College of Nursing and Midwifery NAME:________________________________________ 1.

On the second post partum day, a client states that she has voided four times in the last two hours and with abundant amount. You know that this is normal because glomerular filtration rate remains elevated for how many days postpartum? 2 days 2 weeks 1 week 1 month When the nurse is assessing mother who delivered 4 days ago, the client expresses loss of appetite, fatigue, unhappy and like a failure as a mother with no family support. Which of the following is the most appropriate intervention for this client, instruct the client to Leave her alone Ask a friend for help Let the client have an adequate rest and nutrition Avoid stimulation Priority nursing diagnosis for clients experiencing post partum depression a. Anxiety b. Powerlessness c. Body image disturbance d. Family coping compromised A postpartum client informs who delivered 24 hours ago informs the nurse of night sweats but denies complains. The VS are T 37.3 PR 68/min RR 18/min and BP of 120/68. Which of the following is the most appropriate intervention? Notify the physician Inform the client of the presence of infection Continue to monitor the VS Inform the client this is normal finding and continue A woman had a vaginal delivery for her second child 2 days ago. As nurse you will instruct the mother that this is present usually the ____ day postpartum 2-3 days 7 days 10 days 14 days A mother who had a vaginal delivery of her first baby 6 weeks ago is seen for her postpartum visit. She is feeling well and is bottle feeding her infant for her postpartum visit. She is feeling well and is bottle-feeding her infant successfully. During the physical assessment, the nurse would expect to find the following normal data. Fundus palpated 6 cm below the umbilicus Breast tender, some milk expressed Striae pink but beginning to fade Creamy, yellow vaginal discharge A woman had a normal vaginal delivery 12 hours ago and is to be discharged from the birthing center. The nurse evaluates that the woman needs further teaching related to the episiotomy and perineal area when she states. I know the stitches will be removed at my postpartum clinic visit. The ice pack should be removed for 10 minutes before replacing it. The anesthetic spray, then the heat lamp, will help a lot. The water for the Sitz bath should be warm, about 120130 degree F. 7. A woman delivered her baby 12 hours ago. During the first partum assessment, the uterus is found to be boggy with a heavy lochia flow. The initial action of the nurse is to a. b. c. d. 9. a. b. c. d. Notify the physician Administer PRN oxytocin Encourage the woman to increase ambulation Massage the uterus until firm A woman has just delivered her first baby who will be breastfed. The nurse should include which of the following instructions in the teaching plan? Try to schedule feeding at least every three to four hours Wash nipples with soap and water before each feeding Avoid nursing bras with plastic lining Supplement with water between feedings when necessary 10. Encourage the woman to feed the baby for an average of how many minutes for the succeeding feeding? 10 mins. Per breast 5 mins each breast 15 mins for both breast 8 mins for each breast 11. You are giving health teaching about promotion of bonding to a mother who is bottle feeding this include: a. Bottle propping b. Hold and cuddle, and touch her baby while feeding c. Look her baby to the eye while feeding d. Hold the hand of the baby while feeding a. b. c. d. 12. Rooming in and Breastfeeding act of 1992 RA 9173 RA 7392 RA 7006 RA 7600 13. According to Rooming in and Breastfeeding act of 1992 infant delivered via CS can be roomed- in and breastfeed? within 3 hours after birth As the mother wish to see her baby Anytime 3 hours 14. On the 4th day postpartum, the nurse asks the new mother to describe her vaginal bleeding. The nurse should expect her to say that it is pinkish Red with clots Scant and brown Thin and white 15. A woman delivered a child 2 days ago. She is breastfeeding her child and experienced breast enorgement. Which of the following instructions can the nurse give to the mother to relieve pain and discomfort due to fullness? Wear a good, well-supporting bra Apply warm compress to breast if too full Apply cold compresses to breast if too full Do not apply any soap to your nipples 16. To promote eye to eye contact, application of eye prophylaxis could be delay? a. 6 hours after birth b. 3 hours after birth c. 2 hours after birth d. 5 hours after birth 17. Initial contact between mother and infant should take place in? a. Patients room b. Delivery room c. Nursery d. Nurses station

a. b. c. d. 2.

a. b. c. d. 3.

a. b. c. d.

4.

a. b. c. d. 5. a. b. c. d. 6.

a. b. c. d.

a. b. c. d.

a. b. c. d.

a. b. c. d.

a. b. c. d.

8.

18. Positive mother and infant reciprocity is important when a mother repeated verbal or visual attempts to reinitiate the infants attention is ineffective this could be: a. A sign of rejection b. Normal and in turning away phase c. She doesnt like her baby d. She is depressed 19. Because this is womans third child, the nurse should not be surprised if she explains of Chest pain Afterbirth cramps Burning on urination Chills 20. Motivating mother for breastfeeding starts as early as a. Before conception b. Before true labor starts c. Postpartum period d. Prenatal period 21. Based on the critical time periods, one can conclude that bonding is not to be started during the birth process but long before it. During prenatal period one way which the care giver can promote attachment between parents and the fetus is to: a. Instruct to touch the belly every morning b. Talk to the baby inside the mothers womb c. Allow parents to listen to the fetal heart beats d. Feel the movement of the baby 22. In encouraging breastfeeding your initial action would be? a. Motivate the mother b. Explain the advantages and disadvantages c. Proper technique d. Psychological support 23. Breastmilk promotes better brain development this is because of the substance that can be found in the breastmilk called a. Cholesterol b. Lactose c. Taurine d. Lactoferrin 24. To provide supportive environment rich in encouragement and assistance the nurse must? a. Start the breastfeeding early b. Be present to assist during the entire initial feeding c. Giving instructions d. Explain the advantages 25. A woman who delivered normally per vagina is expected to void within ___ hours after delivery. A.3 hrs B.4 hrs. C.6-8 hrs D.12-24 hours 18. The lochia on the 10-21 days after delivery is characterized as A.Pinkish with some blood clots B.Whitish with some mucus C.Reddish with some mucus D.Serous with some brown tinged mucus 43. Which of the following is an abnormal vital sign in postpartum?

A.Pulse rate between 50-60/min B.BP diastolic increase from 80 to 95mm Hg C.BP systolic between 100-120mm Hg D.Respiratory rate of 16-20/min 20. . When the uterus is firm and contracted after delivery but there is no vaginal bleeding, the nurse should suspect a. b. c. d. Laceration of soft tissues of the cervix and vagina Vulvar hematoma Uterine inversion Uterine hypercontractility

a. b. c. d.

21. The following are interventions to make the fundus contract postpartally EXCEPT A.Make the baby suck the breast regularly B.Apply ice cap on fundus C.Massage the fundus vigorously for 15 minutes until contracted D.Give oxytocin as ordered 22. . The following are nursing interventions to relieve episiotomy wound pain EXCEPT A.Giving analgesic as ordered B.Sitz bath C.Perineal heat D.Perineal care 23. . Postpartum blues is said to be caused by the rapid shift of hormones except a. b. c. d. Estrogen Progesterone Prolactin Hormone Placental Lactogen

25. On the second day postpartum, the nurse asks the new
a. b. c. d. mother to describe her vaginal bleeding. The nurse should expect her to say that it is Red and moderate Red with clots Scant and brown Thin and white Juana Castro is one week post partum. She visits the clinic because of fever and intense pain over the episiotomy site.

26. What will be the FIRST action of the nurse?

a. b. c. d. Assess for the sign of anemia Determine nutritional status Ask for the possibility of sexual intercourse Elicit history of delivery

27. Upon inspection, the nurse observes an edematous

a. b. c. d.

episiotomy site, which of the following interventions will you first apply? Administer antimicrobials as ordered Expose the wound to perilight Cleanse the episitomy with iodine solution Give oral analgesic but does not last longer than how many hours? 48 12 10 24

28. Breast engorgement can also cause temperature elevation,

a. b. c. d.

Mrs. Marth Duque , a 35 y/o G4P4 expressed her desire to undergo BTL. Her youngest child is one year old.

b. c. d. a. b. c. d.

29. In counseling Mrs. Duque and her husband about BTL

which of the following should be the main focus of the nurse? a. Review family planning and personal circumstances that could affect their decision b. Motivate the couple accept the technology c. Assist the couple to make sound, well informed decision to undergo the procedure d. If the couple has any doubt, offer another contraceptive method. 30. After sterilization, which of the following should be avoided by Mrs. Duque? a. Take medications as ordered b. Shower anytime, but keep the incision site dry for 7 days c. Resume sexual relations with husband d. Lift her youngest child

a. b. c. d. a. b. c. d.

31. Which of the following is not true in BTL?

a. b. c. d.

a. b. c. d.

Allows immediate sterility Does not interrupt sexual activities Irreversible Very effective and safe 32. Mrs. Duque asks, will it be possible for me to get pregnant after the procedure? The best response of the nurse will be: The doctors here are all specialist, I wouldnt worry if I were you. absolutely not, this is a permanent sterility There are some reports of women getting pregnant, but this is comparatively rare. What made you ask?

DMPA Progestine only pills None of the above 39. Which among the following is/ are contraindication/s for the use of injectable contraceptives obsessed patient history of jaundice irregular menstrual date all of these 40. A woman comes to the clinic in the 13th day of her cycle. She wants to use contraceptives pills for family planning. You will advise the following EXCEPT wait for her next cycle start her on contraceptive pills advise use of condom for this month tell the couple to abstain until the next menses 41. The milk ejecting hormone is oxytocin prolactin progesterone estrogen

42. On the 2nd day postpartum, Mrs. Gold has difficulty

a. b. c. d.

urinating, you Palpate her abdomen for bladder distention and confirm its diagnosis as a nurse your initial action would be Stimulate voiding Refer to physician Catheterize All of the above

43. What type of immunoglobulin is passed to the baby

during breastfeeding? a. b. c. d. IgG IgM IgA Ig E

33. Other methods of contraception are explored, Mr.

a. b. c. d. a. b. c. d. a. b. c. d.

Duque expresses his non- preference for vasectomy. Which of the following is the main reason why this method is not popular choice among men? Very costly Restoration of fertility does not always succeed Sterility is not immediate Diminishes macho image 34. Main advantage of vasectomy is reversal procedure cannot assure fertility it causes impotence the vas deferens can not be connected wife can still get pregnant 35. Candidates for postpartum tubal ligation should defer the procedure for these Except psychosis mild hypertension prolonged rupture of membrane puerperal fever 36. Which of the following cause failure of bilateral tubal ligation a. spontaneous re anastomosis b. luteal phase pregnancy c. surgical error d. all of these Mrs. Ramos a 2 weeks postpartum mother fully breastfeeding asked the nurse about LAM method of family planning

44. This immunoglobulin has antiviral and antigenica. b. c. d. inhibiting properties and is active against certain bacteria like E. coli Clostridium tetani, Salmonella All of the above

45. Narda A 17 year old single high school student come

a. b. c. d.

to your office and request for contraception. You will? give oral contraceptives advise condom use insert an IUD provide counseling about reproductive health Mrs Seigle, a primipara, has been transferred from labor and delivery to the post-partal unit. She had a vaginal delivery of a 7 pound girl

46. As you check Mrs Seigle at four post delivery, you find
a. b. c. d.

37. She asked about the return of her menstruation, your

a. b. c. d. correct response would be. 2 -3 months 10 weeks 6-8 months 10 months 38. During counseling sessions she asked about any alternative method that can be used by lactating mothers your answers would include: IUD

a.

a. b. c. d.

her uterus to be boggy in consistency and to the left of the mid line. Your initial action is gently massage her fundus until firm give her Methergine immediately obtain an order for oxytocic place her in Tredelenburg position 47. As you check Mrs Seigle,you find her fundus is 2 finger breaths above the umbilicus and displaced to the side .It is not as firm as you would expect,but bleeding is not excessive at this point. You also assess: possible bladder distention the time she last received Methergine whether she is breast or bottle feeding whether her infant was vertex or breech

e.

d.

48. Mrs Seigle voids 50 ml every 2 hours for about 3

a. b. c. d. a. b. c. d.

a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d.

times. On palpation, her bladder feels distended, based on this, your best intervention is to: notify the physician that she has symptoms of cistitis obtain an order to catheterize her for residual urine due to retention with overflow continue to encourage voiding because third is normal increase her fluid intake to twice what it was 49. The vagina should regain normal estrogen levels by: 2-3 weeks postpartum weeks apostpartum 5-8 weeks postpartum 6-10 weeks postpartum 50. When a primipara returns for her postpartal examination, what change has occurred that will always identify her as having borne a child? external cervical os is oval-shaped vaginal introitus is tightly contracted perineum has lost all tonicity internal cervical os is open 51. The appearance of breast milk postpartally coincides with which of the following hormone fluctuations? falling estrogen and progesterone levels, elevated prolactin increased FSH, decreased prolactin levels. increased estrogen and progesterone levels increased androgen and insulin levels 52. Colostrum has some benefits for the newborn. These include which of the following? presence of antibodies and IgA high fat and carbohydrate levels increased fluid content high levels of WBCs 53. Mrs Seigle has sore nipples, Of the following,which will be LEAST helpful for her? air exposure and/or heat lamp to her nipple s lanolin cream and/or vitamin E oil to nipples more frequent feeding for shorter time period encouraging vigorous sucking of each time period 54. Her nipples is too sore and the mother cannot feed her baby, what would be your health teaching Suspend breastfeeding for 1-2 days to give ample time for nipples to heal Expose the nipple to air for 30 mins. For faster healing Use plastic liners that comes with nursing bras Continue breastfeeding and take analgesics

a. b. c. d. a. b. c. d.

a. b. c. d. a. b. c. d.

uterine atony 58. Mrs Locsin delivered 9 lbs. infant in a quick, precipitone delivery. She had been having moderate bright red bleeding ? uterine atony vaginal hematoma cervical lacerations uterine rupture 59. Postpartal hemorrhage is BEST defined as an estimated blood loss of up to 500 cc during the first 24 hours after delivery an estimated blood loss of more than 500 cc from delivery through 28th day postpartum an estimated blood loss of more than 500 cc the first 24 hours after delivery an estimated blood loss of up to 1000 cc during the first week postpartum 60. In advent use of oral contraceptives during pregnancy may lead to: an increased risk of congenital heart defects an increased risk of spontaneous abortion an increased risk of chromosomal defects none of the above 61. Routine care of the episiotomy site and uncomplicated perineal lacerations can include: cleaning and ice cap pain control topical anesthetics all of the above

62. Tekla delivered a baby boy an hour ago, she received

morphine during delivery. Which of the following findings would alert the nurse to report to the physician. BP of 120/90 mmHg PR of 95 BPM CR of 55 PM RR 10 BPM

a. b. c. d. a. b. c. d. a. b. c. d.

63. The most common postpartum psychiatric disorder is :

Depression Mania Schizophrenia Psychosis 64. Which drug would a nurse expect to administer to a client experiencing subinvolution of the uterus? Heparin Methylergonovine Protamine Warfarin Situation: Vicky, a staff Nurse is monitoring the condition of first time mother Lorvy who has just delivered a 7lb baby boy.

55. She has also been complaining about the after pains

a. b. c. d.

a. b. c. d.

a. b. c.

it occur while breastfeeding and questions, you about them. You explain to her that they are due to the fact that: the baby is sucking too vigorously and should breastfeed more often the baby's sucking stimulates the uterus to contract she is tense during breastfeeding resulting in uterine spasms she is probably internalizing her labor experience of feeding 56. Which of the following postpartal clients is most likely to hemorrhage Mrs Jones delivered twins weighing a total of 12 lbs her labor record noted that she had polydramnios Mrs. Chambers delivered 7 lbs. boy vaginally Mrs Cone is 12 hours post delivery. Her fundus is firm Mrs David's lochia is dark red, of moderate amount with no clots 57. Mrs Codinera complains of severe pain in the upper vaginal area and a sense of fullness. Her uterus is firm, her lochia is of normal amount but her BP has dropped somewhat over the past 24 hours. Which of the following postpartal complications do you suspect? uterine rupture vaginal hematoma retained placental fragments

65. In view of the effects of labor, Vicky understands that

1. 2. 3. 4. a. b. c. d. the bladder of her patient is in a condition of: Over distention Under distention Complete emptying Incomplete emptying 1, 3 2, 4 1, 4 2, 3