OBSTETRIC NURSING

1. Childbirth education is vital for a successful and comfortable childbirth method. The firstmethod that includes the father as a
support person while embracing the belief that childbirth is a natural event and with the right preparation most women can have
spontaneous and unmedicated vaginal births is:
 a. Lamaze method
 b. Leboyer method
 c. Bradley method
 d. Grantly Dick-Read method
Bradley childbirth method was the first technique to include the father as a support person during delivery. This method embraces
the belief that childbirth is a natural event and with the right preparation most women can have spontaneous and unmedicated
vaginal births. Lamazemethod is a prepared labor and delivery technique. It is often called psychoprophylactic methodas it uses the
mind (psyche) to prevent labor pains (prophylaxis). Leboyer childbirth methodsometimes termed as “birth without violence,” views
birth as a stressful experience for the newborn. The focus of this method is to primarily improve the quality of the birth experience for
the baby. Grantly Dick-read Method is a psychophysiological preparation for childbirth. This technique alleviates pain during
childbirth by blocking feelings of fear and tension.
2. The easiest method for determining if a woman’s caloric intake is adequate is assessing:
 a. Food intake
 b. Bowel pattern
 c. Weight she is gaining
 d. A “typical day” history or a 24 hour nutrition recall
The easiest method for determining if a woman’s caloric intake is adequate is assessing the weight she is gaining. (Pillitteri, 5th Ed).
A typical day history or a 24 hour nutrition recall is the best method for assessing overall nutritional intake.
3. The total weight gain in pregnancy for women who have multiple fetuses is:
 a. 20-25 lbs
 b. 25-35 lbs
 c. 35-40 lbs
 d. 40-45 lbs
For women who have twins or multiple fetuses the weight gain should be 1 lb/week for a total of 40-45 lbs. (Adelle Pillitteri, 5th Ed
p.302). 25-35 lbs is the average and recommended weight gain for pregnant woman with one fetus only.
4. During one of the sessions a pregnant mother is expressing concern on her baby. She is voicing apprehensions on the outcome
of her delivery that might be stressful to her baby. Birth without violence is under which theory?
 a. Lamaze method
 b. Leboyer method
 c. Bradley method
 d. Grantly Dick-Read method
Leboyer childbirth method sometimes termed as “birth without violence,” views birth as a stressful experience for the newborn. The
focus of this method is to primarily improve the quality of the birth experience for the baby.
5. A sensitive and unobtrusive technique of care while respecting the natural process and promoting a peaceful atmosphere at birth
will help the baby to be born with a minimum stress. This is least likely achieved by:
 a. Keeping the room noise to a minimum
 b. Not delaying the cutting of the cord
 c. Giving the newborn a warm bath after delivery
 d. Not assisting or pulling the baby’s head in expulsion
Because of the word “least likely” the correct option is B. The method employed in promoting a sensitive and unobtrusive technique
of care while respecting the natural process and promoting a peaceful atmosphere at birth to help the baby be born with a minimum
stress is LeBoyer Childbirth Method. To decrease the trauma at birth this technique is an advocate of the following: • The birthing
room is darkened or dimmed. Doing so prevents sudden contrast of light that might distress the newborn. Leboyer thought that this
is less shocking for the neonate’s eyes that have been in semi-darkness for several months. • A soft music is played or at least
harsh noises are kept to a minimum. All the talking inside the delivery room is done by whispering. • The room is kept pleasantly
warm, not chilled, to help the newborn be comfortable with the new environment and adapt to extrauterine life more easily. •
Newborns are handled gently and carefully. Leboyer recommends not pulling the baby’s head to completely allow a natural
childbirth. • The umbilical cord is cut late (It is cut after it has stopped pulsating). According to Leboyer, this allows the newborn to
continue receiving the maternal hormones and oxygen carrying red blood cells. This is also done to allow the baby to breathe when
he is ready and not have to be rushed. • The infant receives a warm bath immediately after birth for relaxation. • Before maternal
and newborn bonding is done, the infant is massage to ease crying. Nowadays, mothers do this massaging to encourage immediate
bonding. • Placing the infant in the mother’s abdomen is done for maternal-neonate bonding.
6. A pregnant woman came in to the clinic expressing concern about her genitalia that has been observed for a change in color. The
nurse explained the physiology adaptations to pregnancy and stated that this discoloration of the vagina is called:
 a. Hegar’s sign
 b. Chadwick’s sign
 c. Goodell’s sign
 d. Vaginal sign
Chadwick’s sign is the increased vascularity of the vagina changing its color from light pink to deep purple or violet. Hegar’s sign is
the softening of the uterus. Goodell’s sign is the change in cervix consistency resembling to that of an earlobe. There is no known
vaginal sign in pregnancy.
7. The entitled Childbirth without Fear is authored by:
 a. Dr. Grantly Dick-Read
 b. Dr. Robert Bradley
 c. Dr. Ferdinand Lamaze
 d. Dr. Frederick Leboyer
Dr. Grantly Dick-Read is an English obstetrician who was practicing medicine in 1900’s. On 1933 his book, “Childbirth without Fear,”
was published. He explained in this publication that no physiological function in a person’s body can give rise to pain under the
condition that it is of normal course of health. Unless a disease process is taking place, pain or agony would associate delivery
Bradley Method was named after an American obstetrician Dr. Robert Bradley. “Husband Coached Childbirth,” was written by Dr.
Bradley and his principles and theories paved the way for fathers to be present in the delivery room. This changed the face of
childbirth around the globe. Lamaze childbirth method is an alternative to the use of medical intervention during childbirth.
The method was originally developed in Russia (based on Pavlov’s conditioningstudies) but was popularized by a French
obstetrician Dr. Ferdinand Lamaze. After watching a woman gave birth in Russia Dr. Lamaze developed his own system of painless
childbirth. Leboyer childbirth method was introduced by Frederick Leboyer. He is a French obstetrician who believed that the
traditional hospital births of the time (1975) were traumatic for the infant. In 1975, he published a book entitled “Birth without
Violence,” where depth of a newborn’s sensitivity and the importance of how the baby is handled by the people around him were
emphasized. He pointed out that babies born in a less stressful environment were more content.
8. Physical assessment is very important during prenatal visits to evaluate the overall health status of a pregnant woman. Weight is
one indicator of the health status. A pregnant woman on her second trimester of pregnancy should gain how many kilograms per
month?
 a. 0.45 kg
 b. 1.82 kg
 c. 1.36 kg
 d. 2 kg
Normal weight gain pattern in pregnancy is 1 lb (0.45 kg) per month in the first trimester and 1 lb per week in the second and third
trimesters. Meaning to say, in the second and third trimester thepregnant woman should be gaining 4 lbs (1.82 kg) per month. To
easily remember the pattern of weight gain in pregnancy is 3-12-12. 3 lbs in the first trimester and 12 lbs each in the second and
third trimester.
9. The obstetrician who pointed out that a baby born in a less stressful environment is more content is:
 a. Dr. Grantly Dick-Read
 b. Dr. Robert Bradley
 c. Dr. Ferdinand Lamaze
 d. Dr. Frederick Leboyer
Leboyer childbirth method was introduced by Frederick Leboyer. He is a French obstetrician who believed that the traditional
hospital births of the time (1975) were traumatic for the infant. In 1975, he published a book entitled “Birth without Violence,” where
depth of a newborn’s sensitivity and the importance of how the baby is handled by the people around him were emphasized. He
pointed out that babies born in a less stressful environment were more content.
10. A patient on labor is offered ice chips. What is the purpose of giving ice chips to a woman on labor?
  a. To reduce a woman’s anxiety
 b. To prevent impulses reach the distracted brain
 c. To promote cutaneous stimulation
 d. To allow more blood to pool in the uterus, thus alleviating pain
In Lamaze method one technique of alleviating pain is by cutaneous stimulation. It is done by effleurage, sacral pressure, thermal
stimulation (offering ice chips) and positioning. Preventing impulses to reach the brain is employing the distraction or imagery
technique. Reducing a woman’s anxiety is done by a continuous support system. Allowing more blood to pool in the uterus to
alleviate pain is a principle in Dick-Read method.
11. The following concepts are emphasized in a Bradley class apart from:
 a. Avoidance of drugs throughout the pregnancy
 b. Natural breathing methods (without patterns)
 c. Coaching techniques
 d. Woman should change position during labor
Encouraging a woman on labor to change position during labor is a concept of Lamaze method to stimulate cutaneous stimulation.
The following concepts are taught in Bradley Classes: • Natural birth process • Active involvement of the husband as a coach •
Proper nutrition during pregnancy • Avoidance of drugs throughout the pregnancy • Natural breathing methods (without patterns) •
Coaching techniques • Natural pain coping methods • Maternal-newborn bonding • Breastfeeding • Education on emergent
situations throughout pregnancy and delivery (CS) • Postpartum and newborn care • Responsible parenthood
12. The priority management for Hyperemesis Gravidarum is:
 a. Easting dry toast or crackers 30 minutes before arising in the morning
 b. Complete bed rest (CBR)
 c. D5NSS 3L in 24 hours
 d. Administer Milk of Magnesia
The priority treatment for Hyperemesis gravidarum is giving 3 L of D5NSS for 24 hours. CBR is also important but the main
treatment is D5NSS to replace the lost fluids. Eating dry crackers before arising in the morning is the management for morning
sickness not Hyperemesis gravidarum. Milk of magnesia is an antacid used to manage heartburn in pregnant woman.
13. A pregnant woman is diagnosed with toxemia. The following are signs of toxemia apart from:
 a. Edema of the lower extremities
 b. Sudden Weight gain
 c. Blurry vision
 d. Protein in urine
Toxemia or Pregnancy induced hypertension has the following manifestations: Edema of the face, hands, ankle and feet,
proteinuria, visual disturbances, sudden weight gain, headache, fever. Edema of lower extremity alone is not a sign of toxemia as it
is a normal adaptation to pregnancy that is the result of the poor circulation in the lower extremities due to the pressure from the
gravid uterus. It is managed by raising the legs above the hip level. Edema of the Lower Extremities plus the upper extremities is a
sign of toxemia.
14. A pregnant woman is asking about the possible causes of morning sickness. The nurse least likely identifies the cause by
stating which of the following?
 a. “It is due to the increased human chorionic gonadotrophin levels during pregnancy.”
 b. “It may be due to increased acidity of the GI tract.”
 c. “It may be the result of increased progesterone level which in return decreases gastric motility thus causing reverse
peristaltic waves.”
 d. “Some cases of morning sickness can also be due to emotional factors.”
Heartburn not morning sickness is the result of increased progesterone level which in return decreases gastric motility thus causing
reverse peristaltic waves.
15. The structure which contains high amount of estrogen is called:
 a. Corpus albicans
 b. Corpus luteum
 c. Primordial follicles
 d. Graafian follicles
Graafian follicles are structures containing high amounts of estrogen. Graafian follicle are derived from primordial follicles. Corpus
Luteum is the structure containing high amounts of progesterone and is yellow in color. If no fertilization occurs corpus luteum turns
white and is now called Corpus Albicans.
16. Change in the consistency of the lower uterine segment causing extreme softening is referred as:
 a. Hegar’s sign
 b. Chadwick’s sign
 c. Goodell’s sign
 d. Vaginal sign
Hegar’s sign is the softening of the uterus. Goodell’s sign is the change in cervix consistency resembling to that of an earlobe.
Chadwick’s sign is the increased vascularity of the vagina changing its color from light pink to deep purple or violet. There is no
known vaginal sign in pregnancy.
17. The nurse is conducting a health teaching on expectant mothers. She is stressing the importance of childbirth education classes
in one of her discussions. Most pregnant women are expressing concern about their fear on the upcoming labor. The nurse is
discussing about the ways of alleviating labor pains using the mind which is based on which childbirth principle?
 a. Lamaze method
 b. Leboyer method
 c. Bradley method
 d. Grantly Dick-Read method
Lamaze method is a prepared labor and delivery technique. It is often called psychoprophylactic method as it uses the mind
(psyche) to prevent labor pains (prophylaxis). The Lamaze method of prepared childbirth is based on the gating control theory of
pain relief. It involves concentration and conditioning to help the woman respond to contractions with relaxation from techniques
thereby alleviating pain. This is based on the theory that through stimulus-response conditioning, women can learn to use controlled
breathing to reduce the pain in the labor. Lamaze method is the most popular approach used to today.
18. A diagnosis of Moniliasis is made. The nurse is aware that symptoms of Moniliasis typically has a symptom of:
 a. White patchy and cheese like particles that adheres to the vaginal wall
 b. Chancres on the vulva
 c. Frothy, cream-colored vaginal discharge
 d. A non-itchy rash covering the whole body or appearing in patches.
Moniliasis or Candidiasis is caused by a fungus Candida Albicans (Monilia). Symptoms include: white patchy and cheese like
particles that adheres to the vaginal wall, irritatingly itchy and foul smelling vaginal discharges. Chancres on vulva and non-itchy
rash covering the whole body or appearing in patches are manifestations of syphilis. Frothy, cream-colored vaginal discharges,
vulvar edema and hyperemia are hallmark signs of Trichomoniasis or vaginitis.
19. The hallmark techniques of Leboyer method are the following except:
 a. Newborn warm bath
 b. Husband as a coach throughout labor and delivery
 c. Infant massage
 d. Immediate maternal-newborn bonding
Infant massage, a warm bath and immediate bonding with the mother are all hallmarks of the Leboyer method. Bradley childbirth
method was the first technique to include the father as a support person during delivery.
20. During a prenatal visit the pregnant woman is complaining of itchy, foul-smelling vaginal discharges that are frothy and cream-
colored. This is a hallmark sign of:
 a. Moniliasis
 b. Candidiasis
 c. Syphilis
 d. Vaginitis
Frothy, cream-colored vaginal discharges, vulvar edema and hyperemia are hallmark signs of Trichomoniasis or vaginitis. Moniliasis
or Candidiasis is caused by a fungus Candida Albicans (Monilia). Symptoms include: white patchy and cheese like particles that
adheres to the vaginal wall, irritatingly itchy and foul smelling vaginal discharges. Chancres on vulva and non-itchy rash covering the
whole body or appearing in patches are manifestations of syphilis.
21. The obstetrician who associated childbirth method with Pavlov’s conditioning studies is:
 a. Dr. Grantly Dick-Read
 b. Dr. Robert Bradley
  c. Dr. Ferdinand Lamaze
 d. Dr. Frederick Leboyer
Lamaze childbirth method is an alternative to the use of medical intervention during childbirth. The method was originally developed
in Russia (based on Pavlov’s conditioning studies) but was popularized by a French obstetrician Dr. Ferdinand Lamaze. After
watching a woman gave birth in Russia Dr. Lamaze developed his own system of painless childbirth.
22. Mrs. White, a pregnant woman, is 5’4” tall and weighs 130 lbs. Calculate her body mass index.
 a. 22 BMI
 b. 30 BMI
 c. 24 BMI
 d. 28 BMI
22 BMI To compute for BMI 1. Convert weight into kilograms: 130 lbs / 2.2= 59.09 kg (1 kg=2.2 lbs) 2. Convert height into cm: 5’4”
( 5 feet 4 inches) 1 foot=12 inches; 1 inch = 2.54 cm CONVERT TO INCH FIRST: 5 x 12 = 60 inches + 4 inches = 64 inches INCN
TO CM: 64 x 2.54 = 162.56 cm 3. Square the height in meters (1 m = 100 cm) CONVERT CM TO METER: 162.56 / 100 = 1.6256 m
or 1.63 m SQUARE THE HEIGHT IN METER: 1.63 x 1.63 = 2.6569 or 2.66 4. Divide weight (kg) by meter squared 59.09 / 2.66 = 22
BMI
23. What is the best interpretation of Mrs. White’s calculated BMI?
 a. Underweight
 b. Normal weight
 c. Overweight
 d. Obese
Normal weight a. Underweight – under 18.5 BMI b. Normal weight – 18.5-24.9 BMI c. Overweight – 25-29.9 BMI d. Obese – above
30.0
24. The nurse is calculating a pregnant woman’s BMI. Her calculated result is 26 BMI. This BMI belongs to the category of:
 a. Underweight
 b. Normal weight
 c. Overweight
 d. Obese
a. Underweight – under 18.5 BMI b. Normal weight – 18.5-24.9 BMI c. Overweight – 25-29.9 BMI d. Obese – above 30.0
25. Myra, a 25-year old woman, on labor firmly told her doctor not to give her pain medications during labor and delivery. She
believes that it is best for her baby if she would not receive pain medications and no physiological events such as birth can give rise
to pain under the condition that she is free from underlying diseases. Myra insisted that knowing what are expected and being
tension-free during the delivery process would need no pain medications. Her principle is based on the philosophy of which method?
 a. Lamaze method
 b. Leboyer method
 c. Bradley method
 d. Grantly Dick-Read method
Grantly Dick-read Method is a psychophysiological preparation for childbirth. This technique alleviates pain during childbirth by
blocking feelings of fear and tension. Dr. Dick-Read postulated that this fear felt by women during delivery causes the blood to be
carried away from the uterus to be used by the muscles needing it due to perceived pain. This results to an unoxygenated uterus
which would be unable to perform its function well leading to pain, a phenomenon called “the fear-tension-pain syndrome.” Dick-
Read believed that presence of fear and tension result to labor pains. Thus, eliminating fear would increase blood supply to the
uterus and alleviating labor pains. He also identified that laboring women needed constant emotional support to help them cope.

MATERNAL AND CHILD NURSING

1. The primitive gonadal tissue that develops into the male reproductive organ:
 a. Mesonephric Duct
 b. Paramesonepric Duct
 c. Mullerian Duct
 d. B and C
The primitive tissue that differentiates to become male reproductive organs is called a mesonephric duct or wolffian duct. Internal
sexual organ differentiation starts at about 7-8 weeks intrauterine life. Both external and internal reproductive organ differentiation is
completed at about 12 week’s age of gestation.
2. Growth of long bones is stimulated in females due to hormonal secretions, however, mature height is only limited. What is the
best explanation for this?
 a. Initiation of fat deposition during the puberty period in females inhibits growth
 b. Progesterone increases bone growth but is mostly utilized for endometrial proliferation before ovulation
 c. Estrogen causes closure of epiphysis
 d. Decrease follicle stimulating hormone is noted during the later stage of adolescence
Estrogen stimulate the growth of long bones however, it also causes closure of the epiphysis (end of a long bone), thereby limiting
bone growth.
3. Sexual development is discussed in a nursing forum. Which of the following is not true about sexual development?
 a. Genetic sex is determined at conception.
 b. The external genitalia start to differentiate when the genetic sex is determined.
 c. Presence of only a small part of Y chromosome directs the primitive cells to become testes
 d. Although ovary is secreted by the female ovary, it is not required to initiate development of female reproductive
structures
The external genitals differentiates internally at about 7-8 weeks intrauterine life. XY produces a genetically male zygote directing
the primitive cells to become testes with the influence of testosterone. At about 10 week’s AOG, if no testosterone is present the
primitive cells develop to become ovary. Thus, it is the absence of testosterone not the presence of estrogen that causes the
development of female reproductive systems.
4. In an anatomy class, the clinical instructor asked a student nurse about the definition of “vulva.” The student nurse answered
correctly if she answered that vulva is composed of:
 a. Vagina, uterus, and cervix
 b. Clitoris, vestibule and fourchette
 c. Labia majora, fallopian tubes and ovaries
 d. Cervix, mammary glands and ovaries
Vulva is a collective term that refers to the external female reproductive organ. Only letter B enumerates all external female
structures.
5. A pregnant woman is admitted. Based on the last menstrual period given she is 38 week’s AOG. During vaginal examination the
doctor tells the patient that she is on station -1. This is best interpreted as:
 a. One cm below the ischial spine
 b. At the level of the ischial spine
 c. One inch above the ischial spine
 d. One cm above the ischial spine
Station refers to the descent of the fetal presenting part in relation to the pelvic structures. The mark is the ischial spines. Once the
presenting part descended at the level of the ischial spines the station is zero and engagement has occurred. If it is above the
ischial spines the station is negative and if below the mark the station is positive. Therefore, -1 is 1 cm above the ischial spines and
+1 is one cm below the ischial spines. Centimeter not inch is used in interpreting a station.
6. Shanna is a 2 year old child. She weighs 30 lbs. What is her birthweight?
 a. 6 lbs
 b. 6.5 lbs
 c. 7 lbs
 d. 7.5 lbs
Birthweight doubles at 6 months triples at 1 year. If at 2 years she weighs 30 lbs, then 30 / 4 = 7.5 lbs. Thus, D is the
correct answer.
7. Shanna’s mother asked what is the MAIN reason why hospitals and clinics weigh children every check-up. The nurse’s
best answer is:
 a. To keep track of the child’s social progress
 b. To be used in calculating drug dosages
 c. For baseline data purposes
 d. To assess developmental delay in a child
The main reason in obtaining weight in children is to provide data that will be used in calculating drug dosages (e.g. Clark’s Rule).
Tracking the growth or physical progress is just secondary to that reason. Developmental delay is assessed through Denver
Developmental Screening Test (DDST).
8. An 8-month old infant is under what stage of development according to Erik Erikson?
 a. Trust vs. Mistrust
 b. Anal
 c. Oral
 d. Initiave vs. Guilt
Erik Erikson’s psychosocial theory states that 1 year old infants are under Trust vs Mistrust. Oral is the psychosexual development
of infants according to Freud.
9. Right after delivery Baby Girl Fe has been suctioned to promote a clear and patent airway. What is the correct technique in
suctioning a newborn?
 a. Starting with the nose then the mouth follows
 b. Positioning the infant in a prone position to drain secretions
 c. Suctioning the mouth first followed by the nose
 d. Wrapping the infant carefully
Keep in mind M comes before N in the alphabet. In suctioning the M (mouth) first before N (nose). Mouth is suctioned first to prevent
aspiration.
10. Wrapping newborns and drying them after bathing is a technique to:
 a. Prevent cold stress
 b. Prevent hypoglycemia
 c. Promote shivering thermogenesis
 d. Metabolize brown fats
Cold stress is prevented in newborns as an immature body system is incapable of shivering to produce heat. If a newborn is
exposed to cold, the neonate’s body metabolizes the brown fats and the process is call non-shivering thermogenesis. Hypoglycemia
occurs within 24 hours if the mother has diabetes.
11. A pregnant client visited the health care agency. During assessment, the nurse learned that her last day of her last menstrual
period (LMP) is January 24, 2010. She added that the duration her last menstruation is 4 days. Using Nagele’s Rule calculate for
the exact date of delivery.
 a. February 29, 2011
 b. October 31, 2011
 c. October 31, 2010
 d. October 27, 2010
In calculating the EDD or exact date of delivery, the first day of LMP should be used. In the case, January 24, 2010 was the last day
of LMP. Since the client said that her last menses has 4 day duration, meaning to say, the first day of LMP was January 20, 2010. In
Nagele’s rule, you countback three months from the first day of the LMP and add 7 days. You cannot substitute the year for months
like January, February and March. Therefore, January 20, 2010 – 3 months + 7 days = October 27, 2010. If you used 2010, the
pregnancy will last more than 9 months.
12. The nurse was performing leopold’s maneuver. In executing the techniques of the maneuver, which is least likely done by the
nurse?
 a. Instruct the patient to drink plenty of fluid before the procedure.
 b. Warm the nurse’s hand before initiating the palpation.
 c. Allowing the client to void first before the procedure.
 d. Close the curtains and provide privacy.
Having the pregnant woman drink plenty of fluids would lead to uncomfortable feeling during the procedure once the woman feels
the need to void. Before starting the maneuver, allow the woman to void, warm the hands of the nurse to prevent discomfort to the
client and provide privacy.
13. During the first maneuver the nurse feels a round, soft portion at the fundus. This is best interpretation of this is:
 a. The head is at the fundus
 b. The abdomen is at the fundus
 c. The buttocks is at the fundus
 d. The shoulder is at the fundus
If the part palpated at the fundus is round and soft it is the fetal buttocks. Fetal head feels round and firm.
14. What is the purpose of doing the fourth maneuver?
 a. To know the fetal part at the fundus
 b. To assess the degree of flexion or attitude
 c. To have an idea what the fetal presenting part is
 d. To know if engagement occurred or not
The fourth maneuver is only done if the presentation is in cephalic. The nurse assesses the degree of flexion in this maneuver.
Maneuver 1 would assess the fetal part found at the fundus. To know what the presenting part is and assess if engagement
occurred Maneuver 3 is done.
15. Seven weeks after the conception the growing structure inside a uterus is now called:
 a. Zygote
 b. Embryo
 c. Fetus
 d. Neonate
A- Zygote: 12-14 days B- Embryo: 15th day – 8 weeks C- Fetus: 8 weeks until delivery D- Neonate: delivery to 1 month
16. A 7-month old child has been diagnosed with meningitis. The nurse has obtained a medical history of the condition. Of the
following choices, which is not a risk factor of meningitis?
 a. Otitis Media
 b. Splenectomy
 c. Genetics
 d. Myelomenigocele
Meningitis is caused by an infection. It is not genetically determined. Children with splenectomy are susceptible to pneumococcal
infections unless they receive a pneumococcal vaccine.
17. The mother of a child diagnosed with meningitis asked the nurse about the signs and symtoms of the disease. The nurse
correctly responded when she said that in most children with meningitis the first noticeable sign of the illness is:
 a. Seizure or shock
 b. Irritability due to headache
 c. Nuchal rigidity
 d. Bulging fontanels
Seizure or shock in most children with meningitis is the first noticeable sign. Headache leading to irritability will not be immediately
noticed or interpreted as infection of the meninges. Nuchal rigidity develops later on. A bulging fontanel (if open) develops later than
the seizures.
18. The causative factor of meningitis has been determined. H. Influenzae has caused the infection. If this is the causative agent,
what would you expect in a child to manifest that is exclusively seen in the meningitis caused by H. Influenzae?
 a. Papular petechial skin rash
 b. Papilledema
 c. Septic arthritis
 d. Photophobia
If the causative agent is H. Influenzae, septic arthritis may develop. If it is caused by N. Meningitidis papula or purple petechial rash
may develop. Papilledema develop if the fontanels are closed already. Photophobia is seen in children with meningitis regardless of
what the causative factor is.
19. During assessment the nurse flexed the patient’s neck which also caused an involuntary and bilateral flexion of the hip, knee
and ankle. The patient is positive for what sign?
 a. Opisthothonus
 b. Kernig’s sign
 c. Brudzinski’s sign
 d. Increase intracranial pressure
A positive Brudzinski’s sign causes bilateral flexion of the hip, knee and ankle as the nurse flexed the patient’s neck. A positive
Kernig’s sign is the pain, resistance and spasm as the leg is extended. Opisthothonus is characterized by an arched back and
hyperextension of the neck.
20. Some children with meningitis cannot follow a light through full visual fields. If this occurred, cranial nerve paralysis is also
suspected. Typically, what cranial nerve damage causes this?
  a. First and second cranial nerves
 b. Third and sixth cranial nerves
 c. First and fourth cranial nerves
 d. Second and sixth cranial nerves
Cranial nerve paralysis may occur in children with meningitis. Most typically, the third and sixth cranial nerves are damaged causing
a child to unable to follow a light through a full visual field.
21. The blood culture and CSF analysis indicates H.Influenzae as the causative agent. What is the drug of choice for meningitis
caused by this organism?
 a. Ampicillin
 b. Cefotaxime
 c. Ceftriaxone
 d. Mannitol
Ampicillin is the drug of choice if the meningitis is caused by a H. Influenzae. If other organisms are detected as the causative agent,
a third-generation cephalosporin is prescribed such as cefotaxime and ceftriaxone. Mannitol is given to relieve or reduce increase
ICP.
22. If a child is suspected with meningitis what is the top priority intervention to execute?
 a. Assess for signs of meningeal irritation
 b. Position the client in a fowler’s position to decrease ICP
 c. Observe and place the child in respiratory precautions
 d. Promoting safety
To prevent the transmission of disease is the top priority in this case. Respiratory precautions should be observed.
23. In CSF analysis, done through lumbar puncture, if a child has meningitis which of the following values would you expect to drop?
 a. WBC
 b. Glucose
 c. Protein
 d. Platelet
CSF indicative of meningitis include increase WBC and protein levels and a decrease of glucose level because the bacteria fed on
the glucose. Platelet count is not affected in meningitis.
24. If the organism that caused meningitis is E. Coli and Group B Streptococcus, what antibiotic would you expect the physician to
prescribe in the patient?
 a. Ampicillin
 b. Cefotaxime
 c. Dexamethasone
 d. Mannitol
Ampicillin is the drug of choice if the meningitis is caused by a H. Influenzae. If other organisms are detected as the causative agent
(such as E. COLI and GROUP B STREP) , a third-generation cephalosporin is prescribed such as cefotaxime and ceftriaxone, that’s
why the correct answer is B. Mannitol and Dexamethasone are not antibiotics.
25. To assess and examine for abscess in children with meningitis what diagnostic procedures can be done?
 a. MRI
 b. CT scan
 c. Ultrasound study
 d. All of the above
An MRI, CT scan and ultrasound study may be ordered to examine for abscesses.