PRACTICE TEST QUESTIONS

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100 Item Obstetrics-Maternal And Child Health Nursing

Examination Answers and Rationale

DEGREE OF QUESTION DIFFICULTY

4 – Very hard question, 25% Chance of answering correctly

3 – Hard question, 50% Chance of answering correctly
2 – Moderately hard question, 75% of answering correctly
1 – Easy question, 99% will answer the question correctly

SITUATION : [ND89] Aling Julia, a 32 year old fish vendor from

baranggay matahimik came to see you at the prenatal clinic. She
brought with her all her three children. Maye, 1 year 6 months; Joy, 3
and Dan, 7 years old. She mentioned that she stopped taking oral
contraceptives several months ago and now suspects she is pregnant.
She cannot remember her LMP.

1. Which of the following would be useful in calculating Aling Julia's

EDC? [3]

A. Appearance of linea negra

B. First FHT by fetoscope
C. Increase pulse rate
D. Presence of edema

* The answer of some people is A because they say linea negra

appears at 2nd trimester. Appearance of Linea negra is not the same
with all women. Some will have it as early as first trimester while other
on the 2nd trimester. It is very subjective and non normative.

However, First FHT by fetoscope is UNIVERSAL and it is arbitrarily

accepted that it starts at the 4th month of gestation. Therefore, If I
heard the First FHT by fetoscope, I can say that Aling Julia's EDC is at
4th month and the EDC will be around 5 months from now.Pulse rate
and Edema will never suggest the estimated date of confinement nor
age of gestation.

2. Which hormone is necessary for a positive pregnancy test? [1]

A. Progesterone
B. HCG
C. Estrogen
D. Placental Lactogen

* HCG is responsible for positive pregnancy test. But it is NOT a

positive sign of pregnancy. Only PROBABLE. Purpose of HCG is to
maintain the secretion of progestrone by the corpus luteum. It will
deteriorate by 2nd trimester as the placenta resumes its funciton. HCG
is also use to stimulate descend of the testes in case of cryptorchidism
or undescended testes. HCG peaks at 10 weeks then decline for the
rest of the pregnancy. Non pregnant females will have less than 5
mIU/ml and can reach up to 100,000 mIU/ml in pregnant women. By
the way, undescended testes repair is done when the child is 1 year
old according to Lippinncots, the doctor will try to wait baka kasi
bumaba pa before they do surgery.

3. With this pregnancy, Aling Julia is a [1]

A. P3 G3
B. Primigravida
C. P3 G4
D. P0 G3

* She has 3 children, so para 3. Since she is pregnant, this is her 4th
gravida. Remember that even if the pregancy is beyond the age of
viability [ >7 months ] consider it as PARA and not GRAVIDA as long
as the baby is still inside the uterus. A common error of the old nurses
in a puericulture center where I dutied in is that they count the child
inside the mother's womb as GRAVIDA when it is greater than 7
months! [ kawawang nanay, mali na ang home based mothers record
mo ] I tried to correct it but they still INSISTED. I read pillitteri
thinking that I might be wrong nakakahiya naman... but I was right.

4. In explaining the development of her baby, you identified in

chronological order of growth of the fetus as it occurs in pregnancy as
[1]

A. Ovum, embryo, zygote, fetus, infant

B. Zygote, ovum, embryo, fetus, infant
C. Ovum, zygote, embryo, fetus, infant
D. Zygote, ovum, fetus, embryo, infant

* The Ovum is the egg cell from the mother, the sperm will fertilize it
to form a zygote. This usually happens in the AMPULLA or the distal
third of the fallopian tube. Hyalorunidase is secreted by the sperm to
dissolve the outer memberane of the ovum. The zygote now containes
46 chromosomes. 23 from each germ cell. The zygote is now termed
as an embryo once it has been implanted. Implantation takes 3-4
days. When the embryo reach 8th weeks, it is now termed as a FETUS
until it has been delivered and then, neonate then infant.

5. Aling Julia states she is happy to be pregnant. Which behavior is

elicited by her during your assessment that would lead you to think
she is stressed? [3]

A. She told you about her drunk husband

B. She states she has very meager income from selling
C. She laughs at every advise you give even when its not funny
D. She has difficulty following instructions

* Stressed is manifested in different ways and one of them, is difficulty

following instructions. Telling you that her husband is drunk and has
meager income from selling is not enough for you to conclude she is
stressed. Assessment is always based on factual and specific
manifestations. A diagnosis is made from either ACTUAL or
POTENTIAL/RISK problems. A and B are both potential problems, but
not actual like D. C is automatically eliminated first because laughing
is not indicative of stress.

6. When teaching Aling Julia about her pregnancy, you should include
personal common discomforts. Which of the following is an indication
for prompt professional supervision? [2]

A. Constipation and hemorrhoids

B. Backache
C. Facial edema
D. frequent urination

*Facial edema is NOT NORMAL. Facial edema is one sign of MILD PRE
ECLAMPSIA and prompt professional supervision is needed to lower
down the client's blood pressure. Blood pressure in Mild Pre Eclampsia
is around 140/90 and 160/110 in severe. Treatment involves bed rest,
Magnesium sulfate, Hydralazine, Diazoxide and Diazepam [ usually a
combination of Magsul + Apresoline [ Hydralazine ] ] Calcium
gluconate is always at the client's bed side when magnesium toxicity
occurs. It works by exchanging Calcium ions for magnesium ions. A,B
and D are all physiologic change in pregnancy that do not need prompt
professional supervision. Frequent urination will disappear as soon as
the pressure of the uterus is released against the bladder and as soon
as the client's blood volume has returned to normal. Backache is a
common complaint of women with an OCCIPUT POSTERIOR
presentation due to pressure on the back. Intervention includes pelvic
rocking or running a tennis ball at the client's back. Constipation and
hemorrhoids are relieved by increasing fluid intake and hot sitz bath.

7. Which of the following statements would be appropriate for you to

include in Aling Julia's prenatal teaching plan? [1]
A. Exercise is very tiresome, it should be avoided
B. Limit your food intake
C. Smoking has no harmful effect on the growth and development of
fetus
D. Avoid unnecessary fatigue, rest periods should be included
in you schedule

* Exercise is not avoided in pregnancy, therfore eliminate A. Food is

never limited in pregnancy. Calories are even increased by around 300
cal a day as well as vitamins and minerals. Smoking, alcohol and drug
use are avoided for the rest of the pregnancy because of their harmful
effects on the growth and development of the fetus. Rest period and
avoiding unecessary fatigue is one of the pillars in health teaching of
the pregnant client.

8. The best advise you can give to Aling Julia regarding prevention of
varicosities is [3]

A. Raise the legs while in upright position and put it against the wall
several times a day
B. Lay flat for most hours of the day
C. Use garters with nylon stocking
D. Wear support hose

* A thigh high stocking or a support hose WORN BEFORE GETTING UP

in the morning is effective in prevention of varicosities. Stocking
should have NO GARTERS because it impedes blood flow, they should
be made of COTTON not nylon to allow the skin to breathe. Lying flat
most of the day WILL PREVENT VARICOSITIES but will not be helpful
for the client's overall health and function. Raising the legs and putting
it against the wall will still create pressure in the legs.

9. In a 32 day menstrual cycle, ovulation usually occurs on the [2]

A. 14th day after menstruation

B. 18th day after menstruation
C. 20th day after menstruation
D. 24th day after menstruation

* To get the day of ovulation, A diary is made for around 6 months to

determine the number of days of menstrual cycle [ from onset of mens
to the next onset of mens ] and the average is taken from that cycles.
14 days are subtracted from the total days of the menstrual cycle. This
signifies the ovulation day. A couple would abstain having sex 5 days
before and 5 days after the ovulation day. Therefore, a 32 day cycle
minus 14 days equals 18, hence... ovulation occurs at the 18th day.
10. Placenta is the organ that provides exchange of nutrients and
waste products between mother and fetus. This develops by [4]

A. First month
B. Third month
C. Fifth month
D. Seventh month

* The placenta is formed at around 3 months. It is a latin word for

PANCAKE because of it's appearance. It arises from the trophoblast
from the chorionic villi and decidua basalis. It functions as the fetal
lungs, kidney, GI tract and an endocrine organ.

11. In evaluating the weight gain of Aling Julia, you know the
minimum weight gain during pregnancy is [3]

A. 2 lbs/wk
B. 5 lbs/wk
C. 7 lbs/wk
D. 10 lbs/wk

* Weight gain should be 1 to 2 lbs per week during the 2nd and 3rd
trimester and 3 to 5 lbs gain during the first trimester for a total of 25-
35 lbs recommended weight gain during the gravida state.

12. The more accurate method of measuring fundal height is [2]

A. Millimeter
B. Centimeter
C. Inches
D. Fingerbreadths

* Fundal height is measured in cm not mm. centimeters is the more

accurate method of measuring fundic height than inches or
fingerbreadths.

13. To determine fetal position using Leopold's maneuvers, the first

maneuver is to [1]

A. Determine degree of cephalic flexion and engagement

B. Determine part of fetus presenting into pelvis
C. Locate the back,arms and legs
D. Determine what part of fetus is in the fundus

* Leopold's one determines what is it in the fundus. This determines

whether the fetal head or breech is in the fundus. A head is round and
hard. Breech is less well defined.
14. Aling julia has encouraged her husband to attend prenatal classes
with her. During the prenatal class, the couple expressed fear of pain
during labor and delivery. The use of touch and soothing voice often
promotes comfort to the laboring patient. This physical intervention is
effective because [2]

A. Pain perception is interrupted

B. Gate control fibers are open
C. It distracts the client away from the pain
D. Empathy is communicated by a caring person

* Touch and soothing voice promotes pain distraction. Instead of

thinking too much of the pain in labor, The mother is diverted away
from the pain sensation by the use of touch and voice. Pain perception
is not interrupted, pain is still present. When gate control fibers are
open, Pain is felt according to the gate control theory of pain. Although
empathy is communicated by the caring person, this is not the reason
why touch and voice promotes comfort to a laboring patient.

15. Which of the following could be considered as a positive sign of

pregnancy ? [1]

A. Amenorrhea, nausea, vomiting

B. Frequency of urination
C. Braxton hicks contraction
D. Fetal outline by sonography

* Fetal outline by sonography or other imaging devices is considered a

positive sign of pregnancy along with the presence of fetal heart rate
and movement felt by a qualified examiner. All those signs with the
discoverer's name on them [ chadwick, hegars, braxton hicks, goodells
] are considered probable and All the physiologic changes brought
about by pregnancy like hyperpigmentation, fatgiue, uterine
enlargement, nausea, vomiting, breast changes, frequent urination are
considered presumptive.

Sonographic evidence of the gestational sac is not POSITIVE sign but

rather, PROBABLE.

SITUATION : [FFC] Maternal and child health is the program of the

department of health created to lessen the death of infants and
mother in the philippines. [2]

16. What is the goal of this program?

A. Promote mother and infant health especially during the

gravida stage
B. Training of local hilots
C. Direct supervision of midwives during home delivery
D. Health teaching to mother regarding proper newborn care

* The goal of the MCHN program of the DOH is the PROMOTION AND
MAINTENANCE OF OPTIMUM HEALTH OF WOMAN AND THEIR
NEWBORN. To achieve this goal, B,C and D are all carried out. Even
without the knowledge of the MCHN goal you SHOULD answer this
question correctly. Remember that GOALS are your plans or things you
MUST ATTAIN while STRATEGIES are those that must be done [
ACTIONS ] to attain your goal.

Looking at B,C and D they are all ACTIONS. Only A correctly followed
the definition of a goal.

17. One philosophy of the maternal and child health nursing is [1]

A. All pregnancy experiences are the same for all woman

B. Culture and religious practices have little effect on pregnancy of a
woman
C. Pregnancy is a part of the life cycle but provides no meaning
D. The father is as important as the mother

* Knowing that not all individuals and pregnancy are the same for all
women, you can safely eliminate letter A. Personal, culture and
religious attitudes influence the meaning of pregnancy and that makes
pregnancy unique for each individual. Culture and religious practice
have a great impact on pregnancy, eliminate B. Pregnancy is
meaningful to each individuals, not only the mother but also the father
and the family and the father of the child is as important as the
mother. MATERNAL AND CHILD HEALTH IS FAMILY CENTERED
and thid will guide you in correctly answering D.

18. In maternal care, the PHN responsibility is [2]

A. To secure all information that would be needing in birth certificate

B. To protect the baby against tetanus neonatorum by immunizing the
mother with DPT
C. To reach all pregnant woman
D. To assess nutritional status of existing children

* The sole objective of the MCHN of the DOH is to REACH ALL

PREGNANT WOMEN AND GIVE SUFFICIENT CARE TO ENSURE A
HEALTHY PREGNANCY AND THE BIRTH OF A FULL TERM
HEALTH BABY. As not to confuse this with the GOAL of the MCHN,
The OBJECTIVE should answer the GOAL, they are different. GOAL : to
promote and maintain optimum health for women and their newborn
HOW? OBJECTIVE : By reaching all pregnant women to give sufficient
care ensuring healthy pregnancy and baby.

19. This is use when rendering prenatal care in the rural health unit. It
serves as a guide in Identification of risk factors [1]

A. Underfive clinic chart

B. Home based mother's record
C. Client list of mother under prenatal care
D. Target list of woman under TT vaccination

* The HBMR is used in rendring prenatal care as guide in identifying

risk factors. It contains health promotion message and information on
the danger signs of pregnancy.

20. The schedule of prenatal visit in the RHU unit is [4]

A. Once from 1st up to 8th month, weekly on the 9th month

B. Twice in 1st and second trimester, weekly on third trimester
C. Once in each trimester, more frequent for those at risk
D. Frequent as possible to determine the presence of FHT each week

* Visit to the RHU should be ONCE each trimester and more frequent
for those who are high risks. The visit to the BHS or health center
should be ONCE for 1st to 6th months of pregnancy, TWICE for the 7th
to 8th month and weekly during the 9th month. They are different and
are not to be confused with.

SITUATION : Knowledge of the menstrual cycle is important in

maternal health nursing. The following questions pertains to the
process of menstruation

21. Menarche occurs during the pubertal period, Which of the following
occurs first in the development of female sex characteristics? [2]

A. Menarche
B. Accelerated Linear Growth
C. Breast development
D. Growth of pubic hair

* Remember TAMO or THELARCHE, ADRENARCHE, MENARCHE and

OVULATION. Telarche is the beginning of the breast development
which is influenced by the increase in estrogen level during puberty.
Adrenarche is the development of axillary and pubic hair due to
androgen stimulation. Menarche is the onset of first menstruation that
averagely occurs at around 12 to 13 years old. Ovulation then occurs
last. However, prior to TAMO, Accelerated LINEAR GROWTH will occur
first in GIRLS while WEIGHT INCREASE is the first one to occur in
boys.
22. Which gland is responsible for initiating the menstrual cycle? [3]

A. Ovaries
B. APG
C. PPG
D. Hypothalamus

* Hypothalamus secretes many different hormones and one of them is

the FSHRF or the FOLLICLE STIMULATING HORMONE RELEASING
FACTOR. This will instruct the ANTERIOR PITUITARY GLAND to secrete
FSH that will stimulate the ovary to release egg and initiate the
menstrual cycle.

The PPG or the posterior pituitary only secretes two hormones :

OXYTOCIN and ADH. It plays an important factor in labor as well as in
the pathophysiology of diabetes insipidus.

23. The hormone that stimulates the ovaries to produce estrogen is

[1]

A. GnRH
B. LH
C. LHRF
D. FSH

* FSH stimulates the ovaries to secrete estrogen. This hormone is a 3

substance compounds known as estrone [e1], estradiol [2] and estriol
[3] responsible for the development of female secondary sex
characteristics. It also stimulates the OOCYTES to mature. During
pregnancy, Estrogen is secreted by the placenta that stimulates
uterine growth to accomodate the fetus.

24. Which hormone stimulates oocyte maturation? [2]

A. GnRH
B. LH
C. LHRF
D. FSH

* Refer to #23

25. When is the serum estrogen level highest in the menstrual cycle?
[4]

A. 3rd day
B. 13th day
C. 14th day
D. End of menstrual cycle

* There are only 3 days to remember in terms of hormonal heights

during pregnancy. 3,13 and 14. During the 3rd day, Serum estrogen is
the lowest. During the 13th day, Serum estrogen is at it's peak while
progestrone is at it's lowest and this signifies that a mature oocyte is
ready for release. At 14th day, Progesterone will surge and this is the
reason why there is a sudden increase of temperature during the
ovulation day and sudden drop during the previous day. This will not
stimulate the release of the mature egg or what we call, OVULATION.

26. To correctly determine the day of ovulation, the nurse must [2]

A. Deduct 14 days at the mid of the cycle

B. Subtract two weeks at cycle's end
C. Add 7 days from mid of the cycle
D. Add 14 days from the end of the cycle

* Refer to # 9

Big thanks to marisse for the correction in this number.

27. The serum progesterone is lowest during what day of the

menstrual cycle? [4]

A. 3rd day
B. 13th day
C. 14th day
D. End of menstrual cycle

* At 3rd day, The serum estrogen is at it's lowest. At the 13th day,
serum estrogen is at it's peak while progesterone is at it's lowest. At
the 13th day of the cycle, An available matured ovum is ready for
fertilization and implantation. The slight sharp drop of temperature
occurs during this time due to the very low progestrone level. The next
day, 14th day, The serum progestrone sharply rises and this causes
the release of the matured ovum. Temperature also rises at this point
because of the sudden increase in the progestrone level.

28. How much blood is loss on the average during menstrual period?
[4]

A. Half cup
B. 4 tablespoon
C. 3 ounces
D. 1/3 cup
* The average blood loss during pregnancy is 60 cc. A, half cup is
equivalent to 120 cc. C, is equivalent to 90 cc while D, is equivalent to
80 cc. 1 tablespoon is equal to 15 ml. 4 tablespoon is exactly 60 cc.

29. Menstruation occurs because of which following mechanism? [2]

A. Increase level of estrogen and progesterone level

B. Degeneration of the corpus luteum
C. Increase vascularity of the endothelium
D. Surge of hormone progesterone

* Degeneration of the corpus luteum is the cause of menstruation.

Menstruation occurs because of the decrease of both estrogen and
progestrone. This is caused by the regression of the corpus luteum
inside the ovary 8 to 10 days in absence of fertilization after an ovum
was released. With the absence of progestrone, the endometrium
degenerates and therefore, vascularity will decrease at approximately
25th day of the cycle which causes the external manifestation of
menstruation.

30. If the menstrual cycle of a woman is 35 day cycle, she will

approximately [2]

A. Ovulate on the 21st day with fertile days beginning on the

16th day to the 26th day of her cycle
B. Ovulate on the 21st day with fertile days beginning on the 16th day
to the 21th day of her cycle
C. Ovulate on the 22st day with fertile days beginning on the 16th day
to the 26th day of her cycle
D. Ovulate on the 22st day with fertile days beginning on the 14th day
to the 30th day of her cycle

* Formula for getting the fertile days and ovulation day is : Number of
days of cycle MINUS 14 [ Ovulation day ] Minus 5 Plus 5 [ Possible
fertile days ].

Since the client has a 35 day cycle, we subtract 14 days to get the
ovulation day which is 21. Minus 5 days is equal to [21 - 5 = 16 ] 16 ,
Plus 5 days [ 21 + 5 = 26 ] is equal to 26. Therefore, Client is fertile
during the 16th to the 26th day of her cycle. This is the same principle
and formula used in the calendar / rhythm method.

SITUATION : Wide knowledge about different diagnostic tests during

pregnancy is an essential arsenal for a nurse to be successful.

31. The Biparietal diameter of a fetus is considered matured if it is

atleast [4]
A. 9.8 cm
B. 8.5 cm
C. 7.5 cm
D. 6 cm

* BPD is considered matured at 8.5 cm and at term when it reaches

9.6 cm.

32. Quickening is experienced first by multigravida clients. At what

week of gestation do they start to experience quickening? [4]

A. 16th
B. 20th
C. 24th
D. 28th

* Multigravid clients experience quickening at around 16 weeks or 4

months. Primigravid clients experience this 1 month later, at the 5th
month or 20th week.

33. Before the start of a non stress test, The FHR is 120 BPM. The
mother ate the snack and the practitioner noticed an increase from
120 BPM to 135 BPM for 15 seconds. How would you read the result?
[3]

A. Abnormal
B. Non reactive
C. Reactive
D. Inconclusive, needs repeat

* Normal non stress test result is REACTIVE. Non stress test is a

diagnostic procedure in which the FHR is compared with the child's
movement. A normal result is an increase of 15 BPM sustained for 15
seconds at every fetal movement. The mother is told to eat a light
snack during the procedure while the examiner carefully monitors the
FHR. The mother will tell the examiner that she felt a movement as
soon as she feels it while the examiner take note of the time and the
FHR of the fetus.

34. When should the nurse expect to hear the FHR using a fetoscope?
[4]

A. 2nd week
B. 8th week
C. 2nd month
D. 4th month

* The FHR is heard at about 4 months using a fetoscope. Remember

the word FeFOUR to relate fetoscope to four.

35. When should the nurse expect to hear FHR using doppler
Ultrasound? [4]

A. 8th week
B. 8th month
C. 2nd week
D. 4th month

* The FHR is heard as early as 8th week [ some books, 12 to 14 weeks

] using doppler ultrasound. Remember the word DOPPLE RATE, [
DOPPLER 8 ] to relate dopple ultrasound to the number 8.

36. The mother asks, What does it means if her maternal serum alpha
feto protein is 35 ng/ml? The nurse should answer [4]

A. It is normal
B. It is not normal
C. 35 ng/ml indicates chromosomal abberation
D. 35 ng/ml indicates neural tube defect

* The normal maternal alpha feto protein is 38-45 ng/ml. Less 38 than
this indicates CHROMOSOMAL ABBERATION [Down,Klinefelters] and
more than 45 means NEURAL TUBE DEFECTS [Spina Bifida].
Remember the word CLINICAL NURSE. C for chromosomal
abberation for <38>N for neural tube defect for >45. C<38>45 Clinic
Nurse.

CLINIC NURSE is also an important mnemonics to differentiate

COUNTER TRANSFERENCE from TRANSFERENCE. Counter
transference is the special feeling of the CLINIC NURSE or CLINICIAN
to the patient while transference is the development of personal
feelings of the patient to the nurse.

37. Which of the following mothers needs RHOGAM? [1]

A. RH + mother who delivered an RH - fetus

B. RH - mother who delivered an RH + fetus
C. RH + mother who delivered an RH + fetus
D. RH - mother who delivered an RH - fetus

* Rhogam is given to RH - Mothers That delivers an RH + Fetus.

Rhogam prevents ISOIMMUNIZATION or the development of maternal
antibodies against the fetal blood due to RH incompatibility. Once the
mother already develops an antibody against the fetus, Rhogam will
not anymore be benificial and the mother is advised no to have
anymore pregnancies. Rhogam is given within 72 hours after delivery.
38. Which family planning method is recommended by the department
of health more than any other means of contraception? [4]

A. Fertility Awareness Method

B. Condom
C. Tubal Ligation
D. Abstinence

* Abstinence is never advocated as a family planning method. Though,

It is probably the BEST METHOD to prevent STD and pregnancy, it is
inhumane and supresses the reproductive rights of the people. It is
also unrealistic. FAM is advocated by the DOH more than any other
kind of contraception. It is a combination of symptothermal and
billings method. CALENDAR method is the only method advocated by
the catholic church.

39. How much booster dose does tetanus toxoid vaccination for
pregnant women has? [4]

A. 2
B. 5
C. 3
D. 4

* TT1 and TT2 are both primary dosages. While TT3 up to TT5
represents the booster dosages.

40. Baranggay pinoybsn.tk has 70,000 population. How much nurse is

needed to service this population? [4]

A. 5
B. 7
C. 50
D. 70

* For every 10,000 population , 1 nurse is needed. therefore, a

population of 70,000 people needs a service of 7 nurses.

SITUATION : [ND2I246] Reproductive health is the exercise of

reproductive right with responsibility. A married couple has the
responsibility to reproduce and procreate.

41. Which of the following is ONE of the goals of the reproductive

health concept? [3]

A. To achieve healthy sexual development and maturation

B. To prevent specific RH problem through counseling
C. Provide care, treatment and rehabilitation
D. To practice RH as a way of life of every man and woman

* EVERY ACHIEVER AVOIDS RECEIVER : Remember this

mnemonics and it will guide you in differentiating which is which from
the goals, visions and strategies. If a sentence begins with these
words, it is automatically a GOAL. Usually, The trend in the board is
that they will mix up the vision, strategies and goals to confuse you. D
is the only vision of the RH program. Anything else aside from the
vision and goals are more likely strategies. [ B and C ]

Strategies, even without knowing them or memorizing them can easily

be seperated as they convey ACTIONS and ACTUAL INTERVENTIONS.
This is universal and also applies to other DOH programs. Notice that
B and C convey actions and interventions.

42. Which of the following is NOT an element of the reproductive

health? [4]

A. Maternal and child health and nutrition

B. Family planning
C. Prevention and management of abortion complication
D. Healthy sexual development and nutrition

* Achieving healthy sexual development and nutrition is a GOAL of the

RH. Knowledge of the elements, goals, strategies and vision of RH are
important in answering this question. I removed the word ACHIEVE to
let you know that it is possible for the board of nursing not to include
those keywords [ although it never happened as of yet ].

43. In the international framework of RH, which one of the following is

the ultimate goal? [3]

A. Women's health in reproduction

B. Attainment of optimum health
C. Achievement of women's status
D. Quality of life

* Quality of life is the ultimate goal of the RH in the international

framework. Way of life is the ultimate goal of RH in the local
framework.

44. Which one of the following is a determinant of RH affecting

woman's ability to participate in social affairs? [3]

A. Gender issues
B. Socio-Economic condition
C. Cultural and psychosocial factors
D. Status of women

* This is an actual board question, Gender issues affects the women

participation in the social affairs. Socio economic condition is the
determinant for education, employment, poverty, nutrition, living
condition and family environment. Status of women evolves in
women's rights. Cultural and psychosocial factors refers to the norms,
behaviors, orientation, values and culture. Refer to your DOH manual
to read more about this.

45. In the philippine RH Framework. which major factor affects RH

status? [4]

A. Women's lower level of literacy

B. Health service delivery mechanism
C. Poor living conditions lead to illness
D. Commercial sex workers are exposed to AIDS/STD.

* Health services delivery mechanism is the major factor that affect

RH status. Other factors are women's behavior, Sanitation and water
supply, Employment and working conditions etc.

46. Which determinant of reproductive health advocates nutrition for

better health promotion and maintain a healthful life? [4]

A. Socio-Economic conditions
B. Status of women
C. Social and gender issues
D. Biological, Cultural and Psychosocial factors

* Refer to # 44

47. Which of the following is NOT a strategy of RH? [3]

A. Increase and improve contraceptive methods

B. Achieve reproductive intentions
C. Care provision focused on people with RH problems
D. Prevent specific RH problem through information dessemination

* Refer to #41

48. Which of the following is NOT a goal of RH? [3]

A. Achieve healthy sexual development and maturation

B. Avoid illness/diseases, injuries, disabilities related to sexuality and
reproduction
C. Receive appropriate counseling and care of RH problems
D. Strengthen outreach activities and the referral system
* Refer to #41

49. What is the VISION of the RH? [2]

A. Attain QUALITY OF LIFE

B. Practice RH as a WAY OF LIFE
C. Prevent specific RH problem
D. Health in the hands of the filipino

* Refer to #43

SITUATION : [SORANGE19] Baby G, a 6 hours old newborn is

admitted to the NICU because of low APGAR Score. His mother had a
prolonged second stage of labor

50. Which of the following is the most important concept associated

with all high risk newborn? [1]

A. Support the high-risk newborn's cardiopulmonary adaptation

by maintaining adequate airway
B. Identify complications with early intervention in the high risk
newborn to reduce morbidity and mortality
C. Assess the high risk newborn for any physical complications that will
assist the parent with bonding
D. Support mother and significant others in their request toward
adaptation to the high risk newborn

* The 3 major and initial and immediate needs of newborns both

normal and high risks are AIR/BREATHING, CIRCULATION and
TEMPERATURE. C and D are both eliminated because they do not
address the immediate newborn needs. Identifying complication with
early intervention is important, however, this does not address the
IMMEDIATE and MOST IMPORTANT newborn needs.

51. Which of the following would the nurse expect to find in a newborn
with birth asphyxia? [1]

A. Hyperoxemia
B. Acidosis
C. Hypocapnia
D. Ketosis

* Birth Asphyxia is a term used to describe the inability of an infant to

maintain an adequate respiration within 1 minute after birth that leads
so acidosis, hypoxia, hypoxemia and tissue anoxia. This results to
Hypercapnia not Hypocapnia due to the increase in carbonic acid
concentration in the fetal circulation because the carbon dioxide fails to
get eliminated from the infant's lungs because of inadequate
respiration. Ketosis is the presence of ketones in the body because of
excessive fat metabolism. This is seen in diabetic ketoacidosis.

52. When planning and implementing care for the newborn that has
been successfully resuscitated, which of the following would be
important to assess? [1]

A. Muscle flaccidity
B. Hypoglycemia
C. Decreased intracranial pressure
D. Spontaneous respiration

* There is no need to assess for spontaneous respiration because OF

the word SUCCESSFULLY RESUSCITATED. What is it to assess is the
quality and quantity of respiration. Infants who undergone tremendous
physical challenges during birth like asphyxia, prolonged labor, RDS
are all high risk for developing hypoglycemia because of the severe
depletion of glucose stores to sustain the demands of the body during
those demanding times.

SITUATION : [P-I/46] Nurses should be aware of the different

reproductive problems.

53. When is the best time to achieve pregnancy? [2]

A. Midway between periods

B. Immediately after menses end
C. 14 days before the next period is expected
D. 14 days after the beginning of the next period

* The best time to achieve pregnancy is during the ovulation period

which is about 14 days before the next period is expected. A Menstrual
cycle is defined as the number of days from the start of the
menstruation period, up to the start of another menstrual period. To
obtain the ovulation day, Subtract 14 days from the end of each cycle.

Example, The start of the menstrual flow was July 12, 2006. The next
flow was experienced August 11, 2006. The length of the menstrual
cycle is then 30 days [ August 11 minus July 12 ]. We then subtract 14
days from that total length of the cycle and that will give us 16 days [
30 minus 14 ] Count 16 days from July 12, 2006 and that will give us
July 28, 2006 as the day of ovulation. [ July 12 + 16 days ] This is the
best time for coitus if the intention is getting pregnant, worst time if
not.

54. A factor in infertility maybe related to the PH of the vaginal canal.

A medication that is ordered to alter the vaginal PH is: [2]
A. Estrogen therapy
B. Sulfur insufflations
C. Lactic acid douches
D. Na HCO3 Douches

* Sperm is innately ALKALINE. Too much acidity is the only PH

alteration in the vagina that can kill sperm cells. Knowing this will
direct you to answering letter D. Sodium Bicarbonate douches will
make the vagina less acidic because of it's alkaline property, making
the vagina's environment more conducive and tolerating to the sperm
cells. Estrogen therapy will not alter the PH of the vaginal canal. HRT [
Hormone replacement therapy ] is now feared by many women
because of the high risk in acquiring breast, uterine and cervical
cancer. Research on this was even halted because of the significant
risk on the sample population. Lactic acid douches will make the
vagina more acidic, further making the environment hostile to the
alkaline sperm. Sulfur insufflation is a procedure used to treat vaginal
infections. A tube is inserted in the vagina and sulfur is introduced to
the body. The yeasts, fungi and other microorganisms that are
sensitive to sulfur are all immediately killed by it on contact.

55. A diagnostic test used to evaluate fertility is the postcoital test. It

is best timed [2]

A. 1 week after ovulation

B. Immediately after menses
C. Just before the next menstrual period
D. Within 1 to 2 days of presumed ovulation

* A poscoital test evaluates both ovulation detection and sperm

analysis. When the woman ovulates [ by using the FAM method or
commercial ovulation detection kits, woman should know she ovulates
] The couple should have coitus and then, the woman will go to the
clinic within 2 to 8 hours after coitus. The woman is put on a lithotomy
position. A specimen for cervical mucus is taken and examined for
spinnbarkeit [ ability to stretch 15 cm before breaking ] and sperm
count. Postcoital test is now considered obsolete because a single
sperm and cervical mucus analysis provides more accurate data.

56. A tubal insufflation test is done to determine whether there is a

tubal obstruction. Infertility caused by a defect in the tube is most
often related to a [3]

A. Past infection
B. Fibroid Tumor
C. Congenital Anomaly
D. Previous injury to a tube
* PID [ Most common cause of tubal obstruction ] due to untreated
gonorrhea, chlamydia or other infections that leads to chronic
salphingitis often leads to scarring of the fallopian tube thereby
causing tubal obstuction. This one of the common cause of infertility,
the most common is Anovulation in female and low sperm count in
males. A ruptured appendix, peritonitis and abdominal surgery that
leads to infection and adhesion of the fallopian tube can also lead to
tubal obstruction.

57. Which test is commonly used to determine the number, motility

and activity of sperm is the [2]

A. Rubin test
B. Huhner test
C. Friedman test
D. Papanicolau test

* Huhner test is synonymous to postcoital test. This test evaluates the

number, motility and status of the sperm cells in the cervical mucus.
refer to # 55 for more information. Rubin test is a test to determine
the tubal patency by introducing carbon dioxide gas via a cannula to
the client's cervix. The sound is then auscultated in the client's
abdomen at the point where the outer end of the fallopian tube is
located, near the fimbriae. Absent of sound means that the tube is not
patent. Friedman test involves a FROG to determine pregnancy that is
why it is also called as FROG TEST. Papanicolaou test [Correct
spelling], discovered by Dr. George Papanicolaou during the 1930's is
a cytolgic examination of the epithelial lining of the cervix. It is
important in diagnosis cervical cancer.

58. In the female, Evaluation of the pelvic organs of reproduction is

accomplished by [2]

A. Biopsy
B. Cystoscopy
C. Culdoscopy
D. Hysterosalpingogram

* Biopsy is acquiring a sample tissue for cytological examination.

Usually done in cancer grading or detecting atypical, abnormal and
neoplastic cells. Cystoscopy is the visualization of the bladder using a
cystoscope. This is inserted via the urethra. TURP or the transurethral
resection of the prostate is frequently done via cystoscopy to remove
the need for incision in resecting the enlarged prostate in BPH.
Culdoscopy is the insertion of the culdoscope through the posterior
vaginal wall between the rectum and uterus to visualize the douglas
cul de sac. This is an important landmark because this is the lowest
point in the pelvis, fluid or blood tends to collect in this place.
Hysterosalpingogram is the injection of a blue dye, or any radio
opaque material through the cervix under pressure. X ray is then
taken to visualize the pelvic organs. This is done only after
menstruation to prevent reflux of the menstrual discharge up into the
fallopian tube and to prevent an accidental irradiation of the zygote. As
usual, as with all other procedures that ends in GRAM, assess for
iodine allergy.

59. When is the fetal weight gain greatest? [3]

A. 1st trimester
B. 2nd trimester
C. 3rd trimester
D. from 4th week up to 16th week of pregnancy

* Vital organs are formed during the first trimester, The greatest
LENGTH gain occurs during the second trimester while the greatest
weight gain occurs during the last trimester. This is the time when
brown fats starts to be deposited in preparation for the upcoming
delivery.

60. In fetal blood vessel, where is the oxygen content highest? [3]

A. Umbilical artery
B. Ductus Venosus
C. Ductus areteriosus
D. Pulmonary artery

* Ductus venosus is directly connected to the umbilical vein, Which is

directly connected to the highly oxygenated placenta. This vessel
supplies blood to the fetal liver. Umbilical arteries carries
UNOXYGENATED BLOOD, they carry the blood away from the fetal
body. Ductus arteriosus shunts the blood away from the fetal lungs,
this carries an oxygenated blood but not as concentrated as the blood
in the ductus venosus who have not yet service any of the fetal organ
for oxygen except the liver. Knowing that the fetal lungs is not yet
functional and expanded will guide you to automatically eliminate the
pulmonary artery which is responsible for carrying UNOXYGENATED
BLOOD away from the lungs.

61. The nurse is caring for a woman in labor. The woman is irritable,
complains of nausea and vomits and has heavier show. The
membranes rupture. The nurse understands that this indicates [1]

A. The woman is in transition stage of labor

B. The woman is having a complication and the doctor should be
notified
C. Labor is slowing down and the woman may need oxytocin
D. The woman is emotionally distraught and needs assistance in
dealing with labor

* The clue to the answer is MEMBRANES RUPTURE. Membranes, as

a rule, rupture at full dilation [ 10 cm ] unless ruptured by amniotomy
or ruptured at an earlier time. The last of the mucus plug from the
cervix is also released during the transition phase of labor. We call that
the OPERCULUM as signaled by a HEAVIER SHOW. During the
transition phase, Cervix is dilated at around 8 to 10 cm and
contractions reaches their peak of intensity occuring every 2 to 3
minutes with a 60 to 90 second duration.

At the transition phase, woman also experiences nausea and vomiting

with intense pain. This question is LIFTED from the previous board and
the question was patterned EXACTLY WORD PER WORD from pillitteri.

SITUATION : [J2I246] Katherine, a 32 year old primigravida at 39-40

weeks AOG was admitted to the labor room due to hypogastric and
lumbo-sacral pains. IE revealed a fully dilated, fully effaced cervix.
Station 0.

62. She is immediately transferred to the DR table. Which of the

following conditions signify that delivery is near? [2]

I - A desire to defecate
II - Begins to bear down with uterine contraction
III - Perineum bulges
IV - Uterine contraction occur 2-3 minutes intervals at 50 seconds
duration

A. I,II,III
B. I,II,III,IV
C. I,III,IV
D. II,III,IV

* Again, lifted word per word from Pillitteri and this is from the NLE. A
is the right answer. A woman near labor experiences desire to defecate
because of the pressure of the fetal head that forces the stool out from
the anus. She cannot help but bear down with each of the contractions
and as crowning occurs, The perineum bulges. A woman with a 50
second contraction is still at the ACTIVE PHASE labor [ 40 to 60
seconds duration, 3 to 5 minutes interval ] Women who are about to
give birth experience 60-90 seconds contraction occuring at 2-3
minutes interval.

63. Artificial rupture of the membrane is done. Which of the following

nursing diagnoses is the priority? [2]
A. High risk for infection related to membrane rupture
B. Potential for injury related to prolapse cord
C. Alteration in comfort related to increasing strength of uterine
contraction
D. Anxiety related to unfamiliar procedure

* Nursing diagnosis is frequently ask. In any case that INFECTION was

one of the choices, remove it as soon as you see it in ALL CASES
during the intra and pre operative nursing care. Infection will only
occur after 48 hours of operation or event. B is much more immediate
and more likely to occur than A, and is much more FATAL.
Prioritization and Appropriateness is the key in correctly answering this
question. High risk for infection is an appropriate nursing diagnosis,
but as I said, Infection will occur in much later time and not as
immediate as B. Readily remove D and C because physiologic needs of
the mother and fetus take precedence over comfort measures and
psychosocial needs.

64. Katherine complains of severe abdominal pain and back pain

during contraction. Which two of the following measures will be MOST
effective in reducing pain? [4]

I - Rubbing the back with a tennis ball

II- Effleurage
III-Imagery
IV-Breathing techniques

A. II,IV
B. II,III
C. I,IV
D. I,II

* Remove B. Imagery is not used in severe pain. This is a labor pain

and the mother will never try to imagine a nice and beautiful scenery
with you at this point because the pain is all encompassing and severe
during the transition phase of labor. Remove A and C Because
breathing techniques is not a method to ELIMINATE PAIN but a
method to reduce anxiety, improve pushing and prevent rapid
expulsion of the fetus during crowning [ By PANTING ]

Back pain is so severe during labor in cases of Posterior presentations

[ ROP,LOP,RMP,LSaP, etc... ] Mother is asked to pull her knees
towards her chest and rock her back. [ As in a rocking chair ] A Tennis
ball rubbed at the client's back can relieve the pain due to the pressure
of the presenting part on the posterior part of the birth canal. Also,
rubbing a tennis ball to the client's back OPENS THE LARGE FIBER
NERVE GATE. Effleurage or a simple rotational massage on the
abdomen simply relieves the client's pain by opening the large fiber
nerve gate and closing the the small fiber nerve gate. [ Please read
about Gate control theory by Mezack and Wall ].

65. Lumbar epidural anesthesia is administered. Which of the following

nursing responsibilities should be done immediately following
procedure? [1]

A. Reposition from side to side

B. Administer oxygen
C. Increase IV fluid as indicated
D. Assess for maternal hypotension

* Hypotension is one of the side effects of an epidural anesthesia. An

epidural anesthesia is injected on the L3 - L4 or L4 - L5 area. The
injection lies just above the dura and must not cross the dura [ spinal
anesthesia crosses the dura ]. Nursing intervention revolves in
assesing RR, BP and other vital signs for possible complication and
side effects. There is no need to position the client from side to side,
The preferred position during the transition phase of labor is
LITHOTOMY. Oxygen is not specific after administration of an
epidural anesthesia. IV fluid is not increased without doctor's order.
AS INDICATED is different from AS ORDERED.

66. Which is NOT the drug of choice for epidural anesthesia? [4]

A. Sensorcaine
B. Xylocaine
C. Ephedrine
D. Marcaine

* A,B and D are all drugs of choice for epidural anesthesia. Ephedrine
is the drug use to reverse the symptom of hypotension caused by
epidural anesthesia. It is a sympathomimetic agent that causes
vasoconstriction, bronchodilation [ in asthma ] and can increase the
amount of energy and alertness. Ephedrine is somewhat similar to
epinephrine in terms of action as well as it's adverse effects of urinary
retention, tremor, hypersalivation, dyspnea, tachycardia,
hypertension.

SITUATION : [SORANGE217] Alpha, a 24 year old G4P3 at full term

gestation is brought to the ER after a gush of fluid passes through here
vagina while doing her holiday shopping.

67. She is brought to the triage unit. The FHT is noted to be 114 bpm.
Which of the following actions should the nurse do first? [2]

A. Monitor FHT ever 15 minutes

B. Administer oxygen inhalation
C. Ask the charge nurse to notify the Obstetrician
D. Place her on the left lateral position

* Remove A. A FHR of 114 bpm is 6 beats below normal. Though

monitoring is continuous and appropriate, This is not your immediate
action. B, Oxygen inhalation needs doctor's order and therefore, is a
DEPENDENT nursing action and won't be your first option. Although
administration of oxygen by the nurse is allowed when given at the
lowest setting during emergency situation. C is appropriate, but should
not be your IMMEDIATE action. The best action is to place the client on
the LEFT LATERAL POSITION to decrease the pressure in the inferior
vena cava [ by the gravid uterus ] thereby increasing venus return and
giving an adequate perfusion to the fetus. Your next action is to call
and notify the obstetrician. Remember to look for an independent
nursing action first before trying to call the physician.

68. The nurse checks the perineum of alpha. Which of the following
characteristic of the amniotic fluid would cause an alarm to the nurse?
[1]

A. Greenish
B. Scantly
C. Colorless
D. Blood tinged

* A greenish amniotic fluid heralds fetal distress not unless the fetus is
in breech presentation and pressure is present on the bowel. Other
color that a nurse should thoroughly evaluate are : Tea colored or
strong yellow color that indicates hemolytic anemia , as in RH
incompatibility.

69. Alpha asks the nurse. "Why do I have to be on complete bed rest?
I am not comfortable in this position." Which of the following response
of the nurse is most appropriate? [3]

A. Keeping you on bed rest will prevent possible cord prolapse

B. Completed bed rest will prevent more amniotic fluid to escape
C. You need to save your energy so you will be strong enough to push
later
D. Let us ask your obstetrician when she returns to check on you

* Once the membrane ruptures, as in the situation of alpha, The

immediate and most appropriate nursing diagnosis is risk for injury
related to cord prolapse. Keeping the client on bed rest is one of the
best intervention in preventing cord prolapse. Other interventions are
putting the client in a modified T position or Kneed chest position.
Once the amniotic fluid escapes, It is allowed to escape. Although bed
rest does saves energy, It is not the most appropriate response why
bed rest is prescribed after membranes have ruptured. Not answering
the client's question now will promote distrust and increase client's
anxiety. It will also make the client think that the nurse is incompetent
for not knowing the answer.

70. Alpha wants to know how many fetal movements per hour is
normal, the correct response is [4]

A. Twice
B. Thrice
C. Four times
D. 10-12 times

* According to Sandovsky, To count for the fetal movement, Mother is

put on her LEFT SIDE to decrease placental insufficiency. This is
usually done after meals. The mother is asked to record the number of
fetal movements per hour. A fetus moves Twice every 10 minutes and
10 to 12 times times an hour.

In SIA'S Book, She answered this question with letter B. But according
to Pillitteri, A movement fewer than 5 in an hour is to be reported to
the health care provider. The Board examiners uses Pillitteri as their
reference and WORD PER WORD, Their question are answered
directly from the Pillitteri book. 10-12 times according to Pillitteri, is
the normal fetal movement per minute.

71. Upon examination by the obstetrician, he charted that Alpha is in

the early stage of labor. Which of the following is true in this state? [1]

A. Self-focused
B. Effacement is 100%
C. Last for 2 hours
D. Cervical dilation 1-3 cm

* The earliest phase of labor is the first stage of labor : latent phase
characterized by a cervical dilation of 0-3 cm, Mild contraction lasting
for 20 to 40 seconds. This lasts approximately 6 hours in primis and
4.5 hours in multis. C is the characteristic of ACTIVE PHASE of labor,
Characterized by a cervical dilation of 4-7 cm and contractions of 40 to
60 seconds. This phase lasts at around 3 hours in primis and 2 hours
in multis. Effacement of 100% is a characteristic of the TRANSITION
PHASE as well as being self focused.

SITUATION : Maternal and child health nursing a core concept of

providing health in the community. Mastery of MCH Nursing is a
quality all nurse should possess.

72. When should be the 2nd visit of a pregnant mother to the RHU?
[2]

A. Before getting pregnant

B. As early in pregnancy
C. Second trimester
D. Third trimester

* Visit to the RHU are once every trimester and more frequent for
those women at risk. Visit to the health center is once during the 0-6th
month of pregnancy, twice during the 7th-8th month and weekly at
the last trimester.

73. Which of the following is NOT a standard prenatal physical

examination? [1]

A. Neck examination for goiter

B. Examination of the palms of the hands for pallor
C. Edema examination of the face hands, and lower extremeties
D. Examination of the legs for varicosities

74. Which of the following is NOT a basic prenatal service delivery

done in the BHS? [2]

A. Oral / Dental check up

B. Laboratory examination
C. Treatment of diseases
D. Iron supplementation

* A is done at the RHU not in BHS.

75. How many days and how much dosage will the IRON
supplementation be taken? [4]

A. 365 days / 300 mg

B. 210 days / 200 mg
C. 100 days/ 100mg
D. 50 days / 50 mg

* Iron supplementation is taken for 210 days starting at the 5th month
of pregnancy up to 2nd month post partum. Dosage can range from
100 to 200 mg.

76. When should the iron supplementation starts and when should it
ends? [4]
A. 5th month of pregnancy to 2nd month post partum
B. 1st month of pregnancy to 5th month post partum
C. As early in pregnancy up to 9th month of pregnancy
D. From 1st trimester up to 6 weeks post partum

* Refer to #75

77. In malaria infested area, how is chloroquine given to pregnant

women? [4]

A. 300 mg / twice a month for 9 months

B. 200 mg / once a week for 5 months
C. 150 mg / twice a week for the duration of pregnancy
D. 100 mg / twice a week for the last trimester of pregnancy

* Always remember that chloroquine is given twice a week for the

whole duration of pregnancy. This knowledge alone will lead you to
correctly identifying letter C.

78. Which of the following mothers are qualified for home delivery? [2]

A. Pre term
B. 6th pregnancy
C. Has a history of hemorrhage last pregnancy
D. 2nd pregnancy, Has a history of 20 hours of labor last
pregnancy.

* Knowing that a preterm mother is not qualified for home delivery will
help you eliminate A. History of complications like bleeding, CPD,
Eclampsia and diseases like TB, CVD, Anemia also nulls this
qualification. A qualified woman for home delivery should only had less
than 5 pregnancies. More than 5 disqualifies her from home delivery.
High risk length of labor for primigravidas ls more than 24 hours and
for multigravidas, it is more than 12 hours. Knowing this will allow you
to choose D.

79. Which of the following is not included on the 3 Cs of delivery? [2]

A. Clean Surface
B. Clean Hands
C. Clean Equipments
D. Clean Cord

* 3 Cs of delivery are CLEAN SURFACE,HANDS AND CORD. " Kinamay

ni Cordapya ang labada gamit ang Surf - Budek "

80. Which of the following is unnecessary equipment to be included in

the home delivery kit? [4]

A. Boiled razor blade

B. 70% Isopropyl Alcohol
C. Flashlight
D. Rectal and oral thermometer

* Home delivery kit should contain the following : Clamps, Scissors,

Blade, Antiseptic, Soap and hand brush, Bp app, Clean towel or cloth
and Flashlight.

Optional equipments include : Plastic sheet, Suction bulb, Weighing

scale, Ophthalmic ointment, Nail cutter, Sterile gloves, Rectal and oral
thermometers.

SITUATION : [NBLUE166] Pillar is admitted to the hospital with the

following signs : Contractions coming every 10 minutes, lasting 30
seconds and causing little discomfort. Intact membranes without any
bloody shows. Stable vital signs. FHR = 130bpm. Examination reveals
cervix is 3 cm dilated with vertex presenting at minus 1 station.

81. On the basis of the data provided above, You can conclude the
pillar is in the [1]

A. In false labor
B. In the active phase of labor
C. In the latent phase of labor
D. In the transitional phase of labor

* Refer to #71

82. Pitocin drip is started on Pilar. Possible side effects of pitocin

administration include all of the following except [3]

A. Diuresis
B. Hypertension
C. Water intoxication
D. Cerebral hemorrhage

* Oxytocin [ Pitocin ] is a synthetic form of hormone naturally released

by the PPG. It is used to augment labor and delivery. Dosage is about
1 to 2 milli units per minute and this can be doubled until the desired
contraction is met. Side effects are Water intoxication, Diuresis,
Hypertonicity of the uterus, Uterine rupture, Precipitated labor,
Walang kamatayang Nausea and Vomiting and Fetal
bradycardia. Diuresis occurs because of water intoxication, The
kidney will try to compensate to balance the fluid in the body.
NEVER give pitocin when FHR is below 120. Even without knowing
anything about Pitocin, A cerebral hemorrhage is LETHAL and
DAMAGE IS IRREVERSIBLE and if this is a side effect of a drug, I do
not think that FDA or BFAD will approve it.

83. The normal range of FHR is approximately [3]

A. 90 to 140 bpm
B. 120 to 160 bpm
C. 100 to 140 bpm
D. 140 to 180 bpm

* A normal fetal heart rate is 120-160 bpm.

84. A negative 1 [-1] station means that [1]

A. Fetus is crowning
B. Fetus is floating
C. Fetus is engaged
D. Fetus is at the ischial spine

* At the negative station, The fetus is not yet engaged and floating. At
0 station, it means that the fetus is engaged to the ischial spine.
Crowning occurs when the fetus is at the +3,+4 Station. Stations
signifies distance of the presensting part below or above ischial spine.
+ denoted below while - denotes above. The number after the sign
denotes length in cm. +1 station therefore means that the presenting
part is 1 cm below the ischial spine.

85. Which of the following is characteristics of false labor [1]

A. Bloody show
B. Contraction that are regular and increase in frequency and duration
C. Contraction are felt in the back and radiates towards the abdomen
D. None of the above

* A,B and C are all charactertistics of a true labor. True labor is

heralded by LIGHTENING. This makes the uterus lower and more
anterior. This occrs 2 weeks prior to labor. At the morning of labor,
women experiences BURST OF ENERGY because of adrenaline rush
induced by the decrease progestrone secretion of the deteriorating
placenta. The pain in labor is felt at the back and radiates towards the
abdomen and becomes regular, increasing frequency and duration. As
the cervix softens and dilates, The OPERCULUM or the mucus plug is
expelled.

False labor is characterized by Irregular uterine contraction that is

relieved by walking, Pain felt at the abdomen and confined there and
in the groin, The cervix do not achieve dilation and Pain that is relieved
by sleep and do not increase in intensity and duration.

86. Who's Theory of labor pain that states that PAIN in labor is cause
by FEAR [4]

A. Bradley
B. Simpson
C. Lamaze
D. Dick-Read

* Believe it or not, this is an actual board question. Grantley Dick-Read

is just one person. Usually a two name theory means two theorist. He
published a book in 1933 "CHILDBIRTH WITHOUT FEAR". He believes
that PAIN in labor is caused by FEAR that causes muscle tension,
thereby halting the blood towards the uterus and causing decreased
oxygenation which causes the PAIN.

1950s French obstetrician, Dr. Ferdinand Lamaze perhaps is the most

popular theorist when it comes to labor. The theory behind Lamaze is
that birth is a normal, natural and healthy event that should occur
without unnecessary medical intervention. Rather than resorting to
pain medication, different breathing techniques are used for each
stage of labor to control pain. Fathers are assigned the role of labor
coach, and are responsible for monitoring and adjusting their partner's
breathing pattern throughout childbirth.

In 1965, obstetrician Robert A. Bradley, MD wrote "Husband Coached

Childbirth." The Bradley method perhaps is the easiest to remember,
BRAD ley necessitates the presence of the FATHER during labor.
Bradley Method views birth as a natural process. This method also
emphasizes the importance of actively involving fathers in the labor
process. Fathers are taught ways to help ease their partner's pain
during childbirth through guided relaxation and slow abdominal
breathing.

James Young Simpson is an english doctor and the first to apply

anesthesia during labor and child birth. He uses ETHER to alleviate
labor pain. He then discovered the effects of chloroform as an
anesthetic agent. Because of his works, He was recognized by Queen
Victoria because the queen herself uses Simpson's chloroform in
alleviating labor pain when she gave birth to prince leopold.

87. Which sign would alert the nurse that Pillar is entering the second
stage of labor? [1]
A. Increase frequency and intensity of contraction
B. Perineum bulges and anal orifice dilates
C. Effacement of internal OS is 100%
D. Vulva encircles the largest diameter of presenting part

* The second stage of labor begins as the cervical internal os is 100%

effaced and fully dilated. It ends after the fetus has been delivered.
Crowning, as in letter B and D is too late of a sign to alert the nurse
that Pillar is entering the second stage of labor. A occurs during the
first stage of labor.

88. Nursing care during the second stage of labor should include [1]

A. Careful evaluation of prenatal history

B. Coach breathing, Bear down with each contraction and
encourage patient.
C. Shave the perineum
D. Administer enema to the patient

* The second stage of labor begins with a full cervical dilation and
effacement and finishes when the baby is fully delivered. Careful
evaluation of prenatal history is done on admission and check ups and
is never done in the second stage of labor. Shaving the perineum and
enema are done during the first stage of labor in preparation for
delivery or before labor begins when client is admitted. Enema is not a
routine procedure before delivery, but can be done to prevent
defecation during labor. B is appropriate during the second stage of
labor when the client's contraction is at it's peak and dilation and
effacement are at maximum to help client accomplish the task of
giving birth.

SITUATION : [NBLUE170] Baby boy perez was delivered

spontaneously following a term pregnancy. Apgar scores are 8 and 9
respectively. Routine procedures are carried out.

89. When is the APGAR Score taken? [1]

A. Immediately after birth and at 30 minutes after birth

B. At 5 minutes after birth and at 30 minutes after birth
C. At 1 minute after birth and at 5 minutes after birth
D. Immediately after birth and at 5 minutes after birth

* APGAR score taken 1 minute after birth determines the initial status
of the newborn while the 5 minute assessment after birth determines
how well the newborn is adjusting to the extrauterine life.

90. The best way to position a newborn during the first week of life is
to lay him [3]
A. Prone with head slightly elevated
B. On his back, flat
C. On his side with his head flat on bed
D. On his back with head slightly elevated

* Sudden infant death syndrome occurs when the fetus is in prone

position. Knowing this will allow you to eliminate A first. During the
first week of life, The fetus has an immature cardiac sphincter and
musculature for swallowing, Knowing this will let you eliminate B and
D. Side lying position is the best position for a neonate during the first
few weeks of life. This will decrease the risk of aspiration of secretion.

91. Baby boy perez has a large sebaceous glands on his nose, chin,
and forehead. These are known as [1]

A. Milia
B. Lanugo
C. Hemangiomas
D. Mongolian spots

* Newborn sebaceous glands are sometimes unopened or plugged.

They are called MILIA. They will disappear once the gland opens at
around 2 weeks after delivery. They are characterized by a pinpoint
white papule. Lanugo is the fine hair that covers the newborn. It
disappears starting 2 weeks after birth. A premature infant has more
lanugo than a post mature infant. Hemangiomas are vascular tumors
of the skin. Mongolian spots are patches that are gray in color and are
often found in sacrum or buttocks. They disappear as the child grows
older.

92. Baby boy perez must be carefully observed for the first 24 hours
for [2]

A. Respiratory distress
B. Duration of cry
C. Frequency of voiding
D. Range in body temperature

* Range in body temperature needs to be observed and carefully

monitored for the first 24 hours after delivery. A newborn has an
inadequate and immature temperature regulating mechanism. RDS is
observed immediately after delivery, not in a continuous 24 hour
observation. Once the fetus establish a normal breathing pattern it is
not anymore of a concern. RDS occurs when the Surfactants are
absent or insufficient. The adequacy of these surfactants is measured
by the L:S ratio [ Lecithin : Spingomyelin ] An L:S ratio of 2:1 is
considered, mature and adequate to sustain fetal lung expansion and
ventilation. Therefore, A child born without RDS is unlikely to have
RDS in 24 hours.

Another thing that is carefully observed during the first 24 hours is the
meconium. Absent of meconium during the first 24 hours after birth
warrants further investigation by the attending physician.

93. According to the WHO , when should the mother starts

breastfeeding the infant? [4]

A. Within 30 minutes after birth

B. Within 12 hours after birth
C. Within a day after birth
D. After infant's condition stabilizes

* According to the world health organization, The mother should start

breastfeeding her infant within 30 minutes after birth.

94. What is the BEST and most accurate method of measuring the
medication dosage for infants and children? [3]

A. Weight
B. Height
C. Nomogram
D. Weight and Height

* A nomogram is the most accurate method for measuring medication

dosage for infants and children. It estimates the body surface area by
drawing a line in the first column [ child's height ] towards the third
column [ child's weight ]. The point in which it crosses the middle
column [ BSA ] is the child's surface area.

95. The first postpartum visit should be done by the mother within [4]

A. 24 hours
B. 3 days
C. a week
D. a month

* Mother should visit the health facility 4 weeks to 6 weeks after

delivery. The first post partum visit by the birth attendant is done
within 24 hours after delivery, the next visit will be at 1 week after
delivery and the third visit is done 2 to 4 weeks after delivery.

96. The major cause of maternal mortality in the philippines is [3]

A. Infection
B. Hemorrhage
C. Hypertension
D. Other complications related to labor,delivery and
puerperium

* Refer to the latest survey of FHSIS in the DOH website.

97. According to the WHO, what should be the composition of a

commercialized Oral rehydration salt solution? [4]

A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium

Chloride 3.5g; Glucose 20 g.
A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride
3.5g; Glucose 10 g.
A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride
4.5g; Glucose 20 g.
A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride
4.5g; Glucose 10 g.

* This is the WHO ORESOL formula for the commercialized ORS.

Remember PA BCG Which stands for POTASSIUM [ Pa ] SODIUM
BICARBONATE [ B ] SODIUM CHLORIDE [ C ] GLUCOSE [ G ].
The numbers are easy to remember because they are just increased
by 1.0 g increment starting from 1.5. Glucose however is at 20 g. So
the MNEMONIC is PA BCG 1.5 2.5 3.5 20. This is the mnemonic I use
and it is easy to remember that way. It is original by the way.

98. In preparing ORESOL at home, The correct composition

recommnded by the DOH is [4]

A. 1 glass of water, 1 pinch of salt and 2 tsp of sugar

B. 1 glass of water, 2 pinch of salt and 2 tsp of sugar
C. 1 glass of water, 3 pinch of salt and 4 tsp of sugar
D. 1 glass of water, 1 pinch of salt and 1 tsp of sugar

99. Milk code is a law that prohibits milk commercialization or artificial

feeding for up to 2 years. Which law provides its legal basis? [4]

A. Senate bill 1044

B. RA 7600
C. Presidential Proclamation 147
D. EO 51

* Executive order # 51 prohibits milk commercialization or artificial

feeding up to 2 years. That is why the milk commercials in the country
has " BREAST MILK IS STILL BEST FOR BABIES UP TO 2 YEARS "
After their presentation in accordance with EO 51. RA 7600 is the
ROOMING IN / BREAST FEEDING ACT which requires the heatlh
professionals to bring the baby to the mother for breastfeeding as
early as possible. Senate bill # 1044 was created to implement RA
7600. Presidential Proclamation # 147 made WEDNESDAY as the
national immunization day.

100. A 40 year old mother in her third trimester should avoid [4]

A. Traveling
B. Climbing
C. Smoking
D. Exercising

* Mother's are not prohibited to travel, climb or exercise. If long

travels are expected, Mother should have a 30 minute rest period for
every 2 hours of travel [ LIPPINCOTT ]. Climbing is a very vague term
used by the board examiners though I assume they are referring to
climbing a flight of stairs. Anyhow, SMOKING is detrimental for both
mother and child no question about it and so is ALCOHOL. In
thousands of questions I answered, it never fails that
HANDWASHING, AVOID SMOKING, AVOID ALCOHOL are always
the answer. It still depends on the question so THINK.