CFRN Obstetrical Patient Management 2 — Questions and Answers
Question 1: A 34-week pregnant patient is transported by air with a BP of 160/110 mmHg, 3+ proteinuria, and severe headache. Which medication is the FIRST-LINE treatment for severe-range hypertension in this setting?
- Hydralazine IV
- Labetalol IV (Correct answer)
- Nifedipine PO
- Magnesium sulfate IV
Correct answer: Labetalol IV
Labetalol IV is the first-line agent for acute severe hypertension in pregnancy due to its rapid onset, predictable response, and safety profile.
Question 2: During air transport, a 28-week gestation patient develops umbilical cord prolapse confirmed on exam. What is the PRIORITY nursing intervention?
- Apply oxygen and elevate head of bed
- Manually elevate the presenting part off the cord (Correct answer)
- Administer tocolytics immediately
- Position the patient supine and increase IV fluids
Correct answer: Manually elevate the presenting part off the cord
Manual elevation of the presenting fetal part off the prolapsed cord relieves compression and preserves umbilical blood flow until emergency delivery.
Question 3: A flight nurse is transporting a patient at 36 weeks gestation who suddenly develops severe abdominal pain, rigid uterus, and fetal bradycardia. These findings are MOST consistent with:
- Placenta previa
- Uterine rupture
- Placental abruption (Correct answer)
- Preterm labor
Correct answer: Placental abruption
Sudden severe abdominal pain, board-like uterine rigidity, and acute fetal distress are classic signs of placental abruption.
Question 4: When managing a patient with eclampsia in a transport environment, magnesium sulfate toxicity is BEST assessed by monitoring which parameter?
- Blood pressure every 5 minutes
- Deep tendon reflexes (DTR) (Correct answer)
- Urine output via Foley catheter
- Fetal heart rate pattern
Correct answer: Deep tendon reflexes (DTR)
Loss of deep tendon reflexes is the earliest clinical sign of magnesium toxicity, preceding respiratory depression and cardiac arrest.
Question 5: A patient at 32 weeks gestation is being transported with suspected HELLP syndrome. Which lab finding is CHARACTERISTIC of this condition?
- Elevated hemoglobin and hematocrit
- Thrombocytopenia and elevated liver enzymes (Correct answer)
- Low serum creatinine and normal platelets
- Leukocytosis with left shift
Correct answer: Thrombocytopenia and elevated liver enzymes
HELLP syndrome is defined by hemolysis, elevated liver enzymes, and low platelets (thrombocytopenia), distinguishing it from isolated preeclampsia.
Question 6: During aeromedical transport, lateral uterine displacement in a third-trimester patient is performed to prevent:
- Placenta previa hemorrhage
- Aortocaval compression syndrome (Correct answer)
- Aspiration of gastric contents
- Fetal bradycardia from vibration
Correct answer: Aortocaval compression syndrome
Left lateral uterine displacement prevents the gravid uterus from compressing the aorta and inferior vena cava, maintaining maternal cardiac output.
Question 7: A term pregnant patient in active labor is transported and delivers the infant mid-flight. After delivery, the placenta delivers but the uterus remains atonic with heavy bleeding. The FIRST pharmacologic intervention should be:
- Ergotamine 0.2 mg IM
- Oxytocin 10–40 units in IV infusion (Correct answer)
- Misoprostol 800 mcg sublingual
- Carboprost 250 mcg IM
Correct answer: Oxytocin 10–40 units in IV infusion
Oxytocin is the first-line uterotonic for postpartum hemorrhage due to uterine atony, administered as an IV infusion after placental delivery.
CFRN Obstetrical Patient Management 2
A 34-week pregnant patient is transported by air with a BP of 160/110 mmHg, 3+ proteinuria, and severe headache.
Which medication is the FIRST-LINE treatment for severe-range hypertension in this setting?