Inpatient OB Certification: Multiple Choice Questions and Answers, Exams of Nursing

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Inpatient OB Certification

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. - a. cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments. A class of antihypertensive drugs that should be avoided in pregnancy is: a. ACE inhibitors b. adrenergic blocking agents c. calcium channel blockers - a. ACE inhibitors Gestational diabetes places a woman at increased risk of: a. a birth with a congenital defect b. oligohydramnios with resultant fetal growth restriction c. overt diabetes in later life - Overt diabetes in later life A sign of symptom that indicates a progression of preeclampsia to eclampsia and warrants a consideration for delivery is: a. epigastric pain b. nausea or vomiting

c. persistent proteinuria - epigastric pain A predisposing factor for preeclampsia is: a. nulliparity b. obesity prior to pregnancy c. previous history of preeclampsia - A, B, and C A women is receiving magnesium sulfate. A sign that the magnesium sulfate is reaching a toxic level is: a. decreased appetite b. difficulty in swallowing c. slurring of speech - Slurring of the speech A positive ankle clonus that occurs with preeclampsia is usually a result of a. cerebral edema b. decreased colloid osmotic pressure c. dependent edema - cerebral edema A potentially life saving measure for a fetus that is exposed to chicken pox just prior to delivery is for the mother to receive: a. acyclovir (Zovirax) b. the chicken pox vaccine c. varicella immune globulin (VZIG) - Varicella immune globulin (VZIG)

Following cesarean delivery for abrupt placenta, a clot observation test is initiated. Placing a small amount of blood in a test tube for 20 minutes yields a soft clot that dissolves easily. This is consistent with: a. hypofibriongenemia b. normal coagulation process c. presence of antithrombin III - Hypofibriongenemia A finding that would indicate a pregnant diabetic patient is at increased risk for giving birth to an infant with a congenital defect is: a. a history of macrosomia in her previous pregnancy b. an elevated hemoglobin A1C levels during the first trimester c. glucose levels above 140 mg/dL in the third trimester - b. an elevated hemoglobin A1C levels during the first trimeter (A1C) — Hemoglobin A1C levels are monitored during pregnancy because they correlate with a woman's blood glucose concentration over the prior 8 to 12 weeks and are predictive of the risk for congenital malformations and neonatal birth weight [9]. Lower values have been associated with better outcomes. (<6) When a pregnant woman experiences a cardiac arrest, the nurse should: a. first focus on assessing fetal status b. if the mother dies, discontinue resuscitative efforts c. treat the patient as the same as a non-pregnant patient - c. Treat the patient as the same as a non- pregnant patient

At term, a woman is labor is found to have severe condylomata which has obstructed the vaginal canal. The appropriate disposition is. a. cesarean delivery b. cryotherapy removal c. immediate removal with podophyllin - a. cesarean delivery A hematologic change in pregnancy that predisposes to venous thrombosis is a. depressed fibrinolytic activity b. increased white blood cell count c. reduced erythrocyte production - a. depressed fibrinolytic activity A women is admitted to labor and delivery at 32 weeks gestation with vaginal bleeding. Her hematocrit is falling and she is tachycardic. A Kleihauer-Betketest is ordered. This is done to: a. detect fetal red blood cells in the maternal circulation b. detect hemolysis of fetal red blood ells c. rule out Rh isoimmunization - a. detect fetal red blood cells in the maternal circulation A pregnant woman at 33 weeks gestation experiences an eclamptic seizure. The medication of choice for this patient is immediate, intravenous administration of: a. diazepam (Valium) b. magnesium sulfate c. phenytoin (Dilantin) - b. magnesium sulfate

A pregnant woman has a hemoglobin level of 9 g/dL and is stable, afebrile, and can ambulate without adverse symptoms. The indicated treatment is a. oral iron preparation b. parenteral iron therapy c. whole blood transfusions - a. oral iron preparation The Centers for Disease Control and Prevention (CDC) has defined anemia as hemoglobin levels of less than 11 g/dL (hematocrit less than 33 percent) in the first and third trimesters and less than 10.5 g/dL (hematocrit less than 32 percent) in the second trimester [21]. Since hemoglobin and hematocrit levels are lower in African-American adults, the Institute of Medicine recommends lowering the hemoglobin cut-off level by 0.8 g/dL in this population A women at 34 weeks gestation is admitted to the antepartum unit for influenza type symptoms and lymphadenopathy. A culture shows an infection caused by T. gondii. The most likely transmission route for this infection is. a. ingestion of raw meat b. rectal transfer c. sexual intercourse - ingestion of raw meat Toxoplasma gondii is a ubiquitous protozoan parasite that infects humans in various settings. Acute infection in the mother is usually asymptomatic. When symptoms of infection occur, they are nonspecific, such as fatigue, fever, headache, malaise, and myalgia. Lymphadenopathy is a more specific sign of the disease. A pregnant woman who is HIV positive is on combination antiviral therapy comes to the hospital for delivery. Drug therapy should be: a. continued on the prenatal dosing regimen throughout labor and delivery b. discontinued until after delivery where combination therapy should be resumed postpartum

c. switched to zidovudine IV for one hour and followed by continuous infusion until delivery - a. continued on the prenatal dosing regimen throughout labor and delivery. Women should continue taking their ART regimen during labor and delivery or scheduled cesarean delivery. For women who have HIV RNA ≥1000 copies/mL or unknown viral levels in late pregnancy and around the time of delivery, we recommend intrapartum intravenous zidovudine to further reduce the risk of perinatal transmission (table 2) (Grade 1B). For women who have had HIV RNA <1000 copies/mL consistently in late pregnancy and around the time of delivery and have no concerns related to adherence or resistance to the regimen, intrapartum intravenous zidovudine is not associated with further reduction of HIV transmission. A diagnostic test used in the diagnosis of HELLP syndrome is. a. decreased liver function studies b. increased creatinine clearance c. presence of burr cells - c. decreased liver function studies During labor, women on full dose prophylactic unfractionated heparin anticoagulation should have the heparin dose. a. increased b, maintained c. withheld - c. withheld An alternative regimen to hydrazine when treating severe maternal hypertension is a. diazoxide b. labetalol c. sodium nitroprusside - b. labetalol

The vascular manifestation of pregnant women with Class F diabetes is a. atherosclerotic heart disease b. nephropathy c. proliferative retinopathy - b. nephropathy Which class of antidepressants is most safe for use by pregnant woman? a. MAO inhibitors b. SSRIs c. Tricyclic - b. SSRIs Selective Serotonin reuptake inhibitors A woman who previously had an infant with anencephaly is planning another pregnancy. She should be advised to supplement her diet with folic acid in the dosage of a. 0.04 mg b. 0.4 mg c. 4.0 mg - c. 4.0 mg - recommendation from ACOG. The dose is decreased to 0.4 mg per day after the first trimester. For most women of reproductive potential, we suggest one multivitamin containing 0.4 mg of folic acid once per day beginning at least one month prior to conception and continuing through the first trimester A woman at 31 weeks gestation is admitted to labor and delivery for cuts and bruises on her stomach and torso. When asked how she acquired the bruise, she admits that her partner beat her after she told him she was leaving him due to repeated abusive episodes. The nurse would recognize that the utmost priority is the woman's

a. need for social support b. physical safety c. risk for fetal loss - b. physical safety Because of potential fetal risks for pregnant woman with chronic hypertension, an antepartum fetal assessment that is recommended is a. amniocentesis b. serial ultrasound c. urinary estriols - b. serial ultrasound Compared to alphafetoprotein testing, triple screen testing improves the ability to detect. a. metabolic disorders b. open neural tube defects c. trisomies - c. trisomies When comparing the non stress over the contraction stress test, the clinician should understand that the non-stress test a. has a low false negative rate b. is more sensitive to fetal oxygen reserve c. Requires more repeat testing. - a. has a low false negative rate A negative contraction stress test is characterized by

a. accelerations with onset of contractions b. maintenance of beat to beat variability c. no decelerations in response to contractions - c. no decelerations in response to contractions Failure to elicit a relative pattern with a non stress test after one hour of monitoring warrants a. initiation of a biophysical profile b. repeat testing after administration of orange juice c. retesting in 24 hours. - a. initiation of a biophysical profile A diagnosis of severe preeclampsia is consistent with a 24 hour urine showing protein excreting of? a. 1 g/L b. 3g/L c. 5g/L - c. 5g/L An indication of impending magnesium sulfate toxicity in the patient being treated for preeclampsia is the absence of? a. deep tendon reflexes b. fetal movement c. urine output - a. deep tendon reflexes The therapeutic range of serum magnesium during magnesium sulfate therapy to prevent eclampsia seizures is

a. 1 to 4 mg/dL b. 5 to 8 mg/dL c. 9 to 12 mg/dL - b. 5 to 8 mg/dL The first priority in the care of a patient during an eclamptic seizure is to? a. administer an anticonvulsant agent b. ensure a patent airway c. establish IV access - b. ensure a patent airway Diagnosis of preeclampsia requires the presence of hypertension and? a. edema b. headaches c. proteinuria - c. proteinuria Severe preeclampsia can be diagnosis in the presence of? a. excretion of 4500 g protein in a 24 hour urine b. serial diastolic bp of at least 110 mm Hg c. serum blood urea nitrogen of 10mg/dL with a serum creatinine of 1mg/dL - b. serial diastolic bp of at least 110mm Hg ______________ disorders are the most common medical complication of pregnancy. - hypertensive

A diastolic blood pressure of _________ mm Hg on two occasions at least 6 hours apart is necessary for the diagnosis of severe preeclampsia. - 110 mm Hg The blood pressure should be recorded with the pregnant woman in the ______________ position. - Semi-Fowler's ___________ is the drug of choice to prevent seizure activity in the patient with preeclampsia. - Magnesium Sulfate Material morbidity from hypertension in pregnancy results from?

4 - Abruption placentae DIC hepatic failure acute renal failure The goals of antihypertensive therapy in the woman with preeclampsia are to _________ and to ___________. - prevent maternal CVA maintain uteroplacental perfusion Laboratory markers for HELLP syndrome are __________, ___________ and ___________ - Hemolysis, Elevated Liver Enzymes, Low Platelet count The leading cause of maternal morbidity following an eclamptic seizure is ______________. - aspiration

Invasion of the trophoblastic cells into the uterine myometrium is termed placenta a. accreta b. increta c. percreta - b. increta The incidence of placenta previa is increasing likely due to a. better diagnostic tools such as transvaginal ultrasound b. increased rate of cesarean birth c. more women delaying childbirth until they are older - b. increased rate of cesarean birth Painless, bright red vaginal bleeding at 28 weeks gestation is most likely due to a. abruptio placentae b. placenta previa c. uterine rupture - b. placenta previa A clinical finding associated with a dehiscence of a uterine scar during a trial of labor after cesarean birth (TOLAC) is: a. cessation of uterine contractions b. fetal heart rate (FHR) with variable decelerations c. sudden decrease of intrauterine pressure - b. fetal heart rate (FHR) with variable decelerations The initial drug of choice for excessive bleeding in the immediate postpartum period is a. Methergine IM b. Oxytocin IV infusion

c. Prostaglandin 15-MF suppository - b. Oxytocin IV infusion The most common cause of postpartum hemorrhage is? a. an atonic uterus b. a cervical laceration c. a placenta accrete - a. an atonic uterus In the last 10 years in the United States, the maternal mortality rate has a. decreased b. stabilized c. increased - c. increased Which group has the highest maternal mortality a. African American Women b. Hispanic Women c. Native American Women - a. African American Women Approximately two thirds of maternal trauma seen in the ED is related to a. domestic violence/intimate partner violence b. falls at home or in the workplace c. motor vehicle accidents - c. motor vehicle accidents

The risk of uterine inversion is increased with a. a prior uterine scar b. suprapubic pressure c. traction applied to the cord - c. traction applied to the cord Cervical lacerations after birth should be suspected if a. estimated blood loss exceeds 500mL b. the mother reports severe cramping pain c. the uterus is well contracted but frank bleeding continues - c. the uterus is well contracted but frank bleeding continues. Vasa previa is the result of a ____________ insertion of the cord - Velamentous For the fetus to maintain adequate oxygenation, the maternal oxygen saturation must be at least _______% - 95% _______ is a late sign of hypovolemia in the woman experiencing bleeding during pregnancy - hypotension Active Management of the third state of labor involves

4. • 1. Administer oxytocin with delivery of the anterior shoulder

5. Clamping/cutting the umbilical cord by 2 to 3 minutes of birth

3. Controlling traction of the umbilical cord, with the provider's hand supporting the uterus to prevent uterine inversion
4. Preforming vigorous fundal massage for at least 15 seconds. Based on 28 day cycles, when using the first day of the last menstrual period, the estimated date of confinement is calculated by adding a. 220 days b. 240 days c. 280 days - c. 280 days What does EDC stand for? - Estimated day of Confinement The most accurate method for determining gestational age is? a. crown-rump length by ultrasound at 6-12 weeks b. multiple biometric measurements by ultrasound between 12 and 20 weeks c. stated date for the first day of the last menstrual period. - a. crown-rump length by ultrasound at 6- weeks. By 28 to 34 weeks gestation in a normal pregnancy, blood volume has increased by approximately a. 10-20% b. 30-50% c. 60-80% - b. 30-50% During pregnancy, the position for optimum maternal cardiac output is. a. lateral b. semi-Fowler's c. supine - a. lateral

During labor, maternal cardiac output a. decreased slightly b. increases progressively c. remains the same - b. increases progressively An intravenous (IV) fluid bolus is given before epidural anesthesia to prevent. a. hypotension b. renal hypoperfusion c. sympathetic blockade - a. hypotension Normally during pregnancy, maternal sitting and standing diastolic blood pressure readings a. decrease, then increase b. increase progressively c. remain unchanged. - a. decrease, then increase The volume of the maternal auto transfusion immediately after birth is approximately a. 600mL b. 800mL c. 1000mL - c. 1000mL What happens to maternal PaO2 and PaCo2 levels during pregnancy? a. Both decrease b. Both increase c PaO2 increased and PaCO2 decreases - c. PaO2 increases and PaCO2 decreases

The slight increase in pH that occurs during pregnancy is due to a. a decrease in hemoglobin and hematocrit b. a decrease in renal excretion of bicarbonate c. an increase in ventilatory rate - c. an increase in ventilatory rate During pregnancy serum urea and creatine levels a. decrease b. increase c. remain constant - a. decrease Heartburn is common during pregnancy due primarily to a. decreased gastric motility b. increased secretion of hydrochloric acid c. relaxation of the lower esophageal sphincter - c. relaxation of the lower esophageal sphincter A physical finding that may occur during pregnancy in response to normal cardiovascular changes is a. decreased heart rate b. dependent edema c. elevated blood pressure - b. dependent edema The average blood loss during vaginal birth is less than a. 300mL b. 500mL c. 700mL - b. 500mL

The average blood loss during a cesarean birth is less than a. 600mL b. 800mL c. 1000mL - c. 1000mL During pregnancy, cardiac output increases approximately a. 10-25% b. 30-50% c. 60-70% - b. 30-50% Cardiac output is greatest during which period of birth process? a. First stage, active phase b. Immediately after birth c. second stage - b. immediately after birth A cardiovascular parameter which normally decreases during pregnancy is a. heart rate b. stroke volume c. systemic vascular resistance - c. systemic vascular resistance An expected white blood cell count during labor and the early postpartum is a. 8,000-10,000 mm b. 13,000-15,000 mm c. 20,000-22,000 mm - c. 20,000-22,000 mm

Which of the following coagulation factors does not increase during pregnancy? a. Fibrin b. Platelets c. Fibriogen - b. Platelets Which of the following increases during pregnancy? a. Colloid oncotic pressure b. Glomerular filtration rate C. Serum osmolality - b. Glomerular filtration rate Colloid oncotic (osmotic) pressure (movement of solutions pressure) Increased pressure pushes protein out of capillary carried away by lymphatics. Reduction in oncotic pressure and increase in filtration across the capillary, resulting in excess fluid build up in the tissue (EDEMA) By term, blood flow to the uterus is approximately a. 200mL/min b. 500mL/min c. 800mL/min - b. 500mL/min During pregnancy, the pigmented line in the skin that traverses the abdomen longitudinally from the sternum to the symphysis is called the a. linea nigra b. spider nevus c. striae gravidarum - a. linea nigra Which of the following is a change occurring in the respiratory system during pregnancy?

a. Oxygen consumption increases b. Respiratory rate decreases c. Tidal volume decreases - a. Oxygen consumption increases A normal finding during pregnancy is a. glycosuria b. hematuria c. proteinuria - a. glycosuria The respiratory system parameter that decreases during pregnancy is the a. functional residual capacity b. minute ventilation c. vital capacity - a. functional residual capacity A metabolic change characteristic of late pregnancy is decreased a. blood free fatty acid levels b. insulin sensitivity c. serum glucose levels after meals - b. insulin sensitivity What is the most common complication of early pregnancy? - Spontaneous Abortion What accounts for a large percentage of all spontaneous abortions? - Chromosome abnormalities What type of abortion is defined as having three documented (by pathology or ultrasound with heart beat) consecutive spontaneous abortions? a. Habitual abortion

b. Threatened Abortion c. Complete Abortion - a. Habitual abortion What type of abortion is rare but potentially has lethal complication? a. Habitual Abortion b. Incomplete abortion c. Septic abortion - c. Septic Abortion Define abortion? - Termination of pregnancy by any means, resulting in the expulsion of an immature, nonviable fetus. What is the actual terminology for any gestation 10 weeks or less? - Embryo Which risk factors are known to increase the risk for spontaneous abortion? a. Advanced Maternal Age b. alcohol and cigarette smoking c. previous spontaneous abortion d. uterine anomalies - A,B,C,D Fetal cardiac activity is normally identifiable by ultrasonography at ______ to ______ weeks gestation by crown-rump length measurement. - 6 to 7 What are 2 disorders of pregnancy that are classified as a threatened abortion? - Hydatidiform Mole Ectopic Pregnancy What should be considered in every patient who has vaginal bleeding and pain in the first trimester?

a. Hydatidiform Mole b. Ectopic Pregnancy c. Placenta Previa d. Complete miscarriage - b. Ectopic Pregnancy What is the most common site the fertilized ovum implants during an ectopic pregnancy? a. cervix b. abdominal cavity c. fallopian tube d. ovary - c. fallopian tube What are 5 signs of septic shock that usually follow chills and fevers? - oliguria hypotension tachypnea and tachycardia mental confusion warmth & dryness of the extremities (low peripheral resistance) OR cold and cyanotic extremities (increased resistance) Define preterm labor? - Regular uterine contractions associated with cervical change occurring from 20 - 36 6/7 weeks of gestational age. What statements about Corticosteriods are true? a. Reduce the incidence of neonatal respiratory distress and necrotizing enterocolitis b. Inhibits smooth muscle contraction by inhibiting calcium uptake c. Repeat rescue dosing in not recommended.

d. Use is limited to 48-72 hours to avoid complications. - a and c What statements are true for Indomethacin? a. Use is limited to 48 -72 hours to avoid complications b. Pulmonary edema can be a complication c. It should be avoided or used with caution in patients with diabetes. d. When given to a woman with a history of preterm birth, it can effetely decrease the incidence in a subsequent pregnancy - a. Use is limited to 48 - 72 hours to avoid complications. NSAID - Analgesic Because NSAIDs may cause premature closure of the ductus arteriosus, product labeling for indomethacin specifically states use should be avoided starting at 30-weeks gestation. Pulmonary edema can be a complication for this medication? a. Magnesium Sulfate b. Nifedipine c. Progesterone d. Prostaglandin synthase inhibitors - a. Magnesium Sulfate Which medication when given to a woman with a history of preterm birth, it can effectively decrease the incidence in a subsequent pregnancy? a. Corticosteroids b. Indomethacin c. Nifedipine d. Progesterone - d. Progesterone Which B-Sympathominetic is approved by the FDA? a. Ritodrine

b. Terbutaline - a. Ritodrine Which is the most common B-Sympathominetic and is B2 selective? a. Ritodrine b. Terbutaline - b. Terbutaline Identify the Prostaglandin syntheses inhibitors? a. aspirin b. ibuprofen c. indomethacin d. ketorolac e. sulindac - All listed - NSAIDS What is the most common calcium channel blocker for tocolysis? a. Nifedipine b. Magnesium Sulfate - a. Nifedipine What is not a side effect of calcium channel blockers? a. Headache b. Dizziness c. Excessive Thirst d. Hypotension - c. Excessive Thirst What is the gestational age ranges for administration of a corticosteroid to accelerate fetal lung maturity? a. 24-34

b. 25-33 c. 26-34 - a. 24-34 True or False - Prophylactic antibiotic therapy in preterm labor is recommended? - False Why are prophylactic antibiotics used in labor? - To prevent GBS sepsis in a postive cultured mom. Rupture of amniotic membranes before 37 weeks? a. Prolonged rupture of membranes b. preterm rupture of membranes c. premature rupture of membranes - b. preterm rupture of membranes Rupture of amniotic membranes before the onset of labor, regardless of gestational age? a. Prolonged rupture of membranes b. preterm rupture membranes c. premature rupture of membranes - c. premature rupture of membranes Rupture of amniotic membranes for more that 18 hours? a. prolonged rupture of membranes b. preterm rupture membranes c. premature rupture of membranes - a. prolonged rupture of membranes (PAMG-1) placental alpha microglobulin-1 is a protein found at high levels within amniotic fluid. Which test is it measured? a. Nitrazine Test b. Ferning Test