MATERNAL AND CHILD FROM BOSS LADY a.

Frequency of Visits
Review Notes (ICONS Oct. 10,2022) ❖ Protocol : A certain number of visits must be met to be
considered covered.
❖ Ideal: Visits on monthly visits from the first month to seventh
month, twice a week on the eighth month, and once a
week on the ninth month.
❖ Because of the limited resources and culture of the
Philippines, the DOH focuses on the underprivileged; it is
difficult to provide monthly care and focuses on a
community setting.
❖ DOH Revision: If a pregnant woman is seen 4 then she is
covered.

1st Visit Week 12

DO NOT TOUCH THE NOTES 2nd Visit Week 26

3 Stages of Obstetrics : Antenatal, L&D, Postpartum
1. Antenatal Care
● If you are an antenatal care nurse you provide care to the client ;
Longest Care
● Pregnancy begins when the egg unites with the sperm
● Prenatal phase = Longest care period
● 280 days - average 270 - 290 days
● 40 weeks - average
● 37-42 weeks range
- Pregnant woman immediately involves the rupture of the BOW,
then she must be tr
- ansferred immediately to hospital after emergency care.
● 4 Refocuses
3rd o Week 32
4th Visit 1 Week Before Delivery
b. Maternal Neonatal Child Health and Nutrition (MNCHN)
❖ Done at a community level.
➢ BEmONC (Basic Emergency Obstetric and Newborn
Care) : Includes lifesaving drugs without prescription;
Midwife or Nurse : Can give emergency drug while
transporting to the client to the hospital.
❖ CEmONC (Comprehensive Emergency Obstetric and
Newborn Care): Done at the hospital (?)
c. Iron and Folic Acid Supplementation
 ❖ Given to the pregnant women to have a PAINLESS delivery; ○ Third stage: The mortality cases were due primarily to the third
not bloodless. stage because the placental cannot deliver themselves. (It
❖ Per culture, Filipino women are anemic; given to becomes a foreign/inanimate object in the body that needs to be
supplement or assist to the lost of blood during delivery expelled à if it remains inside the uterus cannot contract and it will
(Mother: 500mg, Fetus: 300mg) continuously bleed.
d. Birth Plan ● More on THIRD stage of Labor → PLACENTA cannot deliver itself
❖ What the mother desires for herself at the time of birth and ● Nurse must show his/her competence (advance beginners)
helps with delivery planning including financial aspects. ● Essential Intrapartum Newborn Care (EINC) is for two people:
❖ Done during the 1 Check Up - EIC for the mother
❖ 1 Birth Plan on the chart and 1 copy for the pregnant client. - ENC for the baby
❖ Every visit, the birth plan should be reviewed for any ● ENC 4 Core Steps
changes. Modify the birth plan ex. BP changes → you ● Crucial Competencies of the MCN Nurse
cannot give birth in a community setting → change to a. Use of Partograph
hospital. b. Performing NSD
2. Labor and Delivery c. Suturing Lacerations
● Shortest Time d. Vaginal Examinations
● Essential intrapartum Newborn Care (EINC) 3. Postpartum Care
- Done for the mother and the baby ; done during the the first three ● Done for 6 to 8 Weeks.
stages of labor ONLY. ● Immediate Care : Most mothers die within 24 hours during the postpartum
● Not more than 24 hours→ may result to DYSTOCIA of power, passage, care more or less 3rd stage.
passenger ● First 2 Hours : Most Crucial
○ Dystocia – slow, non-progressive labor ● Routine Care
○ Dystocia of the power (assisted drip – to assist the uterus to - Done after 24 hours
contract), passenger (assisted by the nurses/midwives) and - Care for the episiotomy, uterine, assisting mother to provide care
passage (cesarean section) for the baby
● Usually when complications of childbirth occurs: - Complications may happen immediately after delivery.
○ First stage and Second stage : The fetus does the cardinal Ex. G5+ = Get ready IV Fluid D5LR
movement (the role of the fetus to deliver themselves). à All the ● Follow up care is necessary to ensure a healthy transition to a non-
nurse has to do is to catch the baby and prevent laceration on pregnancy state.
the vulva of the mother.
 ● Advocacies of MCN Nurse: c. Bacterial Vaginosis
a. Breastfeeding ❖ Caused by Mobiluncus and Prevotella
b. Vaccinations ❖ Grayish secretions; foul smelling odor.
c. Family Planning ❖ DOC: Metronidazole
Child Care d. Chlamydia
● Neonate = First 28 days ❖ Caused by Chlamydia trachomatis
● If in the delivery there is jeopardy, the NICU Nurse/Specialist must be called to ❖ STD; Asymptomatic but can seen in vaginal secretions
provide emergency care. ❖ DOC: Doxycycline / Azithromycni
● Includes the care of Newborn to Adolescent 2. Menstrual Disorders
● MCN - Vaginal bleeding outside of menstruation (abnormal uterine
- Involves Immediate neonatal care bleeding)
- Includes breastfeeding - Treatments
a. Pharmacologic : Oral Pills
Women’s Health b. Surgical
● Least known function of the maternity nurse ❖ D&C
● Reproductive Health Complications / Diseases ❖ Endometrial Ablation : The removal of the thin
1. Vaginal Infections endometrial layer ; 3 layers: perimetrium,
a. Moniliasis myometrium, endometrium (thins/thickens/shed of
❖ Caused by Candida albicans during menstruation/ increases in size when under
❖ White or cheese-like substance between the labia majora influence of estrogen/ thickest under the influence of
and minora progesterone)
❖ THE MOST COMMON IN PREGNANT WOMEN 3. Infertility
❖ DOC: Clotrimazole (Antifungal) - Unable to become pregnant after 12 months of sexual actions.
b. Trichomoniasis - In vitro (more common), surrogacy (not yet accepted in Philippine
❖ Caused by Trichomonas vaginalis setting), adoption.
❖ Creamy secretions; foul smelling and greenish. - Caused by menstrual disorders.
❖ DOC: Metronidazole (Flagyl) - Endometriosis : painful disorder where endometrial tissues grow
❖ If left untreated, it can ascend to the uterine cavity = outside the uterus; involves ovaries, fallopian tubes and tissues
Increased risk for complications lining the pelvis.
 - Polycystic ovarian syndrome (PCOS) d. Certified Nurse Specialist (Pedia, onco, headache) - expert in their
❖ Develop follicles fluid that fail to release eggs own chosen fields
❖ Unknown cause - APN in MCN
❖ Management: treat symptomatically, more androgens ❖ Primarily can prepare her to be an independent practitioner with
(more hair in legs, mustache, fat); give hormones; change a birthing clinic.
lifestyle (healthier, diet and exercise) 2. RA 7600 - Rooming in Act
4. Cancer in Women - Mother-Baby dyad should never be broken
a. Breast - Primary reason is for woman to be motivated to breastfeed and for the
- Most common, get SBE monthly baby to be latched properly

b. Cervix 3. RA 10028 - Expanded Breastfeeding Act

- Establishment of breastfeeding stations among companies with more
- Screened through Pap Smear
than 100+ employees
c. Uterine
- Curriculum for allied professions are mandated to take up breastfeeding
d. Ovarian
in their curriculum subjects.
4. RA 10354 - Responsible Parenthood Reproductive Health (PRH) Law- BEMONC,
Legal Bases of MCN Practice
Family Planning
1. RA 9173 - Philippine Nursing Law
5. RA 11223 Universal Health Law Philhealth is the financial component
- Care of the pregnant woman = Nursing bill approved by congress
- All healthcare facilities turn into primary health care facilities and give
recently
basic essential health care services at the community level without any
- Labor and delivery
out of pocket measures from the client.
- IE and Suturing Conditions
a. IE : Certified, no antenatal bleeding, NSVD ONLY. Hospital delivery 6 500 php

b. Suturing ; Same as IE + Only for 1st and 2nd Degree Lacerations Community (Community What ni?) 8 000 php
- Care of Newborn
- Nurse may be self employed (Advanced Practice Nursing APN) Caesarean Section 19 000 php

- 4 Classifications adapted from Abroad Newborn Package : Screening 1 750 php

a. Certified Nurse Midwives and Hearing Test
b. Nurse Anesthetist
c. Nurse practitioner- not included the spinal and epidural 6. RA 11210 - Expanded Maternity Leave
- Paternity leave for fathers 1 week
 - 105 days for mother 8. RA 10192 Continuing Professional Development (CPD) Across Profession
7. RA 9288 Newborn Screening Act - Ensures lifelong learning 45 CPD every 3 yrs.
- The process of collecting a few drops of blood from the heel into filter - Now: 5 units/year or 15 units every 3 years
paper done by trained Nurses and Midwives. - PRC ID Renewed every 3 years, not the license ; Need valid proof that at least
- Ideally 24 - 48 hours after birth acquired skills and knowledge by attending training courses, webinars,
- Philhealth covered 550 php for original diseases graduate/doctoral degrees, etc.
Not covered 950 php additional 28 disease 9. RA 10968 Philippine Qualification Framework Law
Total: 1,506 - National Policy
- Enables early detection and management of several congenital diseases - Levels of Education Assigned
- May lead to mental retardation and or death if untreated ● Level 6 - Post Basic
- Early diagnosis initiation of treatment and appropriate long term care ● Level 7 - Certification of Competence (Trainings, Master’s, etc.)
help ensure normal growth and development of the affected child Examples:
- BASIC (6 disorders) ❖ IVT → certification allows the RN to perform blood transfusion.
a. Congenital hypothyroidism ❖ DOH - MCN Certification - dispense pills, IE
b. Congenital adrenal hyperplasia ❖ FP Certification BEMONC
c. Galactosemia ● Level 8 - Expertise , Doctorate degree
d. G6pd deficiency-
e. Phenylketonuria Other Legal Bases (DOH -A. Orders)
f. Maple syrup disease 1. AO 0025 Series 2009 ENC (first Embrace Unang Yakap)
- EXPANDED (28 disorders) 2. AO 0029 Series 2008 MNCHN (Maternal mo be in a healthcare facility :
a. Current panel of 6 disorders - MNCHN has disenfranchised birthing attendants ; most mortalities
b. Cystic fibrosis were handled by hilots (if there are birthing attendant, let them
c. Biotinidase disease assist)
d. Organic acid disorders - Must be done in a healthcare facility - not home setting
e. Fatty acid oxidation disorder a. All post partum mothers and babies must have postpartum visits (follow-
f. Amino acid disorders up visits)
g. Urea cycle disorders 3. AO 0012 Series 2012 Birthing Center Requirements for Skilled Birth Attendants
h. Hemoglobin disorders - Must have RM license to supervise Midwife
- Key Points:
 a. NB Screening Facility
● Hearing test - referred
b. Clinical Services
● Prenatal postpartum care
● NSVD For low risk
● Detection of High Risk - Referral
● Family Planning - Natural and Artificial method except
vasectomy, tubal ligation, and D and C -
● Life-saving medications
c. Personnel
● SBA: RN, RM, MD
● Trained in Bemonc and Newborn Resuscitation
● MOA with OB-Gyn and Pedia (purpose: they are your
partner and can be answer referrals immediately)
d. Human Waste Management
● DENR: Local government determines where you put the
placenta and supplies with blood products.
● Dictates contract on proper human waste management.
4. EO 141 - Teenage Pregnancy as an Urgent National Priority
- From President Duterte
- Addresses the rising number of teenage pregnancies and mobilizing
government agencies to implement strategies
- What is being mobilized?
a. Reproductive Health Education - Barangays should have health
education to adolescent in their community
b. Look for teenage pregnant women - Pregnancy tracking involving
women falling out from regular visits ; pregnant teens in every
household
c. Functionality of Violence Against Women and Children at the
Barangay Level - You report violence to the barangay
office/center/officials
- Teenage pregnancies
❖ Defined as Children giving birth to children
❖ Teenage Mothers are Classified
● 10 - 14 Years old : Early; more complications
● 15 - 19 years old : Late teenage pregnancy.
- Risk for Teenage Moms
❖ Childbirth related other problems - anemia, pregnancy related
hypertension, childbirth related complications because the body
has not developed enough to handle pregnancy.
● CEPHALOPELVIC DISPROPORTION → dystocia → possible CS
● MENTAL HEALTH - Poorer prone to postpartum depression
- Risk for Babies
❖ Preterm
❖ Low birth weight
❖ Severe Neonatal Complications- particularly RESPIRATORY
complications
- Main goal of PNC is a healthy pregnancy for mother and child
❖ Can easily identify deviations and abnormalities in pregnancy;
early referrals
❖ Minimizes morbidity and mortality.
- OB Keypoints
❖ Childbirth
❖ Unique from other medical sciences
❖ 3 Characteristics of OB that separate it from other Medical
Sciences Philippine Picture of Maternal and Health
a. Physiologic (Normal Development; UTERUS MADE FOR TWO
IMPORTANT POINTS: FOR GESTATION/BIRTH AND FOR ● 2000= 209
MENSES), ● 2006= 162
b. Time Frame, ● 2012= 221
● Postpartum is 6 weeks, Pregnancy is 9 months ● 2015= 127
● Makes OB easy because time frame is predictable ● 2017= 121
c. 2 Clients - Mother and Child (The fetus is the unseen client in ● MDGs (2000-2015)
pregnancy) 1. Poverty and Hunger
- First 1000 days of the child (nutrition is focused)
- Exclusive breastfeeding
2. Primary Education
3. Gender Sensitivity and Empowering Women
4. Decrease child Mortality
5. Improve Maternal Health - MMR by 52
6. Minimizing HIV, malaria etc.
7. Environmental Care
8. Global Competitiveness
● Objectives of MDG: 1, 4, 5, 6
● SDGs (2015-2030)
SDG # 3 compresses all (Good health and Well-being)
● Health, Well-being, Illness
● MMR to 70 by 2030
17 SDGs
1. No Poverty
2. Zero Hunger
3. Good Health and Well-Being
4. Quality Education
5. Gender Equality
6. Clean Water and Sanitation
7. Affordable and Clean Energy
8. Decent Work and Economic Growth
9. Industry, Innovation, and infrastructure
10. Reduced Inequalities
11. Sustainable Cities and Communities
12. Responsible Consumption and Production
13. Climate Action
14. Life Below Water
15. Life on Land
16. Peace , Justice, & Strong Institution
17. Partnership for The Goals
Additional Notes with no place to go:
● Menorrhagia - bleeding excessively, more than 4 pads increasing per day
● Metrorrhagia - bleeding in between periods
● Normal Menstrual Cycle - 2-9 days
● Placenta
- Not safe to eat or drink
- It served as barrier and filters
- High in collagen
● Ideal Room Temp. for Birthing : 25 - 28 C
● Perinatal Period : When fetus is viable down to time when the baby is 28 days
● All women are at risk at childbirth, no matter how complete the PNC (prenatal)
visits.
● The main goal of prenatal care is a healthy pregnancy for the mother and the
child
- Can easily identify deviations and abnormalities in pregnancy
- Early referrals
- Minimizes morbidity and mortality
MATERNAL AND CHILD FROM BOSS LADY - Meconium Stained (“M”) - fetal distress ONLY in cephalic presentation, if
Review Notes (ICONS Oct. 11,2022) breech “nasusundot sa pwet ng baby”
- If the membranes are not ruptured (“I”) for intact
● Cervical dilatation most important
Partograph
- This is the most important observation to monitor progress of labour
● A record of all the observations made on a woman in labor, the central feature
- Plotting begins at 4 cm and marked with an x
of which is the graphic recording of the cervix as assessed by vaginal
- Is assessed at every vaginal examination and marked with a (x)
examination.
. plotting begins on the partograph at 4cm
● Green - go, Yellow - stop and Red - danger sign
● Contractions
● Information : Cervical dilatation most important
- Are recorded every hour palpate the number of contraction in 10
● Active Labor 4 cm to 10 cm; labor is normal if cervical dilation is 1 cm per hour.
minutes and their duration in seconds
- Partograph one hour per box
-
● Green - Alert; Yellow - Normal; Red - Action
● Oxytocin drugs and intravenous fluids
● Only done in NORMAL LABOR
○ These are recorded in the space provided.
● TOTAL RECORD OF OBSERVATIONS
○ Vital Signs
● Conditions that do not need the use of the partograph
● Blood pressure, pulse, and temperature
○ Antepartum hemorrhage
- Monitor every 4 hours and record the findings (More frequently, if
○ Severe pre-eclampsia and eclampsia
indicated)
○ Fetal distress
● Urine
○ Previous CS
- The amount is recorded every time urine is passed. The woman is
○ Multiple pregnancy
encouraged to pass urine every 2 hours in labor and each specimen is
○ Very premature baby
tested for protein and ketones.
○ Obvious obstructed labor
- Full bladder can slow down the descent of fetus into the cavity
● Fetal Heart Rate
○ This is recorded hourly to monitor the condition of the fetus.
Appropriate use of the partograph is expected to…
● Liquor amniotic fluid is observed and recorded at each vaginal exams as
● Reduce the incidence of prolonged labour
follows:
● Reduce the proportion of labours requiring augmentation.
- Absent (“A”)
● Reduce the rate of emergency cesarean section
- Blood stained (“B”)
● Reduce the intrapartum stillbirth rate
- Clear (“C”) - normal findings with specs of vernix caseosa and lanugo
 -
If partograph passess the ALERT LINE:
- Reassess the woman and consider criteria to for referral plotting the
- Alert transfer service
https://slideplayer.com/slide/12865316/ - The Partograph PPT; similar to Doc’s
- Ensure adequate hydration, omit solid foods
slide
- Encourage upright position and walking if woman wishes
- Monitor intensively, If referral long, assess q2 and REFER IF NO PROGRESS

If partograph assess ACTION line, refer urgently to an emoc facility unless imminent
delivery
● Assist the delivery
- Ensure bladder is empty
- Position the woman comfortably where she will deliver
- When delivery is imminent, wash hands, open delivery kit, ready oxytocin
10 IU and put on gloves just before delivery
- Deliver the baby
- Give oxytocin 10 IU IM
- Watch or vaginal bleeding
- If the woman is admitted in the latent phase of labor (less than 4 cm
dilated)- record only other findings (BP, FHT, etc)
- If she remains in latent phase for next 8 hours (labor os prolonged),
transfer her to hospital.
● Recording the findings in the Partograph
- Start by labeling the record with pertinent patient identifying information
Plotting the Progress of labor
- Begin by plotting the cervical dilatation on the alert line.
- Plot only the CERVICAL DILATATION using the symbol :X”
- Start when women is in ACTIVE LABOR (4 cm or more) and a contracting
adequately (3-4 contractions in 10 mins)

MATERNAL AND CHILD FROM BOSS LADY
Test Ratio (ICONS Oct. 11,2022)
1. Paula attends a seminar on OB emergencies. The following are identified as
alert/danger signs in pregnancy and needs to be referred immediately:
A. pregnant woman fainting on her 16th weeks AOG → physiologic; fainting
→ common/expected in 2nd trimester
B. Maternal BP= 130/100 mhg with history of PES → pre eclampsia
C. Tender uterus with cramping and lower abdominal pain
D. Tender mass, uterus equivalent to age of gestation
Ratio : The cramping and pain - dangerous
Any bleeding or spotting in pregnancy - dangerous (CBR/as instructed by nurse)
NC:
● If spotting – lie down; rest; bathroom privileges
● If Bleeding/use of pampers – refer/seek consultation
Pre Eclampsia:
● Severe headache/ severe epigastric pain (ruptured liver capsule High
fever/ seizure = infection
● Leaking bag = need to check by nurse if it is Urine/ A.Fluid (nitrazine test)
● Absence of fetal movement = need daily movt. Count shows fetal is
healthy and + fetal heart rate
2. The nurse at the PNC is assessing a pregnant client. She notes that the fundus of
the uterus is below the navel. This implies that:
A. The pregnancy is on its early stages and non-viable
B. The pregnancy is on the second trimester
C. The pregnancy is early and viable → @ 20 Weeks
D. The woman needs further monitoring
Ratio:
● Below the Navel = Early
● Over the navel/ pusod = 20 weeks
● Xiphoid = 36 weeks
● 2 fingerbreadths from the xiphoid = Term (37 Weeks)
3. The woman bleeds at around 14-16 weeks AOG. The nurse would consider this
possible condition except:
A. Abortion - Sudden fetus deletus commonly found in early stages
(management: bedrest and monitor vital signs)
B. Placenta Previa → implanted in the lower segment of uterus (cause:
multiparity) [Never I.E unless double set-up operation (operating room
and blood transfusion) Doctor does the I.E]
C. Molar Pregnancy → (H.mole) Degeneration of trophoblastic cells (cause:
abn cycle)
D. Ectopic Pregnancy → implanted outside uterus (cause: PID)
Ratio: Abortion, Molar, and Extopic Pregnancy are the main causes of bleeding
in EARLY pregnancy. Placenta Previa and Abruptio Placenta happen in the LATE
stages.
● Poor Prognosis: Below 12 weeks, before the age of viability, number 1
cause of bleeding = Abortion
● Good Prognosis : Above 12 Weeks
● Abruptio Placenta = Premature separation of the placenta
4. A woman consults the nearest clinic in her neighborhood. She complains of
bleeding and states, she is 6 months pregnant. A certified nurse can do all of the
following except:
A. Take VS and FHB
B. Ask her to lie down in the examining table for further assessment
 C. Fill up a referral form to the nearest BEMONC facility or hospital → You
cannot attend to a 6 month bleeding pregnant: REFER!
D. Performs a vaginal exam to determine is the woman is in labor
Ratio: Many violations, the certified nurse is only allowed to do this when the
woman is low risk and not in pregnancy. Needs to be in the OR (?) w/ Blood
transfusion by the doctor.
5. When upon assessment the nurse observes that the uterus is soft, fetus is
palpable but the woman bleeds on and off at 34 weeks AOG, she suspects:
A. Abnormal proliferation and trophoblast → H. mole
B. Abnormal presentation of the fetus
C. A premature separation of the placenta → abruptio placenta
D. An abnormally implanted placenta → impalpable fetus (should be
planted in the upper/anterior portion of the uterus)
Ratio: Placenta normally separates at the 3rd stage of labor, any placental
separation prior the 3rd stage of labor is premature.
6. All of the factors are causes of postpartum hemorrhage. Which of those is not
labor related?
A. Operative delivery of the baby → 3 Blood Donors Needed
B. Multiparity and anemia of the woman
→ IDA most common anemia in pregnant women
C. Prolonged, dystocia labor → power, passage, passenger,
D. Repeated vaginal examinations
Ratio: Only 5 Vaginal Examinations are allowed d/t RO Infection
● Amount of blood loss in CS= 800 - 1000 mL, incase prepare 1500mL for BT
● Blood donor on standby when CS in hospital setting
● NSD = less than 300mL, incase prepare (1 pack) 500mL for BT
● DOH policy: primi or gravida 5 above → not supposed to be delivered in
a community setting; pregnant mother must be urged to deliver in a
hospital.
7. Seizures during pregnancy are very dangerous. These are the characteristic of
eclampsia that a nurse must know except:
A. Can be cause of high maternal and prenatal mortality
B. May occur before the fetus is viable
C. Can be observed anytime in labor
D. Can occur immediately after birth and on to the first 24 hours postpartum.
Ratio: Eclampsia only found in late stages of pregnancy.
● Tx of eclampsia: delivery of baby. If still present after delivery: MgSo4
8. Which among these type of abortion gives a clinical sign and brownish
bleeding, if negative pregnancy test and uterine size smaller than the age of
gestation?
A. Inevitable Abortion: Abortion where the placenta and fetus are intact
but bow is ruptured and cervix is open.
B. Missed Abortion
C. Threatened Abortion: Everything intact, cervix closed, good prognosis
D. Spontaneous Abortion: Terminating itself
Ratio: Missed abortion where the baby is already dead for 2 weeks. No bag,
closed cervix, but the product of conception is still there.
● Cause of Abortion (Maternal): (1) Infection, (2) Bleeding, (3) Stress,
Trauma, Underlying medical conditions
● 2 Types: Induced (voluntary) and spontaneous (Involuntary)
● 2 Types of Induced Abortion:
 ○ Therapeutic abortion: Common in abroad. E.g. Mother’s life is in
danger (cardiac problem, cancer); the fetus has an anomalies that
can lead to death
○ Criminal/Illegal Abortion: Common in the Philippines
9. Severe preeclampsia has devastating effects on the mother and the fetus.
Which is not a maternal side effect of PES?
A. Acute Renal Failure
B. Pulmonary Edema
C. Intrauterine Fetal Death
D. HELLP Syndrome - Hemolysis, elevated liver enzymes and signs low
platelet count
Ratio: Fetal side effect, not maternal.
● Severe: brain: cause stroke; eye: blindness (temporary - 1 to 2 mos
postpartum); heart: congestive hf; lungs: pulmonary edema; liver: rupture
of liver capsule; blood: DIC(common in abruptio placenta), HELLP
(common in severe preeclampsia); kidneys: renal failure
10. STD’s may cause infertility among women, if not treated. Which among these
can cause it?
A. Syphilis and Chlamydia
B. HIV and Gonorrhea
C. Gonorrhea and Chlamydia
D. All of the above
Ratio: They ascend, causing inflammation in the pelvis in the fallopian tubes
where constriction happens then leading to scarring.
11. Do bearing down efforts when contractions set in to hasten labor - Naur ❌
A. Relax in between contractions - Also tama behavior
Ratio: Bearing down during contractions might lead to cord prolapse.
● Mobility will shorten the labor (BOW should be intact)
● Give food and fluids to women in labor.
○ (Light Carbohydrate (best diet): to provide energy to push during
the 2nd stage
● Have a companion in labor for emotional support.
● Pain reliefs
○ Non pharmacologic - DBE, effleurage, hot(sacrum)/cold(head)
compress
○ Pharmacologic: Nubain, Demerol, Meperidine
↳ GIVEN ONLY ON ACTIVE PHASE (7- 8CM)
● Partograph (Record of all of the observations made on a woman in
labor, the central feature of which is the graphic recording of the dilation
of the cervix as assessed by V.E)
○ Records of all the things you did to the patient (Meds given)
○ If the partograph passess the action line, refer urgently to an
EMOC facility, unless imminent delivery
12. A mother is on her 4th day postpartum. She begins to exhibit discomfort and
verbalize this. The nurse suspects a possible postpartum infection. Which is a
reliable index of puerperal sepsis?
A. Uterine tenderness – not reliable; subjective
B. Rapid pulse rate over 90bpm - tachycardia
C. Fever of 2 days (38C)
D. Increased WBC to 12,000/dl - Normal finding postpartum upto 20,000/dl
Ratio: Fever is always a sign of infection. Fever on the 3rd or 4th day is most likely
from breast engorgement.
13. Oxytocics are beneficial drugs used in labor. The nurse must be aware of the ● 3 TT = 5yrs protection
danger oxytocics use which is: ● 4 TT = 10yrs protection
A. Hypotonic contraction of the uterus ● 5 dose of TT = Lifetime Protection
B. Hypertonic contraction of the uterus
C. Uterine rupture 16. The MD have ended in 2015, SDG are now the basis of targets and
D. Hypotension and shock objectives of the country to address global concerns. By 2030, what is the target
Ratio: Overuse of Oxytocics may overstimulate and strain the uterus. rate of MMR?
A. 52
● First line of defense for controlling bleeding: OXYTOCIN
B. 62
● 2ND line: Methergine can inc. BP SO DO NOT GIVE WITH THE PRE
C. 70
ECLAMPSIA PT
● 3rd line: Carbopristol/misoprostol D. 75 per 100,00
Ratio: ___
14. In the menstrual cycle involving the hypothalamic- pituitary- ovarian-
endometrial relationship, often called the “master gland” is the: 17. Mastitis is a common problem among BF mothers, especially the primiparas.
A. Hypothalamus Considered to be the most common cause of sore the nipple is :
B. Pituitary Gland A. Prolonged BF (instances of newborn fell asleep)
C. Ovary B. Too frequent BF
D. Endometrium C. Sucking in bad position
Ratio: The pituitary also secretes hormones that signal the reproductive organs to D. Failure to wash the nipple prior to every feeding (Cleaning the breast
make sex hormones. The pituitary gland also controls ovulation and the while taking a bath daily is okay)
menstrual cycle in women. Ratio: MOST common. Poor latching, poor attachment. Mastitis is seen once
breastfeeding is already established.
15. Part of the refocused antenatal care by WHO is the injection of tetanus 18. The earliest positive sign of pregnancy in:
toxoid vaccines. The nurses knows that: A. A positive pregnancy test at 8 weeks - probable sign
A. 2 Doses of TT protects the mother for 5 years B. An UTZ done at 6-7 weeks - confirmatory
B. 4 Doses of TT protect the mother for 2 years C. FHB determination by Doppler - (10–12 weeks)
C. One dose of TTT protect the mother for 2 years D. Fetal movement felt by the mother → Latter part of pregnancy
D. 2 Dose of TT protect the mother for at most 3 years Ratio: Ultrasound is the earliest. Pregnancy uterine: 6-7wks -> fetal sac: N; fetal
Ratio: TT is primarily for the baby, secondary for the mother. HR: N
● 2 TT = 3yrs protection
 ● EARLIEST SIGNIFICANT PRESUMPTIVE SIGN: Amenorrhea ● Weight Gain - should increase during pregnancy (25-35lbs through out),
○ As early as 2nd week, take the PT na, even a faint line in the PT is 1st trimester 1pound per month max 1-3months, 2nd and 3rd trimester -
considered positive (97% accurate) 1lb per week
● 3 classic signs of pre-eclampsia
19. A recommended standard method to monitor labor comprehensively is: - Edema
A. Monitoring the regularity of the contractions - Hpn
B. Performing vaginal exams as soon as labor commences - proteinuria
C. Use of partograph
D. Taking the vital signs of the mother and the FHB of the fetus 21. A nurse intends to put up her own birthing center after being certified. Which
Ratio: Highest duration 90 secs, every minute of contraction = Rupture would guide her in the requirement needed to be licensed?
A. RA 10345 -
20. A nurse upon interview of the pregnant woman calculates that her regular B. AO 0029-2008
caloric intake prior to pregnancy is 2,300kcal. She estimates that the mother’s C. AO 0012-2012 - “Rules and Regulations Governing the New Classification
total caloric intake now must be: of Hospitals and Other Health Facilities in the Philippines”
A. 2,500 D. RA 9173
B. 2,600 Ratio: AO 0012 Series 2012 Birthing Center Requirements for Skilled Birth
C. 2,700 Attendants
D. 3,000
Ratio: If pregnant then +300 kcal(2300 add 300kcal = 2,600kcal intake ), if
breastfeeding then + 500 kcal = Highest Calorie per day during lactation period 22. When upon vaginal examination in labor, the nurse assesses the ischial spines
● Vitamins and supplements are nee ded during pregnancy: to be
● Calcium - for bones and teeth of baby, best source of calcium for prominent and less than 9 cm, there is likely a contraction of which part of the
pregnant woman is MILK! (1 quart) (secondary sources: dilis, legumes) pelvis?
Prevents Leg cramps occurs occasionally during pregnancy. A. Midplane
● Iron supplementation B. Outlet
● Folic Acid - the more you take, the more congenital anomalies will be C. Inlet
prevented. D. Ileum
● Protein - building up of tissues for fetus (meat sources, vegetable sources Ratio: If <10cm = contracted midpelvis → prepare for CS Delivery
● Inlet - Anterior Posterior diameters
 - diagonal conjugate MEASURABLE - guide you in estimating the size D. 1 and 4
of the pelvis = 11.5cm, Ratio: EINC On the third stage of labor, Active management means injecting oxy
- MOST accurate but not measurable: OB = 10cm, anatomical/true which is 1 and 2. 3 and 4 are the EXPECTING Management.
conjugates (symphysis pubis to sacrum) ● 2nd stage:Semi Upright/Upright position during delivery not anymore
● Below the Ischial = Floating, Above Ischial spines = Engaged lithotomy position, indicative episiotomy to Primigravida, Woman takes
● 4 Types of Pelvis: Gynecoid = NSD, Android = never NSD, Anthropoid charge in pushing during contractions. Mortal Sin: fundal pressure?
(Oval) = NSD, Platypelloid = never NSD ● Active management - to shorten 3rd stage of labor to lessen blood loss,
within 10mins delivered placenta and feeding is also done.
23. The nurse performs Leopold's maneuver on a pregnant mother. These are her
findings: small parts on the left side of the abdomen, plain mass on the right side. 25. A nurse does a health class for adolescents in a school. She talks about
What is the presumed position of menstruation. These are true except:
the fetus? A. The luteal phase of the menstrual cycle is influenced by estrogen and LH.
A. ROA B. Menstruation comes in predictable, regular cycle in women
B. LOA C. It is assumed that every menstruation comes with ovulation, unless using a
C. LOP method.
D. ROT D. Menstruation is directly influenced by ovarian hormones and indirectly by
Ratio: Point of reference is from the mother’s POV. Presenting part is always gonadotrophic hormones
aligned with the BACK. Ratio: Should be Progesterone and LH
24. What are the factors considered by the nurse to perform AMTSL (Active ● Follicular Phase - Estrogen and FSH
Management of the Third Stage of Labor)? ● Luteal Phase - Progesterone and LH
1. The baby is delivered
2. There is no second baby 26. Abortion is the expulsion of the product of conception before the age of
3. The placental signs of separation are observed: Expectant/ traditional viability. Which best describes an abortus?
rd
management of 3 stage of labor A. Fetus expelled at 20 weeks and weighs 500 grams or more
rd
4. The placenta is expelled: Expectant/ traditional management of 3 B. Fetus expelled in early pregnancy and weighs 500 grams - weight is
stage of labor questionable
A. 1 and 2 C. Fetus expelled before 20 weeks and weighs less than 500 grams
B. 2 and 3 D. Fetus expelled before 28 weeks and weighs less than 1000 grams
C. 3 and 4 Ratio:
 20wk - <500g 28wks - 1000g 32wks - 2500g
40wks - 3000g Term 2.5 g 3k g
● Abortus – expulsion of POC before 20 weeks
● Stillborn – expulsion of POC after 20 weeks
27. The mother develops laceration during the birth of the baby. The nurse assess
the wound and would suture if:
A. If is 3rd-4th degree laceration - first and second degree only
B. Third degree laceration and the nurse is certified
C. The wound involves the cavernous and perineal muscles and she is
certified to do so
D. The wound involves the fourchette and the coccygeus muscle
Ratio: The certified nurse is allowed to suture: skin, mucous membrane, fourchette,
vaginal muscles (cavernous muscles), perineum
● R.A 9173: RNs are allowed to suture, if (1) certified (2) only 1st and 2nd
degree laceration
● 3rd - 4th degree laceration - must be referred due to (heavy) bleeding
● Coccygeus muscle is under 4th degree
● 3 Delays: (1) Delay in seeking care (2) Delay in receiving care (3) Delay
in reaching facility
● Polyglycolic Acid Suture: easily absorbed; lesser risk for infection
● Other Sutures: Double Arm, Vicryl
● Only suture if there are bleeding of blood vessels
● Local anesthetic is being used like lidocaine etc.
28. H-mole is an abnormality that may lead to trophoblastic cancer. In
pregnancy, the nurse begins to suspect H-mole when:
A. The mother suddenly gains weight
B. There is more nausea and vomiting reported by the mother*- also true
due to HCG; not accurate – may be hyperemesis
C. The uterus is rapidly increasing size, more than the expected AOG
D. The uterus is midway between the symphysis pubis and the navel at 16
weeks AOG.
RATIO:
● H. Mole = In Situ
● Best contraceptive method [for 1 year]: Barrier Method (condoms,
diaphragms, etc.)
29. A trained nurse performs a vaginal exam on a woman in labor at the ER. Her
findings show the cx=3cm, Diagonal conjugate is 11 cm. What would she
conclude and inform the doctor?
A. The OB conjugate is 10 cm and the pelvis is adequate for NSD
B. The OB conjugate is more than adequate is adequate for NSD
C. The pelvis is contracted and NSD is not possible
D. The pelvis is borderline and assisted vaginal birth can be tried
RATIO:
● Diagonal Conjugate = can only be measured clinically in the inlet; min.
Measurement is 11.5 cm and 1.5 cm bigger than OB conjugate
● 11.5 - 1.5 = 9.5 cm (X)
● Ischial Spine can also be measured
● Normal DIAGONAL Conjugate= 11.5-13 cm
● Normal OBSTETRIC Conjugate= 10 cm
30. Implantation is a significant event that is necessary for pregnancy to push
through. Choose the right statement on implantation:
A. It occurs from 5-7 days after fertilization -
B. The blastocyst implants in the decidua basalis
 C. The implantation stage of the zygote is the morula.
D. The chorionic villi of the blastocyst implants in the decidua vera-
chorionic villi is for placenta
Rationale:
● “Some say life begins during fertilization, life actually begins when the
fetus is implanted in the decidua.”
● Implantation → Occurs at 7 to 10 days (completed on the 10th Day!)
● If implantation is not completed usually aborted.
● From Zygote - sperm and egg meet at the fallopian tube in the ampulla 3
to 5 days.
● Morula - zygote of fallopian tube (2 types?? in the inner cell mass: fetal
originates and where the placenta originates)
● Blastocysts - zygote implantation stage not morula, its chorionic villi is for
the placenta.
● Endoderm (gives rise to the digestive system and the internal organs),
Ectoderm (gives rise to the nervous system and the epidermal cells),
Mesoderm (gives rise to the muscle cells and the connective tissues)
● Decidua Vera - for nutrition and maintenance of pregnancy
31. The nurse constantly monitors the FHR in labor. She knows fully well if the fetus
is in distress because: (look for signs of distress)
A. The FHR decelerate as soon as uterine contraction begins
B. The FHR decelerated as soon as the fetus begins to move
C. The result of the NST is reactive
D. There are no late deceleration during uterine activity
● Ratio: A, C, D are normal
decelerate= decrease FHR; bumababa as soon as fetal heart rate down
● If the fetus moves the FHR will increases (Non-Stress Test – Reactive:
Normal) 145 bpm
● When the uterus contract the FHR decelerate coz the blood vessel is
constricted resulting to lower O2 (Contraction Stress Test – Normal: No late
deceleration)
● 3 types of deceleration - (1) Early Deceleration - expected as head is
pushed; (2) Late Deceleration - the FHR decreases if it is already in the
acme NOT EXPECTED d/t uteroplacental insufficiency ; (3) Variable
Deceleration - due to compression of umbilical cord
32. If the nurse upon assessing the fundic height of the uterus finds it to have
“dropped” 2FB below the xiphoid, she assumes all of the following except:
A. Labor can ensue with 2 weeks → yes
B. The uterus is smaller than the normal sized uterus
C. Engagement will follow soon after
D. A possible NSD is expected as the pelvis is presumably adequate
Ratio: 3 landmarks - symphysis pubis, navel (pusod), xiphoid process
- Remember if it drops 2 fingers below it is the precursor of
engagement.
- Primigravida - does not usually engage before labor. Possibility of
inlet contraction.
- Multigravida - engagement usually occurs in the latent phase.
33. The BOW ruptures in the course of labor. Upon inspection the nurse observes
a brownish color of the AF and wrote “M” on the partograph. This means:
A. The mother must be transferred to the DR immediately for signs of uterine
rupture.
B. The FHR must be taken ASAP because of impending delivery
C. The fetus is in distressed and must be delivered as soonest
D. The fetus must be further monitored and observed for fetal distress,
asphyxia on stillbirth.
 Ratio: If the bag of water ruptures prior to the onset of labor → premature
rupture of BOW
- Chorioamnionitis - infection (give IV/antibiotics as prescribed.)
- Prolapses of Cord - critical, no BOW.
- Amniotic Fluid = Urine #1 source, Fetus modifies its own amniotic
fluid.
- Do not wait for monitoring, it may cause asphyxia and could be
still born
34. Pregnancy is diabetogenic. Upon first visit at 3 months, these are the routine
procedures done except which one?
A. Palpation of abdomen – to check fundic height, status of fetus
(presentation)
B. Blood sugar screening test with 75 grams glucose- instead we can do
urinalysis, diabetogenic tendency can be seen during 2nd trimester
C. Vaginal exam to assess pelvic adequacy – for checking of diagonal
conjugate
D. Physical assessment- cephalocaudal inspection
Ratio: When a client gets pregnant, her sugar increases (due to hormones;
suppression of insulin production)
● 24-28 Weeks (2nd Trimester)
- High Risk: if she has Diabetes, Prenatal Problem, difficulty in delivering big
baby
- OGTT is done between 24-28 weeks to get the best result
Specimens:
- Check urine for bacterial infection esp UTI.
- Cbc for hgb level and hct - very important
- Hemoglobin Level: 10-11g - needs supplement of iron; <10g - double
supplement of iron; <9g - injectable; <7g - blood transfusion
- Blood type - if blood transfusion is needed, detect blood incompatibility
35. Physiologic anemia in pregnancy occurs . These are true statement except:
A. This is due to increasing blood volume- inc blood volume around 40-50 %
to sustain pregnancy
B. The usual hemoglobin level of Filipino mothers fall at 10-11 gms/dl
C. Increasing clotting factors in pregnancy aggravates anemia
D. Iron is a “must” drug supplementation
36. When will the nurse suspect preeclampsia pregnancy?
1. The blood pressure is 140/90 mmhg at 22 weeks AOG
2. There is protein in the urine
3. The mother complains of not feeling well, fever and headache
4. Before 20 weeks, fainting and dizzy spells are noted → Seldom occurs or
never at 20 weeks gestation
A. 1 and 2
B. 2 and 3
C. 3 and 4
D. All
37. The nurse talks a lot about nutrition to pregnant mothers whenever they do
PNC. Those are nutrients that are much needed especially for fetal
development in the first trimester:
A. Folic acid, mebendazole- mebendazole is for the woman in 2nd trimester
in order to remove worms
B. Iron and anti-malarial drugs → for 2nd trimester in endemic areas
C. Iodine and folic acid – for thyroid development
D. Iron and Iodine - iron is primarily for the mother
 38. An oral glucose tolerance test is ordered on the second trimester to a
pregnant client. Which is the correct dosage?
A. 50 grams glucose in 2 hours - should be in 1 hour (glucose challenge test)
B. 100 grams glucose in 2 hours - should be in 3 hours
C. 75 grams glucose in 2 hours- for women who are in high risk of diabetes
D. 75 grams glucose in 1 hour
RATIO
● Must be conducted during 24-28 wks
39. The first step towards preventing maternal and neonatal complication is:
A. Following the MNCHN referral system - begins at the community level
(preg tracking, immunization, etc)
B. Implementing the BEMONC program during emergencies – there is
already a basic emergency
C. Performing the 4 steps of refocused antenatal care– first step
D. Spacing pregnancy for 3-5 years
A. Descent and Flexion
B. Internal Rotation
C. External rotation
D. Extension of the head
Ratio:
● Dystocia - difficult labor; non-progressive/slow labor
● A fetus delivers itself
● 90% of pregnancies are in anterior position
● Engagement - 1st cardinal movement
● Descent - cardinal movement that occurs throughout
● Complete Flexion of Fetus - compresses to 9.5 cm to fit into 10 cm
● When it reaches the vulva, nurse will do Ritgen’s Maneuver, the nurse will
be the one to deliver the head of baby [in a slow and gentle manner]
while fetus is extending the head
● External Rotation - where the baby faces

5 products of conception that may cause dystocia:

40. A mother in labor goes to a nurse led clinic for possible admission. Upon
1. Fetus (macrosomia, gross congenital anomalies, malpresentation,
inspection she sees the cords protruding through the vulva. Her first immediate
multiple gestation)
action is:
2. Placenta (placenta previa, abruptio placenta, placenta accreta)
A. Take the FHR and prepare for transport
3. Amniotic Fluid (polyhydramnios, oligohydramnios)
B. Push the cord up to reposition - may cause more complications; may
4. Membranes (PROM, Adherent membrane)
compress the cord even more
5. Cord (cord loop, prolapse of cord)
C. Deliver the baby asap to prevent fetal death - a nurse cannot do this
D. Elevate the buttocks and avoid head compressing on the cord and
transport immediately
42. Risks for teenage pregnancies would be the following except:
A. Preeclampsia
41. Dystocia is one of the major reasons for both fetus and mother to be
B. Preterm Labor
compromised during labor. In an ROP, the problem occurs mostly in what
C. Increase abdominal delivery
mechanism or cardinal movement of the fetus in labor.
 D. Transverse lie of the fetus - not common in teenage pregnancy; usually
primigravida – tone of muscles is still strong
43. When the HCW insists on delivering the baby’s head during uterine
contractions and asks the mother to push harder during crowning, This usually
occurs:
A. Cord prolapse
B. Precipitate delivery leading to “fall” of the baby
C. Uterine rupture
D. Lacerations of the birth canal
Mgt: crowning: INSTRUCT MOTHER TO INHALE DEEP/ PANT & AVOID PUSHING
(inc expulsion can cause laceration)
44. A question in MCN class was asked. How are placenta previa and abruptio
placenta similar? The best answer is both —
A. Cause severe bleeding, increasing in amount– primarily in previa
B. Associated with hard firm fundus
C. Cause uterine bleeding leading to hemorrhage
D. May lead to eventual induction of labor to save fetal life– induction of
labor is not done unless necessary/indicated
45. IUD is recommended as a method generally to multipara. A very common
occurrence that must be relayed by the nurse to client is:
A. She may have severe menstruation- complains of menorrhagia
B. She may develop severe cramps
C. She is at risk for vaginal infections
D. Tendency for the device to be spontaneously expelled– ask women to
constantly check thread of device if it is correctly placed; before and after
coitus/menstruation
HORMONAL METHOD- PILLS( esto and progest suppress lh and fsh therefore no
ovulation), OCP, IMPLANTS, INJECTABLES(DEPO PROVERA) ; MOST SYSTEMIC =
MOST RISK AND SIDE EFFECTS
MECHANICAL METHOD- inserting IUD in the uterus (prevents
implantation),multigravid; immobilizes the sperm
BARRIER METHOD - condoms, diaphragm; prevents fertilization
SURGICAL METHOD - permanent method; cut the vas deferens and isthmus of
fallopian tube; prevent the meeting of egg and sperm
● IUD s/e is PID that can cause ectopic pregnancy
46. When a woman at 12 weeks complains of sudden, knife like pain radiating
to the shoulders, the ER nurse suspects:
A. Ectopic Pregnancy
B. H-mole
C. Abortion
D. Abruptio placenta
47. Oral contraceptive pills and implants are hormonal methods of FP. What is its
action as a method?
A. Prevents implantation
B. Suppresses estrogen and FSH in re-blood - oral contraceptives contain
estrogen and progesterone (combination pills)
C. Prevents fertilization to occur
D. Suppresses the release of gonadotropic hormones FSH and LH
RATIO:
● For clients 40 and above - progesterone (only) pills are given instead
● Never take the pills without being assessed by the MD haha
● High estrogen can lead to breast cancer
48. Mastitis is commonly complaints by primiparous mothers. Choose a 3. A glucose test is performed if high factors are identified, otherwise a
characteristic of this complication. glucose screening test is done between 24-28 weeks AOG
A. It occurs in all BF mothers 4. On the screening test of 50 grams glucose, the cut off value after one
B. Occurs generally when BF has been established by around 2-3 weeks hour is 140mg/dl
post partum A. 1 and 2
C. Its causative agents are streptococcus (attacks throat, kidney, heart) and B. 2 and 3
staphylococcus– streptococcus is not a causative agent C. 3 and 4
D. Identified causes are poor nutrition and hygiene of the mother D. 1 and 4

49. A woman in labor, under the watch of the nurse, goes into 14 hours first 52. These maternal conditions are associated with risk to abruptio placenta
stage. The nurses suspects the following causes except: except:
A. A small pelvis; a big baby A. Cigarette smoking
B. Fetal abnormalities like hydrocephalus B. Trauma
C. The fetus may be abnormally presented C. Hypertension
D. The estimated fetal weight is 3,000 grams D. G6 and above
Ratio: 10-12 hours is the average labor; total of 14hrs delivery should be done.
53. Eclampsia is a major event that can lead to maternal death. The nurse must
50. These are risk factors identified with placenta previa except: be alert at these time for its occurrence except:
A. Elderly gravida A. In pregnancy before 20 weeks AOG
B. Multiparity - same rationale with D B. In pregnancy after 20 weeks AOG
C. Primigravida – abruptio placenta is common due to hypertension C. At anytime in labor
D. History of multiple abortions- scarring of area so it will be implanted on the D. During the first 48 hours postpartum
lower segment of the uterus causing Placenta Previa.
54. When will the nurse say that there is PROM?
51. These are true in diabetes in pregnancy: A. Pattern the BOW ruptures at the onset of labor
1. High risk factors are the obese, teenage pregnant mothers B. When the BOW rupture during the transitional phase
2. Insulin is needed as soon as pregnancy commences or begins because C. Before the onset of labor, the BOW ruptures
of HCG D. When the BOW rupture at term with regular contractions
 55. A multigravida must be watched for prolonged labor. The common cause is: A. At the beginning of contraction
A. Cervical dystocia B. In between contractions at intervals
B. Hypertonic contraction of the uterus C. During contraction
C. Tetanic contractions of the uterus D. Immediately after contraction - so that we will be able to detect heart
D. Hypotonic contraction of the uterus rate as contraction decreases

59. A woman continues to vomit beyond her 1st trimester. She is diagnosed to
have hyperemesis gravidarum and is admitted to the hospital. All these are signs
56. All these hormones play a large part in contracting muscles of organs like the manifested by the woman except which one?
uterus. Which one does not? A. Fever and increased pulse rate
A. Prostaglandin - hormone like substance found in the endometrium, B. Loss of weight
seminal fluid in men C. Skin is dry and lacks turgor
B. Estrogen - a hormone produced by ovaries and one of the function is to D. Urine is frequent and excessive - urine is scant because you are
contract organs; Prostaglandin Theory dehydrated
C. Oxytocin - hormone from posterior pituitary gland that contracts muscles
of uterus; prevent bleeding 60. A woman diagnosed with multifetal pregnancy goes for PNC. This is her first
D. Relaxin visit to the clinic. Which sign will not be true upon the nurse assessment?
A. Uterus is three finger below the xiphoid- 22 weeks will be between navel
57. A woman in labor is assessed to have contractions every 10-15 minutes, that and xiphoid
lasts for 40-45 seconds. She is in which phase of labor? B. There is multiplicity of fetal parts on the left and right side of the mother
A. 1st stage of labor C. Frequent Braxton hicks contractions occurs that may lead to preterm
B. Latent - below 30 secs per contraction labor
C. Active D. Location of 2 separate FHR sites
D. Transitional - 50 secs per contraction
61. Which hormone is unique only to pregnancy and begins to be released as
● 2nd stage- 50,60-70 secs per contraction soon as implantation is done?
A. HPL → causes DM
58. Fetal assessment is a major assessment task of the nurse. When the woman is B. LH and FSH - dormant; suppressed
in labor, when is the best time to take the FHR? C. HCG - first pregnancy hormone
 D. Prolactin- In anterior pituitary gland; starts producing milk D. Injecting oxytocin after the birth of the baby ruling out a second baby
Ratio: ABC - avoid!!!
62. Vitamin A is teratogenic if taken in routinely and in large amounts in
pregnancy. How much is generally given? 65. As a certified MCN monitoring the progress of labor, she knows that uterine
A. 10,000 IU - necessary for the development of the fetus contractions begins and last longest at the:
B. 100,000 IU A. Fundus - to count contractions;
C. 1,000 IU B. Corpus
D. 200,000 IU - if not pregnant; resume this dose postpartum/after birth C. Isthmus
D. Lower uterine segment - passive zone
● Vit ADEK are fat soluble vitamins that stay in liver
● Vit B, C- water soluble vitamins easily excreted in urine Rationale: Uterine contractions proceeds in orderly manner; upper uterine segment is
called the active zone -> produces contractions
63. These are true statements of menstruation except:
A. Occurs periodically and regularly to women of reproductive age 66. The secretions produced in pregnancy are thick and sticky. These then form
B. Occurs for an average of one week with moderate flow the “mucus plug”, that is eventually expelled as show. These secretions are
C. Occurs monthly with an approximate amount of 100-150 ml daily – produced by:
monthly is not accurate; 30-80 mL only A. Estrogen- produces mucus in the uterus called leukorrhea and
D. Ceases at approximately around 45 years onwards when reproductive Spinnbarkeit
process end - 45 years old: average menopausal age, generally begins B. HCG and HPL
at this age C. Relaxin
● Menopause- gradual cessation of menstruation D. Progesterone
● 45 and above done with Reproduction = WOF unwanted pregnancies
67. Priscilla, G1P0 is at term. What is the estimated length of the fetus?
64. These are harmful practices that must be avoided by the practicing SBA A. 25 cm
(Skilled Birth Attendant) except which one? B. 40 cm
A. Push on the abdomen during contraction in the second stage of labor - C. 20 cm
fundal pressure D. 50 cm - 10 lunar mos x 5 (Term = 10 lunar mos; Haase’ Rule)
B. Pull on the cord to deliver the placenta
C. Wait for the fluid to stop before referring to the higher level facility 68. Vaginal examination is a skill unique to the MCN. The purposes of vaginal
examination are these:
 1. Determine if the BOW is intact 71. Which among the following findings is a positive sign that the mother is now
2. To evaluate the capacity of the pelvis in the stage of fetal expulsion (second stage of labor)?
3. To determine the station of the presenting part A. Uterine contractions occurring every 60-90 seconds
4. To determine the size of the head and the age of fetus B. Increasing bloody discharge from the vagina
A. 1,2 and 3 C. Complete dilation of the cervix - from full dilatation to expulsion of the
B. 2,3 and 4 baby (2nd stage)
C. 1,2 and 4 D. Mother desire to push during contractions
D. 4 only Rationale: 10cm beginning of contraction stage, 2nd stage expulsion of
the baby??
69. These are true in performing vaginal exam by the MCN:
1. She should be certified to perform IE 72. Rosalyn just gave birth 30 minutes ago. Which would be some expected
2. She can only do IE in normal labor and pregnancy- you cannot do IE assessment finding by the nurse? (4th stage of labor= critical stage)
unless woman is in LABOR 1. A contracted fundus above the navel- fundus should be contracted
3. There should be no antenatal bleeding prior to labor below navel at midline (right after delivery) then try to rise to be at the
4. The can only do this in a hospital setting- you can do this even in level of navel within 8 hrs then subsequently dec. to involution 1cm per
community setting; lying in day
A. 1 and 2 2. Pulse rate is low at 60 beat per minutes- sometimes it can be 50 bpm;
B. 2 and 3 physiologic bradycardia postpartum
C. 1 and 3 3. Lochia is moderate in amount, red in color
D. 3 and 4 4. Temperate and BP are elevated due to the rigors of birth - do not expect
BP to be elevated, except systolic bp.
70. EIC recommends that a woman in normal labor must be given food for A. 1 and 2
energy. Which type of diet would you usually side? B. 2 and 3
A. Soft diet like soft boiled egg C. 3 and 4
B. Light carbohydrates diet like soup, fruit juice D. 4 only
C. Regular balanced diet RATIONALE:
D. Water, chips and liquid diet only 73. Contraceptive method would be one of the health instructions the MCN
Ratio: all are correct but B is the best answer; easily digested teaches the mother. Which among these methods would prevent fertilization to
avoid pregnancy?
 1. Condoms - catches the sperm
2. Billing’s method- natural method (when woman is fertile; you abstain/ 77. The following are the findings of the nurse upon doing the Leopold’s
avoid) Maneuver on Elisa- G1P0 on her 32 weeks AOG; irregular parts on the left side,
3. Depo-Provera- progesterone only; prevents ovulation with a hard, ballotable mass on the fundus. Identify the fetal position and
4. IUD- sperm cannot penetrate thick secretions - presentation:
A. 1, 2 and 3 A. ROA, Cephalic presentation
B. 1, 2 and 4 B. LSA, Breech presentation
C. 3 and 4 C. RSA, (Right Sacrum Anterior) Breech presentation
D. 4 only D. LOA, Cephalic presentation
Ratio: IF irregular parts are on the LEFT, presenting part is on the RIGHT (sacrum)
74. A common vaginal infection caused by protozoa which gives off foul odor is: Pawlik's grip- to know when it is already engaged
A. Moniliasis- fungi; treatment: Clotrimazole
B. Trichomoniasis - treatment: Metronidazole 78. In fraternal or dizygotic twinning, this is not excepted:
C. Bacterial Vaginosis - bacteria C.A A. Same sex, different physical characteristics
D. Chlamydia- bacteria C.A B. 2 placenta, 2 chorion, 2 amnion
C. One ovary that released one ovum
75. The privilege of an MCN to put up her own Birthing Clinic and allows her to D. 2 ovaries that released 2 ova
do autonomous practice is embodied in: Fraternal or dizygotic- can be done d/t clomiphene citrate (clomid) and IVF
A. RA 9173
B. RA 10354 79. When the woman bleeds more than 24 hours after delivery, the nurse must
C. AO 0012-2012- EINC Unang Yakap AO suspects:
D. AO 0025-2009 A. Relaxed uterus -(atony) fundal massage, give methergine
B. Fibroid polyps
76. Which is not done to a woman in labor? C. Retained tissue or infection - left chorion or cotyledon inside the uterus it
A. Pain medication is given early in labor- best time is during active phase will contract then bleeds
B. Food is given to provide energy as long as it is light D. Cervical tear -can be seen right after delivery
C. Bowel and bladder elimination is monitored
D. Breathing exercises are encourage when contractions occurs
Ratio: BCD are all true.
80. When a nurse 6 months after being licensed takes several training to be 83. Which among the following statements is FALSE Re:NB screening?
more competent and enrolls in a MA graduate course, which PQR level is she A. It is mandated in the Philippines by RA 9288
at? B. Ideally, it should be done soon after birth for better accurate results
A. Level 5 C. It can screen several congenital metabolic disorders that can lead to
B. Level 6 mental retardation or even death when left untreated.
C. Level 7 D. The blood sample can be collected by physician, trained nurse or
D. Level 8 midwife

81. As a nurse, Myla assesses normal newborn delivered 30 minutes prior. These 84. A nurse handled the mother who came directly from the ER and fully dilated.
are the findings. Which will make her monitor and refer to the NewBorn The nurse knows that the baby is premature because:
eventually? A. Baby weighs 200 grams and 37 weeks AOG
A. Length – 46-53cm- normal B. Baby is 36 weeks AOG and 2,400 grams in weight - below term period
B. CH 34-35cm; cc= 32 - 33cm- normal C. Baby is 48 cm in length and 2.5kilos in weight
C. Temp: 35OC- axillary- hypothermic; needs immediate hypothermic D. Baby is 37 weeks, 300 grams in weight-term
intervention; apply blankets to NB and refer.
D. R= 30-40 bpm -normal 85. A nurse is assigned in the postpartum division of the obstetrical unit. When is
puerperal sepsis presumably diagnosed?
82. A newborn was assessed within 1 minute of life with these findings : A. When the temperature is elevated 37.5OC after delivery
Respiration– irregular, slow, some flexion of extremities, bluish palms and soles, B. When the temperature is 38C and above on 3rd-4th day postpartum
HR– 90/min. All other parameters are considered normal. What is the APGAR C. With red, lochia, flushed face and engorged breasts
Score? D. Any elevation of temperature 38C above, after 24 hours postpartum
A. 5 persistently
B. 6
C. 7 86. The type of anesthesia used in suturing episiotomy:
D. 8 A. Pudendal block- anesthetize pelvic area; mother loses sensation
Respiration- score 2 B. Local infiltration anesthesia
Muscle tone- 2 C. Spinal- done only in CS; more expensive
Reflex - score 2 D. Epidural- mother does not lose sensation but feels pain
87. A woman in labor has ruptured membranes at 7 cm cervix dilation. What is C. Leukorrhea
the priority action of the nurse? D. Monilial infection
A. Call and refer to the physician ASAP
B. Determine the color, odor of the fluid - 2nd intervention 91. In the immediate postpartum period, the most critical assessment of the
C. Check the heart tone immediately- 1st intervention client with PIH would be:
D. Insert IV fluid to prevent dry labor A. Observing sign of bleeding
Ratio: The given situation is NORMAL. B. Obtaining and monitoring the client’s vital signs
Nitrazine test- turn blue or dark green if it is urine C. Evaluating the client emotional status
D. Alertness for sign of shock
88. The nurse is teaching a new batch of affiliates in the orientation period. She
talks about implantation. Which part of the decidua covers the ovum and shuts Ratio: BP is important to monitor in PIH.
it off from the rest of the uterine cavity, eventually disappearing as the fetus
increases in size? 92. According to Rubin (Psychologist in Obstetrics), postpartum period has 3
A. Decidua basalis stages when the mother is passive and dependent 1-2 days after delivery and
B. Decidua capsularis focused on bodily concerns. She is in:
C. Decidua vera A. Taking in phase
D. Decidua spongiosa B. Taking hold
C. Letting Go
89. Which change in the cardiac system is not expected in pregnancy? D. Dependent and independent
A. Increase in cardiac load- expected
B. Increase in blood cells especially WBC 93. Episiotomy is done to enlarge the birth canal. A major advantage of the
C. C. Heart is displaced slightly to the left- because of increasing uterus that mediolateral method?
is pushing on the diaphragm A. Easy to repair
D. Increase on vital signs especially BP since the heart is beating for two. B. Less pain
Another unexpected is increasing clotting factors, prone to thrombophlebitis. C. Less bleeding
D. Less extension to the anus
90. Presence of white vaginal discharge due to increase in estrogen is called: Ratio: Mediolateral - diagonal episiotomy to enlarge
A. Operculum
B. Mucus plug
94. A mother at 46 y/o has been dreaming of becoming pregnant. She has
been diagnosed as having a phantom pregnancy or pseudocyesis. Which
among these will not occur?
A. Amenorrhea
B. Quickening
C. Enlarged soft uterus
D. Feeling that she is pregnant - commonly seen in women who felt
pressured to be pregnant
Ratio: Menstruation- is highly psychological
95. In the fetal circulation, which among the temporary structures facilitates the
transfer of the blood from the heart directly to the aorta by passing the lungs?
A. Ductus venosus
B. Ductus arteriosus- closes later in life; needs monitoring
C. Foramen ovale
D. Hypogastric arteries
Ratio:
● Aorta= arteriosus
● In fetal circulation, veins carry the oxygenated blood while arteries carry
the deoxygenated blood.
● There are temporary structures in the fetus which should close after birth:
○ Ductus venosus: transfer of blood from the vein directly to the
inferior vena cava, bypassing portal circulation (liver).
○ Ductus arteriosus: transfer of the blood from the heart directly to
the aorta, bypassing the lungs.
○ Foramen ovale: blood from right to left atrium
● Ductus arteriosus is monitored after birth regularly, daily.
● DOC: Indomethacin
96. Per evidence, these are the effects of properly timed cord clamping:
A. Reduces hypoglycemia and hypothermia
B. Reduces midline of RDS in the preterm
C. Reduces anemia, intracranial hemorrhage
D. Reduce anemia, hemolytic disease of the NB
Ratio: 4 core steps EINC
1. Drying thoroughly- to prevent hypothermia; dry from head to foot
Keep the baby warm
2. Skin to skin contact
3. Wait for 1-3 mins cord pulsation stops (reducing anemia and intracranial
hemorrhage in preterm
4. Allowing the baby in prone position for the baby to initiate sucking
(breastfeeding for first 90 mins)
Not all newborns undergo EINC, it depends on assessment
If the baby cries within 30secs proceed with ENC; If the baby does not cry, cut
the cord and suction
97. Which is a recommended arrangement of linen and instruments when a
trained BEMONC nurse attends to deliveries the RHU?
A. Bonnet, 2 baby’s blanket, cord clamp
B. 2 blankets, bonnet, syringe with oxytocin, cord clamp
C. 2 pairs of gloves, bonnet, cord clamp, blankets
D. Bonnet, syringe with oxytocin, 2 pairs of gloves
Ratio: Mayo table arrangement: 2 gloves, 2 bath blankets (1 for wiping baby
thoroughly)(2 blankets to put in the chest of mother), bonnet, oxytocin, cord clamp
and kidney basin for placenta.
98. Still considered to be a major cause of neonatal death in the Philippine and https://discord.gg/MQ9mh39T
beyond:
A. Congenital anomalies Psych link:
B. Infections https://docs.google.com/document/d/1x5Q_N49r8nQGJptyYq28qm1BTZhkAdBoQqb
C. Upper respiratory infections m1eivjTI/edit
D. Prematurity
Ratio: Preterm contraction, inject dexamethasone; if contraction continues, SIDE NOTES:
admit the mother and give tocolytics
NSD: Drying of baby, skin-to-skin, cutting of cord
99. The Philippines is gearing towards the implementation of UHC in the country. CS: Drying of baby, cutting of cord, skin-to-skin contact
Philhealth, the financial arm of this program supports primary birth facilities. This BEYOND 3 CS STOP NA. 4TH CS WILL BE A RISK, 5TH TERRIBLY RISKY
is an evidence:
A. Payment of P19,000 for CS It is recommended NOT to bathe the baby at least 6 hours to keep the temp at 36 and
B. Payment of P6,500 for spontaneous delivery in the hospital above
C. Payment of P8,000 for NSD in the community setting HIV - we will bathe the baby in order to remove the blood, secretions and amniotic
D. Payment of P10,000 for mother-baby dyad in the hospital fluid then proceed to the next steps
Ratio: to decongest the patients in the hospital
Myoma - can lead to cancer, estrogen malakas magpalaki ng mass
100. Which assessment finding will make the nurse allow the woman in labor to The older the woman gets the more she is prone to cancer.
be mobile and walk around?
A. Presentation of the fetus is cephalic Early detection of H.mole - prenatal visit at UTZ, no fetal sac and no FHR
B. She is in active labor
C. The contraction are slow and irregular Causes of Fetal abortion (IT CANNOT BE PREVENTED):
D. The BOW is intact - BULOK na ang ovum common in 40 yrs above (blighted ovum), congenital anomalies
ovum, zygote cannot implant, thin decidua
- Recommended 3-5yrs space for pregnancy to heal the endometrium and thickens it.

Coitus in Normal Pregnancy - if term as long as it is not supine, if pregnant is

uncomfortable in coitus at term it can cause premature labor and contraction.
Implants- more common nowadays protects woman for 3yrs

Growden’s method?

Menstruation:
Red → fresh blood
Pinkish → menstruation is about to end
Brownish → accumulated/old blood