CFRN - Certified Flight Registered Nurse Obstetrical Patient Management Questions and Answers — Questions and Answers
Question 1: A 34-week pregnant patient with severe pre-eclampsia is being transported while receiving a magnesium sulfate infusion. The patient becomes lethargic, her respiratory rate drops to 10 breaths/min, and deep tendon reflexes are absent. What is the flight nurse's most appropriate immediate action?
- Increase the rate of the magnesium sulfate infusion.
- Administer a 500 mL bolus of normal saline.
- Stop the infusion and administer calcium gluconate. (Correct answer)
- Prepare the patient for emergent intubation.
Correct answer: Stop the infusion and administer calcium gluconate.
The patient's clinical presentation, including respiratory depression, lethargy, and loss of deep tendon reflexes, are classic signs of magnesium sulfate toxicity. The immediate priority is to stop the infusion and administer the antidote, calcium gluconate, to reverse the life-threatening effects.
Question 2: A 29-week pregnant patient involved in a motor vehicle collision is immobilized on a backboard. She is hypotensive at 85/48 mmHg and tachycardic at 125 bpm. In addition to securing IV access and initiating fluid resuscitation, which intervention is a priority for managing her hypotension?
- Manually displace the uterus to the left. (Correct answer)
- Place the patient in a steep Trendelenburg position.
- Administer a vasopressor agent like norepinephrine.
- Apply a pneumatic anti-shock garment (PASG).
Correct answer: Manually displace the uterus to the left.
In a pregnant patient beyond 20 weeks gestation, the gravid uterus can compress the inferior vena cava when the patient is supine, leading to supine hypotensive syndrome. This reduces venous return to the heart and decreases cardiac output. Manually displacing the uterus to the left (or tilting the backboard) relieves this compression and can significantly improve maternal hemodynamics.
Question 3: Which of the following clinical presentations is most characteristic of an abruptio placentae?
- Painless, bright red vaginal bleeding with a soft, non-tender uterus.
- Sudden onset of severe abdominal pain, a rigid uterus, and dark red bleeding. (Correct answer)
- A gradual onset of intermittent, dull lower back pain with cervical effacement.
- Hypertension, proteinuria, and severe headache with visual disturbances.
Correct answer: Sudden onset of severe abdominal pain, a rigid uterus, and dark red bleeding.
Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic presentation includes a sudden onset of intense, constant abdominal or back pain, a firm or rigid (hypertonic) uterus, and vaginal bleeding that is often dark red. This contrasts with placenta previa, which typically presents with painless, bright red bleeding.
Question 4: A flight nurse is transporting a patient in active preterm labor at 31 weeks gestation. A tocolytic agent, such as terbutaline or nifedipine, is being administered. What is the primary goal of this therapy during transport?
- To increase the strength of uterine contractions to facilitate delivery.
- To permanently stop labor until the pregnancy reaches full term.
- To suppress uterine contractions long enough to allow for antenatal corticosteroid administration. (Correct answer)
- To provide sedation and pain relief for the mother during transport.
Correct answer: To suppress uterine contractions long enough to allow for antenatal corticosteroid administration.
The primary goal of tocolytic therapy is not to stop labor indefinitely but to delay delivery for a short period, typically 48 hours. This delay allows time for the administration of antenatal corticosteroids (e.g., betamethasone) to enhance fetal lung maturity and for safe transport to a facility with a neonatal intensive care unit.
Question 5: Following a precipitous home delivery, the flight crew is managing a 26-year-old female with significant postpartum hemorrhage. Her uterus is soft and difficult to palpate. What is the most appropriate initial intervention?
- Administer a 1-liter bolus of lactated Ringer's solution.
- Immediately administer tranexamic acid (TXA).
- Initiate a blood transfusion with O-negative blood.
- Perform vigorous fundal massage. (Correct answer)
Correct answer: Perform vigorous fundal massage.
The patient's soft, "boggy" uterus is indicative of uterine atony, the most common cause of postpartum hemorrhage. The first and most critical intervention is vigorous fundal massage to stimulate uterine contraction, which constricts the blood vessels at the placental site and controls bleeding. While fluids, medications, and blood products are important, massage is the immediate action.
Question 6: The CFRN is assessing a 36-week pregnant patient who was the restrained driver in a frontal-impact collision. Her vital signs are stable (BP 118/76, HR 98, RR 20). The nurse understands that due to the physiological changes of pregnancy:
- The patient has decreased plasma volume, making her more susceptible to shock.
- Signs of hypovolemia, such as hypotension, will appear much earlier than in a non-pregnant patient.
- The patient can lose 30-35% of her blood volume before exhibiting hypotension. (Correct answer)
- The resting heart rate is typically lower, so a rate of 98 bpm is a definitive sign of shock.
Correct answer: The patient can lose 30-35% of her blood volume before exhibiting hypotension.
Pregnant patients experience a significant increase in blood volume, up to 45-50%, primarily due to plasma expansion. This hypervolemia creates a physiological reserve, allowing the mother to lose a substantial amount of blood (up to 30-35% or 1500-2000 mL) before classic signs of shock, like hypotension, become apparent. This can mask the true severity of hemorrhage.
CFRN - Certified Flight Registered Nurse Obstetrical Patient Management Questions and Answers
A 34-week pregnant patient with severe pre-eclampsia is being transported while receiving a magnesium sulfate infusion.
The patient becomes lethargic, her respiratory rate drops to 10 breaths/min, and deep tendon reflexes are absent.
What is the flight nurse's most appropriate immediate action?