TCRN TCRN Special Patient Populations 4 — Questions and Answers
Question 1: A 28-year-old pregnant patient at 32 weeks gestation is in the trauma bay after a motor vehicle collision. In what position should she be placed to optimize hemodynamics?
- Supine with legs elevated
- Left lateral decubitus or 15-30 degree left tilt (Correct answer)
- Right lateral decubitus
- Semi-Fowler's at 45 degrees
Correct answer: Left lateral decubitus or 15-30 degree left tilt
Left lateral tilt or full left lateral decubitus relieves aortocaval compression by the gravid uterus, improving cardiac output and uteroplacental perfusion.
Question 2: A pregnant trauma patient at 24 weeks gestation has fetal heart tones of 90 bpm. What does this finding indicate?
- Normal fetal heart rate for this gestational age
- Fetal bradycardia indicating fetal distress or hypoxia (Correct answer)
- Artifact from maternal tachycardia
- Normal variation in the second trimester
Correct answer: Fetal bradycardia indicating fetal distress or hypoxia
Normal fetal heart rate is 110-160 bpm; bradycardia below 110 bpm indicates fetal distress and requires urgent obstetric evaluation.
Question 3: Which test is used at bedside to detect fetal-maternal hemorrhage in a pregnant trauma patient?
- Kleihauer-Betke test (Correct answer)
- Apt test
- D-dimer assay
- Fibrinogen level
Correct answer: Kleihauer-Betke test
The Kleihauer-Betke (KB) test detects fetal red blood cells in the maternal circulation to quantify fetal-maternal hemorrhage and guide Rh immunoglobulin dosing.
Question 4: An Rh-negative pregnant trauma patient at 20 weeks gestation requires Rh immunoglobulin (RhoGAM). What is the standard initial dose and timing?
- 50 mcg within 72 hours
- 300 mcg within 72 hours (Correct answer)
- 300 mcg within 24 hours only
- 600 mcg at any time post-trauma
Correct answer: 300 mcg within 72 hours
Standard RhoGAM dose is 300 mcg IM within 72 hours of potential fetal-maternal hemorrhage to prevent Rh sensitization; additional doses may be needed if KB test shows large bleed.
Question 5: A pregnant patient at 36 weeks presents after blunt abdominal trauma. Continuous fetal monitoring shows repeated late decelerations. What does this pattern indicate?
- Head compression during Braxton Hicks contractions
- Uteroplacental insufficiency and fetal hypoxia (Correct answer)
- Cord compression — normal in late pregnancy
- Fetal movement artifact
Correct answer: Uteroplacental insufficiency and fetal hypoxia
Late decelerations (occurring after the peak of a contraction) are associated with uteroplacental insufficiency and indicate fetal hypoxia requiring urgent intervention.
Question 6: What is the most common cause of fetal death in blunt trauma during pregnancy?
- Direct uterine rupture
- Placental abruption (Correct answer)
- Maternal cardiac arrest
- Umbilical cord avulsion
Correct answer: Placental abruption
Placental abruption is the most common cause of fetal death in blunt maternal trauma because the inelastic placenta shears away from the elastic uterine wall during deceleration forces.
Question 7: A pregnant trauma patient at 28 weeks requires a chest X-ray. Which action should the nurse take regarding radiation exposure?
- Decline the X-ray to protect the fetus entirely
- Shield the abdomen/pelvis and proceed — diagnostic benefits outweigh risks (Correct answer)
- Delay all imaging until after delivery
- Perform only ultrasound regardless of clinical need
Correct answer: Shield the abdomen/pelvis and proceed — diagnostic benefits outweigh risks
Necessary diagnostic imaging should not be withheld; abdominal shielding reduces fetal exposure, and the radiation dose from standard trauma imaging is well below the threshold for fetal harm.
TCRN TCRN Special Patient Populations 4
A 28-year-old pregnant patient at 32 weeks gestation is in the trauma bay after a motor vehicle collision.
In what position should she be placed to optimize hemodynamics?