GTPAL GRAVIDITY =NUMBER OF TOTAL PREGNANCIESG TERM =TERM DELIVERIES [FULL] BIRTHS (38 WEEKS OR MORE)T BIRTHS PRETERM =PRETERM DELIVERIES (FROM VIABILITY UP TO 37 WEEKS)P BIRTHS ABORTIONS/MISCARRIAGES =ABORTIONS (BOTH SURGICAL ABORTIONS AND MISCARRIAGES)A LIVING =LIVING CHILDRENL CHILDREN A. May is 6 weeks pregnant. Her previous two pregnancies ended in a live birth at 41 weeks. G T P A L 3 1 0 0 1 B. Susan is experiencing her fourth pregnancy. Her first pregnancy ended in a spontaneous abortion at 8 weeks, the second resulted in the live birth of twin boys at 38 weeks, and the third resulted in the live birth of a daughter at 34 weeks. G T P A L 4 2 1 1 3 1. Using Nagele’s rule, calculate the expected date of delivery (EDD) for each of the following pregnant women: The rule estimates the expected date of delivery (EDD) (also called EDC, for estimated date of confinement) from the first day of the womans LMP by adding 1 year, subtracting three months and adding seven days to that date. The result is approximately 280 days (40 weeks) from the LMP. Example: LMP = 8 May 2009 +1 year = 8 May 2010 -3 months = 8 February 2010 +7 days = 15 February 2010 A. Susan had intercourse on February 12, 2006. She has not had a menstrual period since the one that began on January 24, 2006, and ended 5 days later. LMP = February 12, 2006 +1 year = February 12, 2007 -3 months = NOVEMBER 12, 2006 +7 days = (EDD) NOVEMBER 19, 2006
B. Dawn has regular 32-day cycles. Her last period began September 4, 2006 and ended September 8, 2006. LMP = September 4, 2006 +1 year = September 4, 2007 -3 months = July 4, 2007 +7 days = (EDD) July 11, 2007Student Review Questions, Ricci-KyleChapter 12: Nursing Management During Pregnancy1.MULTIPLE CHOICEA pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeksand gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document thiswoman’s obstetric history as:31021*301112121220111The woman’s obstetric history would be documented as 30111, G (gravida) = 3 (current pregnancy), T (termpregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeksviability) = 1, and L (number of living children) = 1.2.MULTIPLE CHOICEA woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations?Symphysis pubisBetween the symphysis and umbilicus*At the umbilicusJust below the ensiform cartilageAt 20 weeks’ gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks’ gestation is palpated atthe symphysis pubis. At 16 weeks’ gestation, the fundus is midway between the symphysis pubis and umbilicus. At36 weeks’ gestation, the fundus can be palpated just below the ensiform cartilage.3.MULTIPLE CHOICEThe diagonal conjugate of a pregnant woman’s pelvis is measured. Which measurement would suggest a potentialproblem?*12.0 cm12.5 cm
13.0 cm13.5 cmThe diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. Thediagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal headoccurs if it is too small.4.MULTIPLE CHOICEA woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:*4 weeks3 weeks2 weeks1 weekThe recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks,and then every week from 37 weeks to birth.5.MULTIPLE CHOICEAfter teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching wassuccessful when the client states which of the following?“I’ll do the count once a week on a morning that I’m not rushed for work.”*“I’ll sit comfortably in a recliner or lie on my side when I do the counts.”“I won’t expect more than three movements to happen in an hour.”“I’ll do the counts while I’m sitting and watching my son’s basketball game.”The client should perform the counts in a relaxed environment and a comfortable position, such as a semi-Fowler’sor side-lying position. The woman needs to do fetal movement counts consistently, at approximately the sametime each day. A woman should report a count of less than three fetal movements in an hour. A relaxedenvironment, a comfortable position, and consistency in performing the counts are important to identify changes.6.MULTIPLE CHOICEA pregnant woman who is 26 weeks pregnant arrives for a follow-up visit. Which of the following assessments, inaddition to measuring fundal height and fetal heart rate, would the nurse expect to complete? Select all that apply.*Blood pressure*WeightEdema
*Urine testing*Blood glucose levelUp to 28 weeks’ gestation, follow-up visits involve assessment of the client’s blood pressure and weight, urinetesting for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a bloodglucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks’ gestation.7.MULTIPLE CHOICEThe nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reportedimmediately to her health care provider. Which of the following would the nurse include? Select all that apply.*Headache with visual changes in the third trimesterUrinary frequency in the third trimester*Sudden leakage of fluid during the second trimesterNausea with vomiting during the first trimester*Lower abdominal pain with shoulder pain in the first trimesterBackache during the second trimesterDanger signs and symptoms that need to be reported immediately include headache with visual changes andsudden leakage of fluid in the third trimester, and lower abdominal pain accompanied by shoulder pain in the firsttrimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backacheduring the second trimester are common discomforts of pregnancy.8.MULTIPLE CHOICEWhen providing preconception care to a client, which medication would the nurse identify as being safe tocontinue during pregnancy?AccutaneLithiumWarfarin*FamotidineFamotidine is a category B drug that has been used frequently during pregnancy and does not appear to causemajor birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be takenduring pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided duringpregnancy.9.MULTIPLE CHOICEAfter teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, whichstatement indicates the need for additional teaching?
“I’ll try to drink more fluids to help move things along.”*“I’ll switch to chewing gum instead of using mints.”“I’ll stay away from foods like cabbage and brussels sprouts.”“I’ll increase my time spent on walking each day.”Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gasbuild-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onionsshould be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.10.MULTIPLE CHOICEWhen describing the role of a doula to a group of pregnant women, which of the following would the nurseinclude?The doula is a professionally trained nurse hired to provide physical and emotional support.The doula can perform any necessary clinical procedures.*The doula primarily focuses on providing continuous labor support.The doula is capable of handling high-risk births and emergencies.Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to providewomen and families with encouragement, emotional and physical support, and information through latepregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-riskbirths and emergencies.Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 1 of 6, 0 Figure(s), 0 Table(s), 3 Box(es) 21: Obstetrical AssessmentPRACTICE QUESTIONS1. A client arrives at the prenatal clinic for the first prenatal assessment. The client tells thenurse that the first day of her last menstrual period was September 19, 2007. Using Nägele’srule, the nurse determines the estimated date of confinement as:1. July 26, 20082. June 12, 20083. June 26, 20084. July 12, 2008Answer: 3Rationale: Accurate use of Nägele’s rule requires that the woman have a regular 28-daymenstrual cycle. Add 7 days to the first day of the last menstrual period (LMP), subtract 3months, and then add 1 year to that date. First day of the LMP: September 19, 2007; add 7 days:September 26, 2007; subtract 3 months: June 26, 2007; add 1 year: June 26, 2008.Test-Taking Strategy: Knowledge regarding the use of Nägele’s rule is required to answer thisquestion. Read all of the options carefully, noting the dates and years in the options, beforeselecting an answer. Review Nägele’s rule if you had difficulty with this question.
Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 34.2. A nurse is collecting data during an admission assessment of a client who is pregnant withtwins. The client has a healthy 5-year-old child who was delivered at 38 weeks, and tells thenurse that she does not have a history of any type of abortion or fetal demise. The nurse woulddocument the GTPAL for this client as:1. G = 3, T = 2, P = 0, A = 0, L = 12. G = 2, T = 0, P = 1, A = 0, L = 13. G = 1, T = 1, P = 1, A = 0, L = 14. G = 2, T= 0, P = 0, A = 0, L = 1Answer: 2Rationale: Pregnancy outcomes can be described with the GTPAL acronym: G=gravidity =number of pregnancies; T=term births = number born at term (40 weeks); P=preterm births =number born before 40 weeks’ gestation; A=abortions/miscarriages = number ofabortions/miscarriages (included in gravida if before 20 weeks’ gestation; included in para if past20 weeks’ gestation); L=live births = number of live births or living children. Therefore, awoman who is pregnant with twins and has a child has a gravida of 2. Because the child wasdelivered at 38 weeks, the number of preterm births is 1 and number of term births is 0. Thenumber of abortions is 0 and number of live births is 1.Test-Taking Strategy: Knowledge and understanding of the GTPAL acronym will direct youto option 2. If you had difficulty answering this question, review this method of describingpregnancy outcomes.
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 2 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Wong, D., Perry, S., & Hockenberry, M. (2002). Maternal child nursing care (2nd).St. Louis: Mosby, p. 168.3. A nurse is collecting data during an admission assessment on a client who is pregnant withtwins. The client also has a 5-year-old child. The nurse would document which gravida and parastatus on this client?1. Gravida III, para II2. Gravida II, para II3. Gravida I, para I4. Gravida II, para IAnswer: 4Rationale: Gravida is a term that refers to a woman who is or has been pregnant, regardless ofthe duration of the pregnancy. Para is a term that means the number of pregnancies that haveprogressed past 20 weeks’ gestation. Parity does not reflect the number of fetuses or infants.Option 1, 2, and 3 are incorrect based on the above definition.Test-Taking Strategy: Knowledge of the terms gravida and para is necessary to answer thisquestion correctly. Review the description of these terms if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Communication and DocumentationContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, pp. 33-34.4. A primipara is being evaluated in the clinic during her second trimester of pregnancy. Whichof the following would indicate an abnormal physical finding necessitating further testing?1. Consistent increase in fundal height2. Fetal heart rate of 180 beats per minute3. Braxton Hicks contractions4. QuickeningAnswer: 2Rationale: The fetal heart rate depends on gestational age. It is 160 to 170 beats per minute inthe first trimester and slows with fetal growth to approximately 110 or 120 to 160 beats perminute. Options 1, 3, and 4 are normal expected findings.Test-Taking Strategy: Use the process of elimination. Note the key words, indicates anabnormal physical finding. Recalling the normal fetal heart rate will direct you to option 2.Review normal assessment findings in pregnancy if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 78.
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 3 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)5. A nurse is providing instructions to a pregnant client with genital herpes about the measuresthat need to be implemented to protect the fetus. The nurse tells the client that:1. Daily administration of acyclovir (Zovirax) is necessary during the entire pregnancy.2. Total abstinence from sexual intercourse is necessary during the entire pregnancy.3. Sitz baths need to be taken every 4 hours while awake if vaginal lesions are present.4. A cesarean section will be necessary if vaginal lesions are present at the time oflabor. Answer: 4Rationale: For women with active lesions, either recurrent or primary at the time of labor,delivery should be by cesarean section to prevent the fetus from being in contact with the genitalherpes. The safety of acyclovir has not been established during pregnancy and should be usedonly when a life-threatening infection is present. Clients should be advised to abstain fromsexual contact while the lesions are present. If this is an initial infection, they should continue toabstain until they become culture-negative, because prolonged viral shedding may occur in suchcases. Keeping the genital area clean and dry will promote healing.Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first becauseof the absolute word “entire” in these options. From the remaining options, recalling that thelesions should be kept clean and dry to promote healing will assist in eliminating option 3. Ifyou had difficulty with this question, review the content related to genital herpes as a maternalrisk factor.Level of Cognitive Ability: ApplicationClient Needs: Safe, Effective Care EnvironmentIntegrated Process: Teaching/LearningContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 338.6. A nurse is collecting data on a pregnant client who is at 28 weeks of gestation. The nursemeasures the fundal height in centimeters and expects the findings to be which of the following?1. 22 cm2. 28 cm3. 36 cm4. 40 cmAnswer: 2Rationale: During the second and third trimesters (weeks 18 to 30), fundal height in centimetersapproximately equals the fetus’ age in weeks plus or minus 2 cm. At 16 weeks, the fundus canbe located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, thefundus is at the umbilicus and, at 36 weeks, the fundus is at the xiphoid process.Test-Taking Strategy: Use the process of elimination. Remember that during the second andthird trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus’age in weeks plus or minus 2 cm. If you are unfamiliar with this data collection technique,review this content area.Level of Cognitive Ability: ComprehensionClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReferences: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 192.Silvestri, 3/e, ISBN 1-1460-0052-6
Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 4 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing(3rd ed.). Philadelphia: W.B. Saunders, p. 425.7. A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tellsthe nurse that she is experiencing irregular contractions. The nurse determines that the client isexperiencing Braxton Hicks contractions. Based on this finding, which nursing action isappropriate?1. Instruct the client to maintain bed rest for the remainder of the pregnancy.2. Instruct the client that these are common and may occur throughout the pregnancy.3. Contact the physician.4. Call the maternity unit and inform them that the client will be admitted in aprelabor condition.Answer: 2Rationale: Braxton Hicks contractions are irregular, painless contractions that may occurintermittently throughout pregnancy. Because Braxton Hicks contractions may occur and arenormal in some pregnant women during pregnancy, options 1, 3, and 4 are unnecessary andinappropriate actions.Test-Taking Strategy: Use the process of elimination. Options 3 and 4 are similar and can beeliminated first. From the remaining options, knowing that Braxton Hicks contractions arecommon and can occur throughout pregnancy will assist in directing you to option 2. If you haddifficulty with this question, review the physiology associated with Braxton Hicks contractions.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 83.8. A nurse is reviewing the record of a client who has just been told that a pregnancy test ispositive. The physician has documented the presence of Goodell’s sign. The nurse determinesthat this sign is indicative of:1. A softening of the cervix2. A soft blowing sound that corresponds to the maternal pulse while auscultating the uterus3. The presence of human chorionic gonadotropin (hCG) in the urine4. The presence of fetal movementAnswer: 1Rationale: In the early weeks of pregnancy, the cervix becomes softer as a result of pelvicvasoconstriction, which causes Goodell’s sign. Cervical softening is noted by the examinerduring pelvic examination. A soft blowing sound that corresponds to the maternal pulse may beauscultated over the uterus and is due to blood circulation through the placenta. hCG is noted inmaternal urine in a positive urine pregnancy test. Goodell’s sign does not indicate the presenceof fetal movement.Test-Taking Strategy: Use the process of elimination and knowledge regarding the physiologicalfindings in Goodell’s sign to answer this question. Remember that Goodell’s sign refers to asoftening of the cervix. If you had difficulty with this question, review the changes in the cervixthat occurs during pregnancy.Level of Cognitive Ability: Comprehension
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 5 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)Client Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing(2nd ed.). St. Louis: Elsevier, p. 264.9. A nursing instructor asks a nursing student to describe the process of quickening. Which ofthe following statements, if made by the student, indicates an understanding of this term?1. “It is the irregular, painless contractions that occur throughout pregnancy.”2. “It is the soft blowing sound that can be heard when the uterus is auscultated.”3. “It is the fetal movement that is felt by the mother.”4. “It is the thinning of the lower uterine segment.”Answer: 3Rationale: Quickening is fetal movement and may occur as early as the 14th to 16th weeks ofgestation, when the expectant mother first notices subtle fetal movements that gradually increasein intensity. A soft blowing sound that corresponds to the maternal pulse may be auscultatedover the uterus, which is known as uterine souffle. This sound is due to the blood circulation tothe placenta and corresponds to the maternal pulse. Braxton Hicks contractions are irregular,painless contractions that may occur throughout pregnancy. A thinning of the lower uterinesegment occurs about the sixth week of pregnancy and is called Hegar’s sign.Test-Taking Strategy: Use the process of elimination and knowledge regarding the termquickening to answer this question. Remember that quickening is fetal movement. If you areunfamiliar with this sign associated with pregnancy, review this content area.Level of Cognitive Ability: ComprehensionClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: Maternity/AntepartumReferences: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 386.Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing (3rded.). Philadelphia: W.B. Saunders, p. 163.10. A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetusmove. The nurse responds by telling the mother that fetal movements will be noted between:1. 6 to 8 weeks of gestation2. 8 to 10 weeks of gestation3. 10 to 12 weeks of gestation4. 14 to 16 weeks of gestationAnswer: 4Rationale: Quickening is fetal movement and may occur as early as the 14th to 16th weeks ofgestation. The expectant mother first notices subtle fetal movements during this time, whichgradually increase in intensity. Options 1, 2, and 3 are incorrect.Test-Taking Strategy: Use the process of elimination and knowledge regarding the occurrence ofquickening. In this situation, it is best to select the option that indicates the greatest length ofgestational time. Review the process of quickening if you had difficulty with this question. Levelof Cognitive Ability: ApplicationClient Needs: Health Promotion and Maintenance
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 6 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)Integrated Process: Teaching/Learning Content Area:Maternit y/Antepartum R eference: Murra y, S ., McKinne y, E., &Gorrie, T. (2002). Foundations of maternal-newborn nursing (3rded.). Philadelphia: W.B. Saunders, p. 147.<AQ>11. A nurse is assisting in performing an assessment on a client who suspects that she ispregnant and is checking the client for probable signs of pregnancy. Select all probable signs ofpregnancy.____Uterine enlargement____Fetal heart rate detected by a nonelectronic device____Outline of fetus via radiography or ultrasound____Chadwicks sign Braxton Hicks contractions____ Ballottement____Answers:Uterine enlargementChadwicks signBraxton Hicks contractionsBallottementRationale: The probable signs of pregnancy include uterine enlargement, Hegars sign(softening and thinning of the lower uterine segment that occurs at about week 6), Goodellssign (softening of the cervix that occurs at the beginning of the second month), Chadwicks sign(bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs aboutweek 6), ballottement (rebounding of the fetus against the examiners fingers on palpation),Braxton Hicks contractions, and a positive pregnancy test measuring for human chorionicgonadotropin (hCG). Positive signs of pregnancy include fetal heart rate detected by anelectronic device (Doppler transducer) at 8 to 12 weeks and by a nonelectronic device(fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and anoutline of the fetus via radiography or ultrasound.Test-Taking Strategy: Focusing on the issue, probable signs of pregnancy, will assist inanswering this question. Remember that detection of the fetal heart rate and an outline of thefetus via radiography or ultrasound are positive signs of pregnancy. Review the probable signsof pregnancy if you had difficulty with this question.Level of Cognitive Ability: AnalysisClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newbornnursing (3rd ed.). Philadelphia: W.B. Saunders, p. 132.
1. Estrogen, one of the hormones regulating cyclic activities in female reproductive system isresponsible for which effect?a. Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can bestretched to a distance of 10-13 cm.b. Inhibits the production of LHc. Increases endometrial tortuosityd. All of the above2. Jessa, 17 years old, is bleeding between periods of less than two weeks. This condition is anabnormality in the menstrual cycle known as:a. Metrorrhagiab. Menorrhagiac. Amenorrhead. Dysmenorrheal3. One factor of having a normal delivery is the size of the pelvis. Pelvis serves as the passageway forthe passenger (fetus) during childbirth. The most ideal pelvis for childbirth is:a. Androidb. Anthropoidc. Platypelloidd. Gynecoid4. An important landmark of the pelvis that determines the distance of the descent of the head is knownas:a. Linea terminalisb. Sacrumc. Ischial spinesd. Ischial tuberosities5. The permanent cessation of menstruation is:a. Amenorrheab. Menopausec. Oligomenorrhead. HypomenorrheaSituation: Mrs. Donna, pregnant for 16 weeks age of gestation (AOG), visits the health care facility for herprenatal check-up with her only son, Mark. During assessment the client told the nurse that previouslyshe got pregnant twice. The first was with her only child, Mark, who was delivered at 35 weeks AOG andthe other pregnancy was terminated at about 20 weeks AOG.6. Based on the data obtained, Mrs. Donna’s GTPAL score is:a. 20111b. 21111c. 30111d. 311117. Discomforts during pregnancy are discussed by the nurse to the Mrs. Donna. Which of the following,when complained by the client would alert the nurse?a. Easy fatigability
b. Nausea and vomitingc. Edema of the lower extremitiesd. Heartburn8. Psychological and emotional responses of pregnant women differ. However, general emotionalresponse has been noted during pregnancy based on their gestational age. Mrs. Donna will most likelyhave which emotional response towards her pregnancy?a. Presents denial disbelief and sometimes repression.b. Has personal identification of the baby and realistic plans for future of the child.c. Fantasizes the appearance of the baby.d. Verbalizes fear of death during childbirth.9. The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heartrate (FHR). Which of the following apparatus should the nurse use in auscultating for the FHR?a. Doppler apparatusb. Fetoscopec. Ultrasoundd. Stethoscope10. Mrs. Donna asked the nurse, when a fetal heart starts beating. The nurse correctly responded bystating:a. 3 weeks AOGb. 8 weeks AOGc. 12 weeks AOGd. 20 weeks AOGSituation: Mrs. Dela Cruz is in labor and is brought to the emergency room with a ruptured bag of water.11. The nurse’s initial action once the bag of water has ruptured is:a. Take the fetal heart tonesb. Put the client to the bed immediatelyc. Perform an IEd. Take the woman’s temperature12. Mrs. Dela Cruz’s has contractions growing stronger which lasts for 40-60 seconds and occurapproximately every 3-5 minutes. The doctor is about to perform an IE, the nurse expects that the client’scervical dilatation will be:a. 0-3 cmb. 4-7 cmc. 8-10 cmd. 11-13 cm13. The doctor informed the woman that she is on station -1. Mrs. Dela Cruz asked the nurse, whatdoes a station -1 means, the most appropriate response of the nurse is:a. ―It means that engagement has already occurred.‖b. ―The presenting part of your baby is at the entrance of the true pelvis or the largest diameter of thepresenting part into the true pelvis.‖c. ―Your baby is still floating or ―ballotable‖d. ―The presenting part of your baby is at the vulvar ring of your reproductive organ.‖
14. The history of Mrs. Dela Cruz revealed that she is a multipara. When should the nurse transport theclient from the labor room to the delivery room?a. When the cervical dilatation is 8 cm.b. When the cervical dilatation is 10 cm.c. When the cervical dilatation is 9 cm.d. When the client feels the urge to push.15. Monitoring contractions is very important during labor. To monitor uterine contractions, what shouldthe nurse do?a. Observe for the client’s facial expression to know that the contraction has started or stopped.b. Instruct the client take note of the duration of her contractions.c. Offer ice chips to the woman.d. Spread the fingers lightly over the fundus to monitor the contraction.16. Uterine contractions can occur because of the interplay of the contractile enzyme adenosinetriphosphate and the influence some hormones. Which of the following least likely contributes to theoccurrence of uterine contractions?a. Oxytocinb. Estrogenc. Prolactind. All of the above17. Dysfunctional labor may be caused by which of the following?a. Excessive or too early analgesia administrationb. Exhausted motherc. Overdistention of the uterusd. All of the above18. The client’s uterine contractions are hypotonic. The nurses top priority with hypotonic contractionsduring the intrapartal period is:a. Pain reliefb. Psychological supportc. Monitoring the lochia for possible bleedingd. Infection control19. For a woman experiencing hypotonic contractions, what should be done initially?a. Obtain an ultrasonic resultb. Infusion of oxytocinc. Administration of analgesiad. Amniotomy20. The most important nursing consideration in a postpartal woman with a hypotonic contraction is:a. Assessment for infectionb. Assessment for bleedingc. Assessment for FHRd. Assessment for woman’s coping mechanismSituation: Bleeding during pregnancy is a serious case and should be managed immediately.
21. Mrs. Diane is diagnosed with Placenta Previa. The main difference with the bleeding in placentaprevia and abruption placenta is that placenta previa has:a. Painful bleedingb. Rigid abdomenc. Bright-red bloodd. Blood filled with clots22. In caring for a client diagnosed with placenta previa, the nurse should avoid which of the following?a. Inspecting the perineumb. Performing a Kleihauer-Betke testc. Performing a pelvic examinationd. All of the above23. For the nurse to distinguish that the bleeding of the patient is placenta previa or abruption placentawhat should she ask the woman?a. Whether there was accompanying painb. What she has done for bleedingc. Estimation of blood lossd. All of the above24. Continued bleeding may result to fetal distress. The nurse knows that the fetus is beingcompromised when she observed or note which of the following:a. Fetal tachycardiab. Fetal bradycardiac. Fetal thrashingd. All of the above25. A woman in labor is diagnosed with abruption placenta. The nurse would expect which findings inthe client’s history that may contribute to the occurrence of the complication?a. Age of 24 years oldb. Cigarette smokingc. Sleeping 8 hours per nightd. Sitting for long period1. Answer: A.Effects of estrogen:• Inhibits the production of FSH• Causes hypertrophy of the myometrium• Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can bestretched to a distance of 10-13 cm.Effects of Progesterone• Inhibits the production of LH• Increases endometrial tortuosity• Increased endometrial secretions• Facilitates transport of the fertilized ovum through the fallopian tubes2. Answer: AAbnormalities of Menstruation
1. Amenorrhea – absence of menstrual flow2. Dysmenorrhea – painful menstruation3. Oligomenorrhea – scanty menstruation4. Menorrhagia -excessive menstrual bleeding5. Metrorrhagia – bleeding between periods of less than 2 weeks3. Answer: D. Gynecoid is the ―normal‖ female pelvis. The inlet is well rounded. This is the most idealpelvis for childbirth.• Android – ―male‖ pelvis. Inlet has a narrow, shallow posterior portion and pointed anterior portion.• Anthropoid – transverse diameter is narrow and anteroposterior (AP) diameter of this pelvis is largerthan normal.• Platypelloid – inlet is oval while AP diameter of this pelvis is shallow.4. Answer: C. Ischial spines are the point of reference in determining the station (relationship of thefetal presenting part to the ischial spines). When the fetal head is at the level of the ischial spines thestation is zero. When it is 1 cm above the ischial spines it is -1 and if 1 cm below the ischial spines it is+1.5. Answer: B. The keyword here is ―permanent cessation‖. Thus, menopause is the correct answer.Amenorrhea is a temporary cessation of menses. Oligomenorrhea is a menstruation with scanty bloodflow. Hypomenorrhea is an abnormally short duration of menstruation.6. Answer: C.• Gravida (G) – number of pregnancy• Term (T) – number of full-term infants born (born at 37 weeks or after)• Para (P) – number of preterm infants born (born before 37 weeks)• Abortion (A) – number of spontaneous or induced abortions (pregnancy terminated before the age ofviability). Age of viability is 24 weeks.• Living children (L) – number of living children.• (Source: Maternal and Child Health Nursing by Adelle Pillitteri, 5th Ed. P.252)Since Mrs Donna has two previous pregnancies and is presently pregnant (16 weeks), G is 3. Mark, heronly child was born at 35 weeks AOG which falls under the preterm category. Thus, T is zero and P is 1.The other pregnancy was terminated at 20 weeks AOG which falls under abortion, hence A=1. Mark isher only living child, thereby, L=1. Her GTPAL score is:30111, G=3 T=0 P=1 A=1 L=17. Answer: B. Morning sickness characterized by nausea and vomiting is only noted during the FIRSTTRIMESTER of pregnancy (first 3 months). Excessive nausea and vomiting which persists more than 3months is a condition called Hyperemesis gravidarum that requires immediate intervention to preventstarvation and dehydration. Management for hyperemesis gravidarum includes the administration ofD5NSS 3L in 24 hours and complete bed rest.Easy fatigability is a consequence of the physiologic anemia of pregnancy (physiologic meaning it isnormally expected during pregnancy, thus A is incorrect). Edema of the upper extremities not the lowerextremities should alert the nurse because of the possibility of toxemia, hence C is incorrect. Heartburnduring pregnancy is due to the increase progesterone which decreases gastric motility causing a reversedperistaltic wave leading to regurgitation of the stomach contents through the cardiac sphincter into theesophagus, causing irritation.
8. Answer: C. The client is in her second trimester of pregnancy (16 weeks AOG or 4 months), thus, sheperceived the baby as a separate entity. Presenting denial and disbelief and sometime repression is thepsychological/emotional response of a pregnant woman on her first trimester. Identifying the fetus andsetting realistic plans for the child’s future is noted during the third trimester of pregnancy. It is during thistime also that the woman verbalizes fear of death.9. Answer: A. Mrs. Donna’s gestational age is 16 weeks (4 months). During this time, the fetal heart rateis audible with a Doppler apparatus. A fetal heart beat can be detected with a Doppler apparatus startingat 12 weeks AOG. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. A fetal heartbeat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-NewbornNursing by Murray and McKinney/Saunders 4th Ed.)10. Answer: A. Fetal heart starts beating at 3 weeks AOG. The heart at this time is consisting of twoparallel tubes. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. During 12 weeksAOG, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat is detectable withfetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray andMcKinney/Saunders 4th Ed.)11. Answer: B. The keyword is INITIAL ACTION. The important consideration before answering thequestion is to take a look at the situation. SITUATION: THE WOMAN IS IN THE Emergency Room or isseeking admission.A woman in labor seeking admission to the hospital (in the ER) and saying that her BOW has rupturedshould BE PUT TO BED IMMEDIATELY and the fetal heart tones taken consequently. If a woman in theLabor Room says that her membranes have ruptured, the initial nursing action is to take the fetal hearttone.12. Answer: B. The nurse would expect that the client’s cervical dilatation is 4-7 cm as the contractionduration and interval is noted for clients who are in the active phase of the first stage of labor. Themaximum cervical dilatation is 10 cm, thus, letter D should be eliminated first. The first stage of labor(stage of dilatation) is divided into three phases.• Latent phase – 0-3 cm cervical dilatation; contractions are short and mild lasting 20-40 seconds andoccurring approximately every 5-10 minutes.• Active phase – 4-7 cm cervical dilatation; contractions grow stronger, lasting 40-60 seconds and occurat approximately every 3-5 minutes.• Transition phase – 8-10 cm cervical dilatation; contractions reach their peak of intensity, occurringevery 2-3 minutes with a duration of 60-90 seconds.13. Answer: C. Station -1 means that the fetal presenting part is above the level of the ischial spines.Letter A is wrong because engagement is described as Station 0. Letter B is incorrect because thestatement of nurse is describing the occurrence of engagement that is again station 0. Prior toengagement the fetus is said to be "floating" or ballottable, thus letter C is the best option. Letter D, isdescribing crowning which is described as Station +3 or +4.14. Answer: A. Multiparas are transported to the DR when the cervical dilatation is 7-8 cm because inmultiparas dilatation may proceed before effacement is completed. Effacement must occur at the end ofdilatation, however, before the fetus can be safely pushed through the cervical canal; otherwise, cervicaltearing could result. Primiparas are transported to the DR when the cervical dilatation is 9-10 cm.
15. Answer: D. The nurse should spread his/her fingers lightly over the fundus to monitor the uterinecontractions.16. Answer: C. Prolactin is the hormone that produces milk in mammary glands. Uterine contractionscan occur because of the interplay of the contractile enzyme adenosine triphosphate and the influencesome hormones and major electrolytes which are the following:• Calcium• Sodium• Potassium• Specific contractile proteins (actin and myosin)• Epinephrine and norepinephrine• Oxytocin• Estrogen and progesterone• Prostaglandins17. Answer: D.Dysfunctional Labor is caused by the ff:• Inappropriate use of analgesia• Pelvic bone contraction that has narrowed the pelvic diameter so that a client can’t pass (e.g. in aclient with rickets)• Poor fetal position• Extension rather then extension of the fetal head• Overdistention of the uterus• Cervical rigidity• Presence of a full rectum or bladder• Mother becoming exhausted from labor• Primigravid status18. Answer: D. When the contractions are hypotonic, the length of labor is increased. When the cervixis dilated for a long period of time, both the uterus and fetus are at greater risk of infection. Hypotoniccontractions are not exceedingly painful because of their lack of intensity. Monitoring of bleeding throughevaluation of lochia is done during the postpartum period not the intrapartum period.19. Answer: A. Initially, the nurse should obtain an ultrasonic confirmation ruling out a CPD orcephalopelvic disproportion. Thus, A is the best answer. Oxytocin is infused after the CPD is ruled out,because if CPD is present CS will be done. Analgesic administration will further decrease the intensity ofuterine contractions as its inappropriate use is one of the reasons why hypotonic contractions occur.Amniotomy (artificial rupture of membrane) may be done after oxytocin is infused to speed up the labor20. Answer: B. During the postpartum period, the uterus should be palpated and lochia should beassessed because contractions after birth may also be hypotonic that will result to bleeding.21. Answer: C. In placenta previa the bleeding that occurs is abrupt, painless, bright-red and sudden tofrighten a woman. With abruption placenta, the bleeding is painful, the abdomen is rigid or board-like andthe blood is dark-red or filled with clots.
22. Answer: C. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancybecause any agitation of the cervix when there is placenta previa may initiate massive hemorrhage,possibly fatal to both the mother and the fetus.The perineum should be assessed or observed or inspected for bleeding by looking over the perenialpads. An Apt or Kleihauer-Betke test (test strip procedures) can be used to detect whether the blood is offetal or maternal origin.23. Answer: A. placenta previa presents bleeding without pain whilst the bleeding in abruptio placenta ispainful.24. Answer: D. Signs of fetal distress include: tachycardia, bradycardia, fetal thrashing and meconium-stained amniotic fluid.25. Answer: B. Predisposing factors for abruptio placenta:• Advanced maternal age• Short-umbilical cord• Chronic hypertensive disease• PIH• Direct trauma• Vasoconstriction from cocaine or cigarette use