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100 Item Obstetrics-Maternal And Child Health Nursing Examination Answers and Rationale 100 Item Obstetrics-Maternal And

Child Health Nursing Examination Budek htt !""###$ ino%bsn$tk &uestion 'ool (I)C*AIME+! Care has been taken to ,eri-% that all ans#ers and rationale belo# are accurate$ 'lease comment u i- %ou noticed an% errors or contradictions to maintain accurac% and recision o- the ans#ers as not to mislead the readers$ -Budek (E.+EE O/ &0E)1ION (I//IC0*12 3 4 5er% hard 6uestion7 89: Chance o- ans#ering correctl% ; 4 Hard 6uestion7 90: Chance o- ans#ering correctl% 8 4 Moderatel% hard 6uestion7 <9: o- ans#ering correctl% 1 4 Eas% 6uestion7 ==: #ill ans#er the 6uestion correctl% Introduction! 1he 6uestions are coded according to their sources and #ill onl% be -or m% ersonal re-erence$ +E( 6uestions are original 6uestions I created$ A!IMA students REA" and "I#E$! each o- these 6uestions care-ull%$ .oodluck$ )I10A1ION ! >N(?=@ Aling Aulia7 a ;8 %ear old -ish ,endor -rom barangga% matahimik came to see %ou at the renatal clinic$ )he brought #ith her all her three children$ Ma%e7 1 %ear B monthsC Ao%7 ; and (an7 < %ears old$ )he mentioned that she sto ed taking oral contrace ti,es se,eral months ago and no# sus ects she is regnant$ )he cannot remember her *M'$ 1$ Dhich o- the -ollo#ing #ould be use-ul in calculating Aling AuliaEs E(CF >;@ A$ A earance o- linea negra %& irst H! b' (etosco)e C$ Increase ulse rate ($ 'resence o- edema G 1he ans#er o- some eo le is A because the% sa% linea negra a ears at 8nd trimester$ A earance o- *inea negra is not the same #ith all #omen$ )ome #ill ha,e it as earl% as -irst trimester #hile other on the 8nd trimester$ It is ,er% subHecti,e and non normati,e$ Ho#e,er7 /irst /H1 b% -etosco e is 0NI5E+)A* and it is arbitraril% acce ted that it starts at the 3th month o- gestation$ 1here-ore7 I- I heard the /irst /H1 b% -etosco e7 I can sa% that Aling AuliaEs E(C is at 3th month and the E(C #ill be around 9 months -rom no#$'ulse rate and Edema #ill ne,er suggest the estimated date o- con-inement nor age o- gestation$

8$ Dhich hormone is necessar% -or a ositi,e regnanc% testF >1@ A$ 'rogesterone %& HC# C$ Estrogen ($ 'lacental *actogen G HC. is res onsible -or ositi,e regnanc% test$ But it is NO1 a ositi,e sign oregnanc%$ Onl% '+OBAB*E$ 'ur ose o- HC. is to maintain the secretion orogestrone b% the cor us luteum$ It #ill deteriorate b% 8nd trimester as the lacenta resumes its -unciton$ HC. is also use to stimulate descend o- the testes in case ocr% torchidism or undescended testes$ HC. eaks at 10 #eeks then decline -or the rest othe regnanc%$ Non regnant -emales #ill ha,e less than 9 mI0"ml and can reach u to 1007000 mI0"ml in regnant #omen$ B% the #a%7 undescended testes re air is done #hen the child is 1 %ear old according to *i inncots7 the doctor #ill tr% to #ait baka kasi bumaba a be-ore the% do surger%$ ;$ Dith this regnanc%7 Aling Aulia is a >1@ A$ '; .; B$ 'rimigra,ida C& *+ #, ($ '0 .; G )he has ; children7 so ara ;$ )ince she is regnant7 this is her 3th gra,ida$ +emember that e,en i- the reganc% is be%ond the age o- ,iabilit% > I< months @ consider it as 'A+A and not .+A5I(A as long as the bab% is still inside the uterus$ A common error o- the old nurses in a uericulture center #here I dutied in is that the% count the child inside the motherEs #omb as .+A5I(A #hen it is greater than < monthsJ > ka#a#ang nana%7 mali na ang home based mothers record mo @ I tried to correct it but the% still IN)I)1E($ I read illitteri thinking that I might be #rong nakakahi%a naman$$$ but I #as right$ 3$ In ex laining the de,elo ment o- her bab%7 %ou identi-ied in chronological order ogro#th o- the -etus as it occurs in regnanc% as >1@ A$ O,um7 embr%o7 K%gote7 -etus7 in-ant B$ L%gote7 o,um7 embr%o7 -etus7 in-ant C& O-um. /'gote. embr'o. (etus. in(ant ($ L%gote7 o,um7 -etus7 embr%o7 in-ant G 1he O,um is the egg cell -rom the mother7 the s erm #ill -ertiliKe it to -orm a K%gote$ 1his usuall% ha ens in the AM'0**A or the distal third o- the -allo ian tube$ H%alorunidase is secreted b% the s erm to dissol,e the outer memberane o- the o,um$ 1he K%gote no# containes 3B chromosomes$ 8; -rom each germ cell$ 1he K%gote is no# termed as an embr%o once it has been im lanted$ Im lantation takes ;-3 da%s$ Dhen the embr%o reach ?th #eeks7 it is no# termed as a /E10) until it has been deli,ered and then7 neonate then in-ant$ 9$ Aling Aulia states she is ha % to be regnant$ Dhich beha,ior is elicited b% her during %our assessment that #ould lead %ou to think she is stressedF >;@

A$ )he told %ou about her drunk husband B$ )he states she has ,er% meager income -rom selling C$ )he laughs at e,er% ad,ise %ou gi,e e,en #hen its not -unn% "& $he has di((icult' (ollowing instructions G )tressed is mani-ested in di--erent #a%s and one o- them7 is di--icult% -ollo#ing instructions$ 1elling %ou that her husband is drunk and has meager income -rom selling is not enough -or %ou to conclude she is stressed$ Assessment is al#a%s based on -actual and s eci-ic mani-estations$ A diagnosis is made -rom either AC10A* or 'O1EN1IA*"+I)M roblems$ A and % are both otential roblems7 but not actual like "& C is automaticall% eliminated -irst because laughing is not indicati,e o- stress$ B$ Dhen teaching Aling Aulia about her regnanc%7 %ou should include ersonal common discom-orts$ Dhich o- the -ollo#ing is an indication -or rom t ro-essional su er,isionF >8@ A$ Consti ation and hemorrhoids B$ Backache C& acial edema ($ -re6uent urination G/acial edema is NO1 NO+MA*$ /acial edema is one sign o- MI*( '+E EC*AM')IA and rom t ro-essional su er,ision is needed to lo#er do#n the clientEs blood ressure$ Blood ressure in Mild 're Eclam sia is around 130"=0 and 1B0"110 in se,ere$ 1reatment in,ol,es bed rest7 Magnesium sul-ate7 H%dralaKine7 (iaKoxide and (iaKe am > usuall% a combination o- Magsul N A resoline > H%dralaKine @ @ Calcium gluconate is al#a%s at the clientEs bed side #hen magnesium toxicit% occurs$ It #orks b% exchanging Calcium ions -or magnesium ions$ A.% and " are all h%siologic change in regnanc% that do not need rom t ro-essional su er,ision$ /re6uent urination #ill disa ear as soon as the ressure o- the uterus is released against the bladder and as soon as the clientEs blood ,olume has returned to normal$ Backache is a common com laint o- #omen #ith an OCCI'01 'O)1E+IO+ resentation due to ressure on the back$ Inter,ention includes el,ic rocking or running a tennis ball at the clientEs back$ Consti ation and hemorrhoids are relie,ed b% increasing -luid intake and hot sitK bath$ <$ Dhich o- the -ollo#ing statements #ould be a AuliaEs renatal teaching lanF >1@ ro riate -or %ou to include in Aling

A$ Exercise is ,er% tiresome7 it should be a,oided B$ *imit %our -ood intake C$ )moking has no harm-ul e--ect on the gro#th and de,elo ment o- -etus "& A-oid unnecessar' (atigue. rest )eriods should be included in 'ou schedule G Exercise is not a,oided in regnanc%7 ther-ore eliminate A$ /ood is ne,er limited in regnanc%$ Calories are e,en increased b% around ;00 cal a da% as #ell as ,itamins and minerals$ )moking7 alcohol and drug use are a,oided -or the rest o- the regnanc% because o- their harm-ul e--ects on the gro#th and de,elo ment o- the -etus$ +est eriod and a,oiding unecessar% -atigue is one o- the illars in health teaching o- the regnant client$

?$ 1he best ad,ise %ou can gi,e to Aling Aulia regarding re,ention o- ,aricosities is >;@ A$ +aise the legs #hile in u right osition and ut it against the #all se,eral times a da% B$ *a% -lat -or most hours o- the da% C$ 0se garters #ith n%lon stocking "& 0ear su))ort hose G A thigh high stocking or a su ort hose DO+N BE/O+E .E11IN. 0' in the morning is e--ecti,e in re,ention o- ,aricosities$ )tocking should ha,e NO .A+1E+) because it im edes blood -lo#7 the% should be made o- CO11ON not n%lon to allo# the skin to breathe$ *%ing -lat most o- the da% DI** '+E5EN1 5A+ICO)I1IE) but #ill not be hel -ul -or the clientEs o,erall health and -unction$ +aising the legs and utting it against the #all #ill still create ressure in the legs$ =$ In a ;8 da% menstrual c%cle7 o,ulation usuall% occurs on the >8@ A$ 13th da% a-ter menstruation %& 11th da' a(ter menstruation C$ 80th da% a-ter menstruation ($ 83th da% a-ter menstruation G 1o get the da% o- o,ulation7 A diar% is made -or around B months to determine the number o- da%s o- menstrual c%cle > -rom onset o- mens to the next onset o- mens @ and the a,erage is taken -rom that c%cles$ 13 da%s are subtracted -rom the total da%s o- the menstrual c%cle$ 1his signi-ies the o,ulation da%$ A cou le #ould abstain ha,ing sex 9 da%s be-ore and 9 da%s a-ter the o,ulation da%$ 1here-ore7 a ;8 da% c%cle minus 13 da%s e6uals 1?7 hence$$$ o,ulation occurs at the 1?th da%$ 10$ 'lacenta is the organ that ro,ides exchange o- nutrients and #aste roducts bet#een mother and -etus$ 1his de,elo s b% >3@ A$ /irst month %& !hird month C$ /i-th month ($ )e,enth month G 1he lacenta is -ormed at around ; months$ It is a latin #ord -or 'ANCAME because oitEs a earance$ It arises -rom the tro hoblast -rom the chorionic ,illi and decidua basalis$ It -unctions as the -etal lungs7 kidne%7 .I tract and an endocrine organ$ 11$ In e,aluating the #eight gain o- Aling Aulia7 %ou kno# the minimum #eight gain during regnanc% is >;@ A& 2 lbs3w4 B$ 9 lbs"#k C$ < lbs"#k ($ 10 lbs"#k

G Deight gain should be 1 to 8 lbs er #eek during the 8nd and ;rd trimester and ; to 9 lbs gain during the -irst trimester -or a total o- 89-;9 lbs recommended #eight gain during the gra,ida state$ 18$ 1he more accurate method o- measuring -undal height is >8@ A$ Millimeter %& Centimeter C$ Inches ($ /ingerbreadths G /undal height is measured in cm not mm$ centimeters is the more accurate method omeasuring -undic height than inches or -ingerbreadths$ 1;$ 1o determine -etal osition using *eo oldEs maneu,ers7 the -irst maneu,er is to >1@ A$ (etermine degree o- ce halic -lexion and engagement B$ (etermine art o- -etus resenting into el,is C$ *ocate the back7arms and legs "& "etermine what )art o( (etus is in the (undus G *eo oldEs one determines #hat is it in the -undus$ 1his determines #hether the -etal head or breech is in the -undus$ A head is round and hard$ Breech is less #ell de-ined$ 13$ Aling Hulia has encouraged her husband to attend renatal classes #ith her$ (uring the renatal class7 the cou le ex ressed -ear o- ain during labor and deli,er%$ 1he use otouch and soothing ,oice o-ten romotes com-ort to the laboring atient$ 1his h%sical inter,ention is e--ecti,e because >8@ A$ 'ain erce tion is interru ted B$ .ate control -ibers are o en C& It distracts the client awa' (rom the )ain ($ Em ath% is communicated b% a caring erson G 1ouch and soothing ,oice romotes ain distraction$ Instead o- thinking too much othe ain in labor7 1he mother is di,erted a#a% -rom the ain sensation b% the use o- touch and ,oice$ 'ain erce tion is not interru ted7 ain is still resent$ Dhen gate control -ibers are o en7 'ain is -elt according to the gate control theor% o- ain$ Although em ath% is communicated b% the caring erson7 this is not the reason #h% touch and ,oice romotes com-ort to a laboring atient$ 19$ Dhich o- the -ollo#ing could be considered as a ositi,e sign o- regnanc% F >1@ A$ Amenorrhea7 nausea7 ,omiting B$ /re6uenc% o- urination C$ Braxton hicks contraction "& etal outline b' sonogra)h' G /etal outline b% sonogra h% or other imaging de,ices is considered a ositi,e sign oregnanc% along #ith the resence o- -etal heart rate and mo,ement -elt b% a 6uali-ied

examiner$ All those signs #ith the disco,ererEs name on them > chad#ick7 hegars7 braxton hicks7 goodells @ are considered robable and All the h%siologic changes brought about b% regnanc% like h% er igmentation7 -atgiue7 uterine enlargement7 nausea7 ,omiting7 breast changes7 -re6uent urination are considered resum ti,e$ )onogra hic e,idence o- the gestational sac is not 'O)I1I5E sign but rather7 '+OBAB*E$ )I10A1ION ! >//C@ Maternal and child health is the rogram o- the de artment ohealth created to lessen the death o- in-ants and mother in the hili ines$ >8@ 1B$ Dhat is the goal o- this rogramF A& *romote mother and in(ant health es)eciall' during the gra-ida stage B$ 1raining o- local hilots C$ (irect su er,ision o- mid#i,es during home deli,er% ($ Health teaching to mother regarding ro er ne#born care G 1he goal o- the MCHN rogram o- the (OH is the *ROMO!ION AN" MAIN!ENANCE O O*!IM5M HEA6!H O 0OMAN AN" !HEIR NE0%ORN$ 1o achie,e this goal7 %.C and " are all carried out$ E,en #ithout the kno#ledge o- the MCHN goal %ou )HO0*( ans#er this 6uestion correctl%$ +emember that .OA*) are %our lans or things %ou M0)1 A11AIN #hile )1+A1E.IE) are those that must be done > AC1ION) @ to attain %our goal$ *ooking at %.C and " the% are all AC1ION)$ Onl% A correctl% -ollo#ed the de-inition oa goal$ 1<$ One hiloso h% o- the maternal and child health nursing is >1@ A$ All regnanc% ex eriences are the same -or all #oman B$ Culture and religious ractices ha,e little e--ect on regnanc% o- a #oman C$ 'regnanc% is a art o- the li-e c%cle but ro,ides no meaning "& !he (ather is as im)ortant as the mother G Mno#ing that not all indi,iduals and regnanc% are the same -or all #omen7 %ou can sa-el% eliminate letter A& 'ersonal7 culture and religious attitudes in-luence the meaning o- regnanc% and that makes regnanc% uni6ue -or each indi,idual$ Culture and religious ractice ha,e a great im act on regnanc%7 eliminate %& 'regnanc% is meaning-ul to each indi,iduals7 not onl% the mother but also the -ather and the -amil% and the -ather o- the child is as im ortant as the mother$ MA!ERNA6 AN" CHI6" HEA6!H I$ AMI67 CEN!ERE" and thid #ill guide %ou in correctl% ans#ering "& 1?$ In maternal care7 the 'HN res onsibilit% is >8@ A$ 1o secure all in-ormation that #ould be needing in birth certi-icate B$ 1o rotect the bab% against tetanus neonatorum b% immuniKing the mother #ith ('1 C& !o reach all )regnant woman ($ 1o assess nutritional status o- existing children

G 1he sole obHecti,e o- the MCHN o- the (OH is to REACH A66 *RE#NAN! 0OMEN AN" #I8E $5 ICIEN! CARE !O EN$5RE A HEA6!H7 *RE#NANC7 AN" !HE %IR!H O A 566 !ERM HEA6!H %A%7& As not to con-use this #ith the .OA* o- the MCHN7 1he OBAEC1I5E should ans#er the .OA*7 the% are di--erent$ .OA* ! to romote and maintain o timum health -or #omen and their ne#born HO09 OBAEC1I5E ! B% reaching all regnant #omen to gi,e su--icient care ensuring health% regnanc% and bab%$ 1=$ 1his is use #hen rendering renatal care in the rural health unit$ It ser,es as a guide in Identi-ication o- risk -actors >1@ A$ 0nder-i,e clinic chart %& Home based mother:s record C$ Client list o- mother under renatal care ($ 1arget list o- #oman under 11 ,accination G 1he HBM+ is used in rendring renatal care as guide in identi-%ing risk -actors$ It contains health romotion message and in-ormation on the danger signs o- regnanc%$ 80$ 1he schedule o- renatal ,isit in the +H0 unit is >3@ A$ Once -rom 1st u to ?th month7 #eekl% on the =th month B$ 1#ice in 1st and second trimester7 #eekl% on third trimester C& Once in each trimester. more (re;uent (or those at ris4 ($ /re6uent as ossible to determine the resence o- /H1 each #eek G 5isit to the +H0 should be ONCE each trimester and more -re6uent -or those #ho are high risks$ 1he ,isit to the BH) or health center should be ONCE -or 1st to Bth months oregnanc%7 1DICE -or the <th to ?th month and #eekl% during the =th month$ 1he% are di--erent and are not to be con-used #ith$ )I10A1ION ! Mno#ledge o- the menstrual c%cle is im ortant in maternal health nursing$ 1he -ollo#ing 6uestions ertains to the rocess o- menstruation 81$ Menarche occurs during the ubertal eriod7 Dhich o- the -ollo#ing occurs -irst in the de,elo ment o- -emale sex characteristicsF >8@ A$ Menarche %& Accelerated 6inear #rowth C$ Breast de,elo ment ($ .ro#th o- ubic hair G +emember 1AMO or 1HE*A+CHE7 A(+ENA+CHE7 MENA+CHE and O50*A1ION$ 1elarche is the beginning o- the breast de,elo ment #hich is in-luenced b% the increase in estrogen le,el during ubert%$ Adrenarche is the de,elo ment oaxillar% and ubic hair due to androgen stimulation$ Menarche is the onset o- -irst menstruation that a,eragel% occurs at around 18 to 1; %ears old$ O,ulation then occurs last$ Ho#e,er7 rior to 1AMO7 Accelerated *INEA+ .+OD1H #ill occur -irst in .I+*) #hile DEI.H1 INC+EA)E is the -irst one to occur in bo%s$

88$ Dhich gland is res onsible -or initiating the menstrual c%cleF >;@ A$ O,aries B$ A'. C$ ''. "& H')othalamus G H% othalamus secretes man% di--erent hormones and one o- them is the /)H+/ or the /O**IC*E )1IM0*A1IN. HO+MONE +E*EA)IN. /AC1O+$ 1his #ill instruct the AN1E+IO+ 'I10I1A+2 .*AN( to secrete /)H that #ill stimulate the o,ar% to release egg and initiate the menstrual c%cle$ 1he ''. or the osterior ituitar% onl% secretes t#o hormones ! OO21OCIN and A(H$ It la%s an im ortant -actor in labor as #ell as in the atho h%siolog% o- diabetes insi idus$ 8;$ 1he hormone that stimulates the o,aries to roduce estrogen is >1@ A$ .n+H B$ *H C$ *H+/ "& $H G /)H stimulates the o,aries to secrete estrogen$ 1his hormone is a ; substance com ounds kno#n as estrone >e1@7 estradiol >8@ and estriol >;@ res onsible -or the de,elo ment o- -emale secondar% sex characteristics$ It also stimulates the OOC21E) to mature$ (uring regnanc%7 Estrogen is secreted b% the lacenta that stimulates uterine gro#th to accomodate the -etus$ 83$ Dhich hormone stimulates ooc%te maturationF >8@ A$ .n+H B$ *H C$ *H+/ "& $H G +e-er to P8; 89$ Dhen is the serum estrogen le,el highest in the menstrual c%cleF >3@ A$ ;rd da% %& 1+th da' C$ 13th da% ($ End o- menstrual c%cle G 1here are onl% ; da%s to remember in terms o- hormonal heights during regnanc%$ ;71; and 13$ (uring the ;rd da%7 )erum estrogen is the lo#est$ (uring the 1;th da%7 )erum estrogen is at itEs eak #hile rogestrone is at itEs lo#est and this signi-ies that a mature ooc%te is read% -or release$ At 13th da%7 'rogesterone #ill surge and this is the reason #h% there is a sudden increase o- tem erature during the o,ulation da% and

sudden dro during the re,ious da%$ 1his #ill not stimulate the release o- the mature egg or #hat #e call7 O50*A1ION$ 8B$ 1o correctl% determine the da% o- o,ulation7 the nurse must >8@ A$ (educt 13 da%s at the mid o- the c%cle %& $ubtract two wee4s at c'cle:s end C$ Add < da%s -rom mid o- the c%cle ($ Add 13 da%s -rom the end o- the c%cle G +e-er to P = %ig than4s to marisse (or the correction in this number& 8<$ 1he serum rogesterone is lo#est during #hat da% o- the menstrual c%cleF >3@ A$ ;rd da% %& 1+th da' C$ 13th da% ($ End o- menstrual c%cle G At ;rd da%7 1he serum estrogen is at itEs lo#est$ At the 1;th da%7 serum estrogen is at itEs eak #hile rogesterone is at itEs lo#est$ At the 1;th da% o- the c%cle7 An a,ailable matured o,um is read% -or -ertiliKation and im lantation$ 1he slight shar dro otem erature occurs during this time due to the ,er% lo# rogestrone le,el$ 1he next da%7 13th da%7 1he serum rogestrone shar l% rises and this causes the release o- the matured o,um$ 1em erature also rises at this oint because o- the sudden increase in the rogestrone le,el$ 8?$ Ho# much blood is loss on the a,erage during menstrual eriodF >3@ A$ Hal- cu %& , tables)oon C$ ; ounces ($ 1"; cu G 1he a,erage blood loss during regnanc% is B0 cc$ A. hal- cu is e6ui,alent to 180 cc$ C. is e6ui,alent to =0 cc #hile ". is e6ui,alent to ?0 cc$ 1 tables oon is e6ual to 19 ml$ 3 tables oon is exactl% B0 cc$ 8=$ Menstruation occurs because o- #hich -ollo#ing mechanismF >8@ A$ Increase le,el o- estrogen and rogesterone le,el %& "egeneration o( the cor)us luteum C$ Increase ,ascularit% o- the endothelium ($ )urge o- hormone rogesterone G (egeneration o- the cor us luteum is the cause o- menstruation$ Menstruation occurs because o- the decrease o- both estrogen and rogestrone$ 1his is caused b% the

regression o- the cor us luteum inside the o,ar% ? to 10 da%s in absence o- -ertiliKation a-ter an o,um #as released$ Dith the absence o- rogestrone7 the endometrium degenerates and there-ore7 ,ascularit% #ill decrease at a roximatel% 89th da% o- the c%cle #hich causes the external mani-estation o- menstruation$ ;0$ I- the menstrual c%cle o- a #oman is ;9 da% c%cle7 she #ill a roximatel% >8@

A& O-ulate on the 21st da' with (ertile da's beginning on the 1<th da' to the 2<th da' o( her c'cle B$ O,ulate on the 81st da% #ith -ertile da%s beginning on the 1Bth da% to the 81th da% oher c%cle C$ O,ulate on the 88st da% #ith -ertile da%s beginning on the 1Bth da% to the 8Bth da% oher c%cle ($ O,ulate on the 88st da% #ith -ertile da%s beginning on the 13th da% to the ;0th da% oher c%cle G /ormula -or getting the -ertile da%s and o,ulation da% is ! Number o- da%s o- c%cle MIN0) 13 > O,ulation da% @ Minus 9 'lus 9 > 'ossible -ertile da%s @$ )ince the client has a ;9 da% c%cle7 #e subtract 13 da%s to get the o,ulation da% #hich is 81$ Minus 9 da%s is e6ual to >81 - 9 Q 1B @ 1B 7 'lus 9 da%s > 81 N 9 Q 8B @ is e6ual to 8B$ 1here-ore7 Client is -ertile during the 1Bth to the 8Bth da% o- her c%cle$ 1his is the same rinci le and -ormula used in the calendar " rh%thm method$ )I10A1ION ! Dide kno#ledge about di--erent diagnostic tests during regnanc% is an essential arsenal -or a nurse to be success-ul$ ;1$ 1he Bi arietal diameter o- a -etus is considered matured i- it is atleast >3@ A$ =$? cm %& 1&= cm C$ <$9 cm ($ B cm G B'( is considered matured at ?$9 cm and at term #hen it reaches =$B cm$ ;8$ &uickening is ex erienced -irst b% multigra,ida clients$ At #hat #eek o- gestation do the% start to ex erience 6uickeningF >3@ A& 1<th B$ 80th C$ 83th ($ 8?th G Multigra,id clients ex erience 6uickening at around 1B #eeks or 3 months$ 'rimigra,id clients ex erience this 1 month later7 at the 9th month or 80th #eek$ ;;$ Be-ore the start o- a non stress test7 1he /H+ is 180 B'M$ 1he mother ate the snack and the ractitioner noticed an increase -rom 180 B'M to 1;9 B'M -or 19 seconds$ Ho# #ould %ou read the resultF >;@

A$ Abnormal B$ Non reacti,e C& Reacti-e ($ Inconclusi,e7 needs re eat G Normal non stress test result is +EAC1I5E$ Non stress test is a diagnostic rocedure in #hich the /H+ is com ared #ith the childEs mo,ement$ A normal result is an increase o19 B'M sustained -or 19 seconds at e,er% -etal mo,ement$ 1he mother is told to eat a light snack during the rocedure #hile the examiner care-ull% monitors the /H+$ 1he mother #ill tell the examiner that she -elt a mo,ement as soon as she -eels it #hile the examiner take note o- the time and the /H+ o- the -etus$ ;3$ Dhen should the nurse ex ect to hear the /H+ using a -etosco eF >3@ A$ 8nd #eek B$ ?th #eek C$ 8nd month "& ,th month G 1he /H+ is heard at about 3 months using a -etosco e$ +emember the #ord e O5R to relate -etosco e to -our$ ;9$ Dhen should the nurse ex ect to hear /H+ using do A$ ?th #eek B$ ?th month C$ 8nd #eek ($ 3th month G 1he /H+ is heard as earl% as ?th #eek > some books7 18 to 13 #eeks @ using do ler ultrasound$ +emember the #ord "O**6E RA!E7 > (O''*E+ ? @ to relate do le ultrasound to the number ?$ ;B$ 1he mother asks7 Dhat does it means i- her maternal serum al ha -eto rotein is ;9 ng"mlF 1he nurse should ans#er >3@ A$ It is normal B$ It is not normal C& += ng3ml indicates chromosomal abberation ($ ;9 ng"ml indicates neural tube de-ect G 1he normal maternal al ha -eto rotein is ;?-39 ng"ml$ *ess ;? than this indicates CH+OMO)OMA* ABBE+A1ION >(o#n7Mline-elters@ and more than 39 means NE0+A* 10BE (E/EC1) >) ina Bi-ida@$ +emember the #ord C6INICA6 N5R$E& C -or chromosomal abberation -or R;?IN -or neural tube de-ect -or I39$ C>+1?,= Clinic Nurse$ C6INIC N5R$E is also an im ortant mnemonics to di--erentiate CO5N!ER !RAN$ ERENCE -rom !RAN$ ERENCE& Counter trans-erence is the s ecial ler 0ltrasoundF >3@

-eeling o- the C*INIC N0+)E or C*INICIAN to the atient #hile trans-erence is the de,elo ment o- ersonal -eelings o- the atient to the nurse$ ;<$ Dhich o- the -ollo#ing mothers needs +HO.AMF >1@ A$ +H N mother #ho deli,ered an +H - -etus %& RH - mother who deli-ered an RH @ (etus C$ +H N mother #ho deli,ered an +H N -etus ($ +H - mother #ho deli,ered an +H - -etus G +hogam is gi,en to RH - Mothers 1hat deli,ers an RH @ etus$ +hogam re,ents I)OIMM0NILA1ION or the de,elo ment o- maternal antibodies against the -etal blood due to +H incom atibilit%$ Once the mother alread% de,elo s an antibod% against the -etus7 +hogam #ill not an%more be beni-icial and the mother is ad,ised no to ha,e an%more regnancies$ +hogam is gi,en #ithin <8 hours a-ter deli,er%$ ;?$ Dhich -amil% lanning method is recommended b% the de artment o- health more than an% other means o- contrace tionF >3@ A& ertilit' Awareness Method B$ Condom C$ 1ubal *igation ($ Abstinence G Abstinence is ne,er ad,ocated as a -amil% lanning method$ 1hough7 It is robabl% the BE)1 ME1HO( to re,ent )1( and regnanc%7 it is inhumane and su resses the re roducti,e rights o- the eo le$ It is also unrealistic$ AM is ad,ocated b% the "OH more than an% other kind o- contrace tion$ It is a combination o- s%m tothermal and billings method$ CA6EN"AR method is the onl% method ad,ocated b% the catholic church$ ;=$ Ho# much booster dose does tetanus toxoid ,accination -or regnant #omen hasF >3@ A$ 8 B$ 9 C& + ($ 3 G 111 and 118 are both rimar% dosages$ Dhile 11; u to 119 re resents the booster dosages$ 30$ Barangga% ino%bsn$tk has <07000 o ulation$ Ho# much nurse is needed to ser,ice this o ulationF >3@ A$ 9 %& A C$ 90 ($ <0 G /or e,er% 107000 o ulation 7 1 nurse is needed$ there-ore7 a o ulation o- <07000

eo le needs a ser,ice o- < nurses$ )I10A1ION ! >N(8I83B@ +e roducti,e health is the exercise o- re roducti,e right #ith res onsibilit%$ A married cou le has the res onsibilit% to re roduce and rocreate$ 31$ Dhich o- the -ollo#ing is ONE o- the goals o- the re roducti,e health conce tF >;@ A& !o achie-e health' sexual de-elo)ment and maturation B$ 1o re,ent s eci-ic +H roblem through counseling C$ 'ro,ide care7 treatment and rehabilitation ($ 1o ractice +H as a #a% o- li-e o- e,er% man and #oman G E8ER7 ACHIE8ER A8OI"$ RECEI8ER ! +emember this mnemonics and it #ill guide %ou in di--erentiating #hich is #hich -rom the goals7 ,isions and strategies$ I- a sentence begins #ith these #ords7 it is automaticall% a .OA*$ 0suall%7 1he trend in the board is that the% #ill mix u the ,ision7 strategies and goals to con-use %ou$ " is the onl% ,ision o- the +H rogram$ An%thing else aside -rom the ,ision and goals are more likel% strategies$ > % and C @ )trategies7 e,en #ithout kno#ing them or memoriKing them can easil% be se erated as the% con,e% AC1ION) and AC10A* IN1E+5EN1ION)$ 1his is uni,ersal and also a lies to other (OH rograms$ Notice that % and C con,e% actions and inter,entions$ 38$ Dhich o- the -ollo#ing is NO1 an element o- the re roducti,e healthF >3@ A$ Maternal and child health and nutrition B$ /amil% lanning C$ 're,ention and management o- abortion com lication "& Health' sexual de-elo)ment and nutrition G Achie,ing health% sexual de,elo ment and nutrition is a .OA* o- the +H$ Mno#ledge o- the elements7 goals7 strategies and ,ision o- +H are im ortant in ans#ering this 6uestion$ I remo,ed the #ord ACHIE8E to let %ou kno# that it is ossible -or the board o- nursing not to include those ke%#ords > although it ne,er ha ened as o- %et @$ 3;$ In the international -rame#ork o- +H7 #hich one o- the -ollo#ing is the ultimate goalF >;@ A$ DomenEs health in re roduction B$ Attainment o- o timum health C$ Achie,ement o- #omenEs status "& Bualit' o( li(e G &ualit% o- li-e is the ultimate goal o- the +H in the international -rame#ork$ Da% oli-e is the ultimate goal o- +H in the local -rame#ork$ 33$ Dhich one o- the -ollo#ing is a determinant o- +H a--ecting #omanEs abilit% to artici ate in social a--airsF >;@ A& #ender issues

B$ )ocio-Economic condition C$ Cultural and s%chosocial -actors ($ )tatus o- #omen G 1his is an actual board 6uestion7 .ender issues a--ects the #omen artici ation in the social a--airs$ )ocio economic condition is the determinant -or education7 em lo%ment7 o,ert%7 nutrition7 li,ing condition and -amil% en,ironment$ )tatus o- #omen e,ol,es in #omenEs rights$ Cultural and s%chosocial -actors re-ers to the norms7 beha,iors7 orientation7 ,alues and culture$ +e-er to %our (OH manual to read more about this$ 39$ In the hili ine +H /rame#ork$ #hich maHor -actor a--ects +H statusF >3@

A$ DomenEs lo#er le,el o- literac% %& Health ser-ice deli-er' mechanism C$ 'oor li,ing conditions lead to illness ($ Commercial sex #orkers are ex osed to AI()")1($ G Health ser,ices deli,er% mechanism is the maHor -actor that a--ect +H status$ Other -actors are #omenEs beha,ior7 )anitation and #ater su l%7 Em lo%ment and #orking conditions etc$ 3B$ Dhich determinant o- re roducti,e health ad,ocates nutrition -or better health romotion and maintain a health-ul li-eF >3@ A& $ocio-Economic conditions B$ )tatus o- #omen C$ )ocial and gender issues ($ Biological7 Cultural and 's%chosocial -actors G +e-er to P 33 3<$ Dhich o- the -ollo#ing is NO1 a strateg% o- +HF >;@ A$ Increase and im ro,e contrace ti,e methods %& Achie-e re)roducti-e intentions C$ Care ro,ision -ocused on eo le #ith +H roblems ($ 're,ent s eci-ic +H roblem through in-ormation dessemination G +e-er to P31 3?$ Dhich o- the -ollo#ing is NO1 a goal o- +HF >;@ A$ Achie,e health% sexual de,elo ment and maturation B$ A,oid illness"diseases7 inHuries7 disabilities related to sexualit% and re roduction C$ +ecei,e a ro riate counseling and care o- +H roblems "& $trengthen outreach acti-ities and the re(erral s'stem G +e-er to P31 3=$ Dhat is the 5I)ION o- the +HF >8@

A$ Attain &0A*I12 O/ *I/E %& *ractice RH as a 0A7 O 6I E C$ 're,ent s eci-ic +H roblem ($ Health in the hands o- the -ili ino G +e-er to P3; )I10A1ION ! >)O+AN.E1=@ Bab% .7 a B hours old ne#born is admitted to the NIC0 because o- lo# A'.A+ )core$ His mother had a rolonged second stage o- labor 90$ Dhich o- the -ollo#ing is the most im ortant conce t associated #ith all high risk ne#bornF >1@ A& $u))ort the high-ris4 newborn:s cardio)ulmonar' ada)tation b' maintaining ade;uate airwa' B$ Identi-% com lications #ith earl% inter,ention in the high risk ne#born to reduce morbidit% and mortalit% C$ Assess the high risk ne#born -or an% h%sical com lications that #ill assist the arent #ith bonding ($ )u ort mother and signi-icant others in their re6uest to#ard ada tation to the high risk ne#born G 1he ; maHor and initial and immediate needs o- ne#borns both normal and high risks are AIR3%REA!HIN#. CIRC56A!ION and !EM*ERA!5RE& C and " are both eliminated because the% do not address the immediate ne#born needs$ Identi-%ing com lication #ith earl% inter,ention is im ortant7 ho#e,er7 this does not address the IMME(IA1E and MO)1 IM'O+1AN1 ne#born needs$ 91$ Dhich o- the -ollo#ing #ould the nurse ex ect to -ind in a ne#born #ith birth as h%xiaF >1@ A$ H% eroxemia %& Acidosis C$ H% oca nia ($ Metosis G Birth As h%xia is a term used to describe the inabilit% o- an in-ant to maintain an ade6uate res iration #ithin 1 minute a-ter birth that leads so acidosis7 h% oxia7 h% oxemia and tissue anoxia$ 1his results to H% erca nia not H% oca nia due to the increase in carbonic acid concentration in the -etal circulation because the carbon dioxide -ails to get eliminated -rom the in-antEs lungs because o- inade6uate res iration$ Metosis is the resence o- ketones in the bod% because o- excessi,e -at metabolism$ 1his is seen in diabetic ketoacidosis$ 98$ Dhen lanning and im lementing care -or the ne#born that has been success-ull% resuscitated7 #hich o- the -ollo#ing #ould be im ortant to assessF >1@ A$ Muscle -laccidit% %& H')ogl'cemia

C$ (ecreased intracranial ressure ($ ) ontaneous res iration G 1here is no need to assess -or s ontaneous res iration because O/ the #ord $5CCE$$ 5667 RE$5$CI!A!E"& Dhat is it to assess is the 6ualit% and 6uantit% ores iration$ In-ants #ho undergone tremendous h%sical challenges during birth like as h%xia7 rolonged labor7 +() are all high risk -or de,elo ing h% ogl%cemia because othe se,ere de letion o- glucose stores to sustain the demands o- the bod% during those demanding times$ )I10A1ION ! >'-I"3B@ Nurses should be a#are o- the di--erent re roducti,e roblems$ 9;$ Dhen is the best time to achie,e regnanc%F >8@ A$ Mid#a% bet#een eriods B$ Immediatel% a-ter menses end C& 1, da's be(ore the next )eriod is ex)ected ($ 13 da%s a-ter the beginning o- the next eriod G 1he best time to achie,e regnanc% is during the o,ulation eriod #hich is about 13 da%s be-ore the next eriod is ex ected$ A Menstrual c%cle is de-ined as the number oda%s -rom the start o- the menstruation eriod7 u to the start o- another menstrual eriod$ 1o obtain the o,ulation da%7 )ubtract 13 da%s -rom the end o- each c%cle$ Exam le7 1he start o- the menstrual -lo# #as Aul% 187 800B$ 1he next -lo# #as ex erienced August 117 800B$ 1he length o- the menstrual c%cle is then ;0 da%s > August 11 minus Aul% 18 @$ De then subtract 13 da%s -rom that total length o- the c%cle and that #ill gi,e us 1B da%s > ;0 minus 13 @ Count 1B da%s -rom Aul% 187 800B and that #ill gi,e us Aul% 8?7 800B as the da% o- o,ulation$ > Aul% 18 N 1B da%s @ 1his is the best time -or coitus i- the intention is getting regnant7 #orst time i- not$ 93$ A -actor in in-ertilit% ma%be related to the 'H o- the ,aginal canal$ A medication that is ordered to alter the ,aginal 'H is! >8@ A$ Estrogen thera % B$ )ul-ur insu--lations C$ *actic acid douches "& Na HCO+ "ouches G ) erm is innatel% A*MA*INE$ 1oo much acidit% is the onl% 'H alteration in the ,agina that can kill s erm cells$ Mno#ing this #ill direct %ou to ans#ering letter "& )odium Bicarbonate douches #ill make the ,agina less acidic because o- itEs alkaline ro ert%7 making the ,aginaEs en,ironment more conduci,e and tolerating to the s erm cells$ Estrogen thera % #ill not alter the 'H o- the ,aginal canal$ H+1 > Hormone re lacement thera % @ is no# -eared b% man% #omen because o- the high risk in ac6uiring breast7 uterine and cer,ical cancer$ +esearch on this #as e,en halted because othe signi-icant risk on the sam le o ulation$ *actic acid douches #ill make the ,agina more acidic7 -urther making the en,ironment hostile to the alkaline s erm$ )ul-ur insu--lation is a rocedure used to treat ,aginal in-ections$ A tube is inserted in the ,agina and sul-ur is introduced to the bod%$ 1he %easts7 -ungi and other microorganisms that are

sensiti,e to sul-ur are all immediatel% killed b% it on contact$ 99$ A diagnostic test used to e,aluate -ertilit% is the ostcoital test$ It is best timed >8@ A$ 1 #eek a-ter o,ulation B$ Immediatel% a-ter menses C$ Aust be-ore the next menstrual eriod "& 0ithin 1 to 2 da's o( )resumed o-ulation G A oscoital test e,aluates both o,ulation detection and s erm anal%sis$ Dhen the #oman o,ulates > b% using the /AM method or commercial o,ulation detection kits7 #oman should kno# she o,ulates @ 1he cou le should ha,e coitus and then7 the #oman #ill go to the clinic #ithin 8 to ? hours a-ter coitus$ 1he #oman is ut on a lithotom% osition$ A s ecimen -or cer,ical mucus is taken and examined -or s innbarkeit > abilit% to stretch 19 cm be-ore breaking @ and s erm count$ 'ostcoital test is no# considered obsolete because a single s erm and cer,ical mucus anal%sis ro,ides more accurate data$ 9B$ A tubal insu--lation test is done to determine #hether there is a tubal obstruction$ In-ertilit% caused b% a de-ect in the tube is most o-ten related to a >;@ A& *ast in(ection B$ /ibroid 1umor C$ Congenital Anomal% ($ 're,ious inHur% to a tube G 'I( > Most common cause o- tubal obstruction @ due to untreated gonorrhea7 chlam%dia or other in-ections that leads to chronic sal hingitis o-ten leads to scarring o- the -allo ian tube thereb% causing tubal obstuction$ 1his one o- the common cause oin-ertilit%7 the most common is Ano,ulation in -emale and lo# s erm count in males$ A ru tured a endix7 eritonitis and abdominal surger% that leads to in-ection and adhesion o- the -allo ian tube can also lead to tubal obstruction$ 9<$ Dhich test is commonl% used to determine the number7 motilit% and acti,it% o- s erm is the >8@ A$ +ubin test %& Huhner test C$ /riedman test ($ 'a anicolau test G Huhner test is s%non%mous to ostcoital test$ 1his test e,aluates the number7 motilit% and status o- the s erm cells in the cer,ical mucus$ re-er to P 99 -or more in-ormation$ +ubin test is a test to determine the tubal atenc% b% introducing carbon dioxide gas ,ia a cannula to the clientEs cer,ix$ 1he sound is then auscultated in the clientEs abdomen at the oint #here the outer end o- the -allo ian tube is located7 near the -imbriae$ Absent osound means that the tube is not atent$ /riedman test in,ol,es a /+O. to determine regnanc% that is #h% it is also called as /+O. 1E)1$ 'a anicolaou test >Correct s elling@7 disco,ered b% (r$ .eorge 'a anicolaou during the 1=;0Es is a c%tolgic examination o- the e ithelial lining o- the cer,ix$ It is im ortant in diagnosis cer,ical cancer$

9?$ In the -emale7 E,aluation o- the el,ic organs o- re roduction is accom lished b% >8@ A$ Bio s% B$ C%stosco % C$ Culdosco % "& H'sterosal)ingogram G Bio s% is ac6uiring a sam le tissue -or c%tological examination$ 0suall% done in cancer grading or detecting at% ical7 abnormal and neo lastic cells$ C%stosco % is the ,isualiKation o- the bladder using a c%stosco e$ 1his is inserted ,ia the urethra$ 10+' or the transurethral resection o- the rostate is -re6uentl% done ,ia c%stosco % to remo,e the need -or incision in resecting the enlarged rostate in B'H$ Culdosco % is the insertion othe culdosco e through the osterior ,aginal #all bet#een the rectum and uterus to ,isualiKe the douglas cul de sac$ 1his is an im ortant landmark because this is the lo#est oint in the el,is7 -luid or blood tends to collect in this lace$ H%sterosal ingogram is the inHection o- a blue d%e7 or an% radio o a6ue material through the cer,ix under ressure$ O ra% is then taken to ,isualiKe the el,ic organs$ 1his is done onl% a-ter menstruation to re,ent re-lux o- the menstrual discharge u into the -allo ian tube and to re,ent an accidental irradiation o- the K%gote$ As usual7 as #ith all other rocedures that ends in #RAM7 assess -or iodine allerg%$ 9=$ Dhen is the -etal #eight gain greatestF >;@ A$ 1st trimester B$ 8nd trimester C& +rd trimester ($ -rom 3th #eek u to 1Bth #eek o- regnanc% G 5ital organs are -ormed during the -irst trimester7 1he greatest *EN.1H gain occurs during the second trimester #hile the greatest #eight gain occurs during the last trimester$ 1his is the time #hen bro#n -ats starts to be de osited in re aration -or the u coming deli,er%$ B0$ In -etal blood ,essel7 #here is the ox%gen content highestF >;@ A$ 0mbilical arter% %& "uctus 8enosus C$ (uctus areteriosus ($ 'ulmonar% arter% G (uctus ,enosus is directl% connected to the umbilical ,ein7 Dhich is directl% connected to the highl% ox%genated lacenta$ 1his ,essel su lies blood to the -etal li,er$ 0mbilical arteries carries 0NOO2.ENA1E( B*OO(7 the% carr% the blood a#a% -rom the -etal bod%$ (uctus arteriosus shunts the blood a#a% -rom the -etal lungs7 this carries an ox%genated blood but not as concentrated as the blood in the ductus ,enosus #ho ha,e not %et ser,ice an% o- the -etal organ -or ox%gen exce t the li,er$ Mno#ing that the -etal lungs is not %et -unctional and ex anded #ill guide %ou to automaticall% eliminate the ulmonar% arter% #hich is res onsible -or carr%ing 0NOO2.ENA1E( B*OO( a#a% -rom the lungs$

B1$ 1he nurse is caring -or a #oman in labor$ 1he #oman is irritable7 com lains onausea and ,omits and has hea,ier sho#$ 1he membranes ru ture$ 1he nurse understands that this indicates >1@ A& !he woman is in transition stage o( labor B$ 1he #oman is ha,ing a com lication and the doctor should be noti-ied C$ *abor is slo#ing do#n and the #oman ma% need ox%tocin ($ 1he #oman is emotionall% distraught and needs assistance in dealing #ith labor G 1he clue to the ans#er is MEM%RANE$ R5*!5RE& Membranes7 as a rule7 ru ture at -ull dilation > 10 cm @ unless ru tured b% amniotom% or ru tured at an earlier time$ 1he last o- the mucus lug -rom the cer,ix is also released during the transition hase olabor$ De call that the O*ERC565M as signaled b% a HEA8IER $HO0& (uring the transition hase7 Cer,ix is dilated at around ? to 10 cm and contractions reaches their eak o- intensit% occuring e,er% 8 to ; minutes #ith a B0 to =0 second duration$ At the transition hase7 #oman also ex eriences nausea and ,omiting #ith intense ain$ 1his 6uestion is *I/1E( -rom the re,ious board and the 6uestion #as atterned EOAC1*2 DO+( 'E+ DO+( -rom )illitteri& )I10A1ION ! >A8I83B@ Matherine7 a ;8 %ear old rimigra,ida at ;=-30 #eeks AO. #as admitted to the labor room due to h% ogastric and lumbo-sacral ains$ IE re,ealed a -ull% dilated7 -ull% e--aced cer,ix$ )tation 0$ B8$ )he is immediatel% trans-erred to the (+ table$ Dhich o- the -ollo#ing conditions signi-% that deli,er% is nearF >8@ I - A desire to de-ecate II - Begins to bear do#n #ith uterine contraction III - 'erineum bulges I5 - 0terine contraction occur 8-; minutes inter,als at 90 seconds duration A& I.II.III B$ I7II7III7I5 C$ I7III7I5 ($ II7III7I5 G Again7 li-ted #ord er #ord -rom 'illitteri and this is -rom the N*E$ A is the right ans#er$ A #oman near labor ex eriences desire to de-ecate because o- the ressure o- the -etal head that -orces the stool out -rom the anus$ )he cannot hel but bear do#n #ith each o- the contractions and as cro#ning occurs7 1he erineum bulges$ A #oman #ith a 90 second contraction is still at the AC!I8E *HA$E labor > 30 to B0 seconds duration7 ; to 9 minutes inter,al @ Domen #ho are about to gi,e birth ex erience B0-=0 seconds contraction occuring at 8-; minutes inter,al$ B;$ Arti-icial ru ture o- the membrane is done$ Dhich o- the -ollo#ing nursing diagnoses is the riorit%F >8@ A$ High risk -or in-ection related to membrane ru ture

%& *otential (or inCur' related to )rola)se cord C$ Alteration in com-ort related to increasing strength o- uterine contraction ($ Anxiet% related to un-amiliar rocedure G Nursing diagnosis is -re6uentl% ask$ In an% case that IN/EC1ION #as one o- the choices7 remo,e it as soon as %ou see it in A** CA)E) during the intra and re o erati,e nursing care$ In-ection #ill onl% occur a-ter 3? hours o- o eration or e,ent$ % is much more immediate and more likel% to occur than A7 and is much more A!A6$ 'rioritiKation and A ro riateness is the ke% in correctl% ans#ering this 6uestion$ High risk -or in-ection is an a ro riate nursing diagnosis7 but as I said7 In-ection #ill occur in much later time and not as immediate as %& +eadil% remo,e " and C because h%siologic needs o- the mother and -etus take recedence o,er com-ort measures and s%chosocial needs$ B3$ Matherine com lains o- se,ere abdominal ain and back ain during contraction$ Dhich t#o o- the -ollo#ing measures #ill be MO)1 e--ecti,e in reducing ainF >3@ I - +ubbing the back #ith a tennis ball II- E--leurage III-Imager% I5-Breathing techni6ues A$ II7I5 B$ II7III C$ I7I5 "& I.II G +emo,e %& Imager% is not used in se,ere ain$ 1his is a labor ain and the mother #ill ne,er tr% to imagine a nice and beauti-ul scener% #ith %ou at this oint because the ain is all encom assing and se,ere during the transition hase o- labor$ +emo,e A and C Because breathing techni6ues is not a method to E*IMINA1E 'AIN but a method to reduce anxiet%7 im ro,e ushing and re,ent ra id ex ulsion o- the -etus during cro#ning > B% 'AN1IN. @ Back ain is so se,ere during labor in cases o- 'osterior resentations > +O'7*O'7+M'7*)a'7 etc$$$ @ Mother is asked to ull her knees to#ards her chest and rock her back$ > As in a rocking chair @ A 1ennis ball rubbed at the clientEs back can relie,e the ain due to the ressure o- the resenting art on the osterior art o- the birth canal$ Also7 rubbing a tennis ball to the clientEs back O'EN) 1HE *A+.E /IBE+ NE+5E .A1E$ E--leurage or a sim le rotational massage on the abdomen sim l% relie,es the clientEs ain b% o ening the large -iber ner,e gate and closing the the small -iber ner,e gate$ > 'lease read about .ate control theor% b% MeKack and Dall @$ B9$ *umbar e idural anesthesia is administered$ Dhich o- the -ollo#ing nursing res onsibilities should be done immediatel% -ollo#ing rocedureF >1@ A$ +e osition -rom side to side B$ Administer ox%gen C$ Increase I5 -luid as indicated "& Assess (or maternal h')otension

G H% otension is one o- the side e--ects o- an e idural anesthesia$ An e idural anesthesia is inHected on the *; - *3 or *3 - *9 area$ 1he inHection lies Hust abo,e the dura and must not cross the dura > s inal anesthesia crosses the dura @$ Nursing inter,ention re,ol,es in assesing ++7 B' and other ,ital signs -or ossible com lication and side e--ects$ 1here is no need to osition the client -rom side to side7 1he re-erred osition during the transition hase o- labor is 6I!HO!OM7$ Ox%gen is not s eci-ic a-ter administration oan e idural anesthesia$ I5 -luid is not increased #ithout doctorEs order$ A$ IN"ICA!E" is di--erent -rom A$ OR"ERE"$ BB$ Dhich is NO1 the drug o- choice -or e idural anesthesiaF >3@ A$ )ensorcaine B$ O%locaine C& E)hedrine ($ Marcaine G A.% and " are all drugs o- choice -or e idural anesthesia$ E hedrine is the drug use to re,erse the s%m tom o- h% otension caused b% e idural anesthesia$ It is a s%m athomimetic agent that causes ,asoconstriction7 bronchodilation > in asthma @ and can increase the amount o- energ% and alertness$ E hedrine is some#hat similar to e ine hrine in terms o- action as #ell as itEs ad,erse e--ects o- urinar% retention7 tremor7 h% ersali,ation7 d%s nea7 tach%cardia7 h% ertension$ )I10A1ION ! >)O+AN.E81<@ Al ha7 a 83 %ear old .3'; at -ull term gestation is brought to the E+ a-ter a gush o- -luid asses through here ,agina #hile doing her holida% sho ing$ B<$ )he is brought to the triage unit$ 1he /H1 is noted to be 113 b m$ Dhich o- the -ollo#ing actions should the nurse do -irstF >8@ A$ Monitor /H1 e,er 19 minutes B$ Administer ox%gen inhalation C$ Ask the charge nurse to noti-% the Obstetrician "& *lace her on the le(t lateral )osition G +emo,e A& A /H+ o- 113 b m is B beats belo# normal$ 1hough monitoring is continuous and a ro riate7 1his is not %our immediate action$ %7 Ox%gen inhalation needs doctorEs order and there-ore7 is a (E'EN(EN1 nursing action and #onEt be %our -irst o tion$ Although administration o- ox%gen b% the nurse is allo#ed #hen gi,en at the lo#est setting during emergenc% situation$ C is a ro riate7 but should not be %our IMME(IA1E action$ 1he best action is to lace the client on the *E/1 *A1E+A* 'O)I1ION to decrease the ressure in the in-erior ,ena ca,a > b% the gra,id uterus @ thereb% increasing ,enus return and gi,ing an ade6uate er-usion to the -etus$ 2our next action is to call and noti-% the obstetrician$ +emember to look -or an inde endent nursing action -irst be-ore tr%ing to call the h%sician$ B?$ 1he nurse checks the erineum o- al ha$ Dhich o- the -ollo#ing characteristic o- the amniotic -luid #ould cause an alarm to the nurseF >1@

A& #reenish B$ )cantl% C$ Colorless ($ Blood tinged G A greenish amniotic -luid heralds -etal distress not unless the -etus is in breech resentation and ressure is resent on the bo#el$ Other color that a nurse should thoroughl% e,aluate are ! 1ea colored or strong %ello# color that indicates hemol%tic anemia 7 as in +H incom atibilit%$ B=$ Al ha asks the nurse$ SDh% do I ha,e to be on com lete bed restF I am not com-ortable in this osition$S Dhich o- the -ollo#ing res onse o- the nurse is most a ro riateF >;@ A& Dee)ing 'ou on bed rest will )re-ent )ossible cord )rola)se B$ Com leted bed rest #ill re,ent more amniotic -luid to esca e C$ 2ou need to sa,e %our energ% so %ou #ill be strong enough to ush later ($ *et us ask %our obstetrician #hen she returns to check on %ou G Once the membrane ru tures7 as in the situation o- al ha7 1he immediate and most a ro riate nursing diagnosis is risk -or inHur% related to cord rola se$ Mee ing the client on bed rest is one o- the best inter,ention in re,enting cord rola se$ Other inter,entions are utting the client in a modi-ied 1 osition or Mneed chest osition$ Once the amniotic -luid esca es7 It is allo#ed to esca e$ Although bed rest does sa,es energ%7 It is not the most a ro riate res onse #h% bed rest is rescribed a-ter membranes ha,e ru tured$ Not ans#ering the clientEs 6uestion no# #ill romote distrust and increase clientEs anxiet%$ It #ill also make the client think that the nurse is incom etent -or not kno#ing the ans#er$ <0$ Al ha #ants to kno# ho# man% -etal mo,ements er hour is normal7 the correct res onse is >3@ A$ 1#ice B$ 1hrice C$ /our times "& 10-12 times G According to )ando,sk%7 1o count -or the -etal mo,ement7 Mother is ut on her *E/1 )I(E to decrease lacental insu--icienc%$ 1his is usuall% done a-ter meals$ 1he mother is asked to record the number o- -etal mo,ements er hour$ A -etus mo,es 1#ice e,er% 10 minutes and 10 to 18 times times an hour$ In )IAE) Book7 )he ans#ered this 6uestion #ith letter %& But according to 'illitteri7 A mo,ement -e#er than 9 in an hour is to be re orted to the health care ro,ider$ 1he Board examiners uses 'illitteri as their re-erence and 0OR" *ER 0OR"7 1heir 6uestion are ans#ered directl% -rom the 'illitteri book$ 10-12 times according to 'illitteri7 is the normal -etal mo,ement er minute$ <1$ 0 on examination b% the obstetrician7 he charted that Al ha is in the earl% stage o-

labor$ Dhich o- the -ollo#ing is true in this stateF >1@ A$ )el---ocused B$ E--acement is 100: C$ *ast -or 8 hours "& Cer-ical dilation 1-+ cm G 1he earliest hase o- labor is the -irst stage o- labor ! latent hase characteriKed b% a cer,ical dilation o- 0-; cm7 Mild contraction lasting -or 80 to 30 seconds$ 1his lasts a roximatel% B hours in rimis and 3$9 hours in multis$ C is the characteristic oAC1I5E 'HA)E o- labor7 CharacteriKed b% a cer,ical dilation o- 3-< cm and contractions o- 30 to B0 seconds$ 1his hase lasts at around ; hours in rimis and 8 hours in multis$ E--acement o- 100: is a characteristic o- the 1+AN)I1ION 'HA)E as #ell as being sel- -ocused$ )I10A1ION ! Maternal and child health nursing a core conce t o- ro,iding health in the communit%$ Master% o- MCH Nursing is a 6ualit% all nurse should ossess$ <8$ Dhen should be the 8nd ,isit o- a regnant mother to the +H0F >8@ A$ Be-ore getting regnant B$ As earl% in regnanc% C& $econd trimester ($ 1hird trimester G 5isit to the +H0 are once e,er% trimester and more -re6uent -or those #omen at risk$ 5isit to the health center is once during the 0-Bth month o- regnanc%7 t#ice during the <th-?th month and #eekl% at the last trimester$ <;$ Dhich o- the -ollo#ing is NO1 a standard renatal h%sical examinationF >1@ A$ Neck examination -or goiter B$ Examination o- the alms o- the hands -or allor C$ Edema examination o- the -ace hands7 and lo#er extremeties "& Examination o( the legs (or -aricosities <3$ Dhich o- the -ollo#ing is NO1 a basic renatal ser,ice deli,er% done in the BH)F >8@ A& Oral 3 "ental chec4 u) B$ *aborator% examination C$ 1reatment o- diseases ($ Iron su lementation G A is done at the +H0 not in BH)$ <9$ Ho# man% da%s and ho# much dosage #ill the I+ON su A$ ;B9 da%s " ;00 mg lementation be takenF >3@

%& 210 da's 3 200 mg C$ 100 da%s" 100mg ($ 90 da%s " 90 mg G Iron su lementation is taken -or 810 da%s starting at the 9th month o- regnanc% u to 8nd month ost artum$ (osage can range -rom 100 to 800 mg$ <B$ Dhen should the iron su lementation starts and #hen should it endsF >3@

A& =th month o( )regnanc' to 2nd month )ost )artum B$ 1st month o- regnanc% to 9th month ost artum C$ As earl% in regnanc% u to =th month o- regnanc% ($ /rom 1st trimester u to B #eeks ost artum G +e-er to P<9 <<$ In malaria in-ested area7 ho# is chloro6uine gi,en to regnant #omenF >3@ A$ ;00 mg " t#ice a month -or = months B$ 800 mg " once a #eek -or 9 months C& 1=0 mg 3 twice a wee4 (or the duration o( )regnanc' ($ 100 mg " t#ice a #eek -or the last trimester o- regnanc% G Al#a%s remember that chloro6uine is gi,en t#ice a #eek -or the #hole duration oregnanc%$ 1his kno#ledge alone #ill lead %ou to correctl% identi-%ing letter C& <?$ Dhich o- the -ollo#ing mothers are 6uali-ied -or home deli,er%F >8@ A$ 're term B$ Bth regnanc% C$ Has a histor% o- hemorrhage last regnanc% "& 2nd )regnanc'. Has a histor' o( 20 hours o( labor last )regnanc'& G Mno#ing that a reterm mother is not 6uali-ied -or home deli,er% #ill hel %ou eliminate A& Histor% o- com lications like bleeding7 C'(7 Eclam sia and diseases like 1B7 C5(7 Anemia also nulls this 6uali-ication$ A 6uali-ied #oman -or home deli,er% should onl% had less than 9 regnancies$ More than 9 dis6uali-ies her -rom home deli,er%$ High risk length o- labor -or rimigra,idas ls more than 83 hours and -or multigra,idas7 it is more than 18 hours$ Mno#ing this #ill allo# %ou to choose "& <=$ Dhich o- the -ollo#ing is not included on the ; Cs o- deli,er%F >8@ A$ Clean )ur-ace B$ Clean Hands C& Clean E;ui)ments ($ Clean Cord G ; Cs o- deli,er% are C*EAN )0+/ACE7HAN() AN( CO+($ S Dinama' ni Corda)'a ang labada gamit ang $ur( - Budek S

?0$ Dhich o- the -ollo#ing is unnecessar% e6ui ment to be included in the home deli,er% kitF >3@ A$ Boiled raKor blade B$ <0: Iso ro %l Alcohol C$ /lashlight "& Rectal and oral thermometer G Home deli,er% kit should contain the -ollo#ing ! Clam s7 )cissors7 Blade7 Antise tic7 )oa and hand brush7 B a 7 Clean to#el or cloth and /lashlight$ O tional e6ui ments include ! 'lastic sheet7 )uction bulb7 Deighing scale7 O hthalmic ointment7 Nail cutter7 )terile glo,es7 +ectal and oral thermometers$ )I10A1ION ! >NB*0E1BB@ 'illar is admitted to the hos ital #ith the -ollo#ing signs ! Contractions coming e,er% 10 minutes7 lasting ;0 seconds and causing little discom-ort$ Intact membranes #ithout an% blood% sho#s$ )table ,ital signs$ /H+ Q 1;0b m$ Examination re,eals cer,ix is ; cm dilated #ith ,ertex resenting at minus 1 station$ ?1$ On the basis o- the data ro,ided abo,e7 2ou can conclude the illar is in the >1@ A$ In -alse labor B$ In the acti,e hase o- labor C& In the latent )hase o( labor ($ In the transitional hase o- labor G +e-er to P<1 ?8$ 'itocin dri is started on 'ilar$ 'ossible side e--ects o- itocin administration include all o- the -ollo#ing exce t >;@ A$ (iuresis B$ H% ertension C$ Dater intoxication "& Cerebral hemorrhage G Ox%tocin > 'itocin @ is a s%nthetic -orm o- hormone naturall% released b% the ''.$ It is used to augment labor and deli,er%$ (osage is about 1 to 8 milli units er minute and this can be doubled until the desired contraction is met$ )ide e--ects are 0ater intoxication. "iuresis. H')ertonicit' o( the uterus. 5terine ru)ture. *reci)itated labor. 0alang 4amata'ang Nausea and 8omiting and etal brad'cardia& (iuresis occurs because o#ater intoxication7 1he kidne% #ill tr% to com ensate to balance the -luid in the bod%$ NE8ER gi,e itocin #hen /H+ is belo# 180$ E,en #ithout kno#ing an%thing about 'itocin7 A cerebral hemorrhage is 6E!HA6 and "AMA#E I$ IRRE8ER$I%6E and ithis is a side e--ect o- a drug7 I do not think that /(A or B/A( #ill a ro,e it$ ?;$ 1he normal range o- /H+ is a roximatel% >;@

A$ =0 to 130 b m %& 120 to 1<0 b)m C$ 100 to 130 b m ($ 130 to 1?0 b m G A normal -etal heart rate is 180-1B0 b m$ ?3$ A negati,e 1 >-1@ station means that >1@ A$ /etus is cro#ning %& etus is (loating C$ /etus is engaged ($ /etus is at the ischial s ine G At the negati,e station7 1he -etus is not %et engaged and -loating$ At 0 station7 it means that the -etus is engaged to the ischial s ine$ Cro#ning occurs #hen the -etus is at the N;7N3 )tation$ )tations signi-ies distance o- the resensting art belo# or abo,e ischial s ine$ N denoted belo# #hile - denotes abo,e$ 1he number a-ter the sign denotes length in cm$ N1 station there-ore means that the resenting art is 1 cm belo# the ischial s ine$ ?9$ Dhich o- the -ollo#ing is characteristics o- -alse labor >1@ A$ Blood% sho# B$ Contraction that are regular and increase in -re6uenc% and duration C$ Contraction are -elt in the back and radiates to#ards the abdomen "& None o( the abo-e G A.% and C are all charactertistics o- a true labor$ 1rue labor is heralded b% 6I#H!ENIN#$ 1his makes the uterus lo#er and more anterior$ 1his occrs 8 #eeks rior to labor$ At the morning o- labor7 #omen ex eriences %5R$! O ENER#7 because o- adrenaline rush induced b% the decrease rogestrone secretion o- the deteriorating lacenta$ 1he ain in labor is -elt at the back and radiates to#ards the abdomen and becomes regular7 increasing -re6uenc% and duration$ As the cer,ix so-tens and dilates7 1he O*ERC565M or the mucus lug is ex elled$ /alse labor is characteriKed b% Irregular uterine contraction that is relie,ed b% #alking7 'ain -elt at the abdomen and con-ined there and in the groin7 1he cer,ix do not achie,e dilation and 'ain that is relie,ed b% slee and do not increase in intensit% and duration$ ?B$ DhoEs 1heor% o- labor ain that states that 'AIN in labor is cause b% /EA+ >3@ A$ Bradle% B$ )im son C$ *amaKe "& "ic4-Read G Belie,e it or not7 this is an actual board 6uestion$ .rantle% (ick-+ead is Hust one erson$ 0suall% a t#o name theor% means t#o theorist$ He ublished a book in 1=;; SCHI*(BI+1H DI1HO01 /EA+S$ He belie,es that 'AIN in labor is caused b% /EA+

that causes muscle tension7 thereb% halting the blood to#ards the uterus and causing decreased ox%genation #hich causes the 'AIN$ 1=90s /rench obstetrician7 (r$ /erdinand *amaKe erha s is the most o ular theorist #hen it comes to labor$ 1he theor% behind *amaKe is that birth is a normal7 natural and health% e,ent that should occur #ithout unnecessar% medical inter,ention$ +ather than resorting to ain medication7 di--erent breathing techni6ues are used -or each stage olabor to control ain$ /athers are assigned the role o- labor coach7 and are res onsible -or monitoring and adHusting their artnerEs breathing attern throughout childbirth$ In 1=B97 obstetrician +obert A$ Bradle%7 M( #rote SHusband Coached Childbirth$S 1he Bradle% method erha s is the easiest to remember7 %RA" le% necessitates the resence o- the A!HER during labor$ Bradle% Method ,ie#s birth as a natural rocess$ 1his method also em hasiKes the im ortance o- acti,el% in,ol,ing -athers in the labor rocess$ /athers are taught #a%s to hel ease their artnerEs ain during childbirth through guided relaxation and slo# abdominal breathing$ Aames 2oung )im son is an english doctor and the -irst to a l% anesthesia during labor and child birth$ He uses E1HE+ to alle,iate labor ain$ He then disco,ered the e--ects ochloro-orm as an anesthetic agent$ Because o- his #orks7 He #as recogniKed b% &ueen 5ictoria because the 6ueen hersel- uses )im sonEs chloro-orm in alle,iating labor ain #hen she ga,e birth to rince leo old$ ?<$ Dhich sign #ould alert the nurse that 'illar is entering the second stage o- laborF >1@ A$ Increase -re6uenc% and intensit% o- contraction B$ 'erineum bulges and anal ori-ice dilates C& E((acement o( internal O$ is 100E ($ 5ul,a encircles the largest diameter o- resenting art G 1he second stage o- labor begins as the cer,ical internal os is 100: e--aced and -ull% dilated$ It ends a-ter the -etus has been deli,ered$ Cro#ning7 as in letter % and " is too late o- a sign to alert the nurse that 'illar is entering the second stage o- labor$ A occurs during the -irst stage o- labor$ ??$ Nursing care during the second stage o- labor should include >1@ A$ Care-ul e,aluation o- renatal histor% %& Coach breathing. %ear down with each contraction and encourage )atient& C$ )ha,e the erineum ($ Administer enema to the atient G 1he second stage o- labor begins #ith a -ull cer,ical dilation and e--acement and -inishes #hen the bab% is -ull% deli,ered$ Care-ul e,aluation o- renatal histor% is done on admission and check u s and is ne,er done in the second stage o- labor$ )ha,ing the erineum and enema are done during the -irst stage o- labor in re aration -or deli,er% or be-ore labor begins #hen client is admitted$ Enema is not a routine rocedure be-ore deli,er%7 but can be done to re,ent de-ecation during labor$ % is a ro riate during the second stage o- labor #hen the clientEs contraction is at itEs eak and dilation and e--acement are at maximum to hel client accom lish the task o- gi,ing birth$

)I10A1ION ! >NB*0E1<0@ Bab% bo% ereK #as deli,ered s ontaneousl% -ollo#ing a term regnanc%$ A gar scores are ? and = res ecti,el%$ +outine rocedures are carried out$ ?=$ Dhen is the A'.A+ )core takenF >1@ A$ Immediatel% a-ter birth and at ;0 minutes a-ter birth B$ At 9 minutes a-ter birth and at ;0 minutes a-ter birth C& At 1 minute a(ter birth and at = minutes a(ter birth ($ Immediatel% a-ter birth and at 9 minutes a-ter birth G A'.A+ score taken 1 minute a-ter birth determines the initial status o- the ne#born #hile the 9 minute assessment a-ter birth determines ho# #ell the ne#born is adHusting to the extrauterine li-e$ =0$ 1he best #a% to osition a ne#born during the -irst #eek o- li-e is to la% him >;@ A$ 'rone #ith head slightl% ele,ated B$ On his back7 -lat C& On his side with his head (lat on bed ($ On his back #ith head slightl% ele,ated G )udden in-ant death s%ndrome occurs #hen the -etus is in rone osition$ Mno#ing this #ill allo# %ou to eliminate A -irst$ (uring the -irst #eek o- li-e7 1he -etus has an immature cardiac s hincter and musculature -or s#allo#ing7 Mno#ing this #ill let %ou eliminate % and "& )ide l%ing osition is the best osition -or a neonate during the -irst -e# #eeks o- li-e$ 1his #ill decrease the risk o- as iration o- secretion$ =1$ Bab% bo% ereK has a large sebaceous glands on his nose7 chin7 and -orehead$ 1hese are kno#n as >1@ A& Milia B$ *anugo C$ Hemangiomas ($ Mongolian s ots G Ne#born sebaceous glands are sometimes uno ened or lugged$ 1he% are called MI*IA$ 1he% #ill disa ear once the gland o ens at around 8 #eeks a-ter deli,er%$ 1he% are characteriKed b% a in oint #hite a ule$ *anugo is the -ine hair that co,ers the ne#born$ It disa ears starting 8 #eeks a-ter birth$ A remature in-ant has more lanugo than a ost mature in-ant$ Hemangiomas are ,ascular tumors o- the skin$ Mongolian s ots are atches that are gra% in color and are o-ten -ound in sacrum or buttocks$ 1he% disa ear as the child gro#s older$ =8$ Bab% bo% ereK must be care-ull% obser,ed -or the -irst 83 hours -or >8@ A$ +es irator% distress B$ (uration o- cr% C$ /re6uenc% o- ,oiding

"& Range in bod' tem)erature G +ange in bod% tem erature needs to be obser,ed and care-ull% monitored -or the -irst 83 hours a-ter deli,er%$ A ne#born has an inade6uate and immature tem erature regulating mechanism$ +() is obser,ed immediatel% a-ter deli,er%7 not in a continuous 83 hour obser,ation$ Once the -etus establish a normal breathing attern it is not an%more o- a concern$ +() occurs #hen the )ur-actants are absent or insu--icient$ 1he ade6uac% o- these sur-actants is measured b% the *!) ratio > *ecithin ! ) ingom%elin @ An *!) ratio o- 8!1 is considered7 mature and ade6uate to sustain -etal lung ex ansion and ,entilation$ 1here-ore7 A child born #ithout +() is unlikel% to ha,e +() in 83 hours$ Another thing that is care-ull% obser,ed during the -irst 83 hours is the meconium$ Absent o- meconium during the -irst 83 hours a-ter birth #arrants -urther in,estigation b% the attending h%sician$ =;$ According to the DHO 7 #hen should the mother starts breast-eeding the in-antF >3@ A& 0ithin +0 minutes a(ter birth B$ Dithin 18 hours a-ter birth C$ Dithin a da% a-ter birth ($ A-ter in-antEs condition stabiliKes G According to the #orld health organiKation7 1he mother should start breast-eeding her in-ant #ithin ;0 minutes a-ter birth$ =3$ Dhat is the BE)1 and most accurate method o- measuring the medication dosage -or in-ants and childrenF >;@ A$ Deight B$ Height C& Nomogram ($ Deight and Height G A nomogram is the most accurate method -or measuring medication dosage -or in-ants and children$ It estimates the bod% sur-ace area b% dra#ing a line in the -irst column > childEs height @ to#ards the third column > childEs #eight @$ 1he oint in #hich it crosses the middle column > B)A @ is the childEs sur-ace area$ =9$ 1he -irst ost artum ,isit should be done b% the mother #ithin >3@ A$ 83 hours B$ ; da%s C$ a #eek "& a month G Mother should ,isit the health -acilit% 3 #eeks to B #eeks a-ter deli,er%$ 1he -irst ost artum ,isit b% the birth attendant is done #ithin 83 hours a-ter deli,er%7 the next ,isit #ill be at 1 #eek a-ter deli,er% and the third ,isit is done 8 to 3 #eeks a-ter deli,er%$ =B$ 1he maHor cause o- maternal mortalit% in the

ili

ines is >;@

A$ In-ection B$ Hemorrhage C$ H% ertension "& Other com)lications related to labor.deli-er' and )uer)erium G +e-er to the latest sur,e% o- /H)I) in the (OH #ebsite$ =<$ According to the DHO7 #hat should be the com osition o- a commercialiKed Oral reh%dration salt solutionF >3@ A& *otassium F 1&= g& G $odium %icarbonate 2&=g G $odium Chloride +&=gG #lucose 20 g& A$ 'otassium ! 1$9 g$ C )odium Bicarbonate 8$9g C )odium Chloride ;$9gC .lucose 10 g$ A$ 'otassium ! 8$9 g$ C )odium Bicarbonate ;$9g C )odium Chloride 3$9gC .lucose 80 g$ A$ 'otassium ! 8$9 g$ C )odium Bicarbonate ;$9g C )odium Chloride 3$9gC .lucose 10 g$ G 1his is the DHO O+E)O* -ormula -or the commercialiKed O+)$ +emember *A %C# Dhich stands -or *O!A$$I5M H *a I $O"I5M %ICAR%ONA!E H % I $O"I5M CH6ORI"E H C I #65CO$E H # I& 1he numbers are eas% to remember because the% are Hust increased b% 1$0 g increment starting -rom 1$9$ .lucose ho#e,er is at 80 g$ )o the MNEMONIC is 'A BC. 1$9 8$9 ;$9 80$ 1his is the mnemonic I use and it is eas% to remember that #a%$ It is original b% the #a%$ =?$ In re aring O+E)O* at home7 1he correct com osition recommnded b% the (OH is >3@ A& 1 glass o( water. 1 )inch o( salt and 2 ts) o( sugar B$ 1 glass o- #ater7 8 inch o- salt and 8 ts o- sugar C$ 1 glass o- #ater7 ; inch o- salt and 3 ts o- sugar ($ 1 glass o- #ater7 1 inch o- salt and 1 ts o- sugar ==$ Milk code is a la# that rohibits milk commercialiKation or arti-icial -eeding -or u to 8 %ears$ Dhich la# ro,ides its legal basisF >3@ A$ )enate bill 1033 B$ +A <B00 C$ 'residential 'roclamation 13< "& EO =1 G Executi,e order P 91 rohibits milk commercialiKation or arti-icial -eeding u to 8 %ears$ 1hat is #h% the milk commercials in the countr% has S %REA$! MI6D I$ $!I66 %E$! OR %A%IE$ 5* !O 2 7EAR$ S A-ter their resentation in accordance #ith EO 91$ +A <B00 is the +OOMIN. IN " B+EA)1 /EE(IN. AC1 #hich re6uires the heatlh ro-essionals to bring the bab% to the mother -or breast-eeding as earl% as ossible$ )enate bill P 1033 #as created to im lement +A <B00$ 'residential 'roclamation P 13< made DE(NE)(A2 as the national immuniKation da%$

100$ A 30 %ear old mother in her third trimester should a,oid >3@ A$ 1ra,eling B$ Climbing C& $mo4ing ($ Exercising G MotherEs are not rohibited to tra,el7 climb or exercise$ I- long tra,els are ex ected7 Mother should ha,e a ;0 minute rest eriod -or e,er% 8 hours o- tra,el > *I''INCO11 @$ Climbing is a ,er% ,ague term used b% the board examiners though I assume the% are re-erring to climbing a -light o- stairs$ An%ho#7 $MODIN# is detrimental -or both mother and child no 6uestion about it and so is A*COHO*$ In thousands o- 6uestions I ans#ered7 it ne,er -ails that HAN"0A$HIN#. A8OI" $MODIN#. A8OI" A6COHO6 are al#a%s the ans#er$ It still de ends on the 6uestion so !HIND& (I)C*AIME+! Care has been taken to ,eri-% that all ans#ers and rationale belo# are accurate$ 'lease comment u i- %ou noticed an% errors or contradictions to maintain accurac% and recision o- the ans#ers as not to mislead the readers$