**Maternal Momentum: Advanced NGN
Obstetric Emergencies**
1. Nurse triages pregnant pt at 32 weeks with painless bright red vaginal bleeding. Fundal height 36 cm,
FHR 150. Action?
💫RATIONALE✔️✔️: Placenta previa until proven. NO digital exam. Ultrasound, IV access, type & screen.
💫ANSWER✔️✔️: C. Avoid vaginal examination.
2. Pt at 38 weeks, contractions Q2min, FHR baseline 140, minimal variability for 60 min, no
accelerations, no decels. Category?
💫RATIONALE✔️✔️: Category II: indeterminate due to minimal variability without accelerations. Requires
intervention.
💫ANSWER✔️✔️: B. Category II.
3. Nurse assessing postpartum hemorrhage risk. Which finding most predictive?
💫RATIONALE✔️✔️: Uterine atony (70% PPH causes). Risk factors: overdistention, prolonged labor,
chorioamnionitis.
💫ANSWER✔️✔️: D. Boggy fundus after delivery.
4. Pt at 34 weeks with severe preeclampsia on MgSO4. Respiratory rate 10, patellar reflex absent.
Antidote dose?
💫RATIONALE✔️✔️: Calcium gluconate 1 g IV over 3 min. Stop Mg, prepare intubation.
💫ANSWER✔️✔️: A. Calcium gluconate 1 g.
5. Pt in active labor, FHR shows recurrent late decelerations. After repositioning and O2, decels persist.
Next?
, 💫RATIONALE✔️✔️: Late decels = uteroplacental insufficiency. Amnioinfusion if variable, otherwise
expedite delivery.
💫ANSWER✔️✔️: B. Notify provider for possible cesarean.
6. Newborn, 2 hr old, respiratory rate 80, nasal flaring, grunting, O2 sat 85% on RA. History: C-section at
39 weeks. Likely?
💫RATIONALE✔️✔️: Transient tachypnea of newborn (TTN) from retained fluid. Supportive O2, resolves
24-48 hr.
💫ANSWER✔️✔️: C. Transient tachypnea of newborn.
7. Nurse assessing umbilical cord gas values. Which indicates metabolic acidosis?
💫RATIONALE✔️✔️: pH <7.0 + base deficit >12 = severe acidosis. Cord arterial sample preferred.
💫ANSWER✔️✔️: D. pH 6.9, base excess -15.
8. Pt at 28 weeks with preterm premature rupture of membranes (PPROM). Which intervention reduces
neonatal morbidity?
💫RATIONALE✔️✔️: Antenatal corticosteroids (betamethasone) for lung maturity if 24-34 weeks.
💫ANSWER✔️✔️: B. Betamethasone 12 mg IM x2.
9. Pt in labor, epidural placed 1 hr ago. BP 80/50, FHR 90 x 3 min. Priority action?
💫RATIONALE✔️✔️: Maternal hypotension from epidural reduces uterine perfusion. IV fluid bolus, left
lateral, ephedrine.
💫ANSWER✔️✔️: A. Left lateral position and IV fluids.
10. Nurse assessing newborn with bilious vomiting, abdominal distension, failure to pass meconium in
24 hr. Likely?
💫RATIONALE✔️✔️: Intestinal obstruction (Hirschsprung, malrotation, atresia). NG decompression,
surgical consult.
💫ANSWER✔️✔️: C. Intestinal atresia.
Obstetric Emergencies**
1. Nurse triages pregnant pt at 32 weeks with painless bright red vaginal bleeding. Fundal height 36 cm,
FHR 150. Action?
💫RATIONALE✔️✔️: Placenta previa until proven. NO digital exam. Ultrasound, IV access, type & screen.
💫ANSWER✔️✔️: C. Avoid vaginal examination.
2. Pt at 38 weeks, contractions Q2min, FHR baseline 140, minimal variability for 60 min, no
accelerations, no decels. Category?
💫RATIONALE✔️✔️: Category II: indeterminate due to minimal variability without accelerations. Requires
intervention.
💫ANSWER✔️✔️: B. Category II.
3. Nurse assessing postpartum hemorrhage risk. Which finding most predictive?
💫RATIONALE✔️✔️: Uterine atony (70% PPH causes). Risk factors: overdistention, prolonged labor,
chorioamnionitis.
💫ANSWER✔️✔️: D. Boggy fundus after delivery.
4. Pt at 34 weeks with severe preeclampsia on MgSO4. Respiratory rate 10, patellar reflex absent.
Antidote dose?
💫RATIONALE✔️✔️: Calcium gluconate 1 g IV over 3 min. Stop Mg, prepare intubation.
💫ANSWER✔️✔️: A. Calcium gluconate 1 g.
5. Pt in active labor, FHR shows recurrent late decelerations. After repositioning and O2, decels persist.
Next?
, 💫RATIONALE✔️✔️: Late decels = uteroplacental insufficiency. Amnioinfusion if variable, otherwise
expedite delivery.
💫ANSWER✔️✔️: B. Notify provider for possible cesarean.
6. Newborn, 2 hr old, respiratory rate 80, nasal flaring, grunting, O2 sat 85% on RA. History: C-section at
39 weeks. Likely?
💫RATIONALE✔️✔️: Transient tachypnea of newborn (TTN) from retained fluid. Supportive O2, resolves
24-48 hr.
💫ANSWER✔️✔️: C. Transient tachypnea of newborn.
7. Nurse assessing umbilical cord gas values. Which indicates metabolic acidosis?
💫RATIONALE✔️✔️: pH <7.0 + base deficit >12 = severe acidosis. Cord arterial sample preferred.
💫ANSWER✔️✔️: D. pH 6.9, base excess -15.
8. Pt at 28 weeks with preterm premature rupture of membranes (PPROM). Which intervention reduces
neonatal morbidity?
💫RATIONALE✔️✔️: Antenatal corticosteroids (betamethasone) for lung maturity if 24-34 weeks.
💫ANSWER✔️✔️: B. Betamethasone 12 mg IM x2.
9. Pt in labor, epidural placed 1 hr ago. BP 80/50, FHR 90 x 3 min. Priority action?
💫RATIONALE✔️✔️: Maternal hypotension from epidural reduces uterine perfusion. IV fluid bolus, left
lateral, ephedrine.
💫ANSWER✔️✔️: A. Left lateral position and IV fluids.
10. Nurse assessing newborn with bilious vomiting, abdominal distension, failure to pass meconium in
24 hr. Likely?
💫RATIONALE✔️✔️: Intestinal obstruction (Hirschsprung, malrotation, atresia). NG decompression,
surgical consult.
💫ANSWER✔️✔️: C. Intestinal atresia.
