DELA SALLE HEALTH SCIENCES CAMPUS COLLEGE OF NURSING AND MIDWIFERY Dasmarinas, Cavite MIDTERM EXAM in OBSTETRICS (N102)

GENERAL INSTRUCTIONS: 1. Use the answer sheet for your answer 2. Choose the BEST answer by shading the chosen answer 3. Do not make any unnecessary marks on your answer sheet and questionnaire 4. Use only BLUE or BLACK pen 5. NO ERASURES ALLOWED

1. The softening of the cervical isthmus that occurs early in gestation is called: a. Cullens sign c. Hegars sign b. Chadwicks sign d. Goodels sign 2. The remnants of the hymen after the puerperium are converted to: a. caruncula myrtiformes c. bartholins cyst b. urethral caruncles d. lutein cysts 3. The correct chronological sequence of the following developmental stages: a. zygote, morulla, blastomere, blastocyst b. zygote, blastomere, blastocyst, morula c. zygote, blastocyst, blastomere, morula d. zygote, blastomere, morulla, blastocyst 4. If we are using palpation of the fundus in order to estimate the AOG, this is: a. Naegales Rule c. McDonalds Rule b. Johnsons Rule d. Bartholomews Rule 5. The average blood loss after a vaginal delivery is approximately: a. 300 cc. b. 600 cc c. 700 cc d. 1000 cc 6. The embryonic germ cell from which the epithelium of the liver, lungs, pancreas, and bladder developed is: a. ectoderm b. mesoderm c. endoderm d. epiderm 7. Just after delivery, the weight of the uterus is: a. 500 gms b. 1000 gms c. 1500 gms d. 300 gms

8. Second maneuver is done to determine: a. what lies in the fundus c. if it is engaged or not b. the fetal back of the baby d. cephalic prominence 9. List in order from early postpartum, the stages of lochia: a. lochia rubra, lochia alba, lochia serosa b. lochia rubra, lochia serosa, lochia alba c. lochia serosa, lochia alba, lochia rubra d. lochia alba, lochia serosa, lochia rubra 10. The origin of the syncytiotrophoblast is the: a. inner cell mass c. zona pellucida b. cytotrophoblast d. deciduas capsularis

11. In evaluating a mothers adaptation to motherhood, which of the following behaviors would you expect to see in the taking in phase? a. anxiety because the baby is not nursing well b. eager to return the bath demonstration you gave her yesterday c. upset because her lunch is late d. confident in her ability to nurse the baby without difficulty 12. Client A, 22 y/o, primi, visit health center for prenatal check-up. Her LMP was July 22,2005. You would expect her date of delivery on: a. May 5,2006 b. April 29,2006 c. April 15,2006 d. May 14,2006

13. She asked how much weight is safe for her to gain during pregnancy. Your best response would be: a. a maximum weight gain of 15 lbs b. A weight gain of about 12 lbs each trimester c. As long as the client does not feel hungry, the actual amount of wt gain has little significance d. A range of about 20-25 lbs 14. At the end of the puerperium, the uterus weighs: a. 700 gms b. 500 gms c. 300 gms d. 200 gms 15. Cigarette smoking during pregnancy is associated with an increased risk in: a. delayed growth c. congenital defects b. fetal lung immaturity d. impaired fetal neurologic development 16. Which of the following is the considered the first sign of pregnancy? a. morning sickness c. amenorrhea b. breast changes d. dizziness 17. When timing uterine contractions, the nurse should place her hand on the fundal portion of the uterus for which of the following reasons? a. It causes less discomfort to the patient. b. It is the contractile portion and contracts more strongly. c. The lower uterine portion contracts more slightly and cannot be appreciated well. d. It is the most prominent portion during contractions. 18. Engagement of the fetal head means that: a. There is crowning of the head. b. The head has molded. c. The head is already at the (+) 1 station d. The largest diameter has entered the inlet of the pelvis. 19. Effacement means: a. Elongation of the cervical canal. b. Obliteration of the cervical canal. c. Dilatation of the cervical canal. d. Thinning of the cervix 20. The suture between the frontal and parietal bone. a. coronal c. sagittal b. lambdoidal d. Midsagittal

21. Refers to the descent of the uterus that result from the sinking of the fetal head to the pelvic inlet. a. Lightening c. Engagement b. Floating d. Stationing 22. Lightening occurs: a. 2-3 weeks before EDC b. 1 week after EDC 23. Characteristics of the female pelvis: a. pelvic brim nearly round b. pelvic outlet wide 24. Biparietal diameter is: a. 11.5 cm b. 9.5 cm. 25. Suboccipitobregmatic diameter is: a. 8.5 cm. b. 11.5 cm. c. 3-4 weeks before EDC d. 5 weeks before EDC c. pelvic brim nearly oval d. pelvic outlet flat c. 13.5 cm. d. 8.5 cm. c. 9.5 cm. d. 13.5 cm.

26. Part of the presentation that determine the position of the fetus: a. lie c. denominator b. attitude d. station 27. The peak of uterine contraction is called as: a. increment c. acme b. decrement d. none of the above SITUATION #3 Mrs. Ledesma, 36 years old is on her sixth pregnancy, she had two deliveries at 38 weeks gestation, one delivery at 12 th week gestation, one delivery at 32 weeks gestation and one stillbirth at 38 weeks gestation. (for nos 4352) 28. Mrs. Ledesmas obstetric history is; a. G6 T3 P1 A0 L 4 b. G6 T4 P1 A0 L 5 c. G6 T3 P1 A1 L3 d. G6 T2 P2 A0 L3

29. As Mrs. Ledesma is lying supine on the examining table, she tells the nurse that she is becoming dizzy. The nurse observes that she is pale and perspiring freely. The first action the nurse should do in this situation is to; a. turn the patient into either side b. obtain the patients blood pressure c. lower the patients head below the level of her feet d. place the patient in dorsal recumbent 30. At what gestational age will the fetal heart rate be heard using a stethoscope? a. at approximately 6 weeks c. at approximately 18 weeks b. at approximately 12 weeks d. at approximately 24 weeks 31. A pregnant mother needs to take supplemental iron. The absorption of iron can be increased by taking it; a. at bedtime c. with good source of Vit. C b. between meals d. at the same time everyday

32. Mrs. Ledesma tells the nurse, I hope I dont get varicose veins during pregnancy, what causes them?. The nurse explains that varicose veins are usually due to; a. decrease in normal cardiac output b. increase in maternal blood volume c. interference with venous return from extremities d. constriction in the blood vessel walls in the extremities 32. The nurse determines correctly that Mrs. Ledesma is including foods rich in folic acid in her meal planning when she eats at least two servings of; a. fresh fruits c. whole wheat bread b. dairy products d. green leafy vegetables 33. In relation to relieving constipation it is best to advise Mrs. Ledesma to; a. use glycerine suppository as necessary b. increase fiber and roughage in the diet c. eat foods that contain minimum seasonings d. use a milk of magnesia as necessary 34. Mrs. Ledesma complains of leg cramps, the exercise that helps most to relieve cramps is; a. walking early in the morning b. alternately flex and extend the legs c. push upward on the toes and downward on the knees d. lie flat in bed with the legs extended and elevated 35. Which of the following changes do you expect Mrs Ledesma to notice in her breasts? a. Darkening of the areola, tingling sensations and engorgement b. Lightening of the areola, colostrums secretion and increased size c. Colostrum secretion, tingling sensations and darkening of the areola d. Increased size, engorgement and flattening of the nipple 36. Pregnancy affects major systems in the body such as the respiratory, urinary, endocrine, integumentary, etc. Changes in the digestive system include; a. Traces of sugar in the urine c. Presence of striae gravidarum b. Increased plasma level d. Increased appetite after the 1 st trimester 37. Which female hormone is said to hold the pregnancy? a. estrogen c. progesterone b. luteinizing hormone d. human gonadotropic hormone SITUATION: Mrs. Jasmine Fontanilla is admitted in the labor room because of labor pain. As a nurse on duty, you examined her and revealed upon the internal exam, that the anterior fontanel is palpated at the RLQ of the mother, almost fully; bi parietal diameter is below 2 cm in the ischial spine. (-) BOW, 90% effaced and cephalic presentation with 3 previous pregnancies, 1 abortion. 38. The fetal position is most probably: A. LOP B. ROP C. ROA D. LOA

39. Basrd on the findings, the degree of engagement is: A. station -2 C. station 0 B. station+2 D. Station +1

40. Dilatation revealed as: A. 5-6 cm B. 7-8 cm 41. Fetal lie would be: A. vertical B. extended

C. 9-10cm C. horizontal

D.10cm D. 10 cm

42. The greatest transverse diameter of the fetal head A. biparietal diameter C. mento-occipital B. biparietal diameter D. bi ischial diameter 43. As labor progresses, the interval of uterine contraction would be: A. decreased B. increased C. remain D. no change 44. As labor progresses, the intensity of uterine contraction would be: A. decreased B. increased C. remain D. no change 45. As labor progresses, the duration of uterine contraction would be: A. decreased B. increased C. remain D. no change 46. Which ligament when damaged can cause uterine prolapse? A. uterosacral ligament B. round ligament C. broad ligament D. cardinal ligament 47. The obstetrical conjugate is measured by subtracting___ from the diagonal conjugate: A. 2.5 - 3cm B. 0.5 - 1cm C. 3.5 - 4cm D. 1.5 - 2cm 48. Second maneuver is done to determine A. what lies in the fundus B. the fetal back of the baby C. it is engaged or not D. cephalic prominence 49. Factors concerning labor that forces the fetus through the birth canal: A. power B. passage C. passenger D. maternal position 50. When the cervix becomes thin as the adjacent uterine segment, it is said to be: A. 50% effaced C. 85%effaced B. 75 % effaced D. 100%effaced 51. There is a reason to suspect mid pelvic contraction when interspinous diameter is less than: A. 10.5 cm B. 12 cm C. 10 cm D. 11.5 cm 52. A pregnant mother needs to take supplemental iron. The absorption of iron can be increased by taking it A. at bedtime B. every morning after breakfast C. with good source of Vit. C D. at the same time everyday SITUATION # 4 Mrs. Dales is a mother of 5 year old son, she had one stillbirth at 38 weeks gestation. Her last menstrual period of 5 days began on May 18. Her

first prenatal visit was on July 22, her first pregnancy was normal on all aspects; (FOR NOS. 54-65) 54. Mrs. Dales would be classified as; A. Gravida 3 Para 2 B. Gravida 2 para 1 C. Gravida 1 Para 1 D. Gravida 2 Para 2

55. The estimated date of confinement would be; A. February 25 C. January 25 B. March 25 D. April 25 56. Mrs. Dales is curious to know when the fetal heart begins to function, the nurse tells her it is usually; A. by the 3rd or 4th week of intrauterine life B. within 6 weeks after implantation C. by the 1st trimester D. by the time the placenta is formed 57. During this pregnancy, Mrs. Dales is experiencing some leg cramps. Your nursing intervention would include; A. advising warm compress BID B. instructing her to elevate her legs at least 15 minutes 3x daily C. informing her of the cause ( excessive phosphorus ) and encouraging her to drink milk D. advising her to use iodized salt 58. For relief of her low back pains, you might suggest; A. sitz bath C. pelvic rocking or pelvic tilting exercises B. heating pads to her back D. visits to PT rehab 59. Upon looking at Mrs. Dales chart you see that her hemoglobin is 9, what does this mean? A. patient is anemic and needs treatment stat B. this is probably resulting from increased blood volume of pregnancy C. this must be her baseline D. she should be given Z track iron Dextran 60. Estriol testing is a urine test taken at certain interval to determine; A. fetal age C. uterine nomenclature B. lung surfactant of the fetus D. placental functioning 61. After the 1st three months of pregnancy, the chief source of estrogen and progesterone is the; A. pituitary gland C. corpus luteum B. placenta D. ovary 62. Physiologic anemia during pregnancy is a result of; A. increased blood volume of the mother B. decreased intake of iron rich foods C. decreased erythropoiesis after the first trimester D. increased detoxification demands on the mothers liver 63. During pregnancy a polypeptide hormone that stimulates the melanocyte hormone is responsible for; A. morning sickness C. linea nigra and chloasma B. urinary frequency D. softening of the cervix

64. Mrs. Dales asks the nurse if she can continue to have sexual relations, the nurses response is based on the knowledge that coitus during pregnancy would be contraindicated only in the presence of; A. leukorrhea C. gestation of less than 20 weeks B. premature rupture of membranes D. increased FHB 65. In todays psychosocial climate, which would be an important item to be included in the initial interview of pregnant mother? A. economic and ethnic status C. abuse of drugs or alcohol B. family and genetic history D. educational status SITUATION # 5 Elizabeth Taylor, 29 years old is pregnant for the first time, She has enrolled in childbirth education class and is eager to learn about pregnancy; (For nos. 66-70) 66. Elizabeth wants to know what substance in her urine showed she was positive for pregnancy. The correct response is; A. estrogen C. relaxin B. progesterone D. chorionic gonadotropin 67. She is also curious about the function of umbilical cord. Your best answer would be; A. the cord is the staff of life and is surrounded by Whartons jelly B. it contains two veins and one artery that carry the vital life sustaining products to the fetus C. the umbilical cord contains the umbilical vein which supplies oxygen and nutrients to the fetus and two arteries which carry away the waste products D. the oxygen flows from the umbilical vein to the liver through the ductus venosus, then the arteries go through the ductus arteriosus into the aorta and back to the umbilical arteries 68. Which of the following symptoms would be considered normal in the first trimester of pregnancy? A. vaginal bleeding and 1+ albuminuria B. oliguria and glycosuria C. glycosuria of +1 and urinary frequency D. swelling of the face and increased vaginal discharge 69. Which of the following signs do you expect to assess in a woman during the 10th week of gestation? A. quickening C. dependent edema B. dyspnea D. breast tenderness 70. Which of the following is a probable sign of pregnancy; A. amenorrhea C. enlarged and tender breasts B. positive pregnancy test D. frequent micturition 71. The nurse should instruct pregnant woman to notify the physician immediately if which of the following symptoms occur during the pregnancy; A. dizziness C. increased vaginal discharge B. swelling of extremities D. edema of the face 72. Prenatal care is considered the primary deterrent to complications during pregnancy. Which complications would you consider as most affected by good prenatal care? A. placenta previa C. pregnancy induced hypertension B. hyperemesis gravidarum D. abortion

73. The client asks the nurse how smoking will affect the baby, the nurses best response would be; A. fetal and maternal circulation are separated by the placental barrier B. the placenta is permeable to specific substances C. smoking relieves tension and fetus responds accordingly D. vasoconstriction will affect both fetal and maternal blood vessels 74. A client experienced severe nausea and vomiting because of; A. slowed secretions of free hydrochloric acid B. high level of chorionic gonadotropin C. poor digestion of fats D. excessive amniotic fluid 75. Second step in leopolds maneuver is done to determine; A. what lies in the fundus B. the fetal back of the baby C. if tresenting part is engaged D. cephalic prominence 76. The communicable disease most likely to affect pregnancy with harmful effect to the fetus is; A. chickenpox C. varicella B. rubella D. rubeola 77. If a pregnant woman LMP is December 30, 2004 and she consulted the clinic last July 14, 2005 What will be her AOG? A. 28 weeks C. 28 weeks and 2 days B. 28 weeks and 1 day D. 27 weeks and 6 days 78. Method of placental separation wherein the periphery of the placenta separates first is: A. Schultze C. Duncan B. Calkins D Cullens 79. The nurse knows a woman has begun the transitional phase of labor when she: A. complains of pains at the back B. states the pain has lessened C. assumes the lithotomy position D. perspires & her face flushes 80. When positioning a woman on DR table, both legs should be placed in stirrups at the same time to prevent: A. excessive pull on the fetus C. venous stasis on the legs B. trauma to uterine ligaments D. pressure on perineum 81. One hour following delivery the nurse finds that the patients uterus has become boggy. The initial response would be: A. check the BP C. notify the physician B. massage it until firm D. observe the amount of bleeding 82. The most effective position for the nurse to place the woman in labor when she noted for a prolapse cord is: A. Fowlers C. Sims B. Trendelenburg D. Lithotomy

83. The most effective method of determining if there is CPD for the woman in labor is by: A. Pelvimetry C. Amniocentesis B. Duration of labor D. none of the above 84. A medication given to a woman in labor that might cause respiratory depression of the newborn. A. Meperidine (Demerol) C. Scopolamine B. Promazine D. Promethazine (Phenergan) 85. The fetus is most likely to be damaged by the pregnant womans ingestion of drugs during: A. 1st trimester C. 2nd trimester rd B. 3 trimester D. entire pregnancy 86. In the care for an antepartum client, the nurse knows that the onset of labor is confirmed by: A. rupture of membrane C. blood-tinged vaginal discharge B. progressive cervical changes D. fetal engagement 87. A client is admitted to the labor unit in early labor. Once the admission process is completed, the nurse knows that this time is best used for: A. Teaching baby care to parents. B. Teaching the mother relaxation techniques. C. Quiet time for the parents together. D. Teaching the parents the stages of labor. 88. The nurse is caring for a client in labor. An epidural block is administered during the intrapartum period for pain relief. The nurse must be alert for the complications of: A. severe headache C. hypotension B. pulmonary edema D. nausea & vomiting 89. You are caring for a client in the 1st hour following delivery. You are having difficulty taking her BP because she is shaking uncontrollably. What nursing intervention is indicated at this time? A. Give the client a warm blanket. B. Take the clients temperature immediately. C. Call the charge nurse immediately to come in to assess the client. D. Check to be sure there is a padded tongue blade readily available. 90. The nurse is caring for a client admitted to the labor unit w/ PROM @ 30 weeks gestation. Which of the following nursing actions should receive priority in the clients care. A. Frequent assessment for vaginal bleeding. B. Assessment of BP q 2. C. Continuous FHR monitoring. D. Careful assessment for signs of infection 91. As you are going home riding in a van, a man flags down the car. He wanted help from the driver since his wife in active labor and said the baby is coming. Which nursing action receives the Lowest Priority? A. Maintain a calm atmosphere. B. Tie off or cut the umbilical cord. C. Hold the baby up by the feet & rub the back after delivery. D. Dry the newborn off.

92. The nurse is to administer methylergonovine (Methergin) to a postpartum client. Which nurses assessment would have priority before admininstering the drug? A. Fundus C. BP B. Apical pulse D. RR 93. In assessing a postpartum client, the nurse knows which of the following findings indicates that the methylergonovine (Methergin) is effective? A. Firm fundus C. A rise in BP B. An increase in lochia D. absence of breast discomfort 94. An oxytoxic drugs are administered after the delivery of the placenta in order to: A. relax the patient C. prevent infection B. prevent postpartum complication D. prevent postpartum bleeding 95. What is the demarcation line b/w the true pelvis & false pelvis? A. pelvic outlet C. pelvic brim B. pelvic cavity D. pelvic inlet 96. Fetal circulation is established: A. during the 1st lunar month B. during the 2nd lunar month C. at conception D. during the 3rd lunar month

97. During intrauterine life, the fetal hypogastric arteries carry blood to: A. umbilical arteries C. placenta B. maternal inferior vena cava D. umbilical vein 98. Blood circulation in the fetal period differs significantly from extrauterine life, blood is shunted from the RA through: A. ductus arteriosus C. ductus venosus B. foramen ovale D. tricuspid valve 99. Which of the following is the function of the umbilical arteries? A. carries oxygenated blood to the placenta B. carries unoxygenated blood to the fetus C. carries oxygenated blood to the fetus D. carries unoxygenated blood to the placenta 100. Formation of the buds of the permanent teeth of the fetus occur at what month? A. 4th week C. 5th month th B. 4 month D. 3rd month 101. What landmark will you note in determining the station? A. coccyx C. ischial spine B. symphysis pubis D. sacroiliac joint 102. What landmark will you note for the presentation if cephalic? A. mentum C. occiput B. sacrum D. shoulder 103. The desire to have the body, sexual organs and sex role of the opposite sex is known as: A. transexualism C. homosexuality B. lesbianism D. heterosexuality

104. The personal experience ones sex role is known as: A. sexuality C. transexuality B. gender identity D. gender sexuality 105. Increase in muscle tension which is experienced during sexual arousal is known as: A. vasocongestion B. vasodilation C. atonia D. hypotonia 106. All of the following are true about the function of Bag of water (BOW) except: A. protects against temperature change B. aids in the floating of the fetus C. acts as shield against pressure D. serves as a diagnostic tool 107. Which of the following is the correct ratio of Lecithin to Spingomyelin? A. 2:2 B. 2:3 C. 2:1 D. 1:2 107. Patient Imang, G2P1 is experiencing severe abdominal pain. Amniotomy was ordered and it was noted that the amniotic fluid was increased. As a nurse you know that this indicates: A. renal hyperplasia C. renal parenchyma B. Gastroesophageal reflux D. Tracheoesophageal fistula 108. Foramen ovale closes shortly after birth. This structure is equivalent to what adult structure? A. Fossa Ovalis C. Fossa ovalisus B. Ligamentum teres D. Ligamentum venosum 109. In the fetal circulation, which two structures has increased pressure? A. right atrium and pulmonary vein B. left atrium and pulmonary vein C. right atrium and pulmonary artery D. foramen ovale and right atrium 110. Failure of the ductus arteriosus to close is termed as: A. Tetralogy of fallot C. Ventricular septal defect B. Patent ductus venosus D. Patent ductus arteriosus

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