ANGELES UNIVERSITY FOUNDATION ANGELES CITY

NAME; _______________ 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 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. 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 Answer: A Abnormalities of Menstruation : Amenorrhea absence of menstrual flow, Dysmenorrhea painful menstruation, Oligomenorrhea scanty menstruation, Menorrhagia -excessive menstrual bleeding, Metrorrhagia bleeding between periods of less than 2 weeks 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 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. as: a. b. c. d. An important landmark of the pelvis that determines the distance of the descent of the head is known Linea terminalis Sacrum Ischial spines Ischial tuberosities

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. a. b. c. d. The permanent cessation of menstruation is: Amenorrhea Menopause Oligomenorrhea Hypomenorrhea

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. Situation: Mrs. Donna, pregnant for 16 weeks age of gestation (AOG), visits the health care facility for her prenatal check-up 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. a. b. c. d. Based on the data obtained, Mrs. Donnas GTPAL score is: 20111 21111 30111 31111

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. 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 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. 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. d.

Fantasizes the appearance of the baby. Verbalizes fear of death during childbirth.

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 childs future is noted during the third trimester of pregnancy. It is during this time also that the woman verbalizes fear of death. 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 Answer: A. Mrs. Donnas 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. 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 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. Situation: Mrs. Dela Cruz is in labor and is brought to the emergency room with a ruptured bag of water. 11. a. b. c. d. The nurses initial action once the bag of water has ruptured is: Take the fetal heart tones Put the client to the bed immediately Perform an IE Take the womans temperature

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. Mrs. Dela Cruzs 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 clients cervical dilatation will be: a. 0-3 cm b. 4-7 cm c. 8-10 cm d. 11-13 cm

Answer: B. The nurse would expect that the clients 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. 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. 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. 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. 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. Monitoring contractions is very important during labor. To monitor uterine contractions, what should the nurse do? a. Observe for the clients 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. Answer: D. The nurse should spread his/her fingers lightly over the fundus to monitor the uterine contractions. 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 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

 17. a. b. c. d.

Estrogen and progesterone Prostaglandins Dysfunctional labor may be caused by which of the following? Excessive or too early analgesia administration Exhausted mother Overdistention of the uterus All of the above

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 cant 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. The clients 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 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. a. b. c. d. For a woman experiencing hypotonic contractions, what should be done initially? Obtain an ultrasonic result Infusion of oxytocin Administration of analgesia Amniotomy

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. a. b. c. d. The most important nursing consideration in a postpartal woman with a hypotonic contraction is: Assessment for infection Assessment for bleeding Assessment for FHR Assessment for womans coping mechanism

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.

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 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. a. b. c. d. In caring for a client diagnosed with placenta previa, the nurse should avoid which of the following? Inspecting the perineum Performing a Kleihauer-Betke test Performing a pelvic examination All of the above

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. 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 Answer: A. placenta previa presents bleeding without pain whilst the bleeding in abruptio placenta is painful. 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 Answer: D. Signs of fetal distress include: tachycardia, bradycardia, fetal thrashing and meconiumstained amniotic fluid. 25. A woman in labor is diagnosed with abruption placenta. The nurse would expect which findings in the clients 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 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