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Situation: During an Anatomy and Physiology class, the lecturer discussed about the female reproductive system. 1. a. cm.

b. c. d. 2. a. b. c. d. 3. a. b. c. d. 4. a. b. c. d. 5. a. b. c. d. Inhibits the production of LH Increases endometrial tortuosity All of the above Jessa, 17 years old, is bleeding between periods of less than two weeks. This condition is an abnormality in the menstrual cycle Metrorrhagia Menorrhagia Amenorrhea Dysmenorrheal One factor of having a normal delivery is the size of the pelvis. Pelvis serves as the passageway for the passenger (fetus) during Android Anthropoid Platypelloid Gynecoid An important landmark of the pelvis that determines the distance of the descent of the head is known as: Linea terminalis Sacrum Ischial spines Ischial tuberosities The permanent cessation of menstruation is: Amenorrhea Menopause Oligomenorrhea Hypomenorrhea Estrogen, one of the hormones regulating cyclic activities in female reproductive system is responsible for which effect? Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13

known as:

childbirth. The most ideal pelvis for childbirth is:

Situation: Mrs. Donna, pregnant for 16 weeks age of gestation (AOG), visits the health care facility for her prenatal check-up with her only son, Mark. During assessment the client told the nurse that previously she got pregnant twice. The first was with her only child, Mark, who was delivered at 35 weeks AOG and the other pregnancy was terminated at about 20 weeks AOG. 6. a. b. c. d. 7. a. b. Based on the data obtained, Mrs. Donnas GTPAL score is: 20111 21111 30111 31111 Discomforts during pregnancy are discussed by the nurse to the Mrs. Donna. Which of the following, when complained by the client Easy fatigability Nausea and vomiting

would alert the nurse?

c. d. 8. a. b. c. d. 9. a. b. c. d. 10. a. b. c. d.

Edema of the lower extremities Heartburn Psychological and emotional responses of pregnant women differ. However, general emotional response has been noted during Presents denial disbelief and sometimes repression. Has personal identification of the baby and realistic plans for future of the child. Fantasizes the appearance of the baby. Verbalizes fear of death during childbirth. The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heart rate (FHR). Which of the Doppler apparatus Fetoscope Ultrasound Stethoscope Mrs. Donna asked the nurse, when a fetal heart starts beating. The nurse correctly responded by stating: 3 weeks AOG 8 weeks AOG 12 weeks AOG 20 weeks AOG

pregnancy based on their gestational age. Mrs. Donna will most likely have which emotional response towards her pregnancy?

following apparatus should the nurse use in auscultating for the FHR?

Situation: Mrs. Dela Cruz is in labor and is brought to the emergency room with a ruptured bag of water. 11. a. b. c. d. 12. a. b. c. d. 13. a. b. c. d. 14. a. The nurses initial action once the bag of water has ruptured is: Take the fetal heart tones Put the client to the bed immediately Perform an IE Take the womans temperature Mrs. Dela Cruzs has contractions growing stronger which lasts for 40-60 seconds and occur approximately every 3-5 minutes. 0-3 cm 4-7 cm 8-10 cm 11-13 cm The doctor informed the woman that she is on station -1. Mrs. Dela Cruz asked the nurse, what does a station -1 means, the most It means that engagement has already occurred. The presenting part of your baby is at the entrance of the true pelvis or the largest diameter of the presenting part into the true Your baby is still floating or ballotable The presenting part of your baby is at the vulvar ring of your reproductive organ. The history of Mrs. Dela Cruz revealed that she is a multipara. When should the nurse transport the client from the labor room to When the cervical dilatation is 8 cm.

The doctor is about to perform an IE, the nurse expects that the clients cervical dilatation will be:

appropriate response of the nurse is:

pelvis.

the delivery room?

b. c. d. 15. a. b. c. d. 16. a. b. c. d. 17. a. b. c. d. 18. a. b. c. d. 19. a. b. c. d. 20. a. b. c. d.

When the cervical dilatation is 10 cm. When the cervical dilatation is 9 cm. When the client feels the urge to push. Monitoring contractions is very important during labor. To monitor uterine contractions, what should the nurse do? Observe for the clients facial expression to know that the contraction has started or stopped. Instruct the client take note of the duration of her contractions. Offer ice chips to the woman. Spread the fingers lightly over the fundus to monitor the contraction. Uterine contractions can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence some Oxytocin Estrogen Prolactin All of the above Dysfunctional labor may be caused by which of the following? Excessive or too early analgesia administration Exhausted mother Overdistention of the uterus All of the above The clients uterine contractions are hypotonic. The nurses top priority with hypotonic contractions during the intrapartal period is: Pain relief Psychological support Monitoring the lochia for possible bleeding Infection control For a woman experiencing hypotonic contractions, what should be done initially? Obtain an ultrasonic result Infusion of oxytocin Administration of analgesia Amniotomy The most important nursing consideration in a postpartal woman with a hypotonic contraction is: Assessment for infection Assessment for bleeding Assessment for FHR Assessment for womans coping mechanism

hormones. Which of the following least likely contributes to the occurrence of uterine contractions?

Situation: Bleeding during pregnancy is a serious case and should be managed immediately. 21. a. b. c. d. Mrs. Diane is diagnosed with Placenta Previa. The main difference with the bleeding in placenta previa and abruption placenta is Painful bleeding Rigid abdomen Bright-red blood Blood filled with clots that placenta previa has:

22. a. b. c. d. 23. a. b. c. d. 24. a. b. c. d. 25. a. b. c. d.

In caring for a client diagnosed with placenta previa, the nurse should avoid which of the following? Inspecting the perineum Performing a Kleihauer-Betke test Performing a pelvic examination All of the above For the nurse to distinguish that the bleeding of the patient is placenta previa or abruption placenta what should she ask the Whether there was accompanying pain What she has done for bleeding Estimation of blood loss All of the above Continued bleeding may result to fetal distress. The nurse knows that the fetus is being compromised when she observed or note Fetal tachycardia Fetal bradycardia Fetal thrashing All of the above A woman in labor is diagnosed with abruption placenta. The nurse would expect which findings in the clients history that may Age of 24 years old Cigarette smoking Sleeping 8 hours per night Sitting for long period

woman?

which of the following:

contribute to the occurrence of the complication?

rationales

1.

Answer: A. Inhibits the production of FSH Causes hypertrophy of the myometrium Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a

Effects of estrogen:

distance of 10-13 cm. Effects of Progesterone 2. 1. 2. 3. 4. 5. Inhibits the production of LH Increases endometrial tortuosity Increased endometrial secretions Facilitates transport of the fertilized ovum through the fallopian tubes Answer: A Amenorrhea absence of menstrual flow Dysmenorrhea painful menstruation Oligomenorrhea scanty menstruation Menorrhagia -excessive menstrual bleeding Metrorrhagia bleeding between periods of less than 2 weeks

Abnormalities of Menstruation

3. 4.

Answer: D. Gynecoid is the normal female pelvis. The inlet is well rounded. This is the most ideal pelvis for Android male pelvis. Inlet has a narrow, shallow posterior portion and pointed anterior portion. Anthropoid transverse diameter is narrow and anteroposterior (AP) diameter of this pelvis is larger than normal. Platypelloid inlet is oval while AP diameter of this pelvis is shallow. Answer: C. Ischial spines are the point of reference in determining the station (relationship of the fetal presenting part

childbirth.

to the ischial spines). When the fetal head is at the level of the ischial spines the station is zero. When it is 1 cm above the ischial spines it is -1 and if 1 cm below the ischial spines it is +1. 5. Answer: B. The keyword here is permanent cessation. Thus, menopause is the correct answer. Amenorrhea is a

temporary cessation of menses. Oligomenorrhea is a menstruation with scanty blood flow. Hypomenorrhea is an abnormally short duration of menstruation. 6. Answer: C. Gravida (G) number of pregnancy Term (T) number of full-term infants born (born at 37 weeks or after) Para (P) number of preterm infants born (born before 37 weeks) Abortion (A) number of spontaneous or induced abortions (pregnancy terminated before the age of viability). Age of Living children (L) number of living children. (Source: Maternal and Child Health Nursing by Adelle Pillitteri, 5th Ed. P.252)

viability is 24 weeks.

Since Mrs Donna has two previous pregnancies and is presently pregnant (16 weeks), G is 3. Mark, her only child was born at 35 weeks AOG which falls under the preterm category. Thus, T is zero and P is 1. The other pregnancy was terminated at 20 weeks AOG which falls under abortion, hence A=1. Mark is her only living child, thereby, L=1. Her GTPAL score is: 30111, G=3 T=0 P=1 A=1 L=1 7. Answer: B. Morning sickness characterized by nausea and vomiting is only noted during the FIRST TRIMESTER of pregnancy (first 3 months). Excessive nausea and vomiting which persists more than 3 months is a condition called Hyperemesis gravidarum that requires immediate intervention to prevent starvation and dehydration. Management for hyperemesis gravidarum includes the administration of D5NSS 3L in 24 hours and complete bed rest. Easy fatigability is a consequence of the physiologic anemia of pregnancy (physiologic meaning it is normally expected during pregnancy, thus A is incorrect). Edema of the upper extremities not the lower extremities should alert the nurse because of the possibility of toxemia, hence C is incorrect. Heartburn during pregnancy is due to the increase progesterone which decreases gastric motility causing a reversed peristaltic wave leading to regurgitation of the stomach contents through the cardiac sphincter into the esophagus, causing irritation. 8. Answer: C. The client is in her second trimester of pregnancy (16 weeks AOG or 4 months), thus, she perceived the

baby as a separate entity. Presenting denial and disbelief and sometime repression is the psychological/emotional response of a pregnant woman on her first trimester. Identifying the fetus and setting realistic plans for the childs future is noted during the third trimester of pregnancy. It is during this time also that the woman verbalizes fear of death. 9. Answer: A. Mrs. Donnas gestational age is 16 weeks (4 months). During this time, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat can be detected with a Doppler apparatus starting at 12 weeks AOG. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed.) 10. Answer: A. Fetal heart starts beating at 3 weeks AOG. The heart at this time is consisting of two parallel tubes. By 8

weeks AOG, fetal heartbeat can be detected with an ultrasound. During 12 weeks AOG, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed.)

11.

Answer: B. The keyword is INITIAL ACTION. The important consideration before answering the question is to take a

look at the situation. SITUATION: THE WOMAN IS IN THE Emergency Room or is seeking admission. A woman in labor seeking admission to the hospital (in the ER) and saying that her BOW has ruptured should BE PUT TO BED IMMEDIATELY and the fetal heart tones taken consequently. If a woman in the Labor Room says that her membranes have ruptured, the initial nursing action is to take the fetal heart tone. 12. Answer: B. The nurse would expect that the clients cervical dilatation is 4-7 cm as the contraction duration and interval is noted for clients who are in the active phase of the first stage of labor. The maximum cervical dilatation is 10 cm, thus, letter D should be eliminated first. The first stage of labor (stage of dilatation) is divided into three phases. Latent phase 0-3 cm cervical dilatation; contractions are short and mild lasting 20-40 seconds and occurring Active phase 4-7 cm cervical dilatation; contractions grow stronger, lasting 40-60 seconds and occur at Transition phase 8-10 cm cervical dilatation; contractions reach their peak of intensity, occurring every 2-3 minutes approximately every 5-10 minutes. approximately every 3-5 minutes. with a duration of 60-90 seconds. 13. Answer: C. Station -1 means that the fetal presenting part is above the level of the ischial spines. Letter A is wrong

because engagement is described as Station 0. Letter B is incorrect because the statement of nurse is describing the occurrence of engagement that is again station 0. Prior to engagement the fetus is said to be "floating" or ballottable, thus letter C is the best option. Letter D, is describing crowning which is described as Station +3 or +4. 14. Answer: A. Multiparas are transported to the DR when the cervical dilatation is 7-8 cm because in multiparas

dilatation may proceed before effacement is completed. Effacement must occur at the end of dilatation, however, before the fetus can be safely pushed through the cervical canal; otherwise, cervical tearing could result. Primiparas are transported to the DR when the cervical dilatation is 9-10 cm. 15. 16. Answer: D. The nurse should spread his/her fingers lightly over the fundus to monitor the uterine contractions. Answer: C. Prolactin is the hormone that produces milk in mammary glands. Uterine contractions can occur because

of the interplay of the contractile enzyme adenosine triphosphate and the influence some hormones and major electrolytes which are the following: 17. Calcium Sodium Potassium Specific contractile proteins (actin and myosin) Epinephrine and norepinephrine Oxytocin Estrogen and progesterone Prostaglandins Answer: D. Inappropriate use of analgesia Pelvic bone contraction that has narrowed the pelvic diameter so that a client cant pass (e.g. in a client with rickets) Poor fetal position Extension rather then extension of the fetal head Overdistention of the uterus Cervical rigidity Presence of a full rectum or bladder Mother becoming exhausted from labor Primigravid status

Dysfunctional Labor is caused by the ff:

18.

Answer: D. When the contractions are hypotonic, the length of labor is increased. When the cervix is dilated for a

long period of time, both the uterus and fetus are at greater risk of infection. Hypotonic contractions are not exceedingly painful because of their lack of intensity. Monitoring of bleeding through evaluation of lochia is done during the postpartum period not the intrapartum period. 19. Answer: A. Initially, the nurse should obtain an ultrasonic confirmation ruling out a CPD or cephalopelvic

disproportion. Thus, A is the best answer. Oxytocin is infused after the CPD is ruled out, because if CPD is present CS will be done. Analgesic administration will further decrease the intensity of uterine contractions as its inappropriate use is one of the reasons why hypotonic contractions occur. Amniotomy (artificial rupture of membrane) may be done after oxytocin is infused to speed up the labor 20. Answer: B. During the postpartum period, the uterus should be palpated and lochia should be assessed because

contractions after birth may also be hypotonic that will result to bleeding. 21. Answer: C. In placenta previa the bleeding that occurs is abrupt, painless, bright-red and sudden to frighten a

woman. With abruption placenta, the bleeding is painful, the abdomen is rigid or board-like and the blood is dark-red or filled with clots. 22. Answer: C. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is placenta previa may initiate massive hemorrhage, possibly fatal to both the mother and the fetus. The perineum should be assessed or observed or inspected for bleeding by looking over the perenial pads. An Apt or Kleihauer-Betke test (test strip procedures) can be used to detect whether the blood is of fetal or maternal origin. 23. 24. fluid. 25. Answer: B. Predisposing factors for abruptio placenta: Advanced maternal age Short-umbilical cord Chronic hypertensive disease PIH Direct trauma Vasoconstriction from cocaine or cigarette use Answer: A. placenta previa presents bleeding without pain whilst the bleeding in abruptio placenta is painful. Answer: D. Signs of fetal distress include: tachycardia, bradycardia, fetal thrashing and meconium-stained amniotic

part 1.. 1. The nurse is supervising care given to a group of patients on the unit. The nurse observes a staff member entering a patients room wearing gown and gloves. The nurse knows that the staff member is caring for which of the following patients? 1. An 18-month-old with respiratory syncytial virus.2. A 4-year-old with Kawasaki disease.3. A 10-year-old with Lymes disease.4. A 16-year-old with infectious mononucleosis. Strategy: Think about each answer. (1) correctacute viral infection; requires contact precautions; assign to private room or with otherRSV-infected children(2) acute systemic vasculitis in children under 5; standard precautions(3) connective tissue disease; standard precautions(4) standard precautions 2. The nurse is assessing a client who has had a spinal cord injury. Which of the following assessmentfindings would suggest the complication of autonomic dysreflexia? 1. Urinary bladder spasm pain.2. Severe pounding headache.3. Tachycardia.4. Severe hypotension. Strategy: Think about each answer.

(1) may be the cause of autonomic dysreflexia due to overfilling of the bladder, but pain is notperceived(2) correctsevere headache results from rapid onset of hypertension(3) pulse will slow(4) BP will increase

. A 14-year-old client is scheduled for a below-knee (BK) amputation following a motorcycle accident.The nurse knows preoperative teaching for this client should include 1. explaining that the client will be walking with a prosthesis soon after surgery.2. encouraging the client to share his feelings and fears about the surgery.3. taking the informed consent form to the client and asking him to sign it.4. evaluating how the client plans to maintain his schoolwork during hospitalization. Strategy: Remember therapeutic communication. (1) fails to recognize his immediate concerns(2) correctdiscussing his feelings and fears is important in dealing with his anxiety due to a changein body image and functioning(3) client is underage; parents will need to sign the permit(4) is more appropriate for the postoperative period of time than for the preoperative period 4. A 21-year-old woman at 16-weeks gestation undergoes an amniocentesis. The client asks the nursewhat the physician will learn from this procedure. The nurses response should be based on anunderstanding that which of the following conditions can be detected by this test? 1. Tetralogy of Fallot.2. Talipes equinovarus.3. Hemolytic disease of the newborn.4. Cleft lip and palate. Strategy: Think about each answer. (1) cardiac abnormality detected at birth; pulmonary stenosis, ventricular septal defect, overridingaorta, hypertrophy of right ventricle(2) congenital deformity detected at birth; foot twisted out of normal position, clubfoot(3) correctmaternal antibodies destroy fetal RBCs; bilirubin secreted because of hemolysis(4) congenital deformity detected at birth, midline fissure or opening into lip or palate 5. The nurse evaluates the nutritional intake of a 16-year-old girl at a camp for adolescents. The girleats all of the food provided to her at the camp cafeteria. Each of the days three meals containsfoods from all areas of the food pyramid, and each meal averages about 900 calories and 3 mg ofiron. The girl has been menstruating monthly for about two years. Which of the followingdescriptions, if made by the nurse, BEST describes the girls intake if her weight is appropriate for herheight? 1. Her diet is low in calories and high in iron.2. Her diet is low in calories and low in iron.3. Her diet is high in calories and low in iron.4. Her diet is high in calories and high in iron. Strategy: Think about each answer. (1) only 1,200-1,500 kcal/day required, and 15 mg/day of iron(2) only 1,200-1,500 kcal/day required(3) correct900 x 3 = 2,700 calories/day and women need 1,200-1,500 kcal/day (men need 1,500-1,800 kcal/day); 3 mg x 3 = 9 mg/day of iron and women need 15 mg/day of iron (men need 10mg/day); with pregnancy 30 mg/day required(4) 5 mg/day of iron required

Pharma

1. A nurse is reviewing a patients medication during shift change. Which of the following medication would be contraindicated if the patient were pregnant? Note: More than one answer may be correct. A: Coumadin B: Finasteride C: Celebrex D: Catapress E: Habitrol F: Clofazimine 2. A nurse is reviewing a patients PMH. The history indicates photosensitive reactions to medications. Which of the following drugs has not been associated with photosensitive reactions? Note: More than one answer may be correct.

A: Cipro B: Sulfonamide C: Noroxin D: Bactrim E: Accutane F: Nitrodur 3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following patients medication does not cause urine discoloration? A: Sulfasalazine B: Levodopa C: Phenolphthalein D: Aspirin 4. You are responsible for reviewing the nursing units refrigerator. If you found the following drug in the refrigerator it should be removed from the refrigerators contents? A: Corgard B: Humulin (injection) C: Urokinase D: Epogen (injection) 5. A 34 year old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb? A: IgA B: IgD C: IgE D: IgG 6. A second year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most important action that nursing student should take? A: Immediately see a social worker B: Start prophylactic AZT treatment C: Start prophylactic Pentamide treatment D: Seek counseling 7. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A: Atherosclerosis B: Diabetic nephropathy C: Autonomic neuropathy D: Somatic neuropathy 8. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect? A: Multiple sclerosis B: Anorexia nervosa C: Bulimia D: Systemic sclerosis 9. A 24 year old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Which of the following would you most likely suspect?

A: Diverticulosis B: Hypercalcaemia C: Hypocalcaemia D: Irritable bowel syndrome 10. Rho gam is most often used to treat____ mothers that have a ____ infant. A: RH positive, RH positive B: RH positive, RH negative C: RH negative, RH positive D: RH negative, RH negative Answer Key 1. (A) and (B) are both contraindicated with pregnancy. 2. (F) All of the others have can cause photosensitivity reactions. 3. (D) All of the others can cause urine discoloration. 4. (A) Corgard could be removed from the refigerator. 5. (D) IgG is the only immunoglobulin that can cross the placental barrier. 6. (B) AZT treatment is the most critical innervention. 7. (C) Autonomic neuropathy can cause inability to urinate. 8. (B) All of the clinical signs and systems point to a condition of anorexia nervosa. 9. (B) Hypercalcaemia can cause polyuria, severe abdominal pain, and confusion. 10. (C) Rho gam prevents the production of anti-RH antibodies in the mother that has a Rh positive fetus.

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