# Situation: A nurse works in the labor room of a government birthing facility that provides basic emergency obstetric and newborn care (BEmONC). Two midwives and a nursing attendant share the night shift with the nurse. Past midnight, a woman in labor at 36 weeks' gestation has a blood pressure of 170/112 mmHg and a severe headache. Under the Responsible Parenthood and Reproductive Health Act of 2012 (RA 10354), in which circumstance may the nurse give magnesium sulfate, following Department of Health (DOH) guidelines, without waiting for a physician?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629407  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the labor room of a government birthing facility that provides basic emergency obstetric and newborn care (BEmONC). Two midwives and a nursing attendant share the night shift with the nurse.

Past midnight, a woman in labor at 36 weeks' gestation has a blood pressure of 170/112 mmHg and a severe headache. Under the Responsible Parenthood and Reproductive Health Act of 2012 (RA 10354), in which circumstance may the nurse give magnesium sulfate, following Department of Health (DOH) guidelines, without waiting for a physician?

## 보기

1. She is trained and certified, and no physician is available to attend the woman **✔ 정답**
2. She has many years of labor room experience, and no physician is available
3. She attended the training but is not yet certified, and no physician is available
4. She is trained and certified, and the physician on duty is in the next room

**정답: 1**

## 해설

RA 10354 allows midwives and nurses who are properly trained and certified to give lifesaving drugs such as oxytocin and magnesium sulfate, following DOH guidelines, under emergency conditions when no physician is available. Both conditions must be met: certified training and the absence of an available physician. Experience, or attendance at a course without certification, does not satisfy the law.

## 심화 해설

Clinical context and legal trigger

The woman at 36 weeks gestation with a blood pressure of 170/112 mmHg and severe headache is showing signs of severe preeclampsia with impending eclampsia. Magnesium sulfate is the standard drug for seizure prophylaxis in this situation. Under RA 10354, a nurse may administer this lifesaving drug without a physician only when two conditions are met at the same time: the nurse has completed DOH-approved training and certification, and no physician is available to attend the woman.

The law does not substitute years of experience or attendance at a training course for formal certification. Certification is the legal safeguard that confirms the nurse has demonstrated the required knowledge and skill for magnesium sulfate administration. Availability of a physician, even in the next room, removes the legal basis for independent nurse administration under RA 10354.

| Condition | Satisfies RA 10354? | Reason |
| --- | --- | --- |
| Trained and certified, no physician available | Yes | Both legal requirements are met |
| Many years of experience, no physician available | No | Experience does not replace certification |
| Attended training but not certified, no physician available | No | Certification is mandatory, not just attendance |
| Trained and certified, physician in next room | No | Physician is available, so independent administration is not authorized |

Watch out! The question tests whether you can separate clinical urgency from legal authorization. Severe preeclampsia is urgent, but the legal permission to give magnesium sulfate independently still requires both certification and physician absence. Key point! RA 10354 specifically names magnesium sulfate and oxytocin as drugs that trained and certified nurses and midwives may give in emergencies when no physician is available, following DOH guidelines.

The underlying clinical danger is progression from severe preeclampsia to eclampsia, defined by new-onset seizures or coma in a woman with preeclampsia . Magnesium sulfate is the first-line intervention to prevent that seizure. In a BEmONC facility with limited staffing at night, the nurse must act quickly, but the legal pathway for independent drug administration is narrow and clearly defined.

## 임상 시나리오

Magnesium Sulfate Administration Under RA 10354Legal conditions for nurse administration in BEmONC settings
A nurse may give magnesium sulfate without a physician only when both conditions are met: DOH-approved training and certification and no physician available to attend the woman.

Clinical triggers include severe preeclampsia with BP ≥160/110 mmHg or severe headache, where magnesium sulfate is given for seizure prophylaxis.

CautionYears of experience or training attendance without certification does not authorize independent administration. A physician in the next room is considered available, removing the legal basis for nurse administration under RA 10354.

## 핵심 개념

- **RA 10354** — Responsible Parenthood and Reproductive Health Act of 2012 allowing trained and certified nurses and midwives to give lifesaving drugs in emergencies when no physician is available
- **Magnesium sulfate** — First-line drug for seizure prophylaxis in severe preeclampsia and eclampsia
- **Severe preeclampsia** — Hypertension with severe features such as severe headache, visual changes, or BP ≥160/110 mmHg
- **BEmONC** — Basic Emergency Obstetric and Newborn Care, a service package for emergency obstetric care in birthing facilities
- **Certification** — Formal DOH-approved training credential confirming demonstrated competency for drug administration

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