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WORKBOOK
OBSTETRICS
Philippine Midwifery Licensure Examination
NAME:
1. What is the most important observation to monitor progress of labor?
A. Uterine contractions
B. Cervical Dilation
C. Within the 1st week postpartum
D. In the 3rd and 4th stage of labor
2. The midwifery student is preparing to teach a prenatal class about fetal circulation. Which statement should be included
in the teaching plan?
A. “One artery carries oxygenated blood from the placenta to the fetus.”
B. Two arteries carry oxygenated blood from the placenta to the fetus.”
c. “Two arteries carry deoxygenated blood and waste products away from the fetus to the
placenta.”
d. “Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the
placenta.”
3. A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the midwife
would determine whether this method of family planning would be most appropriate?
A. “Has either of you ever had surgery?”
B. “Do you plan to have any other children?”
C. “Do either of you have diabetes mellitus?”
D. “Do either of you have problems with high blood pressure?”
4. The midwife is reviewing the record of a client who has just been told that a pregnancy test is positive. The health
care provider has documented the presence of Goodell’s sign. This finding is most closely associated with which
characteristic?
A. A softening of the cervix
B. The presence of fetal movement
C. The presence of human chorionic gonadotropin in the urine
D. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus
5. A client arrives at the clinic for the first prenatal assessment. She tells the midwife that the first day of her last
menstrual period was October 19, 2015. Using Nägele’s rule, which expected date of delivery should the midwife
document in the client’s chart?
A. July 12, 2015
B. July 26, 2016
C. August 12, 2016
D. August 26, 2016
6. The midwife is performing an assessment of a primigravida who is being evaluated in a clinic during her second
trimester of pregnancy. Which finding concerns the midwife and indicates the need for follow-up?
A. Quickening
B. Braxton Hicks contractions
C. Fetal heart rate of 180 beats/minute
D. Consistent increase in fundal height
7. The midwife is collecting data during an admission assessment of a client who is pregnant with twins. The client has a
healthy 5-year-old child who was delivered at 38 weeks and tells the midwife that she does not have a history of any
type of abortion or fetal demise. Using GTPAL, what should the midwife document in the client’s chart?
A. G = 3, T = 2, P = 0, A = 0, L = 1
B. G = 2, T = 1, P = 0, A = 0, L = 1
C. G = 1, T = 1, P = 1, A = 0, L = 1
D. G = 2, T = 0, P = 0, A = 0, L = 1
8. Early in development (4 months after fertilization), the testes
A. Are located in the abdominal cavity.
B. Move through the inguinal canal.
 C. Produce a membrane that becomes the scrotum.
D. Produce sperm cells.
E. All of the above.
9. The site of spermatogenesis in the male is the
A. ductus deferens
B. epididymis
C. efferent ductule
D. seminiferous tubules
E. rete testis
10. What tissue will removed during circumcision?
A. glans
B. frenulum
C. corpus spongiosum
D. Prepuce
11. Ovulation is the process of _______:
A. Rupture of the ovary followed by the release of an immature follicle.
B. Monthly release of a mature ovum
C. Rupture of the primordial follicle followed by the release of an egg cell happening in the middle of the menstrual
cycle
D. Maturity of the female reproductive function
12. The first polar body is/are described __________.
A. Is when the chromosomes have segregated but there is unequal division of cytoplasm
B. Most of the cytoplasm from original cell goes to the cell that will develop to become the egg
C. Is larger than an oocyte.
D. Both a and b
E. Both b and c
13. After ovulation, the mature follicle collapses, taking on a yellowish appearance to become the
A. Degenerating follicle
B. Corpus albicans
C. Corona radiata
D. Corpus luteum
E. Tunica albuginea
14. The major secretory product of the mature follicle is
A. Estrogen
B. Progesterone
C. LH
D. FSH
E. Relaxin
15. In the average adult female, ovulation occurs at day of the menstrual cycle.
A. 1
B. 7
C. 14
D. 21
E. 28
16. During the secretory phase of the menstrual cycle,
A. The highest levels of progesterone occur.
B. There is a follicle present in the ovary that is ready to undergo ovulation.
C. The endometrium continues and is maintained
D. a and b
E. a and c
17. The cause of menses in the menstrual cycle appears to be
A. Increased progesterone secretion from the ovary, which produces blood clotting.
B. Increased estrogen secretion from the ovary, which stimulates the muscles of the uterus to contract.
C. Decreased progesterone secretion by the ovary.
D. Decreased production of oxytocin, causing the muscles of the uterus to relax.
18. The midwife teaches a group of women about menstruation. Which among these statement verbalized by women
would need further clarification?
A. Average cycle usually lasts 30 days
B. It last around 3-6 days
 C. Blood loss is around 30-40 ml
D. Absence of menstruation in pregnancy is expected.
19. A pregnant client in the first trimester calls the midwife at a health care clinic and reports that she has noticed a thin,
colorless vaginal drainage. The midwife should make which statement to the client?
A. “Come to the clinic immediately.”
B. “The vaginal discharge may be bothersome, but is a normal occurrence.”
C. “Report to the emergency department at the maternity center immediately.”
D. “Use tampons if the discharge is bothersome, but to be sure to change the tampons every 2 hours.”
20. A health care provider has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy and
the client asks the nurse about the procedure. How should the nurse respond to the client?
A. “The procedure takes about 2 hours.”
B. “It will be necessary to drink 1 to 2 quarts of water before the examination.”
C. “The probe that will be inserted into the vagina will be covered with a disposable cover and coated
with a gel.”
D. “Gel is spread over the abdomen, and a round disk transducer will be moved over the abdomen to obtain the
picture.”
21. The midwife has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which
statement by the client indicates a need for further instructions?
A. “I should wear panty hose.”
B. “I should stand for long periods.”
C. “I should wear flat nonslip shoes that have good support.”
D. “I should wear knee-high hose, but I should not leave them on longer than 8 hours.”
22. A 55-year-old male client confides in the midwife that he is concerned about his sexual function. What is the
midwife’s best response?
A. “How often do you have sexual relations?”
B. “Please share with me more about your concerns.”
C. “You are still young and have nothing to be concerned about.”
D. “You should not have a decline in testosterone until you are in your 80s.
23. The health care provider (HCP) is assessing the client for the presence of ballottement. To make this determination,
the HCP should take which action?
A. Auscultate for fetal heart sounds.
B. Assess the cervix for compressibility.
C. Palpate the abdomen for fetal movement.
D. Initiate a gentle upward tap on the cervix.
24. The midwife is performing an assessment on a client who is at 38 weeks’ gestation and notes that the fetal heart rate
is 174 beats/minute. On the basis of this finding, what is the priority action?
A. Document the finding.
B. Check the mother’s heart rate.
C. Notify the health care provider (HCP).
D. Tell the client that the fetal heart rate is normal.
25. The midwife is conducting a prenatal class on the female reproductive system. When a client in the class asks why
the fertilized ovum stays in the fallopian tube for 3 days, what is the midwife’s best response?
A. “It promotes the fertilized ovum’s chances of survival.”
B. “It promotes the fertilized ovum’s exposure to estrogen and progesterone.”
C. “It promotes the fertilized ovum’s normal implantation in the top portion of the uterus.”
D. “It promotes the fertilized ovum’s exposure to luteinizing hormone and follicle-stimulating hormone.”
26. Narrowest AP diameter of the pelvic inlet is ______:
A. Diagonal conjugate
B. Obstetrical conjugate
C. True conjugate
D. Conjugate vera
27. Withdrawal of what hormone in the blood result to menstruation:
A. Progesterone
B. Estrogen
C. FSH
D. LH
28. Preterm baby is _______:
A. More than 40wks AOG
B. Less than 38wks AOG
 C. Less than 37wks AOG
D. 39wks AOG
29. Which of the following is a presumptive sign of pregnancy?
A. Funic soufflé
B. Hegars sign
C. Amenorrhea
D. Fetal movements
30. A pregnant mother with rheumatic heart disease on her 7th month of pregnancy got heart failure and died. What is
the cause?
A. Direct obstetrical
B. Indirect obstetrical
C. Medical
D. current obstetrical
31. For pregnancies past of 40 weeks AOG, do the following:
A. Wait for 2 weeks more
B. Refer to physician
C. Induce labor by oxytocin
D. Induce labor by methergine
32. Descent of fetal head (in fifths) when sinciput and occiput lie above the pelvic brim:
A. 5/5
B. 2/5
C. 3/5
D. 0/5
33. Molding of the head occurs when there is some degree of pelvic contraction. Normally, molding may decrease the BP
and SOB diameters of the fetal skull by?
A. 0.5 cm to 1 cm
B. 1.5 cm to 2 cm
C. 2.5 cm to 3 cm
D. 3.5 cm to 4 cm
34. The presence of Bandl’s ring is a sign of:
A. Impending uterine rupture
B. Presence of progress of labor
C. Obstructed labor
D. Abruptio placenta
35. A cardinal movement in labor that precedes external rotation/ restitution of the head?
A. Internal Rotation
B. Extension
C. Expulsion
D. Crowning
36. When the pulsation stops, clamp the cord using two sterile forceps about ______ from each other:
A. 6-8 inches
B. 2-2.5 cm
C. 5 cm
D. 1 inch
37. What structure lies between the two parietal and frontal bone?
A. Coronal suture
B. Posterior fontanel
C. Anterior fontanel
D. Sagittal suture
38. Concerning the breasts, which is true?
A. Lactiferous ducts open on the areola.
B. Each lactiferous duct supplies an alveolus.
C. They are attached to the pectoralis major muscles by suspensory ligaments.
D. Even before puberty, the female breast is quite different from the male breast.
39. The layer of the uterus that undergoes the greatest change during the menstrual cycle is the
A. Perimetrium
B. Endometrium
C. Broad ligament
D. Hymen
 E. Myometrium
38. When is the fetal weight is gain greatest?
A. 1st trimester
B. 2nd trimester
C. 3rd trimester
D. from 4th week up to 16th week of pregnancy
39. The hormone responsible for the development of the ovum during the menstrual cycle is?
A. Estrogen
B. Progesterone
C. Follicle Stimulating hormone (FSH)
D. Luteneizing hormone (LH)
40. Which hormone is not responsible for differentiation of male reproductive organs during fetal life?
A. Mullerian duct inhibitor (MDI)
B. Dehydroepiandosterone sulfate
C. Dyhydrotestosterone
D. Testosterone
41. Mr. Lianmuel De Guzman visits the clinic and is told that his sperm count is normal. A normal sperm count ranges
from:
A. 20 to 100/ml
B. 100 to 200/ml
C. 100, 000 to 200, 000/ml
D. 20 to 100 million/ml
42. Which of the following statement is TRUE with regards to the use of Depo-medroxy Progesterone Acetate?
A. The mother needs to return to the clinic every three months
B. This natural family planning is highly regarded by pro-life members
C. This entails protection against pregnancy for 3-5 years
D. the use of this type of method make the mother at risk for PID
43. Which of the following method would warrant annual papanicolau pap-smear exam?
A. Pills
B. IUD
C. Diaphragm
D. Female condom
44. To determine the womens EDC, which day of the menstrual period will you ask?
A. First
B. Last
C. Third
D. Second
45. According to Joy, her LMP is November 15, 2013, using the Naegle’s rule what is her EDC?
A. August 22, 2014
B. July 22, 2014
C. August 18, 2014
D. February 22, 2014
46. Joy complained of leg cramps, which usually occurs at night. To provide relief, the nurse tells Diane to:
A. Dorsiflex the foot while extending the knee when the cramps occur
B. Dorsiflex the foot while flexing the knee when the cramps occurs
C. Plantar flex the foot while flexing the knee when the cramps occur
D. Plantar flex the foot while extending the knee when the cramp occur
47. In determining the client’s AOG/ Age of gestation, all of the following can be used EXCEPT:
A. Haase’s Rule
B. Naegel’s Rule
C. Bartholomew’s Rule
D. Mc Donald’s Rule
48. Which is not considered an uteroronin?
A. Prostaglandin
B. misoprostol
C. Oxytocin
D. terbutaline
49. Which is a primary power of labor?
A. uterine contractions
 B. intrathoracic pressure
C. pushing of the mother
D. abdominal contraction
50. The lower uterine segment is formed from the:
A. cervix
B. body of the uterus
C. isthmus and cervix
D. Isthmus
51. When reviewing the ethical dilemmas facing maternal and newborn issues today, which of the following has
contributed to their complexity?
A. Limitation of available options
B. Contradicting actions based on value system
C. Advancement in technology
D. Consistent desirable standards
52. What structure lies between the parietal and frontal bones?
A. Posterior fontanel
B. sagittal suture
C. lambda
D. anterior fontanel
53. Which plays an important role in the initiation of labor?
A. maternal adrenal cortex
B. fetal adrenal cortex
C. Fetal adrenal medulla
D. maternal adrenal medulla
54. Ripening of the cervix occurs during the:
A. first stage
B. second stage
C. third stage
D. fourth stage
55. Signs that the placenta has detached from the uterus:
1. Sudden gush of blood comes from the vagina
2. The umbilical cord gets shorter
3. The placenta becomes round in shape
4. The uterine fundus rises
A. All statements are correct
B. 3 statements are incorrect
C. Only 1 statement is correct
D. All statements are incorrect
56. During which of the following phase of the menstrual cycle is it ideal for implantation of a fertilized egg to occur?
A. Ischemic phase
B. Proliferative phase
C. Menstrual phase
D. Secretory phase
57. Variation on the length of menstrual cycle is due to variations in the number of days in which of the following phase?
A. Proliferative phase
B. Ischemic phase
C. Luteal phase
D. Secretory phase
58. Which of the following is not a part of conceptus?
A. Deciduas
B. amniotic fluid
C. fetus
D. Membranes
59. Ultrasound showed oligohydramnios which indicates:
A. 1200cc – 1500cc amniotic fluid
B. Fetus do not secrete urine
C. Fetus does not able to swallow AF
D. 800cc – 1000cc amniotic fluid
60. Hormone of pituitary gland that stimulate ovary to secrete estrogen:
 A. ACTH
B. FSH
C. Prolactin
D. Thyroxine
61. What is the chromosome of male zygote?
A. 23x
B. 23y
C. 46xx
D. 46xy
62. What stage if the cervix is 2-6cm dilated?
A. 1st
B. 2nd
C. 3rd
D. 4th
63. According to WHO criteria for eligibility, the best time to administer IUD is:
A. During menstruation provided patient is not pregnant
B. 1 week postpartum
C. 2 weeks postpartum
D. 6 weeks postpartum
64. Six days postpartum bleeding, most probable cause?
A. Atony
B. Laceration
C. Blood clotted
D. Retained placental fragments
65. The effect of mismanagement of 3rd stage of labor:
A. Uterine inversion
B. Cord prolapsed
C. Abruptio palcenta
D. Placenta accreta
66. Site of fertilization:
A. Isthmus
B. Infundibulum
C. Cornua
D. Ampulla
69. Concerning the vagina,
A. its wall consists of skeletal muscle.
B. the vaginal orifice is covered by the hymen.
C. it is lined with simple squamous epithelium.
D. all of the above.
70. What happens under the influence of the FSH & LH?
A. Rise in levels causes the Graffian follicle to mature and ovulation takes place
B. Increase in levels causes the menstrual cycle to begin
C. Corpus luteum degenerates and becomes the corpus albicans.
D. Proliferative phase ends
71. During sexual excitement, which of these structures fills with blood and causes the vaginal orifice to narrow?
A. bulb of the vestibule
B. mons pubis
C. prepuce
D. clitoris
E. labia majora
72. A woman with a 28-day menstrual cycle is most likely to become pregnant as a result of coitus on days
A. 1–3
B. 5–8
C. 9–14
D. 15–20
73. A pregnant client asks the nurse about the types of exercises that are allowable during pregnancy. The nurse should
tell that client that which exercise is safest?
A. Swimming
B. Scuba diving
 C. Low-impact gymnastics
D. Bicycling with the legs in the air
74. A pregnant client calls a clinic and tells the nurse that she is experiencing leg cramps that awaken her at night. What
should the nurse tell the client to provide relief from the leg cramps?
A. “Bend your foot toward your body while flexing the knee when the cramps occur.”
B. “Bend your foot toward your body while extending the knee when the cramps occur.”
C. “Point your foot away from your body while flexing the knee when the cramps occur.”
D. “Point your foot away from your body while extending the knee when the cramps occur.”
75. While assessing the FHT, the nurse notes early decelerations during uterine contractions. The next appropriate action
of the midwife is:
A. Document the finding on the partograph
B. Report the finding to the physician at once
C. Change the mother’s position
D. Administer mask oxygen to the client
76. On the third day post-partum, Mrs. Susan A.’s breast became full and the breast appeared inflamed. She complained
of a feeling of tension in the breast. This condition is termed:
A. Engorgement
B. Mastitis
C. Let-down reflex
D. Milk fever
77. It is expected that by the ____ day, the blastocyst must have been implanted into deciduas.
A. 4th day
B. 7th day
C. 15th day
D. 10th day
78. The hormone that stimulates the ovaries to produce estrogen is
A. GnRH
B. LH
C. LHRF
D. FSH
79. How much blood is loss on the average during menstrual period?
A. Half cup
B. 2-3 tablespoons
C. 3 ounces
D. 1/3 cup
80. Menopause _______:
A. Develops when follicles become less responsive to FSH and LH.
B. Results from elevated estrogen levels in 40- to 50-year-old women.
C. Occurs because too many follicles develop during each cycle.
D. Results when follicles develop but contain no oocytes.
E. Occurs because FSH and LH levels decline.
81. The midwife has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. The midwife
interprets the test as reactive. How should the midwife document this finding?
A. Normal
B. Abnormal
C. The need for further evaluation
D. That findings were difficult to interpret
82. Patient Lydia 25 years old G1P1 BP of 150/100 developed post partum bleeding, drug of choice:
A. Oxytocin
B. Methergin
C. Misoprostol
D. Ergotate
83. Prevention of meningocele:
A. Folic acid
B. Vitamin B12
C. Iron
D. Calcium
84. Agent that cause teeth staining:
A. Tetracycline
 B. Streptomycin
C. Metronidazole
D. Penicillin
85. Promotion of health is one major goal in women’s health. As a midwife, which among these will be reinforced in your
health education except?
A. Use a cervical vaccine among women of reproductive age only
B. Use of family planning methods to space children and allow the organs to regain their maximum health.
C. Mammograms yearly for women above 50 years or 40 years for high risk.
D. Pap smear for sexually active women within 3yrs of first sexual contact
86. What is the most important observation to monitor progress of labor?
A. Uterine contraction
B. Cervical Dilation
C. Descent of the fetal head
D. Moulding of the fetal skull
87. What hormone is responsible for constipation during pregnancy:
A. Estrogen
B. Progesterone
C. Thyroxin
D. Prostaglandin
88. The following should be done on the third stage of labor, except:
A. Pull the umbilical cord even without uterine contraction
B. Request the woman to lie on her back
C. Do the Brandt-Andrews Maneuver
D. Wait for sign of placental separation
89. Mechanisms of actions of combined oral contraceptive:
A. Made cervical mucus thick
B. Prevention of ovulation
C. Both
D. Neither
90. What is the common cause of Heartburn?
A. Progesterone
B. Estrogen
C. Relaxin
D. FSH
91. Characteristic of true labor, except:
A. Regular contractions
B. Duration is shorter
C. Interval is shorter
D. Cervical dilatation is improving
92. What is the presenting part if the fetus is in face presentation?
A. Suboccipitobregmatic
B. Submentobregmatic
C. Occipitofrontal
D. Occipitomentum
93. The feet of the fetus lies in close proximity to the head. What kind breech presentation is this?
A. Complete
B. Incomplete
C. Frank
D. Footling
94. This drug is given intramuscularly, very effective and lesser side effect:
A. Misoprostol
B. Oxytocin
C. Ergotriate
D. Prostaglandin
95. Complication of smoking to the pregnant mother and her baby:
A. Macrosomia
B. Low birth weight
C. Post maturity
D. Stillbirth
96. In checking the placenta after delivery, note for the following:
A. Insertion of umbilical cord
B. Intact membranes
C. Additional lobes/cotyledon
D. All of these
97. Which of the following condition do not need ceasarean delivery?
A. Eclampsia
B. Prematurity
C. Placenta previa
D. HIV mother
98. Moving the baby's head towards the mother's coccyx allows delivery of the baby’s:
A. anterior shoulder
B. posterior
C. shoulder
D. Head
99. The third maneuver of Leopold answers the question:
A. Where is the fetal back?
B. Is the presenting part still movable?
C. On which side is the cephalic prominence
D. What fetal part occupies the fundus?
100. After pain is common in:
A. Multiparous breastfeeding
B. Prolonged labor
C. Retained placenta
D. All of these