Text Mode – Text version of the exam
1. Which of the following conditions will lead to a small-for-gestational age fetus due to less blood supply to the fetus?
- Diabetes in the mother
- Maternal cardiac condition
- Premature labor
- Abruptio placenta
2. The lower limit of viability for infants in terms of age of gestation is:
- 21-24 weeks
- 25-27 weeks
- 28-30 weeks
- 38-40 weeks
3. Which provision of our 1987 constitution guarantees the right of the unborn child to life from conception is
- Article II section 12
- Article II section 15
- Article XIII section 11
- Article XIII section 15
4. In the Philippines, if a nurse performs abortion on the mother who wants it done and she gets paid for doing it, she will be held liable because
- Abortion is immoral and is prohibited by the church
- Abortion is both immoral and illegal in our country
- Abortion is considered illegal because you got paid for doing it
- Abortion is illegal because majority in our country are catholics and it is prohibited by the church
5. The preferred manner of delivering the baby in a gravido-cardiac is vaginal delivery assisted by forceps under epidural anesthesia. The main rationale for this is:
- To allow atraumatic delivery of the baby
- To allow a gradual shifting of the blood into the maternal circulation
- To make the delivery effort free and the mother does not need to push with contractions
- To prevent perineal laceration with the expulsion of the fetal head
6. When giving narcotic analgesics to mother in labor, the special consideration to follow is:
- The progress of labor is well established reaching the transitional stage
- Uterine contraction is progressing well and delivery of the baby is imminent
- Cervical dilatation has already reached at least 8 cm. and the station is at least (+)2
- Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.
7. The cervical dilatation taken at 8:00 A.M. in a G1P0 patient was 6 cm. A repeat I.E. done at 10 A.M. showed that cervical dilation was 7 cm. The correct interpretation of this result is:
- Labor is progressing as expected
- The latent phase of Stage 1 is prolonged
- The active phase of Stage 1 is protracted
- The duration of labor is normal
8. Which of the following techniques during labor and delivery can lead to uterine inversion?
- Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head
- Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
- Massaging the fundus to encourage the uterus to contract
- Applying light traction when delivering the placenta that has already detached from the uterine wall
9. The fetal heart rate is checked following rupture of the bag of waters in order to:
- Check if the fetus is suffering from head compression
- Determine if cord compression followed the rupture
- Determine if there is utero-placental insufficiency
- Check if fetal presenting part has adequately descended following the rupture
10. Upon assessment, the nurse got the following findings: 2 perineal pads highly saturated with blood within 2 hours post partum, PR= 80 bpm, fundus soft and boundaries not well defined. The appropriate nursing diagnosis is:
- Normal blood loss
- Blood volume deficiency
- Inadequate tissue perfusion related to hemorrhage
- Hemorrhage secondary to uterine atony
11. The following are signs and symptoms of fetal distress EXCEPT:
- Fetal heart rate (FHR) decreased during a contraction and persists even after the uterine contraction ends
- The FHR is less than 120 bpm or over 160 bpm
- The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm
- FHR is 160 bpm, weak and irregular
12. If the labor period lasts only for 3 hours, the nurse should suspect that the following conditions may occur:
- Laceration of cervix
- Laceration of perineum
- Cranial hematoma in the fetus
- Fetal anoxia
- 1 & 2
- 2 & 4
13. The primary power involved in labor and delivery is
- Bearing down ability of mother
- Cervical effacement and dilatation
- Uterine contraction
- Valsalva technique
14. The proper technique to monitor the intensity of a uterine contraction is
- Place the palm of the hands on the abdomen and time the contraction
- Place the finger tips lightly on the suprapubic area and time the contraction
- Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction
- Put the palm of the hands on the fundal area and feel the contraction at the fundal area
15. To monitor the frequency of the uterine contraction during labor, the right technique is to time the contraction
- From the beginning of one contraction to the end of the same contraction
- From the beginning of one contraction to the beginning of the next contraction
- From the end of one contraction to the beginning of the next contraction
- From the deceleration of one contraction to the acme of the next contraction
16. The peak point of a uterine contraction is called the
17. When determining the duration of a uterine contraction the right technique is to time it from
- The beginning of one contraction to the end of the same contraction
- The end of one contraction to the beginning of another contraction
- The acme point of one contraction to the acme point of another contraction
- The beginning of one contraction to the end of another contraction
18. When the bag of waters ruptures, the nurse should check the characteristic of the amniotic fluid. The normal color of amniotic fluid is
- Clear as water
19. When the bag of waters ruptures spontaneously, the nurse should inspect the vaginal introitus for possible cord prolapse. If there is part of the cord that has prolapsed into the vaginal opening the correct nursing intervention is:
- Push back the prolapse cord into the vaginal canal
- Place the mother on semifowler’s position to improve circulation
- Cover the prolapse cord with sterile gauze wet with sterile NSS and place the woman on trendellenberg position
- Push back the cord into the vagina and place the woman on sims position
20. The fetal heart beat should be monitored every 15 minutes during the 2nd stage of labor. The characteristic of a normal fetal heart rate is
- The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction
- The heart rate will accelerate during a contraction and remain slightly above the pre-contraction rate at the end of the contraction
- The rate should not be affected by the uterine contraction.
- The heart rate will decelerate at the middle of a contraction and remain so for about a minute after the contraction
21. The mechanisms involved in fetal delivery is
- Descent, extension, flexion, external rotation
- Descent, flexion, internal rotation, extension, external rotation
- Flexion, internal rotation, external rotation, extension
- Internal rotation, extension, external rotation, flexion
22. The first thing that a nurse must ensure when the baby’s head comes out is
- The cord is intact
- No part of the cord is encircling the baby’s neck
- The cord is still attached to the placenta
- The cord is still pulsating
23. To ensure that the baby will breath as soon as the head is delivered, the nurse’s priority action is to
- Suction the nose and mouth to remove mucous secretions
- Slap the baby’s buttocks to make the baby cry
- Clamp the cord about 6 inches from the base
- Check the baby’s color to make sure it is not cyanotic
24. When doing perineal care in preparation for delivery, the nurse should observe the following EXCEPT
- Use up-down technique with one stroke
- Clean from the mons veneris to the anus
- Use mild soap and warm water
- Paint the inner thighs going towards the perineal area
25. What are the important considerations that the nurse must remember after the placenta is delivered?
- Check if the placenta is complete including the membranes
- Check if the cord is long enough for the baby
- Check if the umbilical cord has 3 blood vessels
- Check if the cord has a meaty portion and a shiny portion
- 1 and 3
- 2 and 4
- 1, 3, and 4
- 2 and 3
26. The following are correct statements about false labor EXCEPT
- The pain is irregular in intensity and frequency.
- The duration of contraction progressively lengthens over time
- There is no vaginal bloody discharge
- The cervix is still closed.
27. The passageway in labor and deliver of the fetus include the following EXCEPT
- Distensibility of lower uterine segment
- Cervical dilatation and effacement
- Distensibility of vaginal canal and introitus
- Flexibility of the pelvis
28. The normal umbilical cord is composed of:
- 2 arteries and 1 vein
- 2 veins and 1 artery
- 2 arteries and 2 veins
- none of the above
29. At what stage of labor and delivery does a primigravida differ mainly from a multigravida?
- Stage 1
- Stage 2
- Stage 3
- Stage 4
30. The second stage of labor begins with ___ and ends with __?
- Begins with full dilatation of cervix and ends with delivery of placenta
- Begins with true labor pains and ends with delivery of baby
- Begins with complete dilatation and effacement of cervix and ends with delivery of baby
- Begins with passage of show and ends with full dilatation and effacement of cervix
31. The following are signs that the placenta has detached EXCEPT:
- Lengthening of the cord
- Uterus becomes more globular
- Sudden gush of blood
- Mother feels like bearing down
32. When the shiny portion of the placenta comes out first, this is called the ___ mechanism.
33. When the baby’s head is out, the immediate action of the nurse is
- Cut the umbilical cord
- Wipe the baby’s face and suction mouth first
- Check if there is cord coiled around the neck
- Deliver the anterior shoulder
34. When delivering the baby’s head the nurse supports the mother’s perineum to prevent tear. This technique is called
- Marmet’s technique
- Ritgen’s technique
- Duncan maneuver
- Schultze maneuver
35. The basic delivery set for normal vaginal delivery includes the following instruments/articles EXCEPT:
- 2 clamps
- Pair of scissors
- Kidney basin
36. As soon as the placenta is delivered, the nurse must do which of the following actions?
- Inspect the placenta for completeness including the membranes
- Place the placenta in a receptacle for disposal
- Label the placenta properly
- Leave the placenta in the kidney basin for the nursing aide to dispose properly
37. In vaginal delivery done in the hospital setting, the doctor routinely orders an oxytocin to be given to the mother parenterally. The oxytocin is usually given after the placenta has been delivered and not before because:
- Oxytocin will prevent bleeding
- Oxytocin can make the cervix close and thus trap the placenta inside
- Oxytocin will facilitate placental delivery
- Giving oxytocin will ensure complete delivery of the placenta
38. In a gravido-cardiac mother, the first 2 hours postpartum (4th stage of labor and delivery) particularly in a cesarean section is a critical period because at this stage
- There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
- The maternal heart is already weak and the mother can die
- The delivery process is strenuous to the mother
- The mother is tired and weak which can distress the heart
39. The drug usually given parentally to enhance uterine contraction is:
- Magnesium sulfate
40. The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following EXCEPT:
- Vital signs
- Fluid intake and output
- Uterine contraction
- Cervical dilatation
41. The following are natural childbirth procedures EXCEPT:
- Lamaze method
- Dick-Read method
- Ritgen’s maneuver
- Psychoprophylactic method
42. The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage?
- Pelvic bone contraction
- Full bladder
- Extension rather than flexion of the head
- Cervical rigidity
43. At what stage of labor is the mother is advised to bear down?
- When the mother feels the pressure at the rectal area
- During a uterine contraction
- In between uterine contraction to prevent uterine rupture
- Anytime the mother feels like bearing down
44. The normal dilatation of the cervix during the first stage of labor in a nullipara is
- 1.2 cm./hr
- 1.5 cm./hr.
- 1.8 cm./hr
- 2.0 cm./hr
45. When the fetal head is at the level of the ischial spine, it is said that the station of the head is
- Station –1
- Station “0”
- Station +1
- Station +2
46. During an internal examination, the nurse palpated the posterior fontanel to be at the left side of the mother at the upper quadrant. The interpretation is that the position of the fetus is:
47. The following are types of breech presentation EXCEPT:
48. When the nurse palpates the suprapubic area of the mother and found that the presenting part is still movable, the right term for this observation that the fetus is
- Internal Rotation
49. The placenta should be delivered normally within ___ minutes after the delivery of the baby.
- 5 minutes
- 30 minutes
- 45 minutes
- 60 minutes
50. When shaving a woman in preparation for cesarean section, the area to be shaved should be from ___ to ___
- Under breast to mid-thigh including the pubic area
- The umbilicus to the mid-thigh
- Xyphoid process to the pubic area
- Above the umbilicus to the pubic area
Answers and Rationales
- Answer: (B) Maternal cardiac condition. In general, when the heart is compromised such as in maternal cardiac condition, the condition can lead to less blood supply to the uterus consequently to the placenta which provides the fetus with the essential nutrients and oxygen. Thus if the blood supply is less, the baby will suffer from chronic hypoxia leading to a small-for-gestational age condition.
- Answer: (A) 21-24 weeks. Viability means the capability of the fetus to live/survive outside of the uterine environment. With the present technological and medical advances, 21 weeks AOG is considered as the minimum fetal age for viability.
- Answer: (A) Article II section 12. The Philippine Constitution of 1987 guarantees the right of the unborn child from conception equal to the mother as stated in Article II State Policies, Section 12.
- Answer: (B) Abortion is both immoral and illegal in our country. Induced Abortion is illegal in the country as stated in our Penal Code and any person who performs the act for a fee commits a grave offense punishable by 10-12 years of imprisonment.
- Answer: (C) To make the delivery effort free and the mother does not need to push with contractions. Forceps delivery under epidural anesthesia will make the delivery process less painful and require less effort to push for the mother. Pushing requires more effort which a compromised heart may not be able to endure.
- Answer: (D) Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.. Narcotic analgesics must be given when uterine contractions are already well established so that it will not cause stoppage of the contraction thus protracting labor. Also, it should be given when delivery of fetus is imminent or too close because the fetus may suffer respiratory depression as an effect of the drug that can pass through placental barrier.
- Answer: (C) The active phase of Stage 1 is protracted. The active phase of Stage I starts from 4cm cervical dilatation and is expected that the uterus will dilate by 1cm every hour. Since the time lapsed is already 2 hours, the dilatation is expected to be already 8 cm. Hence, the active phase is protracted.
- Answer: (B) Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation. When the placenta is still attached to the uterine wall, tugging on the cord while the uterus is relaxed can lead to inversion of the uterus. Light tugging on the cord when placenta has detached is alright in order to help deliver the placenta that is already detached.
- Answer: (B) Determine if cord compression followed the rupture. After the rupture of the bag of waters, the cord may also go with the water because of the pressure of the rupture and flow. If the cord goes out of the cervical opening, before the head is delivered (cephalic presentation), the head can compress on the cord causing fetal distress. Fetal distress can be detected through the fetal heart tone. Thus, it is essential do check the FHB right after rupture of bag to ensure that the cord is not being compressed by the fetal head.
- Answer: (D) Hemorrhage secondary to uterine atony. All the signs in the stem of the question are signs of hemorrhage. If the fundus is soft and boundaries not well defined, the cause of the hemorrhage could be uterine atony.
- Answer: (C) The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm. The normal range of FHR is 120-160 bpm, strong and regular. During a contraction, the FHR usually goes down but must return to its pre-contraction rate after the contraction ends.
- Answer: (D) 1,2,3,4. all the above conditions can occur following a precipitate labor and delivery of the fetus because there was little time for the baby to adapt to the passageway. If the presentation is cephalic, the fetal head serves as the main part of the fetus that pushes through the birth canal which can lead to cranial hematoma, and possible compression of cord may occur which can lead to less blood and oxygen to the fetus (hypoxia). Likewise the maternal passageway (cervix, vaginal canal and perineum) did not have enough time to stretch which can lead to laceration.
- Answer: (C) Uterine contraction. Uterine contraction is the primary force that will expel the fetus out through the birth canal Maternal bearing down is considered the secondary power/force that will help push the fetus out.
- Answer: (C) Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction. In monitoring the intensity of the contraction the best place is to place the fingertips at the fundal area. The fundus is the contractile part of the uterus and the fingertips are more sensitive than the palm of the hand.
- Answer: (B) From the beginning of one contraction to the beginning of the next contraction. Frequency of the uterine contraction is defined as from the beginning of one contraction to the beginning of another contraction.
- Answer: (B) Acme. Acme is the technical term for the highest point of intensity of a uterine contraction.
- Answer: (A) The beginning of one contraction to the end of the same contraction. Duration of a uterine contraction refers to one contraction. Thus it is correctly measure from the beginning of one contraction to the end of the same contraction and not of another contraction.
- Answer: (A) Clear as water. The normal color of amniotic fluid is clear like water. If it is yellowish, there is probably Rh incompatibility. If the color is greenish, it is probably meconium stained.
- Answer: (C) Cover the prolapse cord with sterile gauze wet with sterile NSS and place the woman on trendellenberg position. The correct action of the nurse is to cover the cord with sterile gauze wet with sterile NSS. Observe strict asepsis in the care of the cord to prevent infection. The cord has to be kept moist to prevent it from drying. Don’t attempt to put back the cord into the vagina but relieve pressure on the cord by positioning the mother either on trendellenberg or sims position
- Answer: (A) The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction. The normal fetal heart rate will decelerate (go down) slightly during a contraction because of the compression on the fetal head. However, the heart rate should go back to the pre-contraction rate as soon as the contraction is over since the compression on the head has also ended.
- Answer: (B) Descent, flexion, internal rotation, extension, external rotation. The mechanism of fetal delivery begins with descent into the pelvic inlet which may occur several days before true labor sets in the primigravida. Flexion, internal rotation and extension are mechanisms that the fetus must perform as it accommodates through the passageway/birth canal. Eternal rotation is done after the head is delivered so that the shoulders will be easily delivered through the vaginal introitus.
- Answer: (B) No part of the cord is encircling the baby’s neck. The nurse should check right away for possible cord coil around the neck because if it is present, the baby can be strangulated by it and the fetal head will have difficulty being delivered.
- Answer: (A) Suction the nose and mouth to remove mucous secretions. Suctioning the nose and mouth of the fetus as soon as the head is delivered will remove any obstruction that maybe present allowing for better breathing. Also, if mucus is in the nose and mouth, aspiration of the mucus is possible which can lead to aspiration pneumonia. (Remember that only the baby’s head has come out as given in the situation.)
- Answer: (D) Paint the inner thighs going towards the perineal area. Painting of the perineal area in preparation for delivery of the baby must always be done but the stroke should be from the perineum going outwards to the thighs. The perineal area is the one being prepared for the delivery and must be kept clean
- Answer: (A) 1 and 3. The nurse after delivering the placenta must ensure that all the cotyledons and the membranes of the placenta are complete. Also, the nurse must check if the umbilical cord is normal which means it contains the 3 blood vessels, 2 veins and 1 artery.
- Answer: (B) The duration of contraction progressively lengthens over time. In false labor, the contractions remain to be irregular in intensity and duration while in true labor, the contractions become stronger, longer and more frequent.
- Answer: (D) Flexibility of the pelvis. The pelvis is a bony structure that is part of the passageway but is not flexible. The lower uterine segment including the cervix as well as the vaginal canal and introitus are all part of the passageway in the delivery of the fetus.
- Answer: (A) 2 arteries and 1 vein. The umbilical cord is composed of 2 arteries and 1 vein.
- Answer: (A) Stage 1. In stage 1 during a normal vaginal delivery of a vertex presentation, the multigravida may have about 8 hours labor while the primigravida may have up to 12 hours labor.
- Answer: (C) Begins with complete dilatation and effacement of cervix and ends with delivery of baby. Stage 2 of labor and delivery process begins with full dilatation of the cervix and ends with the delivery of baby. Stage 1 begins with true labor pains and ends with full dilatation and effacement of the cervix.
- Answer: (D) Mother feels like bearing down. Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any effort from the mother.
- Answer: (A) Schultze. There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes out first, it is called the Schultze mechanism; while if the meaty portion comes out first, it is called the Duncan mechanism.
- Answer: (C) Check if there is cord coiled around the neck. The nurse should check if there is a cord coil because the baby will not be delivered safely if the cord is coiled around its neck. Wiping of the face should be done seconds after you have ensured that there is no cord coil but suctioning of the nose should be done after the mouth because the baby is a “nasal obligate” breather. If the nose is suctioned first before the mouth, the mucus plugging the mouth can be aspirated by the baby.
- Answer: (B) Ritgen’s technique. Ritgen’s technique is done to prevent perineal tear. This is done by the nurse by support the perineum with a sterile towel and pushing the perineum downard with one hand while the other hand is supporting the baby’s head as it goes out of the vaginal opening.
- Answer: (D) Retractor. For normal vaginal delivery, the nurse needs only the instruments for cutting the umbilical cord such as: 2 clamps (straight or curve) and a pair of scissors as well as the kidney basin to receive the placenta. The retractor is not part of the basic set. In the hospital setting, needle holder and tissue forceps are added especially if the woman delivering the baby is a primigravida wherein episiotomy is generally done.
- Answer: (A) Inspect the placenta for completeness including the membranes. The placenta must be inspected for completeness to include the membranes because an incomplete placenta could mean that there is retention of placental fragments which can lead to uterine atony. If the uterus does not contract adequately, hemorrhage can occur.
- Answer: (B) Oxytocin can make the cervix close and thus trap the placenta inside. The action of oxytocin is to make the uterus contract as well make the cervix close. If it is given prior to placental delivery, the placenta will be trapped inside because the action of the drug is almost immediate if given parentally.
- Answer: (A) There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.. During the pregnancy, there is an increase in maternal blood volume to accommodate the need of the fetus. When the baby and placenta have been delivered, there is a fluid shift back to the maternal circulation as part of physiologic adaptation during the postpartum period. In cesarean section, the fluid shift occurs faster because the placenta is taken out right after the baby is delivered giving it less time for the fluid shift to gradually occur.
- Answer: (B) Pitocin. The common oxytocin given to enhance uterine contraction is pitocin. This is also the drug given to induce labor.
- Answer: (B) Fluid intake and output. Partograph is a monitoring tool designed by the World Health Organization for use by health workers when attending to mothers in labor especially the high risk ones. For maternal parameters all of the above is placed in the partograph except the fluid intake since this is placed in a separate monitoring sheet.
- Answer: (C) Ritgen’s maneuver. Ritgen’s method is used to prevent perineal tear/laceration during the delivery of the fetal head. Lamaze method is also known as psychoprophylactic method and Dick-Read method are commonly known natural childbirth procedures which advocate the use of non-pharmacologic measures to relieve labor pain.
- Answer: (B) Full bladder. Full bladder can impede the descent of the fetal head. The nurse can readily manage this problem by doing a simple catheterization of the mother.
- Answer: (B) During a uterine contraction. The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing down during a contraction.
- Answer: (A) 1.2 cm./hr. For nullipara the normal cervical dilatation should be 1.2 cm/hr. If it is less than that, it is considered a protracted active phase of the first stage. For multipara, the normal cervical dilatation is 1.5 cm/hr.
- Answer: (B) Station “0”. Station is defined as the relationship of the fetal head and the level of the ischial spine. At the level of the ischial spine, the station is “0”. Above the ischial spine it is considered (-) station and below the ischial spine it is (+) station.
- Answer: (A) LOA. The landmark used in determine fetal position is the posterior fontanel because this is the nearest to the occiput. So if the nurse palpated the occiput (O) at the left (L) side of the mother and at the upper/anterior (A) quadrant then the fetal position is LOA.
- Answer: (D) Incomplete. Breech presentation means the buttocks of the fetus is the presenting part. If it is only the foot/feet, it is considered footling. If only the buttocks, it is frank breech. If both the feet and the buttocks are presenting it is called complete breech.
- Answer: (C) Floating. The term floating means the fetal presenting part has not entered/descended into the pelvic inlet. If the fetal head has entered the pelvic inlet, it is said to be engaged.
- Answer: (B) 30 minutes. The placenta is delivered within 30 minutes from the delivery of the baby. If it takes longer, probably the placenta is abnormally adherent and there is a need to refer already to the obstetrician.
- Answer: (A) Under breast to mid-thigh including the pubic area. Shaving is done to prevent infection and the area usually shaved should sufficiently cover the area for surgery, cesarean section. The pubic hair is definitely to be included in the shaving