1. 1.

Question
1 point(s)
Mechanism of labor, also known as the cardinal movements, refers to the sequencing of events involved in posturing
and positioning that allows the baby to find the easiest to come out of the birth canal. Arrange the following
mechanisms of labor in the order during the course of labor and fetal delivery.

View Answers:

o Engagement
o Descent
o Flexion
o Internal rotation
o Extension
o External rotation
o Expulsion
Correct
The correct order is shown above.
The mechanism of fetal delivery begins with descent into the pelvic inlet which may occur several days before true
labor sets in the primigravida. Flexion, internal rotation, and extension are mechanisms that the fetus must perform
as it accommodates through the passageway/birth canal. Eternal rotation is done after the head is delivered so that
the shoulders will be easily delivered through the vaginal introitus.

2. 2. Question
1 point(s)
The first thing that a nurse must ensure when the baby’s head comes out is

o A. The cord is intact

o B. No part of the cord is encircling the baby’s neck

o C. The cord is still attached to the placenta

o D. The cord is still pulsating

Incorrect
Correct Answer: B. No part of the cord is encircling the baby’s neck
The nurse should check right away for possible cord coil around the neck because if it is present, the baby can be
strangled by it and the fetal head will have difficulty being delivered.
 Option A: In a newborn who was born a few hours ago, the cord may look plump and pale yellow. One of
the umbilical arteries may be visible and protruding from the cut edge. A normal cord has two arteries and
one vein.
  Option C: The cord is expelled from the mother within a half-hour after birth. It is still attached to the
placenta, which is commonly called “the afterbirth.” With its function completed, it is no longer needed and
so is discarded by the mother’s body.
 Option D: Some cords may pulsate (the pulsation assists the transfer of your baby’s blood back into their
body) for as long as 30 minutes or more, where others may stop pulsating at 5 minutes or less after the
baby is born.

3. 3. Question
1 point(s)
To ensure that the baby will breathe as soon as the head is delivered, the nurse’s priority action is to

 A. Slap the baby’s buttocks to make the baby cry.

 B. Suction the nose and mouth to remove mucous secretions.

 C. Clamp the cord about 6 inches from the base.

 D. Check the baby’s color to make sure it is not cyanotic.

Incorrect
Correct Answer: B. Suction the nose and mouth to remove mucous secretions.
Suctioning the nose and mouth of the fetus as soon as the head is delivered will remove any obstruction that may be
present allowing for better breathing. Also, if mucus is in the nose and mouth, aspiration of the mucus is possible
which can lead to aspiration pneumonia. (Remember that only the baby’s head has come out as given in the
situation.)
 Option A: Earlier, many doctors would hold the baby upside down firmly around his legs and then slap the
butt gently. This not only causes slight pain to the child, but the motion also helps loosen any residues that
might be obstructing the airways. Constantly doing so can irritate the child enough to begin crying.
 Option C: Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births
while initiating simultaneous essential neonatal care. Early umbilical cord clamping (less than 1 min after
birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for
resuscitation.
 Option D: When a baby is first born, the skin is a dark red to purple color. As the baby starts to breathe air,
the color changes to red. This redness normally starts to fade on the first day. A baby’s hands and feet may
stay bluish in color for several days. This is a normal response to a baby’s underdeveloped blood
circulation. But blue coloring of other parts of the body isn’t normal.

4. 4. Question
1 point(s)
When doing perineal care in preparation for delivery, the nurse should observe the following, except?

 A. Use up-down technique with one stroke.

 B. Clean from the mons veneris to the anus.

 C. Use mild soap and warm water.

 D. Paint the inner thighs going towards the perineal area.

Correct
Correct Answer: D. Paint the inner thighs going towards the perineal area
Painting of the perineal area in preparation for delivery of the baby must always be done but the stroke should be
from the perineum going outwards to the thighs. The perineal area is the one being prepared for the delivery and
must be kept clean
 Option A: Wipe the perineum in one stroke to prevent the transfer of infectious microorganisms from the
anal area to the perineum.
 Option B: Always wash from front to back to prevent spreading fecal matter from the anal area to the vagina
or urethra.
 Option C: Use mild soap and warm water. Mild soap would avoid killing the normal flora that lives in and
around the perineum.

5. 5. Question
1 point(s)
What are the important considerations that the nurse must remember after the placenta is delivered? Select all that
apply.

 A. Check if the placenta is complete including the membranes

 B. Check if the cord is long enough for the baby

 C. Check if the umbilical cord has 3 blood vessels

 D. Check if the cord has a meaty portion and a shiny portion

Incorrect
Correct Answer: A & C
The nurse after delivering the placenta must ensure that all the cotyledons and the membranes of the placenta are
complete. Also, the nurse must check if the umbilical cord is normal which means it contains the 3 blood vessels: 1
vein and 2 arteries.
 Option B: At term, the typical umbilical cord is 55 to 60 cm in length, with a diameter of 2.0 to 2.5 cm. The
structure should have abundant Wharton’s jelly, and no true knots or thromboses should be present. The
total cord length should be estimated in the delivery room, since the delivering physician has access to both
the placental and fetal ends.
 Option C: The maternal surface of the placenta should be dark maroon in color and should be divided into
lobules or cotyledons. The structure should appear complete, with no missing cotyledons. The fetal surface
of the placenta should be shiny, gray and translucent enough that the color of the underlying maroon villous
tissue may be seen.
 Option D: The normal cord contains two arteries and one vein. During the placental examination, the
delivering physician should count the vessels in either the middle third of the cord or the fetal third of the
cord, because the arteries are sometimes fused near the placenta and are therefore difficult to differentiate.

6. 6. Question
 1 point(s)
The following are correct statements about false labor, except?

 A. The pain is irregular in intensity and frequency.

 B. The duration of contraction progressively lengthens over time.

 C. There is no bloody vaginal discharge.

 D. The cervix is still closed.

Incorrect
Correct Answer: B. The duration of contraction progressively lengthens over time
In false labor, the contractions remain to be irregular in intensity and duration while in true labor, the contractions
become stronger, longer and more frequent. Braxton Hicks contractions can be described as tightening in the
abdomen that comes and goes. These contractions do not get closer together, do not increase in how long they last
or how often they occur, and do not feel stronger over time. They often come with a change of position and stop with
rest.
 Option A: In false labor, the pain concentrates in the lower abdomen and groin. It is irregular in intensity and
frequency. The pain often ceases regardless of the mother’s activity.
 Option C: There is no evidence of a bloody show. A bloody show or a “mucus plug” could mean a cervical
change, which means labor is close.
 Option D: Some women have painful contractions for days with no cervical changes while other women
might feel only a little pressure and backache.

7. 7. Question
1 point(s)
The passageway in labor and delivery of the fetus include the following, except?

 A. Distensibility of lower uterine segment

 B. Cervical dilatation and effacement

 C. Distensibility of vaginal canal and introitus

 D. Flexibility of the pelvis

Correct
Correct Answer: D. Flexibility of the pelvis
The pelvis is a bony structure that is part of the passageway but is not flexible. The lower uterine segment including
the cervix as well as the vaginal canal and introitus are all part of the passageway in the delivery of the fetus.
 Option A: As uterine contractions cause pressure on the membranes, the hydrostatic action of the amniotic
sac in turn dilates the cervical canal like a wedge. In the absence of intact membranes, the pressure of the
presenting fetal part against the cervix and lower uterine segment is similarly effective.
  Option B: Effacement may be compared to a funneling process in which the whole length of a narrow
cylinder is converted into a very obtuse, flaring funnel with a small circular opening. Because of increased
myometrial activity during uterine preparedness for labor, appreciable effacement of a softened cervix
sometimes is accomplished before active labor begins. Effacement causes expulsion of the mucous plug as
the cervical canal is shortened. Because the lower segment and cervix have lesser resistance during a
contraction, a centrifugal pull is exerted on the cervix and creates cervical dilatation.
 Option C: The tailbone (sacrum or coccyx) needs to be sufficiently mobile to be gently pressed back out of
the way when the baby moves through. The sacroiliac joint allows this nutation or counter-nutation of the
sacrum. The symphysis pubis is a cartilaginous joint in the front of the pelvis. It also needs to be properly
mobile to help the pelvis flex to allow the baby to pass through. The relaxin hormone in your body helps both
the tailbone and the symphysis pubis become more mobile to facilitate birth.

8. 8. Question
1 point(s)
The normal umbilical cord is composed of:

 A. 2 arteries and 1 vein

 B. 2 veins and 1 artery

 C. 2 arteries and 2 veins

 D. None of the above

Incorrect
Correct Answer: A. 2 arteries and 1 vein
Three vessels comprise the umbilical cord: two umbilical arteries and one umbilical vein. The umbilical cord is a soft,
tortuous cord with a smooth outer covering of amnion. It extends from the umbilicus of the fetus to the center of the
placenta. Its length ranges from 50 cm to 60 cm, with a diameter of about 1 cm.[6] The umbilical cord is composed of
a gelatinous ground substance called Wharton’s jelly or substantia gelatinea funiculi umbilicalis.
 Option B: The umbilical arteries carry deoxygenated blood from fetal circulation to the placenta. The two
umbilical arteries converge together about at 5 mm from the insertion of the cord, forming a type of vascular
connection called the Hyrtl’s anastomosis. The primary function of Hartl’s anastomosis is to equalize blood
flow and pressure between the umbilical and placental arteries.
 Option C: The two umbilical arteries arise from the internal iliac arteries of the fetus and enter the umbilical
cord before further branching at the level of the placenta. At the placental level, each umbilical artery
bifurcates into smaller arterioles that continue to branch further to distribute blood to the chorionic villi. The
capillaries of the villi fuse to form venules that converge to form the umbilical vein. The umbilical vein carries
oxygenated blood and nutrients from the mother to the fetus.
 Option D: The umbilical cord is considered both the physical and emotional attachment between mother and
fetus. This structure allows for the transfer of oxygen and nutrients from the maternal circulation into fetal
circulation while simultaneously removing waste products from fetal circulation to be eliminated maternally.

9. 9. Question
1 point(s)
At what stage of labor and delivery does a primigravida differ mainly from a multigravida?
 A. Stage 1

 B. Stage 2

 C. Stage 3

 D. Stage 4
Incorrect
Correct Answer: A. Stage 1
In stage 1 during normal vaginal delivery of a vertex presentation, the multigravida may have about 8 hours of labor
while the primigravida may have up to 12 hours labor.
 Option B: The second stage of labor commences with complete cervical dilation to 10 centimeters and ends
with the delivery of the neonate. In women who have delivered vaginally previously, whose bodies have
acclimated to delivering a fetus, the second stage may only require a brief trial, whereas a longer duration
may be required for a nulliparous female.
 Option C: The third stage of labor commences when the fetus is delivered and concludes with the delivery of
the placenta. Separation of the placenta from the uterine interface is hallmarked by three cardinal signs
including a gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine
fundus on palpation.
 Option D: During the fourth stage of labor, the baby is born, the placenta has delivered, and the woman and
her partner will probably feel joy, relief, and fatigue. Most babies are ready to nurse within a short period
after birth. Others wait a little longer. If the woman is planning to breastfeed, it is strongly encouraged to try
to nurse as soon as possible after the baby is born. Nursing right after birth will help the uterus to contract
and will decrease the amount of bleeding.

10. 10. Question

1 point(s)
The second stage of labor begins with ___ and ends with __?

 A. Begins with full dilatation of cervix and ends with delivery of placenta.

 B. Begins with true labor pains and ends with delivery of the baby.

 C. Begins with complete dilatation and effacement of cervix and ends with delivery of the baby.

 D. Begins with passage of show and ends with full dilatation and effacement of cervix.
Incorrect
Correct Answer: C. Begins with complete dilatation and effacement of cervix and ends with delivery of baby
Stage 2 of labor and delivery process begins with full dilatation of the cervix and ends with the delivery of the baby.
Stage 1 begins with true labor pains and ends with full dilatation and effacement of the cervix.
 Option A: The second stage of labor commences with complete cervical dilation to 10 centimeters and ends
with the delivery of the neonate. This was also defined as the pelvic division phase by Friedman. After
cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing
efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements.
  Option B: The first stage of labor begins when labor starts and ends with full cervical dilation to 10
centimeters. Labor often begins spontaneously or may be induced medically for a variety of maternal or fetal
indications.
 Option D: During the latent phase, the cervix dilates slowly to approximately 6 centimeters. The latent phase
is generally considerably longer and less predictable with regard to the rate of cervical change than is
observed in the active phase. Active labor with more rapid cervical dilation generally starts around 6
centimeters of dilation. During the active phase, the cervix typically dilated at a rate of 1.2 to 1.5 centimeters
per hour. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid
cervical dilation.

11. 11. Question

1 point(s)
The following are signs that the placenta has detached, except?

 A. Lengthening of the cord

 B. Uterus becomes more globular

 C. Sudden gush of blood

 D. Mother feels like bearing down

Correct
Correct Answer: D. Mother feels like bearing down
Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any
effort from the mother.
 Option A: The most reliable sign is the lengthening of the umbilical cord as the placenta separates and is
pushed into the lower uterine segment by progressive uterine retraction. Placing a clamp on the cord near
the perineum makes it easier to appreciate this lengthening. Never place traction on the cord without
countertraction on the uterus above the symphysis; otherwise, one may mistake cord lengthening due to
impending prolapse or inversion for that of uncomplicated placental separation.
 Option B: The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta
descends into the lower segment and the body of the uterus continues to retract. This change may be
clinically difficult to appreciate.
 Option C: As the placenta detaches, the spiral arteries are exposed in the placental bed; massive
hemorrhage would occur if not for the structure of the uterus. The vessels supplying the placental bed
traverse a latticework of crisscrossing muscle bundles that occlude and kink-off the vessels as they contract
and retract following the expulsion of the placenta.

12. 12. Question

1 point(s)
When the shiny portion of the placenta comes out first is called which of the following mechanisms?

 A. Marmets
 B. Ritgens

 C. Duncan

 D. Schultze
Correct
Correct Answer: D. Schultze
There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes out first, it is called
the Schultze mechanism; while if the meaty portion comes out first, it is called the Duncan mechanism.
 Option A: Developed by a mother who needed to express her milk over a long period of time for medical
reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended
method of expressing breastmilk by hand.
 Option B: Ritgen’s maneuver means that the fetal chin is reached between the anus and the coccyx and
pulled anteriorly while using the fingers of the other hand on the fetal occiput to control the speed of delivery
and keep flexion of the fetal neck.
 Option C: Duncan’s mechanism is the expulsion of the placenta with the presentation of the maternal rough
side first, rather than the usual fetal side of the placenta.

13. 13. Question

1 point(s)
When the baby’s head is out, the immediate action of the nurse is

 A. Cut the umbilical cord

 B. Wipe the baby’s face and suction mouth first

 C. Check if there is a cord coiled around the neck

 D. Deliver the anterior shoulder

Incorrect
Correct Answer: C. Check if there is a cord coiled around the neck.
The nurse should check if there is a cord coil because the baby will not be delivered safely if the cord is coiled around
its neck. Normally the umbilical cord coils to the left. Regardless of its origin, umbilical coiling appears to confer turgor
to the umbilical unit, producing a cord that is strong but flexible. The role of umbilical cord coiling is not clear;
nonetheless, it is thought to play a role in protecting the umbilical cord from external forces such as tension,
pressure, stretching or entanglement.
 Option A: The World Health Organization currently recommends clamping the umbilical cord between one
and three minutes after birth, “for improved maternal and infant health and nutrition outcomes,” while the
American College of Obstetricians and Gynecologists recommends clamping within 30 to 60 seconds.
 Option B: Wiping off the face should be done seconds after you have ensured that there is no cord coil but
suctioning of the nose should be done after the mouth because the baby is a “nasal obligate” breather. If the
nose is suctioned first before the mouth, the mucus plugging the mouth can be aspirated by the baby.
  Option D: Anterior shoulder in obstetrics refers to that shoulder of the fetus that faces the pubic symphysis
of the mother during delivery. Depending upon the original position of the fetus, either the left or the right
shoulder can be the anterior shoulder.

14. 14. Question

1 point(s)
When delivering the baby’s head the nurse supports the mother’s perineum to prevent a tear. This technique is called

 A. Marmet’s technique

 B. Ritgen’s technique

 C. Duncan maneuver

 D. Schultze maneuver
Incorrect
Correct Answer: B. Ritgen’s technique
Ritgen’s technique is done to prevent the perineal tear. This is done by the nurse by supporting the perineum with a
sterile towel and pushing the perineum downward with one hand while the other hand is supporting the baby’s head
as it goes out of the vaginal opening.
 Option A: Developed by a mother who needed to express her milk over a long period of time for medical
reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended
method of expressing breastmilk by hand.
 Option C: Duncan’s mechanism is the expulsion of the placenta with the presentation of the maternal rough
side first, rather than the usual fetal side of the placenta.
 Option D: There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes
out first, it is called the Schultze mechanism; while if the meaty portion comes out first, it is called the
Duncan mechanism.

15. 15. Question

1 point(s)
The basic delivery set for normal vaginal delivery includes the following instruments/articles, except?

 A. 2 clamps

 B. Pair of scissors

 C. Kidney Basin

 D. Retractor
Correct
Correct Answer: D. Retractor
 For normal vaginal delivery, the nurse needs only the instruments for cutting the umbilical cord such as 2 clamps
(straight or curve) and a pair of scissors as well as the kidney basin to receive the placenta. The retractor is not part
of the basic set. In the hospital setting, needle holders and tissue forceps are added especially if the woman
delivering the baby is a primigravida wherein episiotomy is generally done.
 Option A: The clamps are used for clamping the umbilical cord. After the cord has stopped pulsating, or after
at least 1-3 minutes after birth, the first clamp is placed near the neonate’s umbilicus, then the other one just
farther down the cord.
 Option B: Using sterile scissors, cut between the two clamps. Keep in mind that the cord is thick and hard to
cut. One pair will be used to cut the baby’s umbilical cord. Another will be used if there is a need for an
episiotomy. In that case, the doctor will have to cut into the perineum (the skin between the vagina and
anus) to help the baby fit through.
 Option C: The kidney basin is used to receive the placenta. Inspect the placenta for completeness before
disposing it properly.

16. 16. Question

1 point(s)
As soon as the placenta is delivered, the nurse must do which of the following actions?

 A. Inspect the placenta for completeness including the membranes.

 B. Place the placenta in a receptacle for disposal.

 C. Label the placenta properly.

 D. Leave the placenta in the kidney basin for the nursing aide to dispose properly.
Incorrect
Correct Answer: A. Inspect the placenta for completeness including the membranes.
The placenta must be inspected for completeness to include the membranes because an incomplete placenta could
mean that there is retention of placental fragments which can lead to uterine atony. If the uterus does not contract
adequately, hemorrhage can occur.
 Option B: During the examination, the size, shape, consistency and completeness of the placenta should be
determined, and the presence of accessory lobes, placental infarcts, hemorrhage, tumors and nodules
should be noted. Once deemed complete, it may be disposed of properly.
 Option C: The placenta is not necessarily labeled. For inspection, keep in mind that the maternal surface of
the placenta should be dark maroon in color and should be divided into lobules or cotyledons. The structure
should appear complete, with no missing cotyledons. The fetal surface of the placenta should be shiny,
gray, and translucent enough that the color of the underlying maroon villous tissue may be seen.
 Option D: Before the proper disposal of the placenta, it should be assessed properly. Evaluating placental
completeness is of critical, immediate importance in the delivery room. Retained placental tissue is
associated with postpartum hemorrhage and infection.

17. 17. Question

1 point(s)
In vaginal delivery done in the hospital setting, the doctor routinely orders oxytocin to be given to the mother
parenterally. The oxytocin is usually given after the placenta has been delivered and not before because:
 A. Oxytocin will prevent bleeding.

 B. Oxytocin can make the cervix close and thus trap the placenta inside.

 C. Oxytocin will facilitate placental delivery.

 D. Giving oxytocin will ensure complete delivery of the placenta.

Incorrect
Correct Answer: B. Oxytocin can make the cervix close and thus trap the placenta inside
The action of oxytocin is to make the uterus contract as well make the cervix close. If it is given prior to placental
delivery, the placenta will be trapped inside because the action of the drug is almost immediate if given parenterally.
 Option A: Active management of the third stage of labor has been shown to reduce the risk of postpartum
hemorrhage. It usually involves the administration of uterotonic drugs. Although active management has
been shown to reduce the risk of postpartum hemorrhage, it may have an impact on the well-being of the
mother and baby in terms of the amount of blood that has been transfused to the baby before the separation
of the placenta.
 Option C: In the United States, oxytocin is the uterotonic most often administered at birth. It is commonly
administered after delivery of the placenta. However, it does not facilitate placental delivery.
 Option D: For the prevention of postpartum hemorrhage, and in conjunction with the other components of
active management of the third stage of labor, oxytocin can be administered with the delivery of the anterior
shoulder or after the delivery of the placenta.

18. 18. Question

1 point(s)
In a gravido-cardiac mother, the first 2 hours postpartum (4th stage of labor and delivery) particularly in a cesarean
section is a critical period because at this stage

 A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the
compromised heart.

 B. The maternal heart is already weak and the mother can die.

 C. The delivery process is strenuous to the mother.

 D. The mother is tired and weak which can distress the heart.
Incorrect
Correct Answer: A. There is a fluid shift from the placental circulation to the maternal circulation which can overload
the compromised heart.
During the pregnancy, there is an increase in maternal blood volume to accommodate the need of the fetus. When
the baby and placenta have been delivered, there is a fluid shift back to the maternal circulation as part of physiologic
adaptation during the postpartum period. In a cesarean section, the fluid shift occurs faster because the placenta is
taken out right after the baby is delivered giving it less time for the fluid shift to gradually occur.
 Option B: Heart rate increases in a linear fashion during pregnancy by 10 to 20 bpm over baseline and
returns to pre-pregnant levels in 6 weeks postpartum. There is ventricular remodeling during pregnancy and
 left ventricular wall thickness and mass increase by 28% to 52% above pre-pregnancy values. Cardiac
contractility and ventricular ejection fraction don’t undergo any significant change during the entire
peripartum period.
 Option C: There is generalized physical fatigue immediately after delivery. The pulse rate may be elevated a
few hours after the childbirth, due to excitement or pain, and usually normalizes on the second day. The
blood pressure could be elevated due to pain or excitement but is generally in the normal range
 Option D: Cardiac output increases throughout pregnancy. However, in the immediate postpartum period,
following delivery, there is an increase in circulating blood volume from the contraction of the uterus and an
increase in preload from the relief of inferior vena cava obstruction, leading to an increase in stroke volume
and heart rate leading to a 60 to 80% rise in cardiac output, which rapidly declines to pre-labor values in 1 to
2 hours following delivery and to pre-pregnancy values in two weeks postpartum.

19. 19. Question

1 point(s)
This drug is usually given parenterally to enhance uterine contraction:

 A. Terbutaline

 B. Pitocin

 C. Magnesium sulfate

 D. Lidocaine
Incorrect
Correct Answer: B. Pitocin
The common oxytocin given to enhance uterine contraction is Pitocin. This is also the drug given to induce labor.
 Option A: Terbutaline, sold under the brand name Bricanyl among others, is a ?2 adrenergic receptor
agonist, used as a “reliever” inhaler in the management of asthma symptoms and as a tocolytic (anti-
contraction medication) to delay preterm labor for up to 48 hours.
 Option C: Magnesium sulfate is often quite effective in slowing contractions, although this effect and how
long it lasts varies from woman to woman. Like all tocolytic medications, however, magnesium sulfate does
not consistently prevent or delay preterm delivery for a significant period of time. The most common
explanation is that magnesium lowers calcium levels in uterine muscle cells. Since calcium is necessary for
muscle cells to contract, this is thought to relax the uterine muscle.
 Option D: The local anesthetic is transferred to the fetus slowly, and its margin of safety is also increased.
Considering how local anesthetics have small direct effects on the fetus even at submaximal doses,
lidocaine may be considered relatively safe for use in pregnant women.

20. 20. Question

1 point(s)
The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following,
except?

 A. Vital signs
 B. Fluid intake and output

 C. Uterine contraction

 D. Cervical dilatation
Incorrect
Correct Answer: B. Fluid intake and output
Partograph is a monitoring tool designed by the World Health Organization for use by health workers when attending
to mothers in labor, especially the high risk ones. For maternal parameters all of the above is placed in the
partograph except the fluid intake since this is placed in a separate monitoring sheet. WHO further modified the
partograph for the third time. This simplified partograph is color-coded. The area to the left of the alert line is colored
green representing the normal progress. The area to the right of the action line is colored red indicating dangerously
slow progress. The area between the alert and action line is colored amber indicating the need for greater vigilance
 Option A: WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an
effective tool for the early detection of maternal and fetal complications during childbirth. All the recordings
for the maternal condition are entered at the foot of the partograph below the recording of uterine
contraction. Maternal vital signs such as temperature, pulse, BP, urine output and urine for protein and
acetone are monitored.
 Option C: Below the cervical dilatation, there is a space for recording uterine contractions per 10 min and
the scale is numbered from 1 to 5. Each square represents one contraction. So if two contractions are felt in
10 min, two squares are shaded.
 Option D: The central feature of the partogram is a graph where cervical dilatation is plotted. Along the left
side, there are squares from 0 to 10, each representing 1-cm dilatation. Along the bottom of graph are
numbers 0–24 each presenting 1 h. The first stage of labor is divided into latent and active phases. The
latent phase is from 0 to 3 cm, and it lasts up to 8 h. The active phase is from 3 to 10 cm (full cervical
dilatation). The dilatation of the cervix is plotted with “x.”

21. 21. Question

1 point(s)
The following are natural childbirth procedures, except?

 A. Lamaze method

 B. Dick-Read method

 C. Ritgen’s maneuver

 D. Psychoprophylactic method
Incorrect
Correct Answer: C. Ritgen’s maneuver
Ritgen’s method is used to prevent perineal tear/laceration during the delivery of the fetal head. Lamaze method is
also known as psychoprophylactic method and Dick-Read method are commonly known natural childbirth procedures
which advocate the use of nonpharmacologic measures to relieve labor pain.
  Option A: Lamaze breathing historically is considered the hallmark of Lamaze preparation for childbirth.
Controlled breathing enhances relaxation and decreases the perception of pain. It is one of many comfort
strategies taught in Lamaze classes. In restricted birthing environments, breathing may be the only non-
pharmacological comfort strategy available to women. Conscious breathing and relaxation, especially in
combination with a wide variety of comfort strategies, can help women avoid unnecessary medical
intervention and have a safe, healthy birth.
 Option B: The term ‘natural childbirth’ derives from the title of a short 1933 treatise by Grantly Dick-Read. In
this and several other books and articles published over the next quarter-century, the British-born physician
outlined an alternative to the anesthetized, medically controlled way of birth common among Western
women of privilege, based on the premise that fear lay at the root of pain in labor. For Dick-Read, whether
or not a mother experienced pain in labor depended not on some property inherent to the physiology of
parturition but on cultural attitudes to childbirth.
Through education and relaxation, women could overcome what he termed the ‘Fear–Tension–Pain’ cycle
and labor in comfort without resorting to medical intervention. Preparation for labor meant providing
pregnant women with detailed instruction, from their physician, midwife, or qualified childbirth educator, on
the physiology of pregnancy and birth, nutrition, exercise, hygiene, and infant care.
 Option D: In the late 1940s, Soviet scientists invented a new non-pharmacological method called the
‘psychoprophylactic method of painless childbirth’ (PPM), which later became well known as the Lamaze
method in the West.1 This gift of Soviet science to the women of the world was based on the assumption
that it was possible to eliminate the sensation of bodily pain during labor by training the mind of a pregnant
woman before she gives birth.

22. 22. Question

1 point(s)
The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage?

 A. Pelvic bone contraction

 B. Full bladder

 C. Extension rather than flexion of the head

 D. Cervical rigidity
Incorrect
Correct Answer: B. Full bladder
A full bladder can impede the descent of the fetal head. The nurse can readily manage this problem by doing a
simple catheterization of the mother.
 Option A: The narrower shape of the android pelvis can make labor difficult because the baby might move
more slowly through the birth canal. Some pregnant women with an android pelvis may require a C-section.
 Option C: Abnormal labor could also be secondary to the passenger, the size of the infant, and/or the
presentation of the infant. In addition to problems caused by the differential in size between the fetal head
and the maternal bony pelvis, the fetal presentation may include asynclitism or head extension. Asynclitism
is malposition of the fetal head within the pelvis, which compromises the narrowest diameter through the
pelvis.
 Option D: According to the most recent evidence, arrest of labor in the first stage should be defined as more
than or equal to 6cm dilation with ruptured membranes and one of the following: 4 hours or more of
adequate contractions (>200 MVU) or 6 hours or more of inadequate contractions and no cervical change.
23. 23. Question
1 point(s)
At what stage of labor is the mother advised to bear down?

 A. When the mother feels the pressure at the rectal area.

 B. During a uterine contraction.

 C. In between uterine contraction to prevent uterine rupture.

 D. Anytime the mother feels like bearing down.

Incorrect
Correct Answer: B. During a uterine contraction
The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing
down during a contraction.
 Option A: During the second stage of labor, the fetal presentation comes down and compression occurs in
both the bladder and rectum, generating a reflex that causes a strong urge to bear down, or ‘push’.
Therefore, the combination of involuntary intrauterine contractions and voluntary expulsive effort, through
the abdominal and respiratory muscles, will help fetus delivery.
 Option C: Maternal pushing during the second stage of labor is an important and indispensable contributor
to the involuntary expulsive force developed by uterine contraction.
 Option D: Waiting for the urge to push with an epidural does shorten the duration of pushing and increases
spontaneous vaginal delivery, but lengthens the second stage and doubles the risk of low umbilical cord pH
(based on data from one study).

24. 24. Question

1 point(s)
The normal dilatation of the cervix during the first stage of labor in a nullipara is

 A. 1.2 cm./hr

 B. 1.5 cm./hr.

 C. 1.8 cm./hr

 D. 2.0 cm./hr
Incorrect
Correct Answer: A. 1.2 cm./hr
For nullipara, the normal cervical dilatation should be 1.2 cm/hr. If it is less than that, it is considered a protracted
active phase of the first stage. For multipara, the normal cervical dilatation is 1.5 cm/hr.
 Option B: For nulliparous women, Friedman (Friedman Studies) reported that the active phase of labor
approximates the time from 2.5 cm cervical dilatation through complete dilatation, approximated at 10 cm.
 Use of 2.5 cm dilatation as the onset of active labor was an aggregate estimate and was, therefore, not
strictly applicable to any individual woman.
 Option C: Active phase labor was further divided into three sub-phases, i.e., an acceleration phase, a phase
of maximum slope, and a deceleration phase. Friedman described the acceleration phase as a rapid change
in the slope of cervical dilation approximating the time needed for the cervix to dilate from 2.5 cm to 4 cm,
and the phase of maximum slope as a period of rapid cervical dilation progressing linearly from
approximately 4 cm to 9 cm cervical dilatation. Friedman reported the mean and slowest-yet-normal (i.e.,
mean – 2 standard deviations) cervical dilation rates in the phase of maximum slope to be 3.0 and 1.2
cm/hr, respectively.
 Option D: The deceleration phase was identified when the rate of dilation once again slowed as full
dilatation was reached. For the aggregate of all labors, this phase approximated the time needed for the
cervix to dilate from 9 cm to 10 cm. Friedman included data from some women without a spontaneous labor
onset and some who were not low-risk by modern standards.

25. 25. Question

1 point(s)
When the fetal head is at the level of the ischial spine, it is said that the station of the head is

 A. Station –1

 B. Station “0”

 C. Station +1

 D. Station +2
Incorrect
Correct Answer: B. Station “0”
Determining is defined as the relationship of the fetal head and the level of the ischial spine. At the level of the ischial
spine, the station is “0”. Above the ischial spine it is considered (-) station and below the ischial spine it is (+) station.
 Option A: By 6 cm of dilation, the median station was 0 (95% CI ?2 to 1) for nulliparous and ?1 (95% CI ?3
to 0) for multiparous women. At 8 cm, 95% of nulliparous women were at ?1 station or lower.
 Option C: The fetal head is already engaged in station +1. The difference between numbers in the score is
equivalent to the length in centimeters. Moving from +1 to +2 is a movement of about 1 centimeter.
 Option D: +2 to +3 station is crowning and beginning to emerge from the birth canal.

26. 26. Question

1 point(s)
During an internal examination, the nurse palpated the posterior fontanel to be at the left side of the mother at the
upper quadrant. The interpretation is that the position of the fetus is:

 A. LOA

 B. ROP
 C. LOP

 D. ROA
Incorrect
Correct Answer: A. LOA
The landmark used in determining fetal position is the posterior fontanel because this is the nearest to the occiput. So
if the nurse palpated the occiput (O) at the left (L) side of the mother and at the upper/anterior (A) quadrant then the
fetal position is LOA.
 Option B: In the right occiput posterior position (ROP), the baby is facing forward and slightly to the right
(looking toward the mother’s left thigh). This presentation may slow labor and cause more pain.
 Option C: When facing forward, the baby is in the occiput posterior position. If the baby is facing forward and
slightly to the left (looking toward the mother’s right thigh) it is in the left occiput posterior (LOP) position.
This presentation can lead to more back pain (sometimes referred to as “back labor”) and slow progression
of labor.
 Option D: The right occiput anterior (ROA) presentation is also common in labor. In this position, the back of
the baby is slightly off center in the pelvis with the back of the head toward the mother’s right thigh. In
general, OA positions do not lead to problems or additional pain during labor or birth.

27. 27. Question

1 point(s)
The following are types of breech presentation, except:

 A. Footling

 B. Frank

 C. Complete

 D. Incomplete
Correct
Correct Answer: D. Incomplete
Breech presentation means the buttocks of the fetus is the presenting part. If it is only the foot/feet, it is considered
footling. If only the buttocks, it is a frank breech. If both the feet and the buttocks are presenting it is called complete
breech.
 Option A: The footling breech can have any combination of one or both hips extended, also known as
footling (one leg extended) breech, or double footling breech (both legs extended).
 Option B: In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the
fetal face, in a pike position.
 Option C: The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position.

28. 28. Question

1 point(s)
When the nurse palpates the suprapubic area of the mother and found that the presenting part is still movable, the
right term for this observation that the fetus is
 A. Engaged

 B. Descended

 C. Floating

 D. Internal Rotation
Incorrect
Correct Answer: C. Floating
The term floating means the fetal presenting part has not entered/descended into the pelvic inlet. If the fetal head has
entered the pelvic inlet, it is said to be engaged.
 Option A: If the fetal head accommodates two fingerbreadths above pelvic brim, it is said to be engaged.
 Option B: Using the rule of fifths, the distance between the base and vertex of the fetal head is divided into
five equal parts. Each fifth corresponds to 2 cm or approximately one transverse fingerbreadth.
 Option D: As the head descends, the presenting part, usually in the transverse position, is rotated about 45°
to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in
line with the AP diameter of the pelvic outlet.

29. 29. Question

1 point(s)
The placenta should be delivered normally within how many minutes after the delivery of the baby?

 A. 5 minutes

 B. 30 minutes

 C. 45 minutes

 D. 60 minutes
Incorrect
Correct Answer: B. 30 minutes
The placenta is delivered within 30 minutes from the delivery of the baby. If it takes longer, probably the placenta is
abnormally adherent and there is a need to refer already to the obstetrician.
 Option A: The absolute time limit for delivery of the placenta, without evidence of significant bleeding,
remains unclear. Periods ranging from 30-60 minutes have been suggested.
 Option C: Retained placenta can be defined as lack of expulsion of the placenta within 30 minutes of
delivery of the infant. This is a reasonable definition in the third trimester when the third stage of labor is
actively managed (ie, administration of a uterotonic agent before delivery of the placenta, controlled cord
traction) because 98 percent of placentas are expelled by 30 minutes in this setting.
 Option D: Physiologic management of the third stage (ie, delivery of the placenta without the use of
uterotonic agents or cord traction) increases the frequency of retained placenta: only 80 percent of
placentas are expelled by 30 minutes and it takes approximately 60 minutes before 98 percent of placentas
are expelled.
30. 30. Question
1 point(s)
When shaving a woman in preparation for cesarean section, the area to be shaved should be from:

 A. Under breast to mid-thigh including the pubic area.

 B. The umbilicus to the mid-thigh.

 C. Xiphoid process to the pubic area.

 D. Above the umbilicus to the pubic area.

Incorrect
Correct Answer: A. Under breast to mid-thigh including the pubic area.
Shaving is done to prevent infection and the area usually shaved should sufficiently cover the area for surgery,
cesarean section. The pubic hair is definitely to be included in the shaving.
 Option B: Infections of surgical incisions are the third most frequently reported hospital?acquired infections.
Women who give birth by cesarean section are exposed to infection from germs already present on the
mother’s own skin, or from external sources. The risk of infection following a cesarean section can be 10
times that of vaginal birth. Therefore, preventing infection by properly preparing the skin before the incision
is made is an important part of the overall care given to women prior to cesarean birth.
 Option C: The xiphoid process is definitely not included in shaving prior to cesarean section. The Centers for
Disease Control and Prevention (CDC) estimates that 27 million surgical procedures are performed in the
United States each year. The CDC’s National Nosocomial Infections Surveillance system reports that
surgical site infections are the third most frequently reported nosocomial infection, accounting for 14% to
16% of all such infections (CDC 2005). Preventing infection by properly preparing the skin before the
incision is thus a vital part of the overall care given to women during a cesarean birth.
 Option D: Proper preparation of an incision site involves removing surface dirt and oil with a soap or
detergent scrub plus applying a topical antimicrobial agent that will reduce the bacterial population to a
minimal level. In surgical patients, the choice of surgical scrub and the duration of scrubbing have not been
shown to make any significant difference in the rate of surgical site infection in either clean or clean?
contaminated wounds (such as cesarean skin incision).

31. 31. Question

1 point(s)
During the postpartum period, the fundus of the uterus is expected to go down normally about how many centimeters
per day?

 A. 1.0 cm

 B. 2.0 cm

 C. 2.5 cm
 D. 3.0 cm
Incorrect
Correct Answer: A. 1.0 cm
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.
 Option B: During the normal puerperium period, the uterine involution is defined by the changing indices of
the uterine size, the uterine cavity inserts, and the uterine artery flow. Most of the studies publish the first
ultrasound examination findings on the 1st, 2nd, and 3rd postpartum days, but there is not a single
ultrasound study examining the uterus within the first two hours after delivery.
 Option C: The most obvious postpartum change is involution of the uterus from a 1-kg structure with a 5- to
10-L volume to a 60-g structure holding 3 to 5 mL. This involution begins during the third stage of labor,
accelerates after expulsion of the placenta, and continues over the next 5 to 6 weeks. Typically, the uterus
is at the umbilicus after delivery of the placenta, and it decreases in height by about a centimeter a day until
it again becomes a pelvic organ at about 12 days postpartum. Slower involution continues over the next
several weeks until prepregnant size is attained. Restoration of the normal endometrial lining occurs by the
16th day postpartum.
 Option D: The most intensive uterine involution period is the first month after delivery. The trend of involution
in primiparous and multiparous women is similar; however, in multiparous women, it lasts longer than 6–8
weeks.

32. 32. Question

1 point(s)
The lochia on the first few days after delivery is characterized as

 A. Pinkish with some blood clots

 B. Whitish with some mucus

 C. Reddish with some mucus

 D. Serous with some brown tinged mucus

Incorrect
Correct Answer: C. Reddish with some mucus
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. Lochia rubra (or cruenta) is the first discharge,
Composed of blood, shreds of fetal membranes, decidua, vernix caseosa, lanugo and membranes. It is red in color
because of the large amount of blood it contains. It lasts 1 to 4 days after birth, before easing to light “spotting”.
 Option A: Lochia serosa is the term for lochia that has thinned and turned brownish or pink in color. It
contains serous exudate, erythrocytes, leukocytes, cervical mucus, and microorganisms. This stage
continues until around the tenth day after delivery. Lochia serosa which persists to some weeks after birth
can indicate late postpartum hemorrhaging and should be reported to a physician.
 Option B: Lochia alba (or purulenta) is the name for lochia once it has turned whitish or yellowish-white. It
typically lasts from the second through the third to sixth weeks after delivery. It contains fewer red blood
cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, mucus and microorganisms.
Continuation beyond a few weeks can indicate a genital lesion, which should be reported to a physician.
  Option D: Between days four and seven, the blood should turn a pinkish or brownish color. Clots should get
smaller or disappear. By the end of the first week, the discharge will likely be white or yellow in color. In
three to six weeks, it should stop.

33. 33. Question

1 point(s)
Lochia normally disappears after how many days postpartum?

 A. 5 days

 B. 7-10 days

 C. 18-21 days

 D. 28-30 days
Incorrect
Correct Answer: B. 7-10 days
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 every day.
 Option A: Lochia for the first 3 days after delivery is dark red in color. A few small blood clots, no larger than
a plum, are normal.
 Option C: For the fourth through tenth day after delivery, the lochia will be more watery and pinkish to
brownish in color.
 Option D: From about the seventh to the tenth day through the fourteenth day after delivery, the lochia is
creamy or yellowish in color. Moms who have cesarean sections may have less lochia after 24 hours than
moms who had vaginal deliveries. The bleeding generally stops within 4 to 6 weeks after delivery.

34. 34. Question

1 point(s)
After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to:

 A. Prevent the recurrence of Rh(+) babies in future pregnancies.

 B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she
delivered to her Rh(+) baby.

 C. Ensure those future pregnancies will not lead to maternal illness.

 D. To prevent the newborn from having problems of incompatibility when it breastfeeds.

Incorrect
Correct Answer: B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have
gotten when she delivered to her Rh(+) baby
 In Rh incompatibility, a 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.
 Option A: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which
an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood.
 Option C: RhoGAM prevents the Rh-negative mother from making antibodies directed against her baby’s
Rh-positive red blood cells during her pregnancy.
 Option D: Rho(D) immune globulin is immune globulin (IgG) rich in IgG antibodies against erythrocyte
antigen Rho(D). IgG is a normal component of breastmilk. Rho(D) immune globulin is frequently used in
nursing mothers and no adverse effects have been reported in breastfed infants. No special precautions are
required.

35. 35. Question

1 point(s)
To enhance milk production, a lactating mother must do the following interventions, except:

 A. Increase fluid intake including milk.

 B. Eat foods that increase lactation which is called galactagogues.

 C. Exercise adequately like aerobics.

 D. Have adequate nutrition and rest.

Incorrect
Correct Answer: C. Exercise adequately like aerobics.
All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does
not necessarily enhance lactation.
 Option A: It is widely assumed that milk production requires a high fluid intake on the part of the mother, yet
the evidence suggests that lactating women can tolerate a considerable amount of water restriction and that
supplemental fluids have little effect on milk volume. However, thirst may sometimes function too slowly to
prevent dehydration among women with high fluid losses resulting from exercise or high ambient
temperature (experienced by many women without air conditioning in the summer).
 Option B: A galactagogue or galactogogue (pronounced gah-lak´tah-gog) is something that can help a
breastfeeding mother to increase her breast milk supply. The word itself is a combination of the Greek terms
“galact-” meaning milk, and “-agogue” meaning leading to or promoting. Herbs are commonly used to boost
low milk supply, but certain actions, foods, and medications can help a breastfeeding mom make more
breast milk as well.
 Option D: Maternal anxiety and stress, which may be exacerbated by poor lactation management, are
believed to influence milk production by inhibiting the milk-ejection reflex. This reflex usually operates well in
women who are relaxed and confident of their ability to breastfeed. In tense women, however, the reflex
may be impaired. Early studies in humans by Gopalan (1958) and Edozien et al. (1976) suggest the same
relationship: milk output of women in India and Nigeria increased when protein intake was increased from
50 to 60 g/day to approximately 100 g/day.

36. 36. Question

1 point(s)
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. Apply warm compress on the engorged breast.

 C. Massage the breast.

 D. Apply analgesic ointment.

Incorrect
Correct Answer: B. Apply warm compress on the engorged breast
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.
 Option A: Using cold packs on the affected breast can help reduce swelling and relieve pain. Use warm
packs just before a feed (for up to a few minutes) to help trigger the let-down reflex to help clear the
blockage and may relieve pain.
 Option C: Gentle massage by stroking toward the nipple while the baby feeds may help in draining the
breast of too much milk.
 Option D: The doctor may recommend an over-the-counter pain reliever, such as acetaminophen or
ibuprofen. Ointments may interfere with the infant’s breastfeeding.

37. 37. Question

1 point(s)
A woman who delivered normally per vaginam is expected to void within how many hours after delivery?

 A. 3 hrs

 B. 4 hrs

 C. 6-8 hrs

 D. 12-24 hours
Incorrect
Correct Answer: C. 6-8 hrs
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.
 Option A: The precise pathophysiology of PPUr is still unknown; however, it is likely to be multifactorial,
including physiological, neurological, and mechanical processes in the postpartum period
 Option B: Postpartum urinary retention has been classified into overt and covert retention by Yip et al.
Women who are unable to micturate spontaneously within 6 h after vaginal delivery are categorized as
having overt (symptomatic) urinary retention. Covert (asymptomatic) urinary retention is defined as having a
postvoid residual bladder volume (PVRBV) of more than 150 mL, detected by ultrasound or by
catheterization, with no symptoms of urinary retention.
 Option D: Postpartum urinary retention (PPUR) is an upsetting condition that has no standard literature
definition. It has been variably defined as the abrupt onset of aching or inability to completely micturate,
 requiring urinary catheterization, over 12 h after giving birth or not to void spontaneously within 6 h of
vaginal delivery.

38. 38. Question

1 point(s)
To ensure adequate lactation the nurse should teach the mother to:

 A. Breastfeed the baby on self-demand day and night.

 B. Feed primarily during the day and allow the baby to sleep through the night.

 C. Feed the baby every 3-4 hours following a strict schedule.

 D. Breastfeed when the breasts are engorged to ensure adequate supply.

Incorrect
Correct Answer: A. Breastfeed the baby on self-demand day and night
Feeding on self-demand means the mother feeds the baby according to the baby’s need. Therefore, this means there
will be regular emptying of the breasts, which is essential to maintain adequate lactation.
 Option B: Some newborns wake up and breastfeed every 2 to 3 hours like clockwork, but that’s not always
the case. The baby may want to breastfeed many times in a short period, and then he might sleep for a little
longer. This type of feeding is called cluster or bunch feeding. Other babies are sleepy, especially in the
very early days, so the mother may have to wake the baby up to breastfeed. All of these patterns are
normal. As long as the child is getting enough breast milk and growing well, there is nothing to worry.
 Option C: On average, a breastfed newborn eats approximately every 2 to 3 hours around the clock. That’s
about 8 to 12 times in a 24-hour period. Newborn have little stomachs and ?breast milk is easily digested,
so they should breastfeed often.
 Option D: In the beginning, breastfeed the newborn for as long as she will stay on the breast. Continue to
breastfeed until there are signs that the child is satisfied. This way, the mother can be sure that the baby is
getting enough breast milk at each feeding. Plus, keeping the baby breastfeeding longer, stimulates milk
production and helps the mother to build up her breast milk supply.

39. 39. Question

1 point(s)
An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is:

 A. Encourage the mother to ambulate to relieve the pain in the leg.

 B. Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return
flow.

 C. Apply warm compress on the affected leg to relieve the pain.

 D. Elevate the affected leg and keep the patient on bedrest.

 Correct
Correct Answer: D. Elevate the affected leg and keep the patient on bed rest.
If the mother already has thrombophlebitis, the nursing intervention is bed rest to prevent the possible dislodging of
the thrombus and keeping the affected leg elevated to help reduce the inflammation.
 Option A: During pregnancy, an increase in most procoagulant factors and a reduction in fibrinolytic activity
occurs. Plasma fibrinogen levels gradually increase after the third month of pregnancy, to double those of
the nonpregnant state. In the second half of pregnancy, levels of factors VII, VIII, IX, and X also increase.
Decreased fibrinolytic activity is probably related to a decrease in the level of circulating plasminogen
activator. In addition, a 68% reduction in protein S levels is measured during pregnancy and in the
postpartum period. Protein S levels do not return to the reference range until 12 weeks after delivery. These
changes are necessary to prevent hemorrhage during placental separation.
 Option B: The routine use of graduated support stockings (class I or II), especially when the patient is
confined on an airplane or otherwise, is extremely important.
 Option C: A warm water compress is valuable in the treatment of phlebitis, and could decrease the degree
of phlebitis both effectively and inexpensively.

40. 40. Question

1 point(s)
The nurse should anticipate that hemorrhage related to uterine atony may occur postnatally if this condition was
present during the delivery:

 A. Excessive analgesia was given to the mother.

 B. Placental delivery occurred within thirty minutes after the baby was born.

 C. An episiotomy had to be done to facilitate delivery of the head.

 D. The labor and delivery lasted for 12 hours.

Incorrect
Correct Answer: A. Excessive analgesia was given to the mother.
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.
 Option B: The absolute time limit for delivery of the placenta, without evidence of significant bleeding,
remains unclear. Periods ranging from 30-60 minutes have been suggested.
 Option C: An episiotomy is a minor incision made during childbirth to widen the opening of the vagina. A
perineal tear or laceration often forms on its own during a vaginal birth. Rarely, this tear will also involve the
muscle around the anus or the rectum. Both episiotomies and perineal lacerations require stitches to repair
and ensure the best healing. Both are similar in recovery time and discomfort during healing.
 Option D: Normal labor usually begins within 2 weeks (before or after) the estimated delivery date. In a first
pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6
to 8 hours.

41. 41. Question

1 point(s)
According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the postpartum
period. These stages are:
 A. Going through, adjustment period, adaptation period

 B. Taking-in, taking hold and letting-go

 C. Attachment phase, adjustment phase, adaptation phase

 D. Taking-hold, letting-go, attachment phase

Incorrect
Correct Answer: B. Taking-in, taking-hold and letting-go
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.
 Option A: The taking-in phase usually sets 1 to 2 days after delivery. This is the time of reflection for the
woman because within the 2 to 3 day period, the woman is passive. The taking-in phase provides time for
the woman to regain her physical strength and organize her rambling thoughts about her new role.
 Option C: The taking hold phase starts 2 to 4 days after delivery. The woman starts to initiate actions on her
own and makes decisions without relying on others. She starts to focus on the newborn instead of herself
and begins to actively participate in newborn care. The woman still needs positive reinforcements despite
the independence that she is already showing because she might still feel insecure about the care of her
child.
 Option D: During the letting go phase, the woman finally accepts her new role and gives up her old roles like
being a childless woman or just a mother of one child. This is the phase where postpartum depression may
set in. Readjustment of relationships is needed for an easy transition to this phase.

42. 42. Question

1 point(s)
The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:

 A. The pancreas is immature and unable to secrete the needed insulin.

 B. There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally
secreting insulin.

 C. The baby is reacting to the insulin given to the mother.

 D. His kidneys are immature leading to a high tolerance for glucose.

Incorrect
Correct Answer: B. There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is
normally secreting insulin.
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.
  Option A: The primary function of ?-cells is to store and secrete insulin in response to glucose load. When ?-
cells lose the ability to adequately sense blood glucose concentration, or to release sufficient insulin in
response, this is classified as ?-cell dysfunction. ?-cell dysfunction is thought to be the result of prolonged,
excessive insulin production in response to chronic fuel excess
 Option C: ?-cell dysfunction is exacerbated by insulin resistance. Reduced insulin-stimulated glucose uptake
further contributes to hyperglycemia, overburdening the ?-cells, which have to produce additional insulin in
response. The direct contribution of glucose to ?-cell failure is described as glucotoxicity. Thus, once ?-cell
dysfunction begins, a vicious cycle of hyperglycemia, insulin resistance, and further ?-cell dysfunction is set
in motion.
 Option D: Insulin resistance occurs when cells no longer adequately respond to insulin. At the molecular
level, insulin resistance is usually a failure of insulin signaling, resulting in inadequate plasma membrane
translocation of glucose transporter 4 (GLUT4)—the primary transporter that is responsible for bringing
glucose into the cell to use as energy.

43. 43. Question

1 point(s)
Which of the following is an abnormal vital sign in postpartum?

 A. Pulse rate between 50-60/min

 B. BP diastolic increase from 80 to 95mm Hg

 C. BP systolic between 100-120mm Hg

 D. Respiratory rate of 16-20/min

Incorrect
Correct Answer: B. BP diastolic increase from 80 to 95mm Hg
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.
 Option A: The pulse rate may be elevated a few hours after the childbirth, due to excitement or pain, and
usually normalizes on the second day.
 Option C: The blood pressure could be elevated due to pain or excitement but is generally in the normal
range. A significant decrease (> 20% below baseline) in blood pressure could be a sign of postpartum
hemorrhage or septic shock.[4] Conversely, high blood pressure could be a sign of pain or pre-eclampsia.
 Option D: The respiratory rate also begins to fall back to the pre-pregnancy level within 2 to 3 days.

44. 44. Question

1 point(s)
The uterine fundus right after delivery of placenta is palpable at

 A. Level of Xiphoid process

 B. Level of umbilicus
 C. Level of symphysis pubis

 D. Midway between umbilicus and symphysis pubis

Incorrect
Correct Answer: B. Level of umbilicus
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
fingerbreadth (1cm) every day until it becomes no longer palpable above the symphysis pubis.
 Option A: The fundus continues to descend into the pelvis at the rate of approximately one centimeter
(finger-breadth) per day and should be nonpalpable by two weeks postpartum.
 Option C: By approximately one-hour post-delivery, the fundus is firm and at the level of the umbilicus. The
fundus continues to descend into the pelvis at the rate of approximate
 Option D: Immediately after delivery, the upper portion of the uterus, known as the fundus, is midline and
palpable halfway between the symphysis pubis and the umbilicus.

45. 45. Question

1 point(s)
A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client
has a saturated perineal pad in 1 hour. The nurse reports the amount of lochial flow as:

 A. Scanty

 B. Light

 C. Heavy

 D. Excessive
Incorrect
Correct Answer: C. Heavy
Heavy lochial discharge is a saturated menstrual pad in 1 hour. The woman can expect to see fresh red or browny-
red blood loss. The flow of blood may be quite heavy, soaking a maternity pad every few hours. Don’t be alarmed if
there are one or two quite large blood clots, they may even be as large as a plum, or the woman may pass several
smaller ones about the same size as grapes. They are all just remnants of the placenta coming out of the body as it’s
no longer needed.
 Option A: Scanty = less than 2.5 cm on a menstrual pad in 1 hour.16. After three weeks: Any blood loss at
this stage should be a pale, yellowish-white in colour – or the woman may find there is no blood at all.
 Option B: Light = less than 10 cm on a menstrual pad in 1 hour. After one week, the blood should now have
turned a pinky brown colour and the stain on maternity pads should be getting smaller and lighter. The pad
shouldn’t be soaking at any time and the woman should let her midwife know if she thinks she might be
passing too much blood after one week. She may pass little blood clots, about the size or a raisin or smaller.
This is all totally normal.
 Option D: Excessive = menstrual pad saturated in 15 minutes. If the woman passes large blood clots after
the first 24 hours, or she continues to pass blood clots after one week, it is important to contact a midwife or
doctor straight away.
46. 46. Question
1 point(s)
In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?

 A. 2-4 weeks

 B. 6-8 weeks

 C. 6 months

 D. 12 months
Incorrect
Correct Answer: B. 6-8 weeks
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 Follicle-Stimulating Hormone (FSH) which in turn stimulates the ovary
to again mature a Graafian follicle and the menstrual cycle post pregnancy resumes.
 Option A: If the mother is nursing, she will typically not have her normal period for many months, depending
on the amount and frequency of nursing and a number of supplemental feedings, if any. Research suggests
only 20% of breastfeeding mothers will get their period back within the first six months.
 Option C: Once the mother has weaned, her period will usually follow within a month or two. The woman
may also see her period return as her baby begins to eat more solid foods or begins to supplement with
formula or solids. This is normal as the amount of breastfeeding is less, meaning the mother is more likely to
ovulate.
 Option D: Some women use the lactational amenorrhea (LAM) technique as a means of birth control during
this time. This is a very specific method of birth control with strict rules. Not every breastfeeding mother can
use this for birth control.?

47. 47. Question

1 point(s)
The following are nursing measures to stimulate lactation, except:

 A. Frequent regular breastfeeding

 B. Breast pumping

 C. Breast massage

 D. Application of cold compress on the breast

Correct
Correct Answer: D. Application of cold compress on the breast
To stimulate lactation, a warm compress is applied to the breast. A cold application will cause vasoconstriction thus
reducing the blood supply consequently the production of milk.
  Option A: Make sure that the baby is latching on to the breast correctly. Latching the baby on properly is the
most efficient way to increase the supply. A poor latch is often the main reason a mother’s supply of breast
milk isn’t as abundant as it can be. Without a proper latch, the baby cannot remove the milk from the breast
well.
 Option B: Use a breast pump or a hand expression technique to continue to stimulate the breasts after
finishing breastfeeding the baby. The extra stimulation will tell the woman’s body that she needs more
breast milk.
 Option C: Starting about two months before the date the baby is expected to join the family, if time permits,
introducing a routine of stimulus and expression for the breasts can help with milk production. Gently
massage the breasts by hand for a few minutes, then use a hospital-grade (multi-user) double electric
breast pump for about 10 minutes more. Do this after waking, before going to sleep, and several times
throughout the day for the body to begin reacting to the implied “demand” for breast milk. Drops of milk
usually appear, on average, about a month or so after starting this routine, and milk supply typically builds
over time.

48. 48. Question

1 point(s)
When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect which of
the following?

 A. Uterine hypercontractility

 B. Uterine atony

 C. Uterine inversion

 D. Laceration of soft tissues of the cervix and vagina

Correct
Correct Answer: D. Laceration of soft tissues of the cervix and vagina.
When the 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 most common complication of a perineal laceration is bleeding.
Most bleeding can be quickly controlled with pressure and surgical repair. However, hematoma formation can lead to
large amounts of blood loss in a very short time.
 Option A: Uterine hyperstimulation or hypercontractility is a serious complication of labor induction. It is
defined as single contractions lasting 2 minutes or more, or five or more contractions in a 10 minute period.
 Option B: Uterine atony refers to the corpus uteri myometrial cell’s inadequate contraction in response to
endogenous oxytocin that is released in the course of delivery. It leads to postpartum hemorrhage as the
delivery of the placenta leaves disrupted spiral arteries which are uniquely void of musculature and
dependent on contractions to mechanically squeeze them into a hemostatic state. Uterine atony is a
principal cause of postpartum hemorrhage, an obstetric emergency. Globally, this is one of the top 5 causes
of maternal mortality.
 Option C: Uterine inversion is one of the most serious complications of childbirth. Uterine inversion refers to
the collapse of the fundus into the uterine cavity. Although it does not often occur, it carries a high risk of
mortality due to hemorrhage and shock.

49. 49. Question

1 point(s)
 The following are interventions to make the fundus contract postpartally, except:

 A. Make the baby suck the breast regularly.

 B. Apply ice cap on fundus.

 C. Massage the fundus vigorously for 15 minutes until contracted.

 D. Give oxytocin as ordered.

Incorrect
Correct Answer: C. Massage the fundus vigorously for 15 minutes until contracted.
Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feels firm and
contracted. If the massage is vigorous and prolonged, the uterus will relax due to overstimulation.
 Option A: If the woman breastfeeds, the hormone oxytocin is released, which causes the uterus to contract.
 Option B: Cooling the uterus by placing an icepack on the lower abdomen is one of the standard non-
pharmacological prophylactic strategies to prevent PPH in Japan; the reasoning is that cold compresses
may help to contract the myometrium and decrease blood loss. Cold therapy causes blood vessels within
the smooth muscles to constrict, which subsequently decreases blood flow. Furthermore, blood vessels in
the skin are affected by cold, resulting in somatovisceral reflex and subsequent vasoconstriction of relevant
internal organs
 Option D: Prophylactic administration of oxytocin (Pitocin) reduces rates of postpartum hemorrhage by 40
percent; this reduction also occurs if oxytocin is given after placental delivery. Oxytocin is the drug of choice
for preventing postpartum hemorrhage because it is at least as effective as ergot alkaloids or prostaglandins
and has fewer side effects. Misoprostol (Cytotec) has a role in the prevention of postpartum hemorrhage;
this agent has more side effects but is inexpensive, heat- and light-stable, and requires no syringes.

50. 50. Question

1 point(s)
The following are nursing interventions to relieve episiotomy wound pain, except:

 A. Giving analgesic as ordered

 B. Sitz bath

 C. Perineal heat

 D. Perineal care
Correct
Correct Answer: D. Perineal care
Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or
not.
 Option A: Analgesics such as ibuprofen may be taken as prescribed by the physician to relieve pain.
  Option B: Use sitz baths (sit in water that covers the vulvar area) a few times a day. Wait until 24 hours after
giving birth to take a sitz bath as well. The woman can buy tubs in any drug store that will fit on the rim of
the toilet. If she prefers, she can sit in this kind of tub instead of climbing into the bathtub.
 Option C: Take warm baths but wait until 24 hours after giving birth. Make sure that the bathtub is cleaned
with a disinfectant before every bath.

51. 51. Question

1 point(s)
Postpartum blues is said to be normal provided that the following characteristics are present. These are

 A. Within 3-10 days only

 B. Woman exhibits the following symptoms- episodic tearfulness, fatigue, oversensitivity, poor appetite

 C. Maybe more severe symptoms in primipara

 D. All of the above

Correct
Correct Answer: D. All of the above
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 last more than 2
weeks, this could be a sign of abnormality like postpartum depression and needs treatment.
 Option A: Postpartum blues, also known as “baby blues,” affect approximately 50% to 80% of new mothers.
Symptoms may include mood swings with times of feeling anxious, irritable, or tearful interspersed with
times of feeling well. Sleeping difficulties may also occur.
 Option B: The symptoms usually begin 3-4 days after delivery, worsen by days 5-7, and tend to resolve by
day 12. For symptoms that last longer than 2 weeks, it is important for the individual to seek medical
attention since approximately 1 in 5 women with postpartum blues develops postpartum major depression.
 Option C: About 60–80% of all new mothers suffer from the PPB which rarely requires medication and
normally subsides with support and education. It is significant to carry out the follow-up because up to 20%
of these mothers are likely to progress to PPD and an adverse consequence on children’s cognitive growth.

52. 52. Question

1 point(s)
The neonatal circulation differs from the fetal circulation because

 A. The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed 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. The blood in the left side of the fetal heart contains oxygenated blood while the blood on the right side
contains unoxygenated blood.
 D. None of the above.
Incorrect
Correct Answer: A. 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 fluid-filled while in utero and are still not functioning. It only begins to function in extrauterine life.
Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.
 Option B: The hole between the top two heart chambers (right and left atrium) is called a patent foramen
ovale (PFO). This hole allows the oxygen rich blood to go from the right atrium to the left atrium and then to
the left ventricle and out the aorta. As a result the blood with the most oxygen gets to the brain.
 Option C: The placenta accepts the blood without oxygen from the fetus through blood vessels that leave
the fetus through the umbilical cord (umbilical arteries, there are two of them). When blood goes through the
placenta it picks up oxygen. The oxygen rich blood then returns to the fetus via the third vessel in the
umbilical cord (umbilical vein). The oxygen rich blood that enters the fetus passes through the fetal liver and
enters the right side of the heart.

53. 53. Question

1 point(s)
The normal respiration of a newborn immediately after birth is characterized as:

 A. Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per
minute.

 B. 20-40 breaths per minute, abdominal breathing with active use of intercostals muscles.

 C. 30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing.

 D. 30-50 breaths per minute, active use of abdominal and intercostal muscles.
Incorrect
Correct Answer: A. Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60
breaths per minute.
A newly born baby still is adjusting to extra 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.
 Option B: The natural elastic property of the lungs is to deflate. When balanced by the outward recoil of the
chest wall, functional residual capacity (FRC) occurs at the end of expiration to prevent alveoli from
collapsing. The newborn chest wall, composed primarily of cartilage, is more pliable, predisposing neonatal
lungs to pulmonary atelectasis and decreased FRC.
 Option C: Normally, the newborn’s respiratory rate is 30 to 60 breaths per minute. Tachypnea is defined as
a respiratory rate greater than 60 breaths per minute. Tachypnea is a compensatory mechanism for
hypercarbia, hypoxemia, or acidosis (both metabolic and respiratory), making it a common but nonspecific
finding in a large variety of respiratory, cardiovascular, metabolic, or systemic diseases.
 Option D: A newborn’s breathing rate is normally 40 to 60 breaths per minute. The Apgar score helps find
breathing problems and other health issues. It is part of the special attention given to a baby in the first few
minutes after birth. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates,
 muscle tone, reflexes, and color. A baby who needs help with any of these issues is getting constant
attention during those first 5 to 10 minutes.

54. 54. Question

1 point(s)
The anterior fontanelle is characterized as:

 A. 3-4 cm anteroposterior diameter and 2-3 cm transverse diameter, diamond shape.

 B. 2-3 cm anteroposterior diameter and 3-4 cm transverse diameter and diamond shape.

 C. 2-3 cm in both anteroposterior and transverse diameter and diamond shape.

 D. None of the above.

Incorrect
Correct Answer: A. 3-4 cm anteroposterior diameter and 2-3 cm transverse diameter, diamond shape.
The anterior fontanelle is a diamond shape with the anteroposterior diameter being longer than the transverse
diameter. The posterior fontanelle is a triangular shape.
 Option B: The anterior fontanelle is the largest of the six fontanelles, and it resembles a diamond-shape
ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm.
 Option C: It forms through the juxtaposition of the frontal bones and parietal bones with the superior sagittal
sinus coursing beneath it. Two frontal bones join to form one-half the anterior fontanelle with the metopic
suture serving as the parallel divider between the paired bones.
 Option D: Next, the parietal bones are positioned against each other to complete the fontanelle. The
positioning of the two parietal bones against each other gives rise to the sagittal suture. Finally, the
alignment of the frontal bones against the parietal bones establishes the coronal suture.

55. 55. Question

1 point(s)
The ideal site for vitamin K injection in the newborn is:

 A. Right upper arm

 B. Left upper arm

 C. Either right or left buttocks

 D. Middle third of the thigh

Correct
Correct Answer: D. Middle third of the thigh
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.
  Option A: The deltoid in infants is not sufficiently bulky to absorb IM medications adequately. The vastus
lateralis muscle avoids the thicker layer of subcutaneous fat on the anterior thigh.
 Option B: The anterolateral thigh is the preferred site for IM injection in infants under 12 months of age.
Medications are injected into the bulkiest part of the vastus lateralis thigh muscle, which is the junction of the
upper and middle thirds of this muscle.
 Option C: Using the vastus lateralis muscle avoids the risk of sciatic nerve damage from gluteal injection.
Also, the vastus lateralis muscle has a larger muscle mass than the gluteal region and therefore has
reduced risk of severe local reactions.

56. 56. Question

1 point(s)
At what APGAR score at 5 minutes after birth should resuscitation be initiated?

 A. 1-3

 B. 7-8

 C. 9-10

 D. 6-7
Incorrect
Correct Answer: A. 1-3
An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10. Apgar
is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby
tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside
the mother’s womb.
 Option B: A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. This test is done to
determine whether a newborn needs help breathing or is having heart trouble.
 Option C: The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is
doing after birth. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and
feet, which is normal for after birth.
 Option D: Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the
more help the baby needs to adjust outside the mother’s womb.

57. 57. Question

1 point(s)
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. Acrocyanosis

 C. Peripheral cyanosis
 D. Cephalo-caudal cyanosis
Incorrect
Correct Answer: B. Acrocyanosis
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. This is relatively common in young infants, and is generally a physiologic finding due to the large
arteriovenous oxygen difference that results during slow flow through peripheral capillary beds.
 Option A: Syndactyly is the most common congenital malformation of the limbs, with an incidence of 1 in
2000-3000 live births. It is a failure of differentiation in which the fingers fail to separate into individual
appendages. This separation usually occurs during the sixth and eighth weeks of embryological
development.
 Option C: Peripheral cyanosis is the bluish discoloration of the distal extremities (hands, fingertips, toes),
and can sometimes involve circumoral and periorbital areas. Mucous membranes are generally not
involved. Peripheral cyanosis is rarely a life-threatening medical emergency.
 Option D: Cephalocaudal proceeds or occurs in the long axis of the body especially in the direction from
head to tail.

58. 58. Question

1 point(s)
The minimum birth weight for full-term babies to be considered normal is:

 A. 2,000 gms

 B. 1,500 gms

 C. 2,500 gms

 D. 3,000 gms
Incorrect
Correct Answer: C. 2,500 gms
According to the WHO standard, the minimum normal birth weight of a full-term baby is 2,500 gms or 2.5 Kg.
 Option A: Low birth weight (LBW) are birth weights that are less than 5 pounds, 8 ounces (2,500 grams).
 Option B: Very low birth weight (VLBW)refers to birth weights less than 3.4 pounds (1,500 grams).
 Option D: High birth weight (HBW) refers to birth weights of more than 8 pounds, 13 ounces (4,000 grams).

59. 59. Question

1 point(s)
This procedure is done to prevent ophthalmia neonatorum is:

 A. Marmet’s technique

 B. Ophthalmic wash
 C. Ritgen’s method

 D. Crede’s method
Correct
Correct Answer: D. Crede’s method
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.
 Option A: Developed by a mother who needed to express her milk over a long period of time for medical
reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended
method of expressing breastmilk by hand.
 Option B: Irrigation of the eye with sterile isotonic saline may be done for neonatal conjunctivitis, and
systemic treatment is required for staphylococcal, gonococcal, Chlamydia, Pseudomonas, and hepatic
conjunctivitis
 Option C: Ritgen’s maneuver means that the fetal chin is reached between the anus and the coccyx and
pulled anteriorly, while using the fingers of the other hand on the fetal occiput to control speed of delivery
and keep flexion of the fetal neck.
.

60. 60. Question

1 point(s)
Which of the following characteristics will distinguish a postmature neonate at birth?

 A. Plenty of lanugo and vernix caseosa.

 B. Lanugo mainly on the shoulders and vernix in the skin folds.

 C. Pinkish skin with good turgor.

 D. Almost leather-like, dry, cracked skin, negligible vernix caseosa.

Correct
Correct Answer: D. Almost leather-like, dry, cracked skin, negligible vernix caseosa
A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already
diminished.
 Option A: Lanugo plays an important role in binding the vernix caseosa to the skin of fetuses. Vernix
caseosa is the viscous white covering on newborns that protects their skin, prevents water loss, plays an
important role in thermoregulation, and contributes to innate immunity.
 Option B: Lanugo is the first type of hair to develop in humans. The interaction of lanugo with the vernix is
also important in controlling the tempo of the fetal developmental rate during various times in the gestation
cycle. Lanugo arises at about three months into development. Hair growth starts on the scalp around the
eyebrow, nose, and forehead area and proceeds in a cephalocaudal direction from head to toe. It is shed at
about 33 to 36 weeks gestation, when it becomes subsequently incorporated into the amniotic fluid,
eventually contributing to the composition of the meconium.
 Option C: The skin of a healthy newborn at birth has: Deep red or purple skin and bluish hands and feet.
The skin darkens before the infant takes their first breath (when they make that first vigorous cry). A thick,
waxy substance called vernix covering the skin.
61. 61. Question
1 point(s)
What would be the appropriate first nursing action when caring for a 20-year old G1P0 woman at 39 weeks gestation
who is in active labor and for whom an assessment reveals mild variable fetal heart rate deceleration

 A. Notify the physician

 B. Prepare the client for immediate delivery

 C. Readjust the fetal monitor

 D. Change the maternal position

Correct
Correct Answer: D. Change the maternal position
The cause of variable fetal heart decelerations is umbilical cord compression, which can usually be corrected by
changing the maternal position.
 Option A: Before informing the physician, the nurse must first intervene. Common causes of variable
decelerations include vagal reflex triggered by head compression during pushing and cord compression
such as that caused by short cord, nuchal cord, body entanglement, prolapsed cord, decreased amniotic
fluid, and fetal descent.
 Option B: Perform a cervical exam to rule out prolapsed cord and funic presentation and check for imminent
delivery only if appropriate.
 Option C: Variable decelerations occur when the fetal heart rate decrease is greater than or equal to 15
beats per minute and last for longer than or equal to 15 seconds but less than 2 minutes from onset to
return to baseline.

62. 62. Question

1 point(s)
In basal body temperature (BBT) technique, the sign that ovulation has occurred is an elevation of body temperature
by

 A. 1.0-1.4 degrees centigrade

 B. 0.2-0.4 degrees centigrade

 C. 2.0-4.0 degrees centigrade

 D. 1.0-4.0 degrees centigrade

Incorrect
Correct Answer: B. 0.2-0.4 degrees centigrade
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.
  Option A: Basal body temperature (BBT) is defined as the lowest natural, non-pathologic body temperature
recorded after a period of rest. Women have used charting average basal body temperatures over the
length of a menstrual period has been a tool to determine if ovulation has occurred or not.
 Option C: Ideally, charting the daily basal body temperature will show a noticeable increase of
approximately 0.5 to 1 degrees F shortly after ovulation. This increase then sustains until the start of
menstruation in which BBT then decreases back to baseline.
 Option D: For most accurate results, temperatures need to be recorded at the same time every day,
immediately upon waking up. Measurements are also subject to environmental influences such as a fever
secondary to an infectious process, emotional stressors, alcohol consumption, and the addition or
discontinuation of oral contraception from a daily regimen.

63. 63. Question

1 point(s)
Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if

 A. The mother breastfeeds mainly at night time when ovulation could possibly occur.

 B. The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental
feedings.

 C. The mother uses mixed feeding faithfully.

 D. The mother breastfeeds regularly until 1 year with no supplemental feedings.

Incorrect
Correct Answer: B. The mother breastfeeds exclusively and regularly during the first 6 months without giving
supplemental feedings.
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 last for 6 months provided the
woman has not had her first menstruation since delivery of the baby.
 Option A: This method requires breastfeeding of the baby every 4 hours during the day and every 6 hours at
night. Elevated prolactin levels and a reduction of gonadotropin-releasing hormone from the hypothalamus
during lactation suppress ovulation. This leads to a reduction in luteinizing hormone (LH) release and
inhibition of follicular maturation.
 Option C: The duration of this suppression varies and is influenced by the frequency and duration of
breastfeeding and the length of time since birth. No supplementation of other foods or formula are allowed,
only exclusive breastfeeding.
 Option D: The baby must be younger than 6 months for perfect use. The perfect-use failure rate within the
first 6 months is 0.5%. The typical-use failure rate within the first 6 months is 2%.

64. 64. Question

1 point(s)
The intrauterine device prevents pregnancy by the ffg mechanism, except:

 A. Endometrium inflames.
 B. Fundus contracts to expel uterine contents.

 C. Copper embedded in the IUD can kill the sperms.

 D. Sperms will be barred from entering the fallopian tubes.

Correct
Correct Answer: D. Sperms will be barred from entering the fallopian tubes.
An Intrauterine device is a T-shaped piece of plastic placed inside the uterus. The piece of plastic contains copper or
a synthetic progesterone hormone that prevents pregnancy. The device releases a constant low dose of a synthetic
hormone continually throughout the day. 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 in size can still pass through.
 Option A: An intrauterine device is a foreign body so that if it is inserted into the uterine cavity, the initial
reaction is to produce an inflammatory process and the uterus will contract in order to try to expel the foreign
body.
 Option B: The IUD changes the lining of the uterus, preventing implantation should fertilization occur. It is
important to consider the ethical implications of this third method.
 Option C: The released progesterone or copper creates changes in the cervical mucus and inside the uterus
that kills sperm or makes them immobile.

65. 65. Question

1 point(s)
Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding?

 A. Estrogen-only

 B. Progesterone only

 C. Mixed type- estrogen and progesterone

 D. 21-day pills mixed type

Incorrect
Correct Answer: B. Progesterone only
Currently, there are three types of oral contraceptive pills: combined estrogen-progesterone, progesterone only and
the continuous or extended use pill. If the mother is breastfeeding, the progesterone only type is the best because
estrogen can affect lactation.
 Option A: Estrogen has some effect with inhibiting follicular development because of its negative feedback
on the anterior pituitary with slow FSH secretion; it’s just not as prominent as the progesterone’s effect.
 Option C: The most commonly prescribed pill is the combined hormonal pill with estrogen and progesterone.
Progesterone is the hormone that prevents pregnancy, and the estrogen component will control menstrual
bleeding.
 Option D: Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then
no pills are taken for the next 7 days.
66. 66. Question
1 point(s)
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 how many days?

 A. 21-26 days

 B. 26-32 days

 C. 28-30 days

 D. 24- 36 days
Incorrect
Correct Answer: B. 26-32 days
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.
 Option A: The Standard Days Method (SDM) is a method of family planning that assumes ovulation to be
close to the midpoint of the menstrual cycle; fertility falls between days 8 and 19; and is most effective for
cycle lengths between twenty-six and thirty-two days.
 Option C: The fixed-day algorithm for the SDM is based on statistical evidence that ovulation occurs around
the middle of the cycle for menstrual cycles that have lengths between twenty-six and thirty-two days.
Theoretically, the SDM will be most effective when the day of ovulation falls close to the center of the
menstrual cycle.
 Option D: For the SDM to be effective, the actual fertile phase of the menstrual cycle should not fall outside
of days 8 through 19 too frequently. The fertile phase of the menstrual cycle is approximately six days, that
is, the day of ovulation and the five days before. The most fertile of those six days are the two days before
ovulation.

67. 67. Question

1 point(s)
Nurse Lesley is conducting health teachings to a group of first-time mothers. Which of the following are signs of
ovulation? Select all that apply.

 A. Mittelschmerz

 B. Spinnbarkeit

 C. Thin watery cervical mucus

 D. Elevated body temperature of 4.0 degrees centigrade

Incorrect
Correct Answer: A, B, & C
 Mittelschmerz, spinnbarkeit 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. Mittelschmerz is one-sided, lower abdominal pain associated with
ovulation. German for “middle pain,” mittelschmerz occurs midway through a menstrual cycle — about 14 days
before the next menstrual period. In most cases, mittelschmerz doesn’t require medical attention. The ‘stretchability’
of cervical mucus, or the length that strands of cervical mucus reach before breaking–? 6 cm, a reaction that parallels
‘ferning’ reaction, peaking on the 14th day–ovulation of the menstrual cycle. This kind of cervical mucus stretches
further than creamy cervical mucus, and it appears clearer. While not the “ideal” fertile cervical mucus, watery
cervical mucus is fertile.

68. 68. Question

1 point(s)
The following methods of artificial birth control works as a barrier device, except:

 A. Condom

 B. Cervical cap

 C. Cervical Diaphragm

 D. Intrauterine device (IUD)

Correct
Correct Answer: D. Intrauterine device (IUD)
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.
 Option A: Condoms are the only type of contraception that can both prevent pregnancy and protect against
sexually transmitted infections (STIs). Condoms are a “barrier” method of contraception. They are made of
very thin latex (rubber), polyurethane or polyisoprene and are designed to prevent pregnancy by stopping
sperm from meeting an egg.
 Option B: The cervical cap is a birth control (contraceptive) device that prevents sperm from entering the
uterus. The cervical cap is a reusable, deep silicone cup that is inserted into the vagina and fits tightly over
the cervix. The cervical cap is held in place by suction and has a strap to help with removal. The cervical
cap is effective at preventing pregnancy only when used with spermicide.
 Option C: The diaphragm is a birth control (contraceptive) device that prevents sperm from entering the
uterus. The diaphragm is a small, reusable rubber or silicone cup with a flexible rim that covers the cervix.
Before sex, the diaphragm is inserted deep into the vagina so that part of the rim fits snugly behind the
pubic bone. The diaphragm is effective at preventing pregnancy only when used with spermicide.

69. 69. Question

1 point(s)
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.

Incorrect
Correct Answer: B. It may occur between 14-16 days before next menstruation.
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.
 Option A: Ovulation occurs approximately 10-12 hours after the LH peak. The LH surge is initiated by a
dramatic rise of estradiol produced by the preovulatory follicle
 Option C: The luteal phase is 14 days long in most women. If the corpus luteum is not rescued by
pregnancy, it will undergo atresia. The resultant progesterone withdrawal results in menses.
 Option D: The follicular phase begins from the first day of menses until ovulation. The development of
ovarian follicles characterizes this phase. The LH surge is initiated by a dramatic rise of estradiol produced
by the preovulatory follicle and results in subsequent ovulation. The LH surge stimulates luteinization of the
granulosa cells and stimulates the synthesis of progesterone responsible for the midcycle FSH surge. Also,
the LH surge stimulates resumption of meiosis and the completion of reduction division in the oocyte with
the release of the first polar body.

70. 70. Question

1 point(s)
If a couple would like to enhance their fertility, the following means can be done. Select all that apply.

 A. Monitor the basal body temperature of the woman every day to determine peak period of fertility.

 B. Have adequate rest and nutrition

 C. Have sexual contact only during the dry period of the woman

 D. Undergo a complete medical check-up to rule out any debilitating disease

Incorrect
Correct Answer: A, B, & D
All of the above are essential for enhanced fertility except option C 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.
 Option A: By measuring the basal body temperature every morning before getting out of bed, the woman
might be able to detect, first, a very slight decrease then a very slight rise in temperature for three mornings
in a row. The temperature rise may be as little as half of a degree. This can be a signal that she has
ovulated. Keep in mind that an egg only survives about 24 hours after ovulation so this so-called fertile
window may not be a good indicator of when the couple should have sex.
  Option B: The doctor might recommend that the couple make lifestyle changes before they get pregnant.
These might include getting to a healthy weight; improving diet/exercise habits; eliminating alcohol; quitting
smoking, if they smoke; and cutting back on caffeine.
 Option D: Most healthy couples will conceive within a year of actively trying to get pregnant. If the woman
doesn’t get pregnant within a year and is under age 35, they should see a doctor for a fertility evaluation. If
the woman is over 35, she should only wait six months before seeing a doctor.

71. 71. Question

1 point(s)
In the sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are:

 A. Temperature, cervical mucus, cervical consistency

 B. Release of ovum, temperature, and vagina

 C. Temperature and wetness

 D. Temperature, endometrial secretion, mucus

Incorrect
Correct Answer: A. Temperature, cervical mucus, cervical consistency
The 3 parameters measured/monitored which will indicate that the woman has ovulated are- a temperature increase
of about 0.2-0.4 degrees centigrade, a softness of the cervix and cervical mucus that looks like the white of an egg
which makes the woman feel “wet”.
 Option B: The symptothermal method is a combination of methods. The two most commonly used are the
BBT method and the cervical mucus method. The Marquette method combines BBT and cervical mucus
tracking with use of an electronic hormonal fertility monitor. The monitor detects hormones in urine to
confirm fertile days. It can be purchased online or at a pharmacy.
 Option C: The symptothermal method combines calendar calculations, basal body temperature charting,
and cervical mucus monitoring.
 Option D: Cervical secretions are the foundation for this method, and the other techniques provide a
“double-check.” Women may use other signs (e.g., consistency and position of the cervix) or symptoms
(e.g., breast tenderness, ovulatory pain) to aid in the identification of the fertile period.

72. 72. Question

1 point(s)
The following are important considerations to teach the woman who is on a low dose (mini-pill) oral
contraceptive except:

 A. The pill must be taken every day at the same time.

 B. If the woman fails to take a pill in one day, she must take 2 pills for added protection.

 C. 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.
 D. If she is breastfeeding, she should discontinue using mini-pill and use the progestin-only type.
Incorrect
Correct Answer: B. If the woman fails to take a pill in one day, she must take 2 pills for added protection.
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.
 Option A: Combined oral contraceptive pills are to be taken daily at approximately the same time each day.
Avoid taking them greater than 24 hours apart as this could affect efficacy.
 Option C: If you miss a tablet just take the missed tablet as soon as you remember and the next tablet at the
usual time (taking 2 tablets in 1 day). If you miss 2 tablets in a row in the first or second week then take 2
tablets the day you remember and 2 tablets the next day, then resume 1 per day. Use another form of
contraception until you begin a new cycle.
 Option D: Progestin-only oral contraceptives, or “The Mini-Pill,” contain only a progestin (a female hormone).
The method, when used daily, is highly effective for breastfeeding women. This method of contraception has
a slightly higher failure rate than oral contraceptives (OCs) containing both estrogen and progestin.

73. 73. Question

1 point(s)
To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is

 A. Huhner’s test

 B. Postcoital test

 C. Rubin’s test

 D. None of the above

Incorrect
Correct Answer: C. Rubin’s test
Rubin’s test is a test to determine patency of fallopian tubes. Huhner’s test is also known as post-coital test to
determine the compatibility of the cervical mucus with sperms of the sexual partner.
 Options A and B: The postcoital test or Huhner’s test determines the adequacy of sperm and the receptivity
of cervical mucus. It is the only test which evaluates the interaction between sperm and the female genital
tract fluids. The Sims-Huhner test should be an integral part of an infertility investigation, but it must not be
used as a substitute for semen analysis. Since cervical mucus accurately reflects the ovarian cycle, the PC
test is a useful indicator of the endocrine preparation of the female reproductive system. It is also an
important method for the evaluation of a variety of contraceptive steroids which may act directly or indirectly
upon cervical secretion.

74. 74. Question

1 point(s)
Infertility can be attributed to male causes such as the following except:
 A. Cryptorchidism

 B. Orchitis

 C. Sperm count of about 20 million per milliliter

 D. Premature ejaculation
Incorrect
Correct Answer: C. Sperm count of about 20 million per milliliter
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.
 Option A: Cryptorchidism is the most common genital problem encountered in pediatrics. Cryptorchidism
literally means hidden or obscure testis and generally refers to an undescended or maldescended testis.
 Option B: Orchitis is an acute inflammatory reaction of the testis secondary to infection. Most cases are
associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis. Testicular
examination reveals the following: testicular enlargement, induration of the testis, tenderness, erythematous
scrotal skin, edematous scrotal skin, and enlarged epididymis associated with epididymo-orchitis.
 Option D: Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or
his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as
1 out of 3 men say they experience this problem at some time.

75. 75. Question

1 point(s)
Spinnbarkeit is an indicator of ovulation which is characterized as:

 A. Thin watery mucus which can be stretched into a long strand about 10 cm.

 B. Thick mucus that is detached from the cervix during ovulation.

 C. Thin mucus that is yellowish in color with fishy odor.

 D. Thick mucus vaginal discharge is influenced by high levels of estrogen.

Incorrect
Correct Answer: A. Thin watery mucus which can be stretched into a long strand about 10 cm
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 spinnbarkeit. And the
woman feels “wet”. When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel
“dry”.
 Option B: Creamy cervical mucus is considered non-fertile since it greatly restricts the movement of sperm.
It is often pearly white or creamy yellow. It is thick and feels like lotion when rubbed between the fingers.
 Option C: Although “yeast” is the name most women know, bacterial vaginosis (BV) actually is the most
common vaginal infection in women of reproductive age. Bacterial vaginosis often will cause an abnormal
smelling vaginal discharge. The discharge usually is thin and milky, and is described as having a “fishy”
odor.
 Option D: Spinnbarkeit mucus is the stringy, stretchy quality of cervical mucus found especially around the
time of ovulation. Usually a result of high estrogen levels, spinnbarkeit mucus refers to the egg white quality
of cervical mucus that is easier for sperm to penetrate.