Deck 5: Gynecology

Question 1

A 16-year-old female patient presents with complaints of abdominal pain and dizziness. She is pale and clammy, and reluctant to answer your questions regarding her sexual activity. Vital signs are: blood pressure 92/62 mmHg, heart rate 102, and respirations 20. You should:

A) make it clear that she must be honest about her sexual history.
B) start a large-bore IV and transport emergently.
C) ask the mother if the patient might be pregnant.
D) transport in a position of comfort.

Answer 1

start a large-bore IV and transport emergently.

Question 2

The paramedic accurately describes the difference between endometritis and endometriosis when she states:

A) "Endometriosis is an infection of the uterine lining, while endometritis occurs when endometrial tissue is found outside the uterus."
B) "Endometriosis occurs in women under age 40, while endometriosis is more common in women who are older."
C) "Endometritis is an infection of the uterine lining, while endometriosis occurs when endometrial tissue is found outside the uterus."
D) "Endometritis patients can be transported code 2, while those with endometriosis should always go code 3."

Answer 2

"Endometritis is an infection of the uterine lining, while endometriosis occurs when endometrial tissue is found outside the uterus."

Question 3

A 22-year-old woman presents in moderate distress, complaining of diffuse lower abdominal pain. She states that the pain has become progressively worse for the past two weeks and she is now unable to walk without an increase in pain. Your physical exam reveals severe pain with palpation of the lower abdomen and the following vital signs: heart rate 102, blood pressure 118/74 mmHg, and respirations 20. Which of the following statements made by the patient would most indicate the presence of pelvic inflammatory disease?

A) "My boyfriend was just diagnosed with chlamydia."
B) "I just had an IUD inserted."
C) "My last menstrual cycle was normal."
D) "I have chronic urinary tract infections."

Answer 3

"My boyfriend was just diagnosed with chlamydia."

Question 4

A 33-year-old woman presents with a low-grade fever and abdominal pain. She reports that she noticed blood in her urine this morning. Which of the following questions would be most helpful when trying to identify the underlying cause of this patient's symptoms?

A) "Have you noticed any foul-smelling discharge?"
B) "Do you have any pain or burning with urination?"
C) "Do you take birth control?"
D) "Have you vomited today?"

Question 5

Which of the following is TRUE of mittelschmerz?

A) It is typically located unilaterally in one of the upper abdominal quadrants.
B) It is usually accompanied by heavy vaginal bleeding.
C) It is associated with ovulation.
D) It is a sign of ectopic pregnancy.

Question 6

Menorrhagia is:

A) irregular cycles of menstruation.
B) painful menstruation.
C) absence of menstruation.
D) excessive menstrual flow.

Question 7

Your patient is a 42-year-old woman who is alert and upset, complaining of vaginal bleeding. She states that the bleeding began ten hours ago and is heavier than her normal menstrual flow. Her last menstrual period was three months ago, G3P3, and there is no other significant gynecologic history. Which of the following is the most likely cause of her signs and symptoms?

A) Ectopic pregnancy
B) Pelvic inflammatory disease
C) Menopause-related dysfunctional uterine bleeding
D) Spontaneous abortion

Question 8

The innermost lining of the uterus is called the:

A) myometrium.
B) perimetrium.
C) endometrium
D) vasometrium.

Question 9

A 35-year-old woman has been raped. She states repeatedly that she wants to change her clothes before going to the hospital, and becomes hysterical when you advise her that she should remain dressed to preserve evidence. You should:

A) allow her to change and carefully bag each item of clothing.
B) refuse to let her change her clothing, as it will destroy evidence.
C) allow her to change only her shirt, not her pants or undergarments.
D) promise to let her change as soon as you get to the hospital.

Question 10

Your patient tells you that she is being treated for cystitis. You recognize that she is being treated for:

A) ovarian cysts.
B) pelvic inflammatory disease.
C) a urinary tract infection.
D) an ectopic pregnancy.

Question 11

A 20-year-old sexually active woman presents with severe right-side abdominal pain that radiates to her back. She states that the pain came on sharply during intercourse about 15 minutes earlier, and she reports a small amount of vaginal bleeding. She states that her menstrual cycles have been irregular for the past 3 months. The most likely clinical diagnosis would be:

A) ruptured ectopic pregnancy.
B) ruptured ovarian cyst.
C) spontaneous abortion.
D) pelvic inflammatory disease.

Question 12

Your patient is a 35-year-old woman who is complaining of severe abdominal pain in both lower quadrants. She states that she had a tubal ligation two years ago. Which of the following questions is appropriate to ask during your care of this patient?

A) "Have you ever had a sexually transmitted disease?"
B) "Do you have more than one sexual partner?"
C) "Have you ever had pelvic inflammatory disease (PID)?"
D) "When was your last menstrual period?"

Question 13

All of the following are associated with spontaneous abortion EXCEPT:

A) nontraumatic vaginal bleeding.
B) the passage of clots and tissue.
C) hypotension and fever.
D) cramping abdominal pain.

Question 14

A 34-year-old woman presents with complaints of vaginal bleeding and pain during intercourse. Her last menstrual period was two weeks ago and was reportedly heavier than normal. She reports that she had saturated two menstrual pads in the past two hours. You should:

A) assess vital signs and transport.
B) apply oxygen and start a large-bore IV.
C) advise her to insert a tampon to control the bleeding.
D) ask her if she has a family history of uterine cancer.

Question 15

Risk factors for ectopic pregnancy include all of the following EXCEPT:

A) use of an intrauterine device for birth control.
B) pelvic inflammatory disease.
C) previous ectopic pregnancies.
D) IV drug usage.

Question 16

Mittelschmerz refers to which of the following?

A) Purulent vaginal discharge
B) False labor pains
C) Midcycle abdominal pain
D) Painful urination

Question 17

You are called to the scene of a sexual assault. The patient is a 17-year-old female who is crying inconsolably and withdraws when you attempt to touch her. Which of the following is the most appropriate response?

A) Explain to the patient that she must allow you to examine her for injuries.
B) Ask the patient to describe how she was assaulted so you know where she is injured.
C) Tell the patient that you cannot help her if she won't allow you to touch her.
D) Explain to the patient that you will not touch her if she does not want you too.

Question 18

A 22-year-old woman presents with severe abdominal pain and signs of shock. When asked whether she is pregnant, she states, "There's no way I'm pregnant, I have an IUD." Which of the following is the most likely cause of her signs and symptoms?

A) Endometriosis
B) Pelvis inflammatory disease
C) Miscarriage
D) Ectopic pregnancy

Question 19

A 19-year-old woman presents with severe lower abdominal pain, an oral temperature of 102.4°F, and skin that is pale and sweaty. She reports that she had an elective abortion 72 hours earlier and has had bloody vaginal discharge ever since. Appropriate treatment for this patient would include which of the following?

A) IV fluids, oxygen, and transport
B) Position of comfort, pain medication, and delayed transport
C) Detailed secondary exam and 12-lead ECG
D) Knee-chest position and rapid transport

Question 20

Which of the following occurs during the proliferative phase of the menstrual cycle?

A) Ovulation
B) An increase in uterine vascularity
C) Endometrial thickening
D) A drop in estrogen levels

Question 21

A 27-year-old pregnant woman was the restrained driver of a vehicle that hit the guardrail at a high rate of speed. She sustained a large laceration to the upper thigh and has lost a significant amount of blood. Vital signs are: heart rate 102, blood pressure 118/78 mmHg, respirations 18, and her skin is pale and clammy. Which of the following BEST explains this patient's presentation?

A) Maternal blood volume increases during pregnancy, allowing vital signs to remain normal despite significant blood loss.
B) Fetal oxygen demand increases after trauma, causing maternal blood pressure and heart rate to increase immediately after injury.
C) Maternal blood volume decreases during pregnancy, amplifying the effects of epinephrine and allowing for the maintenance of blood pressure.
D) Maternal vital signs remain normal following trauma to ensure the survival of the developing fetus.

Question 22

A 30-year-old woman complains of swelling in both of her legs. She is 32 weeks pregnant, and states that she has also developed varicose veins over the past few weeks. Which of the following BEST explains the cause of this patient's signs and symptoms?

A) The gravid uterus compresses the superior vena cava, decreasing venous return to the heart.
B) Changes in the endocrine system cause peripheral edema during the late stages of pregnancy.
C) The gravid uterus compresses the pelvic and femoral vessels, decreasing venous return and causing venous stasis.
D) Changes in kidney function alter the normal electrolyte balance, causing tissue edema in the legs and feet.

Question 23

A 22-year-old woman presents with left-sided lower abdominal pain. She reports that her last menstrual cycle ended approximately 10 days ago. Her blood pressure is normal and she rates the pain as 6 on a scale of 10. You should:

A) palpate the abdomen.
B) administer oxygen.
C) withhold pain medication.
D) look for vaginal bleeding.

Question 24

Which of the following is NOT an appropriate adaptation to make in the assessment and care of a sexual assault victim?

A) Allow a friend to accompany the victim in the back of the ambulance.
B) Ask simple, closed-ended questions about the nature of the assault.
C) Keep the back of the ambulance well lit and warm.
D) Do not touch the patient unless it is necessary to obtain vital signs or examine injuries.

Question 25

A 27-year-old woman reports significant vaginal bleeding. She states that she is 11 weeks pregnant and awoke this morning to heavy bleeding including the passage of clots. She is crying and very upset, stating, "I can't lose this baby-I can't live with that." When caring for this patient, you should:

A) ask her if she has ever had a miscarriage.
B) perform a vaginal exam to determine if she is still bleeding.
C) transport the patient in a position of comfort and provide emotional support.
D) inform the patient's husband that she may be having a miscarriage.

Question 26

The blood-rich structure that serves as a lifeline for the developing fetus is called the:

A) uterus.
B) cervix.
C) placenta.
D) amniotic sac.

Question 27

The medically appropriate term for the projected birth date of a baby is:

A) probable date of delivery.
B) expected date of labor.
C) predicted delivery date.
D) estimated date of confinement.

Question 28

Just before an infant is delivered, the fetal scalp can be seen at the vaginal opening during each contraction. This is referred to as:

A) effacement.
B) crowning.
C) dilation.
D) presentation.

Question 29

Your patient is an 18-year-old woman who is alert and in moderate distress, complaining of abdominal pain and light-headedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea, and vomiting this week. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. Her vital signs are: heart rate 121, blood pressure 90/58 mmHg, respirations 18. The patient's presentation is most consistent with:

A) ectopic pregnancy.
B) pelvic inflammatory disease.
C) spontaneous abortion.
D) pyelonephritis.

Question 30

Which of the following is NOT an appropriate way to control vaginal bleeding in the prehospital setting?

A) Placing sterile gauze over the opening of the vagina
B) Using a tampon
C) Using a sanitary napkin
D) Placing an absorbent pad under the patient

Question 31

A 26-year-old woman is complaining of severe abdominal pain and heavy vaginal bleeding. She has used five sanitary napkins in the past hour. Her last menstrual period was six weeks ago, and she describes a history of irregular periods, but never to this extent. Management of this patient should include:

A) IV dextrose.
B) oral antiemetic.
C) IM epinephrine.
D) IV fluids.

Question 32

You are caring for a woman who is 32 weeks pregnant. While assessing her breathing, you notice that her rib cage expands visibly with each breath and that her tidal volume appears to be deep. You recognize:

A) signs of a severe respiratory condition requiring immediate intervention.
B) an increase in tidal volume that is normal during pregnancy.
C) signs of obstructive shock.
D) an increase in oxygen demand due to an obstetrical emergency.

Question 33

A 30-year-old woman has right-sided abdominal pain and is hypotensive. You suspect she may have a ruptured ectopic pregnancy. You recognize:

A) life-threatening hemorrhagic shock and the need for fluid resuscitation.
B) potentially dangerous obstructive shock that requires rapid transport.
C) a common medical condition that affects many women each year.
D) a very rare disease process that requires immediate surgery to save the pregnancy.

Question 34

Your patient is a transgender man complaining of severe lower abdominal pain. He states that he is in the process of transitioning from female to male, and that he takes hormone supplements. When evaluating this patient, which of the following questions is most appropriate?

A) "Are you planning to have gender reassignment surgery?"
B) "When was your last menstrual cycle?"
C) "How often do you use illegal drugs?"
D) "Are you usually sexually active with men, or with women?"

Question 35

Your patient is a 44-year-old woman who is alert and in mild distress. She states that she had an acute onset of sharp, right lower quadrant abdominal pain last evening while having intercourse and that the pain has not subsided. Physical examination reveals tenderness with palpation to the lower right abdominal quadrant. Vital signs are: heart rate 98, respirations 16, blood pressure 116/78 mmHg. She reports she had a tubal ligation ten years ago and that she has several small fibroid tumors. Which of the following is the most likely diagnosis for this patient?

A) Ectopic pregnancy
B) Pelvic inflammatory disease
C) Mittelschmerz
D) Ruptured ovarian cyst

Question 36

Your patient is a 36-year-old woman who is alert and complaining of abdominal pain. She states that she is having her period and that this pain is "much different than the cramps I usually get." She describes the pain as achy throughout her pelvis and lower abdomen. She says that this has occurred the past three menstrual cycles and that she has experienced dyspareunia and spotting over the same period. She is G2P2 and has no other significant gynecologic history. Physical examination reveals pain with palpation over her entire abdomen; her skin is warm and dry. Vital signs are: heart rate 84, blood pressure 124/76 mmHg, respiration 12, SpO₂ = 99%. Which of the following is the most likely diagnosis for this patient?

A) Uterine fibroids
B) Endometriosis
C) Primary dysmenorrhea
D) Polycystic ovary disease

Question 37

The term "puerperium" refers to:

A) the delivery of the afterbirth.
B) a specific fertility treatment.
C) the time surrounding delivery.
D) a technique used to delay contractions.

Question 38

A 30-year-old woman presents with a fever of 103.5°F, pale skin, and an altered mental status. She cries out and withdraws when you palpate her abdomen. Her husband reports that she had a cervical biopsy three days earlier, and has be "feeling sick" ever since. Vital signs are: blood pressure 88/60 mmHg, heart rate 110, and respirations 22. You suspect:

A) sepsis secondary to endometritis.
B) hypovolemia secondary to miscarriage.
C) infection of fibroid tumors.
D) shock due to pelvic inflammatory disease.

Question 39

During which period of development is the fetus most susceptible to damage from maternal exposure to toxins, such as alcohol and tobacco?

A) 1-8 weeks
B) 16-20 weeks
C) 8-12 weeks
D) 20-40 weeks

Question 40

A 35-year-old woman presents with abdominal pain that she describes as "cramping and dull." She reports having multiple sexual partners in the past six months, and states that she has an IUD. Vital signs are: blood pressure 118/76 mmHg, heart rate 88, and respirations 18. Appropriate care of this patient includes:

A) cardiac monitoring and transport.
B) examining the genitalia for hemorrhage.
C) elevating the legs during transport.
D) position of comfort and routine ALS care.

Question 41

The second stage of labor begins:

A) with the complete dilation of the cervix.
B) at the onset of contractions.
C) when the baby is delivered.
D) at the rupture of membranes.

Question 42

A newborn has just been delivered. He is centrally pink with pale extremities, has a heart rate of 110, and is actively crying and moving. The appropriate APGAR score for this infant is:

A) 6.
B) 7.
C) 8.
D) 9.

Question 43

Which structure allows oxygenated maternal blood to bypass the uninflated lungs of the developing fetus?

A) Ductus venosus
B) Foramen ovale
C) Umbilical artery
D) Ductus arteriosus

Question 44

You are caring for a woman in labor. She has had three previous deliveries and states that her contractions are approximately 3 minutes apart. Physical exam reveals a bulging of tissue at the vaginal opening with each contraction; however, the baby's head is not yet visible. You should:

A) encourage the mother to breathe and ready her for transport.
B) prepare for imminent delivery.
C) place the mother in the knee-chest position.
D) perform an internal exam to see how much the cervix is dilated.

Question 45

Which of the following techniques is an appropriate method of estimating the gestational age?

A) Measuring the circumference of the woman's abdomen; each inch corresponds to one week of pregnancy.
B) Palpate the abdomen and estimate gestational age based on the size of the developing fetus.
C) Measure the height of the fundus; each centimeter corresponds to one week of pregnancy.
D) Palpate the abdomen; if fetal movement is felt then the pregnancy is at least 14 weeks.

Question 46

A 42-year-old woman is 38 weeks pregnant and in active labor. While assessing for crowning, you notice that although the top of the baby's head is visible, a loop of the umbilical cord is protruding from the vagina. You should:

A) gently attempt to reinsert the cord into the vaginal canal.
B) encourage the mother to push while gently pulling traction.
C) clamp and cut the presenting section of the umbilical cord.
D) insert two fingers to raise the head of the baby off the cord.

Question 47

You are caring for a 42-year-old woman who is 32 weeks pregnant with twins. She is complaining of a severe headache and blurred vision, and lives in a rural area approximately 30 miles from the nearest ED. Your physical exam reveals significant peripheral edema and the following vital signs: heart rate 98, blood pressure 156/98 mmHg, respirations 18. The patient states she has a history of hypertension, but has not taken her prescribed medications because "they aren't safe for the babies." Appropriate treatment for this patient includes:

A) administration of nitroglycerine and delayed transport.
B) intravenous calcium chloride and 12-lead ECG.
C) administration of aspirin and a prehospital stroke assessment.
D) intravenous magnesium sulfate and rapid transport.

Question 48

A 24-year-old pregnant woman is actively seizing. Her partner reports that she complained of abdominal pain approximately 10 minutes ago, and then began seizing. He reports that the seizure activity has been consistent for the past 10 minutes, and that she has no significant medical history. You should:

A) apply a nasal cannula, assess blood glucose level, and transport in the left lateral position.
B) insert a nasal airway, administer midazolam, and obtain vital signs.
C) apply high-flow oxygen, administer magnesium sulfate, and transport emergently.
D) suction the airway, obtain IV access, and assess blood pressure.

Question 49

A 25-year-old woman presents complaining of heavy vaginal bleeding accompanied by cramping abdominal pain and backache. She can't stop crying and reports that she is 11 weeks pregnant with her first child. Your physical exam reveals what appears to be the fetus and umbilical cord passing through the vaginal opening; however, the placenta has not been passed. Appropriate care for this patient includes:

A) clamping and cutting the umbilical cord, wrapping fetal material in linen, and providing emotional support for the patient.
B) leaving the fetus untouched and transporting the patient in a position of comfort.
C) oxygen, 1000 mL fluid bolus, and rapid transport.
D) disposing of the fetal material in a biohazard bag, left lateral position, and providing emotional support for the patient.

Question 50

A newborn is listless and has a heart rate of 50 beats per minute after 30 seconds of stimulation. You should FIRST:

A) initiate positive pressure ventilation.
B) begin chest compressions.
C) obtain IV access.
D) apply the AED.

Question 51

You are caring for a patient who is 36 weeks pregnant. She states that she has been experiencing vaginal bleeding after intercourse, and denies any associated pain. Vital signs are: heart rate 84, respirations 18, blood pressure 102/72 mmHg, and warm, dry skin. The most likely cause of this patient's vaginal bleeding is:

A) spontaneous abortion.
B) placenta previa.
C) abruptio placentae.
D) false labor.

Question 52

You are assisting a mother with an out-of-hospital delivery. After the head delivers, it immediately retracts back into the perineum. You should:

A) transport in the knee-chest position.
B) instruct the mother to drop her buttocks off the end of the bed.
C) gently pull downward on the infant's head.
D) instruct the mother to avoid pushing if possible.

Question 53

What is the appropriate sequence of care for a newborn following a normal delivery?

A) Suction the nose, dry the infant, and cut the cord.
B) Dry the infant, cut the cord, and place infant on mother's stomach.
C) Suction the mouth, deliver the placenta, and cut the cord.
D) Apply oxygen, dry the infant, and give the infant to the mother.

Question 54

When assessing the vital signs of a pregnant patient, it is generally most appropriate to have the patient in which position?

A) Supine
B) Left lateral recumbent
C) Semi-Fowler's
D) Standing

Question 55

During delivery, you notice a yellowish-green fluid on the baby's head and face. You recognize:

A) a normal side effect of delivery.
B) that emergency transport is required.
C) a sign of fetal hypoxia.
D) that the infant will require resuscitation.

Question 56

A 38-year-old pregnant woman called 911 after she developed a "splitting headache" unrelieved by over-the-counter analgesics. She states that she has a previous diagnosis of diabetes that is typically well controlled with insulin injections. This patient's history of diabetes makes her more likely to develop which of the following pregnancy-related conditions?

A) Preeclampsia
B) Cerebral aneurysm
C) Congestive heart failure
D) Stroke

Question 57

A 37-year-old, obviously pregnant woman complains of sharp, tearing abdominal pain. She reports that she is pregnant with her fifth child, but states she cannot remember the exact due date. The patient has a history of drug use and states that she last smoked crack cocaine approximately 30 minutes ago. You suspect:

A) spontaneous abortion.
B) placenta previa.
C) abruptio placentae.
D) false labor.

Question 58

A pregnant woman is complaining of a severe headache and "feeling ill." Her vital signs are: heart rate 92, blood pressure 120/82 mmHg, and respiratory rate of 16. Which of the following questions would be most helpful in identifying a possible pregnancy-related emergency?

A) "Do you have a history of migraine headaches?"
B) "Have you been experiencing morning sickness or excessive vomiting today?"
C) "When was the last time you saw your doctor?"
D) "What has been a typical blood pressure for you during this pregnancy?"

Question 59

You are caring for a 19-year-old woman who states that she is 32 weeks pregnant. She is experiencing cramping abdominal pain every six to seven minutes and reports a brief period of fluid discharge from her vagina approximately 15 minutes ago. You should:

A) provide routine BLS care and transport.
B) begin a fluid bolus and transport code 3.
C) administer ondansetron and reassess vital signs.
D) apply oxygen and perform a physical exam.

Question 60

A 29-year-old woman is 28 weeks pregnant. She complains of nausea, abdominal pain, and right shoulder pain. She states she vomited once, which caused temporary relief; however, the pain returned shortly afterward. She has no pertinent medical history or allergies, has stable vital signs, and states that she ate a cheeseburger about 20 minutes prior to the start of her pain. The most likely cause of this patient's presentation is:

A) food poisoning.
B) cholecystitis.
C) hyperemesis gravidarum.
D) appendicitis.

Question 61

You have just assisted in the delivery of a 34-week-gestation infant in the office of a methadone clinic. After 30 seconds of drying and stimulation, the infant remains limp and cyanotic, with a pulse of 50. Which of the following is the most appropriate action to take at this point?

A) Begin CPR at a rate of 3 compressions to 1 ventilation.
B) Intubate the trachea, ventilate, reassess, and prepare to transport to a NICU.
C) Begin bag-valve-mask ventilations and establish intravenous access.
D) Continue to warm and dry the infant for an additional 30 seconds, while preparing to intubate.

Question 62

Which of the following best describes Pierre Robin syndrome?

A) A congenital condition characterized by a small jaw and large tongue in conjunction with a cleft palate
B) A condition in which the ductus arteriosis fails to close completely
C) Repeat febrile seizures within the first 6 months of life
D) Persistent pneumonia following meconium aspiration

Question 63

When is the ideal time to assess a neonate for the APGAR score?

A) 2 to 3 minutes after delivery
B) 1 minute and 5 minutes after delivery
C) 5 to 10 minutes after delivery
D) 2 minutes and 10 minutes after delivery

Question 64

A woman late in her pregnancy is in cardiac arrest. When resuscitating this patient, it is appropriate to:

A) compress at a rate of at least 120 per minute.
B) use a mechanical compression device.
C) lift and push the gravid uterus to the left.
D) assess for imminent delivery.

Question 65

Which of the following statements is TRUE regarding the cardiac output of a neonate?

A) Cardiac output doubles within the first few hours of life.
B) The cardiac output of a neonate is strongly influenced by body temperature.
C) Neonates do not readily alter their pulse rate; cardiac output depends mainly on stroke volume.
D) Newborns have a fixed stroke volume; cardiac output depends mostly on heart rate.

Question 66

You are caring for a newborn who had prolonged respiratory distress and hypoxia following birth. You recognize that continued hypoxia and subsequent severe acidosis can cause:

A) refractory hypotension.
B) rapid development of fetal alveoli to compensate for hypoxia.
C) persistent fetal circulation.
D) the formation of congenital heart defects.

Question 67

At 90 seconds after birth, based on the following findings, which newborn does NOT require resuscitative efforts beyond routine care?

A) HR = 100, RR = 30, peripheral cyanosis, APGAR = 8
B) HR = 158, RR = 40, central cyanosis, APGAR = 6
C) HR = 75, RR = 25, central cyanosis, APGAR = 5
D) HR = 98, RR = 27, peripheral cyanosis, APGAR = 6

Question 68

You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of the following is the best course of action?

A) Administer a 10 mL/kg fluid bolus.
B) Undress the infant to his diaper and sponge him with tepid water.
C) Reassure the parents that the infant's sleep patterns and temperature are normal.
D) Contact medical control to order acetaminophen.

Question 69

Which of the following is NOT a recommended method for assessing the heart rate of a newborn?

A) Palpating the carotid pulse
B) Palpate the umbilical pulse
C) Auscultate heart sounds
D) Palpate a femoral pulse

Question 70

Which of the following is NOT an option for prehospital vascular access in the newborn?

A) Cannulation of a peripheral vein in an extremity
B) Intraosseous needle placed in the proximal tibia
C) Femoral vein cannulation
D) Umbilical vein cannulation

Question 71

Immediately after delivery, a neonate is crying and moving his arms and legs, but is centrally cyanotic. You recognize:

A) the need for supplemental oxygen.
B) signs of a normal, healthy infant.
C) the need to prevent further heat loss.
D) signs of a congenital heart abnormality.

Question 72

A 21-year-old woman is complaining of abdominal pain. She says she is 25 weeks pregnant and has been actively trying to stop using methamphetamines, but slipped and used earlier today. Her abdominal pain comes every 8 to 10 minutes and is described as sharp and cramping. You suspect:

A) hypertensive disorder of pregnancy.
B) abruptio placentae.
C) toxic shock syndrome.
D) preterm labor.

Question 73

In some cases, the spinal cord and associated structures of a newborn may be exposed. This abnormality is called a:

A) Tetralogy of Fallot.
B) meningomyelocele.
C) omphalocele.
D) choanal atresia.

Question 74

A newborn has just been delivered. You notice a greenish-brown substance on the infant, and observe a vigorous cry and active movement. What is the appropriate way to manage this patient?

A) Prepare to suction the trachea with an endotracheal tube and meconium aspirator.
B) Using a bulb syringe, suction the nose and then the mouth.
C) Rub the infant with a dry towel and place on the mother's chest.
D) Lay the infant supine and place padding behind the shoulders.

Question 75

You have just assisted in the delivery of a full-term infant in the back of the ambulance. Ten minutes after delivery, you obtain vital signs on the newborn and find the following: heart rate 120, respirations 54, and SpO₂ of 90%. You recognize:

A) the need for immediate supplemental oxygen.
B) appropriate vital signs for this infant.
C) tachycardia and the possibility of shock.
D) tachypnea and possible respiratory distress.

Question 76

A 32-year-old woman was the restrained passenger of a vehicle that hit a tree at a high rate of speed. She is 34 weeks pregnant and complains of excruciating abdominal pain. She is cool and diaphoretic and has a faint and rapid radial pulse. You suspect:

A) traumatic onset of labor.
B) uterine inversion.
C) uterine rupture.
D) premature rupture of membranes.

Question 77

You have just delivered a healthy newborn to a 35-year-old woman. There is a steady flow of blood from the vagina and her uterus feels soft upon palpation. Her vital signs are: heart rate 122, respirations 20, blood pressure 90/60 mmHg. Appropriate management of this patient includes:

A) sanitary pads placed over the vagina and continued monitoring.
B) two large-bore IVs and oxytocin administration.
C) Trendelenberg position and administration of magnesium sulfate.
D) low-flow oxygen and position of comfort.

Question 78

Factors that stimulate the newborn to take the first breath include all of the following EXCEPT:

A) hypothermia.
B) hypoxia.
C) hyperglycemia.
D) acidosis.

Question 79

Which of the following is TRUE regarding vaginal delivery?

A) Infants delivered vaginally are at greater risk of post-delivery complications.
B) The compression of the infant's chest during vaginal delivery aids in the removal of fluid from the fetal lungs.
C) Vaginal delivery stimulates the production of insulin in the newborn.
D) The foramen ovale close more successfully in newborns delivered vaginally.

Question 80

You have just delivered an infant at 33 weeks gestation. The infant is blue and limp and has a brachial pulse of 70 beats per minute. What is the appropriate sequence of care for this infant?

A) Keep warm and dry, chest compressions, clamp and cut the cord.
B) Keep warm and dry, clamp and cut the cord, positive pressure ventilations.
C) Clamp and cut the cord, positive pressure ventilations, keep warm and dry.
D) Clamp and cut the cord, chest compressions, positive pressure ventilations.