Gynecology
Content
NCLEX Review: Maternity Nursing
Outline: Maternity of Nursing
1. Fetal development
2. Fetal vs. Neonatal Circulation
3. Common Complications of Pregnancy
4. Components of the Birth Process
5. Process of Childbirth
6. Obstetric procedures
7. Emergencies
8. Self-care and recovery
9. Postpartum assessment
10. Handicaps of preterm newborn
11. Postterm Newborn
12. Normal Newborn
NCLEX Questions on Gynecology, Obstetrics
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 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. 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.
a.
b.
c.
d.
The nurse’s 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 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.
a.
b.
c.
d.
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
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.
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
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
NCLEX Questions on Gynecology, Obstetrics Answers and
Rationale
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
correctanswer. 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 duringthe
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/Saunders4th 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.
23. Answer: A. 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
meconium-stained 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
Outline: Maternity of Nursing
1. Fetal development
2. Fetal vs. Neonatal Circulation
3. Common Complications of Pregnancy
4. Components of the Birth Process
5. Process of Childbirth
6. Obstetric procedures
7. Emergencies
8. Self-care and recovery
9. Postpartum assessment
10. Handicaps of preterm newborn
11. Postterm Newborn
12. Normal Newborn
NCLEX Questions on Gynecology, Obstetrics
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 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. 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.
a.
b.
c.
d.
The nurse’s 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 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.
a.
b.
c.
d.
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
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.
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
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
NCLEX Questions on Gynecology, Obstetrics Answers and
Rationale
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
correctanswer. 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 duringthe
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/Saunders4th 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.
23. Answer: A. 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
meconium-stained 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
