CFRN - Certified Flight Registered Nurse Obstetrical Patient Management Questions and Answers

Question 1

A 34-week pregnant patient with severe pre-eclampsia is being transported while receiving a magnesium sulfate infusion. The patient becomes lethargic, her respiratory rate drops to 10 breaths/min, and deep tendon reflexes are absent. What is the flight nurse's most appropriate immediate action?

Accepted Answer

Stop the infusion and administer calcium gluconate.

Answer

The patient's clinical presentation, including respiratory depression, lethargy, and loss of deep tendon reflexes, are classic signs of magnesium sulfate toxicity. The immediate priority is to stop the infusion and administer the antidote, calcium gluconate, to reverse the life-threatening effects.

Question 2

A 29-week pregnant patient involved in a motor vehicle collision is immobilized on a backboard. She is hypotensive at 85/48 mmHg and tachycardic at 125 bpm. In addition to securing IV access and initiating fluid resuscitation, which intervention is a priority for managing her hypotension?

Accepted Answer

Manually displace the uterus to the left.

Answer

In a pregnant patient beyond 20 weeks gestation, the gravid uterus can compress the inferior vena cava when the patient is supine, leading to supine hypotensive syndrome. This reduces venous return to the heart and decreases cardiac output. Manually displacing the uterus to the left (or tilting the backboard) relieves this compression and can significantly improve maternal hemodynamics.

Question 3

Which of the following clinical presentations is most characteristic of an abruptio placentae?

Accepted Answer

Sudden onset of severe abdominal pain, a rigid uterus, and dark red bleeding.

Answer

Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic presentation includes a sudden onset of intense, constant abdominal or back pain, a firm or rigid (hypertonic) uterus, and vaginal bleeding that is often dark red. This contrasts with placenta previa, which typically presents with painless, bright red bleeding.

Question 4

A flight nurse is transporting a patient in active preterm labor at 31 weeks gestation. A tocolytic agent, such as terbutaline or nifedipine, is being administered. What is the primary goal of this therapy during transport?

Accepted Answer

To suppress uterine contractions long enough to allow for antenatal corticosteroid administration.

Answer

The primary goal of tocolytic therapy is not to stop labor indefinitely but to delay delivery for a short period, typically 48 hours. This delay allows time for the administration of antenatal corticosteroids (e.g., betamethasone) to enhance fetal lung maturity and for safe transport to a facility with a neonatal intensive care unit.

Question 5

Following a precipitous home delivery, the flight crew is managing a 26-year-old female with significant postpartum hemorrhage. Her uterus is soft and difficult to palpate. What is the most appropriate initial intervention?

Accepted Answer

Perform vigorous fundal massage.

Answer

The patient's soft, "boggy" uterus is indicative of uterine atony, the most common cause of postpartum hemorrhage. The first and most critical intervention is vigorous fundal massage to stimulate uterine contraction, which constricts the blood vessels at the placental site and controls bleeding. While fluids, medications, and blood products are important, massage is the immediate action.

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Obstetrical Patient Management Questions and Answers