Maternal Final

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Questions and Answers

In the context of managing shoulder dystocia, beyond McRobert's maneuver and suprapubic pressure, what advanced technique addresses the biomechanical challenge of impaction by directly manipulating the fetal shoulders?

The Gaskin maneuver, involving positioning the mother on her hands and knees to utilize gravity.
Zavanelli maneuver, involving cephalic replacement into the vagina, followed by cesarean delivery.
The Woods' screw maneuver, involving progressive rotation of the fetal shoulders to dislodge the anterior shoulder. (correct)
Rubin maneuver, involving adduction of the fetal posterior shoulder to decrease bisacromial diameter.

Which of the following interventions is MOST crucial immediately following the diagnosis of uterine inversion after delivery, prior to the HCP's bimanual compression or potential hysterectomy?

Initiating high-dose oxytocin infusion to promote uterine contraction.
Administering a tocolytic agent to relax the uterus and facilitate manual replacement.
Aggressively managing hypovolemic shock with intravenous fluids and blood products. (correct)
Preparing for immediate surgical intervention, including setting up the operating room.

In managing a patient with severe preeclampsia who develops disseminated intravascular coagulation (DIC), which laboratory finding would be MOST indicative of ongoing, active consumption of coagulation factors requiring immediate intervention?

Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) with a normal D-dimer.
Stable fibrinogen level with a slightly elevated platelet count, suggesting compensated DIC.
Progressive decrease in platelet count below 50,000/μL accompanied by elevated D-dimer levels. (correct)
Elevated fibrinogen level above 600 mg/dL, indicating an acute inflammatory response.

A neonate born to a mother with poorly controlled gestational diabetes is exhibiting signs of respiratory distress. Beyond surfactant administration, what complex metabolic derangement should be anticipated and proactively managed to mitigate potential long-term neurological sequelae?

Severe hypoglycemia leading to potential seizures and brain damage. (D) Signup and view all the answers

For a pregnant patient diagnosed with hyperemesis gravidarum experiencing persistent vomiting and confirmed clinical malnutrition, which advanced nutritional support strategy should be considered AFTER failure of initial NPO status and standard antiemetic therapy?

Total parenteral nutrition (TPN) administered through a central venous catheter to provide complete nutritional requirements. (C) Signup and view all the answers

In a patient presenting with placenta previa at 30 weeks gestation and experiencing moderate vaginal bleeding, what specific contraindication must be considered when weighing the administration of betamethasone for fetal lung maturity?

Maternal history of gestational diabetes, increasing the risk of hyperglycemia. (C) Signup and view all the answers

When evaluating a neonate for potential drug withdrawal using the Neonatal Abstinence Scoring System (NAS), what subtle, yet critical, neurological sign would warrant immediate escalation of care and consideration of pharmacological intervention, even in the absence of other overt symptoms?

Hypertonia exhibited by a persistent clenched fist and exaggerated fetal positioning, unresponsive to gentle manipulation. (A) Signup and view all the answers

Following the vaginal birth of an infant with gastroschisis, and after covering the exposed abdominal contents with sterile, moist dressings, what additional measure is MOST crucial in preventing complications prior to surgical intervention?

Closely monitoring for signs of abdominal compartment syndrome, including respiratory distress and decreased perfusion to the lower extremities. (D) Signup and view all the answers

In the management of recurrent pregnancy loss attributed to an incompetent cervix, what is the MOST critical factor determining the efficacy and appropriateness of a cerclage procedure?

The timing of cerclage placement relative to cervical dilation and gestational age. (A) Signup and view all the answers

In a patient with a history of ectopic pregnancy treated with methotrexate, what specific parameter MUST be achieved before advising the patient it is safe to attempt another pregnancy, considering the potential risk of molar pregnancy and teratogenic effects?

Serial beta-hCG levels decreasing to zero, to rule out persistent trophoblastic tissue and minimize teratogenic effects. (C) Signup and view all the answers

A neonate, stabilized post-delivery, presents with persistent acrocyanosis despite a SpO2 of 98%. End-tidal CO2 monitoring reveals a normal capnogram. Which of the following interventions is most likely indicated, considering the nuanced interplay of factors affecting oxygen delivery and peripheral perfusion?

Increase the ambient temperature of the radiant warmer and reassess peripheral perfusion in 30 minutes, while meticulously documenting the thermal environment and minimizing evaporative heat loss. (D) Signup and view all the answers

A term neonate exhibits persistent hypotonia and poor feeding despite initial resuscitation efforts. Blood gas analysis reveals a normal pH and PaCO2, but base excess is -8. The mother's prenatal history is unremarkable. Which of the following diagnostic pathways is MOST critical in elucidating the underlying etiology?

Extensive metabolic screening, including amino acid and organic acid analysis, along with ammonia levels, to identify an inborn error of metabolism. (D) Signup and view all the answers

A neonate born at 39 weeks gestation via Cesarean section is noted to have mild respiratory distress. Auscultation reveals clear and equal breath sounds bilaterally. The neonate's respiratory rate is 65 breaths/min, and oxygen saturation is 92% in room air. What is the MOST appropriate next step in managing this neonate?

Provide supplemental oxygen via nasal cannula and closely monitor respiratory status, while observing for signs of worsening distress. (C) Signup and view all the answers

A preterm neonate is under a radiant warmer. Despite adjustments to the warmer's servo-control, the neonate's axillary temperature remains at 35.8°C (96.4°F). The nurse has already ensured the probe is securely attached and functioning correctly. Considering heat loss mechanisms, what intervention is MOST likely to improve the neonate's temperature?

Shield the neonate from external sources of radiant heat loss, such as windows or cold surfaces, using a reflective barrier. (D) Signup and view all the answers

A 2-hour-old neonate is jittery and irritable. A point-of-care glucose measurement reveals a value of 38 mg/dL. After initiating intravenous dextrose infusion, the jitteriness persists. Considering counter-regulatory hormone release, which assessment is MOST critical at this juncture?

Monitor the neonate's serum insulin level to assess for hyperinsulinism as a potential cause of refractory hypoglycemia. (B) Signup and view all the answers

A neonate is born at 30 weeks gestation. Post resuscitation, the attending physician orders a complete blood count (CBC). The lab results show a hematocrit of 39%. The venous blood gas results are pH 7.21/pCO2 59/pO2 55/HCO3 23. The baby is showing signs of lethargy and temperature instability. Which of the following interventions is MOST indicated at this time?

Optimize mechanical ventilation settings, focusing on increasing the mean airway pressure (MAP) and positive end-expiratory pressure (PEEP) to enhance alveolar recruitment. (A) Signup and view all the answers

A term neonate, delivered vaginally after a prolonged second stage of labor, presents with marked pallor, weak pulses, and delayed capillary refill. Initial vital signs reveal a heart rate of 90 bpm and a respiratory rate of 20 bpm with shallow chest rise. Considering the potential underlying causes, what is the MOST immediate intervention required?

Administer a bolus of packed red blood cells (10-20 mL/kg) to address probable acute blood loss and improve oxygen delivery, while continuously monitoring for signs of volume overload. (A) Signup and view all the answers

A neonate returns from the NICU for routine care. The nurse notes the baby's temperature is 35.9°C (96.6°F). There is a draft, as the window is open. Which of the following are indicated at this time? (Select all that apply)

Close the window (A), Assess the baby's blood glucose (C), Wrap the baby in a blanket (D) Signup and view all the answers

A 1-hour-old neonate has a blood glucose reading of 35 mg/dL. The priority intervention is to administer IV dextrose. Considering the action of glucose and insulin, what signs should the nurse monitor for?

Seizures, clammy skin, and diaphoresis. (A) Signup and view all the answers

A newborn baby is hypothermic and lethargic. You know that oxygen and glucose are needed to increase the baby's temperature. Considering the physiological processes occurring, which signs could be expected?

Increased work of breathing and hypoglycemia (C) Signup and view all the answers

In the context of severe preeclampsia management, beyond standard blood pressure control, what is the most critical rationale for administering magnesium sulfate, considering its pleiotropic effects on maternal and fetal physiology?

To competitively inhibit calcium influx at the presynaptic motor nerve terminal, thereby preventing neuromuscular excitability and averting the risk of eclamptic seizures. (B) Signup and view all the answers

A neonate born at 30 weeks gestation exhibits signs of respiratory distress immediately following delivery. Given the underlying pathophysiology of respiratory distress syndrome (RDS) in premature infants, which intervention demonstrates the most nuanced understanding of pulmonary mechanics and surfactant dynamics?

Initiating continuous positive airway pressure (CPAP) at 5 cm H2O to maintain alveolar recruitment, followed by immediate bolus surfactant administration via endotracheal tube. (D) Signup and view all the answers

In a patient presenting with gestational hypertension at 34 weeks gestation, complicated by superimposed preeclampsia and thrombocytopenia, which laboratory finding most critically differentiates HELLP syndrome from severe preeclampsia alone, guiding immediate management decisions regarding delivery?

A platelet count below 100,000/µL, suggesting consumptive coagulopathy and increased risk of maternal hemorrhage. (D) Signup and view all the answers

A full-term neonate delivered via emergency C-section exhibits persistent tachypnea, despite supplemental oxygen administration. Considering the various etiologies of neonatal respiratory distress, what diagnostic modality would most definitively differentiate transient tachypnea of the newborn (TTN) from other, more ominous, causes?

Chest radiography to evaluate for pulmonary vascular congestion, pleural effusions, or other structural abnormalities indicative of cardiac or infectious etiologies. (B) Signup and view all the answers

During magnesium sulfate infusion for preeclampsia, a patient exhibits a decline in deep tendon reflexes from +2 to absent, coupled with a respiratory rate of 10 breaths per minute. Which intervention should be implemented with the greatest alacrity, considering both the physiological derangements and the pharmacokinetic properties of magnesium?

Administering intravenous calcium gluconate 1 gram over 5-10 minutes, while simultaneously discontinuing the magnesium sulfate infusion and preparing for potential respiratory support. (D) Signup and view all the answers

A neonate presents with persistent cyanosis and respiratory distress despite adequate oxygen supplementation. An echocardiogram reveals persistent pulmonary hypertension of the newborn (PPHN). Which therapeutic strategy most directly addresses the underlying pathophysiology of PPHN?

Administering inhaled nitric oxide (iNO) to selectively dilate the pulmonary vasculature and reduce pulmonary artery pressure. (C) Signup and view all the answers

A patient diagnosed with mild preeclampsia is being managed at home. Which constellation of signs and symptoms should prompt immediate hospitalization and escalation of care, indicative of progression to severe disease?

Persistent headache unresponsive to acetaminophen, visual disturbances such as blurred vision, and epigastric pain. (D) Signup and view all the answers

A patient at 28 weeks' gestation is admitted with preterm labor and preeclampsia. The decision is made to administer magnesium sulfate. Beyond its tocolytic and neuroprotective effects, what is a critical consideration regarding its impact on fetal well-being?

Magnesium sulfate crosses the placenta and can transiently decrease fetal heart rate variability, making interpretation of fetal heart rate tracings challenging. (D) Signup and view all the answers

A neonate is born with meconium aspiration syndrome (MAS). Following initial stabilization, which advanced respiratory support strategy demonstrates a comprehensive understanding of the complex pathophysiology of MAS and its sequelae?

Administering inhaled nitric oxide (iNO) to treat secondary pulmonary hypertension, coupled with extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia. (D) Signup and view all the answers

In the context of managing gestational hypertension, what is the most critical consideration in differentiating labetalol from hydralazine, given their differing mechanisms of action and potential impacts on uteroplacental blood flow?

Labetalol, as a combined alpha- and beta-adrenergic antagonist, may reduce maternal heart rate and cardiac output, potentially compromising uteroplacental perfusion in volume-depleted patients. (C) Signup and view all the answers

Flashcards

Newborn Transition

The period of adjustment for a newborn after birth, which can last up to two hours in a normal newborn.

Newborn's immediate needs

Stimulate cry, clear airway, dry and provide heat.