APRIL 25-26, 2023

Maternal & Child Nursing

Prepared By: Dr. Marie Therese Pacabis

INSTRUCTION: On the separate Answer Sheet, shade the letter of your chosen answer. DO NOT WRITE ANYTHING ON
THE TEST QUESTIONNAIRE.

1. In labor and delivery care, the nurse must be competent in all the areas. Which one is an exception? (–)
A. Performing vaginal examinations C. Suturing all lacerations
B. Use of partograph D. Handling normal deliveries

Do not IE during Contractions.

Standard: Do not IE beyond 5

Partograph → Labor Care Guide (New)

Suturing – a skills; 1 cm above the laceration to catch the beginning of laceration

Episiotomy – not all primigravida can have; done if the perineal muscles are tight
Nurse & Midwife can suture 2nd or 3rd degree laceration (Episiotomy), except deep suture lacerations.
Vulvoperineal Muscles ✅
Chromic ❌ – prone to infection; source from animal
Polyglycolic, Vicryl material is used instead.

2. A type of vaginal infection characterized by foul grayish discharge is:

A. Bacterial vaginosis – Metronidazole DOC C. Moniliasis
B. Trichomoniasis – greenish, foamy D. Chlamydia

3. Which among these statements is not true about infertility? (–)

A. Defined as inability to become pregnant within 12 months of unprotected regular sexual activity – AFTER
B. Maybe caused by irregular or menstrual disorders
C. Caused by vaginal/pelvic infections
D. Maybe initiated by endometriosis

4. The best diagnostic procedure to detect breast cancer is:

A. Monthly self-breast exam – not a good diagnostic
B. Regular mammogram especially for women aged 40-50 years above
C. Mammotome biopsy – latest procedure; done if not cancerous
D. Breast ultrasound – partner of mammography

Breast Cancer is common in DENSE breasts (big breasts).

Cervical Cancer – most preventable; has vaccines → 2 doses; immunocompromised → 3 doses

5. These are characteristics of a woman with normal menstruation except which? (–)
A. Her ovaries generally alternate each month in release of egg
B. She can more or less predict her next period
C. It is expected that menstruation occurs from pubarche to 45 years in a woman – Menarche to Menopause
D. It can last from 2-7 days

Reproductive Process in a Woman:

1. Ovulation – occurs 14 days before menstruation
Normal ovulation – pain on the left lower abdomen
From Menarche to Menopause, ovulation may not be present.
Egg that is ovulating is as old as herself.
2. Menstruation – begins at menarche (12 years above); persist until woman is menopausal
Menopause – begin at 45 until 55
18 to 35 years – recommended
> 35 – elderly (tubal ligation is recommended if the woman has reached the # babies she want

Menstruation is caused by hormone:

Pituitary Gland → Hypothalamus → Gonadotropin releasing hormones
a. FSH (ovary) – stimulate 4 follicles to ripen eggs → Estrogen (first hormone)
b. LH (ovary) –
● Brain
● Ovary
● Uterus
 3. Fertilization – can be done artificially → test tube or petri dish
4. Implantation
5. Pregnancy

6. The most important and shortest diameter of the pelvis of the woman considered in assessment is:
A. Anatomical conjugate C. OB conjugate – 10 cm
B. Distance between the 2 ischial spines D. Diagonal conjugate – 1.5cm bigger than OB

5 Factors that can make/unmake the labor process:

Power
Passage
a. Soft passages (2) – cervical canal & vaginal canal
b. Major hard passage – pelvis (4 bones); cannot be torn
Pelvis – 2 innominate bone (ileum, ischium, pubis), 1 sacrum (backbone), 1 coccyx (movable)
Assess the pelvis (10cm) in relation to the head of the baby (9.5cm)

SOB – completely flexed head

SMB (submento) –
Passenger
Psyche
Position

7. A temporary structure of the fetal circulation that can create problems in the baby if it does not close at birth is:
A. Foramen ovale C. Ductus arteriosus
B. Ductus vanosus D. Hypogastric arteries

First Cry of the baby – good function of lungs

8. In which sequence – ORDER/PROGRESS would the structures/organs work to effect menstruation?

A. Pituitary ovary endometrium
B. Hypothalamus ovary uterus
C. Ovary endometrium hypothalamus
D. Hypothalamus pituitary ovary uterus

9. A major hormone of the woman that is responsible mainly for development of breast ducts, and initiates the release
of LH when it decreases in the blood?
A. Progesterone C. FSH
B. Estrogen D. Prolactin

10. Thrombus formation is an expected occurrence in pregnancy, which maternal change is responsible for this?
A. Expanded blood volume
B. Increase clotting factors
C. Effects of increase hormones
D. Encouraging rest in between periods during the day

11. The nurse is conducting mother’s class at the PNC. She answers a question regarding the significance of 24 weeks
AOG (6 months). Her answer is:
A. At this time, the fetus is most sensitive to teratogens – 1st trimester; Organogenesis
B. Fetal lung maturity is complete
C. The fetus weighs 2.5lbs and is about 14 inches
D. Survival is possible of the fetus is born now

12. What change in the urinary system predisposes a pregnant woman to UTI?
A. Decreased bladder capacity – UTI attracts organisms as the urine stays
B. Increased blood volume
C. Pressure on the bladder by an enlarging uterus – 1st & 3rd trimester
D. Stasis of the urine in the bladder and ureter due to hormones (Prigesterone)

Progesterone
relaxes the uterus
balances the contracting effect of Estrogen = relaxed
relaxes ureter = prone to stasis.

13. What assessment data would the nurse expect to obtain from a woman who is 14 weeks pregnant?
A. Counting the FHR with a fetoscope
B. Auscultation of the FHR with a doppler
C. Uterus just below the navel – at 14 weeks, 2 fingers above the symphysis pubis
D. Fetal movements as reported by the mother – fetal movements reported once the fetus is viable

14. Performing IE is a competency of the nurse assigned in the Labor room. What are the purposes of doing this?
✔
1. Determine of the BOW is intact
✔
2. To evaluate the capacity of the pelvis
✔
3. Determine the station of the presenting part — locating the ischial spine of the baby
4. To age the pregnancy and by estimating the size of the fetal head
A. 1, 2, 3 C. 1, 3 & 4
B. 2, 3, 4 D. 4 only

When to do Internal Examination (IE):

1. IE in normal labor
2. Cannot do in pregnancy
3. Normal labor if there is no previous bleeding history
4. IE when you are fully certified to do so, with certificate (NO IE in Gyne)

15. A nurse assesses the pregnant mother for signs of preeclampsia. This would be her expected complaints:
A. Vaginal bleeding with discomfort – severe
B. Persistent on severe abdominal pain – not a characteristics in preeclampsia
C. Flashing lights, spots before the eyes, continuous headache
D. Edema of feet and legs that occur in the afternoon

Preeclampsia: if severe → brain (stroke), eyes (blindness)

1. HTN
2. Generalized Edema
3. Proteinuria
Eclampsia: with seizure na; Proteinuria (+1, +2)
1. Check HR of mother
2. Emergency CS

16. Upon history, the mother tells the nurse that she has hypothyroidism or thyroid problem. The nurse knows that this
existing medical condition can lead to:
A. Increased risk of pre-eclampsia
B. Increased incidence of spontaneous abortion, congenital anomalies in the fetus
C. Increased risk for operative delivery
D. Maternal risk for cardiac decompensation and increased death rate
 CS – not recommended unless indicated.
CS Factors:
1. CPD (Cephalopelvic) – mother
2. Fetal distress (5-7 minutes extraction of the fetus to prevent hypoxia) – baby

17. Which statement by a woman would show that further teaching on fertility awareness is needed? (–)
A. “Egg live a lot shorter than sperms” (+)
B. “There will be a slight increase in temperature before ovulation up to menstrual flow”– AFTER
C. “Ovulation usually happens 14 days before my next period” (+)
D. “Wet, clean cervical secretions mean I am fertile” (+)

The minute woman becomes wet = Ovulation; Estrogen is high

18. What are the common laboratory tests done to a pregnant mother initially in her first visit?
1. Urine test for sugar and ketones
2. Blood test for CBC, Hgb, Hct count
3. RPR to test for sexually transmitted disease
4. Oral glucose test to determine DM – 2nd or 3rd trim
A. 1 & 2 C. 3 & 4
B. 2 & 3 D. 1 & 4

Nursing Responsibilities:
1. Getting the data/history (age, Naegel’s rule, current pregnancy, GTPAL, DM)
2. Physical examination (head to foot) – for fetus, Leopold’s Maneuver; vulva
3. Looking at the results of the lab (UTZ – not necessary in the first visit)
a. Blood Tests
CBC – Hgb level
Blood Type – during labor, needs to have 1 donor in the blood bank; if CS, deposit 3
bags of blood for replacement
Hep B
ELISA Test (routine for HIV mothers)
RPR test – specific; VDRL – more general
TB test
Sputum Test
b. Urine Tests
Bacteria
Proteinuria
Ketones
c. Oral Glucose Test (if diabetic)

19. In an MCN class, the teacher is explaining the interplay of hormones in the reproductive process. The luteal phase of
the ovarian cycle is synonymous with one – phase of the uterine cycle?
A. Ovulatory phase C. Secretory phase
B. Proliferative phase D. Menstrual phase

PP – synonymous with PF
LF – syn with SP

20. A woman on her 26 weeks AOG visits the PNC. She complains of weakness and lightheadedness when lying on the
examination table. What would be the primary nursing action?
A. Assess the woman’s BP C. Turn the woman on her side – LEFT SIDE
B. Ask the woman to take deep breaths D. Lower the head of the exam table

21. Discussing the reproductive processes in a woman, implantation in a regular cycle usually occurs on:
A. The first week of the cycle C. Third week of the cycle
B. Second week of the cycle D. Last week of the cycle

1 — 7: menstrual week
8 — 14: pre-ovulatory period; inc estrogen and progesterone
15 — 21: ovulation period
Implantation (7 to 10 days)
22 — 28:
 Blastomere → Morula → Blastocyst

22. As a safety protocol of the WHO the DOH has adopted the following measures discussed with the mother on her first
prenatal visit:
1. Prepare Birth Plan with emergency preparedness measures
2. Encourage all pregnant women to deliver in a Health Facility
3. The mother is given a choice as to her place of delivery – preferably in a health care setting with a skilled HCN
4. Discuss who will be her companion in labor, who will take care of her older kids at home, etc.
A. 1, 2, 3 C. 1, 2 & 4
B. 2, 3, & 4 D. 1 only

23. Adolescent pregnancy has been increasing as per report of the POPCOM. The initial responsibility in teaching the
pregnant adolescent is:
A. Informing her the benefits of BF
B. Advising her to watch for danger signs
C. Emphasizing the importance of consistent regular PNC (Prenatal Check-up) – 4 minimum visits; 8 visits
(monthly) for safer visits
D. Teaching her about Family Planning

24. Which important fetal milestone occurs generally on the 5th month of pregnancy?
A. Organogenesis is completed C. Fetal movements are felt by the mother
B. Fetal circulation is established D. FHR is heard thru DOPPLER

25. Which among these statements is /are true of the placenta?

1. It becomes functional as soon as the fertilization takes place
2. It protects the fetus from any trauma
3. It protects the fetus from bacterial organisms
4. It acts as the lungs of the fetus inside the uterus
A. 1 & 2 C. 1 & 3
B. 3 & 4 D. 2 & 4

5 passengers: (Problems with Dystoxia)

1. Fetus – macrosomic babies
2. Placenta – adherent placenta
3. Amniotic fluid – oligohydramnios
4. Membranes (Chorion & Amnion) – adherent membranes (chorion)
5. Cord – short cord → abruption; low cord →
Ideal cord – 50 cm

Parts of Placenta:
1. Cotyledon (mother)
2. Membranes w/ the cord attached to the baby

26. The nurse performs Leopold’s Maneuver on Ms. Tuazon. She notes the following findings: a soft, firm mass on the
fundus; several knots and protrusions on the left side of the mother; round movable mass above the pubic area. She
concludes that the position is:
A. LOA, longitudinal lie – best position C. ROA, longitudinal lie (Right Occipito Anterior)
B. LSA, transverse lie D. RSA, longitudinal lie

27. A primigravida, unsure of her LMP, is told by the community health provider that she appears to be about 7 months
pregnant. The nurse confirms this and explains to the mother that this is because the fundus is:
A. 18 cm, and the baby just started to move
B. 28 cm and the FHB can be assessed thru stethoscope
C. Just above the xyphoid and FHR are regular
D. Above the umbilicus, the FHR audible by stethoscope

Presentation (cephalic, vertex)

Presenting part (occiput, sacrum, scapula (acromion)
Lie (longitudinal, transverse)
Attitude (partially flex, completely flexed…)
Position (BEST = LOA)
Station (above ischial spine → (–); below ischial spine (+), ischial spine level (0)

28. When taking the heath history of the pregnant mother, the nurse recognizes that she would be at risk for developing
PIH if she is:
A. 34 – 35 years old
 B. Overweight, primigravida
C. Had six pregnancies
D. Has been on contraceptives within 3 months of conception

29. These conditions are expected to occur in teenage pregnancy:

1. Placenta previa – common in multigravida, repeated D&C; caused by denomination of blood supply to the
area of attachment
2. Cephalopelvic disposition ✔
3. Chromosomal abnormalities of the baby – common in elderly d/t elderly eggs
4. Preeclampsia ✔
A. 1 & 2 C. 2 & 4
B. 3 & 4 D. 1 & 4

30. Theoretically, the following hormones increase to initiate onset of labor except the secretion of which hormone?
A. Relaxin – relaxes the lumbosacral part C. Progesterone – relaxes the balances of the 3
B. Fetal corticosteroids D. Oxytocin

Situation: A 26-year-old primigravida is admitted in labor at 8AM. Fetal position: ROP, Cervical Dilatation: 6cm,
BOW (-) = ruptured.

31. With a BOW (–) = ruptured, what would the nurse instruct the mother?
A. She can eat anything for as long as it is a light diet
B. She must stay on bed, left side lying
C. She can move around anytime she pleases → mobility
D. She needs O2 inhalation, 3-5 liters/min to ensure the baby’s safety – dependent function

EINC
Mother – EIC (Essential Intrapartum Care)
1st Stage:
1. Woman can be moving around; mobile mother
2. Can be given in a light diet in the DR (sopas, noodles)
3. Mother is entitled to pain relief; initiate breathing techniques (relaxes the muscles); look for
doctor’s order (Meperidine, Nifedipine, Demerol, Nubain)
4. Use of partograph
5. Provides a companion during labor → provides emotional support
2nd stage: Longer – mas masakit
1. No fundal pressure – allow mother spontaneous pushing (reflex)
2. Assume most feasible position (Best: upright squatting position)
3. Episiotomy when indicated
3rd Stage:
1. Active management – shortens hour if the mother is on the 3rd stage
a. 1.As soon as baby is out; inject oxytocin to mother (hasten contraction)
b. 2.Expel placenta from uterus using controlled cord traction
c. 3.Massage uterus in a circular, gentle manner - shortens the hours the mother is in the
3rd stage
2. Expected
a. Wait for sign of placental expulsion
b. Expel placenta using CCT (Controlled Cord Traction → Oxytocin administration →
massage fundus if firm
Baby – ENC
1. Immediate thorough drying – to prevent hypothermia
2. Skin to skin – promotes bonding; to prevent infection
3. Properly-timed Cord Clamping – wait for pulsation of the cord to stop before cutting – prevent
intraventricular membranes of the brain t o prevent bleeding
4. Breastfeeding – non-separation of the newborn to the mother to facilitate breastfeeding

32. An ROP position would let the nurse inform the woman that:
A. She will have the urge to push until she is fully dilated
B. She can expect to have more back discomfort in labor and have possibly a longer second stage
C. The position of the baby’s head is occipital and will have a spontaneous birth
D. An operative delivery may be needed to deliver the baby

33. Midpelvic capacity (ISCHIAL SPINE) of the pelvis may be measured by:
A. Subtracting 1.5-2cm from the diagonal conjugate = OF Conjugate calculation
B. Clinical measurement of the side wall convergence
C. Clinical measurement of the ischial spines thru IE – N: 10cm above
D. Measurement of the sub pubic angle
34. In the second stage of labor (FULLY DILATED CERVIX), expulsion of the fetus from the birth canal depends on which
important factor?
A. Full dilatation of the cervix C. Uterine contraction
B. Maternal bearing down – voluntary D. Adequate pelvic capacity

Fundal Pressure ❌ contraindicated!

– Asphyxia or trauma to the baby
– Abruptio placenta to the mother or ruptured uterus

35. As the head descends and crowns, supporting the perineum will facilitate:
A. Flexion of the head C. Extension of the head
B. External rotation of the head D. Expulsion of the baby

Crowning of the head + Pag-ere ni mother = laceration 🙁

36. The Philippine policies mandating the safe and quality care on mothers and their newborn across all Birthing
Facilities in the country is embodied in which program?
A. Maternal and child care services
B. Basic Emergency Maternal and Newborn Care
C. Essential Intrapartum and Newborn Care
D. Maternal, Neonatal, child Health and Nutrition

37. Routine suctioning of the newborn was a norm because it was believed that it was necessary to stimulate him to
breathe. These are now the evidence of ill effects of suctioning:
1. Associated with mucosal trauma
2. Associated with risk for infection
3. Associated with apnea, bradycardia
4. It delays achieving normal oxygen saturation in the newborn
A. 1 & 2 C. 3 & 4
B. 2 & 3 D. 1, 2, 3, & 4

38. Postpartum bleeding is still one of the causes of maternal mortality .AMTSL has been promoted to effectively
intervene in preventing bleeding. These are the components of AMTSL EXCEPT: A. Administration of uterotonic
agents
B. Controlled traction to expel the cord
C. Uterine massage prior to placental expulsion to hasten separation of the placenta D.
Uterine massage after delivery of placenta to effect contraction

39. Bathing the newborn immediately after birth has been regarded as a harmful practice. The following are identified to
be the ill effects except which one?
A. It causes hypothermia which is life threatening
B. Washes away the vernix caseosa which have shown to have antimicrobial properties C.
Hinders the crawling reflex which is important in initiation of BF
D. Enhance immune substances in the skin that inhibit the growth of bacteria

40. Early breastfeeding must be a priority in any Birthing Facility to promote safe care of the Newborn. These are
factors that will promote this practice EXCEPT:
A. Implementation of the Mother Baby Friendly initiative
B. Avoidance of narcotic analgesia especially near the end of the first stage of labor C.
Placing healthy newborn on the mother’s chest/abdomen
D. Placing the baby on a crib beside the bed of the mother for safety purposes especially after birth

41. An episiotomy was done to the patient after delivery. An RMLE was performed. What would you tell the mother
about this technique?
A. That she will fell less pain the following day
B. That she will not lose so much blood from the wound
C. That this is done to avoid wound extension to the anus
D. That this was done because crowning is imminent

42. The practice of IV therapy to hydrate women in labor is commonly seen big Birth Facilities. These are the
evidence-based disadvantages:
1. IV line in place causes pain and stress on the mother
2. When a woman receives more than 25 gm of glucose thru IV in labor, results in excessive insulin fetal
production leading to hypoglycemia
3. IV therapy predisposes women to immobilization, risk of fluid overload
4. Studies show that IV therapy in labor prevents poor outcomes in mothers