Principles II- Exam 3

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A review of the material for Exam 3 in Principles covering OB anesthesia.


Questions and Answers
  • 1. 

    If intubation should fail, as an anesthetist you should be most concerned with saving the life of the….

    • A.

      Fetus

    • B.

      Mother

    • C.

      Neither is more important than the other

    • D.

      Myself!!!

    Correct Answer
    B. Mother
    Explanation
    As an anesthetist, your primary concern is the safety and well-being of the patient. In this case, the patient is the mother. If intubation fails, it is crucial to prioritize saving the mother's life as she is the one undergoing the procedure and is at immediate risk. While the fetus is also important, the mother's life takes precedence in this situation.

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  • 2. 

    You are the SRNA for Mrs. Gitz who is coming to you for an elective C-section today. She has refused epidural anesthesia, so will have to undergo general anesthesia today. You begin a rapid sequence induction and are unable to intubate. You able to ventilate the pt with cricioid pressure, but can’t seem to get a tube in. What do you do?

    • A.

      Perform retrograde intubation

    • B.

      Insert LMA and then proceed with case

    • C.

      Wake pt up, then do an awake fiberoptic intubation

    • D.

      Maintain ventilation with cricoid pressure and proceed with surgery

    Correct Answer
    C. Wake pt up, then do an awake fiberoptic intubation
  • 3. 

    You are the SRNA for Ms. Tiyarah who is coming down for an emergent c-section due to fetal distress. She does not have an epidural, so must undergo general anesthesia since there is no time to insert one. You do a rapid sequence induction and are unable to intubate the pt. You are able to maintain ventilation with cricoids pressure but can’t get a tube in. What do you do?

    • A.

      Perform retrograde intubation

    • B.

      Perform Transtracheal Jet Ventilation

    • C.

      Wake pt up, then do an awake fiberoptic intubation

    • D.

      Maintain ventilation with cricoid pressure and proceed with surgery

    Correct Answer
    D. Maintain ventilation with cricoid pressure and proceed with surgery
    Explanation
    In this scenario, the correct answer is to maintain ventilation with cricoid pressure and proceed with surgery. This is because the patient is in need of an emergent c-section due to fetal distress and there is no time to insert an epidural for regional anesthesia. Although the rapid sequence induction was unsuccessful in intubating the patient, the priority is to ensure that the patient is adequately ventilated and oxygenated. By maintaining ventilation with cricoid pressure, the patient's airway can be protected while the surgery proceeds. Other options such as retrograde intubation or awake fiberoptic intubation may not be feasible or may cause further delay in the surgery.

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  • 4. 

    Which of the following is not an indication for general anesthesia?

    • A.

      Precipitous labor

    • B.

      Fetal Distress

    • C.

      Pt hemorrhaging

    • D.

      Failed regional block

    Correct Answer
    A. Precipitous labor
    Explanation
    Precipitous labor is not an indication for general anesthesia because it refers to a labor that progresses very quickly, with the baby being delivered within a few hours of contractions starting. In such cases, there is usually no need for general anesthesia as the labor is fast and the baby can be delivered without the need for additional pain management or interventions. General anesthesia is typically used in situations such as fetal distress, excessive bleeding (hemorrhaging), or when a regional block (such as an epidural) fails to provide adequate pain relief.

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  • 5. 

    Which nonparticulate antacid is commonly given to pregnant pts undergoing general anesthesia?

    • A.

      Metaclopromide

    • B.

      Bicitra

    • C.

      Calcium Carbonate

    • D.

      Pepcid

    Correct Answer
    B. Bicitra
    Explanation
    Bicitra is commonly given to pregnant patients undergoing general anesthesia as a nonparticulate antacid. It helps to neutralize stomach acid and prevent acid reflux during surgery. This is important because acid reflux can cause complications during anesthesia. Bicitra is a liquid medication that contains citric acid and sodium citrate, which work together to reduce stomach acidity. It is considered safe for use in pregnant patients and is often preferred over other antacids due to its nonparticulate nature, which means it does not form particles that could potentially cause harm.

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  • 6. 

    How should the pregnant pt be extubated upon emergence from general anesthesia?

    • A.

      Deep extubation

    • B.

      All pregnant pts should remain intubated until cleared by OB/GYN

    • C.

      Awake extubation

    • D.

      Extubate of jet stylet so re-intubation easier if necessary

    Correct Answer
    C. Awake extubation
    Explanation
    Awake extubation is the recommended approach for pregnant patients upon emergence from general anesthesia. This is because it allows for a smoother transition and reduces the risk of complications. Keeping the patient awake during the extubation process ensures that their airway is protected and allows for immediate intervention if any respiratory distress or airway obstruction occurs. Additionally, awake extubation allows for the assessment of the patient's respiratory function and ability to maintain a patent airway independently.

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  • 7. 

    In the obese patient in labor, it is of particular importance to…

    • A.

      Avoid regional blocks due to difficulty in locating anatomical landmarks

    • B.

      Administer anxiolytic and opioids as soon as possible to initiate pain control

    • C.

      Talk to them about how to lose the baby weight (and then some) after birth

    • D.

      Make every effort to initiate early regional anesthetic

    Correct Answer
    D. Make every effort to initiate early regional anesthetic
    Explanation
    In an obese patient in labor, it is important to make every effort to initiate early regional anesthetic. This is because regional anesthesia, such as epidural or spinal anesthesia, can provide effective pain control during labor. Obesity can make it challenging to locate anatomical landmarks for regional blocks, but initiating the anesthesia early can help overcome this difficulty. Additionally, regional anesthesia allows for better pain management compared to anxiolytic and opioids alone. Therefore, the focus should be on providing early regional anesthesia to ensure optimal pain control for the obese patient in labor.

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  • 8. 

    You are doing general anesthesia on Mrs. Maritt who is having a lap chole today. She is also 7 months pregnant and morbidly obese. Which of the following would not be an airway consideration with this patient?

    • A.

      More anterior larynx

    • B.

      Limited flexion

    • C.

      Narrowed view of pharyngeal opening

    • D.

      Limited mouth opening

    Correct Answer
    A. More anterior larynx
    Explanation
    During pregnancy, the position of the larynx can shift slightly due to hormonal changes and the growing uterus. This can result in a more anterior larynx, which may make intubation more challenging. However, in this question, the correct answer is "More anterior larynx" because it is stated that this would not be an airway consideration with this patient. Therefore, the position of the larynx being more anterior would not have an impact on the airway management in this specific case.

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  • 9. 

    Which of the following is not an indication for cesarean section?

    • A.

      Fetal Distress

    • B.

      Failed regional block

    • C.

      Dystocia

    • D.

      Cephalopelvic disproportion

    Correct Answer
    B. Failed regional block
    Explanation
    A failed regional block refers to the inability to achieve adequate pain relief during labor using regional anesthesia techniques such as epidural or spinal anesthesia. This is not an indication for cesarean section as it does not directly impact the safety or well-being of the mother or baby. Cesarean section is typically performed in cases of fetal distress (when the baby is not receiving enough oxygen), dystocia (difficult or prolonged labor), and cephalopelvic disproportion (when the baby's head is too large to pass through the mother's pelvis).

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  • 10. 

    For cesarean section with epidural in place, you want to achieve a sensory blockade at what level?

    • A.

      T6

    • B.

      T2

    • C.

      T4

    • D.

      T8

    Correct Answer
    C. T4
    Explanation
    During a cesarean section with epidural in place, the goal is to achieve a sensory blockade at the T4 level. This is because the T4 dermatome corresponds to the level of the umbilicus, which is the area where the surgical incision is typically made during a cesarean section. By achieving a sensory blockade at the T4 level, the patient will not feel any pain or discomfort during the procedure.

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  • 11. 

    Duty, Breach, Injury, and Proximate cause are all elements that are necessary to establish what?

    • A.

      Sentinel Event

    • B.

      Obstetric risk

    • C.

      Culpability

    • D.

      Medical Malpractice

    Correct Answer
    D. Medical Malpractice
    Explanation
    Duty, Breach, Injury, and Proximate cause are all elements that are necessary to establish Medical Malpractice. Medical Malpractice refers to the negligence or improper treatment by a healthcare professional that results in harm or injury to a patient. The duty of care is the responsibility of the healthcare provider to provide a certain standard of care to the patient. Breach occurs when the healthcare provider fails to meet this standard of care. Injury refers to the harm caused to the patient as a result of the breach. Proximate cause establishes the link between the breach and the injury suffered by the patient.

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  • 12. 

    What are the most common precipitating events leading to adverse outcome in obstetric anesthesia?

    • A.

      Respiratory Events

    • B.

      Cardiac Events

    • C.

      Fetal Distress

    • D.

      Abnormal fetal presentation

    Correct Answer
    A. Respiratory Events
    Explanation
    Respiratory events are the most common precipitating events leading to adverse outcomes in obstetric anesthesia. This could include complications such as airway obstruction, aspiration, or inadequate ventilation. These events can have serious consequences for both the mother and the fetus, potentially leading to hypoxia, respiratory distress, or even cardiac arrest. It is essential for obstetric anesthesiologists to be vigilant and prepared to manage and prevent these respiratory events to ensure the safety and well-being of both the mother and the baby.

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  • 13. 

    What is the preferred anesthetic method for the obstetric patient?

    • A.

      MAC sedation

    • B.

      Regional Anesthesia

    • C.

      General Anesthesia

    • D.

      All the above are equally good options

    Correct Answer
    B. Regional Anesthesia
    Explanation
    Regional anesthesia is the preferred anesthetic method for obstetric patients because it provides effective pain relief while minimizing the risks associated with general anesthesia. Regional anesthesia techniques, such as epidurals or spinal blocks, can be used to numb specific areas of the body, allowing the patient to remain awake and alert during childbirth. This method also allows for better control of pain during labor and delivery, and reduces the risk of complications for both the mother and the baby.

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  • 14. 

    All OB patients going for a c-section are considered to have full stomachs regardless of how long they have been NPO.  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    This statement is true because it is a standard practice in obstetrics to consider all patients going for a c-section to have full stomachs, regardless of the duration of their fasting (NPO) period. This is because there is a risk of aspiration during surgery, where stomach contents can enter the lungs and cause complications. Therefore, precautions are taken to minimize this risk, such as using medications to reduce stomach acid and using rapid sequence induction techniques during anesthesia.

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  • 15. 

    Minimum NPO status for an elective C-section is ____ hours.

    • A.

      4

    • B.

      8

    • C.

      6

    • D.

      10

    Correct Answer
    C. 6
    Explanation
    The minimum NPO status for an elective C-section is 6 hours. NPO stands for "nil per os," which means nothing by mouth. This requirement is in place to ensure that the patient's stomach is empty during the surgery, reducing the risk of aspiration. By abstaining from food and drink for at least 6 hours before the procedure, the patient's stomach will have enough time to empty its contents. This is a standard safety measure followed in surgical procedures to prevent complications.

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  • 16. 

    Which of the following does not contribute to increases risk of aspiration during anesthesia for pregnant patients?

    • A.

      Increased intragastric pressure

    • B.

      Lower esophageal sphincter tone

    • C.

      Delayed Gastric emptying

    • D.

      All the above contribute.

    Correct Answer
    D. All the above contribute.
    Explanation
    Increased intragastric pressure, lower esophageal sphincter tone, and delayed gastric emptying all contribute to an increased risk of aspiration during anesthesia for pregnant patients. Aspiration occurs when stomach contents enter the lungs, which can lead to serious complications such as pneumonia. Increased intragastric pressure can occur due to the growing uterus pressing on the stomach, causing the contents to be pushed upwards. Lower esophageal sphincter tone can allow stomach acid and contents to reflux into the esophagus and potentially into the lungs. Delayed gastric emptying can result in a larger volume of stomach contents, increasing the risk of aspiration. Therefore, all of these factors contribute to an increased risk of aspiration during anesthesia for pregnant patients.

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  • 17. 

    Aspiration is more likely to occur for all of the following pregnant patients except?

    • A.

      Pt who is overdue by 2 weeks

    • B.

      Emergent c-section

    • C.

      Eclamptic pt

    • D.

      Difficult intubation

    Correct Answer
    A. Pt who is overdue by 2 weeks
    Explanation
    Aspiration is the inhalation of stomach contents into the lungs, which can lead to serious complications. It is more likely to occur in certain situations, such as emergent c-sections, eclamptic patients, and difficult intubations, where there may be a higher risk of regurgitation or vomiting. Being overdue by 2 weeks does not directly increase the risk of aspiration, so it is less likely to occur in this situation.

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  • 18. 

    When does organogenesis occur?

    • A.

      First 4 months of pregnancy

    • B.

      3rd – 5th months of pregnancy

    • C.

      First two months of pregnancy

    • D.

      Throughout the entire pregnancy

    Correct Answer
    C. First two months of pregnancy
    Explanation
    Organogenesis is the process of organ formation during embryonic development. It occurs during the first two months of pregnancy, specifically in the embryonic stage. During this time, the basic structures of major organs and systems are formed. After the first two months, the organs continue to grow and develop, but the major groundwork of organogenesis is completed.

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  • 19. 

    Which of the following is considered unsafe to give during pregnancy?

    • A.

      Vecuronium

    • B.

      Ephedrine

    • C.

      Sevoflurane

    • D.

      Versed

    Correct Answer
    D. Versed
    Explanation
    Versed, also known as midazolam, is considered unsafe to give during pregnancy. It belongs to a class of medications called benzodiazepines, which can potentially harm the developing fetus. Benzodiazepines have been associated with an increased risk of birth defects and other adverse effects when used during pregnancy. Therefore, it is generally recommended to avoid the use of Versed or any other benzodiazepine during pregnancy, unless the potential benefits outweigh the potential risks.

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  • 20. 

    Which of the following is not true regarding surgical considerations of pregnant pts?

    • A.

      They have a greater sensitivity to anesthetics

    • B.

      Optimal positioning for 2nd – 3rd trimester pts is supine

    • C.

      Pts have a greater circulating blood volume

    • D.

      Pts are more susceptible to thromboembolic problems

    Correct Answer
    B. Optimal positioning for 2nd – 3rd trimester pts is supine
    Explanation
    The optimal positioning for 2nd - 3rd trimester pregnant patients is not supine. This position can compress the inferior vena cava, reducing blood flow to the heart and uterus, potentially causing hypotension and decreased fetal oxygenation. Instead, the optimal position is left lateral tilt or a modified supine position with a wedge under the right hip, which helps to alleviate pressure on the vena cava.

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  • 21. 

    During the first and second trimesters, pregnant pts are not considered to be at an increased aspiration risk.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    During the first and second trimesters of pregnancy, the pregnant individuals are actually considered to be at an increased risk of aspiration. This is because the growing uterus can push the stomach upwards, leading to a decrease in the space available for the stomach to expand. As a result, the stomach contents may be more likely to reflux into the esophagus and potentially be aspirated into the lungs. Therefore, pregnant individuals should be cautious and take measures to minimize the risk of aspiration during these trimesters.

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  • 22. 

    Why must nitrous oxide be avoided during pregnancy?

    • A.

      N2O diffuses into and expands uterus, increasing risk for uterine rupture

    • B.

      Nitrous oxide causes fetal bradycardia and increasing risk of spontaneous abortion

    • C.

      N2O interferes with folic acid metabolism, thus impairing DNA synthesis

    • D.

      All the above

    Correct Answer
    C. N2O interferes with folic acid metabolism, thus impairing DNA synthesis
    Explanation
    Nitrous oxide (N2O) must be avoided during pregnancy because it interferes with folic acid metabolism, which is essential for DNA synthesis. Folic acid is crucial for the development of the fetal neural tube and plays a vital role in preventing birth defects. Impairing DNA synthesis can lead to various complications and abnormalities in the developing fetus. Therefore, it is important to avoid nitrous oxide during pregnancy to ensure proper folic acid metabolism and DNA synthesis.

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  • 23. 

    Success in outcome of pregnancy following surgery is determined by all of the following except…

    • A.

      Maternal well-being

    • B.

      Timing of surgery

    • C.

      Choice of anesthetic agents

    • D.

      Maternal age

    Correct Answer
    D. Maternal age
    Explanation
    The success of the outcome of pregnancy following surgery is influenced by various factors, including maternal well-being, timing of surgery, and choice of anesthetic agents. However, maternal age is not a determining factor in the success of the outcome. While advanced maternal age may be associated with certain risks and complications during pregnancy, it does not directly impact the success of the outcome of pregnancy following surgery.

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  • 24. 

    How will pregnancy affect the MAC of anesthetics?

    • A.

      Decrease MAC

    • B.

      Increase MAC

    • C.

      No effect on MAC

    Correct Answer
    A. Decrease MAC
    Explanation
    Pregnancy can decrease the MAC (minimum alveolar concentration) of anesthetics. This is because during pregnancy, there are physiological changes in the body that can affect the metabolism and distribution of anesthetics. Increased hormone levels, changes in cardiac output, and alterations in respiratory function can all contribute to a decreased MAC. Additionally, the increased sensitivity to anesthetics during pregnancy may also be due to changes in the central nervous system.

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  • 25. 

    You are performing an epidural on a patient in labor. As you begin to administer your test dose you see pts heart rate go up. She is now breathing deeply and rubbing her stomach. Is it OK to proceed?

    • A.

      No, elevated HR is a sign of intravascular injection. Stop injection.

    • B.

      Elevated HR is an expected side effect and It is OK to proceed.

    • C.

      This is a sign of accidental dural puncture, just give a smaller dose.

    • D.

      She is probably having a contraction, wait a few minutes and see.

    Correct Answer
    D. She is probably having a contraction, wait a few minutes and see.
    Explanation
    The elevated heart rate and the patient's actions of breathing deeply and rubbing her stomach are all indicative of a contraction. It is common for a patient in labor to experience an increase in heart rate during contractions. Therefore, it is safe to wait a few minutes and observe the situation before proceeding with the epidural.

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  • 26. 

    You are giving a test dose of lido with epi to a patient receiving an epidural. Within 3 minutes of injection the pt complains of numbness in their lower extremities. Is it OK to proceed with the injection?

    • A.

      This is a sign of accidental dural puncture, you will need to adjust your dose.

    • B.

      The epidural is *supposed* to produce numbess, continue with injection

    • C.

      This is a sign of intravascular injection, stop injection.

    • D.

      None of above

    Correct Answer
    A. This is a sign of accidental dural puncture, you will need to adjust your dose.
    Explanation
    The patient's complaint of numbness in their lower extremities within 3 minutes of injection is a sign of accidental dural puncture. This means that the epidural needle has punctured the dura mater, causing the local anesthetic to spread into the cerebrospinal fluid and block nerve conduction. In this case, it is not safe to proceed with the injection as it may lead to complications. The dose of the local anesthetic will need to be adjusted accordingly.

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  • 27. 

    You are giving an epidural to a pt up on the OB floor. As you insert the catheter the patient complains of feeling an electric shock sensation. What do you do?

    • A.

      Pull the catheter back then reinsert

    • B.

      This is to be expected when inserting the catheter

    • C.

      Stop the catheter, you have gone too far

    • D.

      You have inserted the catheter intravascularly, pull out needle and cather.

    Correct Answer
    B. This is to be expected when inserting the catheter
    Explanation
    When inserting an epidural catheter, it is not uncommon for the patient to experience an electric shock sensation. This sensation occurs due to the stimulation of nerve fibers as the catheter passes through them. Therefore, it is normal and expected, and there is no need to stop or pull back the catheter.

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  • 28. 

    Which of the following is not a good candidate for Spinal anesthesia?

    • A.

      Pt with a known difficult airway

    • B.

      Pt with Aortic stenosis

    • C.

      Pt with history of asthma and bronchitis

    • D.

      Pt who is terrified of general anesthesia

    Correct Answer
    B. Pt with Aortic stenosis
    Explanation
    A patient with aortic stenosis is not a good candidate for spinal anesthesia because the procedure can cause a sudden decrease in blood pressure, which can be dangerous for patients with aortic stenosis. Spinal anesthesia can lead to vasodilation and decrease in systemic vascular resistance, which can worsen the already compromised cardiac function in patients with aortic stenosis. Therefore, it is not recommended to use spinal anesthesia in these patients to avoid potential complications.

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  • 29. 

    Which of the following is not an appropriate treatment for Post dural Puncture headache?

    • A.

      Blood Patch, at same interspace prior epidural was performed

    • B.

      Oral/IV hydration

    • C.

      IV Caffeine

    • D.

      Maintaining pt in upright position, on bedrest

    Correct Answer
    D. Maintaining pt in upright position, on bedrest
    Explanation
    Maintaining the patient in an upright position and on bedrest is not an appropriate treatment for Post dural Puncture headache. This position may actually worsen the headache as it increases the pressure in the head. The other options, such as a Blood Patch (a procedure to seal the hole in the dura), Oral/IV hydration (to increase fluid volume), and IV Caffeine (to constrict blood vessels and reduce headache) are appropriate treatments for Post dural Puncture headache.

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  • 30. 

    How far should your epidural catheter be inserted?

    • A.

      Until pt begins to feel an ‘electric shock’ sensation

    • B.

      3-5 cm

    • C.

      1-2 cm

    • D.

      5-10 cm

    Correct Answer
    B. 3-5 cm
    Explanation
    The epidural catheter should be inserted 3-5 cm. This is the recommended depth for insertion to ensure that the catheter is properly placed and can effectively deliver anesthesia. Inserting the catheter too shallow or too deep can result in inadequate pain relief or complications.

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  • 31. 

    Which of the following will not help to decrease the incidence of PDpH?

    • A.

      Use of rounded point needle

    • B.

      Use of smaller gauge needle

    • C.

      Making sure the point of the needle used to puncture the dura is oriented PARALLEL rather than perpendicular to the meningeal fibers

    • D.

      Placing pt in lateral position during administration of epidural

    Correct Answer
    D. Placing pt in lateral position during administration of epidural
    Explanation
    Placing the patient in a lateral position during the administration of an epidural will not help decrease the incidence of Post-Dural Puncture Headache (PDPH). PDPH is a common complication of epidural procedures, characterized by a severe headache that worsens when sitting or standing. The use of rounded point needles, smaller gauge needles, and ensuring the needle is oriented parallel to the meningeal fibers can help decrease the incidence of PDPH. However, the position of the patient during administration does not have a significant impact on the occurrence of PDPH.

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  • 32. 

    How much volume would you inject for a blood patch to treat PDpH?

    • A.

      10-20 cc’s

    • B.

      5-10 cc’s

    • C.

      25-30 cc’s

    • D.

      Depends upon size of pt and severity of headache

    Correct Answer
    A. 10-20 cc’s
    Explanation
    The correct answer is 10-20 cc's. This is the recommended volume for injecting a blood patch to treat post-dural puncture headache (PDPH). The blood patch involves injecting the patient's own blood into the epidural space to form a clot and seal the puncture site, relieving the headache. The specific volume within the range of 10-20 cc's may vary depending on the size of the patient and the severity of the headache.

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  • 33. 

    Where would you place your epidural catheter for a labor epidural?

    • A.

      L2

    • B.

      T12

    • C.

      L3

    • D.

      L5

    Correct Answer
    C. L3
    Explanation
    The epidural catheter for a labor epidural is typically placed at the L3 level. This is because the L3 level corresponds to the level of the spinal cord where the nerves for pain sensation during labor are located. By placing the catheter at this level, the medication can effectively block the pain signals from reaching the brain, providing pain relief for the mother during labor.

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  • 34. 

    Which of the following is not true of CV changes that occur during pregnancy?

    • A.

      Increase in intravascular volume

    • B.

      Decrease in SVR

    • C.

      Increase in HR

    • D.

      Largest increase in CO is during third trimester

    Correct Answer
    D. Largest increase in CO is during third trimester
    Explanation
    Largest increase in CO is immediately following delivery.

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  • 35. 

    Which of the following is not true of respiratory changes during pregnancy?

    • A.

      Pts will need larger ETT’s

    • B.

      O2 dissociation curve shifts to right

    • C.

      Decrease in FRC

    • D.

      Respiratory Alkalosis may be normal

    Correct Answer
    A. Pts will need larger ETT’s
    Explanation
    During pregnancy, there are several respiratory changes that occur. One of these changes is an increase in tidal volume and minute ventilation, which leads to a decrease in functional residual capacity (FRC). This decrease in FRC can result in the need for larger endotracheal tubes (ETTs) to accommodate the increased airway resistance. Additionally, the O2 dissociation curve shifts to the right during pregnancy, allowing for increased oxygen delivery to the fetus. Respiratory alkalosis may also be normal due to the increased respiratory drive. Therefore, the statement "Pts will need larger ETT's" is not true of respiratory changes during pregnancy.

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  • 36. 

    Which of the following patients is an Absolute contraindication to spinal anesthesia?

    • A.

      Mrs. A what has severe mitral stenosis.

    • B.

      Mr. B who has advanced HIV disease

    • C.

      Mrs. C who weighs 350 pounds.

    • D.

      Mr. D who suffers from chronic back pain.

    Correct Answer
    A. Mrs. A what has severe mitral stenosis.
    Explanation
    Mrs. A, who has severe mitral stenosis, is an absolute contraindication to spinal anesthesia. Mitral stenosis is a condition where the mitral valve in the heart is narrowed, leading to impaired blood flow. Spinal anesthesia can cause a decrease in blood pressure, which can be dangerous for patients with mitral stenosis as it can further compromise blood flow to the heart. Therefore, it is not safe to administer spinal anesthesia to Mrs. A.

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  • 37. 

    Which of the following is not true regarding anesthetic requirements during pregnancy?

    • A.

      Decreased epidural space

    • B.

      Plasma cholinesterase activity increased

    • C.

      Increased response to LA’s

    • D.

      Decreased MAC requirements

    Correct Answer
    B. Plasma cholinesterase activity increased
    Explanation
    During pregnancy, there is an increase in plasma cholinesterase activity. This is because pregnancy hormones can stimulate the production of cholinesterase, an enzyme responsible for breaking down certain medications, including anesthetics. As a result, the increased activity of plasma cholinesterase can lead to a more rapid metabolism and elimination of anesthetics from the body, potentially requiring higher doses or more frequent administration of anesthesia during pregnancy.

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  • 38. 

    What happens to coagulation factors during pregnancy?

    • A.

      Decreased plasma concentration

    • B.

      No change in plasma concentration

    • C.

      Increase in plasma concentration

    • D.

      Look.... Honestly I am sooooooo not motivated to study right now.

    Correct Answer
    C. Increase in plasma concentration
    Explanation
    During pregnancy, there is an increase in plasma concentration of coagulation factors. This is because the body prepares for potential blood loss during childbirth. The increased concentration of coagulation factors helps in the formation of blood clots to prevent excessive bleeding.

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  • 39. 

    Which of the following is not true regarding GI changes during pregnancy?

    • A.

      Gastric fluid volume increase

    • B.

      Insulin secretion increases

    • C.

      Gastroesophageal tone decreases

    • D.

      Gastric pH increases

    Correct Answer
    D. Gastric pH increases
    Explanation
    During pregnancy, there are several gastrointestinal (GI) changes that occur. One of these changes is an increase in gastric fluid volume, which is true. Additionally, insulin secretion increases during pregnancy, which helps regulate blood sugar levels. Gastroesophageal tone, however, decreases during pregnancy, which can lead to symptoms like heartburn and acid reflux. Lastly, the statement that gastric pH increases during pregnancy is not true. In fact, gastric pH tends to decrease during pregnancy due to hormonal changes and increased levels of stomach acid.

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  • 40. 

    Uterine Blood flow is autoregulated. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Uterine blood flow is not autoregulated. Autoregulation refers to the ability of an organ to maintain a constant blood flow despite changes in blood pressure. In the case of the uterus, its blood flow is not autoregulated and can vary depending on factors such as hormonal changes, pregnancy, and menstrual cycle.

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  • 41. 

    What percentage of cardiac output goes to the uterus?

    • A.

      10%

    • B.

      20%

    • C.

      30%

    • D.

      5%

    Correct Answer
    A. 10%
    Explanation
    The correct answer is 10%. During pregnancy, the uterus receives approximately 10% of the cardiac output. This is because the uterus requires a significant amount of blood flow to support the growing fetus and provide oxygen and nutrients. The increased blood flow helps to ensure that the fetus receives everything it needs for proper development.

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  • 42. 

    Spinal and Epidural anesthesia are known to decrease uterine blood flow.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Spinal and Epidural anesthesia are not known to decrease uterine blood flow. In fact, these types of anesthesia are commonly used during childbirth to provide pain relief while minimizing the impact on uterine blood flow. They work by blocking nerve signals in the spine, allowing the mother to be comfortable during labor while still maintaining adequate blood flow to the uterus. Therefore, the statement that spinal and epidural anesthesia decrease uterine blood flow is incorrect.

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  • 43. 

    Placental exchange occurs primarily via ….

    • A.

      Active Transport

    • B.

      Diffusion

    • C.

      Osmosis

    • D.

      Forced Filtration

    Correct Answer
    B. Diffusion
    Explanation
    Placental exchange occurs primarily via diffusion. Diffusion is the passive movement of molecules from an area of higher concentration to an area of lower concentration. In the placenta, oxygen and nutrients from the mother's blood diffuse across the placental membrane into the fetal blood, while waste products such as carbon dioxide diffuse from the fetal blood into the mother's blood. This process allows for the exchange of gases, nutrients, and waste products between the mother and the developing fetus. Active transport, osmosis, and forced filtration are not the primary mechanisms for placental exchange.

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  • 44. 

    What is the optimal surgical position for a pt undergoing c-section to prevent hypotension?

    • A.

      Reverse trendelenburg

    • B.

      Lithotomy

    • C.

      Supine and slightly lateral

    • D.

      Trendelenburg

    Correct Answer
    C. Supine and slightly lateral
    Explanation
    The optimal surgical position for a patient undergoing a c-section to prevent hypotension is supine and slightly lateral. This position helps to improve blood flow to the heart and brain, reducing the risk of hypotension. The supine position allows for proper ventilation and oxygenation, while the slight lateral tilt prevents compression of the inferior vena cava, ensuring adequate venous return. This position also provides good access to the surgical site and allows for effective monitoring of the patient's vital signs during the procedure.

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  • 45. 

    Which of the following fetal shunts directs blood from the umbilical vein to the inferior vena cava?

    • A.

      Foramen Ovale

    • B.

      Hepatic shunt

    • C.

      Ductuc Arteriosus

    • D.

      Ductuc Venosus

    Correct Answer
    D. Ductuc Venosus
    Explanation
    The correct answer is Ductus Venosus. During fetal development, the ductus venosus is a shunt that allows oxygenated blood from the placenta to bypass the liver and flow directly into the inferior vena cava. This ensures that the developing fetus receives oxygenated blood from the placenta for proper oxygenation and nutrition. Once the baby is born and takes its first breath, the ductus venosus closes and becomes a ligament known as the ligamentum venosum.

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  • 46. 

    During the first stage of labor, the pain felt is visceral in origin and derived from nerve fibers originating where?

    • A.

      T10-L1

    • B.

      L3-L5

    • C.

      S1-S4

    • D.

      T6-T8

    Correct Answer
    A. T10-L1
    Explanation
    During the first stage of labor, the pain felt is visceral in origin and derived from nerve fibers originating from the T10-L1 region. This region corresponds to the thoracic and lumbar spinal segments, which innervate the lower abdomen and pelvis. The pain is experienced in these areas due to the contraction and stretching of the uterus and cervix during labor.

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  • 47. 

    During vaginal delivery of the baby, pain is somatic in origin and mainly derived from nerve fibers originating where?

    • A.

      L3-L5

    • B.

      S1-S4

    • C.

      T10-L1

    • D.

      T6-T8

    Correct Answer
    B. S1-S4
    Explanation
    During vaginal delivery, the pain is somatic in origin and mainly derived from nerve fibers originating from the sacral spinal cord segments S1-S4. These nerve fibers innervate the perineum and pelvic floor muscles, which are involved in the birthing process. The somatic pain experienced during vaginal delivery is typically sharp and localized, as opposed to visceral pain, which is more diffuse and dull.

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  • 48. 

    You are caring for Mrs. Lincinia who is in active labor. While looking at the fetal HR tracing you notice fetal HR decelerations. There doesn’t appear to be any pattern in regards to onset, in fact most seem to be short and vary in the magnitude.  However, when it does occur the descents in fetal HR are steep. Is this baby in distress?

    • A.

      Yes!! We should prepare for c-section

    • B.

      This is a sign Mom must be fully dilated and ready to push, totally normal.

    • C.

      No, just change Mom’s position and make sure decelerations do not become prolonged

    Correct Answer
    C. No, just change Mom’s position and make sure decelerations do not become prolonged
    Explanation
    The given scenario describes variable decelerations in fetal heart rate (FHR). Variable decelerations are caused by cord compression and are characterized by a sudden and abrupt decrease in FHR. They are not associated with contractions and do not have a consistent pattern. In this case, the correct response is to change the mother's position to relieve cord compression and ensure that the decelerations do not become prolonged. This is a standard intervention to address variable decelerations and does not indicate that the baby is in distress.

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  • 49. 

    Which of the following scenarios would indicate fetal distress?

    • A.

      Fetal deceleration that are short, and variable in nature with steep descent in FHR

    • B.

      Fetal deceleration that occur with onset of uterine contractions

    • C.

      FHR that varies by 15 beats each minute

    • D.

      Fetal deceleration that occur 30 seconds after onset of uterine contraction

    Correct Answer
    D. Fetal deceleration that occur 30 seconds after onset of uterine contraction
    Explanation
    Fetal deceleration that occurs 30 seconds after the onset of uterine contractions indicates fetal distress. This delay suggests that the fetus is not receiving enough oxygen during contractions, which can be a sign of fetal distress. The timing of the deceleration in relation to the contractions is crucial in determining fetal well-being.

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  • 50. 

    The incidence of maternal aspiration is higher for emergent c-sections. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement is true because emergent c-sections are usually performed in urgent situations where there is a higher risk to the mother and baby. These situations may include complications during labor or delivery that require immediate intervention. The urgency of the procedure can increase the likelihood of complications such as maternal aspiration, which is the inhalation of stomach contents into the lungs. Therefore, the incidence of maternal aspiration is indeed higher for emergent c-sections.

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 20, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Apr 15, 2009
    Quiz Created by
    Scottishduffy
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