Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 2 — Questions and Answers
Question 1: A patient at 34 weeks gestation presents with sudden severe headache, visual disturbances, and BP of 168/112 mmHg. Which intervention is the PRIORITY?
- Administer magnesium sulfate IV (Correct answer)
- Perform immediate cesarean section
- Obtain urine for protein analysis
- Place the patient in Trendelenburg position
Correct answer: Administer magnesium sulfate IV
Magnesium sulfate is the priority intervention to prevent seizures in severe preeclampsia with neurological symptoms.
Question 2: During the third stage of labor, the nurse observes a sudden gush of blood, cord lengthening, and the uterus rising in the abdomen. This indicates:
- Placental separation (Correct answer)
- Uterine inversion
- Umbilical cord prolapse
- Vasa previa rupture
Correct answer: Placental separation
These are the classic signs of placental separation: gush of blood, cord lengthening, and uterine fundus rising and becoming globular.
Question 3: A multiparous patient delivers and then develops massive hemorrhage. The uterus is boggy despite fundal massage. After oxytocin fails, which uterotonic agent is contraindicated if the patient has hypertension?
- Methylergonovine (Methergine) (Correct answer)
- Carboprost (Hemabate)
- Misoprostol
- Tranexamic acid
Correct answer: Methylergonovine (Methergine)
Methylergonovine causes vasoconstriction and is contraindicated in hypertension as it can dangerously elevate blood pressure.
Question 4: A laboring patient suddenly develops fetal bradycardia to 60 bpm and the nurse visualizes a loop of umbilical cord at the vaginal introitus. The nurse's FIRST action is to:
- Manually elevate the presenting part off the cord (Correct answer)
- Place the patient in lithotomy position and push the cord back
- Apply oxygen and call the physician
- Begin IV fluid bolus immediately
Correct answer: Manually elevate the presenting part off the cord
Manual elevation of the presenting part relieves cord compression and is the immediate priority to restore fetal blood flow.
Question 5: A patient at 38 weeks is diagnosed with placenta previa and begins heavy vaginal bleeding. The nurse should:
- Establish large-bore IV access and avoid vaginal examination (Correct answer)
- Perform a sterile vaginal exam to assess cervical dilation
- Prepare the patient for amniotomy
- Apply fundal pressure to slow the bleeding
Correct answer: Establish large-bore IV access and avoid vaginal examination
Vaginal examination with placenta previa can provoke catastrophic hemorrhage; IV access is essential for fluid resuscitation.
Question 6: Which finding is MOST consistent with amniotic fluid embolism (AFE)?
- Sudden cardiovascular collapse with DIC shortly after rupture of membranes (Correct answer)
- Gradual onset of chest pain and tachycardia over several hours
- Elevated blood pressure with severe headache
- Heavy vaginal bleeding with a firm, board-like uterus
Correct answer: Sudden cardiovascular collapse with DIC shortly after rupture of membranes
AFE classically presents as sudden, unexplained cardiovascular collapse followed by DIC, typically occurring around rupture of membranes or delivery.
Question 7: A patient with a history of classical uterine incision from a prior cesarean section is in labor. She suddenly reports severe abdominal pain between contractions, and the fetal presenting part is no longer palpable. This presentation is most consistent with:
- Complete uterine rupture (Correct answer)
- Placental abruption
- Severe preeclampsia
- Umbilical cord prolapse
Correct answer: Complete uterine rupture
Loss of fetal station combined with sudden severe pain between contractions strongly suggests complete uterine rupture with fetal extrusion.
Obstetric Nurse Test Obstetric Nurse Obstetric Emergencies 2
A patient at 34 weeks gestation presents with sudden severe headache, visual disturbances, and BP of 168/112 mmHg.
Which intervention is the PRIORITY?