Principles Of Obstetric Anesthesia Quiz

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Principles Of Obstetric Anesthesia Quiz - Quiz

Dive into the intricate world of obstetric anesthesia with our engaging quiz designed for medical professionals seeking to enhance their knowledge and expertise. This quiz meticulously covers the principles of obstetric anesthesia, from understanding the physiological changes during pregnancy to mastering the nuances of pain management during labor and delivery.

Whether you're a seasoned anesthesiologist, an obstetrician, or a medical student eager to deepen your understanding, this quiz offers a comprehensive assessment of essential concepts and practices. Explore scenarios that mirror real-life obstetric situations, testing your ability to make critical decisions for the well-being of both the mother and the Read morenewborn.

Elevate your proficiency in obstetric anesthesia by taking this quiz, where each question is crafted to enhance your skills and contribute to safe and effective care in obstetrics.


Questions and Answers
  • 1. 

    Which of the following describes the proper intubation technique for a pregnant pet undergoing general anesthesia?

    • A.

      Rapid Sequence induction

    • B.

      Awake Fiber Optic Intubation

    • C.

      Regular induction, but have glidescope ready is needed

    • D.

      Perform all cases with LMA’s due to airway difficulty

    Correct Answer
    A. Rapid Sequence induction
    Explanation
    Rapid Sequence Induction is the proper intubation technique for a pregnant pet undergoing general anesthesia. This technique involves the administration of a rapid-acting induction agent and a neuromuscular blocking agent to facilitate intubation quickly and minimize the risk of aspiration. It is important to secure the airway promptly to ensure the safety of both the mother and the unborn offspring.

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  • 2. 

    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 should be the well-being and safety of the patient. In this case, the patient is the mother. If intubation fails, it can lead to serious complications and potentially endanger the mother's life. Therefore, it is crucial to prioritize saving the life of the mother in such a situation. The fetus is also important, but the mother's life takes precedence in this scenario.

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  • 3. 

    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
  • 4. 

    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 an emergent situation and there is no time to try other methods of intubation. The priority is to ensure that the patient is able to receive oxygen and maintain ventilation during the surgery. Cricoid pressure helps to prevent aspiration of gastric contents while maintaining ventilation. Although other options such as retrograde intubation, transtracheal jet ventilation, or awake fiberoptic intubation may be considered in different circumstances, they are not suitable in this urgent situation.

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  • 5. 

    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 very rapid labor and delivery process, typically lasting less than 3 hours. In such cases, there is usually not enough time to administer general anesthesia safely and effectively. General anesthesia requires time for preparation, induction, and recovery, which may not be feasible in the context of precipitous labor. Therefore, other methods of pain management or local anesthesia are typically used in these situations.

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  • 6. 

    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 reduce the risk of aspiration during surgery. Bicitra contains citric acid and sodium citrate, which work together to increase the pH level in the stomach and provide relief from heartburn and indigestion. Its nonparticulate nature makes it a safe choice for pregnant patients, as it does not pose a risk of causing harm to the fetus.

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  • 7. 

    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 correct answer because it is the recommended method for extubating pregnant patients upon emergence from general anesthesia. This approach allows for a smoother transition from being under anesthesia to being fully awake, minimizing the risk of complications. It also allows for immediate assessment of the patient's airway and breathing, ensuring their safety during the extubation process.

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  • 8. 

    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, provides effective pain relief during labor and delivery. It can also help avoid the need for general anesthesia, which carries more risks in obese patients. Additionally, early initiation of regional anesthesia allows for better pain control and improves the overall experience for the patient.

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  • 9. 

    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 general anesthesia, the position of the patient's larynx becomes more anterior. This is due to the relaxation of the muscles in the neck and throat. In the case of Mrs. Maritt, who is 7 months pregnant and morbidly obese, this change in the position of the larynx may not be a significant airway consideration. The other options, such as limited flexion, narrowed view of the pharyngeal opening, and limited mouth opening, are all potential airway considerations that need to be taken into account when managing the airway of a patient in this condition.

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  • 10. 

    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 anesthesia or pain relief during labor and delivery through the use of regional anesthesia techniques such as epidural or spinal anesthesia. This is not an indication for cesarean section because it can be managed by alternative methods or by adjusting the anesthesia technique. Cesarean section is typically indicated for fetal distress, dystocia (difficult labor), and cephalopelvic disproportion (baby's head is too large to pass through the mother's pelvis).

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  • 11. 

    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 an epidural in place, the goal is to achieve a sensory blockade at the T4 level. This means that the anesthesia should numb the nerves at the fourth thoracic vertebrae level, providing pain relief and allowing the surgery to be performed without discomfort for the patient. Achieving a sensory blockade at T4 ensures that the necessary area for the surgery is adequately numbed, providing optimal conditions for a successful procedure.

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  • 12. 

    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. In order to prove medical malpractice, it must be shown that there was a duty of care owed by the healthcare professional to the patient, a breach of that duty occurred, an injury or harm was suffered by the patient, and that the breach of duty was the proximate cause of the injury. These elements are essential in establishing a case of medical malpractice.

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  • 13. 

    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 can include events such as airway obstruction, inadequate ventilation, or respiratory depression. These events can be caused by various factors, including the administration of anesthesia medications, pre-existing respiratory conditions in the patient, or complications during labor and delivery. Prompt recognition and management of respiratory events are crucial in preventing adverse outcomes for both the mother and the baby.

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  • 14. 

    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 during labor and delivery while minimizing the risks associated with general anesthesia. Regional anesthesia techniques, such as epidural or spinal anesthesia, can be tailored to the individual patient's needs and provide targeted pain relief without affecting the baby's well-being. This method allows the mother to remain awake and actively participate in the birthing process while reducing the risk of complications and side effects compared to general anesthesia or MAC sedation.

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  • 15. 

    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
    In obstetric patients undergoing a cesarean section, it is considered that they have full stomachs regardless of the duration of fasting. This is because pregnancy can delay gastric emptying and increase the risk of aspiration during anesthesia induction. Therefore, it is important to assume that these patients have full stomachs and take appropriate precautions to minimize the risk of aspiration during the procedure.

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  • 16. 

    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 (nothing by mouth) status for an elective C-section is 6 hours. This means that the patient should not consume any food or drink for at least 6 hours prior to the surgery. This is important to prevent aspiration of stomach contents during the procedure, which can lead to serious complications such as pneumonia. Following the NPO guidelines helps ensure the safety of the patient during the surgery.

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  • 17. 

    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 putting pressure on the stomach, lower esophageal sphincter tone may be reduced due to hormonal changes during pregnancy, and delayed gastric emptying is common in pregnant patients. These factors combined increase the likelihood of stomach contents refluxing into the lungs during anesthesia.

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  • 18. 

    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 more likely to occur in pregnant patients who have certain risk factors such as emergent c-section, eclampsia, and difficult intubation. However, being overdue by 2 weeks does not directly increase the risk of aspiration. Therefore, the patient who is overdue by 2 weeks is less likely to experience aspiration compared to the other three patients mentioned.

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  • 19. 

    The hallmark sign of post dural puncture headache is a headache that is relieved by what position?

    • A.

      Sitting while leaning forward

    • B.

      Laying flat

    • C.

      Laying on the left side

    • D.

      Standing and walking

    Correct Answer
    B. Laying flat
    Explanation
    Post dural puncture headache is a type of headache that occurs after a procedure involving the puncture of the dura mater, which is the membrane surrounding the spinal cord. This type of headache is typically relieved by laying flat. The reason for this is that when a person is in an upright position, the cerebrospinal fluid (CSF) leaks out of the puncture site, causing a decrease in CSF pressure around the brain and spinal cord. This decrease in pressure leads to the characteristic headache. By laying flat, the CSF pressure is restored, relieving the headache.

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  • 20. 

    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 in a developing embryo. It occurs during the first two months of pregnancy, when the major organs and body systems begin to form. This is a critical period for the development of the embryo, as any disruptions or abnormalities during this time can have long-lasting effects on the health and well-being of the individual. After the first two months, the organs continue to grow and mature, but the basic structures have already been established.

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  • 21. 

    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 is considered unsafe to give during pregnancy because 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, particularly when taken during the first trimester of pregnancy. Therefore, it is generally recommended to avoid using Versed or any other benzodiazepines during pregnancy unless the potential benefits outweigh the risks.

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  • 22. 

    When attempting to maintain fetal safety during anesthesia, we are concerned with all of the following except….

    • A.

      Maintaining deep maternal sedation and fetal relaxation during procedures

    • B.

      Prevention of preterm labor

    • C.

      Avoidance of teratogenic medications, such as nitrous oxide

    • D.

      Maintaining optimal uteroplacental perfusion

    Correct Answer
    A. Maintaining deep maternal sedation and fetal relaxation during procedures
    Explanation
    When attempting to maintain fetal safety during anesthesia, it is important to consider all of the following except maintaining deep maternal sedation and fetal relaxation during procedures. This is because deep maternal sedation and fetal relaxation can pose risks to the fetus, such as compromising fetal oxygenation and increasing the risk of fetal distress. Therefore, it is important to prioritize other factors such as prevention of preterm labor, avoidance of teratogenic medications, and maintaining optimal uteroplacental perfusion to ensure fetal safety during anesthesia.

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  • 23. 

    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
  • 24. 

    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 considered to be at an increased risk of aspiration. This is because the growing uterus can put pressure on the stomach, causing the stomach contents to be pushed up into the esophagus. This can increase the likelihood of regurgitation and aspiration during anesthesia or surgery. Therefore, the correct answer is False.

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  • 25. 

    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 should 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 neural tube in the fetus, and any disruption in its metabolism can lead to birth defects and other complications. Therefore, it is important to avoid nitrous oxide during pregnancy to ensure proper fetal development.

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  • 26. 

    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 determined by various factors such as 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 increase the risk of certain complications during pregnancy, it does not directly impact the success of the outcome following surgery.

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  • 27. 

    Succinylcholine will normally last longer during pregnancy.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    During pregnancy, the metabolism of succinylcholine is altered, resulting in a prolonged duration of action. This is because pregnancy causes an increase in plasma cholinesterase levels, which is the enzyme responsible for metabolizing succinylcholine. As a result, the drug is cleared from the body at a slower rate, leading to a longer duration of action. Therefore, it is true that succinylcholine will normally last longer during pregnancy.

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  • 28. 

    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
    During pregnancy, there are physiological changes that can affect the minimum alveolar concentration (MAC) of anesthetics. These changes include an increase in blood volume, cardiac output, and hormonal levels. As a result, pregnant women may require lower concentrations of anesthetics to achieve the same level of anesthesia, leading to a decrease in MAC. This is important for determining the appropriate dosage of anesthetics during pregnancy to ensure the safety and well-being of both the mother and the fetus.

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  • 29. 

    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 patient's increased heart rate, deep breathing, and rubbing of the stomach are indicative of a contraction during labor. This is a normal physiological response and not a sign of an adverse reaction to the epidural. It is recommended to wait a few minutes and observe the patient's condition before proceeding with the administration of the epidural.

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  • 30. 

    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 complaining of numbness in their lower extremities within 3 minutes of injection is a sign of accidental dural puncture. This means that the needle has punctured the dura, the protective covering of the spinal cord, allowing the local anesthetic to spread to the surrounding nerves and causing numbness. In this case, it is necessary to adjust the dose because the intended effect of the epidural has been achieved too quickly and may result in excessive numbness or other complications.

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  • 31. 

    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
  • 32. 

    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 it can cause a sudden decrease in blood pressure, which may be poorly tolerated by the patient. Aortic stenosis is a condition where the aortic valve is narrowed, leading to restricted blood flow from the heart to the rest of the body. Spinal anesthesia can cause vasodilation and a decrease in systemic vascular resistance, which can further compromise blood flow in patients with aortic stenosis. Therefore, it is safer to avoid spinal anesthesia in these patients.

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  • 33. 

    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 can actually worsen the headache and prolong the recovery time. The recommended treatment options for Post dural Puncture headache include a Blood Patch, which involves injecting the patient's own blood into the site of the dural puncture to seal the hole and relieve the headache. Oral/IV hydration is also recommended to ensure adequate fluid intake and IV caffeine may be used to alleviate the headache symptoms.

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  • 34. 

    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 into the patient. This is the recommended depth for proper placement and effectiveness of the epidural anesthesia. Inserting the catheter too shallow (1-2 cm) may not provide adequate pain relief, while inserting it too deep (5-10 cm) can lead to complications such as dural puncture or nerve damage. The sensation of an 'electric shock' is not a reliable indicator for the correct depth of insertion, and should not be used as a guide.

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  • 35. 

    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 PDPH (post-dural puncture headache). PDPH is a common complication of epidural anesthesia, and it is caused by leakage of cerebrospinal fluid (CSF) through the dural puncture site. Placing the patient in a lateral position does not affect the risk of dural puncture or CSF leakage, and therefore, it will not help decrease the incidence of PDPH. Other measures such as using a rounded point needle, a smaller gauge needle, or orienting the needle parallel to the meningeal fibers can help decrease the risk of dural puncture and subsequent PDPH.

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  • 36. 

    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. When performing a blood patch to treat post-dural puncture headache (PDPH), a volume of 10-20 cc's is typically injected. The specific volume may vary depending on the size of the patient and the severity of the headache. However, in general, a range of 10-20 cc's is commonly used for this procedure.

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  • 37. 

    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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  • 38. 

    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. The O2 dissociation curve shifts to the right, which means that oxygen is more readily released to the tissues. There is a decrease in functional residual capacity (FRC), which is the volume of air remaining in the lungs after a normal exhalation. Respiratory alkalosis may be normal due to an increase in minute ventilation. However, there is no evidence to suggest that patients will need larger endotracheal tubes (ETT) during pregnancy.

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  • 39. 

    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 with severe mitral stenosis is an absolute contraindication to spinal anesthesia. Mitral stenosis is a condition characterized by narrowing of the mitral valve, which can lead to impaired blood flow and increased pressure in the left atrium. Spinal anesthesia can cause a sudden decrease in systemic vascular resistance and venous return, which can further compromise cardiac function in patients with mitral stenosis. Therefore, it is not safe to administer spinal anesthesia to Mrs. A.

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  • 40. 

    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 bleeding during childbirth by increasing the levels of clotting factors. This helps to prevent excessive bleeding and ensures proper blood clot formation.

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  • 41. 

    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 changes that occur in the gastrointestinal (GI) system. One of these changes is an increase in gastric fluid volume, which is true. Another change is an increase in insulin secretion, which is also true. Additionally, the tone of the gastroesophageal sphincter decreases during pregnancy, which is true as well. However, it is not true that gastric pH increases during pregnancy. In fact, gastric pH tends to decrease due to increased production of gastric acid.

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  • 42. 

    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 or tissue to maintain a constant blood flow despite changes in perfusion pressure. In the case of the uterus, its blood flow is not autoregulated and can vary depending on factors such as hormonal changes, uterine contractions, and placental blood flow. Therefore, the correct answer is false.

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  • 43. 

    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 requires a significant amount of blood supply to support the growing fetus. The uterine arteries, which branch off from the main arteries in the body, supply blood directly to the uterus. These arteries receive approximately 10% of the total cardiac output, ensuring an adequate blood supply to the uterus and the developing baby. This allows for proper oxygen and nutrient delivery to support the growth and development of the fetus.

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  • 44. 

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

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Spinal and Epidural anesthesia do not decrease uterine blood flow. In fact, they have been found to have minimal effects on uterine blood flow. These types of anesthesia primarily affect sensory and motor nerve function, allowing for pain relief during childbirth. They are commonly used during labor and delivery and have been shown to be safe for both the mother and the baby. Therefore, the statement that spinal and epidural anesthesia decrease uterine blood flow is false.

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  • 45. 

    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 uterus and prevent compression of the inferior vena cava, which can lead to a decrease in blood pressure. The supine position allows for easy access to the abdomen for the surgical team, while the slight lateral tilt helps to alleviate pressure on the vena cava. This position is commonly used during c-sections to maintain hemodynamic stability and prevent hypotension.

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  • 46. 

    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. The Ductus Venosus is a fetal shunt that directs blood from the umbilical vein to the inferior vena cava. It allows oxygenated blood from the placenta to bypass the liver and flow directly into the systemic circulation. This helps to ensure that the developing fetus receives a sufficient oxygen supply. The other options listed are not involved in this specific blood flow pathway.

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  • 47. 

    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 spinal segments. These segments innervate the uterus and cervix, which are the main areas involved in the first stage of labor. The pain is transmitted through these nerve fibers to the brain, causing the sensation of pain.

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  • 48. 

    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 segments S1-S4. These segments innervate the perineum, vagina, and lower part of the uterus, which are involved in the birthing process. The pain experienced during delivery is transmitted through these nerve fibers, leading to the somatic pain perception in the mother.

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  • 49. 

    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 fetal HR decelerations that are short, vary in magnitude, and do not follow a specific pattern. However, the descents in fetal HR are steep when they occur. This suggests that the baby is not in distress, but rather the decelerations may be caused by changes in the baby's position. By changing the mother's position and ensuring that the decelerations do not become prolonged, the healthcare provider can help alleviate the decelerations and ensure the well-being of the baby. Therefore, preparing for a c-section or assuming that the mother is fully dilated and ready to push would not be appropriate in this situation.

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  • 50. 

    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 would indicate fetal distress. This suggests that the baby is experiencing a decrease in heart rate shortly after the start of a contraction, which may be a sign of inadequate oxygen supply or other complications. It is important to monitor these decelerations closely and take appropriate medical action to ensure the well-being of the fetus.

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