Deck 3: Antenatal Assessment and High-Risk Delivery

Question 1

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

A) Significant blood loss
B) Endomyometriosis
C) Failure to progress in labor
D) Placenta previa

Answer 1

A
Although cesarean delivery might be the least traumatic for the fetus, for the mother it is associated with an increased risk of significant blood loss, anesthesia complications, intraoperative bladder or bowel injuries, postoperative wound infection, endomyometritis, and thromboembolic events. The syndrome of transient tachypnea of the newborn (wet lung or type II respiratory distress syndrome) includes the clinical features of cyanosis, grunting, and tachypnea during the first hours of life. It is more commonly seen in infants delivered by cesarean section. Placenta previa occurs when the placenta covers the cervical os. Cesarean delivery is usually required.

Question 2

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

Answer 2

B
In utero, the fetus is contained in the sterile fluid-filled amniotic sac. If the membranes that compose the external lining of the amniotic sac rupture before term (before 37 weeks of gestation) or before the onset of normal labor at term, the fetal environment is no longer sterile, increasing the risk of fetal infection.

Question 3

How should the therapist interpret a fetal biophysical profile score of 8?

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.

Answer 3

C
The fetal biophysical profile (BPP) assesses placental function and fetal well-being. The BPP has been likened to the Apgar score. Five determinants of fetal status are assessed and a score of 0 to 2 is given. Four are assessed by ultrasonography: fetal breathing, fetal tone, fetal gross body movement, and amniotic fluid volume. The fifth determinant is the nonstress test. A BPP score of 8 to 10 is considered normal and reassuring; a score of 6 is equivocal and is generally repeated within 24 hours; BPP scores of 0 to 4 are clearly abnormal and are associated with poor perinatal outcomes and require careful evaluation and usually immediate delivery.

Question 4

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

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

Question 5

The respiratory therapist is attending a term labor of a woman diagnosed with gestational diabetes. The baby is very large for gestational age. What 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 6

Which of the following microorganisms most commonly affect pregnancy outcome?

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

Question 7

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 8

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 9

Which of the following procedures is performed after the 16th week of pregnancy and can be used to assess for chromosomal abnormalities?

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

Question 10

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.

Question 11

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 12

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 13

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 14

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) Asthma

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

Question 15

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 administered to prevent more fetal stress.

Question 16

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

Question 17

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 18

A pregnant woman has been diagnosed with pregestational diabetes. Of which of the following adverse fetal outcomes should the therapist be aware at the time of delivery?

A) Unexplained abruption placenta
B) Oligohydramnios
C) Malformations of the cardiovascular system
D) Fetal limb malformations

Question 19

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

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

Question 20

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 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 32-week newborn. What FiO₂ should be used to start positive pressure ventilation?

A) 100% and then adjusted using clinical assessment and preductal pulse oximetry
B) 50% and then adjusted using clinical assessment and preductal pulse oximetry
C) 30% and then adjusted using clinical assessment and preductal pulse oximetry
D) Any FiO₂ as long as peak pressures do not exceed 20 cm H₂O

Question 23

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