Deck 3: Antenatal Assessment and High Risk Delivery

Question 1

What is generally accepted as a safe limit for alcohol consumption during pregnancy to avoid the development of fetal alcohol syndrome?

A)One to two 8-ounce drinks per day are considered acceptable.
B)Four to five 8-ounce drinks per week are considered safe.
C)Three to four 12-ounce drinks per week are considered reasonable.
D)No safe range of alcohol consumption is deemed safe during pregnancy.

Answer 1

D
Alcohol is a potent teratogen,an agent or factor that causes malformation in the fetus.Fetal alcohol syndrome,associated with maternal use of alcohol in pregnancy,is characterized by mental retardation and prenatal and postnatal growth restriction,as well as by brain,cardiac,spinal,and craniofacial anomalies.It is usually seen among children of women who consume four to six alcoholic drinks daily throughout pregnancy.However,no safe range of alcohol consumption during pregnancy exists.

Question 2

A fetus is undergoing a contraction stress test.Uterine contractions are stimulated by the intravenous infusion of oxytocin into the mother.The fetal PO₂ drops below 12 mm Hg and causes the fetal heart rate to slow.Which of the following conditions is likely indicated by this occurrence?

A)Placenta abruption
B)Oligohydramnios
C)Uteroplacental insufficiency
D)Nuchal cords

Answer 2

C
During a contraction stress test FHR levels are monitored continuously while uterine contractions are stimulated by intravenous infusion into the mother of a dilute solution of oxytocin.In a normal pregnancy,fetal Po₂ (partial pressure of oxygen)decreases with each uterine contraction and then rapidly returns to normal.A fetal Po₂ drop below 12 mm Hg,resulting in slowing of the FHR,indicates uteroplacental insufficiency.This slowing of the FHR in response to uterine contractions is called a late deceleration.

Question 3

A pregnant woman has been diagnosed with pregestational diabetes.Which of the following risk factors should the therapist be aware at the time of delivery?

A)Unexplained abruption placenta
B)Oligohydramnios
C)Microcephaly
D)Fetal malformations

Answer 3

C
Adverse fetal outcomes include unexplained fetal death in the third trimester of pregnancy and major fetal structural malformations.Close surveillance of the maternal metabolism and close fetal biophysical evaluation have significantly decreased the risk of fetal death as well as the necessity of delivering a fetus prematurely because of abnormal test results.The rate of fetal structural malformations in infants born to pregestational diabetic women can be as high as 10% to 15% compared with a rate of 1% to 2% for infants of otherwise normal women.The most frequently encountered defects include malformations of the cardiovascular system,including both the heart and great vessels,and the central nervous system,including the brain and spinal cord.No amount of maternal metabolic surveillance or fetal biophysical assessment after the period of fetal organogenesis will decrease this risk.Therefore,it is recommended strongly that women with diabetes mellitus receive counseling and treatment with the goal of achieving optimal glycemic control before they become pregnant.

Question 4

A woman with a long history of smoking is now in the last part of the third trimester of her pregnancy.She is at high risk for which of the following conditions?
I)Premature rupture of membranes
II)Placental abruption
III)Placenta previa
IV)Sudden infant death syndrome

A)II and IV only
B)I,II,and III only
C)I and III only
D)I,II,III,and IV

Question 5

In lieu of obtaining a scalp blood gas sample,what can the therapist do to conduct intrapartum assessment of the fetus?

A)Fetal scalp stimulation
B)Umbilical cord blood sampling
C)Placental blood sampling
D)Biophysical profile

Question 6

How should the therapist interpret a fetal biophysical profile score of 7?

A)The fetus requires careful evaluation and possibly immediate delivery.
B)The fetus requires another biophysical profile in 24 hours.
C)The fetus appears to be normal.
D)The data are inconclusive and the profile needs to be redone immediately.

Question 7

The respiratory therapist is called to assist in the labor of a pregnant woman whose NST reported two accelerations in fetal heart rate,each of at least 15 beats per minute and lasting at least 15 seconds,associated with maternal perception of fetal movement over a period of 20 minutes.What is the best course of action?

A)A C-section should be scheduled as soon as possible.
B)No action is required because this reactive NST is associated with normal uteroplacental function.
C)A CST should be performed before fetal stress is confirmed.
D)Oxytocin should be to be administered to prevent more fetal stress.

Question 8

Which of the following microorganisms often affect pregnancy outcome?

A)Group B Streptococcus
B)Haemophilus influenzae
C)Mycobacterium tuberculosis
D)Hepatitis C virus

Question 9

A pregnant woman at 30 weeks of gestation with premature rupture of membranes has been admitted to the hospital with preterm labor.The physician has ordered betamethasone.When does the maximal benefit of antenatal corticosteroid occur to reduce RDS?

A)After 12 hours
B)After 24 hours
C)After 48 hours
D)After 1 week

Question 10

A woman 41-weeks pregnant is at high risk for complication in the postpartum period.Which of the following agents will be more appropriate to induce labor?

A)Magnesium sulfate
B)Aspirin
C)Terbutaline
D)Oxytocin

Question 11

Once preterm labor is diagnosed,which of the following medications should be considered as tocolytic?

A)Magnesium sulfate
B)Sodium bicarbonate
C)Calcium carbonate
D)Epinephrine

Question 12

Which of the following conditions are associated with preeclampsia?
I)Multiparity
II)Proteinuria
III)Generalized edema
IV)Hypertension

A)II and III
B)I,II,and III
C)I,III,and IV
D)II,III,and IV

Question 13

The respiratory therapist is attending a term labor of a woman diagnosed with gestational diabetes.The baby is very large for gestational age.What other metabolic disturbances should be considered?
I)Hyperglycemia
II)Hypocalcemia
III)Hyperkalemia
IV)Hypoglycemia

A)II and IV only
B)I,II,and III only
C)I and III only
D)II,III,and IV only

Question 14

What is the average birth weight difference between infants born of mothers who smoke and those born of nonsmoking mothers?

A)Infants born of mothers who smoke tend to be about 200 g lighter than infants born of mothers who do not smoke.
B)Infants born of mothers who smoke are generally about 400 g lighter than infants born of nonsmoking mothers.
C)Infants born of mothers who smoke are predisposed to weigh approximately 600 g less than infants born of mothers who do not smoke.
D)Infants of mothers who smoke are likely to be born about 800 g lighter than those born of mothers who do not smoke.

Question 15

What is the main potential problem associated with the premature rupture of membranes?

A)Fetal dehydration
B)Fetal infection
C)Maternal hypotension
D)Maternal renal failure

Question 16

How should the therapist interpret an amniotic fluid index of 5 cm?

A)Polyhydramnios
B)Multihydramnios
C)Oligohydramnios
D)Anhydramnios

Question 17

Which of the following maternal complications is associated with cesarean section?

A)Intraoperative bladder or bowel injuries
B)Endomyometriosis
C)Failure to progress in labor
D)Placenta previa

Question 18

Which of the following conditions is a significant problem in postterm pregnancy?

A)Infection
B)Fetal anencephaly
C)Meconium aspiration
D)Obesity

Question 19

What is the most common invasive procedure to assess the fetal condition?

A)Amniocentesis
B)Scalp fetal pH
C)Stress test
D)Needle ultrasound

Question 20

Which of the following conditions is responsible for up to 40% of the preterm births in the United States?

A)Cervical insufficiency
B)Premature rupture of the fetal membranes
C)Obstetrical intervention mandated by fetal jeopardy
D)Hormonal treatment during pregnancy

Question 21

A therapist treating a newborn with hypoxemia due to hypothermia should also be aware of which of the following conditions?

A)Hypercarbia
B)Hypoglycemia
C)Hypocalcemia
D)Left-to-right shunt

Question 22

A therapist is called to the labor and delivery room to assist in the resuscitation of a term newborn.If necessary,what FiO₂ should be used to start positive pressure ventilation?

A)100% and wean as needed
B)21% and make changes utilizing preductal oximetry
C)50% and wean for SPo₂ > 88%
D)Any Fio₂ as long as peak pressures do not exceed 20 cm H₂O

Question 23

A therapist is resuscitating a term newborn.The heart rate falls to 55 beats per minute.What is the best course of action?

A)Intubate and provide positive airway pressure
B)Administer IV or ET epinephrine
C)Apply bag-mask ventilation
D)Continue compressions until heart rate is greater than 60

Question 24

A therapist is resuscitating a term newborn.What should be the rate of ventilation?

A)20 to 30 breaths per minute
B)30 to 40 breaths per minute
C)40 to 60 breaths per minute
D)60 to 100 breaths per minute