Maternity & Child Practice Exam 6
After how many weeks after delivery should a woman have her postpartal check-up based on the protocol followed by the DOH? A 6 weeks B 2 weeks C 12 weeks D 3 weeks
6 weeks Rationale: According to the DOH protocol postpartum check-up is done 6-8 weeks after delivery to make sure complete involution of the reproductive organs has be achieved.
A woman who delivered normally per vagina is expected to void within ___ hours after delivery. A 12-24 hours B 4 hrs. C 3 hrs D 6-8 hrs
6-8 hrs Rationale: A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don't work, the nurse may decide to catheterize the woman.
The following are nursing measures to stimulate lactation EXCEPT A Frequent regular breast feeding B Application of cold compress on the breast C Breast pumping D Breast massage
Application of cold compress on the breast Rationale: To stimulate lactation, warm compress is applied on the breast. Cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.
Which of the following is an abnormal vital sign in postpartum? A Respiratory rate of 16-20/min B BP diastolic increase from 80 to 95mm Hg C BP systolic between 100-120mm Hg D Pulse rate between 50-60/min
BP diastolic increase from 80 to 95mm Hg Rationale: All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.
The normal respiration of a newborn immediately after birth is characterized as: A 30-50 breaths per minute, active use of abdominal and intercostal muscles B Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute C 30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing D 20-40 breaths per minute, abdominal breathing with active use of intercostals muscles
Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute Rationale: A newly born baby still is adjusting to xtra uterine life and the lungs are just beginning to function as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be brief lasting not more than 15 seconds otherwise it will be considered abnormal.
Lochia normally disappears after how many days postpartum? A 7-10 days B 5 days C 28-30 days D 18-21 days
7-10 days Rationale: Normally, lochia disappears after 10 days postpartum. What's important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier everyday.
Birth Control Methods and Infertility: In basal body temperature (BBT) technique, the sign that ovulation has occurred is an elevation of body temperature by A 0.2-0.4 degrees centigrade B 2.0-4.0 degrees centigrade C 1.0-4.0 degrees centigrade D 1.0-1.4 degrees centigrade
0.2-0.4 degrees centigrade Rationale: The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 - 0.4 degrees centigrade
Which of the following are signs of ovulation? Mittelschmerz; Spinnabarkeit; Thin watery cervical mucus; Elevated body temperature of 4.0 degrees centigrade A 1, 2, 3, 4 B 1 & 2 C 1, 2, & 3 D 3 & 4
1, 2, & 3 Rationale: Mittelschmerz, spinnabarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.
According to the Philippine Nursing Law, a registered nurse is allowed to handle mothers in labor and delivery with the following considerations: 1. The pregnancy is normal; 2. The labor and delivery is uncomplicated; 3. Suturing of perineal laceration is allowed provided the nurse had special training; 4. As a delivery room nurse she is not allowed to insert intravenous fluid unless she had special training for it. A 3 and 4 B 1 and 2 C 1, 2, and 3 D 1, 2, and 4
1, 2, and 3 Rationale: To be allowed to handle deliveries, the pregnancy must be normal and uncomplicated. And in RA9172, the nurse is now allowed to suture perineal lacerations provided s/he has had the special training. Also, in this law, there is no longer an explicit provision stating that the nurse still needs special training for IV insertion.
If a couple would like to enhance their fertility, the following means can be done: Monitor the basal body temperature of the woman everyday to determine peak period of fertility; Have adequate rest and nutrition; Have sexual contact only during the dry period of the woman; Undergo a complete medical check-up to rule out any debilitating disease A 1 only B 1 & 4 C 1,2,4 D 1,2,3,4
1,2,4 Rationale: All of the above are essential for enhanced fertility except no. 3 because during the dry period the woman is in her infertile period thus even when sexual contact is done, there will be no ovulation, thus fertilization is not possible.
At what APGAR score at 5 minutes after birth should resuscitation be initiated? A 6-7 B 1-3 C 7-8 D 9-10
1-3 Rationale: An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10.
In assisted reproductive technology (ART), there is a need to stimulate the ovaries to produce more than one mature ova. The drug commonly used for this purpose is: A Provera B Bromocriptine C Clomiphene D Esrogen
Clomiphene Rationale: Clomiphene or Clomid acts as an ovarian stimulant to promote ovulation. The mature ova are retrieved and fertilized outside the fallopian tube (in-vitro fertilization) and after 48 hours the fertilized ovum is inserted into the uterus for implantation.
The procedure done to prevent ophthalmia neonatorum is: A Marmet's technique B Ophthalmic wash C Crede's method D Ritgen's method
Crede's method Rationale: Crede's method/prophylaxis is the procedure done to prevent ophthalmia neonatorum which the baby can acquire as it passes through the birth canal of the mother. Usually, an ophthalmic ointment is used.
Which of the following is the correct practice of self breast examination in a menopausal woman? A Any day of the month as long it is regularly observed on the same day every month B Anytime she feels like doing it ideally every day C Menopausal women do not need regular self breast exam as long as they do it at least once every 6 months D She should do it at the usual time that she experiences her menstrual period in the past to ensure that her hormones are not at its peak
Any day of the month as long it is regularly observed on the same day every month Rationale: Menopausal women still need to do self examination of the breast regularly. Any day of the month is alright provided that she practices it monthly on the same day that she has chosen. The hormones estrogen and progesterone are already diminished during menopause so there is no need to consider the time to do it in relation to the menstrual cycle.
The nursing intervention to relieve pain in breast engorgement while the mother continues to breastfeed is A Apply cold compress on the engorged breast B Massage the breast C Apply warm compress on the engorged breast D Apply analgesic ointment
Apply warm compress on the engorged breast Rationale: Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold.
Postpartum Period: The fundus of the uterus is expected to go down normally postpartally about __ cm per day. A 1.0 cm B 3.0 cm C 2.0 cm D 2.5 cm
1.0 cm Rationale: The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery.
A woman is considered to be menopause if she has experienced cessation of her menses for a period of A 6 months B 12 months C 18 months D 24 months
12 months Rationale: If a woman has not had her menstrual period for 12 consecutive months, she is considered to be in her menopausal stage.
The minimum birth weight for full term babies to be considered normal is: A 2,000gms B 3,000gms C 1,500gms D 2,5000gms
2,500gms Rationale: According to the WHO standard, the minimum normal birth weight of a full term baby is 2,500 gms or 2.5 Kg.
The natural family planning method called Standard Days (SDM), is the latest type and easy to use method. However, it is a method applicable only to women with regular menstrual cycles between ___ to ___ days. A 28-30 days B 26-32 days C 21-26 days D 24- 36 days
26-32 days Rationale: Standard Days Method (SDM) requires that the menstrual cycles are regular between 26-32 days. There is no need to monitor temperature or mucus secretion. This natural method of family planning is very simple since all that the woman pays attention to is her cycle. With the aid of CycleBeads, the woman can easily monitor her cycles.
The anterior fontanelle is characterized as: A 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape B 2-3 cm antero-posterior diameter and 3-4 cm transverse diameter and diamond shape C 2-3 cm in both antero-posterior and transverse diameter and diamond shape D none of the above
3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape Rationale: The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the transverse diameter. The posterior fontanelle is triangular shape.
In a woman who is not breastfeeding, menstruation usually occurs after how many weeks? A 6 months B 6-8 weeks C 12 months D 2-4 weeks
6-8 weeks Rationale: When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Folicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a graafian follicle and the menstrual cycle post pregnancy resumes.
Right after birth, when the skin of the baby's trunk is pinkish but the soles of the feet and palm of the hands are bluish this is called: A Syndactyly B Cephalo-caudal cyanosis C Peripheral cyanosis D Acrocyanosis
Acrocyanosis Rationale: Acrocyanosis is the term used to describe the baby's skin color at birth when the soles and palms are bluish but the trunk is pinkish.
Postpartum blues is said to be normal provided that the following characteristics are present. These are Within 3-10 days only; Woman exhibits the following symptoms- episodic tearfulness, fatigue, oversensitivity, poor appetite; Maybe more severe symptoms in primpara A 1 and 2 B All of the above C 2 and 3 D 2 only
All of the above Rationale: All the symptoms 1-3 are characteristic of postpartal blues. It will resolve by itself because it is transient and is due to a number of reasons like changes in hormonal levels and adjustment to motherhood. If symptoms lasts more than 2 weeks, this could be a sign of abnormality like postpartum depression and needs treatment.
Which of the following characteristics will distinguish a postmature neonate at birth? A Plenty of lanugo and vernix caseosa B Almost leather-like, dry, cracked skin, negligible vernix caseosa C Lanugo mainly on the shoulders and vernix in the skin folds D Pinkish skin with good turgor
Almost leather-like, dry, cracked skin, negligible vernix caseosa Rationale: A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished.
To ensure adequate lactation the nurse should teach the mother to: A Feed primarily during the day and allow the baby to sleep through the night B Breast feed the baby on self-demand day and night C Breastfeed when the breast are engorged to ensure adequate supply D Feed the baby every 3-4 hours following a strict schedule
Breast feed the baby on self-demand day and night Rationale: Feeding on self-demand means the mother feeds the baby according to baby's need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation.
An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is: A Elevate the affected leg and keep the patient on bedrest B Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow C Encourage the mother to ambulate to relieve the pain in the leg D Apply warm compress on the affected leg to relieve the pain
Elevate the affected leg and keep the patient on bedrest Rationale: If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation.
The nurse should anticipate that hemorrhage related to uterine atony may occur postpartally if this condition was present during the delivery: A An episiotomy had to be done to facilitate delivery of the head B The labor and delivery lasted for 12 hours C Placental delivery occurred within thirty minutes after the baby was born D Excessive analgesia was given to the mother
Excessive analgesia was given to the mother Rationale: Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus.
To enhance milk production, a lactating mother must do the following interventions EXCEPT: A Increase fluid intake including milk B Eat foods that increases lactation which are called galactagues C Have adequate nutrition and rest D Exercise adequately like aerobics
Exercise adequately like aerobics Rationale: All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation.
The following are important considerations to teach the woman who is on low dose (mini-pill) oral contraceptive EXCEPT: A If the woman fails to take a pill in one day, she must take 2 pills for added protection B The pill must be taken everyday at the same time C If she is breast feeding, she should discontinue using mini-pill and use the progestin-only type D If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack
If the woman fails to take a pill in one day, she must take 2 pills for added protection Rationale: If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.
The following methods of artificial birth control works as a barrier device EXCEPT: A Intrauterine device (IUD) B Cervical Diaphragm C Cervical cap D Condom
Intrauterine device (IUD) Rationale: Intrauterine device prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube.
Which of the following is a TRUE statement about normal ovulation? A It occurs on the 14th day of every cycle B It may occur between 14-16 days before next menstruation C Every menstrual period is always preceded by ovulation D The most fertile period of a woman is 2 days after ovulation
It may occur between 14-16 days before next menstruation Rationale: Not all menstrual cycles are ovulatory. Normal ovulation in a woman occurs between the 14th to the 16th day before the NEXT menstruation. A common misconception is that ovulation occurs on the 14th day of the cycle. This is a misconception because ovulation is determined NOT from the first day of the cycle but rather 14-16 days BEFORE the next menstruation.
When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect A Laceration of soft tissues of the cervix and vagina B Uterine hypercontractility C Uterine inversion D Uterine atony
Laceration of soft tissues of the cervix and vagina Rationale: When uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.
The uterine fundus right after delivery of placenta is palpable at A Level of umbilicus B Midway between umbilicus and symphysis pubis C Level of Xyphoid process D Level of symphysis pubis
Level of umbilicus Rationale: Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) everyday until it becomes no longer palpable above the symphysis pubis.
The following are interventions to make the fundus contract postpartally EXCEPT A Apply ice cap on fundus B Give oxytocin as ordered C Massage the fundus vigorously for 15 minutes until contracted D Make the baby suck the breast regularly
Massage the fundus vigorously for 15 minutes until contracted Rationale: Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feel firm and contracted. If massaging is vigorous and prolonged, the uterus will relax due to over stimulation.
The ideal site for vitamin K injection in the newborn is: A Either right or left buttocks B Middle third of the thigh C Right upper arm D Left upper arm
Middle third of the thigh Rationale: Neonates do not have well developed muscles of the arm. Since Vitamin K is given intramuscular, the site must have sufficient muscles like the middle third of the thigh.
The following are nursing interventions to relieve episiotomy wound pain EXCEPT A Perineal care B Giving analgesic as ordered C Perineal heat D Sitz bath
Perineal care Rationale: Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not.
After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to: A Ensure that future pregnancies will not lead to maternal illness B To prevent the newborn from having problems of incompatibility when it breastfeeds C Prevent the recurrence of Rh(+) baby in future pregnancies D Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby
Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby Rationale: In Rh incompatibility, an Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen.
Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding? A Progesterone only B Mixed type- estrogen and progesterone C Estrogen only D 21-day pills mixed type
Progesterone only Rationale: If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation.
The lochia on the first few days after delivery is characterized as A Reddish with some mucus B Whitish with some mucus C Serous with some brown tinged mucus D Pinkish with some blood clots
Reddish with some mucus Rationale: Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue and mucus. Since it is not pure blood it is non-clotting.
Breast self examination is best done by the woman on herself every month during A During the menstrual period B Just before the menstrual period to determine if ovulation has occurred C Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen D The middle of her cycle to ensure that she is ovulating
Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen Rationale: The best time to do self breast examination is right after the menstrual period is over so that the hormonal level is low thus the breasts are not tender.
To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is A Postcoital test B None of the above C Rubin's test D Huhner's test
Rubin's test Rationale: Rubin's test is a test to determine patency of fallopian tubes. Huhner's test is also known as post-coital test to determine compatibility of the cervical mucus with sperms of the sexual partner.
Infertility can be attributed to male causes such as the following EXCEPT: A Sperm count of about 20 million per milliliter B Orchitis C Premature ejaculation D Cryptorchidism
Sperm count of about 20 million per milliliter Rationale: Sperm count must be within normal in order for a male to successfully sire a child. The normal sperm count is 20 million per milliliter of seminal fluid or 50 million per ejaculate.
Intra-uterine device prevents pregnancy by the ff. mechanism EXCEPT A Copper embedded in the IUD can kill the sperms B Sperms will be barred from entering the fallopian tubes C Fundus contracts to expel uterine contents D Endometrium inflames
Sperms will be barred from entering the fallopian tubes Rationale: An intrauterine device is a foreign body so that if it is inserted into the uterine cavity the initial reaction is to produce inflammatory process and the uterus will contract in order to try to expel the foreign body. Usually IUDs are coated with copper to serve as spermicide killing the sperms deposited into the female reproductive tract. But the IUD does not completely fill up the uterine cavity thus sperms which are microscopic is size can still pass through.
According to Rubin's theory of maternal role adaptation, the mother will go through 3 stages during the post partum period. These stages are: A Taking-hold, letting-go, attachment phase B Taking-in, taking-hold and letting-go C Attachment phase, adjustment phase, adaptation phase D Going through, adjustment period, adaptation period
Taking-in, taking-hold and letting-go Rationale: Rubin's theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role
In sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are: A Temperature, endometrial secretion, mucus B Temperature, cervical mucus, cervical consistency C Release of ovum, temperature and vagina D Temperature and wetness
Temperature, cervical mucus, cervical consistency Rationale: The 3 parameters measured/monitored which will indicate that the woman has ovulated are- temperature increase of about 0.2-0.4 degrees centigrade, softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel "wet".
The neonatal circulation differs from the fetal circulation because A The blood in left side of the fetal heart contains oxygenated blood while the blood in the right side contains unoxygenated blood. B The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage to the lungs C None of the above D The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.
The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood. Rationale: The fetal lungs is fluid-filled while in utero and is still not functioning. It only begins to function in extra uterine life. Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.
Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if A The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings B The mother breastfeeds regularly until 1 year with no supplemental feedings C The mother uses mixed feeding faithfully D The mother breast feeds mainly at night time when ovulation could possibly occur
The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings Rationale: A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby.
The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because: A His kidneys are immature leading to a high tolerance for glucose B The pancreas is immature and unable to secrete the needed insulin C The baby is reacting to the insulin given to the mother D There is rapid diminution of glucose level in the baby's circulating blood and his pancreas is normally secreting insulin
There is rapid diminution of glucose level in the baby's circulating blood and his pancreas is normally secreting insulin Rationale: If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.
Spinnabarkeit is an indicator of ovulation which is characterized as: A Thick mucus vaginal discharge influence by high level of estrogen B Thin mucus that is yellowish in color with fishy odor C Thin watery mucus which can be stretched into a long strand about 10 cm D Thick mucus that is detached from the cervix during ovulation
Thin watery mucus which can be stretched into a long strand about 10 cm Rationale: At the midpoint of the cycle when the estrogen level is high, the cervical mucus becomes thin and watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an ovum. This is called spinnabarkeit. And the woman feels "wet". When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel "dry".
Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is A Vas deferens B Prostate gland C Testes D Seminal vesicle
Vas deferens Rationale: Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.