OB PATHOLOGICAL EVALUATION EXAM II.

. Multiple Choice Choose the letter of the best answer A) A 32 years old G1P0 primigravida at 20 weeks AOG soon to be mother undergo prenatal check in the UST-OPD 1. The client ask the nurse about when the movement of fetus inside the womb quickening can be strongly felt by the mother. The nurse best response is A. It is usually felt at the beginning of 4th months of pregnancy when at first time B. It usually varies to the sense of mother C. Usually it can be felt at the beginning of 5th months of pregnancy at first time D. It is usually felt at 3rd months of pregnancy at first time 2. The nurse assess for the placental grading of the client and found out that the placenta is 20 weeks old. The nurse would document what score in placental grading A. 1 B. 0 C. 2 D. 3

3. The client ask the nurse about amniocentesis. The nurse best explains the procedure by explaining. A. This procedure is done by extracting sufficient amount of amniotic fluid for evaluation of fetal lung maturity and also to detect possible genetic disorders . Usually done at 14 20 weeks AOG B. This diagnosed blood disorders in the newborn and also for karyotyping procedure C. Genetic studies usually done at 8-10 weeks AOG to determine genetic make up of the fetus D. Screening procedure of NTD done between 18-20 weeks AOG 4. In MSAFP test , a low level of AFP is indicative of what genetic disorder A. Trisomy 21 B. Trisomy 18 C. Anoploidy D. Trisomy XXY

5. During the prenatal assessment the nurse found out all the information about the client. Which among the following information given by the client needs teaching about the pregnant condition. A. Everyday I usually exercise by walking not less than 15 minutes. B. Caffeinated drinks is being restricted to me because it may cause complication to my pregnancy C. I usually wear face mask everytime I go our in our house because steel factory is only in the other side D. During social affair I drink wine even just a little so that my social life will not be affected even that I am pregnant.

B) A G3P2 multigravida who gave birth twice was rush in UST hospital because of the bleeding episodes of her 18 weeks AOG 3rd pregnancy.

1. The characteristics of the bleeding is spotting and light bleeding which has no cervical dilatation. The nurse document the findings as what kind of abortion. A. Incomplete B. Threatened C. Missed D. Imminent

2. As a nurse you what drug would you probably see in the medication sheet to be ordered by the MD A. MgSO4 B. Calcium Gluconate C. Isoxsuprine D. Methergine

3. If some but not all the product of pregnancy was expelled with cervix dilated and bleeding continue the type of abortion occurred is A. Complete B. Missed C. Incomplete D. Recurrent Abortion

4. Recurrent abortion is primarily cause by what factor A. Infection B. DIC C. Incompetent Cervix D. Premature rupture of membrane

5. If the uterus decrease in size not normal for AOG and no FHT detected by Doppler. Means the kind of abortion occurred is what A. Stillbirth B. Imminent C. Recurrent D. Complete

C. A woman G0P1 was rush in UST hospital due to pelvic pain and HCG test is below as expected during pregnancy and also progesterone also is low as expected. 1. It is highly indicative by seeing the blood analysis of HCG. The nurse may think that the client have A. H-mole B. Chorioamnionitis C. Endometriosis D. Ectopic Pregnancy

2. The MD as the nurse where should the said problem commonly happen inside the reproductive tract A. Cervix B.Abdominal cavity C. Ampulla of the fallopian tube D. Ischmus

3. At early onset of the condition as a nurse you should see what medication in the medication sheet A. Methothrexate B. Zytotec C. Duvadilan D. MgSO4

4. Another client with 12 weeks AOG was rush in the hospital complaining of excessive vomiting a high level of HCG was documented after the blood test also the Doppler detected no FHT. The nurse should suspect what kind of disorder A. Hyperemesis gravidarum B. Hydatidiform mole C. IUFD D. Ectopic Pregnancy

5. Usually if the client have this kind of condition (referring to no.4). pregnancy should not occurred until A. 12-24 months B. 6 -9 months C. 3-6 months D. 9- 12 months

D). A G3P3 was rush in TMC complaining of bright red uterine bleeding and a soft uterus with bleeding stop spontaneously and was diagnosed with abruptio placenta . 1. Using critical thinking do you think that the diagnosis made was correct A. YES B. NO

2. By reviewing all the notes in your OB class. Abruptio placenta is characterized by I. Hard board like uterus II. Dark red vaginal bleeding III. Low uterus baseline tone IV. Fundal height is above normal range A. 1,2,3 B.1,2,4 C. 2,3,4 D. 1,2,3,4

3. The risk factor of having abruptio placenta are the following EXCEPT A. Smoking B. Cocaine use C. Primigravida D. Multiparity

4. What action done by the nurse may aggravate the client if she has rush in the hospital with Placenta Previa A. Internal Examination is done to detect fetal presentation of the baby inside ASAP B. The nurse assess the bleeding of the client every time when there is a spotting present C. The nurse instructed the client to have bed rest if there is no contraction present and no bleeding D. Pelvic examination is done under double set up if the client is in 37 weeks AOG above 5. What is the 3 classical signs of Abruptio placenta I. Vaginal bleeding which is dark red II. Sharp and stabbing uterine pain III. Hyperactivity of the uterus IV. High Fundal pressure A. 1,2,3 B.2,3,4 C.1,2,4 D.1,2,3,4

6. The primary complications of Abruptio and Placenta Previa are the following EXCEPT A. Hemorrhage B. Infection C. DIC D. Uterine rupture

E) During the 20th week AOG of Elizabeth is manifested by a BP of 145/95 and was rush to the hospital Elizabeth was diagnosed with Pregnancy Induced Hypertension and was admitted for monitoring of health being 1. As 24 hour monitoring of Elizabeth the health team found out that the urine specimen of Elizabeth contains +1 protein via dipstick. This finding is conclusive to what condition A. Mild Pre-eclampsia B. Severe Pre-eclampsia C. Eclampsia D. Chronic hypertension

2. As a nurse caring for Elizabeth all clinical finding would you assess in PARTICULAR in the condition of Elizabeth EXCEPT A. Proteinuria level B. Blood pressure C. Edema D. Level of consciousness

3. To prevent aggravation of the condition of Elizabeth which is convulsion the MD would suggest what kind of drug commonly and initially A. Methergine B. MgSO4 C. Phenobarbital D. Diazepam

4. As a nurse prior to administering the medication in (no.3) you should check primarily all EXCEPT A. Blood pressure B. Urine output C. DTR D. Respiratory rate

5. As safety measure of the medication in (no.3) what antidote should be on stand by when toxicity develop A. Protalamine sulfate B. Calcium Carbonate C. Mucomyst D. Calcium gluconate

6. In checking the blood pressure of Elizabeth the nurse should take note that A. Blood pressure is check at different arm to a conclusive findings and must be done twice B. BP checking is done twice at the same arm and same position at cuff at heart level C. Bp checking is done in the proximal part where the heart is located to have accurate findings D. BP can be check at the same arm but in different position of the client to facilitate comfort 7. If Chronic hypertension is present in the client and even lifestyle modification are done next is medication regimen. During pregnancy what is the safest known anti-hypertensive drug commonly prescribe A. Metopolol B. Enalapril C. Losartan D. Methyldopa

F) A pregnant woman is complaining of weight loss, heat intolerance, tachycardia and palpitations. He was admitted in UST hospital for further evaluation and monitoring . 1. As a nurse on duty what conclusive finding must you suspect in the condition of the pregnant woman A. Hypoparathyroidism B. Hyperthyroidism C. Hyperparathyroidism D. Hypothyroidism

2. What medical treatment would you believe to see in the medication sheet of the client A. Prophythiouracil B. Levothyroxine C. Strong Iodide solution D. Calcitriol

3. If however another client came and diagnosed with hypothyroidism what clinical manifestation would you evaluate I. Dry skin II. Cold tolerance III. Nervousness IV. Weight gain A.1,2,3 B.1,2,4 C.2,3,4 D.1,2,3,4

4. What medical regime should you believe to administered to a client with hypothyroidism A. Levothyroxine B. Methimazole C. Prophylthiouracil D. Calcitriol

5. What condition is usually associated with hyperthyroidism A. Thyroid cancer B. Wilsons Disease C. Graves disease D. Osteodystrophy

G) A pregnant woman was diagnosed of Gestational Diabetes Mellitus during her course of pregnancy and also she was test for OGTT and found out that her blood glucose level is high 1. As a laboratory exam OGTT, the health care team suggest a diagnosis of GDM in a pregnant woman if A. The blood glucose level of the ingestion 50g glucose after 1 hour is more than 140mg/dl B. If one of the level of blood glucose is high during the 3 hour fasting C. if two of the level of blood glucose is high during the 3 hour fasting D. Blood glucose level of pregnant woman is above 180 mg/dl after ingestion of 50 g glucose solution 2. All hormones contribute to the diabetogenic effect of pregnancy EXCEPT A. HPL B. Progesterone C. estrogen D. glucagon

3. Effects of diabetes to the pregnant woman include which of the following I. Hydramnios II. Infection III. Risk for pre-eclampsia and eclampsia A.1,2 B.2,3 C.1,2,3

4. The nurse should educate the pregnant client when the client state that A. I should exercise lightly for it increases my muscle contraction and thus increase glucose uptake B. I should take Oral hypoglycemic medication for it will help regulate my blood glucose level C. I should increase my uptake of insulin during my latter half of pregnancy D. I should eat equally distributed 3 meals and snacks for my nutritional requirements 5. The baby born with a mother with Diabetes Mellitus usually have a A. Macrosomia and Hypoglycemia B. Hyperglycemia C. SGA D. Febrile and Lethargic

H) Cardiovascular Disorder of Pregnancy 1. Usually characterized by mid systolic click on auscultation and pregnant woman having this condition may tolerate pregnancy while having mild symptoms A. Peripartum cardiomyopathy B. Aortic stenosis C. Mitral valve prolapsed D. PDA

2. The most common pre-existing cardiac condition in woman in child bearing age and in pregnancy A. ASD B. Eisenmenger syndrome C. VSD D. Rheumatic heart fever

3. Supine hypotension syndrome is common to woman during pregnancy as a nurse what is the best management in woman having hypotension syndrome. A. Allow the client to sit upright B. Allow the client to a side lying position C. Allow the client to stand and walk during the excarbation of the syndrome D. Allow prone position 4. If the woman is having no limitation on physical activity and uncompromised the woman is said to which classification of heart disease A. Class I B. Class II C. Class III D. Class IV

5. Left sided cardiac failure in pregnant woman is usually followed by A. Systemic failure B. Jugular vein distension C. Pulmonary edema D. Pressure in the upper extremity I) Hematologic disorders in pregnancy 1. Risk factor for having iron deficiency anemia to a woman at reproductive age are the following I. Diet low in iron A.1,2,3 II. Low socioeconomic income B.1,2,4 III. Heavy menstrual flow C.1,3,4 IV. Woman who gets pregnant less than 2 years before current pregnancy D. 1,2,3,4 2. As a nurse when you will instruct the client to take the iron supplement A. Take the supplement anytime you want C. Take the supplement before going to sleep B. Take supplement w/ meal with orange juice D. At morning prior to waking up

3. Iron deficiency anemia in pregnancy is associated with what kind of nutritional related disorder A. Pica B. Anorexia nervosa C. Binge eating disorder D. Crash diet

4. Carla is 4 months pregnant her as a nurse what amount do you think is the proper intake of folic acid in the diet of Carla to have a NTD free baby A. 400 ug B. 500ug C. 600ug D.120ug

5. Claire ask her nurse what is the normal anti-D antibody titer of a pregnant woman who does not have any isoimmunization . The nurse is correct if he replied A. 1:8 B. 1:16 C. 1:12 D. 0

6. The client ask the nurse about erythroblastosis fetalis. The nurse remembered his lesson by answering A. EF is a condition by which a Rh woman get pregnant with a Rh + child thus after birth the woman form anti-Rh antibody and when the second pregnancy occur with again a Rh + child. The mother antibody will destroy the RBC of the fetus B. . EF is a condition by which a Rh +woman get pregnant with a Rh - child thus after birth the woman form anti-Rh antibody and when the second pregnancy occur with again a Rh - child. The mother antibody will destroy the RBC of the fetus C. When a Rh + father having a daughter or son with a Rh blood resulting to inheritance of a Rh + blood of a father to a new member of the family if any . D. . EF is a condition by which a Rh woman get pregnant with a Rh + child thus after birth the woman form anti-Rh antibody and when the second pregnancy occur with again a Rh - child. The mother antibody will destroy the RBC of the fetus 7. Martha is having a shot of what solution in order to prevent formation of anti-Rh and isoimmunization A. Anti-Sensitization B. Rho-Gam C. Isoimmunitan D. Rh-vaccine

J) Post partum hemorrhage 1. All are categorized as early post partum hemorrhage EXCEPT A. Hematoma B. Uterine Atony C. Retained placenta D. Subinvolution

2. Signs of placental separation are the following I. Sudden gush of fluids II. Lenghtening of the cord III. Change in the shape of the uterus IV. Rise of the fundus A.1,2,3 B1,2,4 C. 2,3,4 D.1,2,3,4

3. When the nurse assess the uterus and it is bog and soft the initial intervention of the nurse is A. Administered methergine as ordered C. Massage the fundus B. Notify the physician D. Document the findings

4. Margie suffered before from placenta accreta. As Margie ask the nurse what is placenta acrreta, the nurse best response is A. Placental accreta is slight penetration of myometrium by placental trophoblast it is a kind of nonadherent retained placenta B. Placental accreta is slight penetration of myometrium by placental trophoblast it is a kind of adherent retained placenta C. Placenta accreta is deep penetration of myometrium by placental tropoblast it is a kind of adherent retained placental D.Placenta accrete is the perforation of the uterus by the placenta 5. Candice was complaining in the UST- Hospital during her post partum period of having severe vulvar pain, unilateral purplish discoloration of the perineum and a discolored bulging mass producing deep unrelieved pain with pressure. As a nurse you know that Candice is having what kind of post partum complication A. Vulvar hematoma K) Menstral disorders 1.) Anita a 48 year old female is having a hot flushes, irregular periods, insomnia and mood changes. Her physician notify her that she is at the peak of cessation of her menses. According to your knowledge Anita is having what kind of menstrual condition A. Perimenopause B.Premenopausal syndrome C. Menarche D. Metroharrgia B. Perineal trauma C. Arterial laceration D. Vaginal ischemia

2. Betbet is a primigravida and she is afraid because her menstruation cease. As a nurse you should explain betbet that A. It is a disease condition you should notify it to your physician it is a sign of impending pathology B. Dont worry cessation of menses during pregnancy is normal it is called physiologic amenorrhea C. The cessation of menses have something to do with the development of your baby you should notify your physician asap 3. Betty is having a scanty menstrual flow without relation to frequency. As a nurse you know that the condition of betty is A. Metroharrgia B. Hypomenorrhea C. Hypermenorrhea D. Polymennorhea

4. It is termed as reduction in the frequency of menstruation usually from 38 3 months A.Oligomenorrhea B. Polymenorrhea C. Dsymenorrhea D. Metroharrgia

5. Bleeding or spotting without obvious relation to menstrual cycle. A.Oligomenorrhea B. Polymenorrhea C. Dsymenorrhea D. Metroharrgia