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According to the March of Dimes, there may be four main routes to spontaneous premature labor. They include all except which of the following? a. infections or inflammation b. maternal or fetal stress c. diabetes d ...

According to the March of Dimes, there may be four main routes to spontaneous premature labor. They include all except which of the following? a. infections or inflammation b. maternal or fetal stress c. diabetes d. bleeding - ANSWER c. diabetes Diabetes is not a route considered. The fourth route is uterine stretching. Overdistention of the uterus due to multiple gestation, or placental abnormalities can lead to the release of chemicals that stimulate uterine contractions. The presence of 10^5 or more bacterial colonies per milliliter of urine on two consecutive, clean catch, midstream voided specimens is an indication of: a. pyelonephritis b. cystitis c. thrombophlebitis d. bacteriuria - ANSWER d. bacteriuria Bacteriuria is defined as the presence of 10^5 or more bacterial colonies per milliliter of urine on two consecutive, clean catch, midstream voided specimens. Risk is associated with sickle cell trait, lower socio-economic status, increased parity, and reduced availability of medical care. Which of the following is least likely to be a risk factor for postpartum hemorrhage? a. prolonged labor b. induced or augmented labor c. prior vaginal birth d. difficult third stage of labor - ANSWER c. prior vaginal birth The least likely to be a risk factor for postpartum hemorrhage is prior vaginal birth. Prior cesarean birth is a risk factor, however. Other risk factors include: multiparity, coagulopathies, and uterine rupture (among others). At what point postpartum does the infarcted superficial tissue over the placental site slough off? a. immediately after the placenta is delivered b. 24 hours after delivery c. 72 hours after delivery d. 7-14 postpartum - ANSWER d. 7-14 postpartum At this time, the woman may notice an episode of increased vaginal bleeding, which is usually self-limited. Bleeding lasting more than 1 to 2 hours should be evaluated for late postpartum hemorrhage. During the first few days after birth, which of the following secretions causes strong uterine contractions and a further reduction in size of the uterus? a. progesterone b. estrogen c. prolactin d. oxytocin - ANSWER d. oxytocin During the first few days after birth, oxytocin secretion causes uterine contractions, especially after breastfeeding and in multiparas. Multiparity, multiple gestation, polyhydramnios, and bladder distention can influence uterine size and the progression of uterine involution. The National Screening Committee timeline states that all babies should be formally reviewed at the latest by what age? a. 8 weeks b. 6 weeks c. 1 week d. 2 weeks - ANSWER a. 8 weeks The developmental assessment of the baby at this point gives the practitioner an opportunity to ensure that the baby's neurological development is progressing as would be expected. Transient tachypnea of the newborn is sometimes referred to as which of the following? a. wet lung syndrome b. retained lung fluid c. RDS type II d. all of the above - ANSWER d. all of the above All of these choices are other names for transient tachypnea of the newborn (TTN). The pathophysiology of TTN is excess fluid in the lungs, failure to clear normal fetal lung fluid, or both. Respiratory distress syndrome (RDS) is the major cause of respiratory distress in the newborn. It accounts for approximately what percentage of all premature infant deaths? a. 50-70% b. 20-30% c. 25-45% d. 10-20% - ANSWER a. 50-70% RDS, also known as hyaline membrane disease, accounts for approximately 50-70% of all premature infant deaths. RDS occurs in 60% of babies born at less than 28 to 34 weeks, and in less than 5% of those born after approximately 34 weeks. Which of the following would NOT be an appropriate intervention for a preterm newborn? a. monitor vital signs every 2-4 hours b. avoid touching the infant as much as possible c. monitor weight daily d. monitor intake and output along with electrolyte balance - ANSWER b. avoid touching the infant as much as possible This is not an appropriate intervention. The newborn should be provided with appropriate stimulation, such as touch and cuddling. Which of the following would indicate implied consent to a procedure? a. the patient voluntarily submits to the procedure b. the patient consents in writing c. the patient orally consents d. the patient consents orally and in writing - ANSWER a. the patient voluntarily submits to the procedure When a patient voluntarily submits to the procedure, this indicates implied consent. Consenting in writing or orally is considered expressed consent. Which of the following is a risk factor for a retained placenta? a. previous uterine curettage b. preeclampsia c. nulliparity d. all of the above - ANSWER d. all of the above Risk factors for a retained placenta include all of the first three choices along with previous retained placenta, augmented labor, birth in a dorsal position, and use of ergotamine. The primary risk associated with retained placenta is hemorrhage. Immediately postpartum, the lochia consists primarily of which of the following? a. exudate b. leukocytes c. mucus d. blood - ANSWER d. blood Initially, the lochia consists primarily of blood. As a result, it is red or brownish red in color. As the uterine bleeding decreases at approximately 3-5 days postpartum, leukocyte infiltration occurs and the placental implantation site undergoes exfoliation; at this point, the discharge contains some blood but is primarily exudate and leukocytes, and is pinkish brown in color. An increase in the volume of amniotic fluid is referred to as a. hydramnios b. ketoacidosis c. dystocia d. retinopathy - ANSWER a. hydramnios Hydramnios, or an increase in the volume of amniotic fluid, occurs in 10-20% of pregnant women with diabetes. It is thought to be a result of excessive fetal urination because of fetal hyperglycemia. Preeclampsia occurs more often in diabetic pregnancies, especially when diabetes related vascular changes already exist. Which of the following would be indicative of false labor? a. sedation decreases or stops contractions b. progressive frequency and intensity of contractions c. discomfort begins in the back, radiating into the abdomen d. activity increases contractions - ANSWER a. sedation decreases or stops contractions If sedation decreases or stops contractions it is an indication of false labor. Other indications include: longer intervals between contractions, discomfort in lower abdomen and groin, and no appreciable change in the cervix. Cigarette smoking has been linked to which of the following? a. low birth weight and prematurity b. gestational diabetes c. maternal infections d. fetal infections - ANSWER a. low birth weight and prematurity Cigarette smoking has been linked to an increased incidence of low birth weight and prematurity. From a preventative perspective, it is not enough to discourage smoking in pregnant women. The focus must be on discouraging smoking in any woman of childbearing age who may potentially become pregnant. A shortage of oxygen can have devastating effects on your baby's growth and development. On average, smoking during pregnancy doubles the chances that a. the baby will be born late or weight more than 9.5 lb at birth b. the baby will be born with tremors c. the baby will be born too early and have a higher chance of obesity d. the baby will be born too early or weigh less than 5.5 lb at birth - ANSWER d. the baby will be born too early or weigh less than 5.5 lbs at birth Smoking also more than doubles the risk of stillbirth. The recommended weight gain for an underweight woman who becomes pregnant is which of the following?