TOTAL POINTS: 175

CASE STUDY #1 (20 POINTS)

Amaya, 20 years old, primipara, is on the 20 th week of pregnancy, and she is experiencing vaginal spotting with slight
cramping. She went the doctor and he told her that she is having the manifestations of threatened abortion.

1. Describe the difference between abortion and miscarriage. (2)

Miscarriage is a natural or spontaneous termination of pregnancy, meaning the body expels the pregnancy on
it's own without the aid of medicine or surgical procedure.

An Abortion occurs when the procedure is done with the purpose of ending a pregnancy

2. Define induced abortion and spontaneous abortion. (2)

Induced abortion is defined as the termination of pregnancy using drugs or surgical interventions after
implantation and before the embryo or fetus has become independently viable.

Spontaneous Abortion is defined as the involuntary loss of the products of conception prior to 20 weeks of
gestation.

3. Contrast early miscarriage from late miscarriage. (2)

4. What is the meaning of threatened abortion? (1)

A threatened abortion is vaginal bleeding that occurs in the first 20 weeks of pregnancy. The bleeding is
sometimes accompanied by abdominal cramps.

5. In terms of manifestations, what is the main difference between threatened miscarriage and imminent
abortion. (2)

6. How can you help Amaya minimize the guilt that she felt? (1)

7. What are the management that will be administered to preserve the pregnancy? Include rationales. (5X2 =10)

CASE STUDY #2 (6 POINTS)

Bea, 30 year old, mulitgravida, is having moderate bleeding , rupture of membranes, and cervical dilation.

1. What is the type of abortion that is now being experienced by Bea?(1)

2. Why should Bea save any tissue fragments that she had passed? (1)

3. What is the purpose of a vacuum extraction (dilatation and evacuation)? (1)

4. How will you know that Bea is having an abnormally heavy bleeding? (1)

5. What is the mechanism of action of prostaglandin analogs? Give an example. (2)

CASE #3 (6 POINTS)

Marikit, G5P4 is on her 2nd month of pregnancy, and is suffering from intense vaginal pain and heavy vaginal

bleeding. She is now at the ER of Mindanao Sanitarium and Hospital. Upon IE, the cervix is already dilated

1. As an ER nurse, what do you suspect is happening to Marikit? Explain your answer. (2)

2. Why is it that Marikit is at risk of having a hemorrhage? (1)

3. Why did the doctor perform a dilatation and curettage for Marikit? (1)

4. Compare and contrast incomplete abortion and complete abortion. (2)

CASE #4 (11 POINTS)

Melinda is now on her 3rd month of pregnancy and goes to her OB-Gyne for her regular prenatal check-up. Her doctor

diagnosed her as having a “missed” abortion. This is her 2 nd after she gave to her first child five years ago.

1. What is another term for missed abortion? (1)

2. How do you describe “missed” abortion? (1)

3. What are the manifestations of a client with this type of abortion? (3)

4. What medications are administered to have an elective termination of pregnancy? (2)

5. Why do you think DIC is considered as a dangerous complication? (2)

6. List 2 nursing diagnoses for this case. (2)

CASE #5 (13 POINTS)

Rosario, 35 years old, did not have any pregnancy that reached term. She already experienced three abortions. She is
known to be a “habitual aborter.”

1. What is the new term of habitual abortion? (1)

2. List the possible causes of recurrent pregnancy loss. Discuss each cause briefly. (6X2 = 12)

CASE #6 (15 POINTS)

Mrs. Napakasakit, 25 years old is on the 2nd month of her pregnancy. She is being brought to the emergency room
because of a severe knife-like stabbing pain in the right lower quadrant.
 1. After a thorough assessment, the ER nurse would expect that the client is experiencing what kind of pregnancy
complication? (1)

2. Where is the most common site for ectopic pregnancy? (1)

3. What other signs and symptoms will be manifested by Mrs. Napakasakit? (3)

4. List the risk factors for ectopic pregnancy and describe each factor briefly. (4X2=8)

5. What is a very dangerous complication that will be experienced by Mrs. Napakasakit if she had delayed herself in
going to the hospital? (1)

6. What is Cullen’s sign? (1)

CASE STUDY #7 (16 POINTS)

Sittie, 40 years old, Indonesian, on the 20 th week pregnancy noticed that her abdomen is becoming bigger than usual
compared to her first pregnancy and she has some spotting of dark-brown blood. She comes to the health center for
her monthly prenatal check-up.

1. As a nurse, what further assessments are you going to perform for Sittie? What are the diagnostic tests to be
done? (4)

2. Based on your assessments, what possible medical diagnosis are you going to expect? (1)

3. Explain briefly the pathophysiology of gestational trophoblastic disease? (2)

4. What are the risk factors of Sittie that made her vulnerable to develop GTD? Add other risk factors. (5)

5. Compare and contrast partial mole from complete mole. (2)

6. What is the drug of choice for choriocarcinoma? (1)

7. Why is it very important for Sittie not to get pregnant for one year after the mole extraction? (1)

CASE STUDY #8 (16 POINTS)

Rhian, 28 years cannot carry her pregnancy to term because of premature cervical dilatation. She is now pregnant for
the fourth time and she is anxious whether this pregnancy will be successful.

1. What is premature cervical dilatation? What is its old term? (2)

2. What is the primary symptom of premature cervical dilatation? List 3 other signs and symptoms.(4)
3. List the possible causes of PCD and discuss briefly. (2X2=4)
4. The doctor ordered a cervical cerclage for Rhian. Describe this procedure. (2)
5. Differentiate McDonald’s method from Shirodkar technique. (2)
6. What will be your discharge health teachings to Rhian? (2)
CASE #9 (19 POINTS)

Sharon, 45 years old, on her 7th month of pregnancy rushes immediately to Lanao del Norte Provincial Hospital because
of a continuous painless vaginal bleeding. Upon ultrasound, the attending physician confirmed that she has placenta
previa that occludes a portion of her cervical os. This is her 10 th pregnancy.

1. Define placenta previa. (1)

2. Based on the result of the ultrasound, what type of placenta previa Sharon has? List other types of placenta
previa and describe each type briefly.(5)

3. What are the risk factors that would lead to placenta previa? (5)

4. Why is there bleeding in placenta previa? (2)

5. Identify 3 complications that will occur because of placental loosening? (3)

6. As a nurse, what is your initial nursing action as soon as Sharon arrives in the ER?(1)

7. Why is it that an IE should not be done in the ER when the client has placenta previa? If ever an IE will be done
for Sharon, what should be prepared? (2)

CASE#10 (15 POINTS)

Zsazsa, 40 years old, G6P5, is admitted to the Labor Room of MSH. She is now on her first stage

of labor. The implantation of the placenta is normal as seen in her biophysical profile. Her BP is 150/100. Suddenly she
complained of a knife-like stabbing pain.

1. As a LR nurse, where do you think is the location of the pain? (1)

2. What assessment findings of Zsazsa can you find in the admission data that made her at risk for abruptio
placenta? (3)
 3. What are the other manifestations of abruptio placenta? What is a Couvelaire uterus?(5)

4. What are the emergency measures that you have to administer for Zsazsa? Include the rationale. (6)

CASE#11 (24 POINTS)

Kim, 20 years old, G1P0 is on her 36th week of gestation. She is experiencing a persistent, dull, low backache, vaginal
spotting, and menstrual-like cramps. She called the health facility and she is very anxious of her condition.

1. As the nurse who receives the call, what would be your instruction to Kim? (1)

Kim must be admitted in the hospital

2. What is primary interventions once Kim is admitted to the hospital? (1)

Placed on bed rest to relieve the pressure of the fetus on the cervix

3. Why do you need to administer an IV fluid to Kim? Give the rationale. (2)

IV therapy is needed to keep her well hydrated becaude it may help stop contractions. This is thought to be
effective because if a woman is dehydrated, the pituitary gland will be activated to secrete antidiuretic
hormone, which might cause the pituitary gland to release oxytocin as well, strengthening uterine contractions.

4. What is a tocolytic agent? Explain briefly its mechanism of action. (2)

Tocolytic agent is an agent to halt labor. It is a drug approved to prevent and treat bronchospasm (narrowing of
airways)

5. Fortunately the contractions of Kim stop. How could she prevent recurrence of preterm labor? (5)
A. Strict bed rest
B. Limit strenous activities
C. Maintain adequate nutrition
D. Do not smoke cigarettes
E. Record a daily fetal "kick" count or "count to 10" test.
6. Discuss the purpose of giving betamethasone to the fetus when preterm labor cannot be halted. (2)
Betamethasone appears to accelerate, thus reducing the possibility of respiratory distress syndrome or
bronchopulmonary dysplasia.
7. What is the mechanism of action of terbutaline? What are the possible side effects? Give your nursing
responsibilities when you are going to administer this medication.
Terbutaline is a drug approved to prevent and treat bronchospasm. It carries a "black box" warning, however,
that it should not be used for over 48-72 hours of therapy because of a potential for serious maternal heart
 problems and death. It should not be used in an outpatient of home setting because its administration
requires constant professional assessment.

CASE #12 (14 POINTS)

Samantha, 30 years old, G3P2 is being rushed to AMC because of a leaking bag of water. She is now on her 36 th week of
pregnancy.

1. Define preterm rupture of membranes. (1)

2. List at least 3 possible complications that will occur because of preterm rupture of membranes.(3)
3. The leaking fluid is being tested through the use of a Nitrazine paper. Describe the color for an alkaline reaction
as well as the color for an acidic reaction. (2)
4. If the amniotic fluid is leaking, why is there a ferning pattern? (1)
5. What should be done if the fetus can already survive outside the uterus and before infection can set in? (1)
6. If the fetus is not yet viable, discover the 6 interventions that can be administered for Samantha? (6)