Operational Obstetrics &
Gynecology Correspondence Course Nonresident Training Course [ Home ] Assignment 5 |
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the Course Return to General Information Page Medical Support of Women in Field Environments Appendix A |
In the fifth assignment, you will read Normal Labor and Delivery, Abnormal Labor and Delivery, and Newborn Care. After completing the reading, answer the
questions listed below. You can read the textbook off the computer screen, but many people find it easier to read a printed copy. To obtain a printed copy, click on the chapter and print it. When you are ready to begin answering the test questions, print an Answer Sheet by clicking here. After you have completed all six assignments and tests, mail them to the Naval School of Health Sciences. If you need a more detailed explanation of the answer sheets, click here. When you have completed this assignment, you will be ready for the 6th and final assignment. Test Questions Learning Objective: Understand the medical basis for normal labor and delivery. 5-1. Labor consists of regular, frequent uterine contractions which lead to progressive cervical dilatation and effacement. 1. True 2. False 5-2. The diagnosis of labor is always obvious. 1. True. 2. False In answering questions 5-3 through 5-7, select from column B the phase of labor which most closely matches the description in column A. Some responses may be used once, more than once, or not at all.
5-8. For a woman having her first baby, labor usually lasts about: 1. 12-14 minutes. 2. 12-14 hours. 3. 12-14 days. 4. 12-14 weeks. In answering questions 5-9 through 5-12, select from column B the station which most closely matches the description in column A. Some responses may be used once, more than once, or not at all.
5-13. During delivery, what comes next after Engagement, Descent, and Flexion? 1. Internal Rotation. 2. Extension. 3. External Rotation. 4. Expulsion. 5-14. For women having their first baby, the 2nd stage of labor usually lasts: 1. 1-2 seconds. 2. 1-2 minutes. 3. 1-2 hours. 4. 1-2 days. 5-15. Which of the following signs is not NOT an indication of placental separation? 1. Cessation of contractions.
5-16. Most labors and deliveries are safe, spontaneous processes, requiring little or no intervention, and result in a healthy mother and healthy baby. 1. True 2. False 5-17. All of the following are part of an initial evaluation of a woman in labor, EXCEPT: 1. Evaluation of the current health status of the mother. 2. Identification of risk factors. 3. Establish names for the baby. 4. Determine the labor status of the mother. In answering questions 5-18 through 5-27, select from column B the risk category which most closely matches the pregnancy complication in column A. Some responses may be used once, more than once, or not at all.
5-28. The normal fetal heart rate at term ranges between: 1. 90-110 BPM 2. Up to 100 BPM 3. 110-200 BPM 4. 120-160 BPM 5-29. Confirmation of rupture of membranes can be by any of the following, EXCEPT: 1. A history of a sudden gush of fluid. 2. Pooling of clear, Nitrazine positive fluid in the vagina. 3. Ferning of dried fluid. 4. Continuing, steady leakage of large amounts of fluid from the vagina. 5-30. During early labor, maternal vital signs should be re-checked about every... 1. Day 2. 40 minutes 3. 4 hours 4. 8 hours 5-31. Causes of fetal tachycardia include all of the following, EXCEPT: 1. Maternal fever 2. Intrauterine infection (chorio-amnionitis) 3. Fetal hypoxia 4. Increased fetal vagal tone 5-32. Narcotics are not used during labor because they are too dangerous. 1. True 2. False 5-35. Preparation of the vulva with antiseptic solution, shaving of pubic hairs and evacuating the bowels with an enema is not generally necessary, but might be a good idea in selected operational settings where contamination may be significant. 1. True. 2. False 5-36. HM3 Chessie Nimitz sees you during Sick Call, complaining of frequent, intense, abdominal pain that waxes and wanes every 5 minutes. She has an abdominal mass that extends from the pubic bone up to the ribs that palpably hardens and rises out of the abdomen during each "pain." She denies any possibility that she might be pregnant but does not recall when her last period began. You should:
5-37. 10 minutes later, HM3 Nimitz says she feels like she needs to move her bowels. You should:
Learning Objective: Understand common labor and delivery problems. 5-39. Which of the following is useful in treating preterm labor? 1. Magnesium sulfate. 2. Methotrexate. 3. 4 low dose birth control pills, followed 12 hours later by 4 more pills. 4. Valium. 5-40. Preterm labor is: 1. Associated with intrauterine infection in about 10% of cases. 2. Any labor occurring prior to the due date. 3. Always treated with drugs to stop the labor. 4. Associated with risk of immaturity of the fetal respiratory tree. 5-41. With premature rupture of membranes, 1. No treatment may be needed if at full term initially. 2. Labor induction may be undertaken if remote from term. 3. Waiting for further fetal maturity may be undertaken if remote from term. 4. All of the above. In answering questions 5-42 through 5-51, select from column B the type of delivery which most closely matches the labor complication in column A. Some responses may be used once, more than once, or not at all.
5-52. Shoulder dystocia may require special obstetrical maneuvers to avoid injury to the baby. 1. True 2. False 5-53. Maneuvers commonly used to disimpact the anterior shoulder during a shoulder dystocia include all of the following EXCEPT: 1. Flexing the mother's legs tightly against her abdomen. 2. Excessive downward traction on the fetal head. 3. Suprapubic pressure 4. Delivery of the posterior arm. 5-54. Following delivery of the first twin, there is a period of time during which contractions slow or stop. 1. True. 2. False. 5-55. Immediate delivery is the best solution to the problem of prolapsed umbilical cord. 1. True 2. False 5-56. Your ship, a frigate, is engaged in the evacuation of 10 American civilians from an American Embassy which is taking fire during a local insurrection. Among the civilians is Katie Beach, a 32 year old dependent wife of the Military Attache. Katie is pregnant with her second baby, thinks she is about 36 weeks pregnant, but is uncertain, and is having regular uterine contractions every 5 minutes. She doesn't think that she's in labor as she's had several episodes like this in the last few weeks. You have called for further MEDEVAC to the amphibious battle group, but they are en route to your area and will not be within helicopter range for another 10 hours. You should: 1. Prepare for cesarean section. 2. Ask her to return during normal sick call hours 3. Have her lie down in the medical department and start an IV. 4. Ask the Executive Officer if he knows of any good OB-GYN doctors on board the ship. 5-57. 30 minutes later, Mrs. Beach experiences a sudden gush of clear liquid from the vagina. She continues to leak large amounts of fluid. You place a strip of Nitrazine paper against the fluid and the paper turns a deep blue color. She complains of more frequent, very painful contractions and rectal pressure. She asks to use the bathroom because she feels like she is about to have a bowel movement. You should: 1. Do a pelvic examination to see if delivery is imminent. 2. Let her use the head but caution her not to take too much time. 3. Reassure her that this is a normal sensation during pregnancy. 4. All of the above
Learning Objective: Understand basic, immediate care of the newborn. 5-62. Newborn babies should be dried only with warm, soft towels. 1. True 2. False 5-63. Babies can lose a tremendous amount of heat very quickly, particularly if they are wet. 1. True 2. False 5-64. Babies should be kept on their backs or tilted to the side, but not on their stomachs. 1. True 2. False 5-65. A newborn (5 minutes old), has pink skin color of its' chest, belly, and face, but it's arms, hands, legs and feet are blue. This is: 1. Normal 2. Abnormal, but usually does not result in brain damage. 3. Abnormal and usually results in brain damage. 4. Normal as far as the brain is concerned, but permanent and considered a birth defect.
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