WorksheetsOB First Exam
Total questions: 73
Worksheet time: 37mins
Which of the following is considered normal in urine during pregnancy
Protein
Glucose
Hematuria
Leukocytes
Cardiac increases by approximately what percentage over non-pregnancy values? What is the cardiac output percentage immediately after delivery?
40%; 60%
50%; 70%
40%; 80%
50%; 80%
Which cardiac symptoms are considered normal during pregnancy
S3 heart sounds
Increase in CO
Increase in SVR
Plasma volume increase
Exercise intolerance with shortness of breath
What is a normal blood loss for vaginal birth
500 ml
5000 ml
800 ml
1000 ml
How often do you assess blood pressure for spinal in a patient that is scheduled for a C-section?
Every 3 minutes
Every 2 minutes
Every 4 minutes
Every 1 minute
What are select the factors that favor diffusion across the placenta barrier
Low molecular weight
High Lipid solubility
Low degree of ionization
High protein binding
Low Lipid solubility
Fetal heart tone is compared with what on Fetal monitor/ paper
Maternal contraction
Maternal heart rate
Maternal oxygenation
Maternal Blood pressure
Which of the following indicate fetal well-being? Select all that apply
Moderate amplitude beat to beat variability
Marked amplitude beat to beat variability
Early Deceleration
Accelerations
Late deceleration
What is the normal fetal heart rate?
110-160 bpm
120-170 bpm
150-180 bpm
100-170 bpm
Which of the following is the appropriate Bromage level needed for a spinal C-section; (NOTE: The most frequently used measure of motor block is the Bromage Scale).
Bromage 3
Bromage 2
Bromage 1
Bromage 0
Mrs. Jones is a 25 year old nulliparous at 39 weeks gestation she has a epidural in place by the CRNA she is in the the first stage of labor in the active phase. She is supine, and is having continuous bouts of hypotension with no nausea. What would you do?
Shift the patient to the right side
Give ephedrine 10 mg
Give phenylephrine
Shift the patient to the left
28 year old mom 38 weeks gestation, due to increased contraction. When administering a weak basic medication. What is a typical expectation?
Due to the mothers decreased pH and fetal increase pH; ion trapping in the fetus
Due to maternal pH increase and fetal pH increase: ion trapping in the maternal blood stream
Due to the maternal increase in pH and decrease in fetal pH; ion trapping in the maternal blood stream
Due to the maternal increase in pH and decrease in fetal pH; ion trapping in the fetal blood stream
What is the suggested cause of decrease MAC in the pregnant patient?
Increased minute ventilation with decrease residual volume
Increase CO throughout the pregnancy
Progesterone
Increase in cerebral blood flow to the magnus ralphi
The critical period of organ development extends from approximately _____ to ______ days after the last menstrual period.
14 to 51 days
21 to 68 days
31 to 71 days
30 to 100 days
Which of the following anti-coagulants can be utilized during pregnancy?
Warfarin
Tylenol
Heparin
Low molecular weight heparin
Clopidogrel (Palvix)
What is the correct dose of uterotonic drugs
Oxytocin 20 to 40 units in a 1 liter bag IV
Misoprostol 1200 mcg Intrauterine
Caroprost (Hemabate) 0.25 IV
Ergometrine 0.2 mg IM
Misoprostol 200-800 mcgs sublingual
What is the definitive treatment for PIH
C-section
Magnesium sulfate
Beta- Agonist
Bed rest
Which physiology change during pregnancy is false?
Increase in Heart rate by 20 to 30%
Increase in CO by 40 to 80%
Decrease in SVR by 20%
Decrease in Renal Blood Flow by 10%
Which of the following is true about pain related to stage 1 of labor. (Select 2)
Results from C fibers
Compression and stretching of the pelvic musculature and perineum
T10, T11, T12 ,L1 are the spinal segments that are responsible for pain
S2, S3, S4, are the spinal segments that are responsible for pain
Which states are true regarding the second stage of Labor. (Select 2)
Starts in the Perineum and compression of pelvic musculature
Starts in the cervix and uterus
Innervated by nerves T10- L2
Innervated by nerves S2, S3, S4 in addition to T10-L2
Which of the following stages of labor is false?
First stage of labor latent phase: period between the onset of labor and the point at which the cervix begins to rapidly change
First stage of labor active phase: 2 to 3 cm cervical dilation and is the period during which the cervix undergoes maximum dilation
Second stage: begins at full cervical dilation 10 and ends with delivery of the fetus
Third Stage: begins at fetus passing through the vaginal canal and the passing of the placenta.
What is the recommended total weight gain for a Mrs. Smith if she has a BMI of 29 kg/m2
11.9-15.9 kg
12.47-18.2 kg
6.8-11.4 kg
5-9.1 kg
What percentage of women will require a non-OB surgery while pregnant
0.3-2.2%
1-3%
0.6-1%
4-6%
Which of the following causes teratogenicity in a 35 day old fetus. Select 4
Radioidoine
Tetracyclines
Warfarin
Nitrous oxide
Heparin
Mrs. Fernandez is 33 year old parturient at 30 weeks gestation with a multiple gravida pregnancy. You notice marked deceleration after a maternal contraction what are some intervention that can be performed? Select all that apply
Change maternal positioning
rapid infusion of IV fluids
Maternal oxygen administration
Start Pitocin
Begin Mag sulfate drip.
According to the American College of Obstetricians and Gynecologists what is the absolute minimal platelet level considered appropriate for regional anesthesia
50,000 to 100,000
80,000 to 120,000
100,000 or greater
75,000 or greater
Which of the following is the highest cause of PPH (Post Partum Hemorrhage)
Uterine atony
Laceration, hematomas
Retained tissue, invasive placenta
Coagulopathies
An abnormal placental implantation on the uterus myometrium is referred to as?
Placenta accreta
Placenta increta
Placenta percreta
Placenta previa
Select 3 of the classic signs and treatment of placenta previa
Painless vaginal bleeding
Vaginal examination to stop placenta bleeding
Replacement of blood loss
Increased bleeding postpartum
What is necessary to collect in a maternal history and physical examination 3 weeks prior to term in an uncomplicated pregnant patient? Select all that apply
Maternal vital signs
Gestational age
Gravidity and parity
Platelet count
Airway assessment
Competence to make legal decision occurs at the age of 18 years old in the United States of America Yes/No? What is the exception to that rule?
Yes; Marriage
No; Minor emancipation
Yes; Minor emancipation
No; Marriage
What are the major arteries that provide intervillous blood supply to the fetus?
Spiral Arteries
Straight arteries
Uterine arteries
Radial Artery
2017 AANA Practice Guidelines state the following about CRNA's performing anesthesia in the OB population. Select two
Should be able to determine cervical dilation and effacement
Determine the fetal status prior to administration of any anesthetic
Document fetal status after administration of epidural anesthetic
Document Obstetrician intervention and manipulation prior to insertion of epidural
Mrs. Williams is 28 year nulliparous whom denied any past medical history. She was a difficult IV stick and after three attempts was unable to achieve IV access. The CRNA was called to attempt epidural access for as the patient is rapidly progressing into stage 1 active phase of labor and requesting anesthesia. What do you do?
Place the epidural
Explain the risk of epidural placement without an IV and place the epidural
Explain the risk of placing an epidural catheter without IV access; and attempt IV access
Walk out of the room and tell the nurse she has wasted your time
Which factors minimize the effect of drug circulation within the fetus. Select all that apply
Dilution by the intervillous blood supply
Fetus and metabolizes medication
Medication absorbed by the placenta
Duration of maternal utilization of medication
Mrs. Garcia is 29 year parturient who is approximately 39 weeks gestation, denies co-morbidities and has had a relatively normal pregnancy. Her baby is currently in breech position, she is 2 cm dilated and has a epidural in place. She states an allergy to morphine. At 0500 you receive a page that Mrs. Garcia has a cord prolapse and is heading to the
OR now. What local anesthetic would you give?
Lidocaine 2% with Epi 1:100,000
Lidocaine 2% with Epi 1:200,000
2-Chloroprocaine
Bupivacaine
If the patient is have a C-section with an epidural in place and is not a emergency, cut-down what local anesthetic would be most appropriate
Lidocaine 2% with Epi 1:200,000/cc
Lidocaine 2% with Epi 1:100,000/cc
2-Chloroprocaine
Ropivacaine
Which of the following is the preferred antiseptic of choice for Neuraxial Anesthesia?
2-Chloroprocaine sprayed on the patient
Chlorhexidine with a 3 minute dry time
Iodine
Betadine
Select two indications for a lateral neuraxial anesthetic placement?
Fetal head entrapment
Early deceleration
Umbilical cord prolapse
Marked variability
Which of the following statements regarding pregnancy and physiology is false
Increase of tidal volume as pregnancy approaches term gestation
Decrease in total functional residual capacity
Decrease in residual capacity
Decrease closing capacity
Ultrasound of the spine increases the ability to see structure for an epidural placement, what are some of the hypoechoic structure? select all that apply
Bone
CSF
Blood
Muscles
Intrathecal space
What medication, given concomitantly with tocolytics allows the fetus' lungs to mature?
Pitocin
Hemabate
None, their lungs are matured prior to 37 weeks.
corticosteroids
Initial benefits of corticosteroid, when given with tocolytics, occurs at (pick 2)
18 hours after administration of the first dose.
Immediately following the first dose.
Max benefit at 48 hours
Max benefit at 72 hours
You're caring for a parturient in active labor, You administer a test dose of 1.5% Lidocaine w/ 1:200,000 Epi. You find that the HR is increased, along with circumoral numbness, lightheadedness, and auditory changes. Which of the adverse effects leads you to believe the patient is having LA toxicity?
Circumoral Numbness
Increased HR
Lightheadedness
Auditory Changes.
According to the LAST pdf. a >70kg patient will receive
Bolus 100mL Lipid Emulsion 20%rapidly over 2-3 min
Bolus 1.5mL/kg Lipid Emulsion 20%rapidly over 2-3 min
Infuse 200-250mL over 15-20min
0.25mL/kg/min (Ideal Body Weight)
According to the LAST pdf. a <70kg patient
Bolus 100mL Lipid Emulsion 20%rapidly over 2-3 min
Bolus 1.5mL/kg Lipid Emulsion 20%rapidly over 2-3 min
Infusion 200 - 250mL over 15-20min
Infusion of 0.25mL/kg/min (Ideal Body Weight)
Pt is presenting with a serum magnesium level of 18ml/dL accompanying with hypotention and respiratory depression. The SRNA would:
Reduce Magnesium continuous infusion from 2g IV to 1g IV, give ephedrine, administer O2, and airway support
Stop Magnesium infusion, administer ephedrine IV, administer O2, and airway support
Stop Magnesium infusion, administer neosynepherine, administer O2, and airway support
Stop Magnesium infusion, administer calcium gluconate IV, administer O2, and airway support.
During the SRNA anesthesia pre-evaluation the 34 week parturient begins to have a seizure... There is no-one to be found because there is a MH case going in OR4. You and the PACU RN implement;
Turn the pt in left lateral position, apply jaw thrust, ambu bag 15LPM continuously, delegate RN to start an IV, infuse Magnesium 2g bolus IV followed by 1g/hr maintenance infusion, and administer 10mg labetalol IV
Turn the pt in left lateral position, apply jaw thrust, ambu bag 15LPM continuously, delegate RN to start an IV, infuse Magnesium 5mg bolus IV followed by 2g/hr maintenance, and administer 30mg esmolol IV
Turn the pt in left lateral position, apply jaw thrust, ambu bag 15LPM continuously, delegate RN to start an IV, infuse Magnesium 5g bolus IV followed by 2g/hr maintenance, and administer 10mg labetalol IV
Delegate the RN to grab some dry towels and a basin full of warm water because we gonna deliver this baby now!!!!
What percentage decrease is seen in FRC when a 28 week pregnant patient is placed in the supine position
60%
50%
70%
80%
When should the SRNA and circulating nurse displace the uterus?
At the start of first trimester
At the start of the second trimester
At the third trimester
Only during labor
How many hours postpartum does spinal dosing return to pre-pregnancy dose
12-36 hours
14 days
2-6 days
24-72 hours
Which medication below is associated with higher incidence of cleft lip or cleft palate utilized prior to 10 weeks
Dexamethasone
Warfarin
Labetalol
Amiodarone
If there is no allergies which antibiotics are considered safe for
Cefazolin (ancef)
Doxycycline
Tetracycline
Augmentin
Ciprofloxacin [Quinolones]
The principle of mono-therapy related to anticonvulsants is to reduce multiple medication interaction with the fetus. Which medications are highly teratogenic related to anticonvulsant medication
Valproic acid
Phenytoin
Carbamazepine
Gabapentin
Phenobarbital
Mrs. Jackson is a pre-eclamptic parturient who is 32 weeks gestation, she is on a mag sulfate drip at 5 mg/min. Upon assessment Mrs. Jackson has no deep tendon reflex, what do you do?
Turn the mag sulfate up to 7mg/min
Place oxygen on the patient and reassess in an hour
Shut the mag sulfate off and administer 1g calcium gluconate over 3-5 minutes
Mrs. Jackson had hyperreflexive coming into the hospital, so it is only right she has absent reflexes now.
Which of the following weights with an associated physiologic component is incorrect
Uterus: 1 Kg
Amniotic fluid: 1 Kg
Fetus and Placenta: 4 Kg
Interstitial fluid: 2 Kg
Mrs. Jacobs is a 38 year old parturient who is approximately 34 weeks gestation. Upon assessment you hear what appears to be a grade 5 heart murmur. What is your next step?
Bring a crash cart
Let the OB know, and/or call a cardiology consult
Systolic ejection murmur's are normal
Tell the nurse to pass it on, you have better things to do
Which of the following medications have a anti-pruritus effect on neuraxial opioids. Select all that apply
Nalbuphine
Ondansetron
Droperidol
Diphenhydramine
Metoclopramide
What dosage of spinal medication is appropriate for a c-section parturient. Select all that apply
Fentanyl 10-20 mcgs
Morphine 0.1-0.25 mg
Sufentanil 2.5 to 15 mcgs
Bupivacaine 0.75% in 8.25% dextrose 13 mg
Bupivacaine 0.75% 13 mg
Mrs. Harris is a 30 year old parturient who is 34 weeks gestation, is being flown in on helicopter after a fatal car accident. Her vitals are HR 130, B/P: 80/40, fetal heart sounds are heard and estimated around 130 bpm the radio cuts off after that what medication would you use to induce general anesthesia?
Ketamine 1 mg/kg
Propofol 2 mg/kg
We avoid general anesthesia in pregnant population
Use succinylcholine only 1 to 1.5 mg/kg
Which of the following statements regarding general anesthesia for a cesarean section is true?
Volatile anesthetic has no effect on uterine contraction as long as pitocin is running
100% oxygen with high flow should be avoided at all cost as it can harm the neonate
General anesthesia should be delivered to achieve a 0.8 MAC concentration pre-delivery
Nitrous oxide should never be used because it is harmful to the fetus.
Which of the following is a disadvantage of epidural neuraxial anesthesia
Large dural puncture increases risk for PDPH
Slow onset of anesthesia
Larger doses required than spinal
Limited duration of anesthesia
Greater fetal drug exposure
Which epidural medication dose range is incorrect
Lidocaine 2% with epinephrine 1:200,000: 300-500 mg
Fentanyl 50-100 mcg
Morphine 3-4 mg
Bupivacaine 0.5% 25-75 mg
True or false: Tranexamic acid is a synthetic derivative of lysine which binds to sites of plasminogen and inhibits the conversion of plasminogen to plasmin.
True
False
What is the ideal volume for an epidural blood patch? Does the technique have to be sterile?
15-20 ml; No
15-20 ml; Yes
20-30 ml; No
20-30 ml; Yes
What coagulation factor increases
Thromboplastin XI
Prothrombin time
Factor XII Hageman factor
Factor XIII Fibrin-stabilizing factor
Mrs. Tina is in first stage of labor she is 29 weeks gestation, she has preeclampsia with a B/P of 165/98. She receives labetalol. Does her fetus receive effects of the medication?
Yes
No
What is the duration of lidocaine 2% with epinephrine 5 mcg/ml
75-100 minutes
35-75 minutes
120-400 minutes
40-50 minutes
What is the preferred density for laboring epidural?
Very dense block, abolish motor movement
Only opioids go into laboring epidurals
Smaller density; do not abolish motor movement
Density only deals with spinal anesthesia
A epidural test dose is given and in 3 to 5 minutes the patients cannot feel their legs what has happen?
Spinal Anesthetic
Epidural block continue monitoring
It is a total spinal and unmanageable quickly intubate the patient
Call Colonel Glymph
What is the correct dose of Epidural Analgesia select all that apply? (Max volume is 8 to 12 ml)
Bupivacaine 0.0625% to 0.125%
Ropivacaine 0.1% to 0.2%
Fentanyl 1 to 3 mcg/ml
Fentanyl 10 to 25 mcg/ml
Sufentanil 0.3 to 0.5 mcg/ml
PDPH can have one symptom to be diagnosed. Which symptoms apply to PDPH? Select all that apply
Headache
Neck stiffness
Photophobia
Nausea
Postural Change
What step is excluded from a Dural puncture epidural
Proceed mid-line like a spinal
Insert an touchy needle
Once dura is puncture instill opioids only
Thread epidural catheter like normal and administer test dose
