CPM Emergency Obstetric Complications 3

Question 1

When applying suprapubic pressure during management of shoulder dystocia, the direction of force should be:

Accepted Answer

Lateral and downward toward the fetal face to dislodge the impacted anterior shoulder

Answer

Directly downward toward the maternal spine to push the fetal head down

Answer

Upward toward the maternal head to create space in the pelvis

Answer

Circular to rotate the shoulder into the oblique diameter

Question 2

A client in augmented labor suddenly experiences the cessation of contractions, severe abdominal pain, and a change in fetal station on repeat examination. These findings are MOST consistent with:

Accepted Answer

Uterine rupture

Answer

Placental abruption with concealed hemorrhage

Answer

Prolapsed umbilical cord with sudden fetal descent

Answer

Severe fetal distress without structural complication

Question 3

The recommended management of a retained placenta at a homebirth when it has not delivered 30 minutes after the birth of the infant includes:

Accepted Answer

Establish IV access, attempt controlled cord traction with fundal support, and initiate transfer

Answer

Continue sustained cord traction alone for an additional 30 minutes

Answer

Attempt manual removal in the homebirth setting under sterile conditions

Answer

Administer IV oxytocin infusion and observe for up to 2 hours before transfer

Question 4

According to Neonatal Resuscitation Program (NRP) guidelines, the FIRST intervention for a newborn who is apneic with a heart rate of 60 bpm at birth is:

Accepted Answer

Provide stimulation and initiate positive pressure ventilation

Answer

Initiate chest compressions at a rate of 90 compressions per minute

Answer

Administer epinephrine via umbilical venous catheter

Answer

Perform endotracheal intubation for definitive airway management

Question 5

The drug of choice for both treatment and prevention of eclamptic seizures in obstetric patients is:

Accepted Answer

Magnesium sulfate loading dose followed by maintenance infusion

Answer

Diazepam (Valium) IV bolus for rapid seizure termination

Answer

Emergency cesarean section to remove the fetal trigger

Answer

Phenytoin (Dilantin) loading dose to achieve therapeutic levels

Question 6

A CPM should initiate immediate emergency transport during a homebirth for which of the following fetal heart rate findings?

Accepted Answer

Prolonged fetal bradycardia to 82 bpm for 6 minutes unresponsive to position change and oxygen

Answer

Fetal heart rate of 140 bpm that accelerates to 160 bpm with fetal movement

Answer

Maternal blood pressure of 118/72 mmHg with mild edema

Answer

Occasional variable decelerations that return to baseline within 30 seconds

Question 7

According to standard CPM practice and ACNM/NARM guidelines, which uterotonic medication is considered FIRST-LINE for treating uterine atony at a homebirth?

Accepted Answer

Oxytocin (Pitocin) 10–40 units IV or 10 units IM

Answer

Misoprostol (Cytotec) 800 mcg sublingual

Answer

Methylergonovine (Methergine) 0.2 mg IM

Answer

Carboprost tromethamine (Hemabate) 250 mcg IM