BCEN Obstetric and Gynecological Emergencies 2 — Questions and Answers
Question 1: A laboring patient develops variable decelerations and a loop of umbilical cord is visible at the vaginal opening. What is the PRIORITY nursing intervention?
- Administer oxygen by non-rebreather mask
- Manually elevate the presenting fetal part to relieve cord compression (Correct answer)
- Prepare the OR for emergency cesarean section
- Place the patient in Trendelenburg position
Correct answer: Manually elevate the presenting fetal part to relieve cord compression
Manual elevation of the presenting fetal part immediately relieves pressure on the prolapsed cord, maintaining fetal circulation until emergency delivery can be performed.
Question 2: A patient at 36 weeks has BP of 145/95 mmHg, +2 proteinuria, and mild pedal edema, but no neurological symptoms or severe-range BP readings. This presentation is consistent with:
- Severe preeclampsia
- HELLP syndrome
- Preeclampsia without severe features (Correct answer)
- Gestational hypertension
Correct answer: Preeclampsia without severe features
Preeclampsia without severe features is characterized by BP ≥140/90 with proteinuria but without severe-range blood pressures or end-organ damage.
Question 3: HELLP syndrome is characterized by which triad of findings?
- Hypertension, edema, and proteinuria
- Hemolysis, elevated liver enzymes, and low platelets (Correct answer)
- Headache, epigastric pain, and leg swelling
- Hypoglycemia, elevated creatinine, and leukocytosis
Correct answer: Hemolysis, elevated liver enzymes, and low platelets
HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelets, representing a severe variant of preeclampsia with significant maternal morbidity.
Question 4: A patient presents with pelvic pain, fever of 38.8°C, purulent cervical discharge, and cervical motion tenderness. Which condition is most likely?
- Ovarian torsion
- Pelvic inflammatory disease (PID) (Correct answer)
- Ectopic pregnancy
- Ruptured ovarian cyst
Correct answer: Pelvic inflammatory disease (PID)
Pelvic inflammatory disease presents with the classic triad of cervical motion tenderness, mucopurulent discharge, and fever due to ascending infection of the upper reproductive tract.
Question 5: Which of the following is the most common cause of first-trimester vaginal bleeding?
- Placenta previa
- Threatened miscarriage (Correct answer)
- Ectopic pregnancy
- Cervical polyp
Correct answer: Threatened miscarriage
Threatened miscarriage is the most common cause of first-trimester vaginal bleeding, occurring when the cervix remains closed but uterine bleeding is present.
Question 6: A patient at 10 weeks gestation presents with heavy vaginal bleeding, passage of tissue, and a dilated cervical os. This presentation is consistent with which type of abortion?
- Threatened abortion
- Complete abortion
- Inevitable abortion (Correct answer)
- Missed abortion
Correct answer: Inevitable abortion
Inevitable abortion is characterized by cervical dilation with active bleeding and tissue passage, indicating that the pregnancy loss cannot be prevented.
Question 7: A pregnant patient at 34 weeks develops sudden severe chest pain and dyspnea following a 6-hour car ride. Which condition should the nurse suspect?
- Placental abruption
- Pulmonary embolism (Correct answer)
- Peripartum cardiomyopathy
- Preterm labor
Correct answer: Pulmonary embolism
Pulmonary embolism is a leading cause of maternal mortality; pregnancy creates a hypercoagulable state, and prolonged immobility significantly increases DVT and PE risk.
BCEN Obstetric and Gynecological Emergencies 2
A laboring patient develops variable decelerations and a loop of umbilical cord is visible at the vaginal opening.
What is the PRIORITY nursing intervention?