NARM Emergency and Complication Management 5

Question 1

A client at 28 weeks gestation presents with headache, visual changes, epigastric pain, and a blood pressure of 162/110.
Laboratory results show platelets 88,000 and ALT 3x normal.
What syndrome is present?

Accepted Answer

HELLP syndrome

Answer

Severe preeclampsia without features

Answer

Gestational hypertension

Answer

Acute fatty liver of pregnancy

Question 2

During neonatal resuscitation, after 60 seconds of effective chest compressions and ventilation with no improvement in heart rate, epinephrine is indicated. What is the preferred route of administration?

Accepted Answer

Umbilical vein catheter

Answer

Endotracheal tube

Answer

Intraosseous route

Answer

Intramuscular injection

Question 3

A laboring client at 9 cm suddenly becomes unresponsive and seizing with no prior history of hypertension. After ensuring airway safety, what is the immediate pharmacologic treatment?

Accepted Answer

Magnesium sulfate 4-6g IV over 15-20 minutes

Answer

Phenobarbital 20mg/kg IV

Answer

Lorazepam 4mg IV push

Answer

Diazepam 10mg IM

Question 4

After delivery of a macrosomic infant, the midwife notes the placenta delivers but then the uterine fundus follows it through the vaginal introitus. This describes which obstetric emergency?

Accepted Answer

Uterine inversion

Answer

Uterine prolapse

Answer

Uterine rupture

Answer

Complete uterine atony

Question 5

What is the recommended initial management of uterine inversion before attempting replacement?

Accepted Answer

Administer a tocolytic agent to relax the uterus, then attempt replacement

Answer

Administer oxytocin IV to contract the uterus first

Answer

Attempt manual replacement immediately without tocolysis

Answer

Pack the vagina with gauze and transport

Question 6

A client at 34 weeks is in preterm labor with cervical dilation of 6 cm and intact membranes. The fetus is in breech presentation. Which statement regarding management is most accurate for an out-of-hospital midwife?

Accepted Answer

Facilitate immediate transport to hospital, supporting the client during transfer

Answer

Prepare for vaginal breech delivery using the Burns-Marshall technique

Answer

Attempt external cephalic version before complete dilation

Answer

Await spontaneous version and plan vaginal delivery if vertex

Question 7

Which maternal vital sign change is the earliest indicator of significant postpartum hemorrhage before blood pressure drops?

Accepted Answer

Increased heart rate (tachycardia)

Answer

Decreased respiratory rate

Answer

Decreased temperature

Answer

Increased oxygen saturation