September 2012 General Starter to Midwifery Quiz Q&A

1 What clinical experiences are needed under EEC directives to qualify as a midwife? 5 points 100 antenatal examinations Conduct 40 births (which this cannot be reached owing to an lack of women in labour it may be reduced to a minimum of 30, providing you assist with 20 further cases) Care of 40 pregnant women at risk 100 postnatal examinations of each mother and baby 2 You meet Sally and book her and she agrees to be your student continuity what can she expect from you? 4 points That you will care for her under the supervision of a registered midwife, will attend as many of her antenatal check ups as possible (and will catch up when you cant), you will go on call for her actual labour and birth (at term but will try to attend if premature labour) and will provide as much of her postnatal home appointments as possible 3 Name 5 areas a midwife may work in (ie antenatal clinic) you arent allowed to count antenatal clinic! (5 points) Antenatal ward Postnatal ward Labour Ward Birth Centre Community Fetal Medicine or any others you can think of 4 Harriet is pregnant for the 4th time, and for the first time has got to full term, her first pregnancy she lost at 22 weeks, her second she had a cervical cerclage put in but her waters broke at 25 weeks and her son was born soon after, he has cerebral palsy as a result of the prematurity, last time she conceived twins but miscarried at 9 weeks. What is her gravida and parity? (2points) G4 P1 5 Where may a woman plan to give birth? 4 points Home Standalone Birth Centre Alongside Midwifery Led Unit Labour ward/hospital 6 What does Dr M C Q Bravado stand for, and what is its use? (9 points) For interpreting CTGS Dr define risk M movements C contractions Q quality Bra baseline rate

V- variability A accelerations D decelerations O overall impression and plan 7 Your colleague calls you into a labour room as Saras baby is about to be born and she wants a second midwife. What is the second midwifes role? (3 points) To resuscitate baby if needed To give oxytoxic drug if active management of third stage To support the first midwife 8 Your mentor asks you to crash bleep the paeds what does she want you to do and why? (5 points) A baby needs resuscitating and possible transport to SCBU Ring the emergency number (usually 222) and ask for the NEONATAL emergency team this compromises of senior paediatrican, SCBU nurse, anaesthetist and transport incubator 9 Lucy has just had a normal birth, without regional anaesthetic what are her options for the third stage of labour? (7 points) Timing of cord clamping immediate, delayed, after pulsation, once delivered or lotus birth Management active or physiological 10 You have been caring for Stacey in labour for the past hour, when you read her birth plan you notice she has written that she doesnt want students present what do you do? (2 points) Acknowledge this to Stacey and partner and ask if she wants you to leave Bonus What should you do if a friend/relative asks you to look after her in her pregnancy and labour? (4 points) Think hard about it it can be very rewarding but is a big commitment and responsibility if something went wrong it could affect your relationship forever you can say no if you want! Explain that it would need to be under the supervision of a registered midwife Check with the university Check with trust where she is having her baby (if you arent a student of that trust it may be a no)

April 2013 Quiz Questions and Answers Postnatal Community Care

1. What should a midwife be asking a woman at each postnatal visit? (6) (1 point for each of the following answers maximum of six points) About her physical and emotional health and well-being, assessing: i. Vaginal loss ii. Perineum discuss signs of infection and hygiene iii. Breast health discuss signs of mastitis iv. Support network v. Emotional attachment

About her babys health and well-being, especially: i. Feeding giving advice on breastfeeding/formula feeding as appropriate ii. Jaundice iii. Stools iv. Cord care v. Eye care 2. You visit Salma on day 3 postnatally; she is struggling with breastfeeding and thinks her baby is not getting enough milk. What can you do to reassure her that her baby is successfully breastfeeding (15) Observe a feed and evaluate attachment and positioning (2) Weigh the baby to assess weight gain/loss (up to 10% loss can be considered physiologically normal at this stage) (2) Swallowing is audible and visible (1) The baby is relaxed during the feed (1) The babys mouth is moist (1) The baby has plenty of wet and dirty nappies (1) The babys stools are soft and change colour (black/meconium, changing/green, yellow) (2) The baby has more of the areola showing at the top lip than the bottom lip (moustache not beard!) (1) The babys chin is touching the breast with the bottom lip rolled down (1) The nipple is not getting damaged and sore (1) The baby is relaxed at the end of the feed (1) The breast softens during the feed (1) 3. You visit Jane on day 6 postnatally; she is experiencing increased discomfort on her perineum where she had an episiotomy sutured. She feels slightly unwell but has associated this with not getting much sleep. She reports a smelly discharge on her pad. What do you do next? (10) Offer to assess the perineum (1) Evaluate for signs of infection, wound breakdown, inadequate repair or inadequate healing (4) Discuss perineal hygiene (1) Take a swab to assess for wound infection if it is breaking down, moist or has a discharge (2) Arrange prophylactic antibiotics from her GP (1) Advise analgesia as appropriate (1) Arrange a follow up visit (1) 4. On arrival at Veronicas home for her first visit following discharge from the postnatal ward on day 1 postnatally you find the baby swaddled in several blankets and a baby nest on her side in the moses basket, which is situated in front of the radiator. What advice do you give Veronica? (4) That the current advice re SIDS is to not overwrap/overheat the baby The room temperature should be between 16-20 degrees Celsius, and that the baby should only need one light blanket The baby does not need quilts/pillows The baby should be placed on her back in the feet to foot position

Bonus points for discussion of other risk factors for SIDS (smoking, sleeping on the sofa etc) 5. You are going to visit Emily who has had a normal birth and six hour discharge from the birth centre the previous day. On arrival you find Emily in bed very distressed with afterpains. She is sweaty and pale and unable to lie still on the bed, she can just about talk coherently through the pain. Her mum tells you that the pains have been increasing through the night and is asking you to hurry up and help her. What do you think is happening and what actions do you take? (19) Suspected secondary PPH, retained products or uterine infection (3) Take basic observations BP, Pulse, Respiration, Temperature (Signs of infection Tachycardia and low grade pyrexia) (3) Assess vaginal loss (3) Attempt to palpate Emilys uterus to assess if it is contracted (rub up contraction if not contracted and if Emily is able to cope with the pain, expel any clots if able to) (2) Try to keep Emily and her mum calm, explain what you think is happening and what you are going to do (1) Encourage Emily to breathe deeply and slowly (1) Call for an ambulance and offer analgesia if available (entonox once ambulance present) (2) If equipment available and appropriately trained gain consent to insert intravenous cannula, if not ask paramedic to do this (1) Call Labour ward and advise them that you are sending/bringing Emily In (1) Ensure the baby is also accompanying Emily to the hospital (1) Dont forget to document everything in Emilys postnatal notes! (1) 6. In the most recent CMACE report (2011) what was the biggest cause of maternal death postnatally and how can we prevent this? (7) Sepsis, primarily genital tract and uterine infections. The main source seemed to be Strep A infection, all of the women who died had been in contact with or had themselves had a sore throat. (2) The main symptoms are feeling unwell, pyrexia and tachycardia (3) Prevention: good hygiene and being alert to the symptoms of infection (2) 7. What signs can alert us that a woman may possibly be suffering from postnatal depression? (10) (1 point for each correct answer) Anxiety Excessive maternal crying Panic attacks Irritability Lack of concentration Rejection of partner or baby Inappropriate or obsessional thoughts Excessive need for sleep Guilt and anxiety about the baby/birth Pre-occupied with the babys health 8. Magda tells you that she is co-sleeping with her baby as it makes breastfeeding at night easier, what advice do you give to ensure that she does not put her baby at risk? (8) Co-sleeping should be discouraged if:

The mother or her partner smokes (1) Either of them have drunk alcohol (1) Either of them have taken any drug (legal or illegal) that makes them drowsy (1) If either of them have a medical condition that affects their awareness (1) If they are overtired to the point that they would not respond to their baby (1) Never sleep with baby on a sofa or in a chair (1) Ensure the baby is flat on their back, with no pillow and cant wriggle down under the duvet/blankets (1) Bonus: bottle-feeding mothers are advised not to bed-share as they are more likely to turn their back on their baby after falling asleep and sleep deeper. (1) 9. Name five risk factors for neonatal jaundice (5) (1 point for each of the following answers maximum of 5 points) Gestational age of less than 38 weeks History of previous sibling requiring phototherapy treatment Maternal intention to breastfeed Jaundice visible within 24 hours Rhesus incompatibility Birth trauma (Forceps, cephalhaematoma, caput succedaneum) Low birth weight Prolonged rupture of membranes Increased weight loss, delayed feeding and dehydration 10. You visit baby Sophie on day 6 to do her newborn blood spot test and notice that she has a sticky eye, what advice do you give to Sophies mum? (4) Gently bathe the eye with cooled boiled water as needed, using a separate piece of cotton wool for each wipe. Do not use the same piece of cotton wool on both eyes as the infection could be transferred If the woman is breastfeeding you could mention that anecdotally breast-milk used as eyedrops may help, although there is no research to support this If the eye shows no signs of improvement or worsens then to see the GP Bonus question: What is the earliest time a woman can be discharged from communitybased postnatal care providing all is well with her and her baby? Answer: 10 days

March 2013 Obstetric Emergencies

Q1 You are in Labour Ward and caring for Sarah who is 35 and has a BMI of 36. She is being induced for post dates and has laboured well on syntocinon infusion. You VE her and confirm full dilatation. She commences pushing and you notice that the 2nd stage is slow, there is slow delivery of the face and chin, the head fails to restitute and is tight against the perineum. What is your management of this situation? 25 Points

Answer: Suspect shoulder dystocia (1)- commence Helperr Mnemonic (1), each manoeuver should be undertaken for 30 seconds before moving on to the next one. (1)

Pull the emergency buzzer. (1) Explain to Sarah that you think the baby's shoulder is stuck and you have called for help and the room will fill with people. (1) Evaluate the need for an epis. (1) SD is a bony problem, the epis will not release the shoulders however is to prevent soft tissue trauma and create more room for the operator to perform internal manoeuvers. (2) With assistance from another midwife, assist Sarah to move into McRoberts position, by bringing back her legs to widen the pelvic diameters and flatten the sacrum. (3) Ask Sarah to continue pushing when she has a contraction, apply gentle to moderate traction to the fetal head to attempt delivery of the fetus. Ensure that care is taken to prevent brachial plexus injury. (2) If unsuccessful, ask another member of staff to commence continuous suprapubic pressure. (1) If unsuccessful, continue with 30 seconds of rocking suprapubic pressure. (1) Should this manouever be unsuccesful then you may consider internal manoeuvers or rolling the woman onto all fours (1) also known as the Gaskin manoeuver. (1) Commence internal manoeuvers, (1) usually commence with Rubin II manoeuver. (1) If unsuccessful, attempt the woods manoeuvre (1) and then attempt the reverse woods manoeuvre. (1) Should the manoeuvers be unsuccessful, then again consider the gaskin manoeuvre if not already attempted. Continue by repeating all previous manoeuvers until resolution of the dystocia is achieved. (1) In extreme cases, medical staff may decide to do further manoeuvres including, cleidotomy, symphysiotomy and zavanelli manoeuvre, although the former two are most often used in developing countries and all have further risk of complications and are unlikely to save the fetus. (3)

Question 2 What is the sepsis six? 9 points The sepsis six a care bundle for management for sepsis to be used in conjunction with ABCDE, (1) Sepsis six consists of: 1.Give high flow Oxygen (1) 2. Take blood cultures (1) 3. Give IV antibiotics (1) (usually broad spectrum abx such as Gentamycin until blood cultures are back) 4. Commence IV fluid resuscitation (Hartmanns or equivalent) (1) 5. Check haemoglobin and Serum Lactate. (2) 6. Ensuring catheterisation with an indwelling catheter and urometer bag to accurately monitor hourly urine output. (1) The sepsis 6 should be implemented within 1 hour of suspected sepsis diagnosis. (1) Question 3. Name 5 risk factors for Cord Prolapse: 5 points Polyhydramnios CPD Placenta Praevia

High Parity High or ill fitting presenting part Malpresentation Prematurity Multiple Pregnancy Unstable lie All answers 1 point each, up to max of 5. Question 4 Name 5 non - pharmocolgical methods can be used to treat a pph by a midwife or by medical staff in theatre. 5 points Rubbing up contraction Emptying the urinary bladder Internal and external bimanual compression Abdominal Aortic compression Tamponade Uterine packing Pelvic vessel ligation Uterine artery embolisation Internal iliac balloon catheter B Lynch suture Hysterectomy (all answers 1 point each, up to max 5)

Question 5 What is SBAR? 5 points A method of relaying relevant information to a hcp in order to transfer or discuss care. (1) Situation Background Assessment Recommendation (1 point each) Question 6. Uterine atony is the most common cause of PPH. What drugs are commonly used in the UK to treat uterine atony and what are the correct dosages? 9 points Active management of 3rd stage 10iu Syntocinon or 1 ampoule Syntometrine (5iu Syntocinon & 500mcg Ergometrine) by IM injection (3) Further 5 iu of Syntocinon by IM injection (1) Ergometrine Maleate, 500mcg by IM injection (1) Haemabate / Carboprost, 250mcg by IM injection, can have up to 8 doses 15 minutes apart. (2) Misoprostol, 1000mcg, PR, 1 dose only, not licensed for this purpose in the UK. (2)

Question 7. What methods can be used to assist delivery of the head in a breech presentation? 11 points Mauriceau-Smellie-Veit manoeuvre: (1) Ensure the sub occipital region has delivered (1) Place the fetus on one forearm (1), place two fingers of the same hand into the vagina and onto the maxillae of the fetus (1). Place two fingers of your free hand onto the occiput (1) Flex the head by exerting pressure on the occiput (1) and apply gentle traction to deliver the head (1) The head should be delivered slowly to prevent rapid expansion of the head which could cause intracranial haemorrhage. (1) The practioner has 5 mins to safely deliver the head from time of delivery of the shoulders. (1) The Burns -Marshall manoeuvre (where the fetus was lifted by the feet) is no longer used in contemporary practice and should never be attempted by a midwife or obstetrician. (2) Question 8. Name 3 positions that could be used in the management of cord presentation or prolapse. 3 points Trendelenberg Exaggerated Sims Knee Chest 1 point for each answer. Question 9. You are caring for Louisa in recovery after an emergency caesarean section due to pre-eclampsia. Louisa is receiving a Magnesium Sulphate infusion of 1g per hour. Name 4 signs of Magnesium Sulphate toxicity. 4 points Flushing Double Vision Slurred Speech Urine output less than 100mls in 4 hours Loss of deep tendon reflexes Respiratory depression - less than 12 breaths per minute Respiratory arrest Cardiac arrest 1 point for each answer, up to max of 4. Question 10 Name 4 types of breech presentation and which is most common? 5 points Complete/flexed Frank/extended - most common 70% Footling Knee 1 point for each answer.

Bonus: What drug is used as the antidote to Magnesium Sulphate? Calcium Gluconate. 1 point

Midwifery Related Tests Quiz - July 2011

1. Anne is a Primigravida who is 8 weeks pregnant. She has been vomiting and is becoming dehydrated as cannot keep any food down. She calls out the local GP who performs Urinalysis on her urine using a dipstick. What in particular is the GP looking for to show signs of dehydration and why? A. Ketones Ketones show up on Urinalysis when the body starts using its own body fat reserves for energy because it cannot get enough glucose from consumed or readily available energy stores. 2. Anne is now 24 weeks and is at home following her routine antenatal check up with her midwife. In her notes she reads Urinalysis NAD which stands for No anomalies detected and is unsure of what NAD stands for. What could the midwife have done to better explain to Anne her Urinalysis test results? A. Followed the NMC record keeping guidelines 2009 Ensure all entries into notes are legible to the reader they are intended for. Discuss the results of any tests in full with Anne at the time they are performed and recorded. 3. Anne is now 37 weeks gestation and has attended the assessment unit following spontaneous rupture of membranes a few hours earlier. The Liquor is slightly offensive smelling and the midwife takes a blood sample to take a CRP level. What does this stand for and what would a rising CRP level indicate? A. C-Reactive Protein A rising CRP level indicates an inflammatory respose, often in response to infection. 4. Whilst in the unit, Annes full blood count is also tested and her Haemoglobin comes back at 11.8g/dl. What action would a midwife take on a haemoglobin result such as this? A. None, NICE antenatal care guidelines state that iron supplementation is only indicated if Hb levels are below 10.5g/dl after 28 weeks. The midwife can fulfil her role in promoting public health however and take the time to reassure Anne of her excellent haemoglobin levels! There are other guidelines such as WHO that state slightly different variations, and these might

be quoted. 5. Anne has just had an emergency caesarean section for fetal distress. The paediatrician in attendance at the delivery gives the baby an APGAR score of 3 at one minute. What does this test result indicate? An APGAR score is given at one minute following birth and a score of 3 or less indicates that full resuscitation is necessary which may include cardiac massage, intubation and ventilation. 6. Annes babys cord gases are analysed and the midwife is trying to interpret the results. Which aspects of a cord gas analysis are important for the midwife to look at if she is wanting to know if the newborn baby may be acidotic? pH important to diagnose fetal acidaemia 7. Anne is rhesus negative. Following delivery a kleihauer test is performed what does this look for? A. To detect if any fetal cells have crossed over into the maternal circulation. If the baby is found to be rhesus positive an injection of Anti D will be offered to the mother.

8. Anne is now at home and is 6 days postnatal. She complains of feeling clammy and the midwife takes her temperature. Anne is pyrexial with a temperature of 38.2 degrees Celsius. What might this indicate?

A. Infection, this may be from a number of sources including: - genital tract perineum, vegina, cervix, uterus. - Breasts such a mastitis - urinary system - Thrombophlebitis - Respiratory infection following a general anaesthesia or a cold. 9. In a woman with preeclampsia the obstetric team reviewing the woman will require many blood test results to gain an overview of the womans wellbeing. What test may the midwife be required to perform on a woman with suspected pre eclampsia? A. Full blood count Electrolytes Renal function tests

Liver function tests Clotting studies This is because pre eclampsia is a multi organ syndrome! 10. If a woman is found to have pre eclampsia her liver will most likely be being put under stress. This is indicated by her liver enzymes tests changing in which way? They will rise

11. Bonus Question: Is an ultrasound scan a diagnostic or screening test? A. Both!

Breastfeeding Quiz (June 2011)

1: How long does the World Health Organisation recommend breastfeeding for? To two years of age and beyond. 2: Jessica had a SVD 3 days ago, her baby Chloe has been breastfeeding well, today Jessica is feeling very weepy and her breasts are swollen, tender and Chloe is finding it difficult to latch onto the nipple. What could be happening and what advice would you give? Engorged as her milk has come in Advice is to hand express a small amount from the breast to allow Chloe to latch more easily or sit in a warm bath with flannels on the breasts 3: What are the main nutrients found in breastmilk? protein, fat, lactose, immunoglobuins. Also contained are vitamins, enzymes, certain hormones, growth factors and protective agents 4: Paula has been breastfeeding her baby Jack following a forceps delivery, you are the community midwife visiting at home on day 5. Whilst discussing breastfeeding with Paula she mentions that Jack has been feeding more frequently today and she is concerned she does not have enough milk and wonders if she should give him a bottle of artificial formula milk. What would you suggest and why? Discuss with Paula that all babies tend to have a growth spurt around day 5, explain about supply and demand and discuss the implications supplementing will have such as; leaky gut,

reduction of breast milk supply, engorgement and others 5: Samantha is breastfeeding her first baby following a caesarean section this morning. What additional support may she need and why? Due to spinal anaesthesia and her c-section wound Samantha will find it difficult to sit up and therefore position baby correctly It may be helpful to discuss other positions for Samantha to try to breastfeed in such as lying down or rugby ball position. 6: What is the Baby Friendly Initiative? When did it begin and what does it recommend? It began in 1992 and was established in conjunction with UNICEF and the WHO (additional point for mentioning UNICEF and WHO) to encourage hospitals to promote the Ten steps to successful breastfeeding and to promote practice that conforms to the International Code of Marketing Breast Milk Substitutes. It also discusses safe infant formula feeding practises. 7: Sara is 33 weeks pregnant and wants to know why she should breastfeed her baby. What information could you give? The general benefits to the infant include unlimited access to a milk which is specifically designed for them individually that is always at the correct temperature, had no additives and for which there are no concerns regarding sterility In terms of cost breastfeeding is environmentally friendly, reducing the use of heat and sterilising resources such as wood and water and limited the use of manmade materials such as tins for formula, plastic and rubber for artificial feeding equipment. If every child was breastfed it would also reduce the strain on the NHS of treating what have now become considered as 'common' childhood illnesses Health benefits to the infant include a reduction in the likelihood of contracting illnesses such as gastroenteritis, respiratory tract infections, otis media, asthma, allergies, cardiovascular disease, diabetes types one and two, necrotising entercolitis in the preterm infant and childhood cancers. Breastfeeding also reduces the risks of sudden infant death syndrome occurring Also benefits to the mother, such as reduced risks of breast cancer, weight loss etc 8: Do breast-feeding women in the UK have any legal rights? Breastfeeding women in the UK are protected in kind by the Equality Act 2010 which makes it unlawful discrimination for a woman to be asked to stop breastfeeding in a public place This does not mean that it is illegal to ask a woman to stop breastfeeding in public however. This provides protection for women feeding babies less than 6 months of age and in theory women feeding babies over this age are protected by the Sex Discrimination Act At work employers have a duty to carry out a risk assessment for all breastfeeding mothers returning to work, however there is no legal right for women to have facilities or breaks in order to continue breastfeeding. 9: Beatrice gave birth 2 days ago at home, she has been breastfeeding her daughter Florence but is finding that Florence is feeding little and often, becomes agitated and pulls off the

breast following a few sucks. Beatrices right nipple is sore and grazed and Beatrice reports it is misshapen when Florence comes off the breast. You decide to observe a feed. What signs would you look for and why? Looking for good p&a, tummy to mummy, nose to nipple, baby reaching for breast, full cheeks, lip curled under and chin tucked in. Breast moving, no noise, not painful for Beatrice after initial latch. Florences arm moving from by her face down to side throughout feed. Sucking pattern, small quick sucks at first followed by longer, slower sucks, baby falling asleep and coming off the breast by herself. 10: The baby friendly initiative does not recommend the use of dummies. Explain why. It can interfere with the mother recognising cues that the baby wishes to feed therefore jeopardising the supply and demand feature of breastfeeding Suckling on a dummy is a different way of sucking than at the breast and this can therefore interfere with getting breastfeeding established in the crucial early weeks. 11: What role can Dads play in supporting breastfeeding women? Support partner, fetch drinks, help make her comfortable, advocate her choices to others, offer encouragement, have skin to skin with the baby, bath the baby, do the household chores, cook her a nutritious meal, change nappies (points for anything really as long as question has been thought about!) BONUS: The breastfeeding initiation rate in 2010/2011 was 73.7%, whilst the continuation rate was 45.2% at 6-8 weeks. What is the most common reason cited for women stopping breastfeeding and what could you as a student midwife do to support women through this? Perceived insufficient milk supply Provide information and support around supply and demand, growth spurts, how to tell if your baby is getting enough milk, expressing, growth spurts, local support groups/peer supporters

Obstetric Emergencies Quiz (May 2011)

1 What is McRoberts position, and how does it work? A position where the woman is flat on her back with her legs abducted and flexed to as close to her shoulders as possible, this is used to aid in cases of shoulder dystocia and resolves up to 88% of them. It works by tilting the pelvis so that the symphysis pubis bone moves from diagonal to horizontal and allows the coccyx to drop to allow extra room. 2 You are attending Phoebe at a planned homebirth, she is a gravid 4 para 3 who was 7cm 2hours ago. She SROMs and a loop of cord appears at the

introitus. What do you do now? Call for help (999), VE to assess dilation - if fully dilated and head low consider getting her to push and get baby out ASAP and prepare to resuscitate (really need baby out in 7 minutes) Lift the presenting part off of the cord with your fingers. Turn her into a knee chest position (head lower than hips), Consider filling her bladder with 500mls-1litre of normal saline to lift baby out of the pelvis. 3 What is the difference between primary and secondary apnea? A baby with primary apnea has decreased tone and heartrate but respond well to stimulation and oxygen. Cord gases between 7.2 and 7.0. Secondary apnea occurs after the fetus has gone through primary apnea and then starts trying to gasp. These babies have decreased tone, heartrate and blood pressure. The cord gas pH is below 7.0. This baby will need full blown resuscitation but may not be successful. 4 Katy is in established labour. She is having an epidural sited when her waters break. As she sits back after the epidural she starts having trouble breathing and then collapses with no pulse. What may have happened? The epidural may have been sited incorrectly and have too high a block.She may have had an amniotic fluid embolism.She may have had a cardiac arrest for something completely unconnected with the pregnancy or labour.She may be allergic to the epidural drugs. 5 You are looking after a woman who has a major antepartum haemorrhage. Name 5 members of staff who you would need to call? Senior Obstetrician Obstetrician to assist (for possible lscs) Anaesthetist ODP Senior Midwife Someone to scribe Paediatrician Haematologist Porter 6 Anna is 38 weeks pregnant when she starts fitting on the antenatal ward, what do you do? Call for help Make area safe (so she cant fall off bed etc) Turn onto left lateral

Aspirate material from mouth Insert guedal airway Give oxygen Give magnesium sulphate loading dose (4-6g over 15-20minutes) if IV access available Diazepam PR if no IV access Once stable site IV access if none Catheterise Consider delivery once stable Maintain magnesium sulphate maintence dose for 24hours Monitor hourly (urine, reflexes) and 5-15minutes (BP, pulse, resps) 7 In a vaginal breech birth there is a chance that the head can become entrapped if the cervix is not completely dilated. What can be done (by obstetricians) if this happens? Duhrssens incision cutting the cervix Symphsiotomy surgically dividing the symphysis pubis. 8 You deliver a baby on labour ward and the mother has requested active third stage as you apply CCT the placenta delivers and you notice a large purply red organ attached. What now? Emergency bellExplain to woman and familyGet uterine inversion box (someone else, you dont leave her)Replace the uterus either by hand or through hydrostatic pressure (using water and a ventouse cup)Do NOT try to remove placentaUterine relexant (some sort of tocolytic or GA)Continue bimanual compression Consider theatre for surgical replacement/possible hysterectomyWhen uterus in abdomen use some oxytoxic to try and keep it in then MROP 9 What are the 4 Ts and what is the most common? The reasons for PPH Tone, Tissue, Trauma, Thrombin. Tone (uterus not contracting properly) accounts for 70% of all PPHs. 10 What is shoulder dystocia? when the shoulders do not deliver spontaneously with gentle traction. It is caused by the anterior shoulder becoming impacted against the symphysis pubis, after delivery of the head. It occurs when the breadth of the shoulders is greater than the biparietal diameter of the head. It occurs in between 0.3 1% of all births. If birth weight >4kg then 5-7% risk & birth weight <4.5kg 8-10% risk but 50% occur in normal birth weight babies Bonus what is a secondary PPH and when is it most likely to occur? A bleed of more than 500mls from the vagina more than 24 hours post delivery. Usually occurs around day 10.

Perinatal Mental Health Quiz (March 2011)

Questions and answers by the lovely Scallywag 1. Sophie is 16 weeks pregnant and attends the Antenatal Clinic complaining of feeling anxious, irritable and crying easily. Her blood tests are fine and the pregnancy is progressing well. What is the likely diagnosis? A. Antenatal Depression 2. Sophie doesnt believe that this is a real illness. What percentage of women is this condition estimated to affect? A. Around 10% 3. Laura has a history of Bipolar Disorder and takes Clozapine. At her booking appointment, she asks whether the drugs will harm her baby. What do you say? A. Clozapine is not known to have any adverse effect on pregnancy, although caution is advised 4. Laura is still concerned about possible complications due to her medication. She asks if she should stop taking them. What do you suggest? A. No. Laura shouldnt stop taking her medication without first seeking the advice of her GP or Psychiatrist if she has one 5. Amy has a history of substance misuse. She is in early labour and admits that she has smoked cannabis regularly throughout her pregnancy, and had a joint a couple of hours ago to help ease the pain. She wants to know if she can have some Pethidine. Are there any dangers associated with giving Pethidine? What should Amy be warned about? A. Although cannabis can increase the effects of Pethidine, there is no evidence that it is dangerous, so Pethidine can be safely given. Amy should be warned that she may feel particularly woozy or disorientated due to the effects of both drugs 6. After a short labour, Amys baby son is born. What problems may her son experience in childhood due to her cannabis use during pregnancy? A. Slow physical growth, asthma, SIDS, learning difficulties, behavioural difficulties, eyesight problems, heart defects 7. Trish gave birth naturally three days ago to a baby girl. On a postnatal visit at her home, she reports feeling tearful, tired and emotional. What could possibly be wrong and what would you suggest to Trish? A. Baby Blues. Reassure Trish that its normal around 3-5 days after birth. Recommend that she gets as much help as possible with the baby, and gets plenty of rest. This feeling will usually pass in a few days

8. Trish contacts you ten days later, claiming that shes feeling worse and doesnt think she can cope. She is constantly tearful and anxious and is finding it hard to get out of bed. What is a possible diagnosis, and approximately what percentage of women experience this problem? A. Postnatal Depression. Between 10-15% 9. Joan gave birth to twins three weeks ago and she complains to her Health Visitor of feeling extremely tired and emotional. What is the name of the test that her Health Visitor asks her to complete? A. The Edinburgh Postnatal Depression Scale 10. A few days later, Joans husband calls you in distress. Joan is suffering from delusions that one of her twins is possessed by the devil, and she has spoken about drowning him in the bath. What could be the diagnosis? What professionals or agencies may be involved in her care? A. Puerperal Psychosis. GP, Community Psychiatric Nurse, Community Mental Health Team, Health Visitor, Social Services Bonus. What are the known risk factors for Postnatal Illness? A. Hormonal imbalance, history of mental illness / depression, fertility problems, twins / multiple births, previous miscarriage / stillbirth, unwanted pregnancy, single parent, young mother, traumatic birth, bereavement, domestic abuse, financial worries, relationship problems, housing problems

Maternity Assessment Q&A (February 2011)

You are working as a student midwife on the Maternity Day Assessment Unit and you have just started your shift so check the diary to see what experience you are likely to gain today. 1)09.00 Anna (31)arrives with a letter outlining her appointment for a 12/40 week ultrasound scan, she decided to decline screening for Downs Syndrome in this pregnancy. What is the purpose of this scan and will Anna have been given any instructions to follow prior her ultrasound scan appointment? To date the pregnancy To check there is a heartbeat and that it's in the uterus To see the number of fetuses She will be asked to have a full bladder and to bring a urine sample

2)09.40 You answer the telephone to an extremely anxious woman. Kelly (19) is pregnant with her first baby at 10/40 and in general good health. Throughout the night she has been experiencing period-like cramps and slight staining of toilet paper upon wiping. This morning the pain has increased and Kelly is reporting fresh red loss PV with some small clotting. Kelly is anxious that she is having a miscarriage. How would you advise Kelly on the telephone? Would you offer any reassurance? Ask how much blood there is Ask Kelly to come in for an ultrasound scan to see if it is miscarriage Reassure her that it isnt definitely a miscarriage but she needs to be checked to be sure. Do not tell her itll be ok 3)10.15 Kelly arrives at the MDAU with her partner, Jonathan. They are both visibly upset. How would you treat Kelly and which investigations would you undertake and why? Take a full history from Kelly regarding what happened prior to the bleed and how many weeks she thinks she is. Calm them down, offer drinks etc. Arrange ultrasound scan beta Hcg bloods to see hormone levels Arrange repeat appointment depending on results 4)11.30 Jennifer (25) has been referred to the MDAU via her Community Midwife as her blood pressure readings at her antenatal appointment was 150/95, 155/100 and 155/105 and there is ++protein in her urine. This is her 3rd pregnancy with a new partner. What could these symptoms indicate? What questions would you ask Jennifer regarding other symptoms? What would the next line of investigation be? Could be pre-eclampsia Ask re epigastric pain, headaches, odema (swelling), visual disturbances Repeat her observations for yourself Take bloods (LFTs, U&Es, FBC, Coag) Arrange for 24hour urine collection to start Review by doctor to potentially start medication immediately 5) 13.00 Belinda (33) self refers from home stating she doesnt feel right. She gives a history of feeling sick, difficulty opening bowels without discomfort, dizziness, intermittent left hand abdominal pain and a funny feeling at the shoulders. She is approx. 8 weeks pregnant and this is her 4th pregnancy.

What could this be and what are the possible long-term effects on fertility? Could be ectopic pregnancy Can reduce fertility as can cause scarring in the fallopian tube or tube may be removed 6)14.00 Gemma (26) arrives for an ultrasound scan to confirm fetal position. She is 37 weeks pregnant with her second baby. If the fetus is found to be breech What are the options available to Gemma? ECV Elective section Vaginal breech birth 7) 14.45 Stacey (16) arrives at the MDAU unannounced with her 2 year old daughter in tow. She is 30/40 pregnant with her second baby with a new partner. She smells strongly of cigarettes and gives a history of very reduced fetal movements over the last 2 days. You see from her notes that she did not attend her antenatal appointment at 28/40. What would you do for Stacey upon arrival? What advice would you give her whilst she was there? Full antenatal check (BP, urine etc) CTG Advice on the importance of attending appointments, of monitoring fetal movements and on stopping smoking 8) 15.30 Fay (29) arrives for her pre-operative assessment. This is her third pregnancy and she is having her third elective caesarean following her first baby being breech. She is 38 weeks pregnant and her caesarean section is planned for the following week. During her assessment, Fay discloses that she had a bit of snotty bloody goo in her knickers a couple of days beforehand and her back has been aching all night. She has had a dull ache in her lower abdomen with occasional sharp pains, approx. 3-4 times an hour. This has been going on for about 4 hours and she is irritable and fed up with pregnancy now. What could be the cause of Fays symptoms? What investigations might the midwife wish to do? She may be going into labour On top of the investigations for the section (ie MRSA swabs and bloods) midwife may want to do CTG and vaginal examination 9) 16.00 You take a call from Alana (30) who is complaining for extreme morning sickness. This is her first pregnancy and she is 11/40. She has been

unable to stomach any food for a couple of days and is now finding it difficult to keep down water. She is feeling very weak and dizzy and does not know what to do. You ask her to come in. What do you think Alana is suffering from? What do you expect to do for her when she arrives at the unit? Hyperemesis gravitarum Set of obs (BP, pulse) Put up fluids to hydrate her Get reviewed re medication and vitamins 10) 16.55 Just before the end of your shift you check the computer system for the results of the HVS sent to the lab earlier. The results show that there is a heavy growth of yeast and BV has been detected. What is the common name for a yeast infection and what does BV stand for? What treatment would the woman be offered for these conditions? Yeast Thrush BV Bacterial Vaginosis treatment for thrush canesten treatment for BV antibiotics BONUS Some women receive an anti-D injection at the MDAU. At what point in pregnancy would these be offered, why and to whom? Offered to rhesus negative women to prevent problems if the fetal blood mixes with the mothers blood 28, 34 weeks and after sensitizing event (ie ECV, bleed, fall)

100 Item Obstetrics-Maternal And Child Health Nursing Examination

100 Item Obstetrics-Maternal And Child Health Nursing Examination Budek http://www.pinoybsn.tk Question Pool DISCLAIMER: Care has been taken to verify that all answers and rationale below are accurate. Please comment up if you noticed any errors or contradictions to maintain accuracy and precision of the answers as not to mislead the readers. -Budek

DEGREE OF QUESTION DIFFICULTY 4 3 2 1 Very hard question, 25% Chance of answering correctly Hard question, 50% Chance of answering correctly Moderately hard question, 75% of answering correctly Easy question, 99% will answer the question correctly

Introduction: The questions are coded according to their sources and will only be for my personal reference. RED questions are original questions I created. FATIMA students READ and DIGEST each of these questions carefully. Goodluck. SITUATION : [ND89] Aling Julia, a 32 year old fish vendor from baranggay matahimik came to see you at the prenatal clinic. She brought with her all her three children. Maye, 1 year 6 months; Joy, 3 and Dan, 7 years old. She mentioned that she stopped taking oral contraceptives several months ago and now suspects she is pregnant. She cannot remember her LMP. 1. Which of the following would be useful in calculating Aling Julia's EDC? [3] A. Appearance of linea negra B. First FHT by fetoscope C. Increase pulse rate D. Presence of edema 2. Which hormone is necessary for a positive pregnancy test? [1] A. Progesterone B. HCG C. Estrogen D. Placental Lactogen 3. With this pregnancy, Aling Julia is a [1] A. P3 G3 B. Primigravida C. P3 G4 D. P0 G3 4. In explaining the development of her baby, you identified in chronological order of growth of the fetus as it occurs in pregnancy as [1] A. Ovum, embryo, zygote, fetus, infant B. Zygote, ovum, embryo, fetus, infant C. Ovum, zygote, embryo, fetus, infant D. Zygote, ovum, fetus, embryo, infant

5. Aling Julia states she is happy to be pregnant. Which behavior is elicited by her during your assessment that would lead you to think she is stressed? [3] A. She told you about her drunk husband B. She states she has very meager income from selling C. She laughs at every advise you give even when its not funny D. She has difficulty following instructions 6. When teaching Aling Julia about her pregnancy, you should include personal common discomforts. Which of the following is an indication for prompt professional supervision? [2] A. Constipation and hemorrhoids B. Backache C. Facial edema D. frequent urination 7. Which of the following statements would be appropriate for you to include in Aling Julia's prenatal teaching plan? [1] A. Exercise is very tiresome, it should be avoided B. Limit your food intake C. Smoking has no harmful effect on the growth and development of fetus D. Avoid unnecessary fatigue, rest periods should be included in you schedule 8. The best advise you can give to Aling Julia regarding prevention of varicosities is [3] A. Raise the legs while in upright position and put it against the wall several times a day B. Lay flat for most hours of the day C. Use garters with nylon stocking D. Wear support hose 9. In a 32 day menstrual cycle, ovulation usually occurs on the [2] A. 14th day after menstruation B. 18th day after menstruation C. 20th day after menstruation D. 24th day after menstruation 10. Placenta is the organ that provides exchange of nutrients and waste products between mother and fetus. This develops by [4] A. First month B. Third month C. Fifth month D. Seventh month

11. In evaluating the weight gain of Aling Julia, you know the minimum weight gain during pregnancy is [3] A. 2 lbs/wk B. 5 lbs/wk C. 7 lbs/wk D. 10 lbs/wk 12. The more accurate method of measuring fundal height is [2] A. Millimeter B. Centimeter C. Inches D. Fingerbreadths 13. To determine fetal position using Leopold's maneuvers, the first maneuver is to [1] A. Determine degree of cephalic flexion and engagement B. Determine part of fetus presenting into pelvis C. Locate the back,arms and legs D. Determine what part of fetus is in the fundus 14. Aling julia has encouraged her husband to attend prenatal classes with her. During the prenatal class, the couple expressed fear of pain during labor and delivery. The use of touch and soothing voice often promotes comfort to the laboring patient. This physical intervention is effective because [2] A. Pain perception is interrupted B. Gate control fibers are open C. It distracts the client away from the pain D. Empathy is communicated by a caring person 15. Which of the following could be considered as a positive sign of pregnancy ? [1] A. Amenorrhea, nausea, vomiting B. Frequency of urination C. Braxton hicks contraction D. Fetal outline by sonography SITUATION : [FFC] Maternal and child health is the program of the department of health created to lessen the death of infants and mother in the philippines. [2] 16. What is the goal of this program? A. Promote mother and infant health especially during the gravida stage B. Training of local hilots

C. Direct supervision of midwives during home delivery D. Health teaching to mother regarding proper newborn care 17. One philosophy of the maternal and child health nursing is [1] A. All pregnancy experiences are the same for all woman B. Culture and religious practices have little effect on pregnancy of a woman C. Pregnancy is a part of the life cycle but provides no meaning D. The father is as important as the mother 18. In maternal care, the PHN responsibility is [2] A. To secure all information that would be needing in birth certificate B. To protect the baby against tetanus neonatorum by immunizing the mother with DPT C. To reach all pregnant woman D. To assess nutritional status of existing children 19. This is use when rendering prenatal care in the rural health unit. It serves as a guide in Identification of risk factors [1] A. Underfive clinic chart B. Home based mother's record C. Client list of mother under prenatal care D. Target list of woman under TT vaccination 20. The schedule of prenatal visit in the RHU unit is [4] A. Once from 1st up to 8th month, weekly on the 9th month B. Twice in 1st and second trimester, weekly on third trimester C. Once in each trimester, more frequent for those at risk D. Frequent as possible to determine the presence of FHT each week SITUATION : Knowledge of the menstrual cycle is important in maternal health nursing. The following questions pertains to the process of menstruation 21. Menarche occurs during the pubertal period, Which of the following occurs first in the development of female sex characteristics? [2] A. Menarche B. Accelerated Linear Growth C. Breast development D. Growth of pubic hair 22. Which gland is responsible for initiating the menstrual cycle? [3] A. Ovaries

B. APG C. PPG D. Hypothalamus 23. The hormone that stimulates the ovaries to produce estrogen is [1] A. GnRH B. LH C. LHRF D. FSH 24. Which hormone stimulates oocyte maturation? [2] A. GnRH B. LH C. LHRF D. FSH 25. When is the serum estrogen level highest in the menstrual cycle? [4] A. 3rd day B. 13th day C. 14th day D. End of menstrual cycle 26. To correctly determine the day of ovulation, the nurse must [2] A. Deduct 14 days at the mid of the cycle B. Subtract two weeks at cycle's end C. Add 7 days from mid of the cycle D. Add 14 days from the end of the cycle 27. The serum progesterone is lowest during what day of the menstrual cycle? [4] A. 3rd day B. 13th day C. 14th day D. End of menstrual cycle 28. How much blood is loss on the average during menstrual period? [4] A. Half cup B. 4 tablespoon C. 3 ounces D. 1/3 cup

29. Menstruation occurs because of which following mechanism? [2] A. Increase level of estrogen and progesterone level B. Degeneration of the corpus luteum C. Increase vascularity of the endothelium D. Surge of hormone progesterone 30. If the menstrual cycle of a woman is 35 day cycle, she will approximately [2] A. Ovulate on the 21st day with fertile days beginning on the 16th day to the 26th day of her cycle B. Ovulate on the 21st day with fertile days beginning on the 16th day to the 21th day of her cycle C. Ovulate on the 22st day with fertile days beginning on the 16th day to the 26th day of her cycle D. Ovulate on the 22st day with fertile days beginning on the 14th day to the 30th day of her cycle SITUATION : Wide knowledge about different diagnostic tests during pregnancy is an essential arsenal for a nurse to be successful. 31. The Biparietal diameter of a fetus is considered matured if it is atleast [4] A. 9.8 cm B. 8.5 cm C. 7.5 cm D. 6 cm 32. Quickening is experienced first by multigravida clients. At what week of gestation do they start to experience quickening? [4] A. 16th B. 20th C. 24th D. 28th 33. Before the start of a non stress test, The FHR is 120 BPM. The mother ate the snack and the practitioner noticed an increase from 120 BPM to 135 BPM for 15 seconds. How would you read the result? [3] A. Abnormal B. Non reactive C. Reactive D. Inconclusive, needs repeat 34. When should the nurse expect to hear the FHR using a fetoscope? [4]

A. 2nd week B. 8th week C. 2nd month D. 4th month 35. When should the nurse expect to hear FHR using doppler Ultrasound? [4] A. 8th week B. 8th month C. 2nd week D. 4th month 36. The mother asks, What does it means if her maternal serum alpha feto protein is 35 ng/ml? The nurse should answer [4] A. It is normal B. It is not normal C. 35 ng/ml indicates chromosomal abberation D. 35 ng/ml indicates neural tube defect 37. Which of the following mothers needs RHOGAM? [1] A. RH + mother who delivered an RH - fetus B. RH - mother who delivered an RH + fetus C. RH + mother who delivered an RH + fetus D. RH - mother who delivered an RH - fetus 38. Which family planning method is recommended by the department of health more than any other means of contraception? [4] A. Fertility Awareness Method B. Condom C. Tubal Ligation D. Abstinence 39. How much booster dose does tetanus toxoid vaccination for pregnant women has? [4] A. 2 B. 5 C. 3 D. 4 40. Baranggay pinoybsn.tk has 70,000 population. How much nurse is needed to service this population? [4]

A. 5 B. 7 C. 50 D. 70 SITUATION : [ND2I246] Reproductive health is the exercise of reproductive right with responsibility. A married couple has the responsibility to reproduce and procreate. 41. Which of the following is ONE of the goals of the reproductive health concept? [3] A. To achieve healthy sexual development and maturation B. To prevent specific RH problem through counseling C. Provide care, treatment and rehabilitation D. To practice RH as a way of life of every man and woman 42. Which of the following is NOT an element of the reproductive health? [4] A. Maternal and child health and nutrition B. Family planning C. Prevention and management of abortion complication D. Healthy sexual development and nutrition 43. In the international framework of RH, which one of the following is the ultimate goal? [3] A. Women's health in reproduction B. Attainment of optimum health C. Achievement of women's status D. Quality of life 44. Which one of the following is a determinant of RH affecting woman's ability to participate in social affairs? [3] A. Gender issues B. Socio-Economic condition C. Cultural and psychosocial factors D. Status of women 45. In the philippine RH Framework. which major factor affects RH status? [4] A. Women's lower level of literacy B. Health service delivery mechanism C. Poor living conditions lead to illness D. Commercial sex workers are exposed to AIDS/STD. 46. Which determinant of reproductive health advocates nutrition for better health

promotion and maintain a healthful life? [4] A. Socio-Economic conditions B. Status of women C. Social and gender issues D. Biological, Cultural and Psychosocial factors 47. Which of the following is NOT a strategy of RH? [3] A. Increase and improve contraceptive methods B. Achieve reproductive intentions C. Care provision focused on people with RH problems D. Prevent specific RH problem through information dessemination 48. Which of the following is NOT a goal of RH? [3] A. Achieve healthy sexual development and maturation B. Avoid illness/diseases, injuries, disabilities related to sexuality and reproduction C. Receive appropriate counseling and care of RH problems D. Strengthen outreach activities and the referral system 49. What is the VISION of the RH? [2] A. Attain QUALITY OF LIFE B. Practice RH as a WAY OF LIFE C. Prevent specific RH problem D. Health in the hands of the filipino SITUATION : [SORANGE19] Baby G, a 6 hours old newborn is admitted to the NICU because of low APGAR Score. His mother had a prolonged second stage of labor 50. Which of the following is the most important concept associated with all high risk newborn? [1] A. Support the high-risk newborn's cardiopulmonary adaptation by maintaining adequate airway B. Identify complications with early intervention in the high risk newborn to reduce morbidity and mortality C. Assess the high risk newborn for any physical complications that will assist the parent with bonding D. Support mother and significant others in their request toward adaptation to the high risk newborn 51. Which of the following would the nurse expect to find in a newborn with birth asphyxia? [1]

A. Hyperoxemia B. Acidosis C. Hypocapnia D. Ketosis 52. When planning and implementing care for the newborn that has been successfully resuscitated, which of the following would be important to assess? [1] A. Muscle flaccidity B. Hypoglycemia C. Decreased intracranial pressure D. Spontaneous respiration SITUATION : [P-I/46] Nurses should be aware of the different reproductive problems. 53. When is the best time to achieve pregnancy? [2] A. Midway between periods B. Immediately after menses end C. 14 days before the next period is expected D. 14 days after the beginning of the next period 54. A factor in infertility maybe related to the PH of the vaginal canal. A medication that is ordered to alter the vaginal PH is: [2] A. Estrogen therapy B. Sulfur insufflations C. Lactic acid douches D. Na HCO3 Douches 55. A diagnostic test used to evaluate fertility is the postcoital test. It is best timed [2] A. 1 week after ovulation B. Immediately after menses C. Just before the next menstrual period D. Within 1 to 2 days of presumed ovulation 56. A tubal insufflation test is done to determine whether there is a tubal obstruction. Infertility caused by a defect in the tube is most often related to a [3] A. Past infection B. Fibroid Tumor C. Congenital Anomaly D. Previous injury to a tube 57. Which test is commonly used to determine the number, motility and activity of sperm is

the [2] A. Rubin test B. Huhner test C. Friedman test D. Papanicolau test 58. In the female, Evaluation of the pelvic organs of reproduction is accomplished by [2] A. Biopsy B. Cystoscopy C. Culdoscopy D. Hysterosalpingogram 59. When is the fetal weight gain greatest? [3] A. 1st trimester B. 2nd trimester C. 3rd trimester D. from 4th week up to 16th week of pregnancy 60. In fetal blood vessel, where is the oxygen content highest? [3] A. Umbilical artery B. Ductus Venosus C. Ductus areteriosus D. Pulmonary artery 61. The nurse is caring for a woman in labor. The woman is irritable, complains of nausea and vomits and has heavier show. The membranes rupture. The nurse understands that this indicates [1] A. The woman is in transition stage of labor B. The woman is having a complication and the doctor should be notified C. Labor is slowing down and the woman may need oxytocin D. The woman is emotionally distraught and needs assistance in dealing with labor SITUATION : [J2I246] Katherine, a 32 year old primigravida at 39-40 weeks AOG was admitted to the labor room due to hypogastric and lumbo-sacral pains. IE revealed a fully dilated, fully effaced cervix. Station 0. 62. She is immediately transferred to the DR table. Which of the following conditions signify that delivery is near? [2] I - A desire to defecate II - Begins to bear down with uterine contraction

III - Perineum bulges IV - Uterine contraction occur 2-3 minutes intervals at 50 seconds duration A. I,II,III B. I,II,III,IV C. I,III,IV D. II,III,IV 63. Artificial rupture of the membrane is done. Which of the following nursing diagnoses is the priority? [2] A. High risk for infection related to membrane rupture B. Potential for injury related to prolapse cord C. Alteration in comfort related to increasing strength of uterine contraction D. Anxiety related to unfamiliar procedure 64. Katherine complains of severe abdominal pain and back pain during contraction. Which two of the following measures will be MOST effective in reducing pain? [4] I - Rubbing the back with a tennis ball II- Effleurage III-Imagery IV-Breathing techniques A. II,IV B. II,III C. I,IV D. I,II 65. Lumbar epidural anesthesia is administered. Which of the following nursing responsibilities should be done immediately following procedure? [1] A. Reposition from side to side B. Administer oxygen C. Increase IV fluid as indicated D. Assess for maternal hypotension 66. Which is NOT the drug of choice for epidural anesthesia? [4] A. Sensorcaine B. Xylocaine C. Ephedrine D. Marcaine SITUATION : [SORANGE217] Alpha, a 24 year old G4P3 at full term gestation is brought to the ER after a gush of fluid passes through here vagina while doing her holiday shopping.

67. She is brought to the triage unit. The FHT is noted to be 114 bpm. Which of the following actions should the nurse do first? [2] A. Monitor FHT ever 15 minutes B. Administer oxygen inhalation C. Ask the charge nurse to notify the Obstetrician D. Place her on the left lateral position 68. The nurse checks the perineum of alpha. Which of the following characteristic of the amniotic fluid would cause an alarm to the nurse? [1] A. Greenish B. Scantly C. Colorless D. Blood tinged 69. Alpha asks the nurse. "Why do I have to be on complete bed rest? I am not comfortable in this position." Which of the following response of the nurse is most appropriate? [3] A. Keeping you on bed rest will prevent possible cord prolapse B. Completed bed rest will prevent more amniotic fluid to escape C. You need to save your energy so you will be strong enough to push later D. Let us ask your obstetrician when she returns to check on you 70. Alpha wants to know how many fetal movements per hour is normal, the correct response is [4] A. Twice B. Thrice C. Four times D. 10-12 times 71. Upon examination by the obstetrician, he charted that Alpha is in the early stage of labor. Which of the following is true in this state? [1] A. Self-focused B. Effacement is 100% C. Last for 2 hours D. Cervical dilation 1-3 cm SITUATION : Maternal and child health nursing a core concept of providing health in the community. Mastery of MCH Nursing is a quality all nurse should possess. 72. When should be the 2nd visit of a pregnant mother to the RHU? [2]

A. Before getting pregnant B. As early in pregnancy C. Second trimester D. Third trimester 73. Which of the following is NOT a standard prenatal physical examination? [1] A. Neck examination for goiter B. Examination of the palms of the hands for pallor C. Edema examination of the face hands, and lower extremeties D. Examination of the legs for varicosities 74. Which of the following is NOT a basic prenatal service delivery done in the BHS? [2] A. Oral / Dental check up B. Laboratory examination C. Treatment of diseases D. Iron supplementation 75. How many days and how much dosage will the IRON supplementation be taken? [4] A. 365 days / 300 mg B. 210 days / 200 mg C. 100 days/ 100mg D. 50 days / 50 mg 76. When should the iron supplementation starts and when should it ends? [4] A. 5th month of pregnancy to 2nd month post partum B. 1st month of pregnancy to 5th month post partum C. As early in pregnancy up to 9th month of pregnancy D. From 1st trimester up to 6 weeks post partum 77. In malaria infested area, how is chloroquine given to pregnant women? [4] A. 300 mg / twice a month for 9 months B. 200 mg / once a week for 5 months C. 150 mg / twice a week for the duration of pregnancy D. 100 mg / twice a week for the last trimester of pregnancy 78. Which of the following mothers are qualified for home delivery? [2] A. Pre term B. 6th pregnancy C. Has a history of hemorrhage last pregnancy D. 2nd pregnancy, Has a history of 20 hours of labor last pregnancy.

79. Which of the following is not included on the 3 Cs of delivery? [2] A. Clean Surface B. Clean Hands C. Clean Equipments D. Clean Cord 80. Which of the following is unnecessary equipment to be included in the home delivery kit? [4] A. Boiled razor blade B. 70% Isopropyl Alcohol C. Flashlight D. Rectal and oral thermometer SITUATION : [NBLUE166] Pillar is admitted to the hospital with the following signs : Contractions coming every 10 minutes, lasting 30 seconds and causing little discomfort. Intact membranes without any bloody shows. Stable vital signs. FHR = 130bpm. Examination reveals cervix is 3 cm dilated with vertex presenting at minus 1 station. 81. On the basis of the data provided above, You can conclude the pillar is in the [1] A. In false labor B. In the active phase of labor C. In the latent phase of labor D. In the transitional phase of labor 82. Pitocin drip is started on Pilar. Possible side effects of pitocin administration include all of the following except [3] A. Diuresis B. Hypertension C. Water intoxication D. Cerebral hemorrhage 83. The normal range of FHR is approximately [3] A. 90 to 140 bpm B. 120 to 160 bpm C. 100 to 140 bpm D. 140 to 180 bpm 84. A negative 1 [-1] station means that [1] A. Fetus is crowning

B. Fetus is floating C. Fetus is engaged D. Fetus is at the ischial spine 85. Which of the following is characteristics of false labor [1] A. Bloody show B. Contraction that are regular and increase in frequency and duration C. Contraction are felt in the back and radiates towards the abdomen D. None of the above 86. Who's Theory of labor pain that states that PAIN in labor is cause by FEAR [4] A. Bradley B. Simpson C. Lamaze D. Dick-Read 87. Which sign would alert the nurse that Pillar is entering the second stage of labor? [1] A. Increase frequency and intensity of contraction B. Perineum bulges and anal orifice dilates C. Effacement of internal OS is 100% D. Vulva encircles the largest diameter of presenting part 88. Nursing care during the second stage of labor should include [1] A. Careful evaluation of prenatal history B. Coach breathing, Bear down with each contraction and encourage patient. C. Shave the perineum D. Administer enema to the patient SITUATION : [NBLUE170] Baby boy perez was delivered spontaneously following a term pregnancy. Apgar scores are 8 and 9 respectively. Routine procedures are carried out. 89. When is the APGAR Score taken? [1] A. Immediately after birth and at 30 minutes after birth B. At 5 minutes after birth and at 30 minutes after birth C. At 1 minute after birth and at 5 minutes after birth D. Immediately after birth and at 5 minutes after birth 90. The best way to position a newboarn during the first week of life is to lay him [3] A. Prone with head slightly elevated B. On his back, flat

C. On his side with his head flat on bed D. On his back with head slightly elevated 91. Baby boy perez has a large sebaceous glands on his nose, chin, and forehead. These are known as [1] A. Milia B. Lanugo C. Hemangiomas D. Mongolian spots 92. Baby boy perez must be carefully observed for the first 24 hours for [2] A. Respiratory distress B. Duration of cry C. Frequency of voiding D. Range in body temperature 93. According to the WHO , when should the mother starts breastfeeding the infant? [4] A. Within 30 minutes after birth B. Within 12 hours after birth C. Within a day after birth D. After infant's condition stabilizes 94. What is the BEST and most accurate method of measuring the medication dosage for infants and children? [3] A. Weight B. Height C. Nomogram D. Weight and Height 95. The first postpartum visit should be done by the mother within [4] A. 24 hours B. 3 days C. a week D. a month 96. The major cause of maternal mortality in the philippines is [3] A. Infection B. Hemorrhage C. Hypertension D. Other complications related to labor,delivery and puerperium

97. According to the WHO, what should be the composition of a commercialized Oral rehydration salt solution? [4] A. A. A. A. Potassium Potassium Potassium Potassium : : : : 1.5 1.5 2.5 2.5 g. g. g. g. ; ; ; ; Sodium Sodium Sodium Sodium Bicarbonate Bicarbonate Bicarbonate Bicarbonate 2.5g 2.5g 3.5g 3.5g ; ; ; ; Sodium Sodium Sodium Sodium Chloride Chloride Chloride Chloride 3.5g; 3.5g; 4.5g; 4.5g; Glucose Glucose Glucose Glucose 20 10 20 10 g. g. g. g.

98. In preparing ORESOL at home, The correct composition recommnded by the DOH is [4] A. 1 glass of water, 1 pinch of salt and 2 tsp of sugar B. 1 glass of water, 2 pinch of salt and 2 tsp of sugar C. 1 glass of water, 3 pinch of salt and 4 tsp of sugar D. 1 glass of water, 1 pinch of salt and 1 tsp of sugar 99. Milk code is a law that prohibits milk commercialization or artificial feeding for up to 2 years. Which law provides its legal basis? [4] A. Senate bill 1044 B. RA 7600 C. Presidential Proclamation 147 D. EO 51 100. A 40 year old mother in her third trimester should avoid [4] A. Traveling B. Climbing C. Smoking D. Exercising

ANSWERS AND RATIONALES

SITUATION : [ND89] Aling Julia, a 32 year old fish vendor from baranggay matahimik came to see you at the prenatal clinic. She brought with her all her three children. Maye, 1 year 6 months; Joy, 3 and Dan, 7 years old. She mentioned that she stopped taking oral contraceptives several months ago and now suspects she is pregnant. She cannot remember her LMP. 1. Which of the following would be useful in calculating Aling Julia's EDC? [3] A. Appearance of linea negra B. First FHT by fetoscope C. Increase pulse rate D. Presence of edema

* The answer of some people is A because they say linea negra appears at 2nd trimester. Appearance of Linea negra is not the same with all women. Some will have it as early as first trimester while other on the 2nd trimester. It is very subjective and non normative. However, First FHT by fetoscope is UNIVERSAL and it is arbitrarily accepted that it starts at the 4th month of gestation. Therefore, If I heard the First FHT by fetoscope, I can say that Aling Julia's EDC is at 4th month and the EDC will be around 5 months from now.Pulse rate and Edema will never suggest the estimated date of confinement nor age of gestation. 2. Which hormone is necessary for a positive pregnancy test? [1] A. Progesterone B. HCG C. Estrogen D. Placental Lactogen * HCG is responsible for positive pregnancy test. But it is NOT a positive sign of pregnancy. Only PROBABLE. Purpose of HCG is to maintain the secretion of progestrone by the corpus luteum. It will deteriorate by 2nd trimester as the placenta resumes its funciton. HCG is also use to stimulate descend of the testes in case of cryptorchidism or undescended testes. HCG peaks at 10 weeks then decline for the rest of the pregnancy. Non pregnant females will have less than 5 mIU/ml and can reach up to 100,000 mIU/ml in pregnant women. By the way, undescended testes repair is done when the child is 1 year old according to Lippinncots, the doctor will try to wait baka kasi bumaba pa before they do surgery. 3. With this pregnancy, Aling Julia is a [1] A. P3 G3 B. Primigravida C. P3 G4 D. P0 G3 * She has 3 children, so para 3. Since she is pregnant, this is her 4th gravida. Remember that even if the pregancy is beyond the age of viability [ >7 months ] consider it as PARA and not GRAVIDA as long as the baby is still inside the uterus. A common error of the old nurses in a puericulture center where I dutied in is that they count the child inside the mother's womb as GRAVIDA when it is greater than 7 months! [ kawawang nanay, mali na ang home based mothers record mo ] I tried to correct it but they still INSISTED. I read pillitteri thinking that I might be wrong nakakahiya naman... but I was right. 4. In explaining the development of her baby, you identified in chronological order of growth of the fetus as it occurs in pregnancy as [1]

A. Ovum, embryo, zygote, fetus, infant B. Zygote, ovum, embryo, fetus, infant C. Ovum, zygote, embryo, fetus, infant D. Zygote, ovum, fetus, embryo, infant * The Ovum is the egg cell from the mother, the sperm will fertilize it to form a zygote. This usually happens in the AMPULLA or the distal third of the fallopian tube. Hyalorunidase is secreted by the sperm to dissolve the outer memberane of the ovum. The zygote now containes 46 chromosomes. 23 from each germ cell. The zygote is now termed as an embryo once it has been implanted. Implantation takes 3-4 days. When the embryo reach 8th weeks, it is now termed as a FETUS until it has been delivered and then, neonate then infant. 5. Aling Julia states she is happy to be pregnant. Which behavior is elicited by her during your assessment that would lead you to think she is stressed? [3] A. She told you about her drunk husband B. She states she has very meager income from selling C. She laughs at every advise you give even when its not funny D. She has difficulty following instructions * Stressed is manifested in different ways and one of them, is difficulty following instructions. Telling you that her husband is drunk and has meager income from selling is not enough for you to conclude she is stressed. Assessment is always based on factual and specific manifestations. A diagnosis is made from either ACTUAL or POTENTIAL/RISK problems. A and B are both potential problems, but not actual like D. C is automatically eliminated first because laughing is not indicative of stress. 6. When teaching Aling Julia about her pregnancy, you should include personal common discomforts. Which of the following is an indication for prompt professional supervision? [2] A. Constipation and hemorrhoids B. Backache C. Facial edema D. frequent urination *Facial edema is NOT NORMAL. Facial edema is one sign of MILD PRE ECLAMPSIA and prompt professional supervision is needed to lower down the client's blood pressure. Blood pressure in Mild Pre Eclampsia is around 140/90 and 160/110 in severe. Treatment involves bed rest, Magnesium sulfate, Hydralazine, Diazoxide and Diazepam [ usually a combination of Magsul + Apresoline [ Hydralazine ] ] Calcium gluconate is always at the client's bed side when magnesium toxicity occurs. It works by exchanging Calcium ions for magnesium ions. A,B and D are all physiologic change in pregnancy that do not need prompt professional supervision. Frequent

urination will disappear as soon as the pressure of the uterus is released against the bladder and as soon as the client's blood volume has returned to normal. Backache is a common complaint of women with an OCCIPUT POSTERIOR presentation due to pressure on the back. Intervention includes pelvic rocking or running a tennis ball at the client's back. Constipation and hemorrhoids are relieved by increasing fluid intake and hot sitz bath. 7. Which of the following statements would be appropriate for you to include in Aling Julia's prenatal teaching plan? [1] A. Exercise is very tiresome, it should be avoided B. Limit your food intake C. Smoking has no harmful effect on the growth and development of fetus D. Avoid unnecessary fatigue, rest periods should be included in you schedule * Exercise is not avoided in pregnancy, therfore eliminate A. Food is never limited in pregnancy. Calories are even increased by around 300 cal a day as well as vitamins and minerals. Smoking, alcohol and drug use are avoided for the rest of the pregnancy because of their harmful effects on the growth and development of the fetus. Rest period and avoiding unecessary fatigue is one of the pillars in health teaching of the pregnant client. 8. The best advise you can give to Aling Julia regarding prevention of varicosities is [3] A. Raise the legs while in upright position and put it against the wall several times a day B. Lay flat for most hours of the day C. Use garters with nylon stocking D. Wear support hose * A thigh high stocking or a support hose WORN BEFORE GETTING UP in the morning is effective in prevention of varicosities. Stocking should have NO GARTERS because it impedes blood flow, they should be made of COTTON not nylon to allow the skin to breathe. Lying flat most of the day WILL PREVENT VARICOSITIES but will not be helpful for the client's overall health and function. Raising the legs and putting it against the wall will still create pressure in the legs.

9. In a 32 day menstrual cycle, ovulation usually occurs on the [2] A. 14th day after menstruation B. 18th day after menstruation C. 20th day after menstruation D. 24th day after menstruation

* To get the day of ovulation, A diary is made for around 6 months to determine the number of days of menstrual cycle [ from onset of mens to the next onset of mens ] and the average is taken from that cycles. 14 days are subtracted from the total days of the menstrual cycle. This signifies the ovulation day. A couple would abstain having sex 5 days before and 5 days after the ovulation day. Therefore, a 32 day cycle minus 14 days equals 18, hence... ovulation occurs at the 18th day. 10. Placenta is the organ that provides exchange of nutrients and waste products between mother and fetus. This develops by [4] A. First month B. Third month C. Fifth month D. Seventh month * The placenta is formed at around 3 months. It is a latin word for PANCAKE because of it's appearance. It arises from the trophoblast from the chorionic villi and decidua basalis. It functions as the fetal lungs, kidney, GI tract and an endocrine organ. 11. In evaluating the weight gain of Aling Julia, you know the minimum weight gain during pregnancy is [3] A. 2 lbs/wk B. 5 lbs/wk C. 7 lbs/wk D. 10 lbs/wk * Weight gain should be 1 to 2 lbs per week during the 2nd and 3rd trimester and 3 to 5 lbs gain during the first trimester for a total of 25-35 lbs recommended weight gain during the gravida state. 12. The more accurate method of measuring fundal height is [2] A. Millimeter B. Centimeter C. Inches D. Fingerbreadths * Fundal height is measured in cm not mm. centimeters is the more accurate method of measuring fundic height than inches or fingerbreadths. 13. To determine fetal position using Leopold's maneuvers, the first maneuver is to [1] A. Determine degree of cephalic flexion and engagement

B. Determine part of fetus presenting into pelvis C. Locate the back,arms and legs D. Determine what part of fetus is in the fundus * Leopold's one determines what is it in the fundus. This determines whether the fetal head or breech is in the fundus. A head is round and hard. Breech is less well defined. 14. Aling julia has encouraged her husband to attend prenatal classes with her. During the prenatal class, the couple expressed fear of pain during labor and delivery. The use of touch and soothing voice often promotes comfort to the laboring patient. This physical intervention is effective because [2] A. Pain perception is interrupted B. Gate control fibers are open C. It distracts the client away from the pain D. Empathy is communicated by a caring person * Touch and soothing voice promotes pain distraction. Instead of thinking too much of the pain in labor, The mother is diverted away from the pain sensation by the use of touch and voice. Pain perception is not interrupted, pain is still present. When gate control fibers are open, Pain is felt according to the gate control theory of pain. Although empathy is communicated by the caring person, this is not the reason why touch and voice promotes comfort to a laboring patient. 15. Which of the following could be considered as a positive sign of pregnancy ? [1] A. Amenorrhea, nausea, vomiting B. Frequency of urination C. Braxton hicks contraction D. Fetal outline by sonography * Fetal outline by sonography or other imaging devices is considered a positive sign of pregnancy along with the presence of fetal heart rate and movement felt by a qualified examiner. All those signs with the discoverer's name on them [ chadwick, hegars, braxton hicks, goodells ] are considered probable and All the physiologic changes brought about by pregnancy like hyperpigmentation, fatgiue, uterine enlargement, nausea, vomiting, breast changes, frequent urination are considered presumptive. Sonographic evidence of the gestational sac is not POSITIVE sign but rather, PROBABLE. SITUATION : [FFC] Maternal and child health is the program of the department of health created to lessen the death of infants and mother in the philippines. [2]

16. What is the goal of this program? A. Promote mother and infant health especially during the gravida stage B. Training of local hilots C. Direct supervision of midwives during home delivery D. Health teaching to mother regarding proper newborn care * The goal of the MCHN program of the DOH is the PROMOTION AND MAINTENANCE OF OPTIMUM HEALTH OF WOMAN AND THEIR NEWBORN . To achieve this goal, B,C and D are all carried out. Even without the knowledge of the MCHN goal you SHOULD answer this question correctly. Remember that GOALS are your plans or things you MUST ATTAIN while STRATEGIES are those that must be done [ ACTIONS ] to attain your goal. Looking at B,C and D they are all ACTIONS. Only A correctly followed the definition of a goal. 17. One philosophy of the maternal and child health nursing is [1] A. All pregnancy experiences are the same for all woman B. Culture and religious practices have little effect on pregnancy of a woman C. Pregnancy is a part of the life cycle but provides no meaning D. The father is as important as the mother * Knowing that not all individuals and pregnancy are the same for all women, you can safely eliminate letter A. Personal, culture and religious attitudes influence the meaning of pregnancy and that makes pregnancy unique for each individual. Culture and religious practice have a great impact on pregnancy, eliminate B. Pregnancy is meaningful to each individuals, not only the mother but also the father and the family and the father of the child is as important as the mother. MATERNAL AND CHILD HEALTH IS FAMILY CENTERED and thid will guide you in correctly answering D. 18. In maternal care, the PHN responsibility is [2] A. To secure all information that would be needing in birth certificate B. To protect the baby against tetanus neonatorum by immunizing the mother with DPT C. To reach all pregnant woman D. To assess nutritional status of existing children * The sole objective of the MCHN of the DOH is to REACH ALL PREGNANT WOMEN AND GIVE SUFFICIENT CARE TO ENSURE A HEALTHY PREGNANCY AND THE BIRTH OF A FULL TERM HEALTH BABY. As not to confuse this with the GOAL of the MCHN, The OBJECTIVE should answer the GOAL, they are different. GOAL : to promote and maintain optimum health for women and their newborn HOW?

OBJECTIVE : By reaching all pregnant women to give sufficient care ensuring healthy pregnancy and baby. 19. This is use when rendering prenatal care in the rural health unit. It serves as a guide in Identification of risk factors [1] A. Underfive clinic chart B. Home based mother's record C. Client list of mother under prenatal care D. Target list of woman under TT vaccination * The HBMR is used in rendring prenatal care as guide in identifying risk factors. It contains health promotion message and information on the danger signs of pregnancy. 20. The schedule of prenatal visit in the RHU unit is [4] A. Once from 1st up to 8th month, weekly on the 9th month B. Twice in 1st and second trimester, weekly on third trimester C. Once in each trimester, more frequent for those at risk D. Frequent as possible to determine the presence of FHT each week * Visit to the RHU should be ONCE each trimester and more frequent for those who are high risks. The visit to the BHS or health center should be ONCE for 1st to 6th months of pregnancy, TWICE for the 7th to 8th month and weekly during the 9th month. They are different and are not to be confused with. SITUATION : Knowledge of the menstrual cycle is important in maternal health nursing. The following questions pertains to the process of menstruation 21. Menarche occurs during the pubertal period, Which of the following occurs first in the development of female sex characteristics? [2] A. Menarche B. Accelerated Linear Growth C. Breast development D. Growth of pubic hair * Remember TAMO or THELARCHE, ADRENARCHE, MENARCHE and OVULATION. Telarche is the beginning of the breast development which is influenced by the increase in estrogen level during puberty. Adrenarche is the development of axillary and pubic hair due to androgen stimulation. Menarche is the onset of first menstruation that averagely occurs at around 12 to 13 years old. Ovulation then occurs last. However, prior to TAMO, Accelerated LINEAR GROWTH will occur first in GIRLS while WEIGHT INCREASE is the first one to occur in boys.

22. Which gland is responsible for initiating the menstrual cycle? [3] A. Ovaries B. APG C. PPG D. Hypothalamus * Hypothalamus secretes many different hormones and one of them is the FSHRF or the FOLLICLE STIMULATING HORMONE RELEASING FACTOR. This will instruct the ANTERIOR PITUITARY GLAND to secrete FSH that will stimulate the ovary to release egg and initiate the menstrual cycle. The PPG or the posterior pituitary only secretes two hormones : OXYTOCIN and ADH. It plays an important factor in labor as well as in the pathophysiology of diabetes insipidus. 23. The hormone that stimulates the ovaries to produce estrogen is [1] A. GnRH B. LH C. LHRF D. FSH * FSH stimulates the ovaries to secrete estrogen. This hormone is a 3 substance compounds known as estrone [e1], estradiol [2] and estriol [3] responsible for the development of female secondary sex characteristics. It also stimulates the OOCYTES to mature. During pregnancy, Estrogen is secreted by the placenta that stimulates uterine growth to accomodate the fetus. 24. Which hormone stimulates oocyte maturation? [2] A. GnRH B. LH C. LHRF D. FSH * Refer to #23 25. When is the serum estrogen level highest in the menstrual cycle? [4] A. 3rd day B. 13th day C. 14th day D. End of menstrual cycle * There are only 3 days to remember in terms of hormonal heights during

pregnancy. 3,13 and 14. During the 3rd day, Serum estrogen is the lowest. During the 13th day, Serum estrogen is at it's peak while progestrone is at it's lowest and this signifies that a mature oocyte is ready for release. At 14th day, Progesterone will surge and this is the reason why there is a sudden increase of temperature during the ovulation day and sudden drop during the previous day. This will not stimulate the release of the mature egg or what we call, OVULATION.

26. To correctly determine the day of ovulation, the nurse must [2] A. Deduct 14 days at the mid of the cycle B. Subtract two weeks at cycle's end C. Add 7 days from mid of the cycle D. Add 14 days from the end of the cycle * Refer to # 9 Big thanks to marisse for the correction in this number. 27. The serum progesterone is lowest during what day of the menstrual cycle? [4] A. 3rd day B. 13th day C. 14th day D. End of menstrual cycle * At 3rd day, The serum estrogen is at it's lowest. At the 13th day, serum estrogen is at it's peak while progesterone is at it's lowest. At the 13th day of the cycle, An available matured ovum is ready for fertilization and implantation. The slight sharp drop of temperature occurs during this time due to the very low progestrone level. The next day, 14th day, The serum progestrone sharply rises and this causes the release of the matured ovum. Temperature also rises at this point because of the sudden increase in the progestrone level. 28. How much blood is loss on the average during menstrual period? [4] A. Half cup B. 4 tablespoon C. 3 ounces D. 1/3 cup * The average blood loss during pregnancy is 60 cc. A, half cup is equivalent to 120 cc. C, is equivalent to 90 cc while D, is equivalent to 80 cc. 1 tablespoon is equal to 15 ml. 4 tablespoon is exactly 60 cc. 29. Menstruation occurs because of which following mechanism? [2]

A. Increase level of estrogen and progesterone level B. Degeneration of the corpus luteum C. Increase vascularity of the endothelium D. Surge of hormone progesterone * Degeneration of the corpus luteum is the cause of menstruation. Menstruation occurs because of the decrease of both estrogen and progestrone. This is caused by the regression of the corpus luteum inside the ovary 8 to 10 days in absence of fertilization after an ovum was released. With the absence of progestrone, the endometrium degenerates and therefore, vascularity will decrease at approximately 25th day of the cycle which causes the external manifestation of menstruation. 30. If the menstrual cycle of a woman is 35 day cycle, she will approximately [2] A. Ovulate on the 21st day with fertile days beginning on the 16th day to the 26th day of her cycle B. Ovulate on the 21st day with fertile days beginning on the 16th day to the 21th day of her cycle C. Ovulate on the 22st day with fertile days beginning on the 16th day to the 26th day of her cycle D. Ovulate on the 22st day with fertile days beginning on the 14th day to the 30th day of her cycle * Formula for getting the fertile days and ovulation day is : Number of days of cycle MINUS 14 [ Ovulation day ] Minus 5 Plus 5 [ Possible fertile days ]. Since the client has a 35 day cycle, we subtract 14 days to get the ovulation day which is 21. Minus 5 days is equal to [21 - 5 = 16 ] 16 , Plus 5 days [ 21 + 5 = 26 ] is equal to 26. Therefore, Client is fertile during the 16th to the 26th day of her cycle. This is the same principle and formula used in the calendar / rhythm method. SITUATION : Wide knowledge about different diagnostic tests during pregnancy is an essential arsenal for a nurse to be successful. 31. The Biparietal diameter of a fetus is considered matured if it is atleast [4] A. 9.8 cm B. 8.5 cm C. 7.5 cm D. 6 cm * BPD is considered matured at 8.5 cm and at term when it reaches 9.6 cm. 32. Quickening is experienced first by multigravida clients. At what week of gestation do they start to experience quickening? [4]

A. 16th B. 20th C. 24th D. 28th * Multigravid clients experience quickening at around 16 weeks or 4 months. Primigravid clients experience this 1 month later, at the 5th month or 20th week. 33. Before the start of a non stress test, The FHR is 120 BPM. The mother ate the snack and the practitioner noticed an increase from 120 BPM to 135 BPM for 15 seconds. How would you read the result? [3] A. Abnormal B. Non reactive C. Reactive D. Inconclusive, needs repeat * Normal non stress test result is REACTIVE. Non stress test is a diagnostic procedure in which the FHR is compared with the child's movement. A normal result is an increase of 15 BPM sustained for 15 seconds at every fetal movement. The mother is told to eat a light snack during the procedure while the examiner carefully monitors the FHR. The mother will tell the examiner that she felt a movement as soon as she feels it while the examiner take note of the time and the FHR of the fetus. 34. When should the nurse expect to hear the FHR using a fetoscope? [4] A. 2nd week B. 8th week C. 2nd month D. 4th month * The FHR is heard at about 4 months using a fetoscope. Remember the word FeFOUR to relate fetoscope to four. 35. When should the nurse expect to hear FHR using doppler Ultrasound? [4] A. 8th week B. 8th month C. 2nd week D. 4th month * The FHR is heard as early as 8th week [ some books, 12 to 14 weeks ] using doppler ultrasound. Remember the word DOPPLE RATE, [ DOPPLER 8 ] to relate dopple ultrasound to the number 8.

36. The mother asks, What does it means if her maternal serum alpha feto protein is 35 ng/ml? The nurse should answer [4] A. It is normal B. It is not normal C. 35 ng/ml indicates chromosomal abberation D. 35 ng/ml indicates neural tube defect * The normal maternal alpha feto protein is 38-45 ng/ml. Less 38 than this indicates CHROMOSOMAL ABBERATION [Down,Klinefelters] and more than 45 means NEURAL TUBE DEFECTS [Spina Bifida]. Remember the word CLINICAL NURSE. C for chromosomal abberation for <38>N for neural tube defect for >45. C<38>45 Clinic Nurse. CLINIC NURSE is also an important mnemonics to differentiate COUNTER TRANSFERENCE from TRANSFERENCE. Counter transference is the special feeling of the CLINIC NURSE or CLINICIAN to the patient while transference is the development of personal feelings of the patient to the nurse. 37. Which of the following mothers needs RHOGAM? [1] A. RH + mother who delivered an RH - fetus B. RH - mother who delivered an RH + fetus C. RH + mother who delivered an RH + fetus D. RH - mother who delivered an RH - fetus * Rhogam is given to RH - Mothers That delivers an RH + Fetus. Rhogam prevents ISOIMMUNIZATION or the development of maternal antibodies against the fetal blood due to RH incompatibility. Once the mother already develops an antibody against the fetus, Rhogam will not anymore be benificial and the mother is advised no to have anymore pregnancies. Rhogam is given within 72 hours after delivery. 38. Which family planning method is recommended by the department of health more than any other means of contraception? [4] A. Fertility Awareness Method B. Condom C. Tubal Ligation D. Abstinence * Abstinence is never advocated as a family planning method. Though, It is probably the BEST METHOD to prevent STD and pregnancy, it is inhumane and supresses the reproductive rights of the people. It is also unrealistic. FAM is advocated by the DOH more than any other kind of contraception. It is a combination of symptothermal and billings method. CALENDAR method is the only method advocated by the catholic

church. 39. How much booster dose does tetanus toxoid vaccination for pregnant women has? [4] A. 2 B. 5 C. 3 D. 4 * TT1 and TT2 are both primary dosages. While TT3 up to TT5 represents the booster dosages. 40. Baranggay pinoybsn.tk has 70,000 population. How much nurse is needed to service this population? [4] A. 5 B. 7 C. 50 D. 70 * For every 10,000 population , 1 nurse is needed. therefore, a population of 70,000 people needs a service of 7 nurses. SITUATION : [ND2I246] Reproductive health is the exercise of reproductive right with responsibility. A married couple has the responsibility to reproduce and procreate. 41. Which of the following is ONE of the goals of the reproductive health concept? [3] A. To achieve healthy sexual development and maturation B. To prevent specific RH problem through counseling C. Provide care, treatment and rehabilitation D. To practice RH as a way of life of every man and woman * EVERY ACHIEVER AVOIDS RECEIVER : Remember this mnemonics and it will guide you in differentiating which is which from the goals, visions and strategies. If a sentence begins with these words, it is automatically a GOAL. Usually, The trend in the board is that they will mix up the vision, strategies and goals to confuse you. D is the only vision of the RH program. Anything else aside from the vision and goals are more likely strategies. [ B and C ] Strategies, even without knowing them or memorizing them can easily be seperated as they convey ACTIONS and ACTUAL INTERVENTIONS. This is universal and also applies to other DOH programs. Notice that B and C convey actions and interventions.

42. Which of the following is NOT an element of the reproductive health? [4] A. Maternal and child health and nutrition B. Family planning C. Prevention and management of abortion complication D. Healthy sexual development and nutrition * Achieving healthy sexual development and nutrition is a GOAL of the RH. Knowledge of the elements, goals, strategies and vision of RH are important in answering this question. I removed the word ACHIEVE to let you know that it is possible for the board of nursing not to include those keywords [ although it never happened as of yet ]. 43. In the international framework of RH, which one of the following is the ultimate goal? [3] A. Women's health in reproduction B. Attainment of optimum health C. Achievement of women's status D. Quality of life * Quality of life is the ultimate goal of the RH in the international framework. Way of life is the ultimate goal of RH in the local framework. 44. Which one of the following is a determinant of RH affecting woman's ability to participate in social affairs? [3] A. Gender issues B. Socio-Economic condition C. Cultural and psychosocial factors D. Status of women * This is an actual board question, Gender issues affects the women participation in the social affairs. Socio economic condition is the determinant for education, employment, poverty, nutrition, living condition and family environment. Status of women evolves in women's rights. Cultural and psychosocial factors refers to the norms, behaviors, orientation, values and culture. Refer to your DOH manual to read more about this. 45. In the philippine RH Framework. which major factor affects RH status? [4] A. Women's lower level of literacy B. Health service delivery mechanism C. Poor living conditions lead to illness D. Commercial sex workers are exposed to AIDS/STD.

* Health services delivery mechanism is the major factor that affect RH status. Other factors are women's behavior, Sanitation and water supply, Employment and working conditions etc. 46. Which determinant of reproductive health advocates nutrition for better health promotion and maintain a healthful life? [4] A. Socio-Economic conditions B. Status of women C. Social and gender issues D. Biological, Cultural and Psychosocial factors * Refer to # 44 47. Which of the following is NOT a strategy of RH? [3] A. Increase and improve contraceptive methods B. Achieve reproductive intentions C. Care provision focused on people with RH problems D. Prevent specific RH problem through information dessemination * Refer to #41 48. Which of the following is NOT a goal of RH? [3] A. Achieve healthy sexual development and maturation B. Avoid illness/diseases, injuries, disabilities related to sexuality and reproduction C. Receive appropriate counseling and care of RH problems D. Strengthen outreach activities and the referral system * Refer to #41 49. What is the VISION of the RH? [2] A. Attain QUALITY OF LIFE B. Practice RH as a WAY OF LIFE C. Prevent specific RH problem D. Health in the hands of the filipino * Refer to #43 SITUATION : [SORANGE19] Baby G, a 6 hours old newborn is admitted to the NICU because of low APGAR Score. His mother had a prolonged second stage of labor 50. Which of the following is the most important concept associated with all high risk

newborn? [1] A. Support the high-risk newborn's cardiopulmonary adaptation by maintaining adequate airway B. Identify complications with early intervention in the high risk newborn to reduce morbidity and mortality C. Assess the high risk newborn for any physical complications that will assist the parent with bonding D. Support mother and significant others in their request toward adaptation to the high risk newborn * The 3 major and initial and immediate needs of newborns both normal and high risks are AIR/BREATHING, CIRCULATION and TEMPERATURE. C and D are both eliminated because they do not address the immediate newborn needs. Identifying complication with early intervention is important, however, this does not address the IMMEDIATE and MOST IMPORTANT newborn needs. 51. Which of the following would the nurse expect to find in a newborn with birth asphyxia? [1] A. Hyperoxemia B. Acidosis C. Hypocapnia D. Ketosis * Birth Asphyxia is a term used to describe the inability of an infant to maintain an adequate respiration within 1 minute after birth that leads so acidosis, hypoxia, hypoxemia and tissue anoxia. This results to Hypercapnia not Hypocapnia due to the increase in carbonic acid concentration in the fetal circulation because the carbon dioxide fails to get eliminated from the infant's lungs because of inadequate respiration. Ketosis is the presence of ketones in the body because of excessive fat metabolism. This is seen in diabetic ketoacidosis. 52. When planning and implementing care for the newborn that has been successfully resuscitated, which of the following would be important to assess? [1] A. Muscle flaccidity B. Hypoglycemia C. Decreased intracranial pressure D. Spontaneous respiration * There is no need to assess for spontaneous respiration because OF the word SUCCESSFULLY RESUSCITATED. What is it to assess is the quality and quantity of respiration. Infants who undergone tremendous physical challenges during birth like asphyxia, prolonged labor, RDS are all high risk for developing hypoglycemia because of the severe depletion of glucose stores to sustain the demands of the body

during those demanding times. SITUATION : [P-I/46] Nurses should be aware of the different reproductive problems. 53. When is the best time to achieve pregnancy? [2] A. Midway between periods B. Immediately after menses end C. 14 days before the next period is expected D. 14 days after the beginning of the next period * The best time to achieve pregnancy is during the ovulation period which is about 14 days before the next period is expected. A Menstrual cycle is defined as the number of days from the start of the menstruation period, up to the start of another menstrual period. To obtain the ovulation day, Subtract 14 days from the end of each cycle. Example, The start of the menstrual flow was July 12, 2006. The next flow was experienced August 11, 2006. The length of the menstrual cycle is then 30 days [ August 11 minus July 12 ]. We then subtract 14 days from that total length of the cycle and that will give us 16 days [ 30 minus 14 ] Count 16 days from July 12, 2006 and that will give us July 28, 2006 as the day of ovulation. [ July 12 + 16 days ] This is the best time for coitus if the intention is getting pregnant, worst time if not. 54. A factor in infertility maybe related to the PH of the vaginal canal. A medication that is ordered to alter the vaginal PH is: [2] A. Estrogen therapy B. Sulfur insufflations C. Lactic acid douches D. Na HCO3 Douches * Sperm is innately ALKALINE. Too much acidity is the only PH alteration in the vagina that can kill sperm cells. Knowing this will direct you to answering letter D. Sodium Bicarbonate douches will make the vagina less acidic because of it's alkaline property, making the vagina's environment more conducive and tolerating to the sperm cells. Estrogen therapy will not alter the PH of the vaginal canal. HRT [ Hormone replacement therapy ] is now feared by many women because of the high risk in acquiring breast, uterine and cervical cancer. Research on this was even halted because of the significant risk on the sample population. Lactic acid douches will make the vagina more acidic, further making the environment hostile to the alkaline sperm. Sulfur insufflation is a procedure used to treat vaginal infections. A tube is inserted in the vagina and sulfur is introduced to the body. The yeasts, fungi and other microorganisms that are sensitive to sulfur are all immediately killed by it on contact.

55. A diagnostic test used to evaluate fertility is the postcoital test. It is best timed [2] A. 1 week after ovulation B. Immediately after menses C. Just before the next menstrual period D. Within 1 to 2 days of presumed ovulation * A poscoital test evaluates both ovulation detection and sperm analysis. When the woman ovulates [ by using the FAM method or commercial ovulation detection kits, woman should know she ovulates ] The couple should have coitus and then, the woman will go to the clinic within 2 to 8 hours after coitus. The woman is put on a lithotomy position. A specimen for cervical mucus is taken and examined for spinnbarkeit [ ability to stretch 15 cm before breaking ] and sperm count. Postcoital test is now considered obsolete because a single sperm and cervical mucus analysis provides more accurate data. 56. A tubal insufflation test is done to determine whether there is a tubal obstruction. Infertility caused by a defect in the tube is most often related to a [3] A. Past infection B. Fibroid Tumor C. Congenital Anomaly D. Previous injury to a tube * PID [ Most common cause of tubal obstruction ] due to untreated gonorrhea, chlamydia or other infections that leads to chronic salphingitis often leads to scarring of the fallopian tube thereby causing tubal obstuction. This one of the common cause of infertility, the most common is Anovulation in female and low sperm count in males. A ruptured appendix, peritonitis and abdominal surgery that leads to infection and adhesion of the fallopian tube can also lead to tubal obstruction. 57. Which test is commonly used to determine the number, motility and activity of sperm is the [2] A. Rubin test B. Huhner test C. Friedman test D. Papanicolau test * Huhner test is synonymous to postcoital test. This test evaluates the number, motility and status of the sperm cells in the cervical mucus. refer to # 55 for more information. Rubin test is a test to determine the tubal patency by introducing carbon dioxide gas via a cannula to the client's cervix. The sound is then auscultated in the client's abdomen at the point where the outer end of the fallopian tube is

located, near the fimbriae. Absent of sound means that the tube is not patent. Friedman test involves a FROG to determine pregnancy that is why it is also called as FROG TEST. Papanicolaou test [Correct spelling], discovered by Dr. George Papanicolaou during the 1930's is a cytolgic examination of the epithelial lining of the cervix. It is important in diagnosis cervical cancer. 58. In the female, Evaluation of the pelvic organs of reproduction is accomplished by [2] A. Biopsy B. Cystoscopy C. Culdoscopy D. Hysterosalpingogram * Biopsy is acquiring a sample tissue for cytological examination. Usually done in cancer grading or detecting atypical, abnormal and neoplastic cells. Cystoscopy is the visualization of the bladder using a cystoscope. This is inserted via the urethra. TURP or the transurethral resection of the prostate is frequently done via cystoscopy to remove the need for incision in resecting the enlarged prostate in BPH. Culdoscopy is the insertion of the culdoscope through the posterior vaginal wall between the rectum and uterus to visualize the douglas cul de sac. This is an important landmark because this is the lowest point in the pelvis, fluid or blood tends to collect in this place. Hysterosalpingogram is the injection of a blue dye, or any radio opaque material through the cervix under pressure. X ray is then taken to visualize the pelvic organs. This is done only after menstruation to prevent reflux of the menstrual discharge up into the fallopian tube and to prevent an accidental irradiation of the zygote. As usual, as with all other procedures that ends in GRAM, assess for iodine allergy. 59. When is the fetal weight gain greatest? [3] A. 1st trimester B. 2nd trimester C. 3rd trimester D. from 4th week up to 16th week of pregnancy * Vital organs are formed during the first trimester, The greatest LENGTH gain occurs during the second trimester while the greatest weight gain occurs during the last trimester. This is the time when brown fats starts to be deposited in preparation for the upcoming delivery. 60. In fetal blood vessel, where is the oxygen content highest? [3] A. Umbilical artery B. Ductus Venosus C. Ductus areteriosus

D. Pulmonary artery * Ductus venosus is directly connected to the umbilical vein, Which is directly connected to the highly oxygenated placenta. This vessel supplies blood to the fetal liver. Umbilical arteries carries UNOXYGENATED BLOOD, they carry the blood away from the fetal body. Ductus arteriosus shunts the blood away from the fetal lungs, this carries an oxygenated blood but not as concentrated as the blood in the ductus venosus who have not yet service any of the fetal organ for oxygen except the liver. Knowing that the fetal lungs is not yet functional and expanded will guide you to automatically eliminate the pulmonary artery which is responsible for carrying UNOXYGENATED BLOOD away from the lungs. 61. The nurse is caring for a woman in labor. The woman is irritable, complains of nausea and vomits and has heavier show. The membranes rupture. The nurse understands that this indicates [1] A. The woman is in transition stage of labor B. The woman is having a complication and the doctor should be notified C. Labor is slowing down and the woman may need oxytocin D. The woman is emotionally distraught and needs assistance in dealing with labor * The clue to the answer is MEMBRANES RUPTURE. Membranes, as a rule, rupture at full dilation [ 10 cm ] unless ruptured by amniotomy or ruptured at an earlier time. The last of the mucus plug from the cervix is also released during the transition phase of labor. We call that the OPERCULUM as signaled by a HEAVIER SHOW. During the transition phase, Cervix is dilated at around 8 to 10 cm and contractions reaches their peak of intensity occuring every 2 to 3 minutes with a 60 to 90 second duration. At the transition phase, woman also experiences nausea and vomiting with intense pain. This question is LIFTED from the previous board and the question was patterned EXACTLY WORD PER WORD from pillitteri. SITUATION : [J2I246] Katherine, a 32 year old primigravida at 39-40 weeks AOG was admitted to the labor room due to hypogastric and lumbo-sacral pains. IE revealed a fully dilated, fully effaced cervix. Station 0. 62. She is immediately transferred to the DR table. Which of the following conditions signify that delivery is near? [2] I - A desire to defecate II - Begins to bear down with uterine contraction III - Perineum bulges IV - Uterine contraction occur 2-3 minutes intervals at 50 seconds duration A. I,II,III

B. I,II,III,IV C. I,III,IV D. II,III,IV * Again, lifted word per word from Pillitteri and this is from the NLE. A is the right answer. A woman near labor experiences desire to defecate because of the pressure of the fetal head that forces the stool out from the anus. She cannot help but bear down with each of the contractions and as crowning occurs, The perineum bulges. A woman with a 50 second contraction is still at the ACTIVE PHASE labor [ 40 to 60 seconds duration, 3 to 5 minutes interval ] Women who are about to give birth experience 60-90 seconds contraction occuring at 2-3 minutes interval. 63. Artificial rupture of the membrane is done. Which of the following nursing diagnoses is the priority? [2] A. High risk for infection related to membrane rupture B. Potential for injury related to prolapse cord C. Alteration in comfort related to increasing strength of uterine contraction D. Anxiety related to unfamiliar procedure * Nursing diagnosis is frequently ask. In any case that INFECTION was one of the choices, remove it as soon as you see it in ALL CASES during the intra and pre operative nursing care. Infection will only occur after 48 hours of operation or event. B is much more immediate and more likely to occur than A, and is much more FATAL. Prioritization and Appropriateness is the key in correctly answering this question. High risk for infection is an appropriate nursing diagnosis, but as I said, Infection will occur in much later time and not as immediate as B. Readily remove D and C because physiologic needs of the mother and fetus take precedence over comfort measures and psychosocial needs. 64. Katherine complains of severe abdominal pain and back pain during contraction. Which two of the following measures will be MOST effective in reducing pain? [4] I - Rubbing the back with a tennis ball II- Effleurage III-Imagery IV-Breathing techniques A. II,IV B. II,III C. I,IV D. I,II * Remove B. Imagery is not used in severe pain. This is a labor pain and the mother will never try to imagine a nice and beautiful scenery with you at this point because the pain is all encompassing and severe during the transition phase of labor. Remove

A and C Because breathing techniques is not a method to ELIMINATE PAIN but a method to reduce anxiety, improve pushing and prevent rapid expulsion of the fetus during crowning [ By PANTING ] Back pain is so severe during labor in cases of Posterior presentations [ ROP,LOP,RMP,LSaP, etc... ] Mother is asked to pull her knees towards her chest and rock her back. [ As in a rocking chair ] A Tennis ball rubbed at the client's back can relieve the pain due to the pressure of the presenting part on the posterior part of the birth canal. Also, rubbing a tennis ball to the client's back OPENS THE LARGE FIBER NERVE GATE. Effleurage or a simple rotational massage on the abdomen simply relieves the client's pain by opening the large fiber nerve gate and closing the the small fiber nerve gate. [ Please read about Gate control theory by Mezack and Wall ]. 65. Lumbar epidural anesthesia is administered. Which of the following nursing responsibilities should be done immediately following procedure? [1] A. Reposition from side to side B. Administer oxygen C. Increase IV fluid as indicated D. Assess for maternal hypotension * Hypotension is one of the side effects of an epidural anesthesia. An epidural anesthesia is injected on the L3 - L4 or L4 - L5 area. The injection lies just above the dura and must not cross the dura [ spinal anesthesia crosses the dura ]. Nursing intervention revolves in assesing RR, BP and other vital signs for possible complication and side effects. There is no need to position the client from side to side, The preferred position during the transition phase of labor is LITHOTOMY. Oxygen is not specific after administration of an epidural anesthesia. IV fluid is not increased without doctor's order. AS INDICATED is different from AS ORDERED. 66. Which is NOT the drug of choice for epidural anesthesia? [4] A. Sensorcaine B. Xylocaine C. Ephedrine D. Marcaine * A,B and D are all drugs of choice for epidural anesthesia. Ephedrine is the drug use to reverse the symptom of hypotension caused by epidural anesthesia. It is a sympathomimetic agent that causes vasoconstriction, bronchodilation [ in asthma ] and can increase the amount of energy and alertness. Ephedrine is somewhat similar to epinephrine in terms of action as well as it's adverse effects of urinary retention, tremor, hypersalivation, dyspnea, tachycardia, hypertension. SITUATION : [SORANGE217] Alpha, a 24 year old G4P3 at full term gestation is

brought to the ER after a gush of fluid passes through here vagina while doing her holiday shopping. 67. She is brought to the triage unit. The FHT is noted to be 114 bpm. Which of the following actions should the nurse do first? [2] A. Monitor FHT ever 15 minutes B. Administer oxygen inhalation C. Ask the charge nurse to notify the Obstetrician D. Place her on the left lateral position * Remove A. A FHR of 114 bpm is 6 beats below normal. Though monitoring is continuous and appropriate, This is not your immediate action. B, Oxygen inhalation needs doctor's order and therefore, is a DEPENDENT nursing action and won't be your first option. Although administration of oxygen by the nurse is allowed when given at the lowest setting during emergency situation. C is appropriate, but should not be your IMMEDIATE action. The best action is to place the client on the LEFT LATERAL POSITION to decrease the pressure in the inferior vena cava [ by the gravid uterus ] thereby increasing venus return and giving an adequate perfusion to the fetus. Your next action is to call and notify the obstetrician. Remember to look for an independent nursing action first before trying to call the physician. 68. The nurse checks the perineum of alpha. Which of the following characteristic of the amniotic fluid would cause an alarm to the nurse? [1] A. Greenish B. Scantly C. Colorless D. Blood tinged * A greenish amniotic fluid heralds fetal distress not unless the fetus is in breech presentation and pressure is present on the bowel. Other color that a nurse should thoroughly evaluate are : Tea colored or strong yellow color that indicates hemolytic anemia , as in RH incompatibility. 69. Alpha asks the nurse. "Why do I have to be on complete bed rest? I am not comfortable in this position." Which of the following response of the nurse is most appropriate? [3] A. Keeping you on bed rest will prevent possible cord prolapse B. Completed bed rest will prevent more amniotic fluid to escape C. You need to save your energy so you will be strong enough to push later D. Let us ask your obstetrician when she returns to check on you * Once the membrane ruptures, as in the situation of alpha, The immediate and most appropriate nursing diagnosis is risk for injury related to cord prolapse. Keeping

the client on bed rest is one of the best intervention in preventing cord prolapse. Other interventions are putting the client in a modified T position or Kneed chest position. Once the amniotic fluid escapes, It is allowed to escape. Although bed rest does saves energy, It is not the most appropriate response why bed rest is prescribed after membranes have ruptured. Not answering the client's question now will promote distrust and increase client's anxiety. It will also make the client think that the nurse is incompetent for not knowing the answer. 70. Alpha wants to know how many fetal movements per hour is normal, the correct response is [4] A. Twice B. Thrice C. Four times D. 10-12 times * According to Sandovsky, To count for the fetal movement, Mother is put on her LEFT SIDE to decrease placental insufficiency. This is usually done after meals. The mother is asked to record the number of fetal movements per hour. A fetus moves Twice every 10 minutes and 10 to 12 times times an hour. In SIA'S Book, She answered this question with letter B. But according to Pillitteri, A movement fewer than 5 in an hour is to be reported to the health care provider. The Board examiners uses Pillitteri as their reference and WORD PER WORD, Their question are answered directly from the Pillitteri book. 10-12 times according to Pillitteri, is the normal fetal movement per minute.

71. Upon examination by the obstetrician, he charted that Alpha is in the early stage of labor. Which of the following is true in this state? [1] A. Self-focused B. Effacement is 100% C. Last for 2 hours D. Cervical dilation 1-3 cm * The earliest phase of labor is the first stage of labor : latent phase characterized by a cervical dilation of 0-3 cm, Mild contraction lasting for 20 to 40 seconds. This lasts approximately 6 hours in primis and 4.5 hours in multis. C is the characteristic of ACTIVE PHASE of labor, Characterized by a cervical dilation of 4-7 cm and contractions of 40 to 60 seconds. This phase lasts at around 3 hours in primis and 2 hours in multis. Effacement of 100% is a characteristic of the TRANSITION PHASE as well as being self focused.

SITUATION : Maternal and child health nursing a core concept of providing health in

the community. Mastery of MCH Nursing is a quality all nurse should possess. 72. When should be the 2nd visit of a pregnant mother to the RHU? [2] A. Before getting pregnant B. As early in pregnancy C. Second trimester D. Third trimester * Visit to the RHU are once every trimester and more frequent for those women at risk. Visit to the health center is once during the 0-6th month of pregnancy, twice during the 7th-8th month and weekly at the last trimester.

73. Which of the following is NOT a standard prenatal physical examination? [1] A. Neck examination for goiter B. Examination of the palms of the hands for pallor C. Edema examination of the face hands, and lower extremeties D. Examination of the legs for varicosities 74. Which of the following is NOT a basic prenatal service delivery done in the BHS? [2] A. Oral / Dental check up B. Laboratory examination C. Treatment of diseases D. Iron supplementation * A is done at the RHU not in BHS. 75. How many days and how much dosage will the IRON supplementation be taken? [4] A. 365 days / 300 mg B. 210 days / 200 mg C. 100 days/ 100mg D. 50 days / 50 mg * Iron supplementation is taken for 210 days starting at the 5th month of pregnancy up to 2nd month post partum. Dosage can range from 100 to 200 mg. 76. When should the iron supplementation starts and when should it ends? [4] A. 5th month of pregnancy to 2nd month post partum B. 1st month of pregnancy to 5th month post partum

C. As early in pregnancy up to 9th month of pregnancy D. From 1st trimester up to 6 weeks post partum * Refer to #75 77. In malaria infested area, how is chloroquine given to pregnant women? [4] A. 300 mg / twice a month for 9 months B. 200 mg / once a week for 5 months C. 150 mg / twice a week for the duration of pregnancy D. 100 mg / twice a week for the last trimester of pregnancy * Always remember that chloroquine is given twice a week for the whole duration of pregnancy. This knowledge alone will lead you to correctly identifying letter C. 78. Which of the following mothers are qualified for home delivery? [2] A. Pre term B. 6th pregnancy C. Has a history of hemorrhage last pregnancy D. 2nd pregnancy, Has a history of 20 hours of labor last pregnancy. * Knowing that a preterm mother is not qualified for home delivery will help you eliminate A. History of complications like bleeding, CPD, Eclampsia and diseases like TB, CVD, Anemia also nulls this qualification. A qualified woman for home delivery should only had less than 5 pregnancies. More than 5 disqualifies her from home delivery. High risk length of labor for primigravidas ls more than 24 hours and for multigravidas, it is more than 12 hours. Knowing this will allow you to choose D. 79. Which of the following is not included on the 3 Cs of delivery? [2] A. Clean Surface B. Clean Hands C. Clean Equipments D. Clean Cord * 3 Cs of delivery are CLEAN SURFACE,HANDS AND CORD. " Kinamay ni Cordapya ang labada gamit ang Surf - Budek " 80. Which of the following is unnecessary equipment to be included in the home delivery kit? [4] A. Boiled razor blade B. 70% Isopropyl Alcohol C. Flashlight D. Rectal and oral thermometer

* Home delivery kit should contain the following : Clamps, Scissors, Blade, Antiseptic, Soap and hand brush, Bp app, Clean towel or cloth and Flashlight. Optional equipments include : Plastic sheet, Suction bulb, Weighing scale, Ophthalmic ointment, Nail cutter, Sterile gloves, Rectal and oral thermometers.

SITUATION : [NBLUE166] Pillar is admitted to the hospital with the following signs : Contractions coming every 10 minutes, lasting 30 seconds and causing little discomfort. Intact membranes without any bloody shows. Stable vital signs. FHR = 130bpm. Examination reveals cervix is 3 cm dilated with vertex presenting at minus 1 station. 81. On the basis of the data provided above, You can conclude the pillar is in the [1] A. In false labor B. In the active phase of labor C. In the latent phase of labor D. In the transitional phase of labor * Refer to #71 82. Pitocin drip is started on Pilar. Possible side effects of pitocin administration include all of the following except [3] A. Diuresis B. Hypertension C. Water intoxication D. Cerebral hemorrhage * Oxytocin [ Pitocin ] is a synthetic form of hormone naturally released by the PPG. It is used to augment labor and delivery. Dosage is about 1 to 2 milli units per minute and this can be doubled until the desired contraction is met. Side effects are Water intoxication, Diuresis, Hypertonicity of the uterus, Uterine rupture, Precipitated labor, Walang kamatayang Nausea and Vomiting and Fetal bradycardia. Diuresis occurs because of water intoxication, The kidney will try to compensate to balance the fluid in the body. NEVER give pitocin when FHR is below 120. Even without knowing anything about Pitocin, A cerebral hemorrhage is LETHAL and DAMAGE IS IRREVERSIBLE and if this is a side effect of a drug, I do not think that FDA or BFAD will approve it. 83. The normal range of FHR is approximately [3] A. 90 to 140 bpm

B. 120 to 160 bpm C. 100 to 140 bpm D. 140 to 180 bpm * A normal fetal heart rate is 120-160 bpm. 84. A negative 1 [-1] station means that [1] A. Fetus is crowning B. Fetus is floating C. Fetus is engaged D. Fetus is at the ischial spine * At the negative station, The fetus is not yet engaged and floating. At 0 station, it means that the fetus is engaged to the ischial spine. Crowning occurs when the fetus is at the +3,+4 Station. Stations signifies distance of the presensting part below or above ischial spine. + denoted below while - denotes above. The number after the sign denotes length in cm. +1 station therefore means that the presenting part is 1 cm below the ischial spine. 85. Which of the following is characteristics of false labor [1] A. Bloody show B. Contraction that are regular and increase in frequency and duration C. Contraction are felt in the back and radiates towards the abdomen D. None of the above * A,B and C are all charactertistics of a true labor. True labor is heralded by LIGHTENING. This makes the uterus lower and more anterior. This occrs 2 weeks prior to labor. At the morning of labor, women experiences BURST OF ENERGY because of adrenaline rush induced by the decrease progestrone secretion of the deteriorating placenta. The pain in labor is felt at the back and radiates towards the abdomen and becomes regular, increasing frequency and duration. As the cervix softens and dilates, The OPERCULUM or the mucus plug is expelled. False labor is characterized by Irregular uterine contraction that is relieved by walking, Pain felt at the abdomen and confined there and in the groin, The cervix do not achieve dilation and Pain that is relieved by sleep and do not increase in intensity and duration.

86. Who's Theory of labor pain that states that PAIN in labor is cause by FEAR [4] A. Bradley B. Simpson C. Lamaze

D. Dick-Read * Believe it or not, this is an actual board question. Grantley Dick-Read is just one person. Usually a two name theory means two theorist. He published a book in 1933 "CHILDBIRTH WITHOUT FEAR". He believes that PAIN in labor is caused by FEAR that causes muscle tension, thereby halting the blood towards the uterus and causing decreased oxygenation which causes the PAIN. 1950s French obstetrician, Dr. Ferdinand Lamaze perhaps is the most popular theorist when it comes to labor. The theory behind Lamaze is that birth is a normal, natural and healthy event that should occur without unnecessary medical intervention. Rather than resorting to pain medication, different breathing techniques are used for each stage of labor to control pain. Fathers are assigned the role of labor coach, and are responsible for monitoring and adjusting their partner's breathing pattern throughout childbirth. In 1965, obstetrician Robert A. Bradley, MD wrote "Husband Coached Childbirth." The Bradley method perhaps is the easiest to remember, BRAD ley necessitates the presence of the FATHER during labor. Bradley Method views birth as a natural process. This method also emphasizes the importance of actively involving fathers in the labor process. Fathers are taught ways to help ease their partner's pain during childbirth through guided relaxation and slow abdominal breathing. James Young Simpson is an english doctor and the first to apply anesthesia during labor and child birth. He uses ETHER to alleviate labor pain. He then discovered the effects of chloroform as an anesthetic agent. Because of his works, He was recognized by Queen Victoria because the queen herself uses Simpson's chloroform in alleviating labor pain when she gave birth to prince leopold. 87. Which sign would alert the nurse that Pillar is entering the second stage of labor? [1] A. Increase frequency and intensity of contraction B. Perineum bulges and anal orifice dilates C. Effacement of internal OS is 100% D. Vulva encircles the largest diameter of presenting part * The second stage of labor begins as the cervical internal os is 100% effaced and fully dilated. It ends after the fetus has been delivered. Crowning, as in letter B and D is too late of a sign to alert the nurse that Pillar is entering the second stage of labor. A occurs during the first stage of labor. 88. Nursing care during the second stage of labor should include [1] A. Careful evaluation of prenatal history B. Coach breathing, Bear down with each contraction and encourage

patient. C. Shave the perineum D. Administer enema to the patient * The second stage of labor begins with a full cervical dilation and effacement and finishes when the baby is fully delivered. Careful evaluation of prenatal history is done on admission and check ups and is never done in the second stage of labor. Shaving the perineum and enema are done during the first stage of labor in preparation for delivery or before labor begins when client is admitted. Enema is not a routine procedure before delivery, but can be done to prevent defecation during labor. B is appropriate during the second stage of labor when the client's contraction is at it's peak and dilation and effacement are at maximum to help client accomplish the task of giving birth. SITUATION : [NBLUE170] Baby boy perez was delivered spontaneously following a term pregnancy. Apgar scores are 8 and 9 respectively. Routine procedures are carried out. 89. When is the APGAR Score taken? [1] A. Immediately after birth and at 30 minutes after birth B. At 5 minutes after birth and at 30 minutes after birth C. At 1 minute after birth and at 5 minutes after birth D. Immediately after birth and at 5 minutes after birth * APGAR score taken 1 minute after birth determines the initial status of the newborn while the 5 minute assessment after birth determines how well the newborn is adjusting to the extrauterine life. 90. The best way to position a newborn during the first week of life is to lay him [3] A. Prone with head slightly elevated B. On his back, flat C. On his side with his head flat on bed D. On his back with head slightly elevated * Sudden infant death syndrome occurs when the fetus is in prone position. Knowing this will allow you to eliminate A first. During the first week of life, The fetus has an immature cardiac sphincter and musculature for swallowing, Knowing this will let you eliminate B and D. Side lying position is the best position for a neonate during the first few weeks of life. This will decrease the risk of aspiration of secretion. 91. Baby boy perez has a large sebaceous glands on his nose, chin, and forehead. These are known as [1] A. Milia

B. Lanugo C. Hemangiomas D. Mongolian spots * Newborn sebaceous glands are sometimes unopened or plugged. They are called MILIA. They will disappear once the gland opens at around 2 weeks after delivery. They are characterized by a pinpoint white papule. Lanugo is the fine hair that covers the newborn. It disappears starting 2 weeks after birth. A premature infant has more lanugo than a post mature infant. Hemangiomas are vascular tumors of the skin. Mongolian spots are patches that are gray in color and are often found in sacrum or buttocks. They disappear as the child grows older. 92. Baby boy perez must be carefully observed for the first 24 hours for [2] A. Respiratory distress B. Duration of cry C. Frequency of voiding D. Range in body temperature * Range in body temperature needs to be observed and carefully monitored for the first 24 hours after delivery. A newborn has an inadequate and immature temperature regulating mechanism. RDS is observed immediately after delivery, not in a continuous 24 hour observation. Once the fetus establish a normal breathing pattern it is not anymore of a concern. RDS occurs when the Surfactants are absent or insufficient. The adequacy of these surfactants is measured by the L:S ratio [ Lecithin : Spingomyelin ] An L:S ratio of 2:1 is considered, mature and adequate to sustain fetal lung expansion and ventilation. Therefore, A child born without RDS is unlikely to have RDS in 24 hours. Another thing that is carefully observed during the first 24 hours is the meconium. Absent of meconium during the first 24 hours after birth warrants further investigation by the attending physician. 93. According to the WHO , when should the mother starts breastfeeding the infant? [4] A. Within 30 minutes after birth B. Within 12 hours after birth C. Within a day after birth D. After infant's condition stabilizes * According to the world health organization, The mother should start breastfeeding her infant within 30 minutes after birth. 94. What is the BEST and most accurate method of measuring the medication dosage for infants and children? [3]

A. Weight B. Height C. Nomogram D. Weight and Height * A nomogram is the most accurate method for measuring medication dosage for infants and children. It estimates the body surface area by drawing a line in the first column [ child's height ] towards the third column [ child's weight ]. The point in which it crosses the middle column [ BSA ] is the child's surface area. 95. The first postpartum visit should be done by the mother within [4] A. 24 hours B. 3 days C. a week D. a month * Mother should visit the health facility 4 weeks to 6 weeks after delivery. The first post partum visit by the birth attendant is done within 24 hours after delivery, the next visit will be at 1 week after delivery and the third visit is done 2 to 4 weeks after delivery. 96. The major cause of maternal mortality in the philippines is [3] A. Infection B. Hemorrhage C. Hypertension D. Other complications related to labor,delivery and puerperium * Refer to the latest survey of FHSIS in the DOH website. 97. According to the WHO, what should be the composition of a commercialized Oral rehydration salt solution? [4] A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride Glucose 20 g. A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride 3.5g; g. A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride 4.5g; g. A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride 4.5g; g. 3.5g; Glucose 10 Glucose 20 Glucose 10

* This is the WHO ORESOL formula for the commercialized ORS. Remember PA BCG Which stands for POTASSIUM [ Pa ] SODIUM BICARBONATE [ B ] SODIUM

CHLORIDE [ C ] GLUCOSE [ G ]. The numbers are easy to remember because they are just increased by 1.0 g increment starting from 1.5. Glucose however is at 20 g. So the MNEMONIC is PA BCG 1.5 2.5 3.5 20. This is the mnemonic I use and it is easy to remember that way. It is original by the way. 98. In preparing ORESOL at home, The correct composition recommnded by the DOH is [4] A. 1 glass of water, 1 pinch of salt and 2 tsp of sugar B. 1 glass of water, 2 pinch of salt and 2 tsp of sugar C. 1 glass of water, 3 pinch of salt and 4 tsp of sugar D. 1 glass of water, 1 pinch of salt and 1 tsp of sugar

99. Milk code is a law that prohibits milk commercialization or artificial feeding for up to 2 years. Which law provides its legal basis? [4] A. Senate bill 1044 B. RA 7600 C. Presidential Proclamation 147 D. EO 51 * Executive order # 51 prohibits milk commercialization or artificial feeding up to 2 years. That is why the milk commercials in the country has " BREAST MILK IS STILL BEST FOR BABIES UP TO 2 YEARS " After their presentation in accordance with EO 51. RA 7600 is the ROOMING IN / BREAST FEEDING ACT which requires the heatlh professionals to bring the baby to the mother for breastfeeding as early as possible. Senate bill # 1044 was created to implement RA 7600. Presidential Proclamation # 147 made WEDNESDAY as the national immunization day.

100. A 40 year old mother in her third trimester should avoid [4] A. Traveling B. Climbing C. Smoking D. Exercising * Mother's are not prohibited to travel, climb or exercise. If long travels are expected, Mother should have a 30 minute rest period for every 2 hours of travel [ LIPPINCOTT ]. Climbing is a very vague term used by the board examiners though I assume they are referring to climbing a flight of stairs. Anyhow, SMOKING is detrimental for both mother and child no question about it and so is ALCOHOL. In thousands of questions I answered, it never fails that HANDWASHING, AVOID SMOKING, AVOID ALCOHOL are always the answer. It still depends on the question so THINK.