Obstetric Nursing

Question 1
The obstetrician who pointed out that a baby born in a less stressful environment is more content is:

Dr. Grantly Dick-Read Dr. Robert Bradley Dr. Ferdinand Lamaze Dr. Frederick Leboyer
Question 1 Explanation:Leboyer childbirth method was introduced by Frederick Leboyer. He is a French obstetrician who believed that the traditional hospital births of the time (1975) were traumatic for the infant. In 1975, he published a book entitled Birth without Violence, where depth of a newborns sensitivity and the importance of how the baby is handled by the people around him were emphasized. He pointed out that babies born in a less stressful environment were more content.

Question 2
The easiest method for determining if a womans caloric intake is adequate is assessing:

Food intake Bowel pattern Weight she is gaining A typical day history or a 24 hour nutrition recall
Question 2 Explanation:The easiest method for determining if a womans caloric intake is adequate is assessing the weight she is gaining. (Pillitteri, 5th Ed). A typical day history or a 24 hour nutrition recall is the best method for assessing overall nutritional intake.

Question 3
The following concepts are emphasized in a Bradley class apart from:

Avoidance of drugs throughout the pregnancy Natural breathing methods (without patterns) Coaching techniques Woman should change position during labor

Question 3 Explanation:Encouraging a woman on labor to change position during labor is a concept of Lamaze method to stimulate cutaneous stimulation. The following concepts are taught in Bradley Classes: Natural birth process Active involvement of the husband as a coach Proper nutrition during pregnancy Avoidance of drugs throughout the pregnancy Natural breathing methods (without patterns) Coaching techniques Natural pain coping methods Maternal-newborn bonding Breastfeeding Education on emergent situations throughout pregnancy and delivery (CS) Postpartum and newborn care Responsible parenthood

Question 4
Childbirth education is vital for a successful and comfortable childbirth method. The first method that includes the father as a support person while embracing the belief that childbirth is a natural event and with the right preparation most women can have spontaneous and unmedicated vaginal births is:

Lamaze method Leboyer method Bradley method Grantly Dick-Read method

Question 4 Explanation:Bradley childbirth method was the first technique to include the father as a support person during delivery. This method embraces the belief that childbirth is a natural event and with the right preparation most women can have spontaneous and unmedicated vaginal births. Lamaze method is a prepared labor and delivery technique. It is often called psychoprophylactic method as it uses the mind (psyche) to prevent labor pains (prophylaxis). Leboyer childbirth method sometimes termed as birth without violence, views birth as a stressful experience for the newborn. The focus of this method is to primarily improve the quality of the birth experience for the baby. Grantly Dick-read Method is a psychophysiological preparation for childbirth. This technique alleviates pain during childbirth by blocking feelings of fear and tension.

Question 5
The entitled Childbirth without Fear is authored by:

Dr. Grantly Dick-Read Dr. Robert Bradley Dr. Ferdinand Lamaze

Dr. Frederick Leboyer

Question 5 Explanation:Dr. Grantly Dick-Read is an English obstetrician who was practicing medicine in 1900s. On 1933 his book, Childbirth without Fear, was published. He explained in this publication that no physiological function in a persons body can give rise to pain under the condition that it is of normal course of health. Unless a disease process is taking place, pain or agony would associate delivery Bradley Method was named after an American obstetrician Dr. Robert Bradley. Husband Coached Childbirth, was written by Dr. Bradley and his principles and theories paved the way for fathers to be present in the delivery room. This changed the face of childbirth around the globe. Lamaze childbirth method is an alternative to the use of medical intervention during childbirth. The method was originally developed in Russia (based on Pavlovs conditioning studies) but was popularized by a French obstetrician Dr. Ferdinand Lamaze. After watching a woman gave birth in Russia Dr. Lamaze developed his own system of painless childbirth. Leboyer childbirth method was introduced by Frederick Leboyer. He is a French obstetrician who believed that the traditional hospital births of the time (1975) were traumatic for the infant. In 1975, he published a book entitled Birth without Violence, where depth of a newborns sensitivity and the importance of how the baby is handled by the people around him were emphasized. He pointed out that babies born in a less stressful environment were more content.

Question 6
A sensitive and unobtrusive technique of care while respecting the natural process and promoting a peaceful atmosphere at birth will help the baby to be born with a minimum stress. This is least likely achieved by:

Keeping the room noise to a minimum Not delaying the cutting of the cord Giving the newborn a warm bath after delivery Not assisting or pulling the babys head in expulsion
Question 6 Explanation:Because of the word least likely the correct option is B. The method employed in promoting a sensitive and unobtrusive technique of care while respecting the natural process and promoting a peaceful atmosphere at birth to help the baby be born with a minimum stress is LeBoyer Childbirth Method. To decrease the trauma at birth this technique is an advocate of the following: The birthing room is darkened or dimmed. Doing so prevents sudden contrast of light that might distress the newborn. Leboyer thought that this is less shocking for the neonates eyes that have been in semi-

darkness for several months. A soft music is played or at least harsh noises are kept to a minimum. All the talking inside the delivery room is done by whispering. The room is kept pleasantly warm, not chilled, to help the newborn be comfortable with the new environment and adapt to extrauterine life more easily. Newborns are handled gently and carefully. Leboyer recommends not pulling the babys head to completely allow a natural childbirth. The umbilical cord is cut late (It is cut after it has stopped pulsating). According to Leboyer, this allows the newborn to continue receiving the maternal hormones and oxygen carrying red blood cells. This is also done to allow the baby to breathe when he is ready and not have to be rushed. The infant receives a warm bath immediately after birth for relaxation. Before maternal and newborn bonding is done, the infant is massage to ease crying. Nowadays, mothers do this massaging to encourage immediate bonding. Placing the infant in the mothers abdomen is done for maternal-neonate bonding.

Question 7
A pregnant woman is diagnosed with toxemia. The following are signs of toxemia apart from:

Edema of the lower extremities Sudden Weight gain Blurry vision Protein in urine
Question 7 Explanation:Toxemia or Pregnancy induced hypertension has the following manifestations: Edema of the face, hands, ankle and feet, proteinuria, visual disturbances, sudden weight gain, headache, fever. Edema of lower extremity alone is not a sign of toxemia as it is a normal adaptation to pregnancy that is the result of the poor circulation in the lower extremities due to the pressure from the gravid uterus. It is managed by raising the legs above the hip level. Edema of the Lower Extremities plus the upper extremities is a sign of toxemia.

Question 8
The structure which contains high amount of estrogen is called:

Corpus albicans Corpus luteum Primordial follicles Graafian follicles

Question 8 Explanation:Graafian follicles are structures containing

high amounts of estrogen. Graafian follicle are derived from primordial follicles. Corpus Luteum is the structure containing high amounts of progesterone and is yellow in color. If no fertilization occurs corpus luteum turns white and is now called Corpus Albicans.

Question 9
During one of the sessions a pregnant mother is expressing concern on her baby. She is voicing apprehensions on the outcome of her delivery that might be stressful to her baby. Birth without violence is under which theory?

Lamaze method Leboyer method Bradley method Grantly Dick-Read method

Question 9 Explanation:Leboyer childbirth method sometimes termed as birth without violence, views birth as a stressful experience for the newborn. The focus of this method is to primarily improve the quality of the birth experience for the baby.

Question 10
The obstetrician who associated childbirth method with Pavlovs conditioning studies is:

Dr. Grantly Dick-Read Dr. Robert Bradley Dr. Ferdinand Lamaze Dr. Frederick Leboyer
Question 10 Explanation:Lamaze childbirth method is an alternative to the use of medical intervention during childbirth. The method was originally developed in Russia (based on Pavlovs conditioning studies) but was popularized by a French obstetrician Dr. Ferdinand Lamaze. After watching a woman gave birth in Russia Dr. Lamaze developed his own system of painless childbirth.

Question 11
Change in the consistency of the lower uterine segment causing extreme softening is referred as:

Hegars sign Chadwicks sign Goodells sign

Vaginal sign
Question 11 Explanation:Hegars sign is the softening of the uterus. Goodells sign is the change in cervix consistency resembling to that of an earlobe. Chadwicks sign is the increased vascularity of the vagina changing its color from light pink to deep purple or violet. There is no known vaginal sign in pregnancy.

Question 12
Physical assessment is very important during prenatal visits to evaluate the overall health status of a pregnant woman. Weight is one indicator of the health status. A pregnant woman on her second trimester of pregnancy should gain how many kilograms per month?

0.45 kg 1.82 kg 1.36 kg 2 kg

Question 12 Explanation:Normal weight gain pattern in pregnancy is 1 lb (0.45 kg) per month in the first trimester and 1 lb per week in the second and third trimesters. Meaning to say, in the second and third trimester the pregnant woman should be gaining 4 lbs (1.82 kg) per month. To easily remember the pattern of weight gain in pregnancy is 3-12-12. 3 lbs in the first trimester and 12 lbs each in the second and third trimester.

Question 13
The priority management for Hyperemesis Gravidarum is:

Easting dry toast or crackers 30 minutes before arising in the morning Complete bed rest (CBR) D5NSS 3L in 24 hours Administer Milk of Magnesia
Question 13 Explanation:The priority treatment for Hyperemesis gravidarum is giving 3 L of D5NSS for 24 hours. CBR is also important but the main treatment is D5NSS to replace the lost fluids. Eating dry crackers before arising in the morning is the management for morning sickness not Hyperemesis gravidarum. Milk of magnesia is an antacid used to manage heartburn in pregnant woman.

Question 14
A pregnant woman is asking about the possible causes of morning sickness. The nurse least likely identifies the cause by stating which of the following?

It is due to the increased human chorionic gonadotrophin levels during pregnancy. It may be due to increased acidity of the GI tract. It may be the result of increased progesterone level which in return decreases gastric motility thus causing reverse peristaltic waves. Some cases of morning sickness can also be due to emotional factors.
Question 14 Explanation:Heartburn not morning sickness is the result of increased progesterone level which in return decreases gastric motility thus causing reverse peristaltic waves.

Question 15
A patient on labor is offered ice chips. What is the purpose of giving ice chips to a woman on labor?

To reduce a womans anxiety To prevent impulses reach the distracted brain To promote cutaneous stimulation To allow more blood to pool in the uterus, thus alleviating pain
Question 15 Explanation:In Lamaze method one technique of alleviating pain is by cutaneous stimulation. It is done by effleurage, sacral pressure, thermal stimulation (offering ice chips) and positioning. Preventing impulses to reach the brain is employing the distraction or imagery technique. Reducing a womans anxiety is done by a continuous support system. Allowing more blood to pool in the uterus to alleviate pain is a principle in Dick-Read method.

Question 16
The nurse is conducting a health teaching on expectant mothers. She is stressing the importance of childbirth education classes in one of her discussions. Most pregnant women are expressing concern about their fear on the upcoming labor. The nurse is discussing about the ways of alleviating labor pains using the mind which is based on which childbirth principle?

Lamaze method Leboyer method

Bradley method Grantly Dick-Read method

Question 16 Explanation:Lamaze method is a prepared labor and delivery technique. It is often called psychoprophylactic method as it uses the mind (psyche) to prevent labor pains (prophylaxis). The Lamaze method of prepared childbirth is based on the gating control theory of pain relief. It involves concentration and conditioning to help the woman respond to contractions with relaxation from techniques thereby alleviating pain. This is based on the theory that through stimulus-response conditioning, women can learn to use controlled breathing to reduce the pain in the labor. Lamaze method is the most popular approach used to today.

Question 17
Myra, a 25-year old woman, on labor firmly told her doctor not to give her pain medications during labor and delivery. She believes that it is best for her baby if she would not receive pain medications and no physiological events such as birth can give rise to pain under the condition that she is free from underlying diseases. Myra insisted that knowing what are expected and being tension-free during the delivery process would need no pain medications. Her principle is based on the philosophy of which method?

Lamaze method Leboyer method Bradley method Grantly Dick-Read method

Question 17 Explanation:Grantly Dick-read Method is a psychophysiological preparation for childbirth. This technique alleviates pain during childbirth by blocking feelings of fear and tension. Dr. Dick-Read postulated that this fear felt by women during delivery causes the blood to be carried away from the uterus to be used by the muscles needing it due to perceived pain. This results to an unoxygenated uterus which would be unable to perform its function well leading to pain, a phenomenon called the fear-tensionpain syndrome. Dick-Read believed that presence of fear and tension result to labor pains. Thus, eliminating fear would increase blood supply to the uterus and alleviating labor pains. He also identified that laboring women needed constant emotional support to help them cope.

Question 18
A pregnant woman came in to the clinic expressing concern about her genitalia that has been observed for a change in color. The nurse explained the physiology adaptations to pregnancy and stated that this discoloration of the vagina is called:

Hegars sign Chadwicks sign Goodells sign Vaginal sign

Question 18 Explanation:Chadwicks sign is the increased vascularity of the vagina changing its color from light pink to deep purple or violet. Hegars sign is the softening of the uterus. Goodells sign is the change in cervix consistency resembling to that of an earlobe. There is no known vaginal sign in pregnancy.

Question 19
A diagnosis of Moniliasis is made. The nurse is aware that symptoms of Moniliasis typically has a symptom of:

White patchy and cheese like particles that adheres to the vaginal wall Chancres on the vulva Frothy, cream-colored vaginal discharge A non-itchy rash covering the whole body or appearing in patches
Question 19 Explanation:Moniliasis or Candidiasis is caused by a fungus Candida Albicans (Monilia). Symptoms include: white patchy and cheese like particles that adheres to the vaginal wall, irritatingly itchy and foul smelling vaginal discharges. Chancres on vulva and non-itchy rash covering the whole body or appearing in patches are manifestations of syphilis. Frothy, cream-colored vaginal discharges, vulvar edema and hyperemia are hallmark signs of Trichomoniasis or vaginitis.

Question 20
During a prenatal visit the pregnant woman is complaining of itchy, foul-smelling vaginal discharges that are frothy and cream-colored. This is a hallmark sign of:

Moniliasis Candidiasis Syphilis Vaginitis

Question 20 Explanation:Frothy, cream-colored vaginal discharges, vulvar edema and hyperemia are hallmark signs of Trichomoniasis or vaginitis. Moniliasis or Candidiasis is caused by a fungus Candida Albicans (Monilia). Symptoms include: white patchy and cheese like particles that adheres to the vaginal wall, irritatingly itchy and foul smelling vaginal discharges. Chancres on vulva and non-itchy rash covering the whole body or appearing in patches are manifestations of syphilis.

Question 21
The hallmark techniques of Leboyer method are the following except:

Newborn warm bath Husband as a coach throughout labor and delivery Infant massage Immediate maternal-newborn bonding
Question 21 Explanation:Infant massage, a warm bath and immediate bonding with the mother are all hallmarks of the Leboyer method. Bradley childbirth method was the first technique to include the father as a support person during delivery.

Question 22
Mrs. White, a pregnant woman, is 54 tall and weighs 130 lbs. Calculate her body mass index.

22 BMI 30 BMI 24 BMI 28 BMI

uestion 22 Explanation:22 BMI To compute for BMI 1. Convert weight into kilograms: 130 lbs / 2.2= 59.09 kg (1 kg=2.2 lbs) 2. Convert height into cm: 54 ( 5 feet 4 inches) 1 foot=12 inches; 1 inch = 2.54 cm CONVERT TO INCH FIRST: 5 x 12 = 60 inches + 4 inches = 64 inches INCN TO CM: 64 x 2.54 = 162.56 cm 3. Square the height in meters (1 m = 100 cm) CONVERT CM TO METER: 162.56 / 100 = 1.6256 m or 1.63 m SQUARE THE HEIGHT IN METER: 1.63 x 1.63 = 2.6569 or 2.66 4. Divide weight (kg) by meter squared 59.09 / 2.66 = 22 BMI

Question 23
The nurse is calculating a pregnant womans BMI. Her calculated result is 26 BMI. This BMI belongs to the category of:

Underweight Normal weight Overweight Obese

Question 23 Explanation:a. Underweight under 18.5 BMI b. Normal weight 18.5-24.9 BMI c. Overweight 25-29.9 BMI d. Obese above 30.0

Question 24
What is the best interpretation of Mrs. Whites calculated BMI?

Underweight Normal weight Overweight Obese

Question 24 Explanation:Normal weight a. Underweight under 18.5 BMI b. Normal weight 18.5-24.9 BMI c. Overweight 25-29.9 BMI d. Obese above 30.0

Question 25
The total weight gain in pregnancy for women who have multiple fetuses is:

20-25 lbs 25-35 lbs 35-40 lbs 40-45 lbs

Question 25 Explanation:For women who have twins or multiple fetuses the weight gain should be 1 lb/week for a total of 40-45 lbs. (Adelle Pillitteri, 5th Ed p.302). 25-35 lbs is the average and recommended weight gain for pregnant woman with one fetus only.