CEN Pediatric and Obstetric Emergencies 2

Question 1

A pregnant patient at 36 weeks presents with sudden painless bright red vaginal bleeding. Which condition is most likely?

Accepted Answer

Placenta previa

Answer

Painless bright red vaginal bleeding in the third trimester is the hallmark presentation of placenta previa.

Question 2

A patient at 32 weeks gestation presents with sudden severe abdominal pain, rigid abdomen, and dark vaginal bleeding. Fetal heart tones are absent. Which complication is most likely?

Accepted Answer

Placental abruption with fetal demise

Answer

Painful dark vaginal bleeding with board-like rigidity and fetal demise indicates severe placental abruption with complete placental separation.

Question 3

A patient at 38 weeks is admitted in active labor. After a prolonged deceleration, the baby's head is not descending despite pushing. The fetal heart rate drops to 60 bpm. Which maneuver is first-line for shoulder dystocia?

Accepted Answer

McRoberts maneuver with suprapubic pressure

Answer

The McRoberts maneuver (hyperflexion of maternal hips) combined with suprapubic pressure is the first-line management for shoulder dystocia.

Question 4

A patient with preeclampsia at 34 weeks is being treated with IV magnesium sulfate. The nurse notes absent deep tendon reflexes and a respiratory rate of 10. Which action is immediately required?

Accepted Answer

Administer calcium gluconate IV and stop magnesium

Answer

Absent DTRs and respiratory depression are signs of magnesium toxicity; calcium gluconate is the antidote and the infusion must be stopped immediately.

Question 5

A woman delivers a baby and 20 minutes later has heavy vaginal bleeding (estimated 600 mL). The uterus is boggy on palpation. What is the first intervention?

Accepted Answer

Administer 10 units oxytocin IM and perform uterine massage

Answer

Uterine atony is the most common cause of postpartum hemorrhage and is initially treated with uterine massage and uterotonic medications (oxytocin).

CEN - Certified Emergency Nurse Practice Test

CEN - Certified Emergency Nurse Practice Test

CEN Pediatric and Obstetric Emergencies 2