Situation: During an Anatomy and Physiology class, the lecturer discussed about the female reproductive system. 1.

Estrogen, one of the hormones regulating cyclic activities in female reproductive system is responsible for which effect? a. Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. b. Inhibits the production of LH c. Increases endometrial tortuosity d. All of the above 2. Jessa, 17 years old, is bleeding between periods of less than two weeks. This condition is an abnormality in the menstrual cycle known as: a. Metrorrhagia b. Menorrhagia c. Amenorrhea d. Dysmenorrheal 3. One factor of having a normal delivery is the size of the pelvis. Pelvis serves as the passageway for the passenger (fetus) during childbirth. The most ideal pelvis for childbirth is: a. Android b. Anthropoid c. Platypelloid d. Gynecoid 4. An important landmark of the pelvis that determines the distance of the descent of the head is known as: a. Linea terminalis b. Sacrum c. Ischial spines d. Ischial tuberosities

5. The permanent cessation of menstruation is: a. Amenorrhea b. Menopause c. Oligomenorrhea d. Hypomenorrhea Situation: Mrs. Donna, pregnant for 16 weeks age of gestation (AOG), visits the health care facility for her prenatal checkup with her only son, Mark. During assessment the client told the nurse that previously she got pregnant twice. The first was with her only child, Mark, who was delivered at 35 weeks AOG and the other pregnancy was terminated at about 20 weeks AOG. 6. Based on the data obtained, Mrs. Donna s GTPAL score is: a. 20111 b. 21111 c. 30111 d. 31111 7. Discomforts during pregnancy are discussed by the nurse to the Mrs. Donna. Which of the following, when complained by the client would alert the nurse? a. Easy fatigability b. Nausea and vomiting c. Edema of the lower extremities d. Heartburn 8. Psychological and emotional responses of pregnant women differ. However, general emotional response has been noted during pregnancy based on their gestational age. Mrs. Donna will most likely have which emotional response towards her pregnancy? a. Presents denial disbelief and sometimes repression.

b. Has personal identification of the baby and realistic plans for future of the child. c. Fantasizes the appearance of the baby. d. Verbalizes fear of death during childbirth. 9. The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heart rate (FHR). Which of the following apparatus should the nurse use in auscultating for the FHR? a. Doppler apparatus b. Fetoscope c. Ultrasound d. Stethoscope 10. Mrs. Donna asked the nurse, when a fetal heart starts beating. The nurse correctly responded by stating: a. 3 weeks AOG b. 8 weeks AOG c. 12 weeks AOG d. 20 weeks AOG Situation: Mrs. Dela Cruz is in labor and is brought to the emergency room with a ruptured bag of water. 11. The nurse s initial action once the bag of water has ruptured is: a. Take the fetal heart tones b. Put the client to the bed immediately c. Perform an IE d. Take the woman s temperature 12. Mrs. Dela Cruz s has contractions growing stronger which lasts for 40-60 seconds and occur approximately every 3-5 minutes. The doctor is about to perform an IE, the nurse expects that the client s cervical dilatation will be: a. 0-3 cm b. 4-7 cm c. 8-10 cm d. 11-13 cm

13. The doctor informed the woman that she is on station -1. Mrs. Dela Cruz asked the nurse, what does a station -1 means, the most appropriate response of the nurse is: a. It means that engagement has already occurred. b. The presenting part of your baby is at the entrance of the true pelvis or the largest diameter of the presenting part into the true pelvis. c. Your baby is still floating or ballotable d. The presenting part of your baby is at the vulvar ring of your reproductive organ. 14. The history of Mrs. Dela Cruz revealed that she is a multipara. When should the nurse transport the client from the labor room to the delivery room? a. When the cervical dilatation is 8 cm. b. When the cervical dilatation is 10 cm. c. When the cervical dilatation is 9 cm. d. When the client feels the urge to push. 15. Monitoring contractions is very important during labor. To monitor uterine contractions, what should the nurse do? a. Observe for the client s facial expression to know that the contraction has started or stopped. b. Instruct the client take note of the duration of her contractions. c. Offer ice chips to the woman. d. Spread the fingers lightly over the fundus to monitor the contraction. 16. Uterine contractions can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence some hormones. Which of the

following least likely contributes to the occurrence of uterine contractions? a. Oxytocin b. Estrogen c. Prolactin d. All of the above 17. Dysfunctional labor may be caused by which of the following? a. Excessive or too early analgesia administration b. Exhausted mother c. Overdistention of the uterus d. All of the above 18. The client s uterine contractions are hypotonic. The nurses top priority with hypotonic contractions during the intrapartal period is: a. Pain relief b. Psychological support c. Monitoring the lochia for possible bleeding d. Infection control 19. For a woman experiencing hypotonic contractions, what should be done initially? a. Obtain an ultrasonic result b. Infusion of oxytocin c. Administration of analgesia d. Amniotomy 20. The most important nursing consideration in a postpartal woman with a hypotonic contraction is: a. Assessment for infection b. Assessment for bleeding c. Assessment for FHR d. Assessment for woman s coping mechanism Situation: Bleeding during pregnancy is a serious case and should be managed immediately.

21. Mrs. Diane is diagnosed with Placenta Previa. The main difference with the bleeding in placenta previa and abruption placenta is that placenta previa has: a. Painful bleeding b. Rigid abdomen c. Bright-red blood d. Blood filled with clots 22. In caring for a client diagnosed with placenta previa, the nurse should avoid which of the following? a. Inspecting the perineum b. Performing a Kleihauer-Betke test c. Performing a pelvic examination d. All of the above 23. For the nurse to distinguish that the bleeding of the patient is placenta previa or abruption placenta what should she ask the woman? a. Whether there was accompanying pain b. What she has done for bleeding c. Estimation of blood loss d. All of the above 24. Continued bleeding may result to fetal distress. The nurse knows that the fetus is being compromised when she observed or note which of the following: a. Fetal tachycardia b. Fetal bradycardia c. Fetal thrashing d. All of the above 25. A woman in labor is diagnosed with abruption placenta. The nurse would expect which findings in the client s history that may contribute to the occurrence of the complication? a. Age of 24 years old b. Cigarette smoking c. Sleeping 8 hours per night d. Sitting for long period

1. Answer: A. Effects of estrogen: Inhibits the production of FSH Causes hypertrophy of the myometrium Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. Effects of Progesterone Inhibits the production of LH Increases endometrial tortuosity Increased endometrial secretions Facilitates transport of the fertilized ovum through the fallopian tubes 2. Answer: A Abnormalities of Menstruation 1. Amenorrhea absence of menstrual flow 2. Dysmenorrhea painful menstruation 3. Oligomenorrhea scanty menstruation 4. Menorrhagia -excessive menstrual bleeding 5. Metrorrhagia bleeding between periods of less than 2 weeks 3. Answer: D. Gynecoid is the normal female pelvis. The inlet is well rounded. This is the most ideal pelvis for childbirth. Android male pelvis. Inlet has a narrow, shallow posterior portion and pointed anterior portion. Anthropoid transverse diameter is narrow and anteroposterior (AP) diameter of this pelvis is larger than normal. Platypelloid inlet is oval while AP diameter of this pelvis is shallow. 4. Answer: C. Ischial spines are the point of reference in determining the station (relationship of the fetal presenting part to the ischial spines). When the fetal head is at the level of the

ischial spines the station is zero. When it is 1 cm above the ischial spines it is -1 and if 1 cm below the ischial spines it is +1. 5. Answer: B. The keyword here is permanent cessation . Thus, menopause is the correct answer. Amenorrhea is a temporary cessation of menses. Oligomenorrhea is a menstruation with scanty blood flow. Hypomenorrhea is an abnormally short duration of menstruation. 6. Answer: C. Gravida (G) number of pregnancy Term (T) number of full-term infants born (born at 37 weeks or after) Para (P) number of preterm infants born (born before 37 weeks) Abortion (A) number of spontaneous or induced abortions (pregnancy terminated before the age of viability). Age of viability is 24 weeks. Living children (L) number of living children. (Source: Maternal and Child Health Nursing by Adelle Pillitteri, 5th Ed. P.252) Since Mrs Donna has two previous pregnancies and is presently pregnant (16 weeks), G is 3. Mark, her only child was born at 35 weeks AOG which falls under the preterm category. Thus, T is zero and P is 1. The other pregnancy was terminated at 20 weeks AOG which falls under abortion, hence A=1. Mark is her only living child, thereby, L=1. Her GTPAL score is: 30111, G=3 T=0 P=1 A=1 L=1 7. Answer: B. Morning sickness characterized by nausea and vomiting is only noted during the FIRST TRIMESTER of pregnancy (first 3 months). Excessive nausea and vomiting which persists more than 3 months is a condition

called Hyperemesis gravidarum that requires immediate intervention to prevent starvation and dehydration. Management for hyperemesis gravidarum includes the administration of D5NSS 3L in 24 hours and complete bed rest. Easy fatigability is a consequence of the physiologic anemia of pregnancy (physiologic meaning it is normally expected during pregnancy, thus A is incorrect). Edema of the upper extremities not the lower extremities should alert the nurse because of the possibility of toxemia, hence C is incorrect. Heartburn during pregnancy is due to the increase progesterone which decreases gastric motility causing a reversed peristaltic wave leading to regurgitation of the stomach contents through the cardiac sphincter into the esophagus, causing irritation. 8. Answer: C. The client is in her second trimester of pregnancy (16 weeks AOG or 4 months), thus, she perceived the baby as a separate entity. Presenting denial and disbelief and sometime repression is the psychological/emotional response of a pregnant woman on her first trimester. Identifying the fetus and setting realistic plans for the child s future is noted during the third trimester of pregnancy. It is during this time also that the woman verbalizes fear of death. 9. Answer: A. Mrs. Donna s gestational age is 16 weeks (4 months). During this time, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat can be detected with a Doppler apparatus starting at 12 weeks AOG. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. A fetal heart beat is detectable with fetoscope by

the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed.) 10. Answer: A. Fetal heart starts beating at 3 weeks AOG. The heart at this time is consisting of two parallel tubes. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. During 12 weeks AOG, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed.) 11. Answer: B. The keyword is INITIAL ACTION. The important consideration before answering the question is to take a look at the situation. SITUATION: THE WOMAN IS IN THE Emergency Room or is seeking admission. A woman in labor seeking admission to the hospital (in the ER) and saying that her BOW has ruptured should BE PUT TO BED IMMEDIATELY and the fetal heart tones taken consequently. If a woman in the Labor Room says that her membranes have ruptured, the initial nursing action is to take the fetal heart tone. 12. Answer: B. The nurse would expect that the client s cervical dilatation is 4-7 cm as the contraction duration and interval is noted for clients who are in the active phase of the first stage of labor. The maximum cervical dilatation is 10 cm, thus, letter D should be eliminated first. The first stage of labor (stage of dilatation) is divided into three phases.

Latent phase 0-3 cm cervical dilatation; contractions are short and mild lasting 20-40 seconds and occurring approximately every 5-10 minutes. Active phase 4-7 cm cervical dilatation; contractions grow stronger, lasting 40-60 seconds and occur at approximately every 3-5 minutes. Transition phase 8-10 cm cervical dilatation; contractions reach their peak of intensity, occurring every 2-3 minutes with a duration of 60-90 seconds. 13. Answer: C. Station -1 means that the fetal presenting part is above the level of the ischial spines. Letter A is wrong because engagement is described as Station 0. Letter B is incorrect because the statement of nurse is describing the occurrence of engagement that is again station 0. Prior to engagement the fetus is said to be "floating" or ballottable, thus letter C is the best option. Letter D, is describing crowning which is described as Station +3 or +4. 14. Answer: A. Multiparas are transported to the DR when the cervical dilatation is 7-8 cm because in multiparas dilatation may proceed before effacement is completed. Effacement must occur at the end of dilatation, however, before the fetus can be safely pushed through the cervical canal; otherwise, cervical tearing could result. Primiparas are transported to the DR when the cervical dilatation is 9-10 cm. 15. Answer: D. The nurse should spread his/her fingers lightly over the fundus to monitor the uterine contractions. 16. Answer: C.

Prolactin is the hormone that produces milk in mammary glands. Uterine contractions can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence some hormones and major electrolytes which are the following: Calcium Sodium Potassium Specific contractile proteins (actin and myosin) Epinephrine and norepinephrine Oxytocin Estrogen and progesterone Prostaglandins 17. Answer: D. Dysfunctional Labor is caused by the ff: Inappropriate use of analgesia Pelvic bone contraction that has narrowed the pelvic diameter so that a client can t pass (e.g. in a client with rickets) Poor fetal position Extension rather then extension of the fetal head Overdistention of the uterus Cervical rigidity Presence of a full rectum or bladder Mother becoming exhausted from labor Primigravid status 18. Answer: D. When the contractions are hypotonic, the length of labor is increased. When the cervix is dilated for a long period of time, both the uterus and fetus are at greater risk of infection. Hypotonic contractions are not exceedingly painful because of their lack of intensity. Monitoring of bleeding through evaluation of lochia is done during the postpartum period not the intrapartum period. 19. Answer: A.

Initially, the nurse should obtain an ultrasonic confirmation ruling out a CPD or cephalopelvic disproportion. Thus, A is the best answer. Oxytocin is infused after the CPD is ruled out, because if CPD is present CS will be done. Analgesic administration will further decrease the intensity of uterine contractions as its inappropriate use is one of the reasons why hypotonic contractions occur. Amniotomy (artificial rupture of membrane) may be done after oxytocin is infused to speed up the labor. 20. Answer: B. During the postpartum period, the uterus should be palpated and lochia should be assessed because contractions after birth may also be hypotonic that will result to bleeding. 21. Answer: C. In placenta previa the bleeding that occurs is abrupt, painless, bright-red and sudden to frighten a woman. With abruption placenta, the bleeding is painful, the abdomen is rigid or board-like and the blood is dark-red or filled with clots. 22. Answer: C. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is placenta previa may initiate massive hemorrhage, possibly fatal to both the mother and the fetus. The perineum should be assessed or observed or inspected for bleeding by looking over the perenial pads. An Apt or Kleihauer-Betke test (test strip procedures) can be used to detect whether the blood is of fetal or maternal origin.

Placenta previa presents bleeding without pain whilst the bleeding in abruptio placenta is painful. 24. Answer: D. Signs of fetal distress include: tachycardia, bradycardia, fetal thrashing and meconiumstained amniotic fluid. 25. Answer: B. Predisposing factors for abruptio placenta: Advanced maternal age Short-umbilical cord Chronic hypertensive disease PIH Direct trauma Vasoconstriction from cocaine or cigarette use

23. Answer: A.