CFRN Obstetrical Patient Management 5

Question 1

A flight nurse receives a patient who delivered vaginally 2 hours ago and now has a boggy uterus that does not firm with fundal massage and oxytocin infusion. What is the MOST likely cause of her ongoing hemorrhage?

Accepted Answer

Uterine atony refractory to oxytocin

Answer

A uterus that fails to contract despite massage and oxytocin represents refractory uterine atony, the most common cause of postpartum hemorrhage.

Question 2

A patient at 20 weeks gestation requires intubation during air transport. Compared to a non-pregnant patient, rapid sequence intubation in pregnancy requires consideration of:

Accepted Answer

Faster oxygen desaturation and increased aspiration risk

Answer

Pregnancy decreases FRC and increases oxygen consumption, causing rapid desaturation; delayed gastric emptying and increased gastric acid raise aspiration risk during intubation.

Question 3

A 36-week patient is transported after an eclamptic seizure that has now resolved. She is postictal with a GCS of 12. What is the MAINTENANCE dose of magnesium sulfate for seizure prophylaxis?

Accepted Answer

1–2 g/hr IV infusion

Answer

After a 4–6 g IV loading dose, magnesium sulfate is maintained at 1–2 g/hr IV infusion to prevent recurrent eclamptic seizures.

Question 4

During flight, a multiparous patient at 39 weeks suddenly reports an urge to push. Exam reveals crowning. Which step of emergency delivery management should be performed FIRST?

Accepted Answer

Apply gentle steady pressure to the fetal head to control delivery

Answer

Controlled delivery of the fetal head with gentle steady pressure prevents rapid expulsion, reduces perineal lacerations, and allows the infant's airway to clear.

Question 5

A 31-week gestation patient with preterm premature rupture of membranes (PPROM) is transported. Which finding would indicate chorioamnionitis requiring immediate delivery consideration?

Accepted Answer

Maternal fever >38°C, uterine tenderness, and fetal tachycardia

Answer

Chorioamnionitis is diagnosed clinically by maternal fever combined with uterine tenderness and fetal tachycardia, indicating intrauterine infection that may require delivery.

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Obstetrical Patient Management 5