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Maternal & Child Practice Exam 5 (PM)
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Question 1
When the fetal head is at the level of the ischial spine, it is said that the station of the head is
A
Station +2
B
Station +1
C
Station “0”
D
Station –1
Question 1 Explanation:
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.
Question 2
The lower limit of viability for infants in terms of age of gestation is:
A
38-40 weeks
B
21-24 weeks
C
28-30 weeks
D
25-27 weeks
Question 2 Explanation:
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.
Question 3
When the baby’s head is out, the immediate action of the nurse is
A
Wipe the baby’s face and suction mouth first
B
Cut the umbilical cord
C
Deliver the anterior shoulder
D
Check if there is cord coiled around the neck
Question 3 Explanation:
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.
Question 4
The basic delivery set for normal vaginal delivery includes the following instruments/articles EXCEPT:
A
2 clamps
B
Kidney basin
C
Retractor
D
Pair of scissors
Question 4 Explanation:
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.
Question 5
To monitor the frequency of the uterine contraction during labor, the right technique is to time the contraction
A
From the beginning of one contraction to the end of the same contraction
B
From the deceleration of one contraction to the acme of the next contraction
C
From the beginning of one contraction to the beginning of the next contraction
D
From the end of one contraction to the beginning of the next contraction
Question 5 Explanation:
Frequency of the uterine contraction is defined as from the beginning of one contraction to the beginning of another contraction.
Question 6
To ensure that the baby will breath as soon as the head is delivered, the nurse’s priority action is to
A
Suction the nose and mouth to remove mucous secretions
B
Check the baby’s color to make sure it is not cyanotic
C
Slap the baby’s buttocks to make the baby cry
D
Clamp the cord about 6 inches from the base
Question 6 Explanation:
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.)
Question 7
Which of the following techniques during labor and delivery can lead to uterine inversion?
A
Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
B
Applying light traction when delivering the placenta that has already detached from the uterine wall
C
Massaging the fundus to encourage the uterus to contract
D
Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head
Question 7 Explanation:
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.
Question 8
The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following EXCEPT:
A
Vital signs
B
Uterine contraction
C
Fluid intake and output
D
Cervical dilatation
Question 8 Explanation:
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.
Question 9
The following are natural childbirth procedures EXCEPT:
A
Lamaze method
B
Ritgen’s maneuver
C
Dick-Read method
D
Psychoprophylactic method
Question 9 Explanation:
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.
Question 10
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
A
Floating
B
Descended
C
Engaged
D
Internal Rotation
Question 10 Explanation:
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.
Question 11
Which of the following conditions will lead to a small-for-gestational age fetus due to less blood supply to the fetus?
A
Premature labor
B
Abruptio placenta
C
Diabetes in the mother
D
Maternal cardiac condition
Question 11 Explanation:
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.
Question 12
The first thing that a nurse must ensure when the baby’s head comes out is
A
The cord is still attached to the placenta
B
The cord is still pulsating
C
No part of the cord is encircling the baby’s neck
D
The cord is intact
Question 12 Explanation:
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.
Question 13
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
A
The rate should not be affected by the uterine contraction.
B
The heart rate will accelerate during a contraction and remain slightly above the pre-contraction rate at the end of the contraction
C
The heart rate will decelerate at the middle of a contraction and remain so for about a minute after the contraction
D
The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction
Question 13 Explanation:
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.
Question 14
Which provision of our 1987 constitution guarantees the right of the unborn child to life from conception is
A
Article II section 12
B
Article XIII section 15
C
Article II section 15
D
Article XIII section 11
Question 14 Explanation:
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.
Question 15
When the bag of waters ruptures, the nurse should check the characteristic of the amniotic fluid. The normal color of amniotic fluid is
A
Clear as water
B
Yellowish
C
Greenish
D
Bluish
Question 15 Explanation:
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.
Question 16
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
A
The maternal heart is already weak and the mother can die
B
The delivery process is strenuous to the mother
C
The mother is tired and weak which can distress the heart
D
There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
Question 16 Explanation:
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.
Question 17
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
A
Abortion is immoral and is prohibited by the church
B
Abortion is illegal because majority in our country are catholics and it is prohibited by the church
C
Abortion is considered illegal because you got paid for doing it
D
Abortion is both immoral and illegal in our country
Question 17 Explanation:
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.
Question 18
The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage?
A
Full bladder
B
Extension rather than flexion of the head
C
Cervical rigidity
D
Pelvic bone contraction
Question 18 Explanation:
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.
Question 19
The normal umbilical cord is composed of:
A
2 arteries and 2 veins
B
2 arteries and 1 vein
C
2 veins and 1 artery
D
none of the above
Question 19 Explanation:
The umbilical cord is composed of 2 arteries and 1 vein.
Question 20
The following are signs and symptoms of fetal distress EXCEPT:
A
The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm
B
Fetal heart rate (FHR) decreased during a contraction and persists even after the uterine contraction ends
C
The FHR is less than 120 bpm or over 160 bpm
D
FHR is 160 bpm, weak and irregular
Question 20 Explanation:
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.
Question 21
At what stage of labor is the mother is advised to bear down?
A
In between uterine contraction to prevent uterine rupture
B
Anytime the mother feels like bearing down
C
During a uterine contraction
D
When the mother feels the pressure at the rectal area
Question 21 Explanation:
The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing down during a contraction.
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.
Question 23
The passageway in labor and deliver of the fetus include the following EXCEPT
A
Flexibility of the pelvis
B
Distensibility of lower uterine segment
C
Cervical dilatation and effacement
D
Distensibility of vaginal canal and introitus
Question 23 Explanation:
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.
Question 24
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:
A
Hemorrhage secondary to uterine atony
B
Blood volume deficiency
C
Normal blood loss
D
Inadequate tissue perfusion related to hemorrhage
Question 24 Explanation:
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.
Question 25
The placenta should be delivered normally within ___ minutes after the delivery of the baby.
A
5 minutes
B
45 minutes
C
60 minutes
D
30 minutes
Question 25 Explanation:
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.
Question 26
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:
A
LOP
B
LOA
C
ROA
D
ROP
Question 26 Explanation:
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.
Question 27
The following are types of breech presentation EXCEPT:
A
Incomplete
B
Footling
C
Complete
D
Frank
Question 27 Explanation:
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.
Question 28
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
A
1 & 2
B
2,3,4
C
2 & 4
D
1,2,3,4
Question 28 Explanation:
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.
Question 29
When doing perineal care in preparation for delivery, the nurse should observe the following EXCEPT
A
Clean from the mons veneris to the anus
B
Use up-down technique with one stroke
C
Use mild soap and warm water
D
Paint the inner thighs going towards the perineal area
Question 29 Explanation:
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
Question 30
At what stage of labor and delivery does a primigravida differ mainly from a multigravida?
A
Stage 1
B
Stage 2
C
Stage 3
D
Stage 4
Question 30 Explanation:
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.
Question 31
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:
A
Cover the prolapse cord with sterile gauze wet with sterile NSS and place the woman on trendellenberg position
B
Place the mother on semifowler’s position to improve circulation
C
Push back the cord into the vagina and place the woman on sims position
D
Push back the prolapse cord into the vaginal canal
Question 31 Explanation:
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
Question 32
When shaving a woman in preparation for cesarean section, the area to be shaved should be from ___ to ___
A
Xyphoid process to the pubic area
B
The umbilicus to the mid-thigh
C
Above the umbilicus to the pubic area
D
Under breast to mid-thigh including the pubic area
Question 32 Explanation:
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
Question 33
The primary power involved in labor and delivery is
A
Uterine contraction
B
Valsalva technique
C
Cervical effacement and dilatation
D
Bearing down ability of mother
Question 33 Explanation:
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.
Question 34
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
A
1 and 3
B
1, 3, and 4
C
2 and 3
D
2 and 4
Question 34 Explanation:
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.
Question 35
When giving narcotic analgesics to mother in labor, the special consideration to follow is:
A
Cervical dilatation has already reached at least 8 cm. and the station is at least (+)2
B
Uterine contraction is progressing well and delivery of the baby is imminent
C
Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.
D
The progress of labor is well established reaching the transitional stage
Question 35 Explanation:
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.
Question 36
When the shiny portion of the placenta comes out first, this is called the ___ mechanism.
A
Duncan
B
Schultze
C
Ritgens
D
Marmets
Question 36 Explanation:
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.
Question 37
When delivering the baby’s head the nurse supports the mother’s perineum to prevent tear. This technique is called
A
Duncan maneuver
B
Ritgen’s technique
C
Marmet’s technique
D
Schultze maneuver
Question 37 Explanation:
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.
Question 38
As soon as the placenta is delivered, the nurse must do which of the following actions?
A
Place the placenta in a receptacle for disposal
B
Inspect the placenta for completeness including the membranes
C
Label the placenta properly
D
Leave the placenta in the kidney basin for the nursing aide to dispose properly
Question 38 Explanation:
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.
Question 39
The normal dilatation of the cervix during the first stage of labor in a nullipara is
A
1.2 cm./hr
B
1.8 cm./hr
C
1.5 cm./hr.
D
2.0 cm./hr
Question 39 Explanation:
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.
Question 40
The drug usually given parentally to enhance uterine contraction is:
A
Lidocaine
B
Terbutalline
C
Magnesium sulfate
D
Pitocin
Question 40 Explanation:
The common oxytocin given to enhance uterine contraction is pitocin. This is also the drug given to induce labor.
Question 41
The peak point of a uterine contraction is called the
A
Acceleration
B
Axiom
C
Acme
D
Deceleration
Question 41 Explanation:
Acme is the technical term for the highest point of intensity of a uterine contraction.
Question 42
The proper technique to monitor the intensity of a uterine contraction is
A
Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction
B
Put the palm of the hands on the fundal area and feel the contraction at the fundal area
C
Place the palm of the hands on the abdomen and time the contraction
D
Place the finger tips lightly on the suprapubic area and time the contraction
Question 42 Explanation:
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.
Question 43
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:
A
The active phase of Stage 1 is protracted
B
The latent phase of Stage 1 is prolonged
C
Labor is progressing as expected
D
The duration of labor is normal
Question 43 Explanation:
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.
Question 44
The following are signs that the placenta has detached EXCEPT:
A
Sudden gush of blood
B
Mother feels like bearing down
C
Lengthening of the cord
D
Uterus becomes more globular
Question 44 Explanation:
Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any effort from the mother.
Question 45
The following are correct statements about false labor EXCEPT
A
The cervix is still closed.
B
The pain is irregular in intensity and frequency.
C
There is no vaginal bloody discharge
D
The duration of contraction progressively lengthens over time
Question 45 Explanation:
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.
Question 46
The second stage of labor begins with ___ and ends with __?
A
Begins with true labor pains and ends with delivery of baby
B
Begins with full dilatation of cervix and ends with delivery of placenta
C
Begins with passage of show and ends with full dilatation and effacement of cervix
D
Begins with complete dilatation and effacement of cervix and ends with delivery of baby
Question 46 Explanation:
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.
Question 47
The fetal heart rate is checked following rupture of the bag of waters in order to:
A
Check if fetal presenting part has adequately descended following the rupture
B
Determine if there is utero-placental insufficiency
C
Check if the fetus is suffering from head compression
D
Determine if cord compression followed the rupture
Question 47 Explanation:
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.
Question 48
When determining the duration of a uterine contraction the right technique is to time it from
A
The acme point of one contraction to the acme point of another contraction
B
The beginning of one contraction to the end of the same contraction
C
The end of one contraction to the beginning of another contraction
D
The beginning of one contraction to the end of another contraction
Question 48 Explanation:
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.
Question 49
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:
A
To allow a gradual shifting of the blood into the maternal circulation
B
To make the delivery effort free and the mother does not need to push with contractions
C
To prevent perineal laceration with the expulsion of the fetal head
D
To allow atraumatic delivery of the baby
Question 49 Explanation:
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.
Question 50
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:
A
Oxytocin will prevent bleeding
B
Oxytocin can make the cervix close and thus trap the placenta inside
C
Oxytocin will facilitate placental delivery
D
Giving oxytocin will ensure complete delivery of the placenta
Question 50 Explanation:
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.
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Maternal & Child Practice Exam 5 (EM)
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Question 1
At what stage of labor and delivery does a primigravida differ mainly from a multigravida?
A
Stage 4
B
Stage 3
C
Stage 1
D
Stage 2
Question 1 Explanation:
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.
Question 2
The first thing that a nurse must ensure when the baby’s head comes out is
A
The cord is still pulsating
B
The cord is still attached to the placenta
C
The cord is intact
D
No part of the cord is encircling the baby’s neck
Question 2 Explanation:
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.
Question 3
The following are signs and symptoms of fetal distress EXCEPT:
A
The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm
B
FHR is 160 bpm, weak and irregular
C
The FHR is less than 120 bpm or over 160 bpm
D
Fetal heart rate (FHR) decreased during a contraction and persists even after the uterine contraction ends
Question 3 Explanation:
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.
Question 4
The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage?
A
Extension rather than flexion of the head
B
Pelvic bone contraction
C
Full bladder
D
Cervical rigidity
Question 4 Explanation:
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.
Question 5
The following are natural childbirth procedures EXCEPT:
A
Lamaze method
B
Ritgen’s maneuver
C
Dick-Read method
D
Psychoprophylactic method
Question 5 Explanation:
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.
Question 6
As soon as the placenta is delivered, the nurse must do which of the following actions?
A
Inspect the placenta for completeness including the membranes
B
Leave the placenta in the kidney basin for the nursing aide to dispose properly
C
Label the placenta properly
D
Place the placenta in a receptacle for disposal
Question 6 Explanation:
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.
Question 7
At what stage of labor is the mother is advised to bear down?
A
During a uterine contraction
B
In between uterine contraction to prevent uterine rupture
C
When the mother feels the pressure at the rectal area
D
Anytime the mother feels like bearing down
Question 7 Explanation:
The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing down during a contraction.
Question 8
When giving narcotic analgesics to mother in labor, the special consideration to follow is:
A
Uterine contraction is progressing well and delivery of the baby is imminent
B
The progress of labor is well established reaching the transitional stage
C
Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.
D
Cervical dilatation has already reached at least 8 cm. and the station is at least (+)2
Question 8 Explanation:
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.
Question 9
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:
A
Push back the prolapse cord into the vaginal canal
B
Cover the prolapse cord with sterile gauze wet with sterile NSS and place the woman on trendellenberg position
C
Place the mother on semifowler’s position to improve circulation
D
Push back the cord into the vagina and place the woman on sims position
Question 9 Explanation:
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
Question 10
The normal umbilical cord is composed of:
A
2 arteries and 2 veins
B
2 arteries and 1 vein
C
2 veins and 1 artery
D
none of the above
Question 10 Explanation:
The umbilical cord is composed of 2 arteries and 1 vein.
Question 11
When determining the duration of a uterine contraction the right technique is to time it from
A
The beginning of one contraction to the end of the same contraction
B
The acme point of one contraction to the acme point of another contraction
C
The beginning of one contraction to the end of another contraction
D
The end of one contraction to the beginning of another contraction
Question 11 Explanation:
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.
Question 12
When the fetal head is at the level of the ischial spine, it is said that the station of the head is
A
Station +1
B
Station +2
C
Station “0”
D
Station –1
Question 12 Explanation:
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.
Question 13
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:
A
ROP
B
LOA
C
LOP
D
ROA
Question 13 Explanation:
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.
Question 14
Which provision of our 1987 constitution guarantees the right of the unborn child to life from conception is
A
Article XIII section 11
B
Article II section 12
C
Article II section 15
D
Article XIII section 15
Question 14 Explanation:
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.
Question 15
Which of the following conditions will lead to a small-for-gestational age fetus due to less blood supply to the fetus?
A
Maternal cardiac condition
B
Diabetes in the mother
C
Abruptio placenta
D
Premature labor
Question 15 Explanation:
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.
Question 16
The normal dilatation of the cervix during the first stage of labor in a nullipara is
A
1.2 cm./hr
B
1.5 cm./hr.
C
1.8 cm./hr
D
2.0 cm./hr
Question 16 Explanation:
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.
Question 17
When the bag of waters ruptures, the nurse should check the characteristic of the amniotic fluid. The normal color of amniotic fluid is
A
Bluish
B
Yellowish
C
Clear as water
D
Greenish
Question 17 Explanation:
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.
Question 18
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:
A
Oxytocin will prevent bleeding
B
Oxytocin can make the cervix close and thus trap the placenta inside
C
Giving oxytocin will ensure complete delivery of the placenta
D
Oxytocin will facilitate placental delivery
Question 18 Explanation:
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.
Question 19
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
A
2,3,4
B
1,2,3,4
C
1 & 2
D
2 & 4
Question 19 Explanation:
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.
Question 20
The drug usually given parentally to enhance uterine contraction is:
A
Terbutalline
B
Magnesium sulfate
C
Pitocin
D
Lidocaine
Question 20 Explanation:
The common oxytocin given to enhance uterine contraction is pitocin. This is also the drug given to induce labor.
Question 21
The fetal heart rate is checked following rupture of the bag of waters in order to:
A
Check if fetal presenting part has adequately descended following the rupture
B
Check if the fetus is suffering from head compression
C
Determine if cord compression followed the rupture
D
Determine if there is utero-placental insufficiency
Question 21 Explanation:
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.
Question 22
The following are signs that the placenta has detached EXCEPT:
A
Lengthening of the cord
B
Mother feels like bearing down
C
Uterus becomes more globular
D
Sudden gush of blood
Question 22 Explanation:
Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any effort from the mother.
Question 23
The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following EXCEPT:
A
Fluid intake and output
B
Cervical dilatation
C
Uterine contraction
D
Vital signs
Question 23 Explanation:
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.
Question 24
When delivering the baby’s head the nurse supports the mother’s perineum to prevent tear. This technique is called
A
Schultze maneuver
B
Marmet’s technique
C
Duncan maneuver
D
Ritgen’s technique
Question 24 Explanation:
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.
Question 25
Which of the following techniques during labor and delivery can lead to uterine inversion?
A
Massaging the fundus to encourage the uterus to contract
B
Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head
C
Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
D
Applying light traction when delivering the placenta that has already detached from the uterine wall
Question 25 Explanation:
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.
Question 26
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
A
There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
B
The delivery process is strenuous to the mother
C
The mother is tired and weak which can distress the heart
D
The maternal heart is already weak and the mother can die
Question 26 Explanation:
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.
Question 27
The second stage of labor begins with ___ and ends with __?
A
Begins with true labor pains and ends with delivery of baby
B
Begins with passage of show and ends with full dilatation and effacement of cervix
C
Begins with complete dilatation and effacement of cervix and ends with delivery of baby
D
Begins with full dilatation of cervix and ends with delivery of placenta
Question 27 Explanation:
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.
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.
Question 29
The following are types of breech presentation EXCEPT:
A
Incomplete
B
Complete
C
Frank
D
Footling
Question 29 Explanation:
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.
Question 30
The following are correct statements about false labor EXCEPT
A
The cervix is still closed.
B
There is no vaginal bloody discharge
C
The pain is irregular in intensity and frequency.
D
The duration of contraction progressively lengthens over time
Question 30 Explanation:
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.
Question 31
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:
A
To prevent perineal laceration with the expulsion of the fetal head
B
To make the delivery effort free and the mother does not need to push with contractions
C
To allow atraumatic delivery of the baby
D
To allow a gradual shifting of the blood into the maternal circulation
Question 31 Explanation:
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.
Question 32
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
A
2 and 4
B
2 and 3
C
1 and 3
D
1, 3, and 4
Question 32 Explanation:
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.
Question 33
The primary power involved in labor and delivery is
A
Cervical effacement and dilatation
B
Bearing down ability of mother
C
Uterine contraction
D
Valsalva technique
Question 33 Explanation:
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.
Question 34
When shaving a woman in preparation for cesarean section, the area to be shaved should be from ___ to ___
A
The umbilicus to the mid-thigh
B
Above the umbilicus to the pubic area
C
Under breast to mid-thigh including the pubic area
D
Xyphoid process to the pubic area
Question 34 Explanation:
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
Question 35
When the shiny portion of the placenta comes out first, this is called the ___ mechanism.
A
Duncan
B
Schultze
C
Marmets
D
Ritgens
Question 35 Explanation:
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.
Question 36
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:
A
Normal blood loss
B
Inadequate tissue perfusion related to hemorrhage
C
Blood volume deficiency
D
Hemorrhage secondary to uterine atony
Question 36 Explanation:
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.
Question 37
The basic delivery set for normal vaginal delivery includes the following instruments/articles EXCEPT:
A
Retractor
B
Kidney basin
C
Pair of scissors
D
2 clamps
Question 37 Explanation:
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.
Question 38
To monitor the frequency of the uterine contraction during labor, the right technique is to time the contraction
A
From the deceleration of one contraction to the acme of the next contraction
B
From the beginning of one contraction to the beginning of the next contraction
C
From the end of one contraction to the beginning of the next contraction
D
From the beginning of one contraction to the end of the same contraction
Question 38 Explanation:
Frequency of the uterine contraction is defined as from the beginning of one contraction to the beginning of another contraction.
Question 39
To ensure that the baby will breath as soon as the head is delivered, the nurse’s priority action is to
A
Slap the baby’s buttocks to make the baby cry
B
Suction the nose and mouth to remove mucous secretions
C
Clamp the cord about 6 inches from the base
D
Check the baby’s color to make sure it is not cyanotic
Question 39 Explanation:
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.)
Question 40
When doing perineal care in preparation for delivery, the nurse should observe the following EXCEPT
A
Use up-down technique with one stroke
B
Paint the inner thighs going towards the perineal area
C
Clean from the mons veneris to the anus
D
Use mild soap and warm water
Question 40 Explanation:
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
Question 41
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
A
The heart rate will accelerate during a contraction and remain slightly above the pre-contraction rate at the end of the contraction
B
The rate should not be affected by the uterine contraction.
C
The heart rate will decelerate at the middle of a contraction and remain so for about a minute after the contraction
D
The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction
Question 41 Explanation:
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.
Question 42
The lower limit of viability for infants in terms of age of gestation is:
A
25-27 weeks
B
21-24 weeks
C
38-40 weeks
D
28-30 weeks
Question 42 Explanation:
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.
Question 43
The placenta should be delivered normally within ___ minutes after the delivery of the baby.
A
45 minutes
B
60 minutes
C
5 minutes
D
30 minutes
Question 43 Explanation:
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.
Question 44
When the baby’s head is out, the immediate action of the nurse is
A
Check if there is cord coiled around the neck
B
Deliver the anterior shoulder
C
Wipe the baby’s face and suction mouth first
D
Cut the umbilical cord
Question 44 Explanation:
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.
Question 45
The peak point of a uterine contraction is called the
A
Deceleration
B
Acceleration
C
Acme
D
Axiom
Question 45 Explanation:
Acme is the technical term for the highest point of intensity of a uterine contraction.
Question 46
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
A
Abortion is considered illegal because you got paid for doing it
B
Abortion is both immoral and illegal in our country
C
Abortion is illegal because majority in our country are catholics and it is prohibited by the church
D
Abortion is immoral and is prohibited by the church
Question 46 Explanation:
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.
Question 47
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
A
Floating
B
Internal Rotation
C
Descended
D
Engaged
Question 47 Explanation:
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.
Question 48
The proper technique to monitor the intensity of a uterine contraction is
A
Place the palm of the hands on the abdomen and time the contraction
B
Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction
C
Put the palm of the hands on the fundal area and feel the contraction at the fundal area
D
Place the finger tips lightly on the suprapubic area and time the contraction
Question 48 Explanation:
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.
Question 49
The passageway in labor and deliver of the fetus include the following EXCEPT
A
Distensibility of vaginal canal and introitus
B
Flexibility of the pelvis
C
Distensibility of lower uterine segment
D
Cervical dilatation and effacement
Question 49 Explanation:
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.
Question 50
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:
A
Labor is progressing as expected
B
The active phase of Stage 1 is protracted
C
The latent phase of Stage 1 is prolonged
D
The duration of labor is normal
Question 50 Explanation:
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.
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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
2,3,4
1,2,3,4
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
Acceleration
Acme
Deceleration
Axiom
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
Bluish
Greenish
Yellowish
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
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.
Schultze
Ritgens
Duncan
Marmets
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
Retractor
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:
Terbutalline
Pitocin
Magnesium sulfate
Lidocaine
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:
LOA
ROP
LOP
ROA
47. The following are types of breech presentation EXCEPT:
Footling
Frank
Complete
Incomplete
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
Engaged
Descended
Floating
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