import React, { useState, useEffect } from 'react';
import { CheckCircle, XCircle, RefreshCw, ChevronRight, AlertCircle } from 'lucide-react';
const LaborComplicationsTest = () => {
const [currentQuestion, setCurrentQuestion] = useState(null);
const [selectedAnswer, setSelectedAnswer] = useState(null);
const [showFeedback, setShowFeedback] = useState(false);
const [score, setScore] = useState({ correct: 0, total: 0 });
const [usedQuestions, setUsedQuestions] = useState([]);
const [dragItems, setDragItems] = useState([]);
const [droppedItems, setDroppedItems] = useState({});
// Comprehensive question bank covering ALL topics
const questionBank = [
// PROM Questions
{
id: 1,
type: 'multiple-choice',
topic: 'PROM',
question: 'A client at 34 weeks gestation reports a sudden gush of fluid. What is the MOST important initial assessment?',
options: [
'Check for contractions',
'Assess for cervical changes/dilation',
'Monitor fetal movement',
'Take maternal temperature'
],
correct: 1,
rationale: 'With PROM, the priority is to assess for cervical changes/dilation to determine if labor has begun. PROM does NOT mean labor is imminent, but cervical assessment helps determine the clinical picture.'
},
{
id: 2,
type: 'scenario',
topic: 'PROM',
question: 'A 28-year-old G1P0 at 35 weeks calls reporting fluid leakage that is yellow and cloudy. She denies contractions but reports mild cramping. What is your priority concern?',
options: [
'Preterm labor',
'Chorioamnionitis',
'Placental abruption',
'Normal discharge'
],
correct: 1,
rationale: 'Yellow/cloudy discharge is a red flag for infection (chorioamnionitis). This is a serious complication of PROM that requires immediate evaluation and treatment.'
},
// Medication Questions
{
id: 3,
type: 'multiple-choice',
topic: 'Medications',
question: 'Which medication should NEVER be given to send a mother home?',
options: [
'Terbutaline',
'Magnesium sulfate',
'Oxytocin',
'Nifedipine'
],
correct: 2,
rationale: 'Oxytocin causes strong contractions and should never be given to send a mother home. It is used for labor induction/augmentation in a monitored setting only.'
},
{
id: 4,
type: 'prioritization',
topic: 'Medications',
question: 'Before administering oxytocin, what assessments must be completed? Arrange in priority order:',
items: [
'Check fetal heart rate',
'Assess contraction pattern',
'Verify IV access',
'Review maternal vital signs'
],
correctOrder: [0, 1, 3, 2],
rationale: 'Fetal heart rate assessment is the priority before oxytocin administration, followed by contraction pattern to ensure no tachysystole, maternal vitals for baseline, and IV access for medication administration.'
},
// Emergency Situations
{
id: 5,
type: 'scenario',
topic: 'Shoulder Dystocia',
question: 'During delivery, the fetal head delivers but shoulders do not follow. The physician calls out "shoulder dystocia!" What is your FIRST action?',
options: [
'Apply fundal pressure',
'Help client into McRoberts position',
'Apply suprapubic pressure',
'Call for additional help'
],
correct: 1,
rationale: 'McRoberts position (knees to chest) is the first-line intervention for shoulder dystocia. This widens the pelvic outlet. NEVER apply fundal pressure as it can worsen the impaction.'
},
{
id: 6,
type: 'drag-drop',
topic: 'Cord Prolapse',
question: 'Arrange the priority actions for cord prolapse in the correct order:',
items: [
'Administer oxygen to mother',
'Elevate fetal head manually',
'Position in Trendelenburg/knee-chest',
'Call for immediate assistance'
],
correctOrder: [0, 1, 2, 3],
rationale: 'Priority sequence: 1) Oxygen to mother (improves fetal oxygenation), 2) Take pressure off cord by elevating fetal head, 3) Position to reduce cord compression, 4) Call for help while maintaining interventions.'
},
// Amniotic Fluid Embolism
{
id: 7,
type: 'critical-thinking',
topic: 'Amniotic Fluid Embolism',
question: 'A client suddenly becomes dyspneic, cyanotic, and hypotensive after ROM. What is your PRIORITY action?',
options: [
'Check fetal heart rate',
'Begin maternal CPR',
'Position in left lateral',
'Increase IV fluids'
],
correct: 1,
rationale: 'Amniotic fluid embolism is a medical emergency requiring immediate maternal resuscitation. Remember: if mom dies, baby dies. Maternal stabilization is the absolute priority.'
},
// Labor Assessment
{
id: 8,
type: 'multiple-choice',
topic: 'CPD',
question: 'A client has been pushing for 3 hours with no fetal descent. The baby weighs 4500g. What is the ONLY management option?',
options: [
'Continue pushing with position changes',
'Augment with oxytocin',
'Cesarean section',
'Vacuum-assisted delivery'
],
correct: 2,
rationale: 'Cephalopelvic disproportion (CPD) occurs when the baby is too large for the pelvis. The ONLY option is cesarean section. Continuing vaginal delivery attempts risks injury to mother and baby.'
},
{
id: 9,
type: 'scenario',
topic: 'Tachysystole',
question: 'A client on oxytocin has contractions every 90 seconds lasting 80 seconds with late decelerations. What is your FIRST action?',
options: [
'Increase IV fluids',
'Turn off oxytocin',
'Reposition client',
'Administer oxygen'
],
correct: 1,
rationale: 'Tachysystole (incomplete uterine relaxation) is often caused by oxytocin. The first action is to stop the oxytocin to allow uterine relaxation and improve fetal oxygenation.'
},
// Fetal Assessment
{
id: 10,
type: 'multiple-choice',
topic: 'Fetal Assessment',
question: 'Before performing a fetal fibronectin test, the client must avoid what for 24 hours?',
options: [
'Exercise',
'Eating',
'Vaginal exams/intercourse',
'Lying on back'
],
correct: 2,
rationale: 'No vaginal exams or intercourse 24 hours before fetal fibronectin test as these can cause false positive results.'
},
{
id: 11,
type: 'critical-thinking',
topic: 'Fetal Assessment',
question: 'During Leopold maneuvers, you hear the fetal heart rate loudest above the umbilicus. What does this indicate?',
options: [
'Normal vertex presentation',
'Breech presentation',
'Transverse lie',
'Face presentation'
],
correct: 1,
rationale: 'Heart rate heard above the umbilicus indicates breech presentation, as the heart is higher in the maternal abdomen when the baby is bottom-first.'
},
// Phone Triage
{
id: 12,
type: 'scenario',
topic: 'Phone Triage',
question: 'A term pregnant client calls reporting severe back pain. What is the ONLY appropriate response?',
options: [
'Take acetaminophen and rest',
'Apply heat to the back',
'Come to hospital for evaluation',
'Wait for regular contractions'
],
correct: 2,
rationale: 'NEVER diagnose over phone or recommend medications. ALWAYS instruct clients to come for evaluation. Back pain in term pregnancy could indicate labor or complications.'
},
// Complex Scenarios
{
id: 13,
type: 'bowtie',
topic: 'Labor Dystocia',
question: 'Complete the cause-and-effect relationship for Labor Dystocia:',
causes: ['Small pelvis', 'Large baby', 'Multiple pregnancies', 'Dehydration'],
effects: ['Prolonged labor', 'Fetal distress', 'Maternal exhaustion', 'Need for C-section'],
rationale: 'Labor dystocia has multiple causes including anatomical (small pelvis, large baby) and physiological factors (multiple pregnancies causing uterine fatigue, dehydration affecting contractions). These lead to various complications requiring intervention.'
},
// Additional Emergency Scenarios
{
id: 14,
type: 'prioritization',
topic: 'Emergency Response',
question: 'A student nurse finds a client with cord prolapse. Arrange actions by priority:',
items: [
'Perform life-saving intervention',
'Check scope of practice',
'Call for help',
'Document the incident'
],
correctOrder: [0, 2, 3, 1],
rationale: 'Student nurses CAN perform life-saving interventions in emergencies. Act first to save lives, call for help while maintaining intervention, document after, and scope is not a concern in life-threatening situations.'
},
// Medication Effects
{
id: 15,
type: 'multiple-choice',
topic: 'Medications',
question: 'Which side effect is expected with terbutaline administration?',
options: [
'Bradycardia',
'Increased heart rate',
'Respiratory depression',
'Hypotension'
],
correct: 1,
rationale: 'Terbutaline is a beta-agonist that can increase heart rate as a side effect. Monitor maternal pulse when administering.'
},
// Station Assessment
{
id: 16,
type: 'critical-thinking',
topic: 'Fetal Assessment',
question: 'A fetal station of -3 indicates the presenting part is:',
options: [
'At the pelvic inlet',
'At the ischial spines',
'High above the pelvis',
'Crowning'
],
correct: 2,
rationale: 'Minus numbers indicate the presenting part is above the ischial spines (0 station). -3 means the baby is high above the pelvis.'
},
// Complex Emergency
{
id: 17,
type: 'scenario',
topic: 'Multiple Complications',
question: 'A diabetic client at 39 weeks has been pushing for 2.5 hours. Baby weighs 4200g. FHR shows variables. What complication should you anticipate MOST?',
options: [
'Cord prolapse',
'Shoulder dystocia',
'Placental abruption',
'Uterine rupture'
],
correct: 1,
rationale: 'With diabetes, macrosomia (4200g), and prolonged pushing, shoulder dystocia is the most likely complication. Prepare McRoberts position and suprapubic pressure techniques.'
},
// Infection Recognition
{
id: 18,
type: 'drag-drop',
topic: 'PROM Complications',
question: 'Match signs/symptoms with chorioamnionitis diagnosis:',
items: [
'Maternal fever',
'Yellow/cloudy fluid',
'Fetal tachycardia',
'Uterine tenderness'
],
correctOrder: [0, 1, 2, 3],
rationale: 'All listed items are signs of chorioamnionitis. Recognition of these signs requires immediate intervention with antibiotics and delivery planning.'
},
// Position Management
{
id: 19,
type: 'multiple-choice',
topic: 'Emergency Positioning',
question: 'Which position is NEVER appropriate for shoulder dystocia?',
options: [
'McRoberts position',
'Hands and knees',
'Trendelenburg',
'Lateral position'
],
correct: 2,
rationale: 'Trendelenburg is used for cord prolapse, NOT shoulder dystocia. McRoberts (knees to chest) is first-line for shoulder dystocia.'
},
// Assessment Priorities
{
id: 20,
type: 'bowtie',
topic: 'Comprehensive Assessment',
question: 'Link magnesium sulfate effects with nursing assessments:',
causes: ['Stops contractions', 'CNS depression', 'Smooth muscle relaxation', 'Decreased reflexes'],
effects: ['Monitor contraction pattern', 'Check deep tendon reflexes', 'Assess respiratory rate', 'Monitor for toxicity'],
rationale: 'Magnesium sulfate has multiple effects requiring specific assessments. Understanding these relationships ensures safe administration and early toxicity recognition.'
}
];
// Initialize with random question
useEffect(() => {
loadNewQuestion();
}, []);
const loadNewQuestion = () => {
const availableQuestions = questionBank.filter(q => !usedQuestions.includes(q.id));
if (availableQuestions.length === 0) {
// Reset if all questions used
setUsedQuestions([]);
const randomIndex = Math.floor(Math.random() * questionBank.length);
setCurrentQuestion(questionBank[randomIndex]);
setUsedQuestions([questionBank[randomIndex].id]);
} else {
const randomIndex = Math.floor(Math.random() * availableQuestions.length);
setCurrentQuestion(availableQuestions[randomIndex]);
setUsedQuestions([...usedQuestions, availableQuestions[randomIndex].id]);
}
setSelectedAnswer(null);
setShowFeedback(false);
setDragItems([]);
setDroppedItems({});
};
const handleAnswerSelect = (index) => {
if (!showFeedback) {
setSelectedAnswer(index);
}
};
const checkAnswer = () => {
setShowFeedback(true);
const isCorrect = selectedAnswer === currentQuestion.correct;
setScore({
correct: score.correct + (isCorrect ? 1 : 0),
total: score.total + 1
});
};
const handleDragStart = (e, item, index) => {
e.dataTransfer.setData('text/plain', index);
};
const handleDrop = (e, targetIndex) => {
e.preventDefault();
const sourceIndex = parseInt(e.dataTransfer.getData('text/plain'));
const newDropped = { ...droppedItems };
newDropped[targetIndex] = currentQuestion.items[sourceIndex];
setDroppedItems(newDropped);
};
const handleDragOver = (e) => {
e.preventDefault();
};
const checkDragDropAnswer = () => {
setShowFeedback(true);
let correct = true;
currentQuestion.correctOrder.forEach((correctIndex, position) => {
if (droppedItems[position] !== currentQuestion.items[correctIndex]) {
correct = false;
}
});
setScore({
correct: score.correct + (correct ? 1 : 0),
total: score.total + 1
});
};
const renderQuestion = () => {
if (!currentQuestion) return null;
switch (currentQuestion.type) {
case 'multiple-choice':
case 'scenario':
case 'critical-thinking':
return (