TCRN TCRN Special Patient Populations 4

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?

Accepted Answer

Left lateral decubitus or 15-30 degree left tilt

Answer

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?

Accepted Answer

Fetal bradycardia indicating fetal distress or hypoxia

Answer

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?

Accepted Answer

Kleihauer-Betke test

Answer

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?

Accepted Answer

300 mcg within 72 hours

Answer

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?

Accepted Answer

Uteroplacental insufficiency and fetal hypoxia

Answer

Late decelerations (occurring after the peak of a contraction) are associated with uteroplacental insufficiency and indicate fetal hypoxia requiring urgent intervention.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN TCRN Special Patient Populations 4