CFRN Obstetrical Patient Management 4 — Questions and Answers
Question 1: A 24-week gestation patient is in preterm labor during air transport. Terbutaline is ordered as a tocolytic. Which maternal side effect requires CLOSEST monitoring?
- Bradycardia and hypotension
- Tachycardia and hyperglycemia (Correct answer)
- Hypertension and bradypnea
- Renal failure and hypokalemia
Correct answer: Tachycardia and hyperglycemia
Beta-2 agonist tocolytics like terbutaline cause maternal tachycardia and hyperglycemia, requiring continuous cardiac monitoring and glucose assessment.
Question 2: During flight transport of a postpartum patient with uterine atony unresponsive to oxytocin, which second-line uterotonic is CONTRAINDICATED in a patient with asthma?
- Methylergonovine (Methergine)
- Misoprostol
- Carboprost (Hemabate) (Correct answer)
- Tranexamic acid
Correct answer: Carboprost (Hemabate)
Carboprost (15-methyl PGF2α) is contraindicated in patients with asthma because it can cause severe bronchospasm.
Question 3: A neonate is born during air transport and has a heart rate of 50 bpm with no spontaneous respirations after 30 seconds of positive pressure ventilation. The NEXT step per NRP guidelines is:
- Administer epinephrine via IV immediately
- Begin chest compressions with continued PPV at a 3:1 ratio (Correct answer)
- Increase PPV rate to 60 breaths per minute only
- Check glucose level before proceeding
Correct answer: Begin chest compressions with continued PPV at a 3:1 ratio
When HR remains <60 bpm after adequate PPV, NRP directs initiation of chest compressions coordinated with PPV at a 3:1 compression-to-ventilation ratio.
Question 4: When transporting a patient with suspected ectopic pregnancy at 8 weeks who is hemodynamically unstable, which assessment finding BEST confirms rupture?
- Unilateral adnexal tenderness on palpation
- Referred shoulder pain (Kehr's sign) and peritoneal signs (Correct answer)
- Absence of intrauterine pregnancy on portable ultrasound
- Positive urine beta-hCG with no visible IUP
Correct answer: Referred shoulder pain (Kehr's sign) and peritoneal signs
Kehr's sign (referred shoulder pain from diaphragmatic irritation by hemoperitoneum) combined with peritoneal signs indicates ruptured ectopic with free abdominal bleeding.
Question 5: A patient at 34 weeks is receiving magnesium sulfate for seizure prophylaxis. The flight nurse notes absent deep tendon reflexes and a respiratory rate of 10/min. The CORRECT immediate action is:
- Reduce the magnesium infusion rate by half
- Stop magnesium and administer calcium gluconate IV (Correct answer)
- Increase supplemental oxygen and continue monitoring
- Administer naloxone to reverse respiratory depression
Correct answer: Stop magnesium and administer calcium gluconate IV
Absent DTRs with respiratory depression indicates magnesium toxicity; the antidote is calcium gluconate 1 gram IV given slowly to reverse neuromuscular blockade.
Question 6: Which position is MOST appropriate for a term pregnant patient in hemorrhagic shock during aeromedical transport who cannot tolerate left lateral tilt?
- Trendelenburg with head down 15 degrees
- Right lateral decubitus to redistribute blood volume
- Manual left uterine displacement while supine (Correct answer)
- Full left lateral decubitus position
Correct answer: Manual left uterine displacement while supine
Manual left uterine displacement while the patient remains supine effectively relieves aortocaval compression without requiring positional changes that complicate resuscitation.
Question 7: During air transport of a 29-week gestation patient, the flight nurse administers betamethasone. This corticosteroid is given to:
- Prevent maternal sepsis from chorioamnionitis
- Accelerate fetal lung maturity and reduce RDS risk (Correct answer)
- Reduce uterine contractions in preterm labor
- Treat fetal anemia detected on Doppler ultrasound
Correct answer: Accelerate fetal lung maturity and reduce RDS risk
Antenatal betamethasone at 24–34 weeks gestation accelerates fetal lung surfactant production, significantly reducing the risk of neonatal respiratory distress syndrome.
CFRN Obstetrical Patient Management 4
A 24-week gestation patient is in preterm labor during air transport.
Terbutaline is ordered as a tocolytic.
Which maternal side effect requires CLOSEST monitoring?