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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

IV-Breathing techniques * 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 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.

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

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]

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

77. In malaria infested area, how is chloroquine given to pregnant women? [4] A. 300 mg / twice a month for 9 months

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.

* 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.

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

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 DickRead 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 3.5g; Glucose 20 g. A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride 3.5g; Glucose 10 g. A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride 4.5g; Glucose 20 g.

A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride 4.5g; Glucose 10 g. * 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.

7. The frenulum and prepuce of the clitoris are formed by the? 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. Obstetrics Nursing Questions Answer Key Heres the answer key for the OB Nursing questions. All answers are correct to the best of my knowledge. If you see something wrong, you can PM me or just post a comment. Thank You, hope this little endeavor helps. Rationale will follow shortly. Good luck to everyone. God Bless. (sorry for the delay 3 days kaming alang kuryente!!) Select the best answer 1. Mr. and Mrs. Cremasteric arrive at the clinic for their first pre natal visit. Mr. Crema tells the nurse that the women in his family usually have girl babies first and wonders why some women always have girls. The nurse correct response is: a. The sex of the baby is determined by the sperm. b. Some women are just more fertile with females. c. Nature determines whether the baby will be a girl or a boy. d. The sex of the baby is determined by the egg. 2. The hormone responsible for the development of the ovum during the menstrual cycle is? a. Estrogen b. Progesterone c. Follicle Stimulating hormone (FSH) d. Luteneizing hormone (LH) 3. Which hormone is not responsible for differentiation of male reproductive organs during fetal life? a. Mullerian duct inhibitor (MDI) b. Dyhydrotestosterone c. Dehydroepiandosterone sulfate d. Testosterone 4. Which principal factor causes vaginal pH to be acidic? a. Cervical mucus changes b. Secretion of the Skenes gland c. The action of the doderlein bacillus d. Secretion of the bartholins gland 5. Family centered nursing care for women and newborn focuses on which of the following? a. Assisting individuals and families achieve their optimal health b. Diagnosing and treating problems promptly c. Preventing further complications from developing d. Conducting nursing research to evaluate clinical skills 6. When reviewing the ethical dilemmas facing maternal and newborn nurses today, which of the following has contributed to their complexity? a. Limitation of available options b. Support for one viable action c. Advancement in technology d. Consistent desirable standards a. Fossa Navicularis b. Mons veneris c. Labia majora d. Labia minora 8. The vas deferens is a: a. storage for spermatozoa b. Site of spermatozoa production c. Conduit of spermatozoa d. Passageway of sperm 9. Cremasteric visits the clinic and is told that his sperm count is normal. A normal sperm count ranges from: a. 20 to 100/ml b. 100, 000 to 200, 000/ml c. 100 to 200/ml d. 20 to 100 million/ml 10. During which of the following phase of the menstrual cycle is it ideal for implantation of a fertilized egg to occur? a. Ischemic phase b. Menstrual phase c. Proliferative phase d. Secretory phase 11. Variation on the length of menstrual cycle is due to variations in the number of days in which of the following phase? a. Proliferative phase b. Luteal phase c. Ischemic phase d. Secretory phase Situation: Mrs. Calamares G2P1 1001, comes out of the labor and

delivery room and reports ruptured amniotic membranes and contractions that occur every 3 minutes lasting 50-60 seconds. The fetus is in LOA position 12. The nurses first action should be to: a.Check the FHR b.Call the physician c. Check the vaginal discharge with nitrazine paper d.Admit Mrs. Calamares to the delivery area 13. When asked to describe the amniotic fluid, Mrs. Calamares states that it is brown-tinged. This indicates that: a. The fetus had infection b. At some point, the fetus experienced oxygen deprivation c. The fetus is in distress and should be delivered immediately d. The fetus is not experiencing any undue stress 14. The nurse established an IV line, and then connects Calamares to an electronic fetal monitor. The fetal monitoring strip shows FHR deceleration occurring about 30 sec after each contraction begins; the FHR returns to baseline after the contraction is over. This type of deceleration is caused by: a. Fetal head compression b. Umbilical cord compression c. Utero-placental insufficiency d. Cardiac anomalies 15. With this type of deceleration, the nurses first action should be to: a. Do nothing, this is a normal occurrence b. Call the physician c. Position the patient on her left side d. Continue monitoring the FHR 16. Which of the following methods would be avoided for a woman

who is 38 years old, has 3 children and smokes a pack of cigarette per day? a. Oral contraceptives b. Cervical cap c. Diaphragm d. IUD (Intra-uterine device) 17. A woman using diaphragm for contraception should be instructed to leave it in place for at least how long after intercourse? a. 1 hour b. 6 hours c. 12 hours d. 28 hours 18. When assessing the adequacy of sperm for conception to occur, which of the following is the most helpful criterion? a. sperm count b. sperm motility c. Sperm maturity d. Semen volume 19. A couple with one child had been trying, without success for several years to have another child. Which of the following terms would describe the situation? a. Primary Infertility b. Secondary Infertility c. Irreversible infertility d. Sterility Situation: Melanie a 33y/o G1P0 at 32 weeks AOG is admitted to the Hospital with the diagnosis of PIH. 20. Magnesium Sulfate is ordered per IV. Which of the following should prompt the nurse to refer to the obstetricians prior to

administration of the drug? a. BP= 180/100 b. Urine output is 40 ml/hr c. RR=12 bpm d. (+) 2 deep tendon reflex 21. The nurse knows that Melanie is knowledgeable about the occurrence of PIH when she remarks: a. It usually appears anytime during the pregnancy b. Its similar to cardio-vascular disease c. PIH occurs during the 1st trimester d. PIH occurs after the 20th wks AOG 22. After several hours of MgSO4 administration to Melanie, she should be observed for clinical manifestations of: a. Hyperkalemia b. Hypoglycemia c. Hypermagnesemia d. Hypercalcemia 23. The nurse instructs Melanie to report prodromal symptoms of seizures associated with PIH. Which of the following will she likely identify? a. Urine output of 15ml/hr b. (-) deep tendon reflex c. sudden increase in BP d. Epigastric pain Situation: The following questions pertain to intrapartum complications: 24. Which of the following may happen if the uterus becomes over stimulated by oxytocin during induction of labor? a. Weak contractions prolonged to more than 70 sec

b. Titanic contractions prolonged for more than 90 sec c. Increased pain with bright red vaginal bleeding d. Increased restlessness 25. Which of the following factors is the underlying cause of dystocia? a. Nutritional b. Environmental c. Mechanical d. Medical 26. When Umbilical cord is inserted at the edge of the placenta is termed: a. Central insertion b. Battledore insertion c. Velamentous insertion d. Lateral insertion 27. When fetal surface of the placenta presents a central depression surrounded by a thickened grayish white ring, the condition is known as: a. Placenta succenturiata b. Placenta marginata c. Fenestrated placenta d. Placenta Circumvallata 28. Which of the following is derived form mesoderm? a. lining of the GI tract b. liver c. brain d. skeletal system 29. The average length of the umbilical cord in human is: a. 35 cm

b. 55 cm c. 65 cm d. 45 cm 30. Urinary excretion of HCG is maximal between which days of gestation? 50-60 40-50 60-70 30-40 31. Which of the following is not a part of conceptus? a. deciduas b. amniotic fluid c. fetus d. membranes 32. Protection of the fetus against syphilis during the 1st trimester is attributed to: a. amniotic fluid b. langhans layer c. syncitiothrophoblast d. placenta Situation: Diane is pregnant with her first baby. She went to the clinic for check up. 33. To determine the clients EDC, which day of the menstrual period will you ask? a. first b. last c. third d. second 34. According to Diane, her LMP is November 15, 2002, using the

Naegles rule what is her EDC? a. August 22, 2003 b. August 18, 2003 c. July 22, 2003 d. February 22, 2003 35. She complained of leg cramps, which usually occurs at night. To provide relief, the nurse tells Diane to: a. Dorsiflex the foot while extending the knee when the cramps occur b. Dorsiflex the foot while flexing the knee when the cramps occurs c. Plantar flex the foot while flexing the knee when the cramps occur d. Plantar flex the foot while extending the knee when the cramp occur Situation: Marita is a nurse working in a STD clinic (question 3645) 36. The main symptom of gonorrhea in male is: a. Maculopapular rash b. Jaundice c. Urinary retention d. Urethral discharge 37. In providing education to your clients, you should take into account the fact that the most effective method known to control the spread of HIV infection is: a. Premarital serological screening b. Prophylactic treatment of exposed person c. On going sex education about preventive behaviors d. Laboratory screening of pregnant woman 38. You counseled one of your clients who developed herpes

genitalis concerning follow up care. Women who have developed the disease are at risk of developing: a. Heart and CNS damage b. Cervical cancer c. Infant Pneumonia and eye infection d. Sterility 39. Cremasteric, 19 y/o states that he has Gonorrhea. In performing assessment, the nurse should expect to identify which of the following symptoms? a. Lesion on the palms and soles b. A pinpoint rash on the penis c. Urinary dribbling d. Dysuria 40. The nurse should explain to Rhone, 15 y/o that untreated Gonorrhea in the female frequently leads to: a. Obstruction of the Fallopian tubes b. Ovarian cysts c. Ulceration of the cervix d. Endometrial polyps 41. Diane, a 16 y/o female high school student has syphilis. Treatment is initiated. Before the client leaves the clinic, which of the following actions is essential for the nurse to take? a. Advice the client to avoid sexual contact for 2 months b. Ask the client to identify her sexual contacts c. Arrange for the client to have hearing and vision screening d. Have the client to return to the clinic weekly for blood test 42. Kris complains of fishy smelling, white cheeslike vaginal discharge with pruritus. You suspect that Kris may have: a. Moniliasis b. Trichomoniasis c. Syphilis

d. Gonorrhea 43. Demi who has history of repeated Trichomonas infections was advised to have Pap-smear by her physician. She asked you what the test is for. Your appropriate response is: a. Its a screening for cervical cancer b. Its a screening test for presence of cancer in the female reproductive tract c. It is a diagnostic test for the presence of Trichomonas infection d. It is a test that will show if she has cervical cancer or not. 44. The result of the pap-test is class II. This means that: a. Presence of malignant cells b. Presence of benign or possible malignancy c. Normal finding d. Possible inflammation or infections 45. You should be aware that a major difficulty in preventing spread of gonorrhea is that many women who have the disease: a. Is un aware that they have it b. Have milder form of the disease than most men c. Are more reluctant to seek health care than men d. Acquire the disease without having sexual contact Situation: Mrs. Rhona Mahilum was admitted to the hospital with signs and symptoms of pre-eclampsia 46. Because of the possibility of convulsive seizures, which of the following should the nurse have available at the clients bed side? a. Oxygen and nasopharyngeal suction b. leather restraints c. cardiac monitor d. venous cutdown set 47. One morning, Rhona tells the nurse that she think she is having contractions. Which of the following approaches should

the nurse use to fully assess the presence of uterine co tractions? a. Place the hand on opposite side of the upper part of the abdomen, and curve them somewhat around the uterine fundus. b. Place the heel of the hand on the abdomen just above the umbilicus firmly c. Place the hand flat on the abdomen over the uterine fundus, with the fingers apart and press lightly d. Place the hand in the middle of the upper abdomen and then move hand several times to different parts of the abdomen 48. Exposure of a woman pregnant of a female offspring to which of the following substance increases the risk of the offspring during reproductive years to cervical and uterine cancer steroids thalidomides diethylstilbestrol tetracyclines 49. In which of the following conditions is vaginal rugae most prominent? a. multiparous women b. before menopause c. after menopause d. nulliparous waman 50. The deepest part o the perineal body surrounding the urethra, vagina and rectum that when damaged can result to cystocele, rectocele and urinary stress incontinence is the? a. Pubococcygeus muscle b. Spinchter of urethra and anus c. Bulbocavernous muscle d. Ischiocavernous muscle Situation: Review of concepts of parturition was made by the clinical instructor to a group of nursing students preliminary to their assignment to Labor and delivery room

51. Which plays an important role in the initiation of labor? a. maternal adrenal cortex b. fetal adrenal cortex c. fetal adrenal medulla d. maternal adrenal medulla 52. Which is not considered an uteroronin? a. Prostaglandin b. Endothelin-1 c. Oxytocin d. Relaxin 53. Which is a primary power of labor? a. uterine contractions b. pushing of the mother c. intrathoracic pressure d. abdominal contraction 54. The lower uterine segment is formed from the: a. cervix b. isthmus and cervix c. body of the uterus d. isthmus 55. Ripening of the cervix occurs during the: a. first stage b. second stage c. third stage d. fourth stage 56. In the second stage of labor, uterine contraction last: a. 20 seconds b. 30 seconds

c. 60 seconds d. 120 seconds 57. The time between uterine contractions is: a. intensity b. interval c. duration d. frequency 58. Midpelvic capacity may be precisely determined by: a. imaging studies b. clinical measurement of the sidewall convergence c. clinical measurement of the ischial spine prominence d. sub pubic angel measurement 59. The inanimate bone of the pelvis is not composed of the: a. sacrum b. ilium c. Pubis d. Ischium 60. Which does not refer to the transverse diameter of the pelvic outlet? a. Bi-ischial diameter b. Bi-spinous diameter c. Bi-tuberous diameter d. Intertuberous diameter 61. The Antero-posterior diameter of the pelvic inlet where the fetus will likely most difficulty during labor is the: a. Diagonal conjugate b. True conjugate c. conjugate Vera d. obstetric conjugate

62. The true conjugate can be measured by subtracting ______ to the diagonal conjugate? a. 2.5 3 cm b. 3.5 4 cm c. 3 4 cm d. 1.5 2 cm 63. The most important muscle of the pelvic floor is the: a. levator ani muscle b. ischiocavernous c. bulbocavernous d. pubococcygeous 64. Which pelvic shape has the poorest prognosis fro vaginal delivery? a. platypelloid b. anthropoid c. android d. gynecoid 65. The two pubic bones meet anteriorly at the: a. symphysis pubis b. coccyx c. sacrococcygeal d. sacro-illiac joint 66. In the second stage of labor, expulsion of the fetus from birth canal depends on which important factor? a. Maternal bearing down b. Cervical dilatation c. Uterine contractions d. Adequate pelvic size 67. In what presentation is the head in extreme flexion?

a. sinciput b. brow c. vertex d. face Situation: a 26 y/o primigravida admitted to the hospital. Vaginal exam reveals that her cervix is 5cm dilated, 80% effaced and the presenting part in zero station, membranes still intact, occiput is in posterior position 68. Due to fetal position, the nurse caring for her would be correct in telling her that: a. she will not have the urge to bear down when she becomes fully dilated b. she can expect to have more back discomfort than most woman in labor c. the position of babys head is optimum for passing through the pelvis d. a caesarian section may be necessary to deliver the baby in thin position 69. Upon IE, you noted that the cervix ix its original length. This mean that effacement is: a. 25% b. 75% c. 100% d. 50% 70. Because of the position of the fetus, an episiotomy has to be performed to enlarge the birth canal. Which of the following is an advantage of episiotomy over lacerations? a. it is more difficult to repair than laceration b. it is more painful than laceration c. it involve a more blood loss than laceration d. heals more faster than laceration

71. Supporting the perenium at the time of crowning will facilitate: a. flexion of the fetal head b. external rotation c. extension of the fetal head d. expulsion 72. When the bi-parietal diameter of the fetal head passes through the pelvic inlet, this is referred as: a. descent b. flexion c. engagement d. extension 73. Sudden gush of blood or lengthening of the cord after the delivery of infant should warn the nurse of: a. placenta acrreta b. placental separation c. placental retention d. abruption placenta Situation: Nurse Tsunade is a staff nurse in the OB ward of Konoha Medical Hospital 74. When separation begins at the center of the placenta and slides down the birth canal like a folded umbrella this is referred as: a. Duncan mechanism b. Shultz mechanism c. Brandt Andrews mechanism d. Ritgens maneuver 75. Which of the following is not true regarding the third stage of labor?

a. Care should be taken in the administration of bolus of oxytocin because it can cause hypertension b. Signs of placental separation are lengthening of the cord, sudden gush of blood and sudden change in shape of the uterus c. It ranges from the time of expulsion of the fetus to the delivery of the placenta d. The placenta is delivered approximately 5-15 minutes after delivery of the baby 76. In the immediate postpartum period the action of methylegonovine is to: a. cause sustained uterine contractions b. causes intermittent uterine contractions c. relaxes the uterus d. induces sleep so that the mother can rest after an exhausting labor 77. Rhina is a primipara hospitalized due to preeclampsia. The doctor decided to perform NST. The nurse should apply the fetal transducer over the fetus: a. chest b. back c. head d. buttocks 78. Marisse, a newly delivered multipara complains of heavy and painful breast accompanied by fever. The nurse tells Gina that it is normal breast engorgement as the fever is characterized by a. More than 38 degrees b. Does not last more than 24 hours c. Caused by infection d. Needs to be treated with antibiotic 79. Postpartum depression occurs during which time frame? a. within weeks after delivery

b. within 12 weeks c. within 16 weeks d. within 24 hours 80. Demi, a 38 y/o multipara is admitted with a tentative diagnosis of femoral thrombophlebitis. The nurse assesses the patient with: a. burning on urination b. leg pain c. abdominal pain d. increased lochial flow 81. Fever, foul lochial discharge and subinvolution of the uterus are signs of: a. puerperal psychosis b. puerperal sepsis c. postpartum hemorrhage d. hypertensive disorder 82. Which is most important when caring for a high risk postpartum clients? a. discussing hygiene and nutrition b. referring the mother to others for emotional support c. discussing complications and treatment d. promoting mother-newborn contact 83. A direct cause of mis-management of the third stage of labor is: a. inversion of the uterus b. cord prolapse c. prolonged labor d. all of these 84. Rachel, a diabetic woman at 36 weeks gestation is scheduled for biophysical profile in order to:

d. 10-12 times a. ascertain correct gestational age b. determine fetal lung maturity c. determine fetal well being d. determine fetal size and obvious congenital anomaly 85. In a primigravida, the following demotes contracted pelvis except: a. absence of quickening b. absence of lightening c. absence of engagement d. none of these 86. Which of the following changes in Dianes BP would nurse Tsunade not expect? a. it tends to be highest in sitting b. BP may increase a little in the 2nd tri c. It should be taken at every visit at the clinic d. It is normal for blood pressure to increase as much as 33 in systolic in the 3rd tri when a woman is near delivery 87. Nurse Tsunade referred to Diane to an Obstetrician. At 8 months she was orderd for a contraction stress test and the result is negative. Diane asked when she should be back for her next check up? a. Monthly b. Within 24-hours c. Within a week d. Weekly for 2 weeks then monthly 89. Diane wants to know how many fetal movements per hour is normal. The correct response of Nurse tsunade is: a. twice b. thrice c. four times 90. Which of the following statement about L/S ratio in amniotic fluid is correct? a. a slight variation in technique does not significantly affect the accuracy of result b. a L/S ratio of 2:1 is incompatible with life c. a L/S ratio of less than 1:0 is compatible with fetal survival d. when L/S ratio is 2:1 below, majority of infants develop respiratory distress 91. Every visit, you obtain the pregnant womans fundic height.. At what age of gestion does the fundic height in cm strongly correlates with gestational age in wks? a. 20-24 wks b. 18-24 wks c. 18-32 wks d. 12-38 wks 92. Which is not an indication of amniocentesis? a. previous pregnancy with chromosomal abnormal fetus b. down syndrome in siblings c. pregnancies in women over 35 y/o d. at 8 wks gestation for chromosomal study Situation: Erica is 24 y/o Filipina married to an American. She is pregnant for the second time and now at 8 weeks AOG. She is RH (-) with blood type B 93. Erica gave birth to a term baby with yellowish skin and sclera. The baby is placed on phototherapy. The treatment is effective when blood test shows: a. Low serum bilirubin b. O2 level of 99% c. Normal RBC and WBC count

d. Low platelet count 94. Because of rapidly rising bilirubin level, exchange transfusion was performed on Ericas NB. The nurse understands that the blood to be transfused to the baby should be: a. Type B, RH + b. Type O, RH c. ABO compatible, RH d. Type B, RH 95. Immediately after delivery of Ericas Baby, the nurse should remember to: a. delay clamping of the cord to previde the newborn with more blood b. cut immediately after birth of the baby c. administer RHoGam to the NB immediately on the 3rd stage of labor d. place the NB in an isolette for phototherapy 96. The doctor ordered Kleihauer-Betke. The nurse know which of the following to be wrong about the test: a. it is used to identify the amount of antibodies in the maternal serum b. it is used to determine presence of fetal blood c. it is used to asses whether the mother is RH or RH + d. It is used to determine fetal blood type and RH factor 97. Which of the following findings in Ericas history would identify a need for her to receive RHo (d) immune globulin? a. Rh -, coombs + b. Rh -, Coombs c. Rh +, Coombs d. Rh +, Coombs + 98. The portion of the placenta overlying the blastocyst
52. When planning and implementing care for the newborn

a. decidua capsularis b. decidua vera c. decidua basalis d. decidua parietalis 99. The cardinal function of deciduas is a. Immune resonse b. Production of hormones c. Maintenance of pregnancy d. None of the above 100. O2 and Co2 are exchanged in the placenta through the process of: a. pinocytosis b. diffusion c. facilitated diffusion d. active transport

that has been successfully resuscitated, which of the following would be important to assess? [1] 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] C. 14 days before the next period is expected 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] D. Na HCO3 Douches 55. A diagnostic test used to evaluate fertility is the postcoital test. It is best timed [2] B. Immediately after menses

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] B. Identify complications with early intervention in the high risk newborn to reduce morbidity and mortality rn 51. Which of the following would the nurse expect to find in a newborn with birth asphyxia? [1] B. Acidosis

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] D. Previous injury to a tube 57. Which test is commonly used to determine the number, motility and activity of sperm is the [2] B. Huhner test 58. In the female, Evaluation of the pelvic organs of reproduction is accomplished by [2] D. Hysterosalpingogram

59. When is the fetal weight gain greatest? [3] C. 3rd trimester 60. In fetal blood vessel, where is the oxygen content highest? [3] B. Ductus Venosus 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 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 B. I,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 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 D. I,II 65. Lumbar epidural anesthesia is administered. Which of the following nursing responsibilities should be done immediately following procedure? [1] D. Assess for maternal hypotension 66. Which is NOT the drug of choice for epidural anesthesia? [4] C. Ephedrine 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 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 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]

C. You need to save your energy so you will be strong enough to push later 70. Alpha wants to know how many fetal movements per hour is normal, the correct response is [4] C. Four 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] 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] C. Second trimester 73. Which of the following is NOT a standard prenatal physical examination? [1] 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 75. How many days and how much dosage will the IRON supplementation be taken? [4]

B. 210 days / 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 83. The normal range of FHR is approximately [3] 77. In malaria infested area, how is chloroquine given to pregnant women? [4] C. 150 mg / twice a week for the duration of pregnancy 78. Which of the following mothers are qualified for home delivery? [2] 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] C. Clean Equipments 80. Which of the following is unnecessary equipment to be included in the home delivery kit? [4] C. Flashlight 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] C. In the latent phase of labor B. 120 to 160 bpm 84. A negative 1 [-1] station means that [1] A. Milia B. Fetus is floating 85. Which of the following is characteristics of false labor [1] 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 87. Which sign would alert the nurse that Pillar is entering the second stage of labor? [1] D. Vulva encircles the largest diameter of presenting part C. Nomogram 88. Nursing care during the second stage of labor should include [1] B. Coach breathing, Bear down with each contraction and encourage 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] 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] 92. Baby boy perez must be carefully observed for the first 24 hours for [2] A. Respiratory distress 93. According to the WHO , when should the mother starts breastfeeding the infant? [4] A. Within 30 minutes after birth 94. What is the BEST and most accurate method of measuring the medication dosage for infants and children? [3] B. On his back, flat 91. Baby boy perez has a large sebaceous glands on his nose, chin, and forehead. These are known as [1] 82. Pitocin drip is started on Pilar. Possible side effects of pitocin administration include all of the following except [3] A. Diuresis C. At 1 minute 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]

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. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride 3.5g; Glucose 20 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 99. Milk code is a law the prohibits milk commercialization or artificial feeding for up to 2 years. Which law provides its legal basis? [4] D. EO 51 100. A 40 year old mother in her third trimester should avoid [4] C. Smoking

1. OB/GYN Intrapartum 1. A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted? A. B. C. The client begins to expel clear vaginal fluid The contractions are regular The membranes have ruptured 1. 2. 3. 4. 5. 2. 3. 4. 4.

Fetal heart rate of 180 beats per minute White blood cell count of 12,000 Maternal pulse rate of 85 beats per minute Hemoglobin of 11.0 g/dL A client in labor is transported to the delivery room and is

prepared for a cesarean delivery. The client is transferred to the delivery room table, and the nurse places the client in the:

D. The cervix is dilated completely 2. A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to:

Trendelenburgs position with the legs in stirrups Semi-Fowler position with a pillow under the knees Prone position with the legs separated and elevated Supine position with a wedge under the right hip A nurse is caring for a client in labor and prepares to

auscultate the fetal heart rate by using a Doppler ultrasound 1. 2. Place the mother in the supine position Document the findings and continue to monitor the fetal patterns 3. 4. 3. Administer oxygen via face mask Increase the rate of pitocin IV infusion A nurse is performing an assessment of a client who is 3. 1. 2. Noting if the heart rate is greater than 140 BPM Placing the diaphragm of the Doppler on the mother abdomen Performing Leopolds maneuvers first to determine the location of the fetal heart device. The nurse most accurately determines that the fetal heart sounds are heard by:

scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician?

4.

Palpating the maternal radial pulse while listening to the fetal heart rate

seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate?

10. A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the clients abdomen. After attachment of the monitor, the initial nursing assessment is which of the following?

6.

A nurse is caring for a client in labor who is receiving Pitocin

by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? 2. 1. 2. 3. Three contractions occurring within a 10-minute period A fetal heart rate of 90 beats per minute Adequate resting tone of the uterus palpated between contractions 4. 7. Increased urinary output A nurse is beginning to care for a client in labor. The 3. 4. 9. 1. Encourage the clients coach to continue to encourage breathing exercises Encourage the client to continue pushing with each contraction Continue monitoring the fetal heart rate Notify the physician or nurse mid-wife A nurse is caring for a client in labor and is monitoring the

1. 2. 3. 4.

Identifying the types of accelerations Assessing the baseline fetal heart rate Determining the frequency of the contractions Determining the intensity of the contractions

11. A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at -1 station. The nurse determines that the fetal presenting part is:

fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate?

physician has prescribed an IV infusion of Pitocin. The nurse ensures that which of the following is implemented before initiating the infusion?

1. 1. Document the findings and tell the mother that the monitor indicates fetal well-being 2. 3. 4.

1 cm above the ischial spine 1 fingerbreadth below the symphysis pubis 1 inch below the coccyx 1 inch below the iliac crest

1. 2. 3. 4. 8.

Placing the client on complete bed rest Continuous electronic fetal monitoring An IV infusion of antibiotics Placing a code cart at the clients bedside A nurse is monitoring a client in active labor and notes that

2.

Take the mothers vital signs and tell the mother that bed rest is required to conserve oxygen.

12. A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the clients hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following?

3. 4.

Notify the physician or nurse mid-wife of the findings. Reposition the mother and check the monitor for changes in the fetal tracing

the client is having contractions every 3 minutes that last 45

1. 2. 3. 4.

A loud mouth Low self-esteem Hemorrhage Postpartum infections

15. A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?

1. 2. 3. 4.

Exhaustion Fear of losing control Involuntary grunting Valsalvas maneuver

13. A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:

1. 2. 3. 4.

Early decelerations Variable decelerations Late decelerations Short-term variability

18. A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes.

16. A nurse explains the purpose of effleurage to a client in early 1. 2. 3. 4. Hematoma Placenta previa Uterine atony Placental separation 2. 1. A form of biofeedback to enhance bearing down efforts during delivery Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus 3. The application of pressure to the sacrum to relieve a backache 4. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest 1. 2. 3. 4. Less pressure on her cervix Increased efficiency of contractions Decreased number of contractions The need for increased maternal blood pressure monitoring 17. A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as: 1. 2. 3. 4. Medication that will provide sedation Increased hydration Oxytocin (Pitocin) infusion Administration of a tocolytic medication labor. The nurse tells the client that effleurage is: 1. 2. 3. 4. 5. Stop of Pitocin infusion Perform a vaginal examination Reposition the client Check the clients blood pressure and heart rate Administer oxygen by face mask at 8 to 10 L/min

14. A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nursemidwife explains to the client that after this procedure, she will most likely have:

19. A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physicians orders and would expect to note which of the following prescribed treatments for this condition?

20. A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to:

1. 2. 3. 4.

Over the fetus that is most anterior to the mothers abdomen Over the fetus that is most posterior to the mothers abdomen So that each fetal heart rate is monitored separately So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal monitoring period for the second fetus

2. 3. 4.

A soft and boggy uterus Maternal complaints of severe uterine cramping Changes in the shape of the uterus

25. A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action?

1. 2. 3. 4.

Monitor the Pitocin infusion closely Provide pain relief measures Prepare the client for an amniotomy Promote ambulation every 30 minutes

23. A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?

1. 2.

Place the client in Trendelenburgs position Call the delivery room to notify the staff that the client will be transported immediately

21. A nurse is developing a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects which of the following nursing interventions as the highest priority?

3. 1. 2. 3. Disseminated intravascular coagulation Chronic hypertension Infection Hemorrhage 4.

Gently push the cord into the vagina Find the closest telephone and stat page the physician

26. A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation?

1.

Keeping the significant other informed of the progress of the labor

4.

24. A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery?

2. 3. 4.

Providing comfort measures Monitoring fetal heart rate Changing the clients position frequently

1. 2. 3. 4.

Swelling of the calf in one leg Prolonged clotting times Decreased platelet count Petechiae, oozing from injection sites, and hematuria

22. A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins. The nurse monitors the fetal heart rates by placing the external fetal monitor:

1.

The umbilical cord shortens in length and changes in color

27. A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? 1. 2. 3. 4. Absence of abdominal pain A soft abdomen Uterine tenderness/pain Painless, bright red vaginal bleeding

1. 2. 3. 4.

Complete bed rest for the remainder of the pregnancy Delivery of the fetus Strict monitoring of intake and output The need for weekly monitoring of coagulation studies until the time of delivery

32. A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus head is:

1. 2. 3. 4.

Not yet engaged Entering the pelvic inlet Below the ischial spines Visible at the vaginal opening

30. A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred?

33. After doing Leopolds maneuvers, the nurse determines that 1. 2. 3. 4. Hypotonic contractions Forceps delivery Schultz delivery Weak bearing down efforts 1. 2. 3. 4. Above the umbilicus at the midline Above the umbilicus on the left side Below the umbilicus on the right side Below the umbilicus near the left groin the fetus is in the ROP position. To best auscultate the fetal heart tones, the Doppler is placed:

28. A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physicians orders and would question which order? 1. 2. Prepare the client for an ultrasound Obtain equipment for external electronic fetal heart monitoring 3. 4. Obtain equipment for a manual pelvic examination Prepare to draw a Hgb and Hct blood sample

31. A client is admitted to the birthing suite in early active labor. The priority nursing intervention on admission of this client would be:

34. The physician asks the nurse the frequency of a laboring 1. 2. 3. 4. Auscultating the fetal heart Taking an obstetric history Asking the client when she last ate Ascertaining whether the membranes were ruptured 1. 2. 3. Until the time it is completely over To the end of a second contraction To the beginning of the next contraction clients contractions. The nurse assesses the clients contractions by timing from the beginning of one contraction:

29. An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for:

4.

Until the time that the uterus becomes very firm

2. 3. 4.

Change the clients position Prepare for immediate delivery Take the clients blood pressure

2. 3. 4.

Slow chest Shallow Accelerated-decelerated

35. The nurse observes the clients amniotic fluid and decides that it appears normal, because it is:

38. When monitoring the fetal heart rate of a client in labor, the 1. 2. 3. 4. Clear and dark amber in color Milky, greenish yellow, containing shreds of mucus Clear, almost colorless, and containing little white specks Cloudy, greenish-yellow, and containing little white specks 1. 2. 3. 1. 2. Discontinue the catheter, if the reading is not above 80% Discontinue the catheter, if the reading does not go below 30% 3. Advance the catheter until the reading is above 90% and continue monitoring 4. Reposition the catheter, recheck the reading, and if it is 55%, keep monitoring 37. When examining the fetal monitor strip after rupture of the membranes in a laboring client, the nurse notes variable decelerations in the fetal heart rate. The nurse should: 1. 2. 3. 4. Breech Transverse Occiput anterior Occiput posterior 4. An acceleration An early elevation A sonographic motion A tachycardic heart rate nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as:

41. During the period of induction of labor, a client should be observed carefully for signs of:

1. 2. 3. 4.

Severe pain Uterine tetany Hypoglycemia Umbilical cord prolapse

36. At 38 weeks gestation, a client is having late decelerations. The fetal pulse oximeter shows 75% to 85%. The nurse should:

42. A client arrives at the hospital in the second stage of labor. The fetus head is crowning, the client is bearing down, and the birth appears imminent. The nurse should:

39. A laboring client complains of low back pain. The nurse replies that this pain occurs most when the position of the fetus is:

1. 2. 3.

Transfer her immediately by stretcher to the birthing unit Tell her to breathe through her mouth and not to bear down Instruct the client to pant during contractions and to breathe through her mouth

4.

Support the perineum with the hand to prevent tearing and tell the client to pant

40. The breathing technique that the mother should be instructed to use as the fetus head is crowning is:

43. A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working she:

1.

Stop the oxytocin infusion

1.

Blowing

1. 2. 3. 4.

Will not feel the episiotomy May lose bladder sensation May lose the ability to push Will no longer feel contractions

2. 3. 4.

Fetal position Labor progress Oxygenation

1.

Contractions, passageway, placental position and function, pattern of care

2.

Contractions, maternal response, placental position, psychological response

47. A laboring client is in the first stage of labor and has progressed from 4 to 7 cm in cervical dilation. In which of the following phases of the first stage does cervical dilation occur 3.

44. Which of the following observations indicates fetal distress?

Passageway, contractions, placental position and function, psychological response

1. 2. 3. 4.

Fetal scalp pH of 7.14 Fetal heart rate of 144 beats/minute Acceleration of fetal heart rate with contractions Presence of long term variability

most rapidly?

4.

Passageway, placental position and function, paternal response, psychological response

1. 2. 3. 4.

Preparatory phase Latent phase Active phase Transition phase

50. Fetal presentation refers to which of the following descriptions?

45. Which of the following fetal positions is most favorable for birth?

1. 2. 3.

Fetal body part that enters the maternal pelvis first Relationship of the presenting part to the maternal pelvis Relationship of the long axis of the fetus to the long axis of the mother

48. A multiparous client who has been in labor for 2 hours states 1. 2. 3. 4. Vertex presentation Transverse lie Frank breech presentation Posterior position of the fetal head 1. 2. 3. 4. Let the client get up to use the potty Allow the client to use a bedpan Perform a pelvic examination Check the fetal heart rate that she feels the urge to move her bowels. How should the nurse respond?

4.

A classification according to the fetal part

51. A client is admitted to the L & D suite at 36 weeks gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates titanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms?

46. A laboring client has external electronic fetal monitoring in place. Which of the following assessment data can be determined by examining the fetal heart rate strip produced by the external electronic fetal monitor?

49. Labor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which

1.

Gender of the fetus

are the other four factors?

1. 2. 3. 4.

Hysteria compounded by the flu Placental abruption Uterine rupture Dysfunctional labor

are intense, last 90 seconds, and occur every 1 1/2 to 2 minutes. The nurses immediate action would be to:

because it decreases uterine blood flow to the fetus. The client should be turned to her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous pitocin

1. 2. 3. 4.

Change the womans position Stop the Pitocin Elevate the womans legs Administer oxygen via a tight mask at 8 to 10 liters/minute 3.

infusion is discontinued when a late deceleration is noted. 1. A normal fetal heart rate is 120-160 beats per minute. A count of 180 beats per minute could indicate fetal distress and would warrant physician notification. By full term, a normal maternal hemoglobin range is 11-13 g/dL as a result of the hemodilution caused by an increase in plasma volume during pregnancy. 4. 4. Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and the fetus. The best position to prevent this would be side-lying with the uterus displaced off of abdominal vessels. Positioning for abdominal surgery necessitates a supine position; however, a

52. Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. Which of the following is a correct interpretation of the data?

55. The nurse should realize that the most common and 1. 2. 3. 4. Fetal presenting part is 1 cm above the ischial spines Effacement is 4 cm from completion Dilation is 50% completed Fetus has achieved passage through the ischial spines 1. 2. 3. 4. 1. 2. 3. 4. FHR does not change as a result of fetal activity Average baseline rate ranges between 100 140 BPM Mild late deceleration patterns occur with some contractions Variability averages between 6 10 BPM 2. 1. 4. The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate. 3. Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. The supine position is avoided 5. Severe postpartum headache Limited perception of bladder fullness Increase in respiratory rate Hypotension potentially harmful maternal complication of epidural anesthesia would be:

53. Which of the following findings meets the criteria of a reassuring FHR pattern?

ANSWERS

wedge placed under the right hip provides displacement of the uterus. 4. The nurse simultaneously should palpate the maternal radial or carotid pulse and auscultate the fetal heart rate to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the

54. Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions

fetal heart rate. Leopolds maneuvers may help the examiner locate the position of the fetus but will not ensure a distinction between the two rates. 6. 2. A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue to pitocin. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period. 7. 2. Continuous electronic fetal monitoring should be implemented during an IV infusion of Pitocin. 8. 4. A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the physician or nurse mid-wife needs to be notified. 9. 1. Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve. 10. 2. Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur. Options 1 and 3 are important to assess, but not as the first priority.

11. 1. Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines.

15. 2. Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because it suggests uteroplacental insufficiency during a contraction. Short-term variability refers to the beat-to-

12. 4. Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage. Having a loud mouth is only related to the person typing up this test.

beat range in the fetal heart rate.

16. 2. Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen and is used before transition to promote relaxation and relieve mild to moderate pain. Effleurage provides tactile stimulation to the fetus.

13. 4. As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears. 17. 2. Pains, helplessness, panicking, and fear of losing control are possible behaviors in the 2nd stage of labor. 18. 1, 4, 2. 5, 3. If uterine hypertonicity occurs, the nurse 14. 2. Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. immediately would intervene to reduce uterine activity and increase fetal oxygenation. The nurse would stop the Pitocin infusion and increase the rate of the nonadditive solution, check maternal BP for hyper or hypotension, position the woman in a side-lying position, and administer oxygen by snug face mask at 810 L/min. The nurse then would attempt to determine the cause of

the uterine hypertonicity and perform a vaginal exam to check for prolapsed cord.

(vagina), a firmly contracted uterus, and the uterus changing from a discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness, but not severe uterine

in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophebitis.

19. 3. Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows.

cramping. I am going to look more into this answer. According to our book on page 584, this is not one of our options. 25. 1. When cord prolapse occurs, prompt actions are taken to

27. 3. In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to constrict blood vessels and control bleeding.

20. 2. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern.

relieve cord compression and increase fetal oxygenation. The mother should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff

21. 3. The priority is to monitor the fetal heart rate.

members should call the physician and notify the delivery room. No attempt should be made to replace the cord. The examiner,

22. 3. In a client with a multi-fetal pregnancy, each fetal heart rate is monitored separately.

however, may place a gloved hand into the vagina and hold the presenting part off of the umbilical cord. Oxygen at 8 to 10 L/min by face mask is delivered to the mother to increase fetal 28. 3. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis 26. 1. DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.

23. 4. Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.

oxygenation.

24. 4. Signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark blood from the introitus

show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than

29. 2. The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.

34. 3. This is the way to determine the frequency of the contractions

40. 1. Blowing forcefully through the mouth controls the strong urge to push and allows for a more controlled birth of the head.

35. 3. by 36 weeks gestation, normal amniotic fluid is colorless with small particles of vernix caseosa present.

41. 2. Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion

30. 2. Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall.

36. 4. Adjusting the catheter would be indicated. Normal fetal pulse oximetry should be between 30% and 70%. 75% to 85% would indicate maternal readings.

must be stopped to prevent uterine rupture and fetal compromise.

42. 4. Gentle pressure is applied to the babys head as it emerges so it is not born too rapidly. The head is never held back, and it

37. 2. Variable decelerations usually are seen as a result of cord compression; a change of position will relieve pressure on the cord.

should be supported as it emerges so there will be no vaginal lacerations. It is impossible to push and pant at the same time.

31. 1. Determining the fetal well-being supersedes all other measures. If the FHR is absent or persistently decelerating, immediate intervention is required. 38. 1. An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate. A 32. 3. A station of +1 indicates that the fetal head is 1 cm below the ischial spines. 39. 4. A persistent occiput-posterior position causes intense back 33. 3. Fetal heart tones are best auscultated through the fetal back; because the position is ROP (right occiput presenting), the back would be below the umbilicus and on the right side. pain because of fetal compression of the sacral nerves. Occiput anterior is the most common fetal position and does not cause back pain. tachycardic FHR is above 160 beats per minute.

43. 1. A pudendal block provides anesthesia to the perineum.

44. 1. A fetal scalp pH below 7.25 indicates acidosis and fetal hypoxia.

45. 1. Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires a Csection. Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery. Posterior positioning of

the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis.

49. 3. The five essential factors (5 Ps) are passenger (fetus), passageway (pelvis), powers (contractions), placental position and function, and psyche (psychological response of the mother).

is engaged. Passage through the ischial spines with internal rotation would be indicated by a plus station, such as + 1. Progress of effacement is referred to by percentages with 100% indicating full effacement and dilation by centimeters (cm) with

46. 4. Oxygenation of the fetus may be indirectly assessed through fetal monitoring by closely examining the fetal heart rate strip. Accelerations in the fetal heart rate strip indicate good oxygenation, while decelerations in the fetal heart rate sometimes indicate poor fetal oxygenation. 50. 1. Presentation is the fetal body part that enters the pelvis first; its classified by the presenting part; the three main presentations are cephalic/occipital, breech, and shoulder. The relationship of the presenting fetal part to the maternal pelvis refers to fetal position. The relationship of the long axis to the 47. 3. Cervical dilation occurs more rapidly during the active phase than any of the previous phases. The active phase is characterized by cervical dilation that progresses from 4 to 7 cm. The preparatory, or latent, phase begins with the onset of regular uterine contractions and ends when rapid cervical dilation begins. Transition is defined as cervical dilation beginning at 8 cm and lasting until 10 cm or complete dilation. 51. 3. Uterine rupture is a medical emergency that may occur before or during labor. Signs and symptoms typically include abdominal pain that may ease after uterine rupture, vomiting, vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client typically complains of vaginal 48. 3. A complaint of rectal pressure usually indicates a low presenting fetal part, signaling imminent delivery. The nurse should perform a pelvic examination to assess the dilation of the cervix and station of the presenting fetal part. Dont let the client use the potty or bedpan before she is examined because she could birth that there baby right there in that darn potty. 52. 1. Station of 1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. A station of zero would indicate that the presenting part has passed through the inlet and is at the level of the ischial spines or bleeding and constant abdominal pain. fetus to the long axis of the mother refers to fetal lie; the three possible lies are longitudinal, transverse, and oblique.

10 cm indicating full dilation.

53. 4. Variability indicates a well oxygenated fetus with a functioning autonomic nervous system. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats per minute. Late deceleration patterns are never reassuring, though early and mild variable decelerations are expected, reassuring findings.

54. 2. Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic which stimulates the uterus to contract. The woman is already in an appropriate position for uteroplacental perfusion. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

55. 4. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure. Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic as it would be with a low spinal (saddle block) anesthetic; 2 is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication.