MATERNAL AND CHILD NURSING

 Global community- the develop countries where nurses would like to go

 Countries of limited resources/ developing countries
 MCN in the middle represents the nurse

I. Antenatal care
 Involve concepts of four refocused antenatal care as mandated by DOH
 Longest care done here
1. Frequency of visits- depends primarily on the woman, but protocols set of the DOH requires 4
visits out of the whole nine months for as long as it is distributed, because the ideal method may not
be feasible among the urban poor
o No time to go to checkups
o Finds it as a bother in their income generating activities
o Looks at agencies where they need to shell out money
 Time of visits
Framework of Maternal and Child Nursing in the Philippines o 1st- 12th week of the 1st trimester
o 2nd- 26th week
o 2 last visits
 3rd- 32nd week
 One prior to delivery
 But because maternal mortality rate is still high, they revised it to 8 visits
 Ideal- according to Pilitteri it should be on a monthly basis on the first to the 7 th month
o On the 8th month, twice a month
 o On the last month, weekly  But once the baby is discharged and goes back for checkups, the pediatric nurse is already
2. The MNCHN (Maternal, neonatal, child health and nutrition) responsible
 All pregnancies should be planned and wanted
 Included here is the referral system beginning with the community level→ BEmONC V. Women’s Health
level→ CEmONC level  Least known function of the maternity nurse because it is seldom practiced ☹
 BEmoc- usually at the level of the community
 CEmONC- hospital VI. Perinatal Services
 Under the BEmoc and CEmoc, life-saving drugs may be given even without prescriptions  The antenatal care, labor and delivery care, child health, and postpartum care is collective
from physicians called perinatal services
o Emergency drugs may be given so long as the nurse is trained while transporting  From pregnancy to the time the baby is delivered, up to the 28 days to one month period
the client
o Everything that is done during the intervention will be reported to the ER VII. Labor and Delivery
3. Iron and folic acid supplementation  Essential intrapartum newborn care (EINC)
 Iron- primarily given to the mother o EIC (for the mother), ENC (for the baby)
 Folic acid- given for the development of the fetus  For two people for the mother and the baby
 To prevent anemia as blood loss is expected during delivery  Only begins and ends during the first, second, and third stages of labor
4. Birth plan  EIC- done in the first stage of labor
 A global plan  ENC is performed at the second stage with the four steps
 What the mother desires for herself at the time of birth
o Helps her plan before delivery including financial aspects Antenatal Care
o Who will be with her  Pregnancy- egg unites with sperm
o Who will bring her to the hospital o But there are some that say that life begins with implantation
o How much should she save for this delivery  Longest phase in obstetrics
 Done at the first visit o 280 days- average (270-290 days)
 One birth plan form attached to the mother’s record and the other should be given to the o 40 weeks- average
mother o 37-42 weeks- range
 Should always be reviewed per visit because this is flexible depending on the situation of  <37 weeks- preterm
the mother  >42 weeks- post term
o E.g., the mother developed preeclampsia, she can no longer deliver in the  38-39 weeks is waited when labor needs to be inducted, to make sure
community setting even if she desires to that the fetus is healthy enough to breath and survive on its own
o 9 calendar months- for lay persons, also the basis of the Naegele’s rule
II. Labor and Delivery Care o 10 lunar months
 Shortest care is provided at these phase  4 weeks in 1 month, no more, no less
 Basis of the fetal development seen in the books
III. Postpartum/ Puerperium  ⭐Length of the fetus based on the lunar months—Haase rule
 Midway care  In the first 5 lunar months, square the AOG= length of the
fetus (cm) e.g., at 2 months= 4 cms
IV. Child Health  6-10 months, multiply AOG by 5 e.g., at 7 months= 35 cms
 The neonate (0-28/ 30 days) of newborn is the focus Bartholomew’s Rule
 If the child is in the DR the maternity nurse is still responsible for care  Landmarks- 9 months/ full term→ xiphoid process
o But if during the assessment, the maternity nurse finds the baby to be on  5 months/ 20 weeks→ umbilicus
jeopardy s/he will ask the pediatric specialty nurse to take over of the care and  3 months/ 12 weeks→ symphysis pubis
bring it over to the NICU
  Prenatal care- significant in the success of the outcome of pregnancy
o If the mother has not been able to go to prenatal checkups complications may
not have been screened leading to complicated deliveries
o If (x) prenatal cares/ checkups→ high risk patients
o Prenatal care minimizes maternal and fetal mortality
o Advocate for breastfeeding, vaccinations, and family planning—all these three
should be taught at the pregnancy classes in the antenatal period
o Space pregnancy at least three years
o Nurse and midwives are allowed to perform these so long as certified and
trained- dispense pills, insert IUDs, and inject implants

Labor and Delivery Care Child Health

 Shortest phase or stage in OB  Includes care of the newborn to adolescent
 Should not be more than 24 hours of true labor pains up to the expulsion of the baby  MCN - immediate neonatal care
o The first stage is the longest but not more than 8 hours  Includes breastfeeding
 >8 hours→ dystocia, slow, non-progressive labor
 Three reasons for dystocia—power, passage, and passenger Women’s Health
o Second stage should not be more than 1 hour for the multigravida and 2 hours  Reproductive problems of the non-pregnant women
for the primigravida 1. Vaginal infections
o Third stage- <30 minutes  Teach vaginal hygiene
 Complications in childbirth usually occur  Cause/Sign/Treatment
o In the first and second stage, the fetus will deliver itself→ assist in delivery  Moniliasis- most common especially when (+) GDM
 Problem will only occur if the baby is unhealthy o Cause is fungi
o Mortality is highest at the third stage o Characteristic sign: cheese-like secretion, very itchy
 The placenta cannot deliver itself like the fetus→ becomes a foreign o Treatment: DOC clotrimazole an antifungal
body the minute the cord is cut and it needs to be expelled  Trichomoniasis
 So long as the placenta is inside the uterus and the baby is out→ the o Protozoa
uterus will never contract completely and it will continuously bleed until o Foul odor, greenish. Creamy secretion
it is expelled o Flagyl (metronidazole)
 Therefore, this stage should be timed  Bacterial vaginosis
 Crucial competencies of the MCN are: o Bacteria
o Use of partograph o Grayish secretion with foul odor
o Performing NSD o Antibiotics/ Antibacterials
o Suturing lacerations
 Chlamydia
o Vaginal examinations o Caused by bacteria
o STD
Postpartum Care
o Asymptomatic
 6-8 weeks (for nursing only)
o Antibiotics
 Immediate care
 All should be treated because it can ascend to the pelvic cavity
o Different aspects are monitored of the woman’s body during the first two hours
 Can be seen in the pregnant and non-pregnant women
 Most critical because most mothers die within 24 hours—specifically during the third stage
2. Menstrual disorders
up to the immediate postpartum
 Vaginal bleeding outside of menstruation at times called Abnormal Uterine Bleeding (AUB)
 Routine care- interventions done after 24 hours
 Irregular menstruation
o Care for the episiotomy wound
 Dysfunctional bleeding- bleed outside the menstrual period
o Care of the breast
 Regular cycle is 28 days
o Assisting the mother to provide care for the newborn baby
 Reasons
 Complications can set immediately after delivery
o Climate
 Follow-up care is necessary to ensure healthy transition to non-pregnancy state
o Nutrition—anemia, malnourishment
 o Stress  If (+) cyst, a mammogram will be done—will tell the physician if it is
 (x) menstruation→ assumption is (x) ovulation suspicious or not then undergo other laboratory testing
 Treatment  Rule- remove every time it recurs
o Medical drugs- oral pills o Cervix
 Menstruation is primarily managed by hormones  Pap smear, regularly especially in women in the reproductive age who
o Surgical- D&C or endometrial ablation removes thin layer of endometrium are sexually active
 Done when bleeding is really heavy  If 2 consecutive (-)→ every three years
 Discharge 2-3 hours after the procedure  Primary caused by human papillomavirus (HPV)
 Not only used for abortions  Acetic acid cervical test is done in the community to determine
 Gathered cells/ tissue will be sent to the laboratory for examination suspicion→ if (+) send to the hospital
 The endometrium is the part that thickens and sheds during o Uterus
menstruation  Myomas can be easily removed
 Increases in size during the proliferative phase under the influence of o Ovaries
estrogen  Worst because these are endocrine glands→ Ca cells can easily go to
 Thickens at the secretory phase the blood
 Withdraw estrogen, followed by progesterone→ endometrium will shed  Remove then undergo chemo or radiation therapy
 A woman will not stop bleeding until the endometrium is fully shed off
3. Infertility Additional notes
 Unable to become pregnant 12 months after trying  Normal days of menstruation is 2-9 days—even if it is 2 days only, so long as it has
 Caused by menstrual disorders occurred or that is the normal days of menstruation, then it is normal
 Endometriosis- the endometrial cells are outside of the
uterine cavity Legal Bases of MCN Practice
o Painful disorder where endometrial tissues 1. RA 9173- Philippine Nursing Law
grow outside uterus  Care of the Pregnant women
o Involves Ovaries, Fallopian Tubes and tissue o Nursing bill currently approved by the congress
lining the pelvis o Nursing schools should already be adapting the advanced practicing nursing
o When the estrogen and progesterone acting (APN) can independently practice nursing in the community level and can charge
in the endometrium during the proliferative their own professional fees
phase→ endometrial tissues outside will also thicken→ pain  Labor and Delivery
o Removed through laparoscopic surgery  IE and Suturing
 PCOS (polycystic ovarian syndrome) o IE may only be done if you are certified
o Develop follicles (fluids) in the graafian follicles that fail to release eggs o Without antenatal bleeding
o Management- symptomatic treatment—hormones and lifestyle o Woman is in normal labor— (-) history of bleedings and antenatal bleedings
 Manifestations: ↑ androgen manifested by hirsutism, obesity o Can only suture 1st and 2nd degree suturing if with certification
 Cancer in women o Episiotomy is not allowed
o Breast- an accessory organ of reproduction  Care of newborn
 Number 1 cancer in women
 BSE should be done every month, after menstruation Four Classifications
 The older you are the more prone you are to cancer  Certified nurse midwives
 Annual physical exam to check  Nurse anesthetist- taught to do the basic ways to give anesthesia
 SOP for nurses- gynecological clearance is needed, >40 o Spinal and epidural anesthesia are not included but can assist the doctors
years old ECG tracing to see to it that you are fit to provide  Nurse practitioner
care for clients  Certified nurse specialist e.g., pediatric specialist, oncology nurse specialist
  Early diagnosis, initiation of treatment, and appropriate long term care help ensure normal
APN in MCN growth and development of the affected child
 Primarily can prepare her to be an independent practitioner with a birthing clinic o Done through monitoring of growth and development and addressing of problems
o Nutrition based
2. RA 7600 - Rooming In Act  If (+) detection, treatment may immediately be started→ prevent further deterioration of the
 The mother and baby dyad should not be broken up until discharge newborn
 For the woman to be assisted and urged to breastfeed and for the baby to latch 8. RA 10192- CPD across professions
successfully  Ensures life-long learning- 45 CPD Points
3. RA 10028 - Expanded Breastfeeding Act - Breastfeeding Stations  ID cards are renewed every three years and not the license
4. RA 10354 – Responsible Parenting and Reproductive Health Law – BEmONC/ CEmONC, family  This is to ensure continuous learning of nurses
planning  If you are involved in the care of CoVid patients—full CPDs are given up to the end of this
 Allows the nurses and midwives to give lifesaving drugs even without the prescription of year
physicians 9. RA 10968
5. RA 11223 - Universal Health Law- Philhealth is the financial component  Philippine Qualification Framework Law
 To allow all health care facilities in the community be able to provide basic essential  National Policy
services without any out of pocket from the client  Levels of education are assigned
 Hospital delivery- P 6,500.00 o Level 6- post basic
o For private hospitals o Level 7- certifications for competence, trainings, master's degree
 Community- P 8,000.00  Example
o Applicable in a lying in  IVT
 C/S- P 19,000.00  DOH-MCN Certification
 Newborn package- screening and hearing tests– P 1,750.00  FP-Certification BEMONC
6. RA 11210- Expanded Maternity Leave - 105 days  Done to promote patient safety
 Paternity leave is included under this law o Level 8- expertise, doctorate degree- only applicable in the Philippines
7. RA 9288- Newborn Screen- 24 to 48 hours after birth
 Not done immediately because the signs of metabolic of genetic diseases might not be Other Legal Bases
visible in the first day of life DOH Administrative Orders
 Philhealth covered - P550.00 - for 6 original diseases 1. AO 0025- Series 2009 -ENC (First Embrace, Unang Yakap)
 Not covered - P950.00 - Additional 28 disease 2. AO 0029- Series 2006- MNCHN
 Total P1,500.00 Four Intermediate Objectives of MNCHN
1. Every pregnancy is planned and wanted
RA 9288- NEWBORN SCREENING ACT  If the pregnancy is planned and wanted, everything will be done by the woman to keep the
 Process of collection of a few drops of pregnancy safe
blood from heel into filter paper 2. Pregnancy must be supervised
o The nurse or the midwife  Must undergo prenatal care as it keeps the pregnancy safer
can collect so long as they 3. All deliveries must be handled by SBAs (skilled birth attendants) and must be in a healthcare
are trained facility
 Ideally 24- 48 hours after birth  Disenfranchised tradition birth attendants—traditional hilots are discouraged
 Enables early detection and  Home deliveries are removed
management of several congenital 4. All postpartum mothers and babies must have follow-up visits for babies and postpartum visits for
disorders that were not detected mothers
during pregnancy
 May lead to mental retardation and or 3. AO 0012- Series 2012 - Birthing Center Requirements for SBA
death if untreated
  For independent nurse practitioners
 A maternity nurse can put up her own birthing centers and charge even without the RM Risks of Teenage Moms
license  Anemia
 Pregnancy related Hypertension
 Childbirth related complications
AO 0012 – Series 2012 KEY POINTS  The pelvis of the child has not reached maturation to accommodate delivery
 Should only handle normal and uncomplicated pregnancies  Cephalopelvic disproportion may occur→ cesarean section
1. It is an NB Screen Facility  Mental Health - poorer; prone to postpartum depression
 Hearing Test – referred
2. Clinical Services Risks for Babies
 Prenatal, Postpartum care  Preterm- the uterus has not reached its full capacity to develop
 NSVD for low risk  Low birth weight
 Detection of high risk- referral and where to go  Severe neonatal complications- focusing on respiratory complications, RDS
o Should have a partner physician for referrals
 Family planning Obstetrics
o Natural and artificial  Childbirth
o Except vasectomy, tubal ligation and D&C  Unique from other medical sciences
 Life-saving medications o Physiologic processes- getting pregnancy is normal, accepted
3. Personnel  Delivering babies is also normal
 SBA  Uterus is made for: gestation and menstruation
 Trained in BEMONC and Newborn resuscitation o Time frame- can predict what will happen on certain time frames
 MOA with OB-Gyne and pedia  Follows a time frame
o (+) Partners should be available to answer referrals immediately o Two clients—the mother and the fetus (unseen client of OB)
4. Human waste management
 Must have a clearance for the local DENR- local government Points to Remember
 Where to dispose placenta, where would contaminate supplies be placed  All women are at risk at childbirth, no matter how complete the prenatal care visits are
1. Digging a placental pit, should be distanced from the sewage and water system  The main goal of PNC is a health pregnancy for the mother and child
2. Have a human waste management contractor/ agency that will transport all waste products o Deviations are easily identified and can be referred early→ minimize morbidity
and mortality
4. Executive Order 141  2000 - 209 > 2006 - 162 > 2012 - 221 > 2015 - 127 > 2017 - 121
 Addresses root cause of rising number of teenage pregnancy and mobilizing government
agencies to implement strategies Philippine Picture of Maternal Health- MMR
 Done in the barangay level  MDGs (2000-2015)
1. Reproductive health education- collect all teenagers and talk about reproductive health 1. Poverty and Hunger
2. Look for teenage pregnant women in every households- for pregnancy tracking  First 1000 days of the child
3. Functionality of violence against women and children at the barangay level  Exclusive breastfeeding
2. Primary Education
Teenage Pregnancy 3. Gender Sensitivity and Empowering Women
 Defined as “children giving birth to children” 4. Decrease child Mortality 
 Teenage mothers are classified as: 5. Improve Maternal Health -MMR by 52
o 10-14 years old- early; more complications—commonly become morbid and die 6. Minimizing HIV, malaria etc.
o 15-19 years old- late; better managed 7. Environmental Care
8. Global Competitiveness
 Mothers like this should deliver in high level agencies to address complications
Objectives 3. The woman bleeds at around 14-16 weeks AOG. The nurse would consider this possible
 Sustainable development plan (2015-2030) condition except:  
 SDG #3 encompasses all interventions that promotes good health and well-being A. Abortion 
 Health, well-being, illness B. Placenta previa 
 MMR to 70 by 2030 C. Molar pregnancy 
Additional notes D. Ectopic pregnancy 
 ↑ estrogen may cause nose or gum bleeding but make sure to rule out all problems fires
 If the couple wants to take the placenta home, placenta must be disposed of in <8 hours 4. A woman consults the nearest clinic in her neighborhood. She complains of bleeding and
but this is not an SOP states, she is 6 months pregnant. A certifies nurse can do all of the following except:  
A. Take VS and FHB 
 To determine ovulation, count 14 days from the first day of the last menstruation
B. Ask her to lie down in the examining table for further assessment 
 Infertility may occur after an ectopic pregnancy d/t adhesion of tubes (+) scarring
C. Fill up a referral form to the nearest BEMONC facility or hospital 
 Take iron from pregnancy to postpartum, can be continued up until after postpartum D. Performs a vaginal exam to determine is the woman is in labor 
 Oxytocic drugs
o Oxytocin, pitocin, and syntocinon- first line and sagest 5. When upon assessment the nurse observes that the uterus is soft, fetus is palpable but the
 If these three do not stop bleeding woman bleeds on and off at 34 weeks AOG, she suspects:  
o Methergine- has a lot of side effects A. Abnormal proliferation and trophoblast 
 More powerful contractions and will not stop until the potency of the B. Abnormal presentation of the fetus 
drug runs out C. A premature separation of the placenta 
 Can cause rupture of the uterus, headache D. An abnormally implanted placenta 
 Maximum of 1 g
o Carboprost 6. All of the factors are causes of postpartum hemorrhage. Which of those is not labor
o Misoprostol (Cytotec) related? 
 Menorrhagia, metrorrhagia, and hypermenorrhea A. Operative delivery of the baby 
o Meno- excessive menstruation B. Multiparity and anemia of the woman  
 What is the usual number of pads are you using per day? C. Prolonged, dystocia labor 
o Metro- bleeding in between D. Repeated vaginal examinations 
o Hyper- more than 7 days of bleeding
o Room temperature during delivery should be between 25°C- 28°C 7. Seizures during pregnancy are very dangerous. These are the characteristic of
eclampsia that a nurse must know except:  
Maternal and Child Exam A. Can be cause of high maternal and prenatal mortality 
1. Paula attends a seminar on OB emergencies. The following are identified as alert/danger B. May occur before the fetus is viable 
signs in pregnancy and needs to be referred immediately:   C. Can be observed anytime in labor 
A. A pregnant woman fainting on her 16th weeks AOG  D. Can occur immediately after birth and on to the first 24 hours postpartum.  
B. Maternal BP= 130/100 mmHg with history of PES 
C. Tender uterus with cramping and lower abdominal pain  8. Which among these type of abortion gives a clinical sign and brownish bleeding, if
D. Tender mass, uterus equivalent to age of gestation  negative pregnancy test and uterine size smaller than the age of gestation?  
A. Inevitable Abortion 
2. The nurse at the PNC is assessing a pregnant client. She notes that the fundus of the B. Missed Abortion 
uterus is below the navel. This implies that:   C. Threatened Abortion 
A. The pregnancy is on its early stages and non-viable  D. Spontaneous Abortion 
B. The pregnancy is on the second trimester 
C. The pregnancy is early and viable  9. Severe preeclampsia has devastating effects on the mother and the fetus. Which is not a maternal
D. The woman needs further monitoring  side effect of PES? 
A. Acute Renal Failure 
B. Pulmonary Edema   C. One dose of TTT protect the mother for 2 years 
C. Intrauterine Fetal Death  D. 2 Dose of TT protect the mother for at most 3 years 
D. HELLP Syndrome 
16. The MDG have ended in 2015, SDG are now the basis of targets and objectives of the
10. STD’s may cause infertility among women, if not treated. Which among these can country to address global concerns. By 2030, what is the target rate of MMR? 
cause it? A. 52 
A. Syphilis and Chlamydia  B. 62 
B. HIV and Gonorrhea  C. 70 
C. Gonorrhea and Chlamydia  D. 75 per 100,00 
D. All of the above 
17. Mastitis is a common problem among BF mothers, especially the primiparas. Considered to
11. A nurse is in the labor room instructs a mother in normal labor to do the be the most common cause of sore the nipple is : 
following except: A. Prolonged BF 
A. Perform deep breathing excesses  B. Too frequent BF 
B. Assume any position she wants  C. Sucking in bad position  
C. Do bearing down efforts when contractions set in to hasten labor  D. Failure to wash the nipple prior to every feeding  
D. Relax in between contractions  
18. The earliest positive sign of pregnancy in:  
12. A mother is on her 4th day postpartum. She begins to exhibit discomfort and verbalize A. A positive pregnancy test at 8 weeks 
this. The nurse suspects a possible postpartum infection. Which is a reliable index of B. An UTZ done at 6-7 weeks  
puerperal sepsis? C. FHB determination by Doppler 
A. Uterine tenderness  D. Fetal movement felt by the mother 
B. Rapid pulse rate over 90bpm 
C. Fever of 2 days (38C)  19. A recommended standard method to monitor labor comprehensively is:  
D. Increased WBC to 12,000/dl  A. Monitoring the regularity of the contractions 
B. Performing vaginal exams as soon as labor commences 
C. Use of partograph 
13. Oxytocin are beneficial drugs used in labor. The nurse must be aware of the danger oxytocin use D. Taking the vital signs of the mother and the FHB of the fetus 
which is:  
A. Hypotonic contraction of the uterus   20. A nurse upon interview of the pregnant woman calculates that her regular caloric intake
B. Hypertonic contraction of the uterus  prior to pregnancy is 2,300kcal. She estimates that the mother’s total caloric intake now must
C. Uterine rupture  be: 
D. Hypotension and shock  A. 2,500 
B. 2,600 
14. In the menstrual cycle involving the hypothalamic- pituitary- ovarian- endometrial C. 2,700 
relationship, often called the “master gland” is the:   D. 3,000
A. Hypothalamus 
B. Pituitary Gland  21. A nurse intends to put up her own birthing center after being certified. Which would guide
C. Ovary  her in the requirement needed to be licensed? 
D. Endometrium  A. RA 10345 
B. AO 0029-2008 
15. Part of the refocused antenatal care by WHO is the injection of tetanus toxoid C. AO 0012-2012 
vaccines. The nurses know that:  D. RA 9173 
A. 2 Doses of TT protects the mother for 5 years 
B. 4 Doses of TT protect the mother for 2 years 
22. When upon vaginal examination in labor, the nurse assesses the clinical spines to be C. The wound involves the cavernous and perineal muscles and she is certified
prominent and less than 9cm, there is likely a contraction of which part of the pelvis?  to do so
A. Midplane  D. The wound involves the fourchette and the coccygeus muscle 
B. Outlet 
C. Inlet  28. H-mole is an abnormality that may lead to trophoblastic cancer. In pregnancy, the nurse
D. Ileum  begins to suspect H-mole when: 
A. The mother suddenly gains weight 
23. The nurse performs the Leopold’s maneuver on a pregnant mother. These are her findings: small B. There is more nausea and vomiting reported by the mother 
parts on the left side of the abdomen, plain mass on the right side. What is the presumed position of C. The uterus is rapidly increasing size, more than the expected AOG 
the fetus?  D. The uterus is midway between the symphysis pubis and the navel at 16 weeks AOG. 
A. ROA 
B. LOA  29. A trained nurse performs a vaginal exam on a woman in labor at the ER. Her findings
C. LOP  show the cx=3cm, Diagonal conjugate is 11 cm. What would she conclude and inform the
D. ROT  doctor?
A. The OB conjugate is 10 cm and the pelvis is adequate for NSD 
24. What are the factors considered by the nurse to perform AMTSL?  B. The OB conjugate is more than adequate is adequate for NSD 
1. The baby is delivered  C. The pelvis is contracted and NSD is not possible 
2. There is no second baby  D. The pelvis is borderline and assisted vaginal birth can be tried 
3. The placental signs of separation are observed 
4. The placenta is expelled  30. Implantation is a significant event that is necessary for pregnancy to push through.
A. 1 and 2  Choose the right statement on implantation: 
B. 2 and 3  A. It occurs from 5-7 days after fertilization 
C. 3 and 4  B. The blastocyst implants in the decidua basalis 
D. 1 and 4  C. The implantation stage of the zygote is the morula. 
D. The chorionic villi of the blastocyst implants in the decidua vera 
25. A nurse does a health class for adolescents in a school. She talks about menstruation.
These are true except:  31. The nurse constantly monitors the FHR in labor. She knows fully well if the fetus is in
A. The luteal phase of the menstrual cycle is influenced by estrogen and LH.  distress because: 
B. Menstruation comes in predictable, regular cycle in women  A. The FHR decelerate as soon as uterine contraction begins 
C. It is assumed that every menstruation comes with ovulation, unless using a B. The FHR decelerated as soon as the fetus begins to move 
method.  C. The result of the NST is reactive 
D. Menstruation is directly influenced by ovarian hormones and indirectly by D. There are no late deceleration during uterine activity 
gonadotrophic hormones 
32. If the nurse upon assessing the fundic height of the uterus finds it to have “dropped” 2FB
26. Abortion is the expulsion of the product of conception before the age of viability. below the xiphoid, she assumes all of the following except:  
Which best describes an abortus?   A. Labor can ensue with 2 weeks 
A. Fetus expelled at 20 weeks and weighs 500 grams or more  B. The uterus is smaller than the normal sized uterus 
B. Fetus expelled in early pregnancy and weighs 500 grams  C. Engagement well follow soon after 
C. Fetus expelled before 20 weeks and weighs less than 500 grams   D. A possible NSD is expected as the pelvis is presumably adequate 
D. Fetus expelled before 28 weeks and weighs less than 1000 grams
  33. The BOW ruptures in the course of labor. Upon inspection the nurse observes a brownish
27. The mother develops laceration during the birth of the baby. The nurse assess the color of the AF and wrote “M” on the partograph. This means: 
wound and would not suture if:  A. The mother must be transferred to the DR immediately for signs of uterine
A. If is 3rd-4th degree laceration  rupture.
B. Third degree laceration and the nurse is certified  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 furthered monitored and observed for fetal distress, asphyxia on stillbirth. 40. A mother in labor goes to a nurse led clinic for possible admission. Upon inspection she
sees the cords protruding thru the vulva. Her first immediate action is:  
34. Pregnancy is diabetogenic. Upon first visit at 3 months, these are the routine A. Take the FHR and prepare for transport 
procedures done except which one?  B. Push the cord up to reposition 
A. Palpation of abdomen  C. Deliver the baby asap to prevent fetal death 
B. Blood sugar screening test with 75 grams glucose  D. Elevate the buttocks and avoid head compressing on the cord and transport immediately 
C. Vaginal exam to assess pelvic adequacy 
D. Physical assessment- cephalocaudal inspection  41. Dystocia is one of the major reasons for both fetus and mother to be compromised during
labor.  In an ROP, the problem occurs mostly in what mechanism or cardinal movement of the
35.Physiologic anemia in pregnancy occurs. These are true fetus in labor.
statement except: A. Descent and Flexion 
A. This is due to increasing blood volume  B. Internal Rotation  
B. The usual hemoglobin level of Filipino mothers falls at 10-11 gms/dl  C. External rotation 
C. Increasing clotting factors in pregnancy aggravates anemia  D. Extension of the head 
D. Iron is a “must” drug supplementation 
42. Risks for teenage pregnancies would be the following except: 
36. When will the nurse suspect preeclampsia pregnancy?   A. Preeclampsia 
1. The blood pressure is 140/90mmhg at 22 weeks AOG  B. Preterm Labor  
2. There is protein in the urine  C. Increase abdominal delivery 
3. The mother complains of not feeling well, fever and headache  D. Transverse lie of the fetus 
4. Before 20 weeks, fainting and dizzy spells are noted 
A. 1 and 2  43. When the HCW insists on delivering the baby’s head during uterine contractions and
B. 2 and 3  asks the mother to push harder during crowning, this usually occurs: 
C. 3 and 4  A. Cord prolapse 
D. All  B. Precipitate delivery leading to “fall” of the baby 
37. The nurse talks a lot about nutrition to pregnant mothers whenever they do PNC. Those are C. Uterine rupture 
nutrients that are much needed especially for fetal development in the first trimester: D. Lacerations of the birth canal 
A. Folic acid, mebendazole  44. A question in MCN class was asked. How are placenta previa and abruptio placenta
B. Iron and anti-malarial drugs  similar? The best answer is both — 
C. Iodine and folic acid  A. Cause severe bleeding, increasing in amount 
D. Iron and Iodine  B. Associated with hard firm fundus 
C. Cause uterine bleeding leading to hemorrhage 
38. An oral glucose tolerance test is ordered on the second trimester toa pregnant client. D. May lead to eventual induction of labor to save fetal life 
Which is the correct dosage? 
A. 50 grams glucose in 2 hours  45. IUD is recommended as a method generally to multipara. A very common occurrence
B. 100 grams glucose in 2 hours  that must be relayed by the nurse to client is:  
C. 75 grams glucose in 2 hours  A. She may have severe menstruation 
D. 75 grams glucose in 1 hour  B. She may develop severe cramps 
C. She is at risk for vaginal infections 
39. The first step towards preventing maternal and neonatal complication is: D. Tendency for the device to be spontaneously expelled  
A. Following the MNCHN referral system 
B. Implementing the BEMONC program during emergencies  46. When a woman at 12 weeks complains of sudden, knife-like pain radiating to the
C. Performing the 4 steps of refocused antenatal care  shoulders, the ER nurse suspects: 
D. Spacing pregnancy for 3-5 years  A. Ectopic Pregnancy 
B. H-mole  52. These maternal conditions are associated with risk to abruptio
C. Abortion  placenta except:
D. Abruptio placenta   A. Cigarette smoking 
B. Trauma 
47. Oral contraceptive pills and implants are hormonal methods of FP. What is its C. Hypertension  
action as a method?  D. G6 and above 
A. Prevents implantation 
B. Suppresses estrogen and FSH in re-blood  53. Eclampsia is a major event that can lead to maternal death. The nurse must be alert at this time for
C. Prevents fertilization to occur  its occurrence except: 
D. Suppresses the release of gonadotropic hormones FSH and LH  A. In pregnancy before 20 weeks AOG 
B. In pregnancy after 20 weeks AOG 
48. Mastitis is commonly complaints by primiparous mothers. Choose a C. At any time in labor 
characteristic of this complication.  D. During the first 48 hours postpartum
A. It occurs in all BF mothers 
B. Occurs generally when BF has been established by around 2-3 weeks 54. When will the nurse say that there is PROM? 
post-partum A. Pattern the BOW ruptures at the onset of labor 
C. Its causative agents are streptococcus and staphylococcus  B. When the BOW rupture during the transitional phase? 
D. Identified causes are poor nutrition and hygiene of the mother  C. Before the onset of labor, the BOW ruptures 
D. When the BOW rupture at term 
49. A woman in labor, under the watch of the nurse, goes into 14 hours first stage. The
nurses suspects the following causes except:  55. A multigravida must be watched for prolonged labor. The common cause is:
A. A small pelvis; a big baby  A. Cervical dystocia 
B. Fetal abnormalities like hydrocephalus  B. Hypertonic contraction of the uterus 
C. The fetus may be abnormally presented  C. Tetanic contractions of the uterus 
D. The estimated fetal weight is 3,000 grams  D. Hypotonic contraction of the uterus 

50. These are risk factors identified with placenta previa except:  56.All these hormones play a large part in contracting muscles of organs like the uterus.
A. Elderly gravida  Which one does not? 
B. Multiparity  A. Prostaglandin  
C. Primigravida  B. Estrogen 
D. History of multiple abortions  C. Oxytocin 
D. Relaxin 
51. These are true in diabetes in pregnancy:  
1. High risk factors are the obese, teenage pregnant mothers  57. A woman in labor is assessed to have contractions every 10-15 minutes, that lasts
2. Insulin is needed as soon as pregnancy commences or begins because of HCG for 40-45 seconds. She is in which phase of labor? 
3. A glucose test is performed if high factors are identified, otherwise a glucose A. 1st stage of labor 
screening test is done between 24-28 weeks AOG  B. Latent 
4. On the screening test of 50 grams glucose, the cut off value after one hour is C. Active 
140mg/dl D. Transitional 
A. 1 and 2 
B. 2 and 3  58. Fetal assessment is a major assessment task of the nurse. When the woman is in labor,
C. 3 and 4  when is the best time to take the FHR? 
D. 1 and 4  A. At the beginning of contraction 
B. In between contractions at intervals 
C. During contraction 
D. Immediately after contraction 
65. As a certified MCN monitoring the progress of labor, she knows that uterine contractions
59. A woman continues to vomit beyond her 1st trimester. She is diagnosed to have begins and last longest at the: 
hyperemesis gravidarum and is admitted to the hospital. All these are signs manifested by A. Fundus 
the woman except which one?  B. Corpus 
A. Fever and increased pulse rate  C. Isthmus 
B. Loss of weight  D. Lower uterine segment 
C. Skin is dry and lacks turgor 
D. Urine is frequent and excessive  66. The secretions produced in pregnancy are thick and sticky. These then form the “mucus
plug”, that is eventually expelled as show. These secretions are produced by: 
60. A women diagnosed with multifetal pregnancy goes for PNC. This is her first visit to A. Estrogen 
the clinic.  Which sign will not be true upon the nurse assessment?  B. HCG and HPL 
A. Uterus is three fingers below the xiphoid  C. Relaxin 
B. There is multiplicity of fetal parts on the left and right side of D. Progesterone 
the mother
C. Premature contractions occurs that may lead to preterm 67. Priscilla, G1P0 is at term. What is the estimated length of the fetus? 
labor  A. 25 cm 
D. Location of 2 separate FHR sites B. 40 cm 
  C. 20 cm 
61. Which hormone is unique only to pregnancy and begins to be released as soon as D. 50 cm 
implantation is done? 
A. HPL  68. Vaginal examination is a skill unique to the MCN. The purposes of vaginal examination are
B. LH and FSH  these: 
C. HCG  1. Determine if the BOW is intact 
D. Prolactin  2. To evaluate the capacity of the pelvis 
3. To determine the station of the presenting part 
62. Vitamin A is teratogenic if taken in routinely and in large amounts in pregnancy. How 4. To determine the size of the head and the age of fetus 
much is generally given?  A. 1,2 and 3 
A. 10,000 IU  B. 2,3 and 4 
B. 100,000 IU  C. 1,2 and 4 
C. 1,000 IU  D. 4 only 
D. 200,000 IU 
69. These are true in performing vaginal exam by the MCN: 
63. These are true statements of menstruation except:  1. She should be certified to perform IE 
A. Occurs periodically and regularly to women of reproductive age  2. She can only do IE in normal labor and pregnancy 
B. Occurs for an average of one week with moderate flow  3. There should be no antenatal bleeding prior to labor 
C. Occurs monthly with an approximate amount of 100-150 ml daily  4. The can only do this in a hospital setting 
D. Ceases at approximately around 45 years onwards when reproductive process end  A. 1 and 2 
B. 2 and 3 
64. These are harmful practices that must be avoided by the practicing SBA except C. 1 and 3 
which one? D. 3 and 4 
A. Push on the abdomen during contraction in the second stage of labor 
B. Pull on the cord to deliver the placenta  70. EIC recommends that a woman in normal labor must be given food for energy. Which type of
C. Wait for the fluid to stop before referring to the higher-level facility  diet would you usually side? 
D. Injecting oxytocin after the birth of the baby ruling out a second baby  A. Soft diet like soft boiled egg 
B. Light carbohydrates diet like soup, fruit juice  D. AO 0025-2009 
C. Regular balanced diet 
D. Water, chips and liquid diet only  76. Which is not done to a woman in labor? 
A. Pain medication is given early in labor 
71. Which among the following findings is a positive sign that the mother is now in the stage of B. Food is given to provide energy as long as it is light 
fetal expulsion?  C. Bowel and bladder elimination is monitored 
A. Uterine extractions occurring every 60-90 seconds  D. Breathing exercises are encouraged when contractions occurs 
B. Increasing bloody discharge from the vagina 
C. Complete dilation of the cervix  77. The following are the finding of the nurse upon doing the Leopold’s Maneuver on Elisa-
D. Mother desire to push during contractions  G1P0 on her 32 weeks AOG; irregular parts on the left side, with a hard, ballotable mass on
the fundus.  Identify the fetal position and presentation: 
72. Rosalyn just gave birth 30 minutes ago. Which would be some expected assessment A. ROA, Cephalic presentation 
finding by the nurse?  B. LOA, Breech presentation  
1. A contracted fundus above the navel  C. ROA, Breech presentation 
2. Pulse rate is low at 60 beat per minutes  D. LOA, Cephalic presentation  
3. Lochia is moderate in amount, red in color 
4. Temperate and BP are elevated due to the rigors of birth  78. In fraternal or dizygotic twinning, this is not excepted: 
A. 1 and 2  A. Same sex, different physical characteristics 
B. 2 and 3  B. 2 placenta, 2 chorion, 2 amnion 
C. 3 and 4  C. One ovary that released one ovum 
D. 4 only D. 2 ovaries that released 2 ova

73. Contraceptive method would be one of the health instructions the MCN teaches the 79. When the woman bleeds more than 24 hours after delivery, the nurse
mother.  Which among these methods would prevent fertilization to avoid pregnancy? must suspects:
1. Condoms A. Relaxed uterus 
2. Billing’s method  B. Fibroid polyps 
3. Depo-Provera  C. Retained tissue or infection 
4. IUD  D. Cervical tear 
A. 1 and 2  80. When a nurse 6 months after being licensed takes several trainings to be more
B. 2 and 3  competent and enrolls in a MA graduate course, which PQR level is she at? 
C. 3 and 4  A. Level 5 
D. 4 only  B. Level 6 
C. Level 7 
74. A common vaginal infection caused by protozoa which D. Level 8 
gives off foul odor is:
A. Moniliasis  81. As a nurse, Myla assesses normal newborn delivered 30 minutes prior. These are the
B. Trichomoniasis  findings.  Which will make her monitor and refer to the NB eventually? 
C. Bacterial Vaginosis  A. Length– 46-53cm 
D. Chlamydia  B. CH 34-35cm; cc= 32-33cm 
C. Temp: 35OC- axillary  
75. The privilege of an MCN to put up her own Birthing Clinic and allows her to do D. R= 30-40 bpm 
autonomous practice is embodied in:  
A. RA 9173  .82. A newborn was assessed within 1 minute of life with these findings: Respiration– irregular,
B. RA 10354  slow, some flexion of extremities, bluish palms and soles, HR– 90/min. All other parameters are
C. AO 0012-2012  considered normal. What is the APGAR Score? 
A. 5  D. Decidua spongiosa 
B. 6 
C. 7  89. Which change in the cardiac system is not expected in pregnancy? 
D. 8  A. Increase in cardiac load 
B. Increase in blood cells especially WBC 
83. Which among the following statements is FALSE Re:NB screening?  C. Heart is displaced slightly to the left 
A. It is mandated in the Philippines by RA 9288  D. Increase on vital signs especially BP since the heart is beating for two. 
B. Ideally, it should be done soon after birth for better accurate results 
C. It can screen several congenital metabolic disorders that can lead to mental 90. Presence of white vaginal discharge due to increase in
retardation or even death when left untreated.   estrogen is called:
D. The blood sample can be collected by physician, trained nurse or midwife  A. Operculum 
B. Mucus plug 
84. A nurse handled the mother who came directly from the ER and fully dilated. The nurse C. Leukorrhea 
knows that the baby is premature because:  D. Monilial infection  
A. Baby weighs 200 grams and 37 weeks AOG 
B. Baby is 36 weeks AOG and 2,400 grams in weight  91. In the immediate postpartum period, the most critical assessment of the client with PIH
C. Baby is 48 cm in length and 2.5kilos in weight  would be: 
D. Baby is 37 weeks, 300 grams in weight  A. Observing sign of bleeding  
B. Obtaining and monitoring the client’s vital signs 
85. A nurse is assigned in the postpartum division of the obstetrical unit. When is puerperal C. Evaluating the client emotional status 
sepsis presumably diagnosed?  D. Alertness for sign of shock 
A. When the temperature is elevated 37.5OC after delivery 
B. When the temperature is 38OC and above on 3rd-4th day postpartum  92. According to Rubin, postpartum period has 3 stages when the mother is passive and
C. With re, lochia, flushed face and engorged breasts  dependent 1-2 days after delivery and focused on bodily concerns. She is in: 
D. Any elevation of temperature 38OC above, after 24 hours postpartum persistently A. Taking in phase 
  B. Taking hold 
86. The type of anesthesia used in suturing episiotomy:  C. Letting Go 
A. Pudendal block   D. Dependent and independent
B. Local infiltration anesthesia  93. Episiotomy is done to enlarge the birth canal. A major advantage of
C. Spinal  mediolateral method?
D. Epidural  A. Easy to repair 
B. Less pain 
87. A woman in labor has ruptured membranes at 7cm cervix dilation. What is the priority C. Less bleeding  
action of the nurse?  D. Less extension to the anus 
A. Call and refer to the physician ASAP 
B. Determine the color, odor of the fluid  94. A mother at 46 y/o has been dreaming of becoming pregnant. She has been diagnosed as
C. Check the heart tone immediately   having a phantom pregnancy or pseudocyesis. Which among these will not occur? 
D. Insert IV fluid to prevent dry labor  A. Amenorrhea 
B. Quickening 
88. The nurse is teaching a new batch of affiliates in the orientation period. She talks about C. Enlarged soft uterus  
implantation. Which part of the decidua covers the ovum and shuts it off from the rest of the D. Feeling that she is pregnant 
uterine cavity, eventually disappearing as the fetus increases in size? 
A. Decidua basalis  95. In the fetal circulation, which among the temporary structures facilitates the transfer of the
B. Decidua capsularis  blood from the heart directly to the aorta by passing the lungs? 
C. Decidua vera  A. Ductus venosus 
B. Ductus arteriosus  
C. Foramen ovale 
D. Hypogastric arteries 

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 

97. Which is a recommended arrangement of linen and instruments when a trained

BEMONC nurse attends to delivery’s 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 

98. Still considered to be a major cause of neonatal death in the Philippine

and beyond:
A. Congenital anomalies 
B. Infections 
C. Upper respiratory infections 
D. Prematurity 

99. The Philippines is gearing towards the implementation of UHC in the country.
Philhealth, the financial arm of this program supports primary birth facilities. This is
evidence:
A. Payment of P19,000 for CS 
B. Payment of P6,500 for spontaneous delivery in the hospital 
C. Payment of P8,000 for NSD in the community setting 
D. Payment of P10,000 for mother-baby dyad in the hospital
 
100. Which assessment finding will make the nurse allow the woman in labor to be mobile
and walk around? 
A. Presentation of the fetus is cephalic 
B. She is in active labor 
C. The contraction is slow and irregular 
D. The BOW is intact