a. depressed fibrinolytic activity b. increased white blood cell count
A women is admitted to labor and delivery at 32 weeks gestation with vaginal bleeding. Her hematocrit is falling and she is tachycardic. A Kleihauer-Betketest is ordered. This is done to: a. detect fetal red blood cells in the maternal circulation b. detect hemolysis of fetal red blood ells
circulation A pregnant woman at 33 weeks gestation experiences an eclamptic seizure. The medication of choice for this patient is immediate, intravenous administration of: a. diazepam (Valium) b. magnesium sulfate
A pregnant woman has a hemoglobin level of 9 g/dL and is stable, afebrile, and can ambulate without adverse symptoms. The indicated treatment is a. oral iron preparation b. parenteral iron therapy
The Centers for Disease Control and Prevention (CDC) has defined anemia as hemoglobin levels of less than 11 g/dL (hematocrit less than 33 percent) in the first and third trimesters and less than 10. g/dL (hematocrit less than 32 percent) in the second trimester [21]. Since hemoglobin and hematocrit levels are lower in African-American adults, the Institute of Medicine recommends lowering the hemoglobin cut-off level by 0.8 g/dL in this population
A women at 34 weeks gestation is admitted to the antepartum unit for influenza type symptoms and lymphadenopathy. A culture shows an infection caused by T. gondii. The most likely transmission route for this infection is. a. ingestion of raw meat b. rectal transfer
Toxoplasma gondii is a ubiquitous protozoan parasite that infects humans in various settings. Acute infection in the mother is usually asymptomatic. When symptoms of infection occur, they are nonspecific, such as fatigue, fever, headache, malaise, and myalgia. Lymphadenopathy is a more specific sign of the disease. A pregnant woman who is HIV positive is on combination antiviral therapy comes to the hospital for delivery. Drug therapy should be: a. continued on the prenatal dosing regimen throughout labor and delivery b. discontinued until after delivery where combination therapy should be resumed postpartum c. switched to zidovudine IV for one hour and followed by continuous infusion until delivery -
Women should continue taking their ART regimen during labor and delivery or scheduled cesarean delivery. For women who have HIV RNA ≥1000 copies/mL or unknown viral levels in late pregnancy and around the time of delivery, we recommend intrapartum intravenous zidovudine to further reduce the risk of perinatal transmission (table 2) (Grade 1B). For women who have had HIV RNA <1000 copies/mL consistently in late pregnancy and around the time of delivery and have no concerns related to adherence or resistance to the regimen, intrapartum intravenous zidovudine is not associated with further reduction of HIV transmission. A diagnostic test used in the diagnosis of HELLP syndrome is. a. decreased liver function studies b. increased creatinine clearance
During labor, women on full dose prophylactic unfractionated heparin anticoagulation should have the heparin dose. a. increased b, maintained
An alternative regimen to hydrazine when treating severe maternal hypertension is a. diazoxide b. labetalol
The vascular manifestation of pregnant women with Class F diabetes is a. atherosclerotic heart disease b. nephropathy
Which class of antidepressants is most safe for use by pregnant woman? a. MAO inhibitors b. SSRIs
Selective Serotonin reuptake inhibitors A woman who previously had an infant with anencephaly is planning another pregnancy. She should be advised to supplement her diet with folic acid in the dosage of a. 0.04 mg b. 0.4 mg
The dose is decreased to 0.4 mg per day after the first trimester. For most women of reproductive potential, we suggest one multivitamin containing 0.4 mg of folic acid once per day beginning at least one month prior to conception and continuing through the first trimester A woman at 31 weeks gestation is admitted to labor and delivery for cuts and bruises on her stomach and torso. When asked how she acquired the bruise, she admits that her partner beat her after she told him she was leaving him due to repeated abusive episodes. The nurse would recognize that the utmost priority is the woman's a. need for social support b. physical safety
Because of potential fetal risks for pregnant woman with chronic hypertension, an antepartum fetal assessment that is recommended is a. amniocentesis b. serial ultrasound
Compared to alphafetoprotein testing, triple screen testing improves the ability to detect. a. metabolic disorders b. open neural tube defects
When comparing the non stress over the contraction stress test, the clinician should understand that the non-stress test a. has a low false negative rate b. is more sensitive to fetal oxygen reserve
A negative contraction stress test is characterized by a. accelerations with onset of contractions b. maintenance of beat to beat variability
to contractions Failure to elicit a relative pattern with a non stress test after one hour of monitoring warrants a. initiation of a biophysical profile b. repeat testing after administration of orange juice
A diagnosis of severe preeclampsia is consistent with a 24 hour urine showing protein excreting of? a. 1 g/L b. 3g/L
An indication of impending magnesium sulfate toxicity in the patient being treated for preeclampsia is the absence of? a. deep tendon reflexes b. fetal movement
The therapeutic range of serum magnesium during magnesium sulfate therapy to prevent eclampsia seizures is a. 1 to 4 mg/dL
b. 5 to 8 mg/dL
The first priority in the care of a patient during an eclamptic seizure is to? a. administer an anticonvulsant agent b. ensure a patent airway
Diagnosis of preeclampsia requires the presence of hypertension and? a. edema b. headaches
Severe preeclampsia can be diagnosis in the presence of? a. excretion of 4500 g protein in a 24 hour urine b. serial diastolic bp of at least 110 mm Hg
serial diastolic bp of at least 110mm Hg
A diastolic blood pressure of _________ mm Hg on two occasions at least 6 hours apart is necessary
The blood pressure should be recorded with the pregnant woman in the ______________ position. -
___________ is the drug of choice to prevent seizure activity in the patient with preeclampsia. -
Material morbidity from hypertension in pregnancy results from?
hepatic failure acute renal failure The goals of antihypertensive therapy in the woman with preeclampsia are to _________ and to
maintain uteroplacental perfusion
The leading cause of maternal morbidity following an eclamptic seizure is ______________. -
Invasion of the trophoblastic cells into the uterine myometrium is termed placenta a. accreta b. increta
Painless, bright red vaginal bleeding at 28 weeks gestation is most likely due to a. abruptio placentae b. placenta previa
A clinical finding associated with a dehiscence of a uterine scar during a trial of labor after cesarean birth (TOLAC) is: a. cessation of uterine contractions b. fetal heart rate (FHR) with variable decelerations
variable decelerations The initial drug of choice for excessive bleeding in the immediate postpartum period is a. Methergine IM b. Oxytocin IV infusion
The most common cause of postpartum hemorrhage is? a. an atonic uterus b. a cervical laceration
In the last 10 years in the United States, the maternal mortality rate has a. decreased b. stabilized
Which group has the highest maternal mortality a. African American Women b. Hispanic Women
Approximately two thirds of maternal trauma seen in the ED is related to a. domestic violence/intimate partner violence b. falls at home or in the workplace
The risk of uterine inversion is increased with a. a prior uterine scar b. suprapubic pressure
Cervical lacerations after birth should be suspected if a. estimated blood loss exceeds 500mL b. the mother reports severe cramping pain
well contracted but frank bleeding continues.
For the fetus to maintain adequate oxygenation, the maternal oxygen saturation must be at least
_______ is a late sign of hypovolemia in the woman experiencing bleeding during pregnancy -
Active Management of the third state of labor involves
The most accurate method for determining gestational age is? a. crown-rump length by ultrasound at 6-12 weeks b. multiple biometric measurements by ultrasound between 12 and 20 weeks
length by ultrasound at 6-12 weeks. By 28 to 34 weeks gestation in a normal pregnancy, blood volume has increased by approximately a. 10-20% b. 30-50%
During pregnancy, the position for optimum maternal cardiac output is. a. lateral b. semi-Fowler's
During labor, maternal cardiac output
a. decreased slightly b. increases progressively
An intravenous (IV) fluid bolus is given before epidural anesthesia to prevent. a. hypotension b. renal hypoperfusion
Normally during pregnancy, maternal sitting and standing diastolic blood pressure readings a. decrease, then increase b. increase progressively
The volume of the maternal auto transfusion immediately after birth is approximately a. 600mL b. 800mL
What happens to maternal PaO2 and PaCo2 levels during pregnancy? a. Both decrease b. Both increase
The slight increase in pH that occurs during pregnancy is due to a. a decrease in hemoglobin and hematocrit b. a decrease in renal excretion of bicarbonate
During pregnancy serum urea and creatine levels
a. decrease b. increase
Heartburn is common during pregnancy due primarily to a. decreased gastric motility b. increased secretion of hydrochloric acid
esophageal sphincter A physical finding that may occur during pregnancy in response to normal cardiovascular changes is a. decreased heart rate b. dependent edema
The average blood loss during vaginal birth is less than a. 300mL b. 500mL
The average blood loss during a cesarean birth is less than a. 600mL b. 800mL
During pregnancy, cardiac output increases approximately a. 10-25% b. 30-50%
Cardiac output is greatest during which period of birth process? a. First stage, active phase b. Immediately after birth
A cardiovascular parameter which normally decreases during pregnancy is a. heart rate b. stroke volume
An expected white blood cell count during labor and the early postpartum is a. 8,000-10,000 mm b. 13,000-15,000 mm
Which of the following coagulation factors does not increase during pregnancy? a. Fibrin b. Platelets
Which of the following increases during pregnancy? a. Colloid oncotic pressure b. Glomerular filtration rate
Colloid oncotic (osmotic) pressure (movement of solutions pressure) Increased pressure pushes protein out of capillary carried away by lymphatics. Reduction in oncotic pressure and increase in filtration across the capillary, resulting in excess fluid build up in the tissue (EDEMA) By term, blood flow to the uterus is approximately a. 200mL/min
b. 500mL/min
During pregnancy, the pigmented line in the skin that traverses the abdomen longitudinally from the sternum to the symphysis is called the a. linea nigra b. spider nevus
Which of the following is a change occurring in the respiratory system during pregnancy? a. Oxygen consumption increases b. Respiratory rate decreases
A normal finding during pregnancy is a. glycosuria b. hematuria
The respiratory system parameter that decreases during pregnancy is the a. functional residual capacity b. minute ventilation
A metabolic change characteristic of late pregnancy is decreased a. blood free fatty acid levels b. insulin sensitivity
Abortion
Chromosome abnormalities What type of abortion is defined as having three documented (by pathology or ultrasound with heart beat) consecutive spontaneous abortions? a. Habitual abortion b. Threatened Abortion
What type of abortion is rare but potentially has lethal complication? a. Habitual Abortion b. Incomplete abortion
expulsion of an immature, nonviable fetus.
Which risk factors are known to increase the risk for spontaneous abortion? a. Advanced Maternal Age b. alcohol and cigarette smoking c. previous spontaneous abortion
Fetal cardiac activity is normally identifiable by ultrasonography at ______ to ______ weeks
Hydatidiform Mole Ectopic Pregnancy What should be considered in every patient who has vaginal bleeding and pain in the first trimester? a. Hydatidiform Mole b. Ectopic Pregnancy c. Placenta Previa
What is the most common site the fertilized ovum implants during an ectopic pregnancy? a. cervix b. abdominal cavity c. fallopian tube
hypotension tachypnea and tachycardia mental confusion warmth & dryness of the extremities (low peripheral resistance) OR cold and cyanotic extremities (increased resistance)
change occurring from 20 - 36 6/7 weeks of gestational age. What statements about Corticosteriods are true? a. Reduce the incidence of neonatal respiratory distress and necrotizing enterocolitis b. Inhibits smooth muscle contraction by inhibiting calcium uptake c. Repeat rescue dosing in not recommended.
What statements are true for Indomethacin? a. Use is limited to 48 -72 hours to avoid complications b. Pulmonary edema can be a complication c. It should be avoided or used with caution in patients with diabetes. d. When given to a woman with a history of preterm birth, it can effetely decrease the incidence in a
NSAID - Analgesic Because NSAIDs may cause premature closure of the ductus arteriosus, product labeling for indomethacin specifically states use should be avoided starting at 30-weeks gestation. Pulmonary edema can be a complication for this medication? a. Magnesium Sulfate b. Nifedipine c. Progesterone
Which medication when given to a woman with a history of preterm birth, it can effectively decrease the incidence in a subsequent pregnancy? a. Corticosteroids b. Indomethacin c. Nifedipine
Which B-Sympathominetic is approved by the FDA? a. Ritodrine
Which is the most common B-Sympathominetic and is B2 selective? a. Ritodrine
Identify the Prostaglandin syntheses inhibitors? a. aspirin b. ibuprofen c. indomethacin d. ketorolac
What is the most common calcium channel blocker for tocolysis? a. Nifedipine
What is not a side effect of calcium channel blockers? a. Headache b. Dizziness c. Excessive Thirst
What is the gestational age ranges for administration of a corticosteroid to accelerate fetal lung maturity? a. 24-34 b. 25-33
postive cultured mom.
Rupture of amniotic membranes before 37 weeks? a. Prolonged rupture of membranes b. preterm rupture of membranes
Rupture of amniotic membranes before the onset of labor, regardless of gestational age? a. Prolonged rupture of membranes b. preterm rupture membranes
Rupture of amniotic membranes for more that 18 hours? a. prolonged rupture of membranes b. preterm rupture membranes
(PAMG-1) placental alpha microglobulin-1 is a protein found at high levels within amniotic fluid. Which test is it measured? a. Nitrazine Test b. Ferning Test
Nitrazine Testing relies on the pH of amniotic fluid. What is the pH range that would indicate positive for rupture of membranes? a. 5.0 - 5.5 b. 5.5 - 6.5
What 4 substances can give a false positive test? a. blood b. semen c. urine
d. discharge
What is the primary factor in the decision to continue conservative management of premature rupture of membranes? a. LMP b. Gestational Age c. AFI
After 34 weeks gestation, conservative management of premature rupture of membranes increases the risk for what major concern? a. DIC b. Pyelonephritis c. Chorioamnionits
What is the correct dose for Dexamethasone? a. 12 mg IM x 1 b. 6 mg IM x 2 (q 24 hours) c. 6 mg IM x 4 (q 12 hours)
What test needs to be confirmed before a digital examination can be done of a patient with vaginal bleeding in the third trimester? a. Ultrasound b. BPP c. Reative NST
In an Rh negative woman with vaginal bleeding, what media should be administered to protect
fetal to maternal hemorrhage What characteristics is not associated with placental abruption? a. Vaginal Bleeding b. Abnormal implantation c. Pain
True or False - Vaginal bleeding is always a noticeable clinical symptom of placental abruptions? -
An Apt test is done a woman at 32 weeks gestation with vaginal bleeding. The blood turns brown. This means the blood is: a. Fetal
The risk of placental abruption is higher in women with a history of: a. hypertension b. nulliparity
A women has a mild placental abruption and preterm labor. The tocolytic of choice is: a. Nifedipine b. Magnesium Sulfate
Define the categories of placenta previa?
Total (Complete) Partial (Incomplete)
Partial - part of internal cervical os is covered by placenta Marginal - placental edge extends w/in 2 cm of the internal cervical os.
occurs when the cervix starts to dilate. Vaginal bleeding noted and fetal distress witnessed. Vasa previa occurs when fetal blood vessels travel within the membranes, usually as a velametous insertion, and in so doing , cross the region of the internal cervical os. In the presence of hemorrhagic shock due to bleeding from a placental abruption, fluid replacement should be quickly administered in the form of. a. crystalloid b. normal saline
3ml for every mL of blood lost while waiting for blood products. G2P1001 who is 1-2 cm with contractions q 5-10 minutes; 18 hours later exam is unchanged. a. Prolonged latent phase b. Prolonged second stage c. Protraction disorder of the active phase
Multiparous greater than 14 hours Nullipara who is C/C/+1 at 0300; then C/C/+2 at 0530 - no epidural a. prolonged latent phase b. prolonged second stage