Framework of MCN Nursing in the Philippines Advocacies During pregnancy

● Breastfeeding
● Family planning
● Vaccination

WOMEN’S HEALTH
● Reproductive problems of the non-pregnant women
1. Vaginal Infections
➢ IInitial sign: pruritus → persistent and does not
disappear up
○ cause/sign/treatment
○ Moniliasis (most common)
● Prenatal care - longest stage x ■ Cheese-like secretions, very itchy
� 10 Lunar months, 9 calendar months, 280 days ■ Resides: Fourchette and Labia Majora
(average) we. ■ Tx: Cotrimoxazole
� “Periodic cycle” ○ Trichomoniasis
� Assess and teach the mother (health teaching) ■ greenish to yellowish
● Labor and Delivery Care ■ Foul odor
� Shortest phase ■ Tx: Metronidazole / Flagyl
� True Labor not lasted for 24hrs ○ Bacterial vaginosis
� Rapid assessment ■ Grayish with foul odor
� MOST COMPLICATION OCCUR w ■ Normal vaginal secretion: Clear
● Postpartum care ○ Chlamydia
� 6-8 weeks ■ Modern type of gonorrhea
� Menstruation started ■ Gonorrhea- Can be seen to the naked eye
� Return of organs to pre gravid state ■ Chlamydia seen on vaginal examination
� Mother returns for check up after 1 month ■ Milky secretion
● Child health ■ Tx: Massive doses of ANTIBIOTICS
� Assess the child for complications
� NICU 2. Menstruation disorders
● Women’s Health ○ Vaginal bleeding outside of the menstruation at times
� Care of Women with Normal physio called abnormal uterine bleeding (AUD)
� Reproductive Health → both women and men ■ Irregular menstruation
■ Dysfunctional bleeding
ANTENATAL CARE ○ Menstruation = validation of ovulation
● Pregnancy → egg unites with sperm ➢ Treatment
● Longest phase in obstetrics is ○ Medical Drugs
� Fertilization → life begins with fertilization ■ Oral pill symptomatic
� 280 days average ( below 260 preterm - above 290 ■ Hormones - can also treat reproductive organ
days postterm) problems
� 40 weeks - average ○ Surgical
� 37-42 weeks - range ■ D&C (OPD) or endometrial ablation removes thin
� 9 Calendar months layer of endometrium (due to extra layer) (scrape
� 10 Lunar months the extra endometrium bc this can cause
● NO prenatal care = Mothers at risk bleeding)
Prenatal care
● Significant in the success of the outcome of pregnancy 3. Infertility
● Primigravid → must be hospital setting = avoid community setting ○ Unable to become pregnant 12 months after (after
of pregnancy regular coitus)
● Gravida 2, 3 and 4 → safest ○ 2 years of trying before coming back, the rest of the
● Resources and facilities will not be able to manage the year the mother may ovulate a few times0
complications ○ Caused by menstrual disorders
a) Endometriosis → interfere with fertilization
LABOR AND DELIVERY CARE ■ Painful disorder where endometrial tissue
● Shortest phase or stage in OB grow outside uterus
� Not more than 24 hrs ■ Involves ovaries, fallopian tubes and tissue
� Complication in childbirth usually occur linings of the pelvis
� Crucial competencies of the MCN are:
● USE OF PARTOGRAPHS
● Performing NSD → able to competently deliver the baby
● Suturing Lacerations
● Vaginal Examination
POSTPARTUM CARE
● 6-8 weeks
● Immediate and Routine care
● Complications can set immediate after delivery
○ Accidents that can occur
● Follow up care is necessarily to ensure healthy transition to
non-pregnancy state

CHILD HEALTH
● Includes care of the newborn to adolescent b) Polycystic Ovarian Syndrome (PCOS)
● MCN → immediate neonatal care - Common disorder in the perineum’’
● Includes breastfeeding - Develop follicles (fluid) that fail to release eggs
- Cystic fluid
- Increase weight (overweight) and more hair
 - Eggs cannot ovulate, PCOS pt cannot get pregnant.
- Undergo treatment of fertility if trying to get pregnant
(GIVE 2 YEARS) Advice to get screened after 2 years
● Male - Fertility of the sperm
● Female - Maternal environment assessment
➢ Artificial Insemination → help the sperm to come up the uterus →
1 mil sperm ipapasok sa uterus via catheter
○ Only 50 percent survives due to alkalinity of sperm
➢ In vitro fertilization → frozen eggs, frozen embryo
○ Meet of sperm and egg cells in a test tube or petri dish and
allows it to grow → implantation of embryo in the uterus
● If (+) Autoimmune - women can reject the frozen embryo.
➢ Method of Surrogacy
○ Implanting the uterine fertilized egg in another uterus
○ Transplantation of uterus → borrowing of uterus (temporary)
→ after pregnancy → removal of the uterus.
➢ Legal Adoption
○ via orphanage (last resort)
● Best reproductive age: 18 -35
● Eggs frozen → preservation of eggs
4. Cancer in Women
✔CANCER
● 3rd cause of death in the Philippines
✔BREAST
● #1 killer is the breast Cancer in the Philippines
○ Attack the reproductive ages and even the (elderly,
prone to Ca.
○ Nurse - preventive, HEALTH EDUCATION AND
HEALTH ASSESSMENT (BSE)
○ Diagnostic Test
a) MAMMOGRAM. (start at 40 YO) - Gold standard
for breast screening
b) MASTECTOMY- removal of breast, treatment of
breast cancer.
● monitored until youre a cancer survivor
➢ UTERUS
● Easiest to manage (remove the myoma) or remove the uterus
(HYSTERECTOMY)
➢ CERVIX
○ Cervical Cancer is preventable through VACCINE FOR
HPV (HPV can cause cervical cancer)
○ Vaccine for anti testicular cancer for boys is now
available
➢ OVARIES
● Worst cancer\Most serious (systemic or endocrine)
● (+) pain = late sign
LEGAL BASIS OF MCN PRACTICE
● RA 9173 - Philippine Nursing Law
○ Care of the pregnant women
○ Labor and Delivery
○ IE and suturing (as long as TRAINED & COMPETENT)
○ Care of newborn
○ NURSING BILL APPROVED BY CONGRESS
RECENTLY
● Important point of the bill: Advanced Practice Nursing
(APN)
○ Salary Grade 15: starting PHP 32k up to 36k
○ Advanced Practice Nursing
➢ 4 Classifications (A
1. Certified nurse midwives - can suture, episiotomy,
handle breech deliveries
2. Nurse anesthetist - can basically managed and assist
the doctor
3. Nurse practitioner - basically set ups a delivery clinic,
dialysis clinic, diabetes, psychiatric clinic,
4. Certified nurse specialist
Ex. Nurse in Pedia, Oncology, Headache
Nurse, Seizure Nurse etc.
APN in MCN
● Primarily can prepare her to be an independent practitioner
with birthing clinic
● RA 7600 - Rooming In Act
● RA 10028 - Expanded Breastfeeding Act
○ Breastfeeding Stations (100 or more employees
dapat may breastfeeding stations)
● RA 10354 - Responsible Parenthood and Reproductive
Health Law
○ Bemonc, Family Planning
○ May Give life saving drugs in the absent of the MD
(only if referred by the doctor).
● RA 11223 - Universal Health Law
○ Philhealth is the financial component
○ Hospital delivery - Php 6,500. 00
○ Community - Php 8,000.00
○ C/S - Php 19,000.00
○ Newborn Package - Screening and Hearing Test - Php
1,750.00
○ Note: Universal health law recognized obstetrics as
primary health.
● RA 11210 - Expanded Maternity Leave
○ 105 days
○ With 7 days paternity leave
○ With breastfeeding leave of at least 2 weeks
○ Not covered - Php. 950.00 - additional 28 disease
● RA 9288 - Newborn Screening act
○ 24 to 48 hours after birth
○ Philhealth covered- php 550 - for 6 original
○ Not covered - 950.00 – Additional 28 diseases
○ Total php 1,500.00
Process of collection of a few drops of blood heel not filter
paper
○ Ideally 24-48 hours after birth
○ Enables early detection and management of several
congenital disorders
○ May lead to mental retardation and or death if untreated
○ Early diagnosis: initiation of treatment and appropriate
long term care help ensure normal growth and
development of the affected child.
● RA 10968
● Philippine Qualification Framework Law
● National Policy
● Levels of education are assigned
○ Level 6 - Post Basic
○ Level 7- Certifications for competence, undergoing
trainings, master’s degree
 ■ IVT - Infusion therapy nurse (certification) (most
important)
■ DOH-MCN Certification
■ FP- Certification BEMONC (Basic Emergency
Mandatory Obstetric and Newborn Care).
● BEMONC - all pregnant women with
COMMON problems of pregnancy
■ MUST BE CERTIFIED BY BEMONC to put up a
clinic
■ Side Note on BEMONC (Top Rank CHN lecture
by Sir Daclis):
● Parenteral oxytocin (hemorrhage)
● Parenteral antibiotic (infection)
● Parenteral anticonvulsant (eclampsia)
● Parenteral steroids (preterm labor) -
increase lung maturity; betamethasone
● Assisted delivery
● Manual removal of placenta and retained
products of conception - may lead to toxic
shock
■ CEMOC on the other hand…
● Comprehensive Emergency Obstetrical
Care
● Blood transfusion and cesarean section
○ Level 8 - Expertise, doctorate degree
OTHER LEGAL BASIS
● DOH- A. Orders
○ Agencies that takes cares of the health of Filipino
people
1) AO 0025 - series of 2009
a) ENC (First embrace, UNANG YAKAP)
b) Revolutionized the care
c) Developing underdeveloped countries (Africa)
d) 4 time frames:
i) Drying: immediately after birth dry baby
(Circular motions from face down the back until
able to dry the whole body.)
ii) Skin to skin contact; on the mothers chest in a
prone position with a bonnet → while doing this
separation of placenta. (parallel to the mother)
○ Provides warm and bonding
iii) Cord clamping: cut the cord until pulsations
stops
e) Non time frames:
i) Creeds prophylaxis
ii) Vitamin K
● APGAR- Not breathing → cut the cord immediately →
suction → oxygenate
4. Human Waste Management (important)
○ DENR → local government
○ waste products are blood component → , DENR inspects
placental pits → Shouldn’t be near the water system so it will
not infect.
4) Executive order 141
● Addresses root cause of rising number of teenage
pregnancy and mobilizing government agencies to
implement strategies
● Baranggay level
a) Reproductive health Education
● Strategies looking for:
i) RA 10354: Responsible parenthood - there is
provision there that health education must start in
primary level
ii) Grade 4 to Grade 5 level (8-12 y.o): Teach children
about the process of reproductive system and how to
get pregnant to be cautious.
b) Look for teenage pregnant women
i. Why? They don’t seek help/check up.
ii. Bring to the Health Center
c) Functionality of violence against women and children
at barangay level
● Pag nagbuntisan mga bata → possible violent means the causes
rape or violence → If violence roccur → report to
VAWC(BARANGAY) charged for violence against
children
TEENAGE PREGNANCY
● Defined as “Children giving birth to Children”
● Walang karapatan bata manganak → it should, give them a
chance to play.
● Teenage mothers are classified:
1. 10-14 years old → EARLY; MORE COMPLICATION
2. 15-19 years old → late teenage pregnancy
● Legal age in the Philippines: 18 years old.
● Usual menarche: 8 years old above → 1-2 years should no coitus
→ NO touch and protect
RISKS OF TEENAGE MOMS
● Anemia
● Pregnancy related hypertension
● Childbirth related complication (underdeveloped pelvic floor) →
inc. chance of CS
○ Example: Cephalopelvic disproportion
● Mental Health → poorer; prone to postpartum depression
○ No resources available

iii) Anthropometric measure

RISK FOR BABIES
2) AO 0029 - series of 2008 - MNCHN (maternal and neonatal ● Preterm
child health nutrition) ● Low birth weight: (2 or 3 pounds)
● Severe neonatal complications → incubators, ventilator resource
3) AO 0012 - Series of 2012 - Birthing Center Requirements are diminished → asphyxia, RDS (respiratory distress syndrome)
1. It is a NB Screen Facility
○ hearing test → referred KEY POINTS
○ the birthing facility must have trained nurse to perform OB
newborn screening ○ Childbirth
○ Blood from the heel of the newborn ○ unique from other medical sciences
2. Clinical Services ○ Physiologic (Normal and expected), Time frame
a. Prenatal, Postpartum Care (predictable), 2 clients (Mother and fetus → fetus are
b. NSVD for low risk unseen client in pregnancy and difficult to manage because
c. detection of high risk → referral they don't talk → need mag depend on assessment skills.
d. Family Planning - natural and artificial except
Vasectomy, Tubal ligation, and D&C ● Main function of uterus
e. Life-saving medications → Antibiotics, Mgso4, Oxytocin 1. Menstruation → abnormal if no menstruation
for bleeding, dexamethasone for impending labor 2. Pregnancy and gestation
3. Personnel Important factors
a. Skilled Birth Attendant (SBA) → doctor, nurse, midwife 1. Prenatal care visits
b. Trained in BEMONC and Newborn resuscitation 2. SBA - skilled birth attendants
c. MOA with OB-Gyn and Pedia
i. Agreement with pedia and OB GYN 2 clients in Pregnancy:
- Mother
 - Fetus
● 27% - Prematurity @ birth
POINTS TO REMEMBER: ● 26% - Asphyxia @ birth
1. All women are at risk at childbirth, no matter how ● 10% Infection (Sepsis+Pneumonia)
complete the PNC visits may due to accidents such ● 9% Congenital anomalies
as: ● 2% Neonatal Tetanus
○ Amniotic fluid embolism → can enter the mothers maternal ● 2% Diarrhea
pulmonary circulation causing cardiovascular collapse
2. Masin goal of PNC → is a healthy pregnancy for mother
and child

PHILIPPINE PICTURE OF MATERNAL HEALTH

BARRIERS THAT LIMIT ACCESS TO QUALITY HEALTH

● 2000 CARE: THE THREE DELAYS
○ 209 maternal death rate
Delay in deciding Delay in Delay in
● 2006 to seek care receiving
identifying and
○ 162 maternal death rate appropriate care
reaching the
● 2012
appropriate
○ 221 maternal death rate
facility
● 2015
○ 127 maternal death rate
Failure to distance from Lack of health
● 2017 recognize the womans’ care providers
○ 121 maternal death rate danger sign: home to health - Shortage of
● Latest: - Lack of money facility supplies
● 114 maternal death rate - Unplanned/ providers - lack of
● United nation assembly unwanted - lack of equipment
○ Pledge for the target to: pregnancy emergency - lack of
- Lack of transportation competence
■ Decrease maternal death rate
companion in - lack of of health
■ Met at Geneva switzerland in order to pledge for going to health awareness of providers
this target facility existing - Weak
8 MDGs(2000 -2015) - Millennium Development - No person to services referral
Goals: take care of - lack of system
1. Poverty and Hunger children/home community
- Fear of being support
2. Primary Education
ill treated in
3. Gender Sensitivity and Empowering women health facility
4. Decrease child Mortality (achieved b’cause of EINC)
5. Improve Maternal Health - MMR by 52
6. Minimize HIV, Malaria, etc ● Incompetent → malpractice → negligence
7. Environmental Care ● Coordinate to barangay to prevent delay
8. Global Competitiveness
● Unable to meet the goal → #1 exporters of Health care workers SUSTAINABLE DEVELOPMENT GOALS
(PH) 1. No poverty
2. Zero hunger
After 15 years 3. Good health and well-being
- Sustainable Development Plan (2015 - 2030) SDG 3 : Ensure healthy lives and promote well being for all at
SDG #3 ages
● health, well being, illness ➢ Target 3-1 : Reduce maternal and mortality
● MMR to 70 by 2030 - Less than 70/100,000 LB
- No country should have an MMR >140/100,000
THE STATUS OF MATERNAL HEALTH ➢ Target 3-2: End all preventable death under 5
years of age
● Every day in 2020, 810 women died from preventable - Dec. NMR to at least as low as 12 per 1000 lbs
causes related to pregnancy and childbirth - Dec. Under 5 mortality at least as low as 25 per 1000
● Between 2000-2020 the MMR dropped by 34% worldwide lbs
worldwide
● 95% of all maternal deaths occur in low and lower middle 4. Quality Education
income countries 5. Gender equality
6. Clean Water and Sanitation
7. Affordable and Clean Energy
WHAT ARE PREGNANT WOMEN DYING FROM 8. Decent work and economic growth
9. Industry Innovation and Infrastructure
● 28% - Pre-existing medical conditions exacerbated by 10 . Reduced inequalities
pregnancy (such as diabetes, malaria, HIV, yung obesity) 11.Sustain cities and Communities
● 27% - Severe bleeding (still #1 in pregnant women) 12. Responsible Consumption and Production
● 14% - Pregnancy induced high blood pressure 13. Climate Action
● 8% Abortion complications 14. Life Below Water
● 9% - Obstructed labor and other direct causes 15. LIfe on Land
● 11% Infections (mostly after childbirth) 16. Peace,Justice and Strong INstitutions
● 3% blood clots 17. Partnerships for the goals

MCHN STRATEGY
Intermediate Goals

NEONATAL HEALTH: SCOPE OF THE PROBLEM

 Middle of the pyramid
Every pregnancy is Every pregnancy is
wanted, planned and adequately managed ● BEmONC: District hospitals and rural health units with
supported SBA’s, Private lying in clinics
○ Normal vaginal delivery
Every delivery is facility- Every mother and newborn ○ Imminent breech delivery
based and managed by pair secures proper ○ Emergency drugs antibiotics, MgSO4, oxytocin,
skills health professional postnatal care dexamethasone,
○ ENC
How will we make it happen? ○ Basic NB resuscitation
(current tools to avert maternal death and disability) ○ FP services
● A skilled healthcare professional → attends every child birth Bottom of the pyramid
● Every women has access to → Emergency Obstetric and ● Community level Service provider
Newborn Care (EmONC) ○ Pregnancy tracking
● Family planning services → to help women space their ○ birth planning
pregnancies ○ home visits & follow ups
○ nutrition package including breastfeeding support
CORE PACKAGES OF MNCHN ○ IEC on facility delivery and family planning
PRE PREGNANCY ○ communication activities targeted to mothers and their
● Iron and Folate supplementation : 3 months families
● Family Planning : 3-5 years
● Nutrition Counseling : For all malnourished and anemic INTEGRATED RMCAHN
● Dental Health Filipino women and men achieve their desired family size
● Deworming of women of reproductive health and fulfill the reproductive health and rights through
universal access to quality family planning information and
PREGNANCY (PRE-PREGNANCY) services
● 4 Prenatal Visits
● Iron and Folate Supplementation Every pregnancy is wanted, planned, supported, and
adequately managed throughout its course
● Iodine supplementation
● Tetanus immunization (TO prevent tetanus neonatorum)
Every newborn infant & child are provided with age
● Birth plan appropriate essential health and nutrition care packages.

DELIVERY (PRE-PREGNANCY, PREGNANCY) ADOLESCENTS informed & guided on health matter

● Health facility deliveries particularly reproductive health and nutrition services
● Skilled birth attendants
● EINC : Essential Intrapartum Newborn Care Every adult has access to correct & adequate information &
guidance on RH services including FP & protection from
● BEMONC - CEMONC services
VAWC

POSTPARTUM
(PRE-PREGNANCY, PREGNANCY, DELIVERY)
● Visit within 72 hours DAY 2
● 7th day postpartum EINC HAS TWO COMPONENTS:
● Vitamin A Supplementation 1. Mother- essential intrapartal care
○ 10k units for 4th month pregnant (2nd sem) 2. Child - essential newborn care
○ 200k units for postpartum
● Maternal Nutrition 5 COMPONENTS OF EINC
● Family planning 1. Mobility
● Lactation counseling ● Let woman ambulate in early labor
○ Breastfeeding is very important ● Walking Mobility- enhances descend of the fetus
● Postnatal visits with her baby ● Important to assess- the bag of water if intact
● If ruptured- let pt lay down because there's a
possibility of a prolapsed cord
NEWBORN CARE
(PRE-PREGNANCY, PREGNANCY. DELIVERY, POST
PARTUM, NEWBORN CARE)
2. Companion
● ENC
● Reduced anxiety and struggles are shared
● Routine Immediate Care
● Fear are diminished → having the muscles relaxed →
causing the cervix dilate faster
CHILD CARE
(PRE-PREGNANCY, PREGNANCY. DELIVERY, POST
3. Allow foods
PARTUM, NEWBORN CARE)
● Light carb rich foods (lucky me), to give energy to
● Immunizations
push during active and 2nd phase of labor
● Micronutrient supplementation (VIt A and Iron)
○ RA 11037
4. Pain meds / For Pain Relief
● Exclusive BF for 6 month
“No woman should suffer from pain”
● Sustained BF up to 24 months
● IMCI - pediatric clients
FOR PAIN
NON PHARMACOLOGIC
REPRODUCTIVE MATERNAL NEONATAL CHILD
ADOLESCENT HEALTH AND NUTRITION (MNCHN)
● Breathing Exercises (Deep Breathing) – relaxes the
SERVICE DELIVERY NETWORK abdominal muscle so labor progresses
Top of the pyramid ● Effleurage massage
● CEmONC: End Referral Facility ● Hot and Water to relieve pain (in other countries
○ End Referral Facility ( Provincial Hospitals etc): may chakuzi)
BEMONC services + BT,
○ CS and Advanced NB Resuscitation PHARMACOLOGIC (if pain is unbearable)
○ Operates 24 hrs ● Analgesics Opioids (Demerol,Nalbuphine,Nubain,
○ With OB/Surgeon, pedia nurse MW, med tech. Meperidine Chloride, Nalfudine)
 ○ IV fluids then opioids 2ND STAGE LABOR IN EINC
- give it only in the active phase (1st stage) ! Baby 1. Position of the woman (not lithotomy but upright)
should be able to perform the cardinal movements for Preferred-
mechanism of labor Squat- it widens outline diameter of the cervix
2. Allow the patient to bear down
Partograph ● Allow woman to push on her own will and accord
● Reduces complications during labor ● Just encourage proper pushing
● Detect early deviation from normal
● Monitors uterine contraction, cervical dilation, FHR, 3. No routine episiotomy (only done when vaginal is
progress of the rupture of the bag, type of secretions small)

Type of secretions:
- Amniotic fluid Mortal sin: fundal pressure
● C = Clear (Normal) (ruptured and clear)
● I = Intact (di pa ruptured) - uterus can rupture, abruptio placenta (due to trauma
○ If ruptured, look at the color. on the fundus) and can cause asphyxia in the
■ M = Meconium Fetal Distress newborn
- Baby may come out with fracture
■ B = Bloody (Possible Abruptio)
■ G = Golden (Possible blood
incompatibility) 3RD STAGE OF LABOR IN EINC
■ Y = Yellow (Possible Infection - 1. ACTIVE MANAGEMENT (after the birth of the baby
Chorioamionitis) inject oxytocin) → shortens the 3rd stage of labor which is
advantage for the mother kasi hindi mag bleed
1ST STAGE OF LABOR IN EINC Vernix- contains antimicrobial, keeps baby warm
- Check if the bag is intact (if normal)
- The cervix dilates at 1cm, 10 hours dapat nasa 2nd AMTSL (Active Management of the third period of labor)
stage na ● Administration of oxytocin after delivery
1. Movement\Mobility ● Uterine massage after placenta is expelled
a. will promote descent of the baby
2. Companionship ● Use of controlled cord traction, w/ counter traction
a. Recommended in prenatal\birth plan
b. Mother or Significant other Foot printing IS NO LONGER DONE
c. The moral support “nag sha share ang ● Was canceled by WHO d/t ↑ cross contamination
hirap mo sa partner mo” decreases anxiety ● Limit the number of IEs
and fear = relaxed muscle will promote faster ● Vagina has so much microorganisms, if u IE u
cervix dilation. basically give them a free ride to the cervix bla2
3. Non-pharmaceutical
4. Medication According to WHO and philippine statistics, most mothers
5. Partograph die due to:
a. Graphic tool used by SBA to monitor the first ❖ Bleeding w/in 24 hrs (3rd and 4th stage of labor) → uterine
stage of labor (only in the community setting) atony
***IMPORTANT IS CERVICAL DILATION IN ➢ If uterus not firm, massage gently to promote
- able to detect any deviation from normal uterine to contract → uterine will be firm
- Contains all the things to monitor in 1st stage → ➢ Pharmacologic management
Contraction, Fetal heart rate, progress of rapture the bag, ➢ IVF w/ Oxytocin
type of secretions in amniotic fluid (Clear), Meconium
(Bloody – rapture, Golden → blood incompatibility,
Yellow – infection)*** BEMONC
1. Parenteral antibiotics
Not done anymore: 2. Giving parenteral of oxytocin, Anticonvulsant
● IV 3. Manual removal of placenta
● Perineal shaving 4. Delivery of an imminent Breech presentation
● Enema 5. Removal of retained …….
● Lying down 6. Performance of EINC
● Routine episiotomy 7. Giving of steroids of preterm labor when in danger of
preterm labor
Positioning of woman:
● Upright position dapat CEMONC
● Squatting is “best” ● Is BEMONC with CS and BT
○ It widens the outlet diameter of the pelvis.
● Modified lithotomy position daw kasi bawal naman MNCHN
mag kneel sa hospital ● pregnancy must be planned
● Let woman push on her own accord “one she feels ● Prenatal
like it” ● SBA, delivery facilities
● “Let the patient choose her comfortable position” ● Follow up visits

Indicated episiotomy RANCHAN

- Episiotomy allowed only when small ang vagina or ● Reproductive health
something ● Kasama na ang non pregnant women and their
partners
Fundal pressure is BAWAL ● Adolescent health
● Possibility of rupture of uterus or abruptio placenta ● IE should be only about 5 during the duration of labor
● Causes fetal asphyxia
● Fractures on baby when they come out Causes of bleeding in pregnancy
● Fetal injury ● Abortion
● Ectopic pregnancy
 ● H. mole (molar pregnancy)
● Placenta previa Management:
● Abruptio placenta Px- contracted pelvis= CS, Episiotomy

Choriocarcinoma ● (hard) pelvis

● Monitored in H. mole (Hgc level)
● Give methotrexate to kill trophoblastic cells 3. PASSENGER
● Advice woman not to get pregnant for at least 1 year ❖ Fetus
➢ Malpresented: Transverse or breech
❖ Placenta
H mole ➢ Retained Placenta
● Is a pregnancy ❖ Amniotic fluid
● Is an abnormal zygote (abnormality in the ➢ Polyhydramnios or Oligohydramnios
chromosomes) ❖ Membranes
● Trophoblastic cells becomes disintegrated and fluid ➢ Premature Rupture
accumulation (molar cyst) ❖ Cord
● Causes bleeding, perforation, most fatal is ➢ Cord prolapse or Cord coil
choriocarcinoma
● D&C is done by doctor Hypotonic Contractions
○ Nurse assist doctor in D&C Common in multigravida and happens in active labor
○ Give oxytocin
○ post abortal care Management:
○ Advocate not to get pregnant at-least ● Massage Uterus
12months ● Induce Oxytocin

ADVOCACY OF NURSE:
Hypertonic Contractions
● Family planning
Common in Primigravida - strong, energetic muscles; occurs in
● Breastfeeding
latent phase

Bleeding in non-viable pregnancy: abortion, ectopic h-mole

Management:
❖ Sedate - valium or diazepam
Bleeding in viable pregnancy: placenta previa and placental
❖ Asleep - normal contraction
abruptio
❖ If still hypertonic when awake - OR CS
Complications: rupture of the uterus

DYSTOCIA - labor that goes in abnormal; slow, non-

progressive, difficult
Hypotonic contractions - mabagal; common in multigravida
and happens in active labor
Types of Dystocia
Hypertonic Contractions - galloping uterus (sunod sunod);
1. POWER –
common in primigravida and happens in latent phase
❖ voluntary (utrine contraction - hypotonic contraction: Dysfunctional- variable deceleration "mag contract, then
mabagal) mabagal"
❖ involuntary (voluntary pushing of the mother -
hypertonic contraction: galloping of the uterus “sunod
sunod”) PRESUMPTIVE
❖ Dysfunctional: variable declaration “mag contract, - Amenorrhea (di dinatnan)
then mabagal”
PROBABLE
Management: Augment or induction of labor - Positive pregnancy test

Iv fluid with D5LR and 1 amp oxytocin POSITIVE

- Ultrasound ( weeks
When to induce and augment? - Doppler (10-12 wks)
● Fetus should be in longitudinal lie
● Cephalic
● Head must be engaged Ectopic Pregnancy
● Pelvis must be adequate and not contracted ● Early stage of pregnancy, non-viable pregnancy
● Sight of ectopic: fallopian tube (ampulla)
● Product of conception / embryo did not implant in
2. PASSAGE uterus
● (soft) cervix and vaginal canal ● Due to PID - STD, IUD
● Characteristics:
● Ruptured - severe sharp pain radiating to
shoulder
■ Salpingectomy - remove WHOLE
tube
● Unruptured - on and off pain on one side
■ Medical treatment basta below 2
months: give methotrexate
■ Salpingostomy - binubutas lang
para kunin ang dead products
● Management: below 2 months methotrexate
(as long as the fetus is dead)

Abruptio Placenta
Premature Separation of placenta
 ❖ Commonly occurs in the third stage ● LH causes egg to chu2
❖ Main cause: severe hypertension (pwede ring trauma) ● Ovulation occurs alternately in the 2 ovaries
❖ Characteristic Sign: Painful bleeding, Hard contracting ○ Left this month, right next month
Uterus with bleeding ○ “mittelschmerz ” (pain on lower abdomen)
❖ Treatment: cesarean
MENSTRUATION - reproductive processes; all about
ABORTION hormones;
● Termination of pregnancy before viability (20 weeks) 2 cycles
● Major cause of bleeding Ovarian/follicular
● Cause Endometrial/luteal
○ Fetal - main; chromosomal abnormality Phases
○ Maternal 1. Proliferative phase - managed by estrogen
● Characteristic sign: Uterine cramping bleeding, open 2. Secretory phase - dominated by progesterone
cervix and ruptured BOW 3. Ischemic phase (together with menstrual →
● Management decreased progesterone and estrogen)
○ Incomplete: D and C 4. Menstrual phase
○ Threatened: bed rest, tocolytic
○ Habitual: cerclage ***The brain - ovary and uterus – hypothalamus (will
Involuntary - spontaneous abortion (Only allowed in secrete gonadotropic will secrete FSH and LH
philippines)
Voluntary - non spontaneous abortion / therapeutic FERTILIZATION
abortion / criminal abortion ● Can now be done outside woman’s body (IVF)

Management: Fertilize egg 3-5 days travel - 3-5 days uterine cavity - then
Habitual - cerclage implantation 7th day then ends on 10th day
● Threatened abortion - bed rest Other fertilized egg cannot reach the 7th day, wala na lost na
incomplete/missed - D&C ty

IMPLANTATION (7-10 days)

● Shake test tube with amniotic fluid ● Success of pregnancy depends on implantation
● LS ratio: Lecithin Sphingomyelin Ratio: 2:1 ● Begins 7th day ends 10th day
● Pulmonary function of the fetus ○ Some don’t survive to 10th day
■ Abortion
Pitocin drip: effect rupture of uterus (WOF)

ABORTION
CONTRACTIONS - Major cause of bleeding
- The termination of pregnancy before the age of
First stage: viability (20 weeks - 5 months) the fundus is at the
Latent phase (average) less than 20 seconds navel
Average 40 - active - In abortion can be classified in voluntary and
50 to 60 - Transitional phase involuntary
60> dapat second stage (Fully dilated) - Involuntary (Spontaneous) - di mo gusto
malaglag
FREQUENCY - Voluntary
Latent: 30 secs every 15 mins (Non-Spontaneous/Therapeutic/Criminal)
Active: 60 above every 2 mins duration - not allowed in PH
Transitional: Every 2 mins
Role of the nurse in VAWC:
- Documentation (Nurse will document in the book of
Rectal Pressure - sign for imminent delivery (no need IE) VAWC in ward, submitted to DSWD, they will locate
the abortionist and arrest them)
LACERATION
1st-2nd Laceration can be suture by trained midwives and
trained nurses Missed abortion
(R.A.7392) ● 2 weeks na patay
1st degree - Skin, fourchette skin, mucous membrane ● Dry amniotic fluid, brown secretions
2nd degree - muscle of the perineum, and vagina
3rd degree - muscle of the perineum, vagina and anus Missed abortion
4th degree - muscle of the perineum, vagina, anus, and -fetus is dead for 2 weeks, No HR, Dry Amniotic fluid, Non-
rectum Viable pregnancy

2 weeks or more - negative pregnancy test

5 REPRODUCTIVE PROCESSES J;
1. Ovulation
2. Menstruation Habitual abortion - two or more consecutive abortion
3. Fertilization Cerclage is done in the latter part (14-16 weeks) they do not
4. Implantation want to irritate the baby > increase contraction > death
5. Pregnancy
2 types: Shirodkar and Mcdonalds —> if mag labor na tastas ang
OVULATION tahi → NSVD
(n) regular ovulation
(n) “Ovulation occurs alternately sa dalawang ovario hindi Cerclage: Can be permanent or temporary depends sa laki
simultaneously”
Concepts:
● Woman should ovulate regularly
PREGNANCY INDUCED HYPERTENSION
Preeclampsia is unique in pregnancy
Characteristics CLASSIC SIGNS
1. Gestational hypertension
- no proteinuria
2. Pre-eclampsia (MILD OR SEVERE)
- proteinuria, pitting edema, - 130/90 MILD
ECLAMPSIA, severe diastolic is 100
● HTN and generalized edema with proteinuria
(3 classic sign)
Types:
1) MILD
- 130/90 below: OPD management
Management:
Diet – Low fat, High protein, Moderate salt
Activity – Limited; Provide rest
Medication – (hypotensive drugs) Methyldopa,
Hydralazine (fetus friendly), Nifedipine
2) Severe = DBP(diastolic BP) >100
- SEVERE: Admission - quiet environment,non-
stimulating
Primary Drug: MgSO4 (PREVENT SEIZURES)
a. Antidote: CALCIUM GLUCONATE
b. Measure the intake and output = 30 ml/hr
c. Given by IV push/soluset or IM
Diazepam
Hydralazine (Hypotensive drug)
Diuretic: Furosemide (Valium)
Preeclampsia Complication - Kidney failure
Severe preeclampsia
a. >200
b. Mngmt: admission
c. Quiet environment, non stimulating
d. MgSO4
e. Diazepam
f. Hydralazine (hypotensive)
g. Furosemide (diuretic)
h. Nurse function: medication administration
1. Must be able to give drugs safely
2. Loading dose: direct by IM or soluset
3. Succeeding dose: test for reflexes
a. (-) reflex, give Calcium gluconate
b. Check UO: at least 200 ml/24hrs??
Dapat basta hindi ma oliguria
ganon
3. Eclampsia
- Chronic hypertensive vascular disease (CHVD)
- Mother has been sick with HTN prior to pregnancy
- FHR = best way to assess fetus
- Non-Stress Test and Contraction StressTest
(oxytocin challenge test)
- CST - FHR vs Uterine contraction induced by oxytocin
- deceleration
If the woman becomes pre-eclampia severe
- Admit the woman - confine her to quiet environment
2. Primary Drug: magSul (PREVENT
SEIZURES)
a. Antidote: CALCIUM GLUCONATE)
b. Measure the intake and output = 30 ml/hr
3. Diazepam
4. Hypotensive: hydralazine
5. Diuretic: Furosemide
Measure the intake and output = 30 ml/hr
Prenatal: measurement of weight
1st Tri and 2nd Tri– 1 lb/month
3rd Tri – 1lb/week
Increase weight rapidly (cause: edema) - Automatic pre-
ec? hahaha
Early sign: edema
Late sign - proteinuria
● CST (Contraction Stress Test) - FHR vs Uterine
contraction induced by oxytocin - deceleration ←
uteroplacental insufficiency
- Normal is NO late decelerations
● NST (Non Stress Test) - FHR vs. FM - acceleration
- Normal is reactive
● Biophysical profile
- APGAR score of fetus (FHR, RR, fetal tone, amniotic
fluid volume)
(N) Presence of Late deceleration
Early Deceleration – Head Compression
Late Deceleration – utero placental insufficiency
Variable Deceleration – fetal distress/cord compress
Biophysical profile
● APGAR (Pag umiyak APGAR 9-10 daw sa kanila);
Crying baby is a breathing baby
● Heart rate
● Fetal movement
● Respiratory movements
● Fetal tones
● Amniotic Fluid Volume (At Least 1000 ml)
○ Less fluid - at risk
○ At least 1000mL
If the mother has Heart disease - assisted vaginal delivery
w/ forceps & epidural.
● Not allowed umire
● MAS BAWAL ANG CS sa kanya
● Di kakayayanin blood loss
RN 2023
S1- Davao City
1. Which of the following is a set of evidence based
standards recommended for adoption in the Philippine
hospitals for maternal and newborn care services and
birthing facilities by the DOH, Philhealth and WHO is?
a. Basic Emergency Obstetrical & Newborn Care
b. Sustainable Developmental Goal # 3
c. Maternal Newborn & Child Health Nutrition Delivery
Network
d. Essential Intrapartum and NB Care (EINC)
2. Which of the following is an effective tool for
reducing complications during labor especially in
autonomous birth settings for mother and fetus?
a. Regular monitoring of uterine contractions
b. Taking the fetal heart rate every 30
minutes thru electronic fetal monitoring
equipment
c. Using the Partograph
d. Taking maternal vital signs every 4 minutes
3. Based on WHO report, all are true on the status of maternal
health except which one?
a. The MMR has dropped considerably between
2000-2020 worldwide
b. Still there is a daily death of around 800 women
dying from accidents and unpreventable causes
related to pregnancy and childbirth
c. Most deaths occur in low-income countries
d. Women are dying of bleeding and pre existing
medical conditions
4. For pain relief during labor, which of the following is the
EINC practice?
a. Use of analgesics such as Meperidine Hcl
b. Use of non pharmacologic methods before pain
medications
c. Asking the woman to be in upright position to avoid
specifically sacral pain/ discomfort
d. Use of oxytocin to shorten labor and merely
shortening the suffering of the woman
5. To reduce bleeding post delivery, active management is
recommended. Which of the following are components of
AMTSL?
1. Administration of oxytocin after delivery
2. Injection of oxytocin after placenta is expelled
3. Uterine massage after placenta is expelled
4. Use of controlled cord traction, w/ counter traction
a.1 &2
b. 2 &3
c. 1,3 &4
d. 2,3 & 4
6. The following are the disadvantages of routine suctioning in
the newborn, EXCEPT?
a. May cause bradycardia and apnea
b. Causes mucosal trauma
c. clears airways and aids in babies who are
asphyxiated
d. associated risk for infection
7. These practices became popular in 2000 particularly in birth
settings. Which of the following Newborn practices increased
the risk of cross contamination among babies, the reason for
discontinuance of practice?
a. Suctioning
c. ID tags on the wrist
b. Foot printing
d. Oil bath
8. Which of the following is true in common vaginal infections?
a. Gonorrhea - characterized by creamy discharge,
treated by Flagyl.
b. Moniliasis – characterized by curd like secretions
treated antibiotics
c. Trichomoniasis – characterized by greenish, foul
secretions treated by Flagyl
d. Bacterial vaginosis – with greenish secretions
treated by Clotrimazole
9. Three hours after delivery, the fundus of the primiparous
client is at the midline firm. Upon inspection of the
perineum, the nurse notes blood in constant small trickles.
What is her initial nursing action?
a. Prepare for uterine inspection
b. Refer to the obstetrician
c. Assess for bladder distention
d. Inspect vulva for lacerations
10. Which of the following client statements indicates
successful teaching about episiotomy care?
a. “I’ll use hot, sudsy water to clean the episiotomy
area.”
b. “Wipe the area from front to back using a blotting
motion.”
c. “Before bedtime, I’ll use a cold water sitz bath.”
d. “I can use ice packs for 3 to 4 days after delivery.”
11. WHO and Philippine statistics on MMR state that most
mothers die due to:
a. During pregnancy due to preeclampsia, Previa etc.
b. Bleeding after 24 hours
c. Bleeding within 24 hours
d. Postpartum bleeding
12. These are the identified delays in safe motherhood;
EXCEPT:
a. Delay in seeking care due to non-recognition of
danger signs
b. Delay in reaching the appropriate health facility due
to poor roads or lack of transport
c. Delay in getting safe care due to unsafe practices
and misconceptions
d. Delay in receiving appropriate care in health facility
due to lack of skilled attendants
13. The overall program of the DOH to rapidly reduce maternal
and neonatal death is embodied in which program?
a. BEMONC
b. CEMONC
c. MNCHN
d. EINC/ Unang Yakap
14. Health Education is a very important competency of the
nurse. In giving advice and counsel on post abortal care the
following are emphasized, EXCEPT:
a. Change perineal pads every 4-6 hours
b. Wash perineum daily
c. Sexual relations may resume as soon as the
mother is comfortable
d. Advise to return for checkup if there is continued
bleeding for 2 days or increased bleeding
15. Based on the Philippines clinical guidelines for intrapartum
and immediate postpartum care, the total number of IE that a
woman receives during the course of labor should be limited,
to:
a. 1-3
b. 2 only
c. 6 or less
d. about 5
16. When assessing a client who had a D & C to expel a molar
pregnancy, which of the following would be an important
assessment of the nurse?
a. Urinary tract infection
 b. Hemorrhage a. Attach an external fetal heart monitor
c. Abdominal distention b. Inspect the client’s perineum for bulging
d. Chorioamnionitis c. Perform immediate vaginal examination
d. Ask the client whether her membranes have
17. After suction and evacuation of a complete Hydatidiform ruptured
Mole, the 28-year-old multigravida client asks the nurse when ● Ratio:
she can become pregnant again. The nurse would advise the
client not be become pregnant again for at least within which 25. In the postpartum period, the nurse anticipates that a
of the following? primipara with a second-degree laceration and repair is most
a. 6 months likely to develop:
b. 12 months a. Posterior vaginal varicosities
c. 18 months b. Difficulty voiding spontaneously
d. 24 months c. Delayed hospital or HCF discharge
d. Difficulty taking care of the newborn because of the
18. Dystocia causes mortality among mothers and pain
babies. In augmentation or induction of labor, the ● Ratio:
following criteria should be present:
1. Lie is longitudinal
2. Presentation must be cephalic 26. A nurse educator discusses the reproductive process to a
3. Can be performed in preterm labor when the head is group of student nurses. This is true in menstruation:
unengaged 1. The follicular phase is Day 1 of the cycle to Day 14 and is
4. The diagonal conjugate is 10 cm influenced by FSH and estrogen
a. 1 & 2 2. Before the luteal phase, the estrogen decreases as
b. 2 & 3 progesterone increases to effect ovulation
c. 1 & 3 3. The secretory phase enhances the endometrium to be
d. 2 & 4 thicker for possible implantation
4. Menstruation begins when both ovarian hormones
19. On arrival at the emergency department, a client tells the simultaneously decrease
nurse that she suspects that she may be pregnant but has a. 1 & 2
severe pain in the lower abdomen accompanied with a small b. 2 & 3
amount of bleeding. Her blood pressure is 70/50 mm Hg and c. 3 & 4
her pulse rate is 120bpm. The nurse notifies the physician d. 1 & 3
immediately because she suspects which of the following? ● Ratio:
a. Ectopic pregnancy
b. Abruptio Placentae 27. Abortion is classified as which of the following?
c. Gestational Trophoblastic Disease 1. Termination of the products of conception at 20 weeks
d. Complete Abortion gestation
20. A multigravida client at 34 weeks’ gestation on preterm 2. An expelled fetus weighing 500 gms and below
labor is prepared for the shake test on her amniotic fluid. The 3. Termination of products of conception at 20 weeks AOG and
nurse would inform the client that this test is will to evaluate the below
maturity of which of the following fetal systems? 4. Open cervix, intact BOW
a. Urinary a.1 & 2
b. Gastrointestinal b. 2 & 3
c. Cardiovascular c. 3 & 4
d. Pulmonary d. 1 & 4
● Ratio:
21. When a client is receiving Pitocin drip, the nurse, aware of
the adverse effects of this oxytocic drug, should carefully
28. These are true regarding missed abortion?
observe the client for:
1. Usually occur in early months of pregnancy
a. Increasing blood pressure
2. May have (-) pregnancy test after 2 weeks or more
b. Contractions with duration of 30 sec.
3. Shows signs of HPN/ Preeclampsia
c. A fetal heart rate of 120 to 150 beats per minute
4. Caused by extremes of ages in pregnancy
d. Contractions occurring more frequently than every
a. 1 & 2
2 min
b. 2 & 3
c. 1 & 4
22. A patient in labor asks the nurse about the cause of low
d. 2 & 4
back pain during labor. The nurse replies, “This occurs most
● Ratio:
often when the position of the baby is:”
a. LSA
b. LST 29. Which of the following are true in habitual abortion?
c. Mentum anterior 1. Loss of 2 or more non viable pregnancies
d. Occiput posterior 2. Possible cause cab be abnormalities in the uterus (short
cervix) or mother who is injected DES (diethylstilbestrol) while
23. The nurse inspects the perineum of a client admitted for pregnant with this woman
early labor. The client suddenly turns pale and says she feels 3. Cerclage is done early (6-8 weeks)
as if she is going to faint even while lying flat on her back. 4. Cerclage is always left in place permanently
Which of the following should be the immediate action of the a. 1 & 2
nurse? b. 2 & 3
a. Elevate her feet c. 3 & 4
b. Elevate her head d. 1 & 4
c. Turn her on her left side Ratio:
d. Start oxygen and IV fluids
30. The following are characteristics of PIH except?
24. While having contractions every 2 to 3 minutes with a. Signs usually disappear after birth of fetus and
duration of 60 to 90 seconds, a client complains of having placenta
rectal pressure. The nurse should: b. Increasing BP, pre, intra and post pregnancy
 c. Attributed to possible dietary deficiencies/ excesses b. Ask the woman to stop pushing down during the
in pregnancy delivery of the head and breathe rapidly with mouth
d. This is only seen in a pregnant woman. open
● Ratio: c. When crowning occurs, support the perineum with
a clean pad (ritgens maneuver)
d. Allow her to push as she wishes with contractions -
ask the mother to pant
31. The nurse understands that a positive oxytocin challenge
● Ratio:
test may be indicative of potential fetal compromise. The test
demonstrates that during contractions the fetal heart rate 38. A NICU nurse identifies the following as the handicaps of
shows: preterm babies:
a. A normal baseline 1. Immature immune system - last 2 months of pregnancy ang
b. Late decelerations pagpass ng antibodies
c. Early decelerations 2. Poor swallowing and sucking - immature GI system; feed
d. Variable decelerations breastmilk via NGT or dropper or cup
● Ratio: 3. Jaundice that occurs after 24 hours and last for 7 days -
Physiologic jaundice - after 24 hours lasting for 7 days (term
babies); after 24 hours lasting 2 to 3 weeks in preterm babies
32. To facilitate delivery in a client with class III heart disease,
Before 24 hours - incompatibility
the nurse would expect that the physician will probably:
Rh- - RhoGam
a. Use Pitocin induction
ABO - exchange transfusion
b. Use assisted vaginal delivery
4. Respiratory problems - insuffecient lung surfactant to
c. Schedule a cesarean delivery
support extrauterine life - ventilator assistance
d. Do nothing and let nature proceed
a.1, 2 and 3
● Ratio:
b. 2, 3 and 4
c. 1, 2 and 4
Situation: Elena, G1P0, was admitted at 8am to the Labor d. 4 only
Room. To monitor the progress of the labor, a Partograph was ● Ratio:
done.
39. What is the immediate action of the nurse, if after
33. The Partograph is focused primarily on the: delivery, the baby is floppy/ limp and not breathing?
a. Maternal and fetal conditions a. Suction the baby ASAP
b. Status of cervical dilatation b. Clamp and cut the cord and perform resuscitation -
c. The activity of fetal heart tones performed initially by nurse or midwife
d. The progress of the uterine contraction c. Provide oxygenation
● Ratio: d.Take immediate VS of the baby
● Ratio: EINC is applicable for breathing baby
34. To be able to assess a woman in labor competently, the
nurse must: 40. NB Screening is mandatory per RA 9288. Select the true
1. Be a licensed nurse statement:
2. Be a nurse midwife a. Done soon after birth
3. Must be trained in IE and Suturing b. Can be performed and collected by any SBA
4. Must be trained in accomplishing the Partograph c. Early diagnosis and treatment can help ensure
a. 1&2 normal growth and development - much more
b. 2&3 comprehensive
c. 2&4 d. Process of extracting blood from the NB to detect
d. 3&4 congenital disorders - done by certified and trained
● Ratio: NB
● Ratio:
35. This is not true in pregnancy:
a. Vaginal discharge becomes thick and 41. Which of the following would the nurse include as the most
acidic common contributing factor when teaching a multiparous
b. Some maternal body systems are altered by client who is 8 hours postpartum and diagnosed with a
pregnancy which is normal, temporary, and inevitable puerperal infection?
c. Pregnancy is a state of wellness, not an illness a. Maternal age older than 30 years
d. Edema and vascular congestion that may cause b. Frequent vaginal examinations during labor - do
nasal stuffiness and epistaxis is caused by estrogen not to exceed maximum of 5 IE, because it can
● Ratio: introduce infection even if the gloves is sterile;
another factor includes manipulation of the uterus;
36. Limiting the # of IE in labor results to decreased risk in catheterization; any intervention done such as
1. Thrombophlebitis forceps delivery and vacuum; laceration
2. Endometritis c. Spontaneous delivery of the placenta
3. Neonatal sepsis d. Maternal blood loss of 300 mL during delivery
4. Endometriosis ● Ratio:
a. 1&2
b. 2&3 42. A four days NSVD client visits the clinic complaining of
c. 3&4 excessive lochia rubra with clots. The physician orders
d. 1&4 Methylergonovine Maleate (Methergine), 0.2 mg
● Ratio: intramuscularly. Before administering this drug, which of the
following would the nurse need to assess?
37. This is the delivery process. Identify the wrong statement: a. Blood pressure
a. As soon as the head is out, apply gentle downward b. Pulse rate
pressure to deliver the anterior shoulder first followed c. Breath sounds
by posterior shoulder d. Bowel sounds
● Ratio:
 Primary oxitocic - oxytocin (pitocin) - IM, IV
Secondary, Methergine (Ergotrate) - oral, im, iv push;
not IV drip because it may cause increase rise in
blood pressure
Third, Misoprostol
43. Assessment of a multiparous client who delivered a
neonate weighing 8 lbs. by cesarean delivery an hour earlier,
reveals a soft fundus with excessive lochia rubra. Which of the
following would the nurse expect to include in the client’s plan
of care?
a. Administration of intravenous oxytocin
b. Placement of intravenous oxytocics
c. Rigorous fundal massage every 5 minutes
d. Preparation for an emergency hysteron-
myomectomy
● Ratio:
44. An NSVD multiparous client having persists lochia rubra of
moderate to heavy amount, visits the urgent care center 5
days after. She asks the nurse, “Why am I continuing to bleed
like this?” The nurse replies that this type of postpartum
bleeding is usually caused by which of the following?
a. Uterine atony
b. Cervical lacerations
c. Vaginal laceration
d. Retained placental fragments - chorion remnants
● Ratio:
45. When immediately after birth, a woman who just delivered
to twins develop severe chest pain and inability to breathe.
The nurse suspects _________ and acts to give immediate
oxygenation as the doctor is summoned.
a. Inversion of the uterus
b. Amniotic fluid embolism
c. Uterine rupture
d. Cardiac arrest
● Ratio:
46. The following are the recommended protocol for a woman
with severe preeclampsia, which one is not included?
a. Limit activities with bathroom privileges - is for
preeclampsia mild
b. Bed rest with reduced environmental stimuli in HCF
c. Admit to HCF with frequent monitoring
d. The main goal is to prevent generalized seizures
● Ratio:
47. Which of the following are associated with abruptio
placenta?
1. Couvelaine uterus
2. Hard, contracting uterus
3. HELLP syndrome (Hemolysis, Elevated Liver enzymes and
Low Platelets) - very specific in Preeclampsia
4. DIC
a.1 & 2
b. 1, 2 & 3
c. 3 & 4
d. 1, 2 & 4
● Ratio:
○ Abruptio placenta is the premature separation of
placenta
○ Cause: Hypertension, trauma, multiparity
○ It should be separated 3rd stage of labor called
abruptio
○ 95% occur in pregnancy
○ Characteristics: hard Uterus contracting
○ Types of abruptio Placenta:
a. Complete or partial
b. Marginal or central
48. Which of the following is the major cause of spontaneous
abortion in early pregnancy?
a. Stress
b. Trauma/accidents
c. Maternal infections
d. Chromosomal abnormality of the zygote -
unpreventable - can be genetic or anything that can
be? ; prepare for D and C
● Ratio:
Major/early - is very Critical
Late Preg - Abruptio & Previa
Causes of Abortion: can be fetal or Maternal may be genetics
(familial); destroy of zygote during the development
49. Which of the following would be the management if the
ectopic pregnancy is intact?
1. Administration of methotrexate
2. Salphyngectomy is necessary - X
3. Salphyngeostomy is done to preserve the tube
4. Injection of prostaglandins to expel products of conception
a.1 & 2
b. 2 & 3
c. 1 & 3
d. 3 & 4
● Ratio:
Management of ectopic pregnancy:
1. Administration of methotrexate
2. Do no remove fallopian tube-> only remove kapag
pubutok
3. Salpingostomy is done
4. Never inject prostaglandin
50. Which of the following is not a true statement in Diabetes
of pregnancy?
a. Oral hypoglycemic drugs are not advised (+)
b. An increase in the amount of insulin is needed
during the first trimester, when the woman
experiences N&V, anorexia
c. An increase with insulin requirement in
2nd and 3rd trimester when placental hormones
create resistance to insulin (+)
d. A decrease in the amount of insulin during
puerperium (+)
● Ratio:
○ Diabetes in pregnancy when sugar is not controlled.
○ Initial laboratory:
- CBC for blood typing and hemoglobin determine
- Hepa Screen
- ELISA Test for HIV
- Rapid plasma reagin (RPR) - for syphilis
- Urine test - bacteria, protein and sugar
Characteristic of Diabetes
○ Oral hypoglycemic drugs are teratogenic
○ Insulin is the safest drug - given during 2nd and 3rd
trimester -> Delivery: Stop giving insulin to prevent
hypoglycemia
51. When contractions begin to slow down and labor does
not progress, the nurse assesses this as:
a. Hypotonic contraction of the uterus, begin to
anticipate an Oxytocin Drip order from the doctor
b. Hypotonic labor that occurs primarily in the latent
phase among multigravidas
c. Hypotonic labor that occurs in the active phase and
a sedative is given to rest the uterus and recover it’s
contractility later
d. Hypotonic contraction of the uterus that is common
among primigravidas in the latent phase of labor
● Ratio: 57. On her 38 weeks’ gestation, a primigravid client with poorly
- Hypotonic Dystocia controlled Diabetes and severe Pre eclamsia is admitted for a
cesarean delivery. The nurse explains to the client that a
- Augment contractions with oxytocin drip
cesarian delivery helps to prevent hich of the following?
OPTION B :Hypertonic contraction is common in multigravida a. Neonatal Hyperbilirubinemias
OPTION C: Correct for multi and hypertonic and we give b. Congenital Anomalies
sedative c. Perinatal Asphyxia
OPTION D : Is wrong, Primigravida - hypertonic d. Stillbirth/ Abortion
● Ratio:
52. Identified risks of teenage pregnant mothers are:
● Macrosomia - poorly controlled diabetes
1. Pregnancy Induced Hypertension
● Fetus is prone to neonatal infection
2. Hemolytic Anemia (-)
● Shoulder Dystocia - naka bara yung head
3. Childbirth related complications
➔ Measure the fundic height (should be <30
4. Diabetes of Pregnancy (-)
cm)
a. 1 & 2
● Congenital anomalies – multi organ anomalies,
b. 2 & 3
usually heart disease.
c. 1 & 3
d. 3 & 4
58. Which is a major event that the nurse must be aware of if
● Ratio:
the BOW ruptures at 4cm in labor?
Not common in teenage pregnancy a. Uterine Infection
1. No diabetes b. Prolapse of the cord
2. No Placenta Previa c. Fetal distress
d. Spontaneous delivery of the baby
53. SDG # 3 ensures healthy lives and promote wellbeing for ● Ratio: O
all at all ages. Which is not a correct statement?
Community Setting
a. Decrease NMR to at least 12 per 1,000 LB
(+) If there is prolapse of the cord
b. Decrease under 5 deaths to at least 25 per 1,000 - Keep the cord moist using gauze and then refer → then
LB (+) immediate CS
c. No country should have an MMR >140 per 100,000
LB (+)
d. End all preventable deaths for all NB - Should be 59. As a Women’s Health Advocate, the nurses would teach
under 5 her women client that:
a. Cancer of the Cervix can be diagnosed by yearly
● Ratio:
Pap Smear of reproductive age women
b. Monthly self breast exam is highly predictive of
54. What does the RISK approach per BEMONC program in breast Ca among women aged 18-49 years old
pregnancy include? c. Still the best practice of women to screen Breast
a. Screening and referral during PNC Ca is a regular mammogram preferably beginning
b. All women are at risk at childbirth age 40 and beyond
c. All pregnant women must have at least 4 PNC d. Chemotherapy is always a management to women
visits with cancer regardless of age
d. All mothers should deliver in health facility ● Ratio:
● Ratio:
Option A: Pap smear: screening not diagnostic test
Option B: SBE: screening process
Option C: Mammogram: gold standard
55. As stated in the ENC protocol, the best way initially by Option D: Chemo, radiation, targeted txt, hormonal oral meds
which a baby is kept warm is:
a. Use of droplight 60. Which of the following are the assessment signs observed
b. Spreading the vernix caseosa and delaying giving by the RN in threatened abortion?
bath for 6 hours a. Closed cervix, ruptured BOW
c. Drying the skin thoroughly and putting a bonnet b. Closed cervix, spotting-NO IE
over the head c. Uterine cramps, spotting
d. Putting the baby on a skin to skin contact d. Closed cervix, intact BOW (bag of water)
● Ratio: ● Ratio:
- Target temp for nb: >36C The nurse cannot do IE, except in normal labor and there is no
- Incubator or radiant warmer if temp too low bleeding.

56. Amniotic fluid is a major accessory of pregnancy. Below 61. Which best defines family planning?
are characteristics of AF except: 1. Prevents unplanned pregnancies (+)
a. It progresses as pregnancy matures 2. Proper spacing of birth (+) (3-5 years)
b. It develops as soon as pregnancy commences 3. Limiting the number of children to 2 - wala sa law anf
c. The source of AF is fetal urine number of children
d. It is alkaline in nature and reacts to Nitrazine test 4. More opportunities to focus on career and family
● Ratio: a. 1 & 2
b. 3 & 4
- Amniotic fluid will form when fetus starts voiding since
c. 1 &3
its source is fetal urine (acidic) d. 1 &4
- Amniotic fluid: Alkaline and reacts to nitrazine test (N: ● Ratio:
500-2000 ml) 3 Role’s of nurse in Family Planning:
- >2000 ml = polyhydramnios 1. Motivator - to use methods to avoid unwanted
- <500 ml = oligohydramnios pregnancy for proper spacing
2. Counselor -
3. Service provider
 d. Rapid increase in weight gain, having gained 20 lbs
- Needs to be certified in the 1st and 2nd trimester
- Advocate breastfeeding ● Ratio:
- Pills (systemic effect) - for long term method OPTION A: is not severe. Mild only
- CONDOM is the key 🙂
OPTION B: expected; physiologic edema
- No method is 100% effective
- Abstinence during fertile period (because the woman OPTION C: just a minor discomfort
is in control with their body) OPTION D: nag bilis ng weight gain ni mother (we need 20-
- Hormonal (pills, implants, injectables)
25)
- Mechanical (IUD; 10-12 years)
- Barrier (condom, diaphragm - not common among
filipinos) 67. The nurse would primarily monitor Monique for which sign?
- Surgical (vasectomy and tubal ligation) a. Preterm contractions
b. Severe headaches
62. A woman feels a sense of wellbeing, increased need to c. Vital Signs
learn about fetal growth, development, passivity and d. Onset of seizures
introversion at which period or tern of pregnancy? ● Ratio:
a. First Trimester
OPTION D: can kill, most dangerous that’s why we are giving
b. Second Trimester
c. Third Trimester MgSo4
d. Postpartum
● Ratio: 68. For her PNC visits, this is the diet advised to Monique:
OPTION A: organogenesis, maternal bodily changes a. Low fats, low salt, low fiber
OPTION B: correct ans. b. Low fats, high salt, high fiber
OPTION C: maturity of the organ and preparation c. Low fats, low salt, high protein
of the birth d. Low fats, moderate salt, high protein
● Ratio:
63. The placental stage is considered to be a critical stage for It is the best diet
complications. Select the correct statement: (+)
a. Squeeze or massage the abdomen to deliver the 69. The action of MgSO4 (tocolytic) is classified as:
placenta a. Hypotensive drugs
b. Perform manual exploration of the uterus to expel b. Sedative
retained products c. CNS depressant
c. Never apply cord traction without doing counter d. Relaxes the uterus, avoids irritability of uterine
traction above the pubic area muscle
d. Do an IE to check if placenta is at the lower ● Ratio:
segment OPTION A: Hydralazine, Methlydopa, NifedipineV
● Ratio: OPTION B: Diazepam,Valium
OPTION A: OPTION C:
OPTION B: we are not recommending manual exploration. OPTION D: tocolytic agents → for preterm labor
OPTION C: do not pull placenta w/o counter traction 1. Terbutaline: DOC
OPTION D: not necessary 2. Yutopar
3. Indomethacin
64. These are signs of IMMINENT Delivery of the baby. At this If no mg sulfate, give sedative
point the mother is ready for the second stage, which is NOT a
sign? (-) 70. Monique complained of severe epigastric pain. Which of
a. Bulging of the perineum the following systems would the RN suspect as probably
b. Cervical dilation affected?
c. Pouting of the anus a. Nervous System
d. Gaping of the vulva and head visible b. Cardiovascular System
● Ratio: c. Respiratory System
OPTION B: Also present in the first stage d. GIT system
● Ratio:
Rupture liver capsule > pain > organs affected > nervous
65. Still, the foremost cause of maternal mortality is:
system > stroke > heart attack > cardiovascular > congestive
a. Bleeding due to wounds
heart failure > pulmonary edema or embolism > death
b. Bleeding due to atony
c. Bleeding due to bleeding disorders
71. A woman seeks consultation at the Birthing Clinic for PNC.
d. Bleeding due to placental problems
Upon history these are the findings: • Bleed at 3 months (1
● Ratio:
abortion) and subsequently lost baby
OPTION A: we can suture • Had twins born at 32 weeks, developed H-mole (kayawa) (2
OPTION B: cannot control? abortion) . Identify the OB score of this woman:
OPTION C: not common and not a focus a. G3P1 -01221
OPTION D: not due to? b. G4 P1 -01221
c. G3P2 -01121
Monique G1 P0, on her 35 weeks’ pregnancy is admitted for d. G4P2 -01221
BP 180/100, severe headache and blurred vision. She was ● Ratio:
placed on bed rest and MgSO4 is prescribed
GTPAL
Gravida- all pregnancy that reached the age of viability
66. Which of the following would you anticipate in her maternal
Para- number of pregnancies that reached term
history?
a. Consistent BP of 130/80 mmHg
● G- 4
b. Edema in the morning and becoming more
● T-
pronounced in the evening
c. Frequent headache, constipation
● T- 0
 ● P- 1
● A-2
● L- 2
● M- 1
72. One of the most important strategies taught to the mother
of a preterm baby is KMC. When can KMC be started?
a. When the baby has reached 2500gms weight or
more
b. As soon as possible after birth after 90 minutes
c. When the baby breathes spontaneously and is free
of life threatening disease or malformations
d. When the baby’s VS are within normal range.
● Ratio:
73. Infertility is on the rise. This is a false statement:
a. Unable to become pregnant after a year of regular
sex
b. Menstrual disorder maybe a possible cause
c. Can be caused by proliferation of endometrial cells
in the uterine lining
d. Can develop due to various follicles in the ovary
● Ratio:
OPTION C: It should be outside the uterus (endometriosis)
74. MNCHN has been expanded to RMNCAHN to achieve it’s
goals. These concepts are integrated in the program:
a. Pregnancy, Childbirth
b. Nutrition, Child health
c. Adolescent health, Family Planning, Violence vs
Women & Children (VAWC)
d. All of these
● Ratio:
75. In the process of birth, these are true except: (-)
a. Involuntary contractions are used primarily to expel
fetus & placenta but assisted by voluntary bearing
down by the mother in the 2nd stage
b. Any fetus will be able to undergo the birthing
process
c. As the woman progresses in labor, her body adopts
to the process of birth
d. Cardinal movements of labor are the movements
done by the fetus to expel himself thru the birth canal
● Ratio:
OPTION B: healthy fetus undergo birthing process
76. Which of the following is the main goal of obstetrics about
which as a nurse midwife, you collaborate with the health
team in the community?
a. Reduce maternal mortality to 70 per 100,000 LB by
203
b. Minimize maternal and infant mortality rate
c. Ensure that every pregnancy be healthy and
attended by a SBA in a HCF
d. Every mothers’ pregnancy is planned
● Ratio:
- Main goal is to keep the pregnancy healthy
77. In the case of the woman in labor, which of the following
are the identified trends?
1. Mobility of the woman in labor to promote descent of
the fetus
2. Enema is encouraged to present a clean delivery
environment
3. Allowing the woman in labor to take calorific foods but
easily digestible in early labor
4. Opening the blood lines upon admission by insertion of IVF
for any eventuality.
a. 1 & 2
b. 3 & 4
c. 1, 2 & 3
d. 1 & 3
● Ratio:
2 & 4 are correct but not practive anymore
The mother needs food for energy
78. All BUT one of the following are the evidence based
advantages of a woman in upright position in labor: (-)
a. Promotes fetal descent
b. Stronger and more efficient uterine contractions
that would efface and dilate the cervix
c. Compression of the major vessels results and
decreases placental perfusion
d. Frequent changes relieve fatigue, increase comfort
improve circulation
● Ratio:
79. Which of the following is the most important Nursing
intervention aimed at preventing preterm birth?
a. Avoiding sexual activity between 24 weeks – 37
weeks
b. Limiting the number of hours of standing and doing
house chores
c. Educating pregnant women about the early
symptoms of preterm labor and prompt referral
d. Taking tocolytic drugs as prescribed when signs
appear
● Ratio:
- A,B,D are correct but prevention ang hinahanap
- Important role of the nurse is educating
80. The nurse monitors the mother closely for signs of
cardiac overloading right after birth. The nurse knows that
this is due to:
a. Increased diuresis of about 3000 ml/day
b. Hypercoagulability due to high thrombic factors
c. Rapid return of blood flow to general circulations
d. Rapid release of amniotic fluid of approximately
2000ml.
● Ratio:
81. If on the first postpartum day, the primiparous client
complains of perineal pain unrelieved by Ibuprofen 400 mg
given 2 hours earlier, which of the following will the nurse
assess for?
a. Puerperal infection
b. Vaginal lacerations
c. History of drug abuse
d. Perineal hematoma
● Ratio:
OPTION D: pain that is not relieve by analgesics, tastas then
resuture.
- The blood vessels is not thoroughly ligated causes
hematoma
82. The nurse palpates the fundus of a primiparous client 12
hours postpartum, and finds it firm, above the umbilicus, and
deviated to the right. Which of the following will she do next?
a. Document this as a normal finding in the client’
record
b. Contact the physician for an order for
Methylergonovine
c. Encourage the client to ambulate to the bathroom
and void.
d. Gently massage the fundus to expel the clots.
● Ratio:
Distended bladder is the one who pushes the fundus
BUBBLE SHE
B-breast
U-uterus
B-bladder
B-bowel
L- lochia
E- episiotomy
S- skin
H- homan’s sign (DVT)
E- Emotionality - postpartum blues, depression, psychosis
83. 28 hours after cesarean delivery, a multiparous
breastfeeding client complains of severe postoperative
cramping pains. The nurse explains that these are caused by
which of the following?
a. Flatulence accumulation after a cesarean delivery.
b. Healing of the abdominal incision after cesarean
delivery.
c. Side effects of the medications administered after
delivery
d. Release of oxytocin during the breast-feeding
session.
● Ratio:
- Educate the physiology of Breastfeeding
3 organs that are interconnected
- Brain - anterior pituitary gland= secretes prolactin and
will develop the milk
- Breast - Let down reflex - suck
- Contracts the uterus - hypogastric pain = cramping
84. A 25-year-old primiparous 2 hours postpartum has decided
to breast-feed her neonate. Which of the following would the
nurse expect to address in the teaching plan about preventing
nipple soreness?
a. Keeping plastic liners in the brassiere to keep the
nipple drier.
b. Placing as much of the areola as possible into the
baby’s mouth
c. Smoothly pulling the nipple out of the mouth after
10 minutes
d. Removing any remaining milk left on the nipple with
a soft washcloth
● Ratio:
Mastitis is the 2nd most common infection in postpartum
Teach proper latching
85. A primiparous client delivered by cesarian section, a
4,000g (4pounds 13 oz.) neonate. She asks you, “If I get
pregnant again, will I need to have a cesarean?” Which of the
following will you bear in mind about vaginal birth after
cesarean delivery (VBAC)?
a. VBAC may be possible if the client has not had a
classic uterine incision.
b. A history of rapid labor is a necessary criterion for
VBAC.
c. A low transverse incision contraindicates the
possibility for VBAC
d. VBAC is not possible because the neonate was
large for gestational age.
● Ratio:
3 types of CS
1. CLASSIC - always a cesarean (incision will affect
uterine contraction)
2. Low transverse
3. Bikini/pfannenstiel - can have NSVD on Vaginal
Birth After Cesarean
Marina, G7P5 is admitted to the hospital in labor. at 1 pm
Cx=6-7cm, BOW intact
86. What is the nurse’s assessment re: Marina’s condition?
1. She is in active labor
2. She will deliver at approximately 4pm
3. She may go into hypotonic contractions
4. The RN must be alert in testing for the presence of the
Bandl’s ring
a. 1 & 2
b. 2 & 4
c. 1, 2 & 3
d. all but 3
● Ratio:
87. On which among these cases, can VBAC be done?
1. G2P1 – 1st pregnancy diagnosed as inlet contraction
2. G2P1 – 1st pregnancy – fetus did not lighten or engage
3. G2P1 – mother had history of severe preeclampsia
4. G2P1 – mother had prolonged labor and now has active
herpes lesion
a. 1, 2 & 3
b. 2, 3 & 4
c. 1 & 4
d. 3 only
● Ratio:
88. A woman in Active labor was given an epidural anesthesia
by the doctor. The nurse knows that hypotension and pruritus
are side effects. As she anticipates insertion of IV fluid, which
of the following will she prepare?
a. Meperedine Hcl - analgesic
b. Butorphonol - anesthetic
c. Promethazine - Antiemetic
d. Diphenhydramin -> anti allergy
● Ratio:
89. A pregnant woman 35 weeks, presents to the Family Care
Nursing Unit. She complains of fluid leaking from her vaginal
orifice but is unsure whether that is fluid or urine. The RN in
charge would:
a. Examine vulva and performs an IE to determine
whether labor has began
b. Performs Nitrazine test to check for PH (N pH: 7.1-
7.3)
c. Proceeds to collect sample amniotic fluid and
sends it to the lab for fern test for positive diagnosis
of ruptured bag
d. Continue assessing the mother and tell her to
observe color and odor of fluid daily
● Ratio:
90. Death of an infant at any time during pregnancy is
devastating to the family. By which of the following is this
event managed? (PSYCHOLOGICAL)
1. Use a symbol on the mother’s room and chart to make all
staff aware of the loss
2. Allow the parents to see and inspect the baby as soon as
possible
3. Prepare the parents for the baby’s appearance
4. Tell the parents that it is okay to lose a baby, future
pregnancies can occur
a. 1, 2 & 4
b. 1, 2 & 3
c. 2, 3 & 4
d. 1, 3 & 4
● Ratio:
DON'T say to the mother that it is okay to lose a baby
91. You are the nurse assigned at the LR-DR complex. This
question “How do I know that my labor is progressing” is
expected. Your answer is?
a. “Your uterine contractions will be monitored
regularly”
b. “The heart rate of your baby will be taken every 30
minutes “
c. “Your cx will be measured regularly to check its
progress and plotted in the Partograph. We will
inform you of such progress or deviation."
d. “Everything will be alright; you feel it don’t you?”
● Ratio:
Cervical dilatation measurement - most accurate
92. Which pelvic inlet measurement directly causes CPD and
needs to be measured indirectly?
a. OB conjugate -> 10 cm
b. Diagonal conjugate -> 11 cm
c. Bispinous diameter -> 10 cm
d. Transverse diameter of the inlet - cannot be
measured
● Ratio: c. The mother may push gently as assisted vaginal
By taking the measurement of the diagonal conjugate by doing birth is done under epidural anesthesia
d. Most dangerous period is between 28-32 as the
IE
blood volume peaks at this time
● Ratio:
93. While watching her preterm infant son in the neonatal
- We never ask the woman to push if epidural
intensive care unit, a mother exclaims, “My baby is so little.
anesthesia is given
How will I ever care for him?” The nurse should explain to the
mother that she:
99. In the proposed nursing law, APN is advocated. Which of
a. Can watch his care to assist her in becoming
the following is true of the APN in the field of OB?
familiar with the specific routine
a. The RN is competent, with extended years of
b. Should find someone with training in preterm care
experience and can handle abnormal cases
to help her at home the first week
b. The RN is a nurse clinician, who has specialized in
c. Will be able to care for him in a special nursery for
high risk pregnancies and babies, and is a trainer in a
a few days prior to his discharge
medical center.
d. Will be encouraged to participate in his care as
c. The RN is autonomous in her practice, setting up
much as possible from the beginning - To increase
her own birthing clinic in a community, making
confidence
judgment calls and collaborating with the health team
● Ratio:
d. The RN becomes a nurse midwife, has worked for
at least 5 years in an MCN unit
● Ratio:
94. The nurse observes a postpartum client’s behavior but
cannot decide whether the client is anxious about her baby or 100. A nurse is conducting a mothers’ class in the prenatal
is experiencing postpartum depression. The client’s behaviors clinic, there is need to convince the mothers to breastfeed.
that would clarify this confusion for the nurse would be: One mother asks for the benefit of BF over bottle feeding. The
a. Decreased appetite, crying and insomnia nurse replies that there is one major group of substances in
b. Long periods of sleep, lethargy, and anorexia human milk that cannot be duplicated in any milk formula.
c. Ambivalence, lethargy, and increased appetite Which of the following is this?
d. Increased appetite, insomnia, and ambivalence a. Taurine
● Ratio: b. Plenty of albumin
If not addressed it will go to psychosis c. Essential ions
d. Gamma Globulins
95. The nurse would know that a client taking oral ● Ratio:
contraceptive understood the teaching about estrogen when We cannot give antibodies in the breastmilk - IgG
the states indicates that the most common side effect of
estrogen would be:
a. Amenorrhea
b. Hypomenorrhea
c. Nausea and vomiting
d. Depression and lethargy
● Ratio:
○ Estrogen Pills: S/E = Headache, weight gain, N&V
○ Go back to HCP to change/lower dosage of estrogen
that will be good for you

96. The Nurse who works in the labor and delivery units must
become skilled at recognizing drug induced signs and
symptoms. During assessment the following are signs
observed by the nurses EXCEPT:
a. Lethargic response, hypertension, increased
temperature
b. Tachycardia, hypermobility of the fetus
c. Sudden onset of severely painful contractions
d. Emotional lability, dilated pupils
● Ratio:
Withdrawal symptoms

97. The nurse as a clinician knows that Methotrexate, a

chemotherapeutic agent is given also in pregnancy. Which of
the following obstetrical conditions is this used?
a. Ectopic pregnancy and abruptio placenta
b. Previa and missed abortion
c. Ectopic pregnancy and H-mole
d. H-mole and preeclampsia severe
● Ratio:
- To conquer trophoblastic cells in H-Mole

98. Cardiovascular disorders in pregnancy are threats to

morbidity and mortality. Select the false statement on this
condition:
a. Danger occurs due to increased blood volume that
may overload the heart +
b. Maternal organs are no longer perfused adequately
+