A 19-year-old woman presents to her healthcare provider with a complaint of vaginal discharge. She has
been sexually active with 3 partners over the past year and uses condoms inconsistently. Recently, she
began having pain during intercourse. Her temperature is 38.2°C (100.8°F), heart rate is 78/min, and
blood pressure is 110/80 mm Hg. The pelvic exam reveals cervical motion tenderness. She is started on
an appropriate antibiotic regimen. Which of the following complications is most likely to occur later in
this patient's life?
A. Small bowel obstruction
B. Spontaneous abortion
C. Leiomyoma
D. Ectopic pregnancy
E. Cervical cancer
F. Condyloma acuminatum
A 27-year-old woman presents to the emergency department with left lower quadrant abdominal pain
and vaginal spotting. She denies diarrhea, constipation, or blood in the stool. Her past medical history is
unremarkable.
She does not use tobacco or drink alcohol. She is sexually active with her husband and uses condoms for
contraception. Her last menstrual period was 8 weeks ago. Temperature is 37.2°C (99.0°F), pulse is
80/min, respirations are 12/min, and blood pressure is 110/70 mm Hg. A pelvic examination reveals
localized tenderness in the left adnexa, but no masses are palpable.
Which of the following is most likely to be found in this patient?
A. Rebound tenderness at McBurney's point
b. Positive urine beta-HCG and no intrauterine products of conception
C. X-ray showing free air under the diaphragm
D. Sigmoidoscopy showing diverticuli in the colet
Positive urine beta-HCG and products of conception in the
E.
uterus
A 25-year-old woman experiencing homelessness presents to an urgent care clinic for vaginal bleeding.
She also reports vague right lower abdominal pain that started a few hours ago and is increasing in
intensity. Her medical history is significant for chronic hepatitis C infection, and she claims to take a pill
for it
"every now and then." Her temperature is 36.0°C (98.6°F), blood pressure is 70/41 mmg, and pulse is
131/min. Physical exam reveals localized right adnexal tenderness with rebound tenderness and
guarding. Transvaginal ultrasonography demonstrates a gestational sac in the right fallopian tube.
After starting a fluid bolus, which of the following is the most appropriate next
Step in management?
A. Laparoscopic salpingostomy
B. Methotrexate
C. Pelvic CT without contrast
• D. Paracentesis
• E. Tubal ligation
A 32-year-old woman presents to the emergency department with complaints of abdominal pain and
vaginal bleeding. Her last menstrual period was 3 months ago. Her blood pressure is 160/100 mm Hg
and her pulse is 108/min.
On exam, her fundal height is 23 cm. An ultrasound reveals a grape-like mass in the uterus, and no fetal
parts are seen. What will be the most likely genotype of the substance aspirated by dilation and
evacuation?
0 A. 69 XXY
B. 45 XO
C. 23 XX
D. 47 XYY
E. 46 XX
Research is being conducted on a developing embryo approximately 10 days after fertilization. There is
the presence of a cytotrophoblast and syncytiotrophoblast. Within the embryo, columnar and cuboidal
cells are separated by a membrane. Which of the following cell layers in this embryo will soon line the
embryonic cavity to form the primitive yolk sac?
A. Epiblast
B. Inner cell mass
C. Hypoblast
D. Endoderm
E. Syncytiotrophoblast
A 24-year-old G1P0 woman presents to her healthcare provider for regular prenatal care at 31 weeks
gestation. She is feeling well and the pregnancy has been
uncomplicated. Her pre-gestational history is significant for obesity (BMI = 30.5 kg/m?). She has gained a
total of 10 kg (22.4 |b) during pregnancy and 2 kg (4.48 lb) since
her last visit 4 weeks ago. Vital signs include: blood pressure 145/90 mm Hg, heart rate 87/min,
respiratory rate 14/min, and temperature 36.7°C (98°F). The fetal heart rate is 153/min. Physical exam
reveals a 2/6 systolic murmur best heard at the apex. There is no peripheral edema. A 24-hour urine
sample is negative for protein. Which of the following is the most appropriate next step in management?
A. Admission to the hospital for observation
B. Treatment in the outpatient setting with labetalol
C. Observation in the outpatient setting
D. Treatment in the inpatient setting with methyldopa
E. Treatment in the outpatient setting with nifedipine
A 26-year-old woman, gravida 1, para 0, presents to her physician at 35 weeks' gestation with new-onset
lower leg edema. Her pregnancy has been uneventful, and she has been adherent to the recommended
prenatal care. She reports a four-pack-year smoking history before her pregnancy. She also has a history
of oral contraceptive use. Her family history is remarkable for hypertension in her mother. Before
pregnancy, her BMI was 19.8 kg/m?. Her blood pressure is 145/90 mm Hg, pulse is 91/min, respirations
are 15/min, and temperature is 36.6°C (97.9°F). The blood pressure is unchanged 15 minutes and 4
hours after the initial measurement. The fetal heart rate is 144/min. Physical exam reveals 2+ pitting
lower leg edema. There are no focal neurologic deficits. A urine dipstick test shows 2+ proteinuria. Which
of the following is the strongest risk factor for her condition?
A. Smoking before pregnancy
B. Oral contraceptive use
C. First pregnancy
D. BMI = 20 kg/m prior to pregnancy
E. Family history of hypertension
A 25-year-old woman, gravida 1, para 0, presents to her physician for a routine prenatal visit at 34 weeks'
gestation. She is feeling well but notes that the new shoes she bought 2 weeks ago do not fit anymore.
Her pregnancy has been uneventful, and she has been adherent to the recommended prenatal care.
Her medical history is unremarkable. She has gained 15 pounds since the last visit 3 weeks ago. Her
blood pressure is 148/90 mm Hg, pulse is 88/min, respirations are 16/min, and temperature is 36.6°C
(97.9°F). The blood pressure on repeat assessment 4 hours later is 151/90 mm Hg. The fetal heart rate is
151/min. Physical exam reveals 2+ pitting edema of the lower extremities. Which of the following
diagnostic tests is most appropriate at this time?
A Bilirubin level
B. Coagulation studies
C. Hematocrit level
D Leukocyte count with differential
E. 24-hour urine protein
A 25-year-old woman, gravida 1, para 0, is admitted to the hospital at 35 weeks' gestation with lower leg
edema. She denies any other symptoms. The pregnancy has otherwise been unremarkable, and she is
adherent to the recommended prenatal care. Her blood pressure is 155/90 mm Hg, pulse rate is 84/min,
respiratory rate is 16/min, and temperature is 36.6°C (97.9°F). The fetal heart rate is 142/min. Physical
exam reveals 2+ pitting edema. A 24-hour urine assessment shows proteinuria (1.2 g). Ultrasound
demonstrates a normally developing fetus without structural abnormalities. The placental margin is
located 6 cm away from the internal os. Which of the following is the most appropriate next step in
management?
A.Induction of vaginal delivery at 37 weeks' gestation if it does not begin spontaneously before then
B. Cesarean delivery after a course of corticosteroid treatment
c. induction of vaginal delivery after a course of corticosteroid treatment
D. Cesarean delivery at 37 weeks' gestation or urgently if spontaneous labor occurs before then
E Wait for spontaneous vaginal delivery at any time
A 22-year-old woman, gravida 1, para 0, at 35 weeks' gestation, is admitted to the obstetrics ward with
leg swelling. She denies any other symptoms. Her pregnancy has been uneventful, and she is adherent to
the recommended prenatal care. Her blood pressure is 168/95 mm Hg, pulse is 86/min, respirations are
16/min, and temperature is 36.7°C (98°F). The fetal heart rate is 141/min. Physical exam reveals 2+
pitting edema of the lower extremities. A dipstick test shows 1+ proteinuria. On reassessment 15
minutes later, her blood pressure is 141/88 mm Hg, and the fetal heart rate is 147/min. A decision was
made to observe the patient and continue the workup without initiating antihypertensive therapy.
Which of the following would define a severe form of this condition?
• A. 24-hour urinary protein of 5 g/L
• B. Severe new-onset headache
C. Hematocrit of 48%
• D. Platelet count 133,000/uL
• E. Serum creatinine 0.98 mg/dL
A 23-year-old G1P0 woman with no co-morbidities presents at 34 weeks' gestation with edema and a
moderate headache. Her blood pressure at her previous examination was 125/82, and is now 147/90
mm Hg, her heart rate 82/min, her respiratory rate 16/min, and her temperature 36.6°C (97.9°F). A
physical exam reveals 2+ pitting edema in the lower extremities. A urine dipstick test shows 2+
proteinuria. Laboratory studies show the following.
Which of the lab measurements listed defines this as a severe form of this patient's condition?
Hemoglobin
B. Leukocyte count
• C. Total bilirubin
• D Liver transaminases
•E Creatinine
A 25-year-old woman, gravida 1, para 0, is admitted to the hospital at 36 weeks' gestation after a
generalized tonic-clonic seizure. She is conscious but lethargic and complains of a headache that started
2 hours before the seizure She denieh alcohol intake or drug use. She has no history of a seizure disorder,
and the pregnancy has been otherwise unremarkable. Her last prenatal visit was 2 weeks ago, and she
has been adherent to recommended care. She has gained 2 kg (4.4 |b) since her last visit. Her blood
pressure is 160/90 mm Hg, pulse is 79/min, respiratory rate is 14/min, and her temperature is 37.0°C
(98.6°F). Physical exam reveals bilateral lower leg edema, diffuse hyperreflexia, and ankle clonus. Which
of the following laboratory findings would most likely be found in this patient?
• A Elevated transaminases
• B. Leukocytosis
• C. Hematuria
• D. Hyponatremia
• E. Proteinuria
A 25-year-old woman, gravida 1, para 0, is admitted to the hospital at 36
weeks' gestation with a severe frontal headache. Her blood pressure is 170/90 mm Hg, pulse is 85/min,
respirations are 15/min, and temperature is 36.9°C (98.4°F). The fetal heart rate is 159/min. There is
1+pitting edema of both lower extremities on physical exam. A dipstick urine assessment shows 2+
proteinuria. While being evaluated, the patient has a generalized tonic-clonic seizure. What
pharmacologic agent is the most appropriate for preventing recurrent seizures?
Auto Tr
• A. Valproic acid
B. Diazepam
• C. Phenytoin
• D. Magnesium sulfate
• E. Lamotrigine
A 24-year-old woman, gravida 1, para 0, is admitted to the hospital after a tonic-clonic seizure at 37
weeks' gestation. She complains of a severe headache, double vision, and dizziness. Her blood pressure
is 165/90 mm Hg, pulse is 91/min, respiratory rate is 10/min, and temperature is 37.0°C (98.6°F).
The fetal heart rate is 118/min. A urine dipstick test shows 3+ proteinuria. The patient is lethargic and
has 2+ pitting edema in the lower extremities. She has no neck stiffness or meningeal signs. A neurologic
exam is significant for left eye deviation toward the nose, impaired adduction on lateral gaze, intact
convergence with nystagmus in the right eye, and right hemiplegia. Which of the following would most
likely be seen on a head CT scan?
A. Regions of hyperdensity within the cerebellar hemispheres
• B. Hyperattenuating material in the subarachnoid space
• C. Regions of hyperdensity in the left pons
• D. Cord-like hyperattenuation in the superior sagittal sinus
Subcortical hypodense region with surrounding irregular
E.
hyperdense margins
A 33-year-old woman, gravida 2, para 1, at 35 weeks' gestation, is admitted to the hospital with fever and
active labor. She reports a 2-day history of fluid leakage from the vagina without pain or bleeding. Her
pregnancy has otherwise been uncomplicated. She has attended many prenatal appointments and
followed the physician's advice regarding routine screenings, laboratory testing, diet, and exercise. Her
previous pregnancy was complicated by a preterm delivery at 34 weeks' gestation. The patient reports a
10-pack-year history of smoking before pregnancy and smoked four cigarettes daily during pregnancy. At
the hospital, her temperature is 39.6°C (103.3°F), blood pressure is 108/60 mm Hg, and pulse is 125/min.
Her BMI is 18.2 kg/m2 Uterine palpation reveals tenderness. Cervical examination indicates 100%
effacement and 10 cm dilation. Her lungs are clear to auscultation. The baseline fetal heart rate has been
180/min for the last 15 minutes. Which of the following is the most appropriate next step in
management?
A. Amnioinfusion
• B. Ampicillin and gentamicin
• C. Cesarean delivery
• D. Intravenous betamethasone
• E. Ritodrine hydrochloride
A 45-year-old primigravida is brought to the hospital in labor at 39 weeks' gestation. After 4 hours, she
gives birth to a healthy-appearing baby boy with APGAR scores of 7 at 1 minute and 9 at 5 minutes. She
had limited prenatal screening but did have an ultrasound at 35 weeks that showed polyhydramnios. The
next day, the neonate vomits greenish-yellow fluid after breastfeeding. This occurs 2 more times that day
after feeding and several times between feedings. The next day, the neonate appears weak with
difficulty latching to the breast and is dehydrated. The provider on duty is concerned and orders blood
work, IV fluids, and the abdominal X-ray shown below. Which of the following disorders is most
associated with this newborn's symptoms?
A. Trisomy 18
B. Trisomy 13
C. Trisomy 21
D. 47 XXY
E. 45 XO
A 25-year-old woman, gravida 2, para 1, comes to the provider for her initial prenatal visit at 18 weeks
gestation. She recently immigrated from Thailand.
Her history is significant for anemia since childhood that has not required any treatment. Her mother
and husband also have anemia. She has no history of serious illness and takes no medications. Her vital
signs are within normal limits. Fundal height measures at 22 weeks. Ultrasound shows polyhydramnios
with pleural effusion and ascites in the fetus. What is the most likely clinical course for this fetus?
A. Asymptomatic anemia
B. Carrier state
C. Fetal death in utero
D. Neonatal death
E. Normal development with regular blood transfusion
A 34-year-old man presents to a clinic with complaints of abdominal discomfort and blood in the urine
for 2 days. The sensation of discomfort has been present for 5 years, but the blood in his urine is new. He
has had hypertension for the past 2 years, for which he has been prescribed medication. He has no
history of weight loss, skin rashes, joint pain, vomiting, change in bowel habits, or smoking. On physical
examination, there are ballotable flank masses bilaterally. His bowel sounds are normal. Selected
laboratory tests show the following
Serum BUN
Serum creatinine
Urine protein
Urine RBC
50 mg/dL
1.4 mg/dL
Negative
Numerous
Ultrasonography of the abdomen reveals enlarged kidneys and multiple anechoic cysts with well-defined
walls. A CT scan confirmed the presence of multiple cysts in the kidneys. What is the most likely
diagnosis?
A. Autosomal dominant polycystic kidney disease (ADPKD)
B. Autosomal recessive polycystic kidney disease (ARPKD)
• C. Medullary cystic disease
• D. Simple renal cysts
• E. Acquired cystic kidney disease
A 40-year-old woman with high blood pressure and diabetes presents to the outpatient clinic and states
that she is trying to get pregnant via in vitro fertilization. Her current medications include lisinopril,
metformin, and sitagliptin. Her blood pressure is 136/92 mm Hg, and her heart rate is 76/min.
Her physical examination is unremarkable. What should be done regarding her hypertension
medication?
A. Continue her current regimen.
• B. Discontinue lisinopril and initiate labetalol.
c. Continue her current regimen and add a beta blocker for
D. Discontinue lisinopril and initiate candesartan.
E. Discontinue lisinopril and initiate aliskiren.
A newborn girl is rushed to the neonatal ICU after delivery due to unstable vital signs. The pregnancy
was complicated due to oligohydramnios and pulmonary hypoplasia. She was born at 38 weeks gestation
via spontaneous vaginal delivery after rupture of membranes. APGAR scores were 6 and 8 at one and
five minutes, respectively. The temperature is 37.0°C (98.6°F), blood pressure is 60/40 mm Hg,
respirations are 45/min, and pulse is 140/min.
Physical examination reveals irregularly contoured bilateral abdominal masses. Abdominal ultrasound
reveals markedly enlarged echogenic kidneys (5 cm in the vertical dimension) with multiple cysts in the
cortex and medulla.
This patient is most at risk of which of the following complications?
A. Subarachnoid hemorrhage
B. Emphysema
• C. Portal hypertension
• D. Self-mutilation
What is gestational diabetes?
Impaired glucose tolerance before pregnancy.
Impaired glucose tolerance at the onset of, or first recognized during pregnancy.
Impaired glucose tolerance 6 months post-pregnancy
Impaired glucose tolerance after a baby is born.
According to White's Classification, what is considered class A2?
Fasting plasma glucose levels less than 105 and less than 120 postprandial.
Fasting plasma glucose levels greater than 105 and less than 120 postprandial.
Fasting plasma glucose levels less than 105 and greater than 120 postprandial.
Fasting plasma glucose levels greater than 105 and greater than 120 postprandial.
What best describes the insulin requirements during pregnancy?
Insulin requirements vary from client to client
Insulin requirements increase
Insulin requirements decrease
Insulin requirements remain the same
The placenta's hormones have what effect on insulin?
Insulin resistance
No change to insulin levels
Normal glucose levels in the blood
Low glucose levels in the blood
A client with pre-existing diabetes before pregnancy can expect what consequence during their
pregnancy? Select all that apply.
Accelerated vascular changes
Impaired insulin action
Higher risk for ketoacidosis
Altered carbohydrate metabolism
Decreased carb metabolism
What are the three hormones that the placenta produces? Select all that apply.
Progesterone
Human placental lactogen
Testosterone
Estrogen
Cortisol
What is the potential maternal complication in pregnant women with diabetes?
Hunger
Polyhydramnios
Dysuria
Oligohydramnios
Risk factors for gestational diabetes include which of the following? Select all that apply.
Client older than 38
Hypertension
Hypotension
Obesity
Client older than 25
Maternal complications of diabetes include which of the following? Select all that apply.
Weight gain
Pre-eclampsia
Weight loss
Maternal hypoglycemia
Hypotension
Which of the following could be a potential Fetal complication with a diabetic mother? Select all that
apply
Prematurity
Low weight
Macrosomia
Cardiomyopathy
A client is has completed step 2 testing for gestational diabetes screening. The client's results are 130,
190, 150, 145. What can we conclude from the client's results?
The client is not gestational diabetic.
The client will be diagnosed with gestational diabetes.
Another step 2 test will need to be completed.
An oral glucose tolerance test will be completed.
What is an ideal maternal blood sugar on a hemoglobin A1C test?
Between 5% and 6%
7.5%
Less than 8%
Between 3% and 4%
Signs of hypoglycemia include which of the following? Select all that apply.
Weakness
Fruity breath
Polyuria
Headache
Nervousness
Signs of hyperglycemia include which of the following? Select all that apply
Polyphagia
Polyuria
Feeling weak
Blurred vision
Polydipsia
What are the goals for treatment for a gestational diabetic in the antepartum stage? Select all that apply.
Detect pregnancy complications
Avoid hypertension
Avoid ketosis
Avoid FITT
Prevent fetal macrosomia
A client who is a gestational diabetic should have diet goals that include which of the following? Select
all that apply.
Avoid ketosis
A minimum of 300g of carbohydrates a day
Avoid extreme weight gain or loss
A minimum of 175g of carbohydrates a day
5–7 meals per day
To assess for fetal well being a client is instructed to count fetal movements. When does the healthcare
provider advise the client who is diagnosed with gestational diabetes to start kicking counts?
25 weeks
32 weeks
38 weeks
20 weeks
A gestational diabetic client treated with insulin during her pregnancy will be typically instructed to start
biophysical profiles twice per week at what point in her pregnancy?
32–34 weeks
34–36 weeks
30–32 weeks
28–30 weeks
A gestational diabetic client who has been managing her diagnosis with diet during her pregnancy will be
typically instructed to start biophysical profiles twice per week at what point in her pregnancy?
38–40 weeks
32–34 weeks
34–36 weeks
30–32 weeks
The F in the FITT principle stands for frequency related to fitness for a client diagnosed with gestational
diabetes. How often does FITT recommend that a client exercise?
At least three times a week of moderate exercise
At least six times a week of low impact exercise
At least once per week
At least five times a week of high-intensity exercise
A client was diagnosed with gestational diabetes during pregnancy, and the newborn's blood sugar is 19.
A blood sugar of 19 is considered which of the following?
A low blood sugar, but it can be managed
An emergency
A normal blood sugar
A high blood sugar
A client who has given birth and was diagnosed with gestational diabetes can typically leave the hospital
in what timeframe?
1 week
24 hours
48 hours
After 3 days
A client who was diagnosed with gestational diabetes is six weeks postpartum. When they are tested for
diabetes postpartum, how many grams of sugar is utilized for the screening?
50
100
75
25
Which of the following are considered risk factors for gestational diabetes? Select all that apply.
Infertility
History of pregnancy loss
Age greater than 22
Age greater than 25
Family history
Which of the following are considered maternal complications of gestational diabetes? Select all that
apply.
Hypotension
High blood pressure
Weight loss
Hypoglycemia
Weight gain
Which of the following is the best diagnostic test for rupture of membranes?
Nitrazine paper or swab changing color when placed in the vagina
Ferning of suspected amniotic fluid seen under a microscope
Maximum vertical pocket less than 2 cm on ultrasound
Reported history of a large gush of fluid
Pooling of amniotic fluid on speculum exam with Valsalva maneuver
When should antibiotics be prescribed for rupture of membranes after 37 weeks of gestational age?
If the client has an unknown group B streptococcus status
If the client has a negative group B streptococcus rectovaginal screening swab
If the client's membranes have been ruptured for over four hours before the onset of labor
If the client has a group B streptococcus rectovaginal screening swab done before 35 weeks of
gestational age
If the client has a positive group B streptococcus culture in urine or screening rectovaginal swab
What are the effects of steroids given for preterm premature rupture of membranes?
Increases in fetal lung surfactant production and alveolar recruitment
Increases in fetal risk for intraventricular hemorrhage
Increases in fetal risk for necrotizing enterocolitis
Fetal neuroprotection against cerebral palsy
Increases in latency period to prevent delivery before 34 weeks
When is labor considered preterm?
Before 32 weeks
Before 35 weeks
Before 37 weeks
Before 40 weeks
How many babies are born prematurely in the United States?
1 in 5
1 in 20
1 in 10
1 in 15
What are the risk factors for preterm delivery? Select all that apply.
Cocaine use
Stress
Singular gestation
Periodontal disease
Previous at-term birth
What are indications that a client’s membranes have ruptured? Select all that apply.
Negative fern test
Vaginal bleeding
Leakage of clear fluid from the cervical os
Postive nitrazine test
Negative beta HcG test
The student nurse is caring for a pregnant client with premature ruptured membranes. Which student
nurse action causes the clinical instructor to intervene?
The student nurse provides emotional support to the client and walks them through the following steps.
The student nurse administers a prophylactic antibiotic as prescribed by the provider.
The student nurse explains the importance of fetal surveillance to the client.
The student nurse tells the client that they will perform cervical checks at increased intervals.
A premature infant is at risk for which conditions? Select all that apply.
Hyperthermia
Intraventricular hemorrhage
Hyperglycemia
Long-term disabilities
Hyperbilirubinemia
What is true about terbutaline? Select all that apply.
It is contraindicated in clients with heart disease.
It is an adrenergic agonist.
It is given only by IV.
Tachycardia is an expected effect.
It is the drug of choice for clients with severe preeclampsia.
What is true about nifedipine? Select all that apply.
It should not be given to clients with hypotension.
It aids in relaxing the uterus.
It is a calcium channel blocker.
It is given by IV.
It is a CNS depressant.
What can be given to the birthing client to prevent respiratory distress in the premature newborn?
Select all that apply.
Terbutaline
Magnesium sulfate
Betamethasone
Nifedipine
Dexamethasone
What may a provider order to help prevent preterm labor or birth? Select all that apply.
Oxytocin
Progesterone
Estrogen
Nifedipine
Cerclage
A 27-year-old pregnant woman at 22 weeks gestation, G3P1, visits her physician for a prenatal visit. She
feels well. Her current pregnancy has been uncomplicated. She has attended all her prenatal
appointments and followed the physician's advice about screening for diseases, laboratory testing, diet,
and exercise. The patient's previous pregnancies were complicated by preterm labor at 24 weeks
gestation in one pregnancy and spontaneous abortion at 20 weeks in the other. She takes a multivitamin
with folate every day. At the physician's office, her temperature is 37.2°C (99.0°F), and blood pressure is
100/61 mm Hg. Pelvic examination shows a uterus consistent in size with a 20-week gestation. Fetal
heart sounds are normal. An ultrasound shows a short cervix, measured at 20 mm. Which of the
following is the most appropriate next step in management?
A. Bed rest
Auto
B. Cerclage
C. Cervical pessary
D. Intramuscular progesterone
E. Intravenous betamethasone
• F. Terbutaline
G. Vaginal progesterone
A 24-year-old woman, gravida 1, at 36 4/7 weeks gestation, is admitted to the hospital with regular
contractions and pelvic pressure for the last 5 hours. Her pregnancy has been uncomplicated, and she
has attended many prenatal appointments and followed the physician's advice about screening for
diseases, laboratory testing, diet, and exercise. She tested negative for Group B Streptococcus at her
most recent visit. She has had no history of fluid leakage or bleeding. At the hospital, her temperature is
37.2°C (99.0°F), blood pressure is 108/60 mm Hg, pulse is 88/min, and respiratory rate is 16/min.
Cervical examination shows 60% effacement and 5 cm dilation with intact membranes. The electronic
fetal monitor shows a contraction amplitude of 220 Montevideo units (MVUs) in 10 minutes (adequate
contractions are defined as a total of 200 MVUs within 10 minutes). Which of the following is the most
appropriate therapy at this time?
• A. Dexamethasone
• B. Magnesium sulfate
• C. Oxytocin
• D. Terbutaline
• E. No pharmacotherapy at this time