OB PrepU: Chapter 21 Exam Questions With Correct Answers
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OB PrepU
OB PrepU: Chapter 21 Exam Questions With
Correct Answers
Tocolytic therapy will help to prevent preterm birth.
a) False
b) True - answera) False
Rationale:
Tocolytic therapy does not typically prevent preterm birth, but instead it may delay it.
At 31 weeks' gestation, a 37-year-old woman who...
OB PrepU: Chapter 21 Exam Questions With
Correct Answers
Tocolytic therapy will help to prevent preterm birth.
a) False
b) True - answer✔a) False
Rationale:
Tocolytic therapy does not typically prevent preterm birth, but instead it may delay it.
At 31 weeks' gestation, a 37-year-old woman who has a history of preterm birth reports cramps,
vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Her cervix
is 2.1 cm long; she has fetal fibronectin in her cervical secretions, and her cervix is dilated 3 to 4
cm. For what do you prepare her?
a) Careful monitoring of fetal kick counts
b) Bed rest and hydration at home
c) Hospitalization, tocolytic therapy, and IM corticosteroids
d) An emergency cesarean section - answer✔c) Hospitalization, tocolytic therapy, and IM
corticosteroids
Rationale:
At 31 weeks gestation, the goal would be to maintain the pregnancy as long as possible if the
mother and fetus are tolerating continuation of the pregnancy. Stopping the contractions and
placing the patient in the hospital allow for monitoring and a safe place if the woman continues
and delivers. Administration of corticosteroids may help to develop the lungs and prepare for
early preterm delivery. Sending the woman home is contraindicated in the scenario described.
An emergency cesarean section is not indicated at this time. Monitoring fetal kick counts is
typically done with a post-term pregnancy.
A patient is 23 weeks gestation and was admitted for induction and delivery after noting the
infant was an intrauterine fetal death. The patient had fallen 3 days prior to the diagnosis and
landed on her side. What is the most likely attributable cause to the fetal death?
d) Premature rupture of membranes - answer✔c) Placental abruption
Rationale:
The most common cause of fetal death after a trauma is placental abruption, where the placenta
separates from the uterus and the fetus is not able to survive. Genetic abnormalities typically
cause spontaneous abortion in the first trimester. The scenario does not indicate that there has
been a premature rupture of membranes, nor the possibility of preeclamsia.
A woman experiences an amniotic fluid embolism as the placenta is delivered. Your first action
would be to
a) increase her intravenous fluid infusion rate.
b) administer oxygen by mask.
c) put firm pressure on the fundus of her uterus.
d) tell the woman to take short, catchy breaths. - answer✔b) administer oxygen by mask.
Rationale:
An amniotic embolism quickly becomes a pulmonary embolism. The woman needs oxygen to
compensate for the sudden blockage of blood flow through her lungs.
You are assisting with delivery of the second child of a healthy young woman. Her pregnancy
has been uneventful, and labor has been progressing well. The fetal head begins to deliver but
instead of continuing to emerge, it retracts into the vagina. What should you try first?
a) Attempt to push one of the fetus' shoulders in a clockwise or counterclockwise motion.
b) Zavanelli's maneuver
c) McRobert's maneuver
d) Apply pressure to the fundus. - answer✔c) McRobert's maneuver
Rationale:
This intervention is used with a large baby who may have shoulder dystocia and require
assistance. The legs are sharply flexed, by a support person or nurse, and the movement will help
to open the pelvis to the widest diameter possible. Zavanelli maneuver is performed when the
practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean
delivery. Fundal pressure is contraindicated with shoulder dystocia. It is out of the province of
d) Vacuum extraction - answer✔c) External cephalic version
Rationale:
External cephalic version is the turning of a fetus from a breech to a cephalic position before
birth. It may be done as early as 34 to 35 weeks, although the usual time is 37 to 38 weeks of
pregnancy. A trial birth is performed when a woman has a borderline (just adequate) inlet
measurement and the fetal lie and position are good and involves allowing labor to take its
normal course as long as descent of the presenting part and dilatation of the cervix continue to
occur. Forceps, which are not commonly used anymore, and vacuum extraction are used to
facilitate birth when other complications are present, but would be less likely to be used with a
fetus in breech position.
A nurse is working with a client who has just begun labor and who has given birth vaginally five
previous times. Which of the following interventions will the nurse most likely need to
implement to meet the needs of this particular client?
a) Prepare the client for cesarean birth
b) Prepare to administer oxytocin
c) Darken the room lights
d) Convert the birthing room to birth readiness before full dilatation is obtained - answer✔d)
Convert the birthing room to birth readiness before full dilatation is obtained
Rationale:
Both grand multiparas (women who have given birth five or more times) and women with
histories of precipitate labor should have the birthing room converted to birth readiness before
full dilatation is obtained. Then, even if a sudden birth should occur, it can be accomplished in a
controlled surrounding. As the client is likely to give birth relatively quickly, there is no need for
oxytocin or to darken the room lights. There is also no indication that cesarean birth will be
necessary, particularly because all of the client's previous births were vaginal.
d) Use a fist to apply counter pressure to the lower back. - answer✔d) Use a fist to apply
counter pressure to the lower back.
Rationale:
Counter pressure applied to the lower back with a fisted hand sometimes helps the woman to
cope with the "back labor" characteristic of the occiput posterior position.
You assess that the fetus of a woman is in an occiput posterior position. Which of the following
identifies the way you would expect her labor to differ from others?
a) Need to have the baby manually rotated.
b) Experience of additional back pain.
c) Shorter dilatational stage of labor.
d) Necessity for vacuum extraction for delivery. - answer✔b) Experience of additional back
pain.
Rationale:
Most women whose fetus is in a posterior position experience back pain while in labor. Pressure
against the back by a support person often reduces this type of pain. An occiput posterior
position does not make for a shorter dilatational stage of labor, it does not indicate the need to
have the baby manually rotated, and it does not indicate a necessity for a vacuum extraction
delivery.
After teaching a class about various methods for cervical ripening, the instructor determines that
the teaching was successful when the class identifies which of the following as a surgical
method?
a) Laminaria
b) Prostaglandin
c) Amniotomy
d) Breast stimulation - answer✔c) Amniotomy
Rationale:
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