MAIN SUBJECT: OBSTETRIC NURSING

TOPICS:

1. Antepartum
2. Complications of Pregnancy
3. Intrapartum
4. Postpartum
LEARNING OBJECTIVES:

Chapter 1- Antepartum

1. Explain the anatomy and physiology associated with conception and pregnancy.
2. Differentiate between the stages of fetal development.
3. Differentiate between the signs of pregnancy.
4. Interpret diagnostic tests for antepartal clients.

Chapter 2- Complications of Pregnancy

1. Describe selected complications of pregnancy.

2. Interpret clinical manifestations for clients experiencing selected complications of pregnancy.
3. Identify the treatments for selected complications of pregnancy.

Chapter 3- Intrapartum

1. Differentiate between the stages of labor.

2. Recognize selected intrapartal complications.
3. Evaluate expected outcomes of nursing care for intrapartal clients.

Chapter 4- Postpartum

1. Describe postpartal physiologic and psychosocial changes.

2. Explain teaching and learning for postpartal care and discharge.
3. Explain aspects of health promotion related to postpartal care.
A. Binary Type
Directions: Read the following statement carefully Write TRUE if the statement is correct and FALSE if
otherwise. If the statement is FALSE changed the underlined word or phrase to make it right. Write your
answer on the blank provided. (2 points each)

__________1. External genitalia is collectively known as pudenda.

__________2. The pelvic shape that is transversely rounded and most favorable for vaginal birth is
called Platypelloid.
__________3. Amenorrhea is a menstruation with regular intervals of less than 21 days.
__________4. In the female, evaluation of the pelvic organs or reproduction is accomplished by
Hysterosalphingogram.
__________5. An embryonic germ layer that is responsible for brain and spinal cord development is
called Endoderm.

B. Multiple Choice
Read each questions carefully then write the letter of your choice in the blank before each number.
Write your answer in CAPITAL LETTER. (1 pt)
_____1. Which hormone is produced in high levels to prepare the endometrium for implantation just
after ovulation by the corpus luteum?
A. Estrogen C. Prostaglandin
B. Prolactin D. Progesterone
_____2. Which hormone is necessary for a positive pregnancy test?
A. Estrogen C. Placental Lactogen
B. Human chorionic gonadotropin D. Progesterone
_____3. A pregnant client’s last normal menstrual period was on August 10. Using Naegele’s rule, the
nurse calculates that her estimated date of birth (EDB) will be which of the following?
A. May 17 C. July 10
B. June 23 D. July 30
_____4. The developing cells are called a fetus from the:
A. Time the fetal heart is heard
B. Eight week to the time of birth
C. Implantation of the fertilized ovum
D. End of the second week to the onset of labor
_____5. After the first3 months of pregnancy, the chief source of estrogen and progesterone is the:
A. Adrenal cortex C. Corpus luteum
B. Anterior hypophysis D. Placenta
_____6. In explaining the development of the baby, you identified in chronological order of growth of
the fetus as it occurs in pregnancy.
A. Ovum, embryo, zygote, fetus, infant
B. Zygote, ovum, embryo, fetus, infant
C. Ovum, zygote, embryo, fetus, infant
D. Zygote, ovum, fetus, embryo, infant
_____7. An expected change in the hematologic system that occurs during the second trimester of
pregnancy is:
A. a decrease in WBCs C. an increase in blood volume
B. an increase in hematocrit D. a decrease in sedimentation rate
_____8. An adaptation of pregnancy is an increased blood supply to the pelvic region that results in a
purplish discoloration of the vaginal mucosa, which is known as:
A. Chadwick’s sign C. Hegar’s sign
B. Goodell’s sign D. Ladin’s sign
_____9. A 24 year old woman comes to the clinic because she thinks she is pregnant. Which of the
following is a probable sign of pregnancy?
A. Absence of menses C. Nausea and vomiting
B. Fetal heart tone D. Bluish discoloration of vagina and cervix
_____10. A pregnant client has a negative contraction stress test (CST). Which of the following
statements describes negative CST results?
A. Accelerations of fetal heartbeat occurred, with at least 15 beats/minute lasting 15 to 30
seconds in a 20 minute period.
B. Accelerations of fetal heartbeat were absent or didn’t increase by 15 beats/min for 15 to
30 seconds in a 20 minute period.
C. Persistent late decelerations in fetal heartbeat occurred, with at least three contractions in
a 10 minute window.
D. There was a good fetal heart rate variability and no decelerations from contraction in 10
minute period in which there were three contractions.
_____11. Which of the following rationales best explain why a pregnant client should lie on her left side
when resting or sleeping in the later stages of pregnancy?
A. To avoid the development of fetal anomalies
B. To prevent compression of the vena cava
C. To facilitate bladder emptying
D. To facilitate digestion
_____12. Gravida refers to which of the following descriptions?
A. Number of times a female has been pregnant
B. Number of children a female has delivered
C. Number of term pregnancies a female had
D. Number of living children
_____13. During prenatal development, fetal weight gain is greatest in the:
A. First trimester C. Third trimester
B. Second trimester D. Implantation period
_____14. A pregnant client is making her first antepartum visit. She has a 2 year old son born at 40
weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 36
weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, you
identify that the client is:
A. G4 T3 P2 A1 L4 C. G5 T2 P1 A1 L4
B. G5 T2 P2 A1 L4 D. G4 T3 P1 A1 L4
nd
_____15. A client in the 32 week of pregnancy is scheduled for ultrasonography. The nurse explains the
procedure and informs the client that for this test she will have to:
A. Be given an enema the night before the examination
B. Refrain from voiding for at least 3 hours before the test
C. Be monitored closely afterward for signs of precipitate labor
D. Keep NPO 12 hours before the procedure to minimize possibility of vomiting
_____16. A pregnant client asks the clinic nurse how smoking will affect her baby. The nurse’s response
reflects the knowledge that:
A. Fetal and maternal circulation are separated by the placental barrier
B. Smoking relieves tension and the fetus responds accordingly
C. The placenta is permeable to specific substances
D. Vasoconstriction will affect both fetal and maternal blood vessels
_____17. In the 37th week of gestation, a client is scheduled for a nonstress test. After explaining the
procedure, the nurse evaluates that the client understands the teaching when she says:
A. “I hope this test does not cause my labor to begin early.”
B. “I hope the baby doesn’t get too restless after this procedure.”
C. “I hate having needles in my arm, but now I understand why it is necessary.”
D. “If my baby’s heart reacts normally during the test, he should do okay during delivery.”
_____18. After 2 weeks of medical management, Mrs. Castro goes into labor accompanied by board-like
abdomen with dark red vaginal bleeding. The nurse would suspect which of the following
complications?
A. Abruptio placenta C. Placenta previa
B. Ectopic pregnancy D. Abortion
_____19. Which of the following signs and symptoms is MOST indicative of hypoglycemia in newborn of
a diabetic mother?
A. puffy appearance C. active with good cry
B. longer and larger D. usually premature
_____20. Typical characteristics of Diabetic ketoacidosis include the following EXCEPT:
A. cold clammy skin C. polyphagia
B. polyuria D. tachycardia
_____21. Ms. Perena believes that she is pregnant since she missed her period for 2 months. Upon
examination, she was diagnosed of ectopic pregnancy. Laboratory tests in ectopic pregnancy
would usually reveal?
A. high HCG, high progesterone
B. low HCG, high progesterone
C. high HCG, low progesterone
D. low HCG, low progesterone
_____22. The nurse knows that these are the expected manifestations of threatened abortion EXCEPT:
A. fetal size appropriate for AOG
B. none or mild uterine contractions
C. passage of placental tissues
D. slight vaginal bleeding
_____23. A client at 8 months gestation is diagnosed with oligohydramnios. She asks the nurse if this can
harm the fetus. The nurse’s best response is:
A. “Yes, oligohydramnios can lead to umbilical cord compression.”
B. “Yes, it means the fetus swallowed too much fluid.”
C. “No, this commonly occurs toward the end of pregnancy.”
D. “No, this is a sign that the lungs are maturing.”
_____24.Which of the following nursing actions would take priority when caring for the woman with
suspected ectopic pregnancy?
A. Administering oxygen C. Obtaining surgical consent
B. Monitoring vital signs D. Providing emotional support
_____25. Which of the following signs or symptoms would indicate a need for colposcopy and biopsy for
human papillomavirus?
A. Rash on palms of the hands and soles of the feet.
B. Chancre sore noted on the vulva.
C. A crusted ulcer inside the vagina.
D. 2 to 3 mm soft, papillary swellings either singly or in cluster noted on the genitalia.
_____26. Which of the following is a classic symptom of abruption placenta?
A. Excessive nausea and vomiting C. Knife-like abdominal pain
B. Vaginal bleeding, backache D. Painless, bright-red bleeding
_____27. A pregnant client has a total hemoglobin level of 9 g/dL. Which risk is greatest during the
intrapartum period?
A. excessive postpartum bleeding C. small for gestational age
B. fetal distress D. shortness of breath
_____28. TORCH is an acronym for maternal infections associated with an increase in congenital
malformations and disorders. Which of the following does H represent?
A. Human chorionic gonadotropin virus C. Herpes simplex virus
B. Hepatitis B virus D. Human immunodeficiency virus
_____29. A nurse is reviewing true and false labor signs with a multiparous client. The nurse determines
that the client understands the signs of true labor if she makes which statements?
A. “I won’t be in labor until the baby engages.”
B. “My contractions will be felt in the abdominal area.”
C. “My contractions will not be as painful if I walk around.”
D. “My contractions will increase in duration and intensity.”
_____30. A nurse in the labor room is caring for a client in the active stage of labor. The nurse is
assessing the fetal patterns and notes a late deceleration on the monitor strip. The appropriate
nursing action is to:
A. Administer oxygen via face mask.
B. Document the findings and continue to monitor the fetal patterns.
C. Increase the rate of the oxytocin.
D. Place the mother in a supine position.
_____31. A nurse is monitoring a client who is in the active stage of labor. The client has been
experiencing contractions that are short, irregular, and weak. The nurse documents that the
client is experiencing which type of labor dystocia?
A. Hypertonic C. Hypotonic
B. Precipitous D. Preterm labor
_____32. During a client’s labor, the fetus head is at +1. This indicates that the presenting part is:
A. On the perineum C. Slightly below the ischial spine
B. Slightly above the ischial spine D. High in the false pelvis
_____33. A teenage client, 38 weeks’ gestation, is admitted with a diagnosis of PIH. Data include: BP
160/100, generalized edema, weight gain of 10 lbs in the last 2 weeks, and proteinuria of +3;
the client is also complaining of a backache and nausea. In planning care for this client, the
nurse would set the following priority goal. The client will:
A. comply with medical and nutritional regimen.
B. not experience a seizure prior to delivery.
C. demonstrate a decreased blood pressure within 48 hours.
D. maintain a strict diet prior to delivery.
_____34.Which of the following nursing observations would indicate a sign of impending placental
separation and
A. Steady trickle of blood with an unchanged cord length
B. No bleeding with lengthening of the cord
C. Small gush of blood with lengthening of the cord
D. Small gush of blood with an unchanged cord length
_____35.A woman is in the fourth stage of labor. She and her new daughter are together in the room.
What assessments are essential for the nurse to make during this time?
A. Assess the pattern and frequency of contractions and infant’s vital signs.
B. Assess the woman’s vital signs, fundus, bladder, perineal condition and lochia. Assess the
infant’s vital signs.
C. Assess the woman’s vital signs, fundus, bladder, perineal condition and lochia. Return the
infant to the nursery.
D. Assess the woman for blood loss and firm uterine contraction. Assess the infant for obvious
abnormalities.
_____36. At 1 minute of life, a neonate is crying vigorously, has a heart rate of 98, is active with normal
reflexes, and has a pink body and blue extremities. Which of the following Apgar scores would
be correct for this neonate?
A. 6 C. 8
B. 7 D. 9
_____37. The nurse understands that postpartal breast engorgement occurs 48 to 72 hours after giving
birth as a result of an increase in:
A. Blood and lymph supply C. Estrogen and progesterone levels
B. Colostrum production D. Fluid retention in the breasts
_____38. When checking the client’s fundus on the second postpartum day, the nurse observes that the
client’s fundus is above the umbilicus and displaced to the right. Then nurse evaluates that the
client propably has:
A. A slow rate of involution C. Retained placental fragments
B. A full, over distended bladder D. Overstretched uterine ligaments
_____39. The nurse working on the postpartum unit should encourage client to ambulate early to:
A. promote respiration C. maintain tone of the abdominal muscle
B. increase the tone of the bladder D. increase peripheral vasomotor activity
_____40. When performing discharge teaching for a postpartum client the nurse should inform her that:
A. The episiotomy suture will be removed at the first postpartum checkup.
B. She may not have any vowel movements for up to a week after the birth.
C. She has to schedule a postpartum checkup as soon as her menses return.
D. The perineal tightening exercises started during pregnancy should continue indefinitely.
_____41. A client has an episiotomy and complains of perineal discomfort. She is also afraid to have
bowel movement. Which of the following is nurse highest priority for the client at this time?
A. Activity intolerance C. Pain
B. Deficient knowledge D. Risk for constipation
_____42. To prevent cracked nipples while the mother is breastfeeding, she should be taught to:
A. apply lanolin prior to feedings.
B. nurse at least 20 minutes on each breast the first day.
C. use bra with no underwire.
D. Wash her nipple with water only.