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ALSO Post-Assessment With Complete Solutions
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In classifying hypertensive disorders of pregnancy, exceeding which one of the following parameters defines an elevated blood pressure in pregnancy? 150/ 140/ 130/ 160/110 - correct answers 140/ In considering continuous electronic Fetal Heart Rate (FHR) monitoring of a term pregnancy, which one of the following attributes would classify the FHR tracing as Category II: Indeterminate? Marked baseline variability Sinusoidal pattern Accelerations absent Early decelerations present - correct answers Marked baseline variability Assisted vaginal delivery is an important tool to safely prevent primary cesarean deliveries. Which of the following is an indication for undertaking an assisted vaginal delivery? Suspected cephalopelvic disproportion
Prolonged first stage of labor Category III fetal heart rate tracing Brow presentation - correct answers Category III fetal heart rate tracing The preferred assisted vaginal delivery instrument, both in the US and around the world, is the vacuum device. To optimize safe use, the cup should be placed over the flexion point of the fetal head. Where is the flexion point located? 1 cm above the plane of the vacuum cup 3 cm forward from the posterior fontanelle 90 degrees to the long-maternal axis At the level of the maternal pelvic spines - correct answers 3 cm forward from the posterior fontanelle Since the 1990's, the American Heart Association has recommended resuscitative hysterotomy in pregnant women who have not benefitted from resuscitative efforts after loss of maternal cardiac activity. Which one of the following is true regarding this procedure that could potentially save two lives? It should only be carried out when appropriate facilities and personnel are available to care for the mother and infant after the procedure Uterine evacuation of the fetus can increase maternal cardiac output up by 60% Consent must be obtained from family members before performing the procedure
CHOOSE ONE
She should undergo a cesarean delivery Delivery between 36 and 37 6/7 weeks' gestation has been recommended to maximize maternal and neonatal outcomes Regional anesthesia is contraindicated at the time of cesarean delivery A vaginal delivery will result in increased hemorrhage - correct answers Delivery between 36 and 37 6/7 weeks' gestation has been recommended to maximize maternal and neonatal outcomes Cesarean delivery for labor dystocia can be decreased by which one of the following? CHOOSE ONE Allowing shorter periods for pushing in the second stage Defining active labor as greater than 4 cm Allowing a minimum of 2 hours of adequate contractions to make cervical change in active labor with rupture of membranes Avoiding admit to the hospital during latent phase of labor - correct answers Avoiding admit to the hospital during latent phase of labor Documentation in the medical record after a delivery with a shoulder dystocia is an essential risk management tool. Which of the following should be documented in the medical record pertaining to the circumstances that took place during the shoulder dystocia? CHOOSE ONE Application of supplemental oxygen for the mother after delivery of the fetal head
The degree of shoulder dystocia designated as: mild, moderate, or severe The maternal blood pressure The elapsed amount of time from delivery of the fetal head until complete delivery of the baby - correct answers The elapsed amount of time from delivery of the fetal head until complete delivery of the baby You are called to the ED where the emergency response system has been activated for an unresponsive 42-year-old G at 40 2/7 weeks who was brought in following an MVC in which she was the restrained passenger. You find the patient to be in the supine position receiving chest compressions. In how many minutes, should resuscitative hysterotomy be undertaken if there is no return of spontaneous circulation? CHOOSE ONE 2 minutes 6 minutes 30 seconds 4 minutes - correct answers 4 minutes Magnesium Sulfate is the preferred treatment for preeclampsia with severe features. In considering this therapeutic intervention, which one of the following statements is true? CHOOSE ONE A magnesium level should be checked if the urine output is The loading dose is 4-6 grams over 15-20 minutes
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Accurate identification of pregnant women at risk of deterioration is difficult, due to physiological changes of pregnancy. The Systematic Inflammatory Response Syndrome (SIRS) creates a red flag system (objective criteria) pointing to a diagnosis of sepsis. Which one of the following is an attribute of the SIRS criteria? CHOOSE ONE Temperature greater than 38C Systolic blood pressure less than 100 mmHg Altered mental status Respiratory rate greater than 22 breaths per minute - correct answers Temperature greater than 38C Preeclampsia is a multisystem disorder with the heralding sign being elevated blood pressure. Which one of the following would classify preeclampsia with severe features? CHOOSE ONE Elevated creatinine (greater than 1.1 mg/dL or 2X baseline) Right lower quadrant pain Platelets less than 150, Protein/Creatinine ratio greater than 0.3 - correct answers Elevated creatinine (greater than 1.1 mg/dL or 2X baseline) Which one of the following is the drug of choice for treatment of DVT and PE in pregnancy? CHOOSE ONE Factor Xa Inhibitor
Warfarin Unfractionated heparin Low-molecular-weight heparin - correct answers Low-molecular-weight heparin A 29-year-old G1 presents for routine prenatal care. Based on her LMP, she is 13 2/7 weeks. Her BMI is 36. In discussing her weight, you advise that maternal obesity, particularly in association with excessive maternal weight gain during pregnancy, increases the risk of fetal macrosomia, which may predispose her to prolonged labor and operative outcomes. Which one of the following statements is true regarding obesity and labor dystocia? CHOOSE ONE She may need higher oxytocin doses for augmentation Obese nulliparas have significantly slower latent and active phases of labor than normal weight women Dinoprostone may work better than misoprostol for cervical ripening in obese women There is good evidence that counseling to limit weight gain changes the risk of macrosomia or cesarean delivery for labor dystocia - correct answers Obese nulliparas have significantly slower latent and active phases of labor than normal weight women Septic shock is a potentially fatal medical condition that occurs when sepsis leads to dangerously low blood pressure and abnormalities in cellular metabolism. Which one of the following is part of a set of six interventions that should be performed by any healthcare worker within the first hour of suspected sepsis? CHOOSE ONE Check serial creatinine levels Administer low-flow oxygen
Which one of the following would be considered a red flag requiring prompt evaluation and/or hospitalization for pregnancy related cardiovascular compromise? CHOOSE ONE Resting HR greater than 120 Resting systolic BP greater than 140 Oxygen saturation Shortness of breath on exertion - correct answers Resting HR greater than 120 In evaluating the pregnant patient with minor trauma, an individual should be observed for 24 hours if she has any of the following EXCEPT: CHOOSE ONE Significant uterine tenderness Greater than or equal to 4 contractions per hour Category II FHR tracing. Vaginal bleeding - correct answers Greater than or equal to 4 contractions per hour You are evaluating a G3P2 who you are augmenting for a protracted second stage of labor. One hour after beginning pitocin you discuss amniotomy with the patient. On artificial rupture of membranes, the fluid is clear, and you feel the cord slip down in front of the presenting part. You should: CHOOSE ONE Assess the maternal oxygenation status
Help to elevate the fetal head by placing the patient in Trendelenburg Perform an emergent forceps delivery Attempt to reposition the cord in the uterus - correct answers Help to elevate the fetal head by placing the patient in Trendelenburg A 22-year-old G2P1 presents at 33 1/7 weeks with complaint of spontaneous rupture of membranes. She reports no vaginal bleeding and denies contractions. Her pregnancy has been complicated by tobacco use; she smokes 5- cigarettes per day. Her vital signs are stable, and she has no elevated temperature. A sterile speculum examination confirms rupture of membranes. In considering her care, which one of the following is recommended? CHOOSE ONE Magnesium sulfate Amoxicillin-clavulinic acid Dexamethasone Nifedipine - correct answers Dexamethasone
