Text Mode – Text version of the exam
1. Postpartum Period: The fundus of the uterus is expected to go down normally postpartally about __ cm per day.
- 1.0 cm
- 2.0 cm
- 2.5 cm
- 3.0 cm
2. The lochia on the first few days after delivery is characterized as
- Pinkish with some blood clots
- Whitish with some mucus
- Reddish with some mucus
- Serous with some brown tinged mucus
3. Lochia normally disappears after how many days postpartum?
- 5 days
- 7-10 days
- 18-21 days
- 28-30 days
4. After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to:
- Prevent the recurrence of Rh(+) baby in future pregnancies
- Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby
- Ensure that future pregnancies will not lead to maternal illness
- To prevent the newborn from having problems of incompatibility when it breastfeeds
5. To enhance milk production, a lactating mother must do the following interventions EXCEPT:
- Increase fluid intake including milk
- Eat foods that increases lactation which are called galactagues
- Exercise adequately like aerobics
- Have adequate nutrition and rest
6. The nursing intervention to relieve pain in breast engorgement while the mother continues to breastfeed is
- Apply cold compress on the engorged breast
- Apply warm compress on the engorged breast
- Massage the breast
- Apply analgesic ointment
7. A woman who delivered normally per vagina is expected to void within ___ hours after delivery.
- 3 hrs
- 4 hrs.
- 6-8 hrs
- 12-24 hours
8. To ensure adequate lactation the nurse should teach the mother to:
- Breast feed the baby on self-demand day and night
- Feed primarily during the day and allow the baby to sleep through the night
- Feed the baby every 3-4 hours following a strict schedule
- Breastfeed when the breast are engorged to ensure adequate supply
9. An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is:
- Encourage the mother to ambulate to relieve the pain in the leg
- Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow
- Apply warm compress on the affected leg to relieve the pain
- Elevate the affected leg and keep the patient on bedrest
10. The nurse should anticipate that hemorrhage related to uterine atony may occur postpartally if this condition was present during the delivery:
- Excessive analgesia was given to the mother
- Placental delivery occurred within thirty minutes after the baby was born
- An episiotomy had to be done to facilitate delivery of the head
- The labor and delivery lasted for 12 hours
11. According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the post partum period. These stages are:
- Going through, adjustment period, adaptation period
- Taking-in, taking-hold and letting-go
- Attachment phase, adjustment phase, adaptation phase
- Taking-hold, letting-go, attachment phase
12. The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:
- The pancreas is immature and unable to secrete the needed insulin
- There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin
- The baby is reacting to the insulin given to the mother
- His kidneys are immature leading to a high tolerance for glucose
13. Which of the following is an abnormal vital sign in postpartum?
- Pulse rate between 50-60/min
- BP diastolic increase from 80 to 95mm Hg
- BP systolic between 100-120mm Hg
- Respiratory rate of 16-20/min
14. The uterine fundus right after delivery of placenta is palpable at
- Level of Xyphoid process
- Level of umbilicus
- Level of symphysis pubis
- Midway between umbilicus and symphysis pubis
15. After how many weeks after delivery should a woman have her postpartal check-up based on the protocol followed by the DOH?
- 2 weeks
- 3 weeks
- 6 weeks
- 12 weeks
16. In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?
- 2-4 weeks
- 6-8 weeks
- 6 months
- 12 months
17. The following are nursing measures to stimulate lactation EXCEPT
- Frequent regular breast feeding
- Breast pumping
- Breast massage
- Application of cold compress on the breast
18. When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect
- Laceration of soft tissues of the cervix and vagina
- Uterine atony
- Uterine inversion
- Uterine hypercontractility
19. The following are interventions to make the fundus contract postpartally EXCEPT
- Make the baby suck the breast regularly
- Apply ice cap on fundus
- Massage the fundus vigorously for 15 minutes until contracted
- Give oxytocin as ordered
20. The following are nursing interventions to relieve episiotomy wound pain EXCEPT
- Giving analgesic as ordered
- Sitz bath
- Perineal heat
- Perineal care
21. Postpartum blues is said to be normal provided that the following characteristics are present. These are
- Within 3-10 days only;
- Woman exhibits the following symptoms- episodic tearfulness, fatigue, oversensitivity, poor appetite;
- Maybe more severe symptoms in primpara
- All of the above
- 1 and 2
- 2 only
- 2 and 3
22. The neonatal circulation differs from the fetal circulation because
- The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.
- The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage to the lungs
- The blood in left side of the fetal heart contains oxygenated blood while the blood in the right side contains unoxygenated blood.
- None of the above
23. The normal respiration of a newborn immediately after birth is characterized as:
- Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute
- 20-40 breaths per minute, abdominal breathing with active use of intercostals muscles
- 30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing
- 30-50 breaths per minute, active use of abdominal and intercostal muscles
24. The anterior fontanelle is characterized as:
- 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape
- 2-3 cm antero-posterior diameter and 3-4 cm transverse diameter and diamond shape
- 2-3 cm in both antero-posterior and transverse diameter and diamond shape
- none of the above
25. The ideal site for vitamin K injection in the newborn is:
- Right upper arm
- Left upper arm
- Either right or left buttocks
- Middle third of the thigh
26. At what APGAR score at 5 minutes after birth should resuscitation be initiated?
27. Right after birth, when the skin of the baby’s trunk is pinkish but the soles of the feet and palm of the hands are bluish this is called:
- Peripheral cyanosis
- Cephalo-caudal cyanosis
28. The minimum birth weight for full term babies to be considered normal is:
29. The procedure done to prevent ophthalmia neonatorum is:
- Marmet’s technique
- Crede’s method
- Ritgen’s method
- Ophthalmic wash
30. Which of the following characteristics will distinguish a postmature neonate at birth?
- Plenty of lanugo and vernix caseosa
- Lanugo mainly on the shoulders and vernix in the skin folds
- Pinkish skin with good turgor
- Almost leather-like, dry, cracked skin, negligible vernix caseosa
31. According to the Philippine Nursing Law, a registered nurse is allowed to handle mothers in labor and delivery with the following considerations:
- The pregnancy is normal.;
- The labor and delivery is uncomplicated;
- Suturing of perineal laceration is allowed provided the nurse had special training;
- As a delivery room nurse she is not allowed to insert intravenous fluid unless she had special training for it.
- 1 and 2
- 1, 2, and 3
- 3 and 4
- 1, 2, and 4
32. Birth Control Methods and Infertility: In basal body temperature (BBT) technique, the sign that ovulation has occurred is an elevation of body temperature by
- 1.0-1.4 degrees centigrade
- 0.2-0.4 degrees centigrade
- 2.0-4.0 degrees centigrade
- 1.0-4.0 degrees centigrade
33. Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if
- The mother breast feeds mainly at night time when ovulation could possibly occur
- The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings
- The mother uses mixed feeding faithfully
- The mother breastfeeds regularly until 1 year with no supplemental feedings
34. Intra-uterine device prevents pregnancy by the ff. mechanism EXCEPT
- Endometrium inflames
- Fundus contracts to expel uterine contents
- Copper embedded in the IUD can kill the sperms
- Sperms will be barred from entering the fallopian tubes
35. Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding?
- Estrogen only
- Progesterone only
- Mixed type- estrogen and progesterone
- 21-day pills mixed type
36. The natural family planning method called Standard Days (SDM), is the latest type and easy to use method. However, it is a method applicable only to women with regular menstrual cycles between ___ to ___ days.
- 21-26 days
- 26-32 days
- 28-30 days
- 24- 36 days
37. Which of the following are signs of ovulation?
- Thin watery cervical mucus;
- Elevated body temperature of 4.0 degrees centigrade
- 1 & 2
- 1, 2, & 3
- 3 & 4
- 1, 2, 3, 4
38. The following methods of artificial birth control works as a barrier device EXCEPT:
- Cervical cap
- Cervical Diaphragm
- Intrauterine device (IUD)
39. Which of the following is a TRUE statement about normal ovulation?
- It occurs on the 14th day of every cycle
- It may occur between 14-16 days before next menstruation
- Every menstrual period is always preceded by ovulation
- The most fertile period of a woman is 2 days after ovulation
40. If a couple would like to enhance their fertility, the following means can be done:
- Monitor the basal body temperature of the woman everyday to determine peak period of fertility;
- Have adequate rest and nutrition;
- Have sexual contact only during the dry period of the woman;
- Undergo a complete medical check-up to rule out any debilitating disease
- 1 only
- 1 & 4
41. In sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are:
- Temperature, cervical mucus, cervical consistency
- Release of ovum, temperature and vagina
- Temperature and wetness
- Temperature, endometrial secretion, mucus
42. The following are important considerations to teach the woman who is on low dose (mini-pill) oral contraceptive EXCEPT:
- The pill must be taken everyday at the same time
- If the woman fails to take a pill in one day, she must take 2 pills for added protection
- If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack
- If she is breast feeding, she should discontinue using mini-pill and use the progestin-only type
43. To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is
- Huhner’s test
- Rubin’s test
- Postcoital test
- None of the above
44. Infertility can be attributed to male causes such as the following EXCEPT:
- Sperm count of about 20 million per milliliter
- Premature ejaculation
45. Spinnabarkeit is an indicator of ovulation which is characterized as:
- Thin watery mucus which can be stretched into a long strand about 10 cm
- Thick mucus that is detached from the cervix during ovulation
- Thin mucus that is yellowish in color with fishy odor
- Thick mucus vaginal discharge influence by high level of estrogen
46. Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is
- Prostate gland
- Seminal vesicle
- Vas deferens
47. Breast self examination is best done by the woman on herself every month during
- The middle of her cycle to ensure that she is ovulating
- During the menstrual period
- Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen
- Just before the menstrual period to determine if ovulation has occurred
48. A woman is considered to be menopause if she has experienced cessation of her menses for a period of
- 6 months
- 12 months
- 18 months
- 24 months
49. Which of the following is the correct practice of self breast examination in a menopausal woman?
- She should do it at the usual time that she experiences her menstrual period in the past to ensure that her hormones are not at its peak
- Any day of the month as long it is regularly observed on the same day every month
- Anytime she feels like doing it ideally every day
- Menopausal women do not need regular self breast exam as long as they do it at least once every 6 months
50. In assisted reproductive technology (ART), there is a need to stimulate the ovaries to produce more than one mature ova. The drug commonly used for this purpose is:
Answers and Rationales
- Answer: (A) 1.0 cm. The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery.
- Answer: (C) Reddish with some mucus. Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue and mucus. Since it is not pure blood it is non-clotting.
- Answer: (B) 7-10 days. Normally, lochia disappears after 10 days postpartum. What’s important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier everyday.
- Answer: (B) Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby. In Rh incompatibility, an Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen.
- Answer: (C) Exercise adequately like aerobics. All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation.
- Answer: (B) Apply warm compress on the engorged breast. Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold.
- Answer: (C) 6-8 hrs. A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don’t work, the nurse may decide to catheterize the woman.
- Answer: (A) Breast feed the baby on self-demand day and night. Feeding on self-demand means the mother feeds the baby according to baby’s need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation.
- Answer: (D) Elevate the affected leg and keep the patient on bedrest. If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation.
- Answer: (A) Excessive analgesia was given to the mother. Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus.
- Answer: (B) Taking-in, taking-hold and letting-go. Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role.
- Answer: (B) There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin. If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.
- Answer: (B) BP diastolic increase from 80 to 95mm Hg. All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.
- Answer: (B) Level of umbilicus. Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) everyday until it becomes no longer palpable above the symphysis pubis.
- Answer: (C) 6 weeks. According to the DOH protocol postpartum check-up is done 6-8 weeks after delivery to make sure complete involution of the reproductive organs has be achieved.
- Answer: (B) 6-8 weeks. When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Folicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a graafian follicle and the menstrual cycle post pregnancy resumes.
- Answer: (D) Application of cold compress on the breast. To stimulate lactation, warm compress is applied on the breast. Cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.
- Answer: (A) Laceration of soft tissues of the cervix and vagina. When uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.
- Answer: (C) Massage the fundus vigorously for 15 minutes until contracted. Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feel firm and contracted. If massaging is vigorous and prolonged, the uterus will relax due to over stimulation.
- Answer: (D) Perineal care. Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not.
- Answer: (A) All of the above. All the symptoms 1-3 are characteristic of postpartal blues. It will resolve by itself because it is transient and is due to a number of reasons like changes in hormonal levels and adjustment to motherhood. If symptoms lasts more than 2 weeks, this could be a sign of abnormality like postpartum depression and needs treatment.
- Answer: (A) The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.. The fetal lungs is fluid-filled while in utero and is still not functioning. It only begins to function in extra uterine life. Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.
- Answer: (A) Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute. A newly born baby still is adjusting to xtra uterine life and the lungs are just beginning to function as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be brief lasting not more than 15 seconds otherwise it will be considered abnormal.
- Answer: (A) 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape. The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the transverse diameter. The posterior fontanelle is triangular shape.
- Answer: (D) Middle third of the thigh. Neonates do not have well developed muscles of the arm. Since Vitamin K is given intramuscular, the site must have sufficient muscles like the middle third of the thigh.
- Answer: (A) 1-3. An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10.
- Answer: (B) Acrocyanosis. Acrocyanosis is the term used to describe the baby’s skin color at birth when the soles and palms are bluish but the trunk is pinkish.
- Answer: (C) 2,500gms. According to the WHO standard, the minimum normal birth weight of a full term baby is 2,500 gms or 2.5 Kg.
- Answer: (B) Crede’s method. Crede’s method/prophylaxis is the procedure done to prevent ophthalmia neonatorum which the baby can acquire as it passes through the birth canal of the mother. Usually, an ophthalmic ointment is used.
- Answer: (D) Almost leather-like, dry, cracked skin, negligible vernix caseosa. A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished.
- Answer: (B) 1, 2, and 3. To be allowed to handle deliveries, the pregnancy must be normal and uncomplicated. And in RA9172, the nurse is now allowed to suture perineal lacerations provided s/he has had the special training. Also, in this law, there is no longer an explicit provision stating that the nurse still needs special training for IV insertion.
- Answer: (B) 0.2-0.4 degrees centigrade. The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 – 0.4 degrees centigrade
- Answer: (B) The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings. A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby.
- Answer: (D) Sperms will be barred from entering the fallopian tubes. An intrauterine device is a foreign body so that if it is inserted into the uterine cavity the initial reaction is to produce inflammatory process and the uterus will contract in order to try to expel the foreign body. Usually IUDs are coated with copper to serve as spermicide killing the sperms deposited into the female reproductive tract. But the IUD does not completely fill up the uterine cavity thus sperms which are microscopic is size can still pass through.
- Answer: (B) Progesterone only. If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation.
- Answer: (B) 26-32 days. Standard Days Method (SDM) requires that the menstrual cycles are regular between 26-32 days. There is no need to monitor temperature or mucus secretion. This natural method of family planning is very simple since all that the woman pays attention to is her cycle. With the aid of CycleBeads, the woman can easily monitor her cycles.
- Answer: (B) 1, 2, & 3. Mittelschmerz, spinnabarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.
- Answer: (D) Intrauterine device (IUD). Intrauterine device prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube.
- Answer: (B) It may occur between 14-16 days before next menstruation. Not all menstrual cycles are ovulatory. Normal ovulation in a woman occurs between the 14th to the 16th day before the NEXT menstruation. A common misconception is that ovulation occurs on the 14th day of the cycle. This is a misconception because ovulation is determined NOT from the first day of the cycle but rather 14-16 days BEFORE the next menstruation.
- Answer: (C) 1,2,4. All of the above are essential for enhanced fertility except no. 3 because during the dry period the woman is in her infertile period thus even when sexual contact is done, there will be no ovulation, thus fertilization is not possible.
- Answer: (A) Temperature, cervical mucus, cervical consistency. The 3 parameters measured/monitored which will indicate that the woman has ovulated are- temperature increase of about 0.2-0.4 degrees centigrade, softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel “wet”.
- Answer: (B) If the woman fails to take a pill in one day, she must take 2 pills for added protection. If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.
- Answer: (B) Rubin’s test. Rubin’s test is a test to determine patency of fallopian tubes. Huhner’s test is also known as post-coital test to determine compatibility of the cervical mucus with sperms of the sexual partner.
- Answer: (C) Sperm count of about 20 million per milliliter. Sperm count must be within normal in order for a male to successfully sire a child. The normal sperm count is 20 million per milliliter of seminal fluid or 50 million per ejaculate.
- Answer: (A) Thin watery mucus which can be stretched into a long strand about 10 cm . At the midpoint of the cycle when the estrogen level is high, the cervical mucus becomes thin and watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an ovum. This is called spinnabarkeit. And the woman feels “wet”. When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel “dry”.
- Answer: (D) Vas deferens. Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.
- Answer: (C) Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen. The best time to do self breast examination is right after the menstrual period is over so that the hormonal level is low thus the breasts are not tender.
- Answer: (B) 12 months. If a woman has not had her menstrual period for 12 consecutive months, she is considered to be in her menopausal stage.
- Answer: (B) Any day of the month as long it is regularly observed on the same day every month. Menopausal women still need to do self examination of the breast regularly. Any day of the month is alright provided that she practices it monthly on the same day that she has chosen. The hormones estrogen and progesterone are already diminished during menopause so there is no need to consider the time to do it in relation to the menstrual cycle.
- Answer: (B) Clomiphene. Clomiphene or Clomid acts as an ovarian stimulant to promote ovulation. The mature ova are retrieved and fertilized outside the fallopian tube (in-vitro fertilization) and after 48 hours the fertilized ovum is inserted into the uterus for implantation.