BCEN Obstetric and Gynecological Emergencies 1 — Questions and Answers
Question 1: A pregnant patient at 32 weeks presents with sudden, painless, bright red vaginal bleeding. Which condition should the nurse suspect first?
- Placental abruption
- Placenta previa (Correct answer)
- Vasa previa
- Uterine rupture
Correct answer: Placenta previa
Placenta previa typically presents with painless, bright red vaginal bleeding due to the low-lying placenta covering or near the cervical os.
Question 2: A patient at 28 weeks gestation presents with severe headache, visual disturbances, and BP of 168/110 mmHg with 3+ proteinuria. What is the priority nursing intervention?
- Administer magnesium sulfate IV (Correct answer)
- Prepare for emergency cesarean section
- Administer labetalol IV
- Insert a Foley catheter
Correct answer: Administer magnesium sulfate IV
Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia and eclampsia, making it the first priority.
Question 3: A patient presents with sudden severe abdominal pain, vaginal bleeding, and a rigid board-like uterus. Fetal heart tones are absent. Which condition is most likely?
- Placenta previa
- Threatened abortion
- Placental abruption (Correct answer)
- Ectopic pregnancy
Correct answer: Placental abruption
Placental abruption presents with painful vaginal bleeding and a rigid, tender uterus due to concealed hemorrhage behind the placenta, which can cause fetal death.
Question 4: A woman with 8 weeks amenorrhea and a positive pregnancy test presents with sudden severe unilateral lower abdominal pain, BP 88/56 mmHg, and HR 122 bpm. Which intervention is MOST urgent?
- Obtain a pelvic ultrasound
- Administer methotrexate IM
- Establish large-bore IV access and prepare for emergency surgery (Correct answer)
- Perform a bimanual vaginal examination
Correct answer: Establish large-bore IV access and prepare for emergency surgery
A ruptured ectopic pregnancy causes life-threatening hemorrhage; immediate large-bore IV access and surgical intervention are critical priorities in the hemodynamically unstable patient.
Question 5: Which medication is the first-line treatment for postpartum hemorrhage caused by uterine atony?
- Magnesium sulfate
- Oxytocin (Pitocin) (Correct answer)
- Methotrexate
- Terbutaline
Correct answer: Oxytocin (Pitocin)
Oxytocin promotes uterine contractions and is the first-line uterotonic agent for uterine atony, the most common cause of postpartum hemorrhage.
Question 6: After an eclamptic seizure in a patient at 38 weeks gestation, what is the priority nursing action?
- Prepare for immediate cesarean delivery
- Administer a magnesium sulfate loading dose
- Assess fetal heart tones and maternal oxygen saturation (Correct answer)
- Insert a urinary catheter to monitor hourly output
Correct answer: Assess fetal heart tones and maternal oxygen saturation
Following an eclamptic seizure, immediate assessment of maternal oxygenation and fetal heart rate determines the stability of both patients and guides further management.
Question 7: A patient presents to the ED reporting sexual assault 3 hours ago. Which action should the nurse perform FIRST?
- Collect forensic evidence per rape kit protocol
- Administer emergency contraception
- Conduct a comprehensive physical assessment and ensure patient safety (Correct answer)
- Contact law enforcement
Correct answer: Conduct a comprehensive physical assessment and ensure patient safety
Patient safety and medical stabilization are always the first priorities before forensic evidence collection or notification of authorities.
BCEN Obstetric and Gynecological Emergencies 1
A pregnant patient at 32 weeks presents with sudden, painless, bright red vaginal bleeding.
Which condition should the nurse suspect first?