3. Perinatal and Postpartum

A 32-year-old woman, G2P1 at 38 weeks gestation, reports experiencing significant work-related stress during her pregnancy and also discloses a history of childhood trauma and chronic financial instability predating her current pregnancy. According to the stress hypothesis for perinatal outcomes, which of the following categories of psychosocial stress is MOST relevant to understanding potential impacts on her pregnancy?

Analysis of recent maternal mortality statistics reveals a disproportionately higher rate among non-Hispanic Black women compared to white women in the United States. Beyond racial disparities, which of the following categories encompasses the MAJORITY of pregnancy-related causes of death across all demographics?

A primigravid patient at 39 weeks gestation reports a noticeable change in her pregnancy symptoms over the past week. She describes 'feeling lighter' and notes that breathing has become easier, but she also mentions increased urinary frequency. Which physiological change of late pregnancy BEST explains this constellation of symptoms?

During a prenatal visit at 38 weeks gestation, a patient reports passing a small amount of blood-tinged mucus. She denies any painful contractions or rupture of membranes. Which physiological process is MOST likely indicated by this 'bloody show'?

A patient at 40 weeks gestation presents to the labor and delivery unit reporting contractions. Which characteristic is MOST crucial in differentiating true labor contractions from Braxton Hicks contractions?

A multiparous patient at 39 weeks gestation calls the clinic triage line. She reports contractions occurring every 7-10 minutes, which she describes as uncomfortable but manageable. She also mentions a decrease in fetal movement over the past 24 hours. Based on typical guidelines for hospital presentation in labor, which of her symptoms warrants IMMEDIATE recommendation to go to the hospital?

During the initial evaluation of a patient presenting in labor, Leopold maneuvers are performed. What is the PRIMARY purpose of utilizing Leopold maneuvers in this clinical context?

Electronic fetal monitoring of a patient in labor reveals a pattern of absent fetal heart rate (FHR) variability accompanied by recurrent late decelerations. Which interpretation of this FHR pattern is MOST clinically appropriate?

Which of the following considerations is MOST critical when advising a patient on when to go to the hospital during labor?

A pregnant patient at 39 weeks gestation reports experiencing irregular contractions that subside with rest. She denies any fluid leakage or vaginal bleeding. Which of the following is the MOST likely cause of these contractions?

During an initial assessment of a patient in active labor, the fetal heart rate (FHR) monitoring shows a baseline rate of 140 bpm with moderate variability and occasional accelerations. There are no decelerations noted. Which of the following is the MOST appropriate interpretation of this FHR tracing?

Which component of the initial labor evaluation is designed to ascertain the fetal presentation and position?

A patient at 41 weeks gestation is admitted to the labor and delivery unit. Her cervix is 2 cm dilated, 50% effaced, and the fetal head is at -2 station. She is having irregular contractions. What is the MOST appropriate initial management?

What is the underlying physiological basis for the 'lightening' experienced by some women in late pregnancy?

A researcher is investigating the relationship between chronic pre-conception stress and preterm birth. Which of the following study designs would BEST isolate the impact of pre-conception stressors from stressors occurring during gestation?

In a low-resource setting with limited access to advanced medical technologies, which of the following intrapartum interventions would be MOST critical in reducing maternal mortality associated with postpartum hemorrhage, a leading cause of maternal death?

According to the stress hypothesis for perinatal outcomes, which type of stress refers to significant life events such as divorce or the death of a loved one that occur during pregnancy?

Which of the following BEST exemplifies a chronic preconceptional stressor, as defined in the context of the stress hypothesis for perinatal outcomes?

A pregnant woman has a history of physical abuse during childhood and has experienced multiple job losses in the years leading up to her pregnancy. According to the stress hypothesis for perinatal outcomes, these factors are categorized as:

What approximate percentage of pregnancy-related deaths are attributed to hemorrhage, cardiovascular/coronary conditions, cardiomyopathy, or infection, according to a report from Nine Maternal Mortality Review Committees?

According to data, which of the following is the MOST likely reason for pregnancy-related deaths in non-Hispanic Black women?

Which of the following statements BEST encapsulates the observed disparity in maternal mortality rates between non-Hispanic Black women and non-Hispanic white women in the United States?

Which of the following details represents the MOST nuanced understanding of disparities in pregnancy-related deaths?

Given the disproportionately high rate of maternal mortality among non-Hispanic Black women and the significant contribution of cardiovascular conditions and cardiomyopathy to these deaths, which of the following actions would likely yield the MOST substantial impact on reducing this disparity, assuming resources are limited?

A patient at 38 weeks gestation describes a sensation of 'lightening.' Which physiological change BEST explains this sensation?

Which of the following characteristics is MOST indicative of true labor contractions, as opposed to Braxton Hicks contractions?

What is the physiological process underlying 'bloody show' in late pregnancy?

A primiparous patient at 39 weeks gestation is experiencing contractions that are irregular, short in duration, and felt mainly in the lower abdomen. They subside when she rests and drinks water. Which type of contractions are these MOST likely to be?

Which of the following best describes cervical effacement?

During an initial labor evaluation, Leopold maneuvers are performed. Which aspect of fetal assessment is the PRIMARY goal of these maneuvers?

A patient at 38 weeks gestation calls the triage line reporting a sudden gush of clear fluid from her vagina. What is the MOST likely interpretation of this symptom and the IMMEDIATE advice?

According to typical guidelines, at what contraction frequency and duration should a patient be instructed to go to the hospital during labor?

Which of the following findings on initial labor evaluation is considered diagnostic of active labor in a patient presenting with contractions?

A multiparous woman at 39 weeks of gestation reports contractions that are felt primarily over the uterine fundus and radiate to her lower back and abdomen. She describes them as increasingly intense and frequent over the past few hours. How does this pain pattern MOST likely differ from Braxton Hicks contractions?

Which of the following BEST defines 'social determinants of health' in the context of obstetrics?

A community health initiative is designed to improve perinatal outcomes by addressing social determinants of health. Which of the following interventions would MOST directly target a social determinant?

Beyond individual choices, what is the OVERARCHING mechanism through which social determinants of health exert their influence on perinatal health outcomes?

A pregnant patient in her third trimester lives in a food desert, lacks stable housing, and is experiencing intimate partner violence. How would the INTERSECTIONALITY of these social determinants MOST likely impact her pregnancy?

Postpartum care for a new mother extends beyond physical recovery. Which of the following BEST exemplifies a comprehensive approach to postpartum maternal well-being?

Leopold maneuvers are used to determine which three aspects of the fetus?

What constitutes a reassuring fetal heart rate (FHR) pattern?

A patient in labor exhibits recurrent variable decelerations on the fetal heart rate monitor. What is the FIRST intervention that should be implemented?

Why are vaginal exams NOT performed in cases of premature rupture of membranes (PROM) or vaginal bleeding?

What is indicated by a fetal station of zero?

During which stage of labor is there the highest risk of maternal complications, requiring close assessment?

A woman in labor has been given an epidural for pain management. What parameters should be monitored more frequently?

The umbilical cord is assessed after placental expulsion, what is the normal configuration of vessels?

What is the primary purpose of external cephalic version (ECV)?

A patient is experiencing late decelerations. which of the following interventions is LEAST helpful initially?

A primigravid patient at 40 weeks gestation is admitted in active labor. Her cervix is fully dilated and the fetal head is at +2 station. What stage of labor is the patient in?

Which of the following findings during placental evaluation would warrant further investigation due to potential risks of postpartum complications?

A patient is receiving continuous epidural infusion for labor analgesia. Which of the following is the MOST appropriate nursing intervention related to bladder management?

After delivery of the placenta, the fundus should be palpated to assess for:

A clinician assesses a laboring patient and determines the fetal lie is transverse. Which of the following is the MOST appropriate next step in management?

A community-based program aims to reduce preterm births by addressing social determinants of health. Which initiative MOST directly targets the structural determinant of access to affordable, nutritious food?

An initiative seeks to mitigate disparities in maternal mortality rates. Which intervention demonstrates the MOST comprehensive understanding of how intersecting social determinants of health contribute to these disparities?

Which initiative BEST targets the social determinant of health related to early childhood development to improve long-term health outcomes?

A 25-year-old G1P0 presents for her initial prenatal visit at 10 weeks gestation. She reports unstable housing, food insecurity, and lack of transportation. Which approach BEST addresses the root causes of these social determinants to improve her perinatal outcome?

A public health nurse is designing an intervention to address the social determinants of health affecting perinatal outcomes in a specific community. Which strategy BEST ensures the sustainability and cultural relevance of the intervention?

During labor, what is the primary focus of the initial evaluation regarding fetal status?

Which of the following best describes the influence of social determinants of health on perinatal outcomes?

A patient at 39 weeks gestation is admitted in active labor. What is the significance of assessing fetal station during the labor process?

Which stage of labor involves expulsion of the placenta and typically lasts from 5 to 30 minutes?

During the postpartum period, what is the primary focus of care regarding the neonate in the first 24 hours?

Which factor influencing health outcomes is considered a 'social determinant'?

Which social determinant has a 'tremendous' influence on population health?

Which finding best distinguishes true labor from Braxton Hicks contractions?

What is the MAIN influence on individual behavior, according to the social determinants?

What confirms cervical effacement?

Which action is NOT a direct target of the social determinants of health?

At which point do social determinants of health begin to affect health outcomes?

What indicates ruptured membranes (ROM)?

What is the frequency for hospital admission?

Which of the following occurs during 'bloody show'?

What assesses fetal positioning?

What accompanies true labor?

According to the stress hypothesis, which is considered an acute stressor during pregnancy?

Which factor represents a chronic preconceptional stressor?

What percentage of pregnancy-related deaths are due to hemorrhage?

Which condition is a leading underlying cause of death among non-Hispanic Black women?

Which of the following is considered a preconceptional stressor?

What is not considered a chronic stressor?

At what rate do non-Hispanic Black women experience maternal deaths?

What is the number one underlying cause of death among non-Hispanic black pregnancy-related deaths?

During late pregnancy, what biophysical change definitively confirms impending parturition?

A nulliparous patient reports fluid leakage. What finding necessitates immediate hospital assessment?

Which Leopold maneuver primarily determines fetal attitude, particularly in ambiguous presentations?

What clinical finding defines complete cervical effacement upon digital examination?

Distinguish true labor via contraction characteristics. Which attribute has paramount diagnostic value?

A patient is at -3 station. Where is the fetal presenting part?

Which statement correctly correlates spontaneous rupture of membranes (SROM) and labor onset?

In a prolonged latent phase, unresponsive to hydration, what intervention is MOST definitive?

What is the MOST immediate concern following confirmed spontaneous rupture of membranes (SROM)?

How does labor pain from 1st stage relate with the uterine fundus?

In a breech presentation undergoing external cephalic version (ECV), what immediate risk necessitates RhoGAM administration?

Following epidural initiation, absent fetal heart rate variability and recurrent late decelerations are observed. What is the MOST appropriate intervention?

To alleviate variable decelerations, which maternal position optimizes umbilical cord decompression?

During active labor, a patient exhibits accelerations lasting 20 seconds, peaking at 20 bpm. What is the clinical interpretation?

What is the MOST IMMEDIATE next step after noting late decelerations despite maternal repositioning and intravenous fluid bolus?

What labor stage begins with complete cervical dilation and ends with the fetus's delivery?

In which labor stage is the mother at highest risk of complications, requiring close postpartum monitoring?

How far must the cervix dilate before the start of the active phase of Stage I labor?

Following placental expulsion, what finding warrants further investigation due to potential postpartum complications?

After delivery, diminished uterine tone (atony) increases what risk?

What cervical change indicates labor?

Where is true labor pain felt?

What confirms ruptured membranes (ROM)?

What assesses fetal presentation and lie?

What accompanies true labor contractions uniquely?

What contraction interval warrants hospital admission?

What occurs during 'bloody show'?

What describes Braxton Hicks contractions?

What sensation defines 'lightening'?

What is normal cervical length?

What fetal assessment utilizes palpation to determine lie, presentation and position?

During initial labor evaluation, what condition contraindicates digital cervical examination?

Which labor stage poses the greatest risk of maternal complications requiring close assessment?

What clinical finding defines fetal engagement?

Following epidural initiation, what FHR pattern necessitates immediate intervention?

What parameter should be assessed when giving an epidural?

If the placenta is in pieces, what complication may arise?

What vasculature composes the umbilical cord?

Which delivery is ECV intended to promote?

A public health initiative aims to improve perinatal outcomes by addressing social determinants of health. Which intervention demonstrates a direct approach to tackling structural barriers to healthcare access?

An urban clinic is developing a program to reduce disparities in maternal mortality rates. Which intervention demonstrates the MOST comprehensive understanding of how intersecting social determinants of health contribute to these disparities?

A 25-year-old G1P0 patient presents for her initial prenatal visit at 10 weeks gestation. She reports experiencing unstable housing, food insecurity, and lack of transportation. Which approach BEST addresses the root causes of these social determinants to improve her perinatal outcome?

A patient at 38 weeks gestation reports experiencing contractions that are irregular in frequency and intensity and are primarily felt in her lower abdomen. Which of the following instructions is MOST appropriate?

During a vaginal examination of a patient in labor, the cervix feels soft, thin, and short, compared to the typical length. Which of the following BEST describes this finding?

A patient presents to the labor and delivery unit stating, 'My water broke.' What confirms ruptured membranes?

A primigravid patient at 40 weeks gestation is admitted to the labor and delivery unit. During the initial evaluation, which finding would be MOST indicative of true labor?

Which of the following symptoms reported by a patient at 39 weeks gestation should prompt immediate recommendation to go to the hospital?

A patient at 39 weeks gestation presents to the labor and delivery unit reporting a sudden gush of clear fluid from her vagina. On examination, it's confirmed to be amniotic fluid. Assuming no other complications, what is the MOST critical next step in management, considering the gestational age and the risk of infection?

A 28-year-old African American woman, G1P0 at 12 weeks gestation, presents with a history of long-term unemployment, residing in a high-crime neighborhood, and a prior diagnosis of depression that was not treated. According to the stress hypothesis for perinatal outcomes, which combination of factors presents the GREATEST risk?

A 35-year-old white woman, G3P2 at 39 weeks gestation, experiences a sudden and unexpected job loss during her third trimester. According to the stress hypothesis for perinatal outcomes, this stressor is categorized as:

Which of the following is the MOST accurate description of the disparity in maternal mortality rates in the United States?

A public health initiative aims to reduce maternal mortality in a specific community. Intervention should prioritize which condition, given its high incidence and impact?

A 30 year old G2P1 African American patient is diagnosed with cardiomyopathy postpartum. According to recent data, which intervention would MOST significantly impact maternal mortality rates in similar patients?

A retrospective analysis reveals that a significant proportion of pregnancy-related deaths in a particular region are linked to delays in seeking care. What intervention addresses this problem?

A maternal mortality review committee identifies that non-adherence to prescribed medications for pre-existing conditions contributes significantly to adverse pregnancy outcomes. Which intervention is MOST likely to improve medication adherence?

A recent study showed a link between discriminatory experiences and low birth weight infants. Which intervention would MOST improve their outcomes?

A patient in active labor exhibits recurrent variable decelerations on the fetal heart rate monitor. The initial nursing intervention should be:

Following an amniotomy, the nurse observes the umbilical cord protruding from the vagina. Which action should the nurse perform FIRST?

A patient is receiving continuous epidural infusion for labor analgesia. Which nursing intervention is MOST critical related to bladder management?

A clinician assesses a laboring patient and determines the fetal lie is transverse. Which is the MOST appropriate next step in management?

A routine Leopold maneuver reveals the following: a soft, irregular mass is palpated in the fundus, a long, smooth surface is felt on one side of the uterus, and small parts are noted on the opposite side. A hard, round mass is palpated just above the symphysis. What is the MOST likely fetal presentation?

A patient presents to the labor and delivery unit. Vaginal examination reveals that the fetal presenting part is at the level of the ischial spines. This is documented as:

During the fourth stage of labor, a patient suddenly becomes restless, diaphoretic, and hypotensive. Which potential complication should the nurse suspect FIRST?

A patient at 37 weeks gestation describes irregular abdominal tightening that are painless and subside with walking. Which of the following BEST describes these sensations?

Cervical effacement is BEST assessed by which method?

A primigravida at 39 weeks gestation reports a sudden gush of clear, odorless fluid. She denies contractions. What is the MOST appropriate INITIAL management recommendation?

Leopold maneuvers are primarily used to determine which of the following fetal characteristics?

A patient at 40 weeks gestation is experiencing contractions every 7 minutes lasting 60 seconds. She can still talk through them and is comfortable at home. What is the MOST critical factor to ascertain to differentiate between early labor and when she should present to the hospital?

The sensation of 'lightening' in late pregnancy is BEST explained by which physiological change?

'Bloody show' is most directly related to which cervical process in late pregnancy?

A multiparous woman at 39 weeks gestation calls triage reporting contractions every 8 minutes. She states she also feels a continuous trickle of fluid but is unsure if it's urine or amniotic fluid. Which question is MOST critical to guide immediate triage advice?

A pelvic exam reveals a cervix that is 2 cm dilated and 50% effaced in a primigravida reporting regular contractions. According to the provided text, this finding is:

A G3P2 patient at 41 weeks gestation presents to labor and delivery reporting contractions for 8 hours. On examination, her cervix is 3 cm dilated, 60% effaced, and fetal station is -2. Fetal heart rate tracing shows a baseline of 130 bpm with moderate variability and no decelerations. Considering her parity, gestational age, and cervical exam findings, which of the following is the MOST appropriate initial management approach?