NAME: _______________________________________ DATE:______________________ SCORE: _________ OB Set 1 BY: JEMIMA R. JACOT, BSN, RN
SITUATION 1: Aling Julia, a 32 year old fish vendor from Barangay Matapat came to see you at the prenatal clinic. She brought with her all her three children. Rose, 1 year & 6 months, Joy, 3 and Mike, 7 years old. She mentioned that she stopped taking oral or al contraceptives several months ago and now suspects she is pregnant. She cannot remember her LMP.
6. When teaching Aling Julia about her pregnancy, you should include personal common discomforts. Which of the following is an indication for prompt professional supervision? A. Constipation and and hemorrhoids B. Backache C. Facial edema D. frequent urination 7. Which of the following statements would be appropriate for you to include in Aling Julia's prenatal teaching plan? A. Exercise is is very tiresome, it should be avoided B. Limit your food intake C. Smoking has no harmful effect on the growth and development of fetus D. Avoid unnecessary fatigue, rest periods should be included in your schedule
1. Which of the following would be useful in calculating Aling Julia's EDC? EDC? A. Appearance of linea negra B. First FHT by fetoscope C. Increase pulse rate D. Presence of edema
8. Which of the following is the best advice you can give gi ve to Aling Julia regarding prevention of varicosities? A. Raise the legs legs while in upright position and put it against the wall several times a day B. Lay flat for most hours of the day C. Use garters with nylon stocking D. Wear support hose
2. Which hormone is necessary for a positive pregnancy test? A. Progesterone B. HCG C. Estrogen D. Placental Lactogen
9. In a 32 day menstrual cycle, ovulation usually occurs on the: A. 14th day after menstruation B. 18th day after menstruation C. 20th day after menstruation D. 24th day after menstruation
3. With this pregnancy, Aling Julia is a: A. P3 G3 B. Primigravida C. P3 G4 D. P0 G3
10. Placenta is the organ that provides exchange of nutrients and waste products between mother and fetus. This develops by:
4. In explaining the development of her baby, you identified in chronological order of growth of the fetus f etus as it occurs in pregnancy as: A. Ovum, embryo, zygote, fetus, infant infant B. Zygote, ovum, embryo, fetus, infant C. Ovum, zygote, embryo, fetus, infant D. Zygote, ovum, fetus, embryo, infant 5. Aling Julia states she is happy to be pregnant. Which behavior is elicited by her during your assessment that would lead you to think she is stressed? A. She told you about her drunk husband B. She states she has very meager income from selling C. She laughs at every advice you give even when it’s not funny D. She has difficulty following instructions
A. First month B. Third month C. Fifth month D. Seventh month 11. In evaluating the weight gain of Aling Julia, you know the minimum weight gain during pregnancy is: A. 2 lbs/wk B. 5 lbs/wk C. 7 lbs/wk D. 10 lbs/wk 12. The most accurate method of measuring fundal height among the following is: A. Millimeter B. Centimeter C. Inches D. Fingerbreadths
13. To determine fetal position using Leopold's maneuvers, the first maneuver is to: A. Determine degree of cephalic flexion and engagement B. Determine part of fetus presenting into pelvis C. Locate the back,arms and legs D. Determine what part of fetus is in the fundus 14. Aling Julia has encouraged her husband to attend prenatal classes with her. During the prenatal class, the couple expressed fear of pain during labor and delivery. The use of touch and soothing voice often promotes comfort to the laboring patient. This physical intervention is effective because: A. Pain perception is interrupted B. Gate control fibers are open C. It distracts the client away from the pain D. Empathy is communicated by a caring person 15. Which of the following could be considered as a positive sign of pregnancy? A. Amenorrhea, nausea, vomiting B. Frequency of urination C. Braxton hicks contraction D. Fetal outline by sonography SITUATION 2: Wide knowledge about different diagnostic tests during pregnancy is an essential arsenal for a health care provider to be successful. 16. The Biparietal diameter of a fetus is considered matured if it is at least: A. 9.8 cm B. 8.5 cm C. 7.5 cm D. 6 cm 17. Quickening is experienced first by Multigravida clients. At what week of gestation do they start to experience quickening? A. 16th B. 20th C. 24th D. 28th 18. Before the start of a Non-stress test, The FHR is 120 BPM. The mother ate the snack and the practitioner noticed an increase from 120 BPM to 135 BPM for 15 seconds. How would you read the result? A. Abnormal B. Non-reactive C. Reactive D. Inconclusive, needs repeat 19. When should you expect to hear the FHR using a Fetoscope? A. 2nd week B. 8th week
C. 2nd month D. 4th month 20. When should you expect to hear FHR using Doppler Ultrasound? A. 8th week B. 8th month C. 2nd week D. 10th week 21. The mother asks, what does it means if her maternal serum Alpha Feto Protein is 35 ng/ml? You should answer: A. It is normal B. It is not normal C. 35 ng/ml indicates chromosomal aberration D. 35 ng/ml indicates neural tube defect 22. Which of the following mothers needs RHOGAM? A. RH + mother who delivered an RH - fetus B. RH - mother who delivered an RH + fetus C. RH + mother who delivered an RH + fetus D. RH - mother who delivered an RH – fetus 23. Which family planning method is recommended by the Department of Health more than any other means of contraception? A. Fertility Awareness Method B. Condom C. Tubal Ligation D. Abstinence 24. How much booster dose does tetanus toxoid vaccination for pregnant women has? A. 2 B. 5 C. 3 D. 4 SITUATION 3: Reproductive Health is the exercise of reproductive right with responsibility. A married couple has the responsibility to reproduce and procreate. 25. Which of the following is ONE of the goals of the reproductive health concept? A. To achieve healthy sexual development and maturation B. To prevent specific RH problem through counseling C. Provide care, treatment and rehabilitation D. To practice RH as a way of life of every man and woman 26. Which of the following is NOT an element of the reproductive health? A. Maternal and child health and nutrition B. Family planning C. Prevention and management of abortion complication
D. Healthy sexual development and nutrition 27. In the international framework of RH, which one of the following is the ultimate goal? A. Women's health in reproduction B. Attainment of optimum health C. Achievement of women's status D. Quality of life 28. Which one of the following is a determinant of RH affecting woman's ability to participate in social affairs? A. Gender issues B. Socio-Economic condition C. Cultural and psychosocial factors D. Status of women 29. In the Philippine RH Framework, which major factor affects RH status? A. Women's lower level of literacy B. Health service delivery mechanism C. Poor living conditions lead to illness D. Commercial sex workers are exposed to AIDS/STD. 30. Which determinant of Reproductive Health advocates nutrition for better health promotion and maintain a healthful life? A. Socio-Economic conditions B. Status of women C. Social and gender issues D. Biological, Cultural and Psychosocial factors SITUATION 4: As a midwife, one should be aware of the different reproductive problems. 31. When is the best time to achieve pregnancy? A. Midway between periods B. Immediately after menses end C. 14 days before the next period is expected D. 14 days after the beginning of the next period 32. A factor in infertility maybe related to the pH of the vaginal canal. A medication that is ordered to alter the vaginal PH is: A. Estrogen therapy B. Sulfur insufflations C. Lactic acid douches D. Na HCO3 douches 33. A diagnostic test used to evaluate fertility is the Postcoital test. It is best timed: A. 1 week after ovulation B. Immediately after menses C. Just before the next menstrual period D. Within 1 to 2 days of presumed ovulation 34. A tubal insufflation test is done to determine whether there is a tubal obstruction. Infertility caused by a defect
in the tube is most often related to a: A. Past infection B. Fibroid Tumor C. Congenital Anomaly D. Previous injury to a tube 35. Which test is commonly used to determine the number, motility and activity of sperm is the: A. Rubin test B. Huhner test C. Friedman test D. Papanicolau test 36. In the female, Evaluation of the pelvic organs of reproduction is accomplished by: A. Biopsy B. Cystoscopy C. Culdoscopy D. Hysterosalpingogram 37. You are caring for a woman in labor. The woman is irritable, complains of nausea and vomits and has heavier show. The membranes rupture. The midwife understands that this indicates: A. The woman is in transition stage of labor B. The woman is having a complication and the doctor should be notified C. Labor is slowing down and the woman may need oxytocin D. The woman is emotionally distraught and needs assistance in dealing with labor SITUATION 5: Anna, a 32 year old, Primigravida at 39-40 weeks AOG was admitted to the labor room due to Hypogastric and Lumbo-Sacral pains. IE revealed a fully dilated, fully effaced cervix. Station 0. 38. She is immediately transferred to the DR table. Which of the following conditions signify that delivery is near? 1 - A desire to defecate 2 - Begins to bear down with uterine contraction 3 - Perineum bulges 4 - Uterine contraction occur 2-3 minutes intervals at 50 seconds duration A. 1, 2, 3 B. 1, 2, 3, 4 C. 1, 3, 4 D. 2, 3, 4 39. Anna complains of severe abdominal pain and back pain during contraction. Which two of the following measures will be MOST effective in reducing pain? 1 - Rubbing the back with tennis ball 2 - Effleurage 3 – Imagery
4 - Breathing techniques A. 2, 4 B. 2, 3 C. 1, 4 D. 1, 2 40. Which is NOT the drug of choice for Epidural anesthesia? A. Sensorcaine B. Xylocaine C. Ephedrine D. Marcaine SITUATION 6: Belle is admitted to the hospital with the following signs: Contractions coming every 10 minutes, lasting 30 seconds and causing little discomfort. Intact membranes without any bloody shows. Stable vital signs. FHR = 130bpm. Examination reveals cervix is 3 cm dilated with Vertex presenting at minus 1 (-1) station. 41. On the basis of the data provided above, you can conclude that Belle is: A. In false labor B. In the Active phase of labor C. In the Latent phase of labor D. In the Transitional phase of labor 42. Pitocin drip has been started on Belle. Possible side effects of Pitocin administration include all of the following, except: A. Diuresis B. Hypertension C. Water intoxication D. Cerebral hemorrhage 43. The normal range of FHR is approximately: A. 90 to 140 bpm B. 120 to 160 bpm C. 100 to 140 bpm D. 140 to 180 bpm 44. A negative 1 (-1) station means that: A. Fetus is crowning B. Fetus is floating C. Fetus is engaged D. Fetus is at the Ischial spine 45. Which of the following is the characteristic of False labor: A. Bloody show B. Contraction that are regular and increase in frequency and duration C. Contraction are felt in the back and radiates towards the abdomen D. None of the above
46. Whose theory of labor pain that states that PAIN in labor is caused by FEAR: A. Bradley B. Simpson C. Lamaze D. Dick-Read 47. Which sign would alert the midwife that Belle is entering the second (2nd) stage of labor? A. Increase frequency and intensity of contraction B. Perineum bulges and anal orifice dilates C. Effacement of internal OS is 100% D. Vulva encircles the largest diameter of presenting part 48. Important care during the second stage of labor should include: A. Careful evaluation of prenatal history B. Coach breathing, bear down with each contraction and encourage patient. C. Shave the perineum D. Administer enema to the patient 49. According to the WHO, when should the mother start breastfeeding the infant? A. Within 30 minutes after birth B. Within 12 hours after birth C. Within a day after birth D. After infant's condition stabilizes 50. The major cause of maternal mortality in the Philippines is: A. Infection B. Hemorrhage C. Hypertension D. Other complications related to labor, delivery and puerperium Situation 7: As a midwife, you should be able to respond to certain cases in different settings. 51. A client is in the second (2 nd) stage of labor and has been pushing for almost an hour. Which of the following interventions is the most appropriate for the client as this stage? A. Offer clear fluids in between contractions B. Encourage ambulation C. Instruct the client to push with each contraction D. Encourage frequent changes in position. 52. Your colleague calls you into a labor room as Sara’s baby is about to be born and she wants a second midwife. What is the second midwife’s role? 1 – To resuscitate baby if needed. 2 – To give oxytocic drug (active mgt of 3 rd stage) 3 - To support the first midwife 4 – To critique the performance of the first midwife
A. 1, 2 B. 1, 2, 3 C. 1, 4 D. 3, 4 53. You are caring for Louisa in recovery after an emergency cesarean section due to Pre-eclampsia. Louisa is receiving a Magnesium Sulfate infusion of 1 g per hour. The following are signs and symptoms of Magnesium Sulfate toxicity, except: A. Flushing B. Double vision C. Loss of deep tendon reflexes D. Muscle spasms 54. What drug is used as the antidote to Magnesium Sulfate? A. Potassium chloride B. Calcium gluconate C. Tetracycline D. Oxycodone 55. Which of the following is/are non-pharmacological methods used to treat postpartum hemorrhage by a midwife or any healthcare provider? A. Apply uterine packing B. Rubbing up contraction C. Internal and external bimanual compression D. All of the above 56. The Sepsis Six (6), a care bundle for management for sepsis to be used in conjunction with ABCDE, should be implemented within 1 hour of suspected sepsis diagnosis. This consists of the following, except: A. Give high flow Oxygen B. Take blood cultures C. Give IV antibiotics D. Place in Trendelenburg position 57. A client at 38 weeks gestation comes to the facility after experiencing leakage of clear fluid from the vagina without contractions. Premature rupture of membranes (PROM) is suspected. Which of the following actions by the midwife would be inappropriate for a client with this condition? A. Perform digital vaginal examination B. Administer ampicillin IV C. Assess the client’s cervix and vaginal cavity through sterile speculum vaginal examination D. Order L/S ratio 58. A midwife is monitoring a client in labor who is receiving IV Oxytocin. The FHR monitor tracing reveals decelerations occurring 35 seconds after the onset of each contraction and continuously past the end of each
contraction. Which of the following is the priority action of the midwife? A. Change the client’s position to side-lying position B. Position the client to Trendelenburg position C. Stop the administration of Oxyctocin D. Administer oxygen 59. A midwife is assessing a client and her infant one week after delivery. The infant’s birth weight was 7.5 pounds. Which of the following findings indicate that the infant is getting enough milk? 1 – The mother reports that the infant is wetting 6-8 diapers a day. 2 – The mother informs the midwife that the infant appears content between feedings. 3 – The infant’s weight is 6.8 pounds. 4 – The mother reports that the infant quietly swallows during breastfeeds. A. 1, 2 B. 1, 2, 3 C. 1, 2, 4 D. All of the above 60. On assessment, the midwife notes that a female newborn has pink patches at the nape of the neck. The midwife informs the mother that these patches: A. Occur more often in males than in females. B. Are caused by an injury during labor. C. Do not fade. D. Disappear by school age without treatment. 61. A client is given Oxytocin for the induction of labor. The midwife should monitor the client for which of the following side effects of Oxytocin? A. Vomiting B. Increased urine outflow C. Hypertension D. Bradycardia 62. A midwife is monitoring a client who is in labor. Assessment findings reveal that the fetus is in LOA position. The midwife notes that the presenting part of the fetus is at 0 station. This finding indicates that: A. The presenting part is at the perineum and the fetal head is crowing. B. The presenting part is at the level of the ischial spines and the fetal head is engaged. C. The presenting part is above the level of the ischial spines and the fetal head is floating. D. The presenting part has descended to within the pelvic inlet. 63. A midwife is monitoring a client who was admitted to the labor and delivery unit about 5 hours ago. The midwife notes a cervical dilatation of 5 cm. The contractions occurring every 5 minutes usually last
between 50 and 55 seconds. The client is in which phase of labor? A. Latent Phase B. Active Phase C. Transition Phase D. 2nd stage of labor 64. A midwife is monitoring a client with a cervical dilatation of 3 cm. The midwife determines that the client has contractions occurring every 3 minutes. Each contraction lasts for 50 seconds. The FHR is determined at 100 bpm. Which of the following is the priority action of the midwife? A. Encourage the client to push with every contraction and to rest in between contractions. B. Administer Oxygen via face mask. C. Document the findings as normal. D. Encourage frequent change of position. 65. A midwife is reviewing the FHR monitor tracing obtained from a G2P1 client who is in labor. The midwife notes decelerations at unpredictable times in relation to contractions. The midwife suspects which of the following conditions? A. Cephalopelvic disproportion B. Good fetal well-being C. Uteroplacental insufficiency D. Cord compression 66. A midwife is teaching a female client how to perform breast self-examination. On return demonstration, which of the following actions by the client indicates that further teaching is necessary? A. The client uses the tips of her 2nd, 3rd and 4th fingers to press every part of her breast. B. Using the right hand to examine the left brea st, the client examines the entire breast using small circular motions in a spiral pattern. C. In a supine position, the client places a folded towel under her right shoulder and puts her right hand behind her head. Using the left hand, she palpates her right breast. D. In a standing position, the client places her hands on her hips and presses down firmly. 67. A midwife is assessing four clients who recently gave birth through vaginal delivery. A part of the examination is measuring the fundal height. Which of the following clients needs further evaluation? A. A client who gave birth 24 hours ago; the fundus is 1 fingerbreadth below the umbilicus. B. A client who gave birth1 hour ago; the fundus is at the level of the umbilicus. C. A client who gave birth 72 hours ago; the fundus is 2 cm below the umbilicus. D. A client who gave birth 10 days ago; the fundus is non-palpable.
68. A pregnant client is admitted to the facility due to alcohol abuse. During the 1st 24 hours, which of the following interventions is the least appropriate? A. Orient the client frequently. B. Initiate seizure precautions. C. Provide a quiet, non-stimulating environment. D. Initiate bleeding precautions. 69. A midwife is managing the care of a 25-year-old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, “I’m too tired. Please get her back to the nursery, just for tonight. I need to get some sleep.” Which of the following is the most appropriate action of the midwife? A. Create a teaching plan for the mother that focuses on breastfeeding. B. Encourage the client to join a parenting skill class. C. Accept the client’s behavior as an indication that she is in the taking-in phase. D. Accept the client’s behavior as an indication that she is in the taking-hold phase. 70. A midwife is assessing a mature female neonate born to a 21-year-old G3P2 client. Which of the following findings suggests that further evaluation and notification of the physician is necessary? A. Birth length = 53 cm B. Head circumference = 35 cm C. Birth weight = 11 pounds D. Chest circumference is 2 cm less than the head circumference. 71. A client who gave birth to a healthy newborn experiences crying and expresses feelings of sadness and emptiness. The client delivered her baby 3 days ago. The midwife suspects that the client has: A. Postpartum depression B. Postpartum blues C. Postpartum psychosis D. A normal behavior during the taking-hold phase 72. A client had a cesarean delivery. The client informs the midwife that she intends to breastfeed her baby. Which of the following instructions is the most effective for a client who wants to breastfeed after cesarean delivery? A. “Use the football hold when breastfeeding.” B. “Choose the position that is most comfortable during breastfeeding.” C. “Breastfeeding is withheld for the 1st 12 hours of life.” D. “Breastfeed the newborn every 4 to 8 hours.” 73. A client at 11 weeks gestation complains of severe and extreme nausea and vomiting. During history taking, the midwife learns that the client vomits at least 3x a day.
An ultrasound is performed and reveals that the client is negative for hyatidiform mole and multiple pregnancy. The midwife suspects a case of hyperemesis gravidarum. The client is admitted for monitoring. Which of the following interventions is the least appropriate for the client? A. Increase oral intake of fluids. B. Administer 3,000 ml of Ringer’s Lactate C. Administer Metoclopramide D. Monitor fluid intake and urinary output 74. A midwife tells a client who is trying to get pregnant to eat fresh fruits and vegetables before conceiving. The midwife also recommends 400 mcg of Folic acid a day. Once she gets pregnant, the midwife may recommend that the client increase her Folic acid intake to 600 mcg per day during the 1st trimester. Which of the following is not a benefit of folic acid supplementation before and during pregnancy? A. It prevents the formation of large but ineffective RBCs. B. It prevents neural tube defects. C. It decreases the baby’s risk for cleft lip or palate. D. It ensures proper functioning of the thyroid gland. 75. A client is in her 18th week of pregnancy. Which of the following psychosocial changes is expected at this time? A. The client is ambivalent about being pregnant. B. The client begins to imagine how she will feel during the delivery. C. The client is excited to attend childbirth educational classes. D. The client engages in nest-building activities. 76. The midwife is creating a teaching plan for a program that encourages women to have their regular Pap smear. Which of the following groups of women is the midwife’s priority? A. Women infected with Treponema Pallidum B. Women with a history of genitalia herpes C. Women who are on oral contraceptives D. Women who have plans of conceiving within the next year. Situation 8: The following questions revolve around the Antepartum period. 77. How can a primigravida client most readily meet her increased daily Iron requirements? A. Consuming at least four glasses of milk daily. B. Adding an extra source of red meat to her daily diet. C. Taking an Iron supplement with a Vitamin C source. D. Including an extra source of fruits or vegetables. 78. A primigravida client is experiencing Braxton-Hicks contractions. Which statement is TRUE concerning this type of contraction? A. Are intensified by walking about.
B. Are confined to the lower back. C. Do not increase in intensity or frequency. D. Result in cervical effacement and dilation. 79. A client is 37 weeks pregnant and is admitted to the hospital with bright red vaginal bleeding, complaining of abdominal discomfort, but no contractions. After assessing the client’s vital signs and determining the FHR, what is the most important information to obtain? A. The amount of cervical dilatation that is present. B. The exact location of her abdominal discomfort. C. The station of the presenting part. D. At what time the client last ate. 80. A client reports that her last menstrual period was November 6. She asks the midwife, “When will my baby be due?”. What is the best answer? A. “July 3” B. “August 30” C. “Around the middle of September.” D. “The first or second week of August.” 81. A young woman calls the clinic and reports missing her period. She states that she used a home pregnancy test last night and the results were negative. She tells the midwife that her breasts are tender and that she feels nauseated most of the day. What does the midwife understand about home pregnancy tests? A. They are RIA (radioimmunoassay) type tests, which are quick and most accurate. B. Home pregnancy tests are more reliable if collected on a random specimen. C. The test is accurate and she is not pregnant. D. False-negative results should be followed up in the presence of pregnancy symptoms. 82. Which statement would the midwife make to the client about striae gravidarum? A. Occur in 100% of pregnancies. B. Are silvery streaks that appear especially during the last trimester. C. Can be decreased by a local application of cocoa butter or other types of emollient creams. D. Will fade from their present reddish appearance. 83. A 26-year-old client comes into the emergency room complaining of lower left side abdominal pain. It began suddenly and has gotten worse over the past few hours. What is the most important information for the midwife to obtain? A. Whether she has had an appendectomy or a cholecystectomy. B. What she has had to eat over the last 24 hours. C. Whether she has recently been diagnosed with a sexually transmitted disease. D. The date of her last menstrual period and whether she could be pregnant.
84. A client is at 30 weeks gestation when she comes in for her regular prenatal check-up. What assessment findings would cause the most concern? A. Increased vaginal discharge, weight gain of 3 lb, and decreased activity tolerance. B. Presence of 2 gm of protein in a 24-hour urine collection, swelling of the face and hands, weight gain of 7 lb. C. Complaints of backache and contractions that occur randomly and are uncomfortable. D. State she is dizzy when she stands up from sitting, states she has leg cramps and her feet are swelling. 85. The midwife is caring for a client who is not pregnant but who is considering pregnancy. A rubella titer has been done, and the titer was negative. What will be important for the midwife to tell this client? A. The client should get a rubella vaccine now and not get pregnant for at least 3 months. B. Because the rubella titer was negative, there should be no problems with getting pregnant. C. It is important for the client to get pregnant as soon as possible because the titer was negative. D. The client can get pregnant now, but she should receive the rubella vaccine during the 1 st trimester. Situation 9: The following questions revolve around the Intrapartum and Postpartum period. 86. The midwife is caring for a 20-year-old primigravida who has been in the first stage of labor for about 8 hours. What assessment findings would indicate that the client is progressing into the 2nd stage of labor? A. Uterine contractions about 10 minutes apart, cervical dilatation of 6 cm. B. Cervical effacement at 100% dilatation at 10 cm. C. Scant to moderate blood mucus showing, station +2. D. Fetal station at -2 and FHR noted at level of umbilicus. 87. The labor monitor tracing shows repeated, mild, variable decelerations. What complication would the midwife anticipate is occurring? A. Cord compression B. Fetal hypoxia C. Placental insufficiency D. Head compression 88. The midwife is assessing a client 12 hours after a prolonged labor and delivery. What assessment data would cause the midwife the most concern? A. Oral temperature of 100.6 degrees F B. Moderate amount of dark red lochia. C. Episiotomy area bruised with small amount of dark bloody drainage. D. Uterine fundus palpated to the right of the umbilicus.
89. The midwife is caring for a client in labor. How are contractions timed? A. End of one to the beginning of the next. B. Beginning of one to the end of the next. C. End of one to the end of the next. D. Beginning of one to the beginning of the next. 90. What is the length of time of the 2 nd stage of labor in a woman who is a primipara? A. 20 – 30 minutes B. 50 – 60 minutes C. 2 hours D. 3 hours 91. During the 1 st stage of labor, the cervix becomes thin and indistinct form the body of the uterus. What is the term the midwife would use to describe this observation? A. Dilation B. Attitude C. Effacement D. Transition 92. The client complains of severe perineal pain the 1 st hour after delivery. What should the midwife assess for? A. A soft, boggy uterus B. Swollen, discolored area on the perineum C. Presence of a cervical laceration D. Increase in vaginal flow caused by retained placental fragments 93. The midwife is checking a laboring client. Her assessment reveals the head at +3 station. What will the midwife do? A. Prepare for the delivery of the infant. B. Begin administration of Oxygen at 6 L/min. C. Determine if contractions are increasing. D. Determine the FHR. 94. A woman who gave birth 3 weeks ago calls the midwife to ask what she should do for her sore, cracked nipples. What will the midwife tell her to do? A. Stop breastfeeding the infant until the nipples heal. B. Make sure all of the areola is in the infant’s mouth when she breastfeeds. C. Cleanse the nipples with half-strength peroxide and air dry. D. Place a cool compress on the nipples after breastfeeding. 95. The midwife is caring for a client who is at 38 weeks gestation and is scheduled for a cesarean delivery. Which assessment finding would indicate a need for the midwife to contact the physician? A. Urinary output of 75 ml/hr. B. Contractions occurring 3 minutes apart and lasting 2 minutes. C. Complaints of burning and bloody urine on voiding.
D. Maternal heart rate regular at 98 bpm. 96. A client complains of abdominal cramping and pain after breastfeeding. What does the midwife explain to the client about this type of pain? A. All women experience abdominal discomfort during the postpartum period. B. Breastfeeding causes the release of Oxytocin, which causes uterine contractions. C. Abdominal cramping is frequently associated with endometriosis. D. Abdominal discomfort is a sign of subinvolution and may occur for 3 to 4 weeks. 97. The midwife is monitoring a client during labor and observes an erratic FHR pattern on the monitor at the height of the contraction. What is the first action? A. Position the mother on her right side. B. Check the monitor leads for placement. C. Begin Oxygen administration at 4 L/min and observe mother’s respirations and FHR. D. Determine if contractions are increasing in duration, intensity and frequency. 98. The midwife assesses the psychological status of the mother and promotes bonding during delivery and after delivery. Which of the following maternal observations would cause the midwife to be concerned regarding the bonding process? A. She is not interested in breastfeeding after birth. B. She hands the infant to the father to hold immediately after delivery. C. She is tired and does not want to see the infant at birth. D. She is concerned regarding the newborn’s acrocyanosis and molding of the head. 99. A 31-year-old multipara is admitted to the birthing room after initial examination reveals her cervix to be at 8 cm, completely effaced (100 %), and at 0 station. What phase of labor is she in? A. Latent phase B. Expulsive phase C. Transitional phase D. Active phase 100. While the postpartum client is receiving herapin for thrombophlebitis, which of the following drugs would the midwife expect to administer if the client develops complications related to heparin therapy? A. Protamine sulfate B. Methylegonovine (Methergine) C. Nitrofurantoin (macrodantin) D. Calcium gluconate
