Maternal and Child Care Nursing

Situation 1 – You are working in a prenatal clinic of a maternity hospital doing assessment of Cherry:1. A positive sign that Cherry is pregnant is:

A. Fetal heart tonesB. Enlargement of uterus and abdomen

C. QuickeningD. Positive pregnancy test

2. The doctor recommends that Cherry be screened for diabetes because of her family history. You explain to Cherry that:A. Carbohydrate metabolism is altered in pregnancyB. The renal threshold for glucose is decreased in pregnancyC. Placental hormones produce insulin resistanceD. Increased dietary intake promotes the development of diabetes in pregnancy

3. Cherry smokes and asks you what effect cigarettes might have on her baby. Which would be the BEST response?A. Increasing your calories may offset the effects of cigarette smokingB. Evidence supports a negative effect of smoking on the babyC. Smoking is safe if you limit cigarette use to one pack a dayD. Smoking may cause the baby to have brain damage from decreased oxygen

4. Assessment and laboratory tests are done on Cherry. You inform her that during pregnancy it is normal to have:

A. An increased serum creatinine levelB. A rise in blood pressure

C. A fall in haemoglobin and haematocritD. A decreased pulse rate

5. When planning instructions to clients like Cherry, you note that the correct order of occurrence of pregnancy events is as follows:A. Positive urine pregnancy test, viability, fetal movement felt by the client, fetal heart tones audible by DopplerB. Fetal movement felt by the client, fetal heart tones audible by Doppler, positive urine test, viabilityC. Viability, positive urine test, fetal heart tones felt by Doppler, fetal movement felt by clientD. Positive urine pregnancy test, fetal heart tones audible by Doppler, fetal movement felt by client, viability

Situation 2 – Shelly, a 27 year old client, informs the nurse that she missed 2 menstrual periods and tested positive on her home pregnancy test:6. The nurse listens to Shelly’s history and based on her assessment, Shelly may be presenting probable signs of pregnancy such as:

A. Craving for unusual food and fatigueB. Enlarged uterus, positive pregnancy testC. Missed menstrual periods, positive pregnancy testD. Urinary frequency, nausea and vomiting

7. Shelly’s pregnancy cannot yet be confirmed until positive signs are observed. These positive signs include:A. Ballottement or upward floating of the fetus when uterus is palpatedB. Increased darkening of the areola of the breasts and labiaC. Report of fetal movement by the mother and an enlarging abdomenD. Identification of fetal parts and heart sounds

8. Shelly’s recent blood chemistry result shows anemia with haemoglobin level of 10.5mg/dl. The nurse gives information about excellent sources of iron in food which include:

A. Citrus fruits, bread products, eggsB. Clams, leafy greens, enriched cereals and liver

C. Fish poultry, potatoes, coffee and teaD. Milk and milk products, vegetable oils

9. Shelly does not want much weight gain during pregnancy. Since maternal nutrition is important to ensure her health and normal fetal growth, the nurse motivates Shelly to improve her nutrition by informing her that:A. Total weight gain encouraged throughout pregnancy is 25-35 lbs in a woman with normal weightB. Food intake should follow the food pyramid guide to make sure that all food groups are part of the daily dietC. Mineral supplements and prenatal vitamins must be taken throughout the duration of pregnancyD. Low weight gain in pregnancy is associated with increased risk of fetal and newborn mortality and morbidity

10. Shelly eats a lot of ice chips and asks the nurse about going vegetarian. The nurse gives the correct nutritional information when she says:1. Ice chips are considered non-nutritive substances and cannot substitute for food2. Strict vegetarian diets provide fiber but do not have enough calories to meet the needs of a pregnant woman3. Absence of animal products may lead to inadequate intake of calcium, zinc, vitamins and proteins4. Raw vegetables are ideal sources of phytochemicals, boosts the immune system and provides sufficient nutrients

A. 1, 3 and 4B. 1, 2 and 4

C. 2, 3 and 4D. 1, 2 and 3

Situation 3 – You admit Esther, 34 years old, 38 weeks AOG. She says she had bloody show an hour ago and was having “very frequent but moderate contractions every 4-5 minutes, felt achy and short of breath.” Contractions slowed down and were less intense when they reached the hospital.

11. To assess the characteristics and pattern of uterine contractions you will:A. Place your hand on the abdomen below the umbilicus and palpate the uterus with the fingertipsB. Assess every 30 minutes until contractions increase in intensity and duration then every 10 minutes thereafterC. Time the duration of contractions from the end of one to the end of the next contraction noting interval between contractionsD. Press the uterus at the fundus with fingertips to evaluate the intensity and duration of contraction

12. Esther is told that she had Braxton-Hicks contractions and was sent home with instructions to come back when she is in true labor. Esther is in TRUE labor when:A. More bloody mucus is passed out and the bag of water rupturesB. Cervix is fully dilatedC. Lightening or descent of the uterus away from the xiphoidD. Contractions progress in frequency, duration and pain not relieved by activity

13. Esther returns to the hospital with intense and painful contractions that come every 3-4 minutes. The nurse does Leopold’s maneuver to check fetal presentation and position in the following sequence:1. Determine whether presenting part moves easily or engaged2. Facing the mother, assess fetal attitude of relationships of body parts to one another3. Palpate fetal part at the fundus and identify presenting part4. Palpate both sides of the abdomen for the smooth side and small part of the fetus to determine fetal lie and presentation

A. 3,2,1,4B. 4,3,2,1

C. 3,4,2,1D. 1,2,3,4

14. Fetal presentation is occiput posterior, causing prolonged labor and severe pain. an epidural block was done and Pitocin drip was ordered. Immediately post-epidural block nursing care for Esther includes the following EXCEPT:A. Monitoring of vital signs focusing on hypotension and feverB. Instructing client to remain in bed C. Assisting the client when ambulatingD. Monitoring bladder since client may feel urge to urinate

15. Esther goes into third stage of labor. You monitor client for expulsion of the placenta which is ushered in by these signs EXCEPT:

A. Upward movement of the fundusB. Sudden gush of blood from the vagina

C. Boggy uterusD. Lengthening of the umbilical cord

Situation 4 - Maggie, 22, unmarried, is two months pregnant, drinks socially and occasionally uses marijuana. She recently confirmed her pregnancy and is very ambivalent about her condition. She is not sure who the father of the baby is because she has been promiscuous and her current condition exacerbated her drinking of alcohol.

16. Data from your interview with Maggie indicates that she started drinking alcohol in highschool. You warn her about the condition called fetal alcohol syndrome and inform her that this syndrome has the following characteristics EXCEPT:

A. Lowered birth weightB. Cognitive impairments

C. Facial anomaliesD. Decreased muscle tone

17. You inform Maggie about the effects of alcohol during pregnancy. The CORRECT statement is:A. Alcohol intake is linked to increased risk of spontaneous abortionB. Alcohol has no known teratogenic effects on the fetus at low or high intake levelsC. A woman can safely drink a glass of wine if she has heart problems to aid in circulationD. No safe level of drinking has been set during pregnancy therefore abstinence is advised

18. Maggie tells you “I am not ready for this pregnancy. I want an abortion.” Which of the following is MOST appropriate response to Maggie?A. “You are not ready to face the consequences of this pregnancy?”B. “All you have to do is stop drinking, is that difficult for you?”C. “Why don’t you get married so you can have support during your pregnancy?”D. “You have to have a lot of faith, pray for guidance so you can make a wise choice.”

19. Maggie says that she smokes 1-2 sticks of marijuana when with friends. You advise her to refrain from smoking marijuana because it:A. Increases risks of cerebral abnormalities of the fetusB. Impairs the user’s coordination and critical thinking that puts her at riskC. Has strong evidence of teratogenic effects on the fetusD. Increases risk of sudden infant death syndrome

20. When taking care of pregnant clients who abuse drugs and/or alcohol, your assessment should focus on potential problems that may have deleterious effects on the fetus such as:

A. Parental role conflictB. Ineffective individual coping

C. Imbalanced nutrition, less than body requirementsD. Hygiene self-care deficit

Situation 5 – In a normal health center activity, your task includes health assessment of several clients.

21. You are doing breast assessment on a post-menopausal woman. In your assessment, what finding warrants further attention?A. Presence of striae and superficial veins noted in both breastsB. Left brest slightly smaller compared with right breastC. Inverted nipplesD. Small dimple palpated in the upper outer quadrant of the right breast

22. You are counselling a 52 year old client regarding hormone replacement therapy (HRT). A physician needs to be notified when she experiences:

A. Vaginal drynessB. Hot flashes

C. Leg painD. Urinary frequency

23. Which of the following observations will make you suspect that the client may have osteoporosis?

A. Change in postureB. Decrease in height

C. Recent fracture due to traumaD. Complaints of joint pain

24. You are doing history taking on a post-menopausal woman. One risk factor to watch out for that is associated with breast cancer is:

A. NulliparityB. Age less than 40

C. Late menarcheD. Early menopause

25. Further evaluation of a 64 year old menopausal woman who is NOT on hormone replacement therapy (HRT) is warranted when she complains of:

A. Thinning of the pubic hairB. Vaginal bleeding

C. Loss of vaginal lubricationD. Lower back pain

Situation 6 – Erica, 32 weeks pregnant, G1P0, expelled bloody tinged mucus over 24 hours ago. About 15 minutes ago, a sudden gush of warm liquid flowed, accompanied by stronger painful uterine contractions. Erica was taken to the hospital immediately.26. Erica informs the nurse that her bag of water (BOW) broke. The MOST appropriate question to ask would be:

A. Describe the appearance of the fluidB. How much water did you lose

C. Was it accompanied by bloody show?D. How frequent are your contractions now?

27. Since the membranes ruptured, the nurse protects Erica from increased risk for:

A. HaemorrhageB. Precipitate labor

C. Intrauterine infectionD. Prolonged labor

28. Upon admission to the labor room, the nurse monitors the fetus and Erica’s contractions which are now more intense, regular and lasting for 60-80 seconds at 2-3 minute intervals. Within an hour from admission, a baby girl was delivered spontaneously. The nurse records this as:

A. Emergency child birthB. Precipitous labor

C. Precipitous deliveryD. Hypotonic labor and delivery

29. The condition of Erica and the preterm baby is of paramount importance. The nurse’s immediate action upon expulsion of the fetus would be to:A. Hold the infant’s feet up to drain any fluids that may clog the airwayB. Dry the infant and wipe off the white cheesy materialC. Receive the infant in a warm blanket to prevent heat lossD. Clamp then cut the umbilical cord

30. Considering Erica’s rapid labor and delivery, the nurse’s priority intervention would be based on the following outcomes EXCEPT:

A. Stable maternal vital signsB. Minimal tissue injuries and lacerations

C. Uterus is contracted and firm after deliveryD. Uterine position and size

Situation 7 – Nurse Isabel is a charge nurse in the delivery room. She and her 2 midwives conduct normal deliveries according to the hospital protocols established by the institution.31. Right after the baby is expelled from the womb, which of the following is her priority action?

A. Suctioning the nose and the mouth of the newbornB. Wiping the nose and the mouth of the newborn

C. Cutting the cordD. Putting baby in the nipple of the mother

32. Under the principles of the DOH guidelines, the newborn is to be bathed after how many hours?

A. 4 hoursB. 6 hours

C. 8 hoursD. 10 hours

33. Babies need to be kept warm to prevent all of the following EXCEPT:

A. Brain damageB. Sepsis

C. Coagulation problemsD. Elimination problems

34. The nurse will keep the baby in the radiant warmer until the baby’s temperature is stabilized at:

A. 35.5CB. 36C

C. 37CD. 37.5C

35. She documents that the weight of the baby is normal when

A. 2.5 to 3 kgsB. 3 kgs

C. 1.5 to 2 kgsD. 3 to 4 kgs

Situation 8 – Nurse Vera is in charge of a pediatric clinic which attends to different childhood illnesses as well as attending to well baby monitoring and consultations.36. Which of te following is an appropriate advice to give to a mother who complains that her 2 yr old child is not eating adequately?

A. Ask what the child wants before preparing mealsB. Prepare finger foods that are easily digested

C. Make oatmeal porridge and serve every hourD. Have baby tested for ascariasis

37. Deworming should be done to children who are atleast:

A. 6 monthsB. 1 year and above

C. 18 months and aboveD. 2 years or older

38. Baby Alina is 2 and ½ months old. If her immunizations started on time which immunization is due to be given during this visit?

A. OPV2; DPT2B. OPV3; DPT3

C. OPV1; DPT1D. Antimeasles

39. The child who has a mid arm circumference is classified normal if the reading is which of the following?

A. 120mmB. 130mm

C. 135mmD. 140mm

40. Noli is a 3 year old boy brought for check up because he has been having cough for 2 days with runny nose. Which of the following will the nurse teach the mother as a safe home remedy?

A. To give nasal decongestant TIDB. To give steam inhalation for ½ hour TID

C. To give tamarind or calamansi juiceD. To give cough expectorant

Situation 9 – Nurse Hilda is attending to patients at the fertility clinic.41. Which of the following information from the couple is considered a primary cause of their infertility?

A. The wife says that she started to menstruate at age 14B. The husband works as driver of a bus companyC. The wife has been on anti-depressant medication for 5 yearsD. The husband had repair of kryptorchidism

42. When the wife assisted to receive an externally fertilized ovum into her uterus which successfully gets implanted. This method is which of the following?

A. Surrogate motheringB. Gamete intra fallopian transfer

C. In vitro fertilizationD. Artificial insemination

43. Mr. B has been suspected to be suffering from erectile dysfunction. Which of the following information will be included during the assessment of the possible causes of the problem?

A. The family planning methods employed by the coupleB. The insights of the wife about having children

C. The feelings of the husband about his sexual identityD. The frequency of checkups in the last 2 years

44. Nurse Nida is attending to a woman with secondary amenorrhea. Which of the following may be contributory to this problem?

A. She has been treated with anti tuberculosis drugs B. She is a free lance journalist

C. She is taking anti stress medications D. She exercises in the gym regularly

45. Lanie complains to the nurse that she has menstruated 5 times in the last 3 months. The nurse will document this as which of the following?

A. MetrorrhagiaB. Menorrhagia

C. PolymenorrheaD. Dysmenorrhea

Situation 10 – Nurse Dora is a nurse in charge of the obstetric clinic.46. A woman is confirmed by ultrasound to be 12 weeks pregnant. The nurse is correct when she describes the development of the fetus

as which include all of the following, EXCEPT?

A. The Kidney functions beginB. The liver functions begin

C. The organs are completeD. The primitive tails have disappeared

47. The patient’s internal vaginal examination reveals a softening of the lower uterine segment. This is known as which of the following?

A. Hegar’s signB. Goodell’s sign

C. Chadwick’s signD. Primary sign of pregnancy

48. The mother at 8 months tells she feels breast fullness. Which is the correct information to tell the mother?A. The increase in FSH is responsible for thisB. Your blood volume is doubled which makes the breast firmC. The estrogen is responsible for your breast enlargementD. The luteinizing hormone is responsible for this

49. At 32 weeks age of gestation, the nurse is aware that normal fetus will weigh atleast:

A. 1500 gramsB. 1600 grams

C. 1800 gramsD. 2000 grams

50. Which of the following is appropriate to advice a young pregnant woman about safety?A. You will need to avoid fatigue by staying at homeB. Wear flat or very low-heeled shoes when going for walksC. Wear soft non-irritating clothingD. Avoid colas during pregnancy to prevent vomiting

Situation 11 – Nurse Muriel is caring for pregnant patients admitted for various reasons.51. Which of the following clients she has seen will need further evaluation?

A. A 6 week pregnant for the second time who had a history of tetanusB. A 5 months pregnant woman who has a diabetic husbandC. A 7 months pregnant who is 70 kilogramsD. A 6 months pregnant who has mild back pains

52. A 7 months pregnant woman is confirmed to have candidiasis. The nurse anticipates which of the following drugs to be given to the patient?

A. TetracyclineB. Mycostatin

C. MetronidazoleD. Penicillin

53. A pregnant patient who is an HIV positive is admitted for recurrent fever. The nurse will need to protect her and her baby by employing which of the following infection control protocols?

A. Respiratory isolationB. Strict isolation

C. Reverse isolationD. Universal precautions

54. An 8 months pregnant patient is admitted because of painless vaginal bleeding. The nurse will anticipate that the bleeding will be characterized as which of the following?

A. Bleeding is bright red in colorB. Mild to moderate in amount

C. Profuse amount of bleeding D. Bleeding occurs when moving

55. Which of the following is recommended to pregnant women who have history of incompetent cervix?A. To be on complete bed rest for the full duration of pregnancyB. To have ultrasound monthly and see if the baby is viable to continueC. To undergo cerclage (Shirodkar procedure)D. To take medications (tocolytic) till ultrasound confirms good attachment

Situation 12 – Nurse Amelia is attending to Mrs. Tee who is an elderly primipara at 31 weeks with a triplet pregnancy after an infertility treatment.56. Which of the following will the nurse be alert for as a common problem for patients with multiple pregnancy?

A. Pre eclampsiaB. Gestational diabetes

C. BleedingD. Preterm labor

57. Mrs. Tee is connected to a CTG monitor. What alerts the nurse that she is a candidate for a cesarian section?A. There are contractions every 5 minutes but she does not feel any painB. There are irregular contractions but cervix is closedC. The bag of water ruptures and cervical dilatation simultaneously occursD. There are contractions and the fetal heart rate become high

58. A 34 week pregnant woman is brought by an ambulance to the ER because she has suddenly bleed after the car she was riding on collided with another vehicle. What will the nurse anticipate to do first?A. Determine the body part of the mother that was hit firstB. Take the vital signs including fetal heart rateC. Prepare mother for intubationD. Prepare to give Dopamine infusion

59. The nurse monitors the fetal heart rate but could hardly hear the beats. Which is likely the problem?

A. The baby has drowned from bleedingB. There is massive placental hypoperfusion

C. The babies have severe head injuryD. The babies are just sleeping

60. All of the following indicate that the placenta has been detached from the uterus EXCEPT?

A. There are no contractions when connected to CTGB. The abdomen is deviated to one side

C. The fundus is risingD. The vital signs are normal

Situation 13 – Nurse Graile is assigned to a Gravida 3 para 2 mother who is 5 hours post cesarian section. The patient is starting to become fully awake and restless.61. Which of the following is a care priority?

A. Suctioning the patientB. Assessing the pain rating

C. Assisting the patient to ambulateD. Assisting the patient to sit

62. The nurse gets the patient’s pulse which is 109bpm. Which of the following intervention is next?

A. Checking the wound dressing for soakageB. Putting the patient in Trendelenburg position

C. Checking the oxygen saturationD. Palpating the uterus

63. The nurse anticipates that there is evident bleeding with ALL of the following findings EXCEPT?

A. The wound dressing is fully soakedB. There is vaginal bleeding

C. The uterus is soft and laxD. The hemovac drain is half full in 2 hours

64. Which of the following drugs will the nurse anticipate to administer to the patient if bleeding is active?

A. Aminocaproic acidB. Phenergan

C. EpinephrineD. Hydrocortisone

65. The patient deteriorates further and needs to receive blood transfusion. Which of the following will be anticipated to be given?

A. PlateletsB. Whole blood

C. Packed RBCsD. Albumin