1. B. a decline in growth rate. During the Preschooler stage growth is very minimal.

Weight gain is
only 4.5lbs (2kgs) per year and Height is 3.5in (6-8cm) per year.
Review:
Most rapid growth and development- Infancy
Slow growth- Toddler hood and Preschooler
Slower growth- School age
Rapid growth- Adolescence
2. D. Rate and pattern of growth can be modified. Growth and development occurs in cephalo-
caudal meaning development occurs through out the bodys axis. Example: the child must be able
to lift the head before he is able to lift his chest. Proximo-distal is development that progresses
from center of the body to the extremities. Example: a child first develops arm movement before
fine-finger movement. Different parts of the body grows at different range because some body
tissue mature faster than the other such as the neurologic tissues peaks its growth during the first
years of life while the genital tissue doesnt till puberty. Also G&D is predictable in the sequence
which a child normally precedes such as motor skills and behavior. Lastly G&D can never be
modified .
3. A. Make believe. Make believe is most appropriate because it enhances the imitative play and
imagination of the preschooler. C and D are for infants while letter A is B is recommended for
schoolers because it enhances competitive play.
4. C. Has the ability to try new things. Erickson defines the developmental task of a preschool
period is learning Initiative vs. Guilt. Children can initiate motor activities of various sorts on their
own and no longer responds to or imitate the actions of other children or of their parents.
5. C. nave instrumental orientation. According to Kohlber, a preschooler is under Pre-conventional
where a child learns about instrumental purpose and exchange, that is they will something do for
another if that that person does something with the child in return. Letter A is applicable for
Toddlers and letter B is for a School age child.
6. A. Long. The average length of full-term babies at birth is 20 in. (51 cm), although the normal
range is 46 cm (18 in.) to 56 cm (22 in.).
7. A. From cognitive to psychosexual. Growth and development occurs in cephalo-caudal (head to
toe), proximo-distal (trunk to tips of the extremities and general to specific, but it doesnt occurs in
cognitive to psychosexual because they can develop at the same time.
8. C. Trust vs. mistrust. According to Erikson, children 0-18 months are under the developmental
task of Trust vs. Mistrust.
9. A. Disappears in about a year. Mongolian spots are stale grey or bluish patches of discoloration
commonly seen across the sacrum or buttocks due to accumulation of melanocytes and they
disappears in 1 year. They are not linked to steroid use and pathologic conditions.
10. D. Increased RR. Hypothermia is inaccurate cause normally, temperature of a newborn drop,
Also a child under cold stress will kick and cry to increase the metabolic rate thereby increasing
heat so B isnt a good choice. A newborn doesnt have the ability to shiver, so letter B and C is
wrong. A newborn will increase its RR because the NB will need more oxygen because of too much
activity.
11. A. Mothers breast. Place it at the mothers breast for latch-on. (Note: for NSD breast feed ASAP
while for CS delivery, breast feed after 4 hours)
12. A. Direct Coombs. Coombs test is the test to determine if RH antibodies are present. Indirect
Coombs is done to the mother and Direct Coombs is the one dont to the baby. Blood culture and
Platelet count doesnt help detect RH antibodies.
13. A. Place the crib beside the wall. Placing the crib beside the wall is inappropriate because it can
provide heat loss by radiation. Doing Kangaroo care or hugging the baby, mechanical pressure or
incubators and drying and wrapping the baby will help conserve heat.
14. B. Increase ICP. Hypoglycemia may occur due to increase metabolic rate, and because of
newborns are born slightly acidic, and they catabolize brownfat which will produce ketones which is
an acid will cause metabolic acidosis. Also a NB with severe hypothermia is in high risk for
kernicterus (too much bilirubin in the brain) can lead to Cerebral palsy. There is no connection in
the increase of ICP with hypothermia. (NOTE: pathognomonic sign of Kernicterus in adult- asterexis,
or involuntary flapping of the hand.)
15. D. Foramen Ovale. Foramen ovale is opening between two atria, Ductus venosus is the shunt
from liver to the inferior vena cava, and your Ductus Arteriosus is the shunt from the pulmonary
artery to the aorta.
16. B. Shifting of pressures from right side to the left side of the heart. During feto-placental
circulation, the pressure in the heart is much higher in the right side, but once breathing/crying is
established, the pressure will shift from the R to the L side, and will facilitate the closure of Foramen
Ovale. (Note: that is why you should position the NB in R side lying position to increase pressure in
the L side of the heart.)
Review:
Increase PO2-> closure of ductus arteriosus
 Decreased bloodflow -> closure of the ductus venosus
Circulation in the lungs is initiated by -> lung expansion and pulmonary
ventilation
What will sustain 1st breath-> decreased artery pressure
What will complete circulation-> cutting of the cord
17. B. Atrial Septal defect. Foramen ovale is the opening between two Atria so, if its will not close
Atrial Septal defect can occur.
18. A. Sitting up. The correct position is making the child having an upright sitting position with the
head slightly tilted forward. This position will minimize the amount of blood pressure in nasal
vessels and keep blood moving forward not back into the nasopharynx, which will have the choking
sensation and increase risk of aspiration. Choices b, c, d, are inappropriate cause they can cause
blood to enter the nasopharynx.
19. B. Eustachian tube. This is because children has short, horizontal Eustachian tubes. The
dysfunction in the Eustachian tube enables bacterial invasion of the middle ear and obstructs
drainage of secretions.
20. C. Brain damage. One of the complication of recurring acute otitis media is risk for having
Meningitis, thereby causing possible brain damage. That is why patient must follow a complete
treatment regimen and follow up care. A,B and D are not complications of AOM.
21. A. Riding a tricycle. Answer is A, riding a tricycle is appropriate for a 3 y/o child. Hopping on one
foot can be done by a 4 y/o child, as well as catching and throwing a ball over hand. Skipping can be
done by a 5 y/o.
22. A. Doubling of birth weight. During the first 6 months of life the weight from birth will be
doubled and as soon as the baby reaches 1 year, its birth weight is tripled.
23. C. Doctor and nurse kits. Letter C is appropriate because it will enhance the creativity and
imagination of a pre-school child. Letter B and D are inappropriate because they are too complex
for a 4 y/o. Push-pull toys are recommended for infants.
24. B. Hes just a bit dead. A 5 y/o views death in degrees, so the child most likely will say that
he is just a bit dead. Personification of death like boogeyman occurs in ages 7 to 9 as well as
denying death can if they will be good. Denying death using jokes and attributing life qualities to
death occurs during age 3-5.
25. D. Infant have greater body surface area than adults. Infants have greater body surface area than
adult, increasing their risk to F&E imbalances. Also infants cant concentrate a urine at an adult level
and their metabolic rate, also called water turnover, is 2 to 3 times higher than adult. Plus more
fluids of the infants are at the ECF spaces not in the ICF spaces.
26. C. Metabolic acidosis. Remember that Aspirin is acid (Acetylsalicylic ACID).
27. D. Blisters and edema. The question was asking for a SYSTEMIC clinical manifestation, Letters A,B
and C are systemic manifestations while Blisters and Edema werent.
28. D. Problematic pregnancies. Typical factors that may be risk for Child abuse are problematic
pregnancies, chronic exposure to stress not periodic, low level of self esteem not high level. Also
child abuse can happen in all socio-economic status not just on low socio-economic status.
29. C. Unexplained symptoms of diarrhea, vomiting and apnea with no organic basis. Munchausen
syndrome by Proxy is the fabrication or inducement of an illness by one person to another person,
usually mother to child. It is characterized by symptoms such as apnea and siezures, which may be
due to suffocation, drugs or poisoning, vomiting which can be induced with poisons and diarrhea
with the use of laxatives. Letter A can be seen in a Physical abuse, Letter B for sexual abuse and
Letter C is for Physical Neglect.
30. B. Offering large amount of fresh fruits and vegetables. A child with HIV is immunocompromised.
Fresh fruits and vegetables, which may be contaminated with organisms and pesticides can be
harmful, if not fatal to the child, therefore these items should be avoided.
31. C. Decrease hypoxic spells. The correct answer is letter C. Though letter B would be a good
answer too, this goal is too vague and not specific. Nursing interventions will not solely promote
normal G&D unless he will undergo surgical repair. So decreasing Hypoxic Spells is more SMART.
Letter A and D are inappropriate.
32. B. Place her in knee chest position. The immediate intervention would be to place her on knee-
chest or squatting position because it traps blood into the lower extremities. Though also letter C
would be a good choice but the question is asking for Immediate so letter B is more appropriate.
Letter A and D are incorrect because its normal for a child who have ToF to have hypoxic or tets
spells so there is no need to transfer her to the NICU or to alert the Pediatrician.
33. D. Blalock-Taussig. Blalock-Taussig procedure its just a temporary or palliative surgery which
creates a shunt between the aorta and pulmonary artery so that the blood can leave the aorta and
enter the pulmonary artery and thus oxygenating the lungs and return to the left side of the heart,
then to the aorta then to the body. This procedure also makes use of the subclavian vein so pulse is
not palpable at the right arm. The full repair for ToF is called the Brock procedure. Raskkind is a
palliative surgery for TOGA.
34. A. Friendly with the nurse. Because toddlers views hospitalization is abandonment, separation
anxiety is common. Its has 3 phases: PDD (parang c puff daddy LOL) 1. Protest 2. despair 3.
detachment (or denial). Choices B, C, D are usually seen in a child with separation anxiety (usually in
the protest stage).
REVIEW:
Separation anxiety begin at: 9 months
Peaks: 18 months
35. D. Anticipatory grieving r/t gravity of childs physical status. In this item letter A and be are
inappropriate response so remove them. The possible answers are C and D. Fear defined as the
perceived threat (real or imagined) that is consciously recognized as danger (NANDA) is applicable
in the situation but its defining characteristics are not applicable. Crying per se can not be a
subjective cue to signify fear, and most of the symptoms of fear in NANDA are physiological.
Anticipatory grieving on the other hand are intellectual and EMOTIONAL responses based on a
potential loss. And remember that procedures like this cannot assure total recovery. So letter D is a
more appropriate Nursing diagnosis.
36. B. Epiglottitis. Acute and sever inflammation of the epiglottis can cause life threatening airway
obstruction, that is why its always treated as a medical emergency. NSG intervention : Prepare
tracheostomy set at bed side. LTB, can also cause airway obstruction but its not an emergency.
Asthma is also not an emergency. CF is a chronic disease, so its not a medical emergency.
37. C. Well make sure he avoids exercise to prevent asthma attacks. Asthmatic children dont have
to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator
before administering steroids is correct because steroids are just anti-inflammatory and they dont
have effects on the dilation of the bronchioles. OF course letters A and B are obviously correct.
38. C. Height and weight. Dental problems are more likely to occur in children under going TCA
therapy. Mouth dryness is a expected side effects of Ritalin since it activates the SNS. Also loss of
appetite is more likely to happen, not increase in appetite. The correct answer is letter C, because
Ritalin can affect the childs G&D. Intervention: medication holidays or vacation. (This means
during weekends or holidays or school vacations, where the child wont be in school, the drug can
be withheld.)
39. C. Expanded program on immunization
40. B. Epidemiologic situation. Letters A, C and D are not included in the principles of EPI.
41. D. Target setting
42. A. Interruption of transmission
43. B. MMR. MMR or Measles, Mumps, Rubella is a vaccine furnished in one vial and is routinely
given in one injection (Sub-Q). It can be given at 15 months but can also be given as early as 12th
month.
44. B. Severe pneumonia. For a child aging 2months up to 5 years old can be classified to have sever
pneumonia when he have any of the following danger signs:
Not able to drink
Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child or
Severe under-nutrition
45. D. 50 pbm. A child can be classified to have Pneumonia (not severe) if:
the young infant is less than 2 months- 60 bpm or more
if the child is 2 months up to less than 12 months- 50 bpm or more
if the child is 12 months to 4 y/o- 40 bpm or more
46. B. PD no. 6 Presidential Proclamation no. 6 (April 3, 1986) is the Implementing a United Nations
goal on Universal Child Immunization by 1990. PD 996 (September 16, 1976) is providing for
compulsory basic immunization for infants and children below 8 years of age. PD no. 46 (September
16, 1992) is the Reaffirming the commitment of the Philippines to the universal Child and Mother
goal of the World Health Assembly. RA 9173 is of course the Nursing act of 2002
47. B. 100,000 IU. An infant aging 6-11 months will be given Vitamin supplementation of 100, 000
IU and for Preschoolers ages 12-83 months 200,000 IU will be given.
48. C. Did the child have chest indrawing?. The CARI program of the DOH includes the ASK and
LOOK, LISTEN as part of the assessment of the child who has suspected Pneumonia. Choices A, B
and D are included in the ASK assessment while Chest indrawings is included in the LOOK,
LISTEN and should not be asked to the mother.
49. A. Aganglionic Mega colon. Failure to pass meconium of Newborn during the first 24 hours of life
may indicate Hirschsprung disease or Congenital Aganglionic Megacolon, an anomaly resulting in
mechanical obstruction due to inadequate motility in an intestinal segment. B, C, and D are not
associated in the failure to pass meconium of the newborn.
50. B. Apple slices. Grapes is in appropriate because of its balat that can cause choking. A glass of
milk is not a good snack because its the most common cause of Iron-deficiency anemia in children
 (milk contains few iron), A glass of cola is also not appropriate cause it contains complex sugar.
(walang kinalaman ang asthma dahil ala naman itong diatery restricted foods na nasa choices.)
51. D. IPV. IPV or Inactivated polio vaccine does not contain live micro organisms which can be
harmful to an immunocompromised child. Unlike OPV, IPV is administered via IM route.
52. C. Ortolanis sign. Correct answer is Ortolanis sign; it is the abnormal clicking sound when the
hips are abducted. The sound is produced when the femoral head enters the acetabulum. Letter A
is wrong because its should be asymmetrical gluteal fold. Letter B and C are not applicable for
newborns because they are seen in older children.
53. D. Hypospadias. Hypospadias is a c condition in which the urethral opening is located below the
glans penis or anywhere along the ventral surface of the penile shaft. Epispadias, the urethral
meatus is located at the dorsal surface of the penile shaft. (Para di ka malilto, I-alphabetesize mo
Dorsal, (Above) eh mauuna sa Ventral (Below) , Epis mauuna sa Hypo.)
54. C. 40 lb and 40 in. Basta tandaan ang rule of 4! 4 years old, 40 lbs and 40 in.
55. A. Sucking ability. Because of the defect, the child will be unable to form the mouth adequately
arounf the nipple thereby requiring special devices to allow feeding and sucking gratification.
Respiratory status may be compromised when the child is fed improperly or during post op period.
56. D. Body image. Because of edema, associated with nephroitic syndrome, potential self concept
and body image disturbance related to changes in appearance and social isolation should be
considered.
57. A. G6PD. G6PD is the premature destruction of RBC when the blood is exposed to antioxidants,
ASA (ano un? Aspirin), legumes and flava beans.
58. B. Phenestix test. Phenestix test is a diagnostic test which uses a fresh urine sample (diapers) and
mixed with ferric chloride. If positive, there will be a presence of green spots at the diapers. Guthrie
test is another test for PKU and is the one that mostly used. The specimen used is the blood and it
tests if CHON is converted to amino acid.
59. B. Methionine. Hemocystenuria is the elevated excretion of the amino acid hemocystiene, and
there is inability to convert the amino acid methionine or cystiene. So dietary restriction of this
amino acids is advised. This disease can lead to mental retardation.
60. C. Neutramigen. Neutramien is suggested for a child with Galactosemia. Lofenalac is suggested
for a child with PKU.
1. Answer: C. Washes the cord and surrounding area well with water at each diaper change.
Washing the surrounding area is fine but wetting the cord keeps it moist and predisposes it to infection.
Option A: Exposure to air helps dry the cord.
Option B: Good hand washing is the prime mechanism for preventing infection.
Option D: It is important to check for complications of bleeding and drainage that might
occur.
2. Answer: B. HCG
Human chorionic gonadotropin (HCG) is the biologic marker on which pregnancy tests are based.
Reliability is about 98%, but the test does not positively confirm pregnancy.
3. Answer: B. Sits alone.
A six-month-old child is learning to sit alone.
Option A: The child develops language skills between the ages of one and three.
Option C: The child begins to use a spoon at 12-15 months of age.
Option D: The baby pulls himself to a standing position about ten months of age.
4. Answer: D. Explain the surgery using a model of the heart
According to Piaget, the school-age child is in the concrete operations stage of cognitive development.
Using something concrete, like a model will help the child understand the explanation of the
heart surgery.
5. Answer: D. Blue and green.
The elderly have poor blue-green discrimination. The effects of age are greatest on short wavelengths.
These changes are related to the yellowing of the lens with age.
Option A: The elderly are better able to distinguish between red and blue because of the
difference in wavelengths.
Option B: The elderly are better able to distinguish between blue and gold because of the
difference in wavelengths.
Option C: The elderly are better able to distinguish between red and green because of the
difference in wavelengths. Red and green color blindness is an inherited disorder that is
unrelated to age.
6. Answer: C. Altered body image
The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when
hospitalized is the fear of altered body image, because of the emphasis on physical appearance.
7. Answer: C. Frequent temperature monitoring.
Temperature elevation will indicate beginning infection. This is the most important measure to help
assess the client for infections since the lost mucous plug and the ruptured membranes increase the
potential for ascending bacteria from the reproductive tract. This will infect the fetus, membranes, and
uterine cavity.
Option A: Universal precautions are necessary for all clients but a specific assessment of the
clients temperature will give an indication the client is becoming infected.
Option B: Oxytocin may be needed to induce labor if it is not progressing, but it is not done
initially.
Option D: More frequent vaginal examinations are not recommended, as frequent vaginal
exams can increase chances of infection.
8. Answer: B. Assesses a childs development
The Denver Developmental Test II is a screening test to assess children from birth through 6 years in
personal/social, fine motor adaptive, language and gross motor development. A child experiences the
fun of play during the test.
9. Answer: B. Early prenatal medical care.
Pregnancy makes metabolic control of diabetes more difficult. It is essential that the client starts
prenatal care early so that potential complications can be controlled or minimized by the efforts of the
client and health care team.
Option A: A review of dietary modifications is important once the woman is pregnant.
However, it is not of primary importance when considering pregnancy.
Option C: The alternative of adoption is not necessary just because the client is a diabetic.
Many diabetic women have pregnancies with successful outcomes if they receive good care.
Option D: While there is some risk to the pregnant diabetic woman, it is not considered a
major health risk. The greater risk is to the fetus.
10. Answer: B. Encourage the child to feed himself finger food
According to Erikson, the toddler is in the stage of autonomy versus shame and doubt. The nurse should
encourage increasingly independent activities of daily living.
11. Answer: D. The right scheduling of sexual intercourse.
Sexual activity on demand is the major cause of stress for most infertile couples.
Option A: Having to tell families may also be a factor contributing to stress but is not the
major stressor.
Option B: Cost may also be a contributing factor to stress but is not usually the major factor.
Option C: The inconvenience of multiple tests may also be a factor contributing to stress but
is not usually the major factor.
12. Answer: A. Hold a rattle
The age at which a baby will develop the skill of grasping a toy with help is 4 to 6 months.
13. Answer: A. Holding the bottle so the nipple is always filled with formula.
Holding the bottle so the nipple is always filled with formula prevents the baby from sucking air. Sucking
air can cause gastric distention and intestinal gas pains.
Option B: A seven-pound baby should be getting 50 calories per pound: 350 calories per day.
Standardized formulas have 20 calories per ounce. This seven-pound baby needs 17.5 ounces
per day. 17.5 ounces per day divided by 6-8 feedings equals 2-3 ounces per feeding.
Option C: A normal newborn without feeding problems could be burped halfway through the
feeding and again at the end. If burping needs to be at intervals, it should be done by ounces
or half ounces, not minutes.
Option D: Microwaving is not recommended as a method of warming due to the uneven
heating of the formula. If used, the formula should be shaken after warming and the
temperature then checked with a drop on the wrist. The recommended method of warming
is to place the bottle in a pan of hot water to warm, and then check the temperature on the
wrist before feeding.
14. Answer: A. Bluish coloration of the cervix and vaginal walls
Chadwicks sign is a bluish-purple coloration of the cervix and vaginal walls, occurring at four (4) weeks
of pregnancy, that is caused by vasocongestion.
15. Answer: C. Play-Doh
In the preschooler, play is simple and imaginative and includes activities such as puppets, play-doh, and
coloring book.
Option A: Squeeze toys are appropriate for infants.
Option B: Board games are appropriate for the school-age child.
Option D: Computer games are appropriate for an adolescent.
16. Answer: D. Conduct a diet history to determine her normal eating routines
Assessment is always the first step in planning to teach for any client.
17. Answer: A. Increase her fluid intake to three liters/day.
In pregnancy, constipation results from decreased gastric motility and increased water reabsorption in
the colon caused by increased levels of progesterone. Increasing fluid intake to three liters a day will help
prevent constipation. The client should increase fluid intake, increase roughage in the diet, and increase
exercise as tolerated.
 Option B: Laxatives are not recommended because of the possible development of laxative
dependence or abdominal cramping.
Option C: Iron supplements are necessary during pregnancy, as ordered, and should not be
discontinued.
Option D: Mineral oil is especially bad to use as a laxative because it decreases the
absorption of fat-soluble vitamins (A, D, E, K) if taken near mealtimes.
18. Answer: D. Cooperatively with other preschoolers
Cooperative play is typical of the preschool period.
19. Answer: C. Reminiscence groups
According to Eriksons theory, older adults need to find and accept the meaningfulness of their lives, or
they may become depressed, angry, and fear death. Reminiscing contributes to successful adaptation by
maintaining self-esteem, reaffirming identity, and working through loss.
20. Answer: D. Beef, C. Lima beans, glass of skim milk, C. strawberries
Beef and beans are an excellent source of protein as is skim milk. Strawberries are a good source of
Vitamin C.
1. Answer: (D) Right upper quadrant
Right upper quadrant. The landmark to look for when looking for PMI is the location of the fetal
back in relation to the right or left side of the mother and the presentation, whether cephalic or
breech. The best site is the fetal back nearest the head.
2. Answer: (D) The mass palpated is the buttocks.
The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the
mass.
3. Answer: (B) The mass palpated is the head.
When the mass palpated is hard round and movable, it is the fetal head.
4. Answer: (C) Human Chorionic Gonadotropin
Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi which is the
precursor of the placenta. In the early stage of pregnancy, while the placenta is not yet fully
developed, the major hormone that sustains the pregnancy is HCG.
5. Answer: (A) Follicle stimulating hormone
The hormone that stimulates the maturation if the of the graafian follicle is the Follicle Stimulating
Hormone which is released by the anterior pituitary gland.
6. Answer: (B) Vertical position
Vertical position means the fetal spine is parallel to the maternal spine thus making it easy for the
fetus to go out the birth canal. If transverse or oblique, the fetus cant be delivered normally per
vagina.
7. Answer: (B) The fundus of the uterus is high pushing the diaphragm upwards
From the 32nd week of the pregnancy, the fundus of the enlarged uterus is pushing the respiratory
diaphragm upwards. Thus, the lungs have reduced space for expansion consequently reducing the
oxygen supply.
8. Answer: (B) Fullness of the breast and urinary frequency
Fullness of the breast is due to the increased amount of progesterone in pregnancy. The urinary
frequency is caused by the compression of the urinary bladder by the gravid uterus which is still
within the pelvic cavity during the first trimester.
9. Answer: (D) (+) ultrasound
A positive ultrasound will definitely confirm that a woman is pregnant since the fetus in utero is
directly visualized.
10. Answer: (D) Quickening
Quickening is the first fetal movement felt by the mother makes the woman realize that she is truly
pregnant. In early pregnancy, the fetus is moving but too weak to be felt by the mother. In the 18th-
20th week of gestation, the fetal movements become stronger thus the mother already feels the
movements.
11. Answer: (A) Backache
Backache usually occurs in the lumbar area and becomes more problematic as the uterus enlarges.
The pregnant woman in her third trimester usually assumes a lordotic posture to maintain balance
causing an exaggeration of the lumbar curvature. Low broad heels provide the pregnant woman
with a good support.
12. Answer: (C) Let the woman lie down and dorsiflex the foot towards the knees
Leg cramps is caused by the contraction of the gastrocnimeus (leg muscle). Thus, the intervention is
to stretch the muscle by dosiflexing the foot of the affected leg towards the knee.
13. Answer: (A) week
In the 9th month of pregnancy the mother needs to have a weekly visit to the prenatal clinic to
monitor fetal condition and to ensure that she is adequately prepared for the impending labor and
delivery.
14. Answer: (A) 1 pound a week
 During the 3rd trimester the fetus is gaining more subcutaneous fat and is growing fast in
preparation for extra uterine life. Thus, one pound a week is expected.
15. Answer: (C) 7th month
In Bartholomews Rule of 4, the landmarks used are the symphysis pubis, umbilicus and xyphoid
process. At the level of the umbilicus, the AOG is approximately 5 months and at the level of the
xyphoid process 9 months. Thus, midway between these two landmarks would be considered as 7
months AOG.
16. Answer: (A) Naegeles rule
Naegeles Rule is determined based on the last menstrual period of the woman.
17. Answer: (C) Nov. 7
Based on the last menstrual period, the expected date of delivery is Nov. 7. The formula for the
Naegeles Rule is subtract 3 from the month and add 7 to the day.
18. Answer: (A) Strengthen perineal muscles
Kegels exercise is done by contracting and relaxing the muscles surrounding the vagina and anus in
order to strengthen the perineal muscles
19. Answer: (D) Backache
Backache is caused by the stretching of the muscles of the lower back because of the pregnancy.
Pelvic rocking is good to relieve backache.
20. Answer: (A) The mother may have physiologic anemia due to the increased need for red blood
cell mass as well as the fetal requires about 350-400 mg of iron to grow
About 400 mgs of Iron is needed by the mother in order to produce more RBC mass to be able to
provide the needed increase in blood supply for the fetus. Also, about 350-400 mgs of iron is need
for the normal growth of the fetus. Thus, about 750-800 mgs iron supplementation is needed by
the mother to meet this additional requirement.
21. Answer: (A) Protein, minerals and vitamins
In normal pregnancy there is a higher demand for protein (body building foods), vitamins (esp.
vitamin A, B, C, folic acid) and minerals (esp. iron, calcium, phosphorous, zinc, iodine, magnesium)
because of the need of the growing fetus.
22. Answer: (B) No fetal movement is felt on the 6th month
Fetal movement is usually felt by the mother during 4.5 5 months. If the pregnancy is already in
its 6th month and no fetal movement is felt, the pregnancy is not normal either the fetus is already
dead intra-uterine or it is an H-mole.
23. Answer: (A) Asking her to void
A pelvic examination includes abdominal palpation. If the pregnant woman has a full bladder, the
manipulation may cause discomfort and accidental urination because of the pressure applied
during the abdominal palpation. Also, a full bladder can impede the accuracy of the examination
because the bladder (which is located in front of the uterus) can block the uterus.
24. Answer: (C) Drink at least 2 liters of fluid 2 hours before the procedure and not void until the
procedure is done
Drinking at least 2 liters of water 2 hours before the procedure will result to a distended bladder. A
full bladder is needed when doing an abdominal ultrasound to serve as a window for the
ultrasonic sound waves to pass through and allow visualization of the uterus (located behind the
urinary bladder).
25. Answer: (A) Dry carbohydrate food like crackers
Morning sickness maybe caused by hypoglycemia early in the morning thus giving carbohydrate
food will help.
26. Answer: (A) Upper uterine portion
The embryos normal nidation site is the upper portion of the uterus. If the implantation is in the
lower segment, this is an abnormal condition called placenta previa.
27. Answer: (B) G 5 P 3
Gravida refers to the total number of pregnancies including the current one. Para refers to the
number of pregnancies that have reached viability. Thus, if the woman has had one abortion, she
would be considered Para 3. Twin pregnancy is counted only as 1.
28. Answer: (D) Chadwicks sign
Chadwicks sign is bluish discoloration of the vaginal mucosa as a result of the increased
vascularization in the area.
29. Answer: (A) Within 2-4 hours after intercourse conception is possible in a fertile woman
The sperms when deposited near the cervical os will be able to reach the fallopian tubes within 4
hours. If the woman has just ovulated (within 24hours after the rupture of the graafian follicle),
fertilization is possible.
30. Answer: (D) All of the above
All the four functions enumerated are true of amniotic fluid.
31. Answer: (B) Having supine hypotension
 Supine hypotension is characterized by breathlessness, pallor, tachycardia and cold clammy skin.
This is due to the compression of the abdominal aorta by the gravid uterus when the woman is on a
supine position.
32. Answer: (B) Carbon monoxide binds with the hemoglobin of the mother reducing available
hemoglobin for the fetus
Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the
ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood
reaching the fetus.
33. Answer: (C) Small for gestational age (SGA) baby
Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to
supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of
the fetus.
34. Answer: (B) Passage of clear vesicular mass per vagina
Hydatidiform mole (H-mole) is characterized by the degeneration of the chorionic villi wherein the
villi becomes vesicle-like. These vesicle-like substances when expelled per vagina and is a definite
sign that the woman has H-mole.
35. Answer: (A) Hydatidiform mole
Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration
occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger
than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is
only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7
months AOG. Also, no fetal heart beat is appreciated because the pregnancy degenerated thus
there is no appreciable fetal heart beat.
36. Answer: (C) Position the mother on her side to allow the secretions to drain from her mouth and
prevent aspiration
Positioning the mother on her side will allow the secretions that may accumulate in her mouth to
drain by gravity thus preventing aspiration pneumonia. Putting a mouth gag is not safe since during
the convulsive seizure the jaw will immediately lock. The mother may go into labor also during the
seizure but the immediate concern of the nurse is the safety of the baby. After the seizure, check
the perineum for signs of precipitate labor.
37. Answer: (B) Minimize oxygen consumption which can aggravate the condition of the
compromised heart of the mother
Activity of the mother will require more oxygen consumption. Since the heart of a gravido-cardiac is
compromised, there is a need to put a mother on bedrest to reduce the need for oxygen.
38. Answer: (A) The internal exam is done only at the delivery under strict asepsis with a double set-
up
Painless vaginal bleeding during the third trimester maybe a sign of placenta praevia. If internal
examination is done in this kind of condition, this can lead to even more bleeding and may require
immediate delivery of the baby by cesarean section. If the bleeding is due to soft tissue injury in the
birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery will be
used. A double set-up means there is a set up for cesarean section and a set-up for vaginal delivery
to accommodate immediately the necessary type of delivery needed. In both cases, strict asepsis
must be observed.
39. Answer: (B) Dilation of the cervix
In imminent abortion, the pregnancy will definitely be terminated because the cervix is already
open unlike in threatened abortion where the cervix is still closed.
40. Answer: (B) Put the mother on left side lying position
When a pregnant woman lies on supine position, the weight of the gravid uterus would be
compressing on the vena cava against the vertebrae obstructing blood flow from the lower
extremities. This causes a decrease in blood return to the heart and consequently immediate
decreased cardiac output and hypotension. Hence, putting the mother on side lying will relieve the
pressure exerted by the gravid uterus on the vena cava.
41. Answer: (A) Magnesium sulfate and terbutaline
Magnesium sulfate acts as a CNS depressant as well as a smooth muscle relaxant. Terbutaline is a
drug that inhibits the uterine smooth muscles from contracting. On the other hand, oxytocin and
prostaglandin stimulates contraction of smooth muscles.
42. Answer: (C) Lower segment of the uterus with the edges near the internal cervical os
Placenta marginalis is a type of placenta previa wherein the placenta is implanted at the lower
segment of the uterus thus the edges of the placenta are touching the internal cervical opening/os.
The normal site of placental implantation is the upper portion of the uterus.
43. Answer: (B) Rubella
Rubella is caused by a virus and viruses have low molecular weight thus can pass through the
placental barrier. Gonorrhea, candidiasis and moniliasis are conditions that can affect the fetus as it
passes through the vaginal canal during the delivery process.
44. Answer: (B) Orchitis
 Orchitis is a complication that may accompany mumps in adult males. This condition is
characterized by unilateral inflammation of one of the testes which can lead to atrophy of the
affected testis. About 20-30% of males who gets mumps after puberty may develop this
complication.
45. Answer: (A) Cervix
Papanicolaou (Paps) smear is done to detect cervical cancer. It cant detect cancer in ovaries and
fallopian tubes because these organs are outside of the uterus and the abnormal cells from these
organs will not be detected from a smear done on the cervix.
46. Answer: (A) Vaginismus
Vaginismus is primarily psychological in origin. Endometriosis is a condition that is caused by
organic abnormalities. Dyspareunia is usually caused by infection, endometriosis or hormonal
changes in menopause although may sometimes be psychological in origin.
47. Answer: (A) 100 cc. urine output in 4 hours
The minimum urine output expected for a repeat dose of MgSO4 is 30 cc/hr. If in 4 hours the urine
output is only 100 cc this is low and can lead to poor excretion of Magnesium with a possible
cumulative effect, which can be dangerous to the mother.
48. Answer: (C) On the first pregnancy of the Rh(-) mother, the fetus will not be affected

On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies
against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the
possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce
antibodies against Rh(+) blood. The fetus takes its blood type usually form the father.