NOTRE DAME OF TACURONG COLLEGE COLLEGE OF NURSING TACURONG CITY

In partial fulfilment of the course requirements in NCM 103 (RLE)

BOARD EXAM QUESTIONS(DR) AND DELIVERY ROOM PROCEDURE (NORMAL SPONTANEOUS VAGINAL DELIVERY)

SUBMITTED TO: Mr. RICHARD DEO ROX ALAVE, RN SUBMITTED BY: Ms. BAI SANDRA SINAGANDAL, SN

September 23, 2012

BOARD EXAM QUESTIONS (DR):

Situation: During an Anatomy and Physiology class, the lecturer discussed about the female reproductive system. 1. a. b. c. d. 2. a. b. c. d. 3. a. b. c. d. 4. as: a. b. c. d. 5. a. b. c. d. Linea terminalis Sacrum Ischial spines Ischial tuberosities The permanent cessation of menstruation is: Amenorrhea Menopause Oligomenorrhea Hypomenorrhea Estrogen, one of the hormones regulating cyclic activities in female reproductive system is Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be Inhibits the production of LH Increases endometrial tortuosity All of the above Jessa, 17 years old, is bleeding between periods of less than two weeks. This condition is an Metrorrhagia Menorrhagia Amenorrhea Dysmenorrheal One factor of having a normal delivery is the size of the pelvis. Pelvis serves as the passageway for Android Anthropoid Platypelloid Gynecoid An important landmark of the pelvis that determines the distance of the descent of the head is known responsible for which effect? stretched to a distance of 10-13 cm.

abnormality in the menstrual cycle known as:

the passenger (fetus) during childbirth. The most ideal pelvis for childbirth is:

Situation: Mrs. Donna, pregnant for 16 weeks age of gestation (AOG), visits the health care facility for her prenatal check-up with her only son, Mark. Duringassessment the client told the nurse that previously she got pregnant twice. The first was with her only child, Mark, who was delivered at 35 weeks AOG and the other pregnancy was terminated at about 20 weeks AOG. 6. a. b. c. d. Based on the data obtained, Mrs. Donnas GTPAL score is: 20111 21111 30111 31111

7. a. b. c. d. 8.

Discomforts during pregnancy are discussed by the nurse to the Mrs. Donna. Which of the following, Easy fatigability Nausea and vomiting Edema of the lower extremities Heartburn Psychological and emotional responses of pregnant women differ. However, general emotional

when complained by the client would alert the nurse?

response has been noted during pregnancy based on their gestational age. Mrs. Donna will most likely have which emotional response towards her pregnancy? a. b. c. d. 9. a. b. c. d. 10. a. b. c. d. Presents denial disbelief and sometimes repression. Has personal identification of the baby and realistic plans for future of the child. Fantasizes the appearance of the baby. Verbalizes fear of death during childbirth. The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heart Doppler apparatus Fetoscope Ultrasound Stethoscope Mrs. Donna asked the nurse, when a fetal heart starts beating. The nurse correctly responded by 3 weeks AOG 8 weeks AOG 12 weeks AOG 20 weeks AOG

rate (FHR). Which of the following apparatus should the nurse use in auscultating for the FHR?

stating:

ANSWERS AND RATIONALE:

1. Answer: A. 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 be

Effects of estrogen:

stretched to a distance of 10-13 cm. Effects of Progesterone 2. 1. 2. 3. 4. 5. 3. Inhibits the production of LH Increases endometrial tortuosity Increased endometrial secretions Facilitates transport of the fertilized ovum through the fallopian tubes Answer: A Amenorrhea absence of menstrual flow Dysmenorrhea painful menstruation Oligomenorrhea scanty menstruation Menorrhagia -excessive menstrual bleeding Metrorrhagia bleeding between periods of less than 2 weeks Answer: D. Gynecoid is the normal female pelvis. The inlet is well rounded. This is the most ideal 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 larger Platypelloid inlet is oval while AP diameter of this pelvis is shallow.

Abnormalities of Menstruation

pelvis for childbirth.

than normal.

4.

Answer: C. Ischial spines are the point of reference in determining the station (relationship of the

fetal presenting part to the ischial spines). When the fetal head is at the level of the ischial spines the station 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 blood flow. 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 of Living children (L) number of living children. (Source: Maternal and Child Health Nursing by Adelle Pillitteri, 5th Ed. P.252)

viability). Age of viability is 24 weeks.

Since Mrs Donna has two previous pregnancies and is presently pregnant (16 weeks), G is 3. Mark, her only 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 is her only living child, thereby, L=1. Her GTPAL score is: 30111, G=3 T=0 P=1 A=1 L=1 7. Answer: B. Morning sickness characterized by nausea and vomiting is only noted during the FIRST

TRIMESTER of pregnancy (first 3 months). Excessive nausea and vomiting which persists more than 3 months is a condition called Hyperemesis gravidarum that requires immediate intervention to prevent starvation and dehydration. Management for hyperemesis gravidarum includes the administration of D5NSS 3L in 24 hours and complete bed rest. Easy fatigability is a consequence of the physiologic anemia of pregnancy (physiologic meaning it is normally expected during pregnancy, thus A is incorrect). Edema of the upper extremities not the lower extremities should alert the nurse because of the possibility of toxemia, hence C is incorrect. Heartburn during pregnancy is due to the increase progesterone which decreases gastric motility causing a reversed peristaltic wave leading to regurgitation of the stomach contents through the cardiac sphincter into the esophagus, causing irritation. 8. Answer: C. The client is in her second trimester of pregnancy (16 weeks AOG or 4 months), thus, she

perceived the baby as a separate entity. Presenting denial and disbelief and sometime repression is the psychological/emotional response of a pregnant woman on her first trimester. Identifying the fetus and setting realistic plans for the childs future is noted during the third trimester of pregnancy. It is during this time also that the woman verbalizes fear of death.

9.

Answer: A. Mrs. Donnas gestational age is 16 weeks (4 months). During this time, the fetal heart rate

is audible with a Doppler apparatus. A fetal heart beat can be detected with a Doppler apparatus starting at 12 weeks AOG. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing 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 two

parallel tubes. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. During 12 weeks AOG, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed.)

Normal Spontaneous Vaginal Delivery Stages of Labor

First stage of labor A typical human childbirth will begin the onset of the first stage of labor: contractions of the uterus, at first every 10-30 minutes and lasting about 40 seconds each. Occasionally the labor will begin with a rupture of the amniotic sac, the paired amnion and chorion (breaking of the water). The contractions will accelerate until they happen every two minutes. Each contraction dilates the cervix until it reaches 10 centimeters (4) in width. The duration of labor varies wildly, but averages some 13 hours for women giving birth to their first child (primiparae) and 8 hours for women who have already given birth. Second stage of labor In the second stage of labor, the baby is expelled from the womb through the birth canal by both the uterine contractions and by powerful abdominal contractions (bearing down). The baby is most commonly born head-first. With difficulty, babies can be delivered in the breech position where the babys buttocks or feet are delivered first and the legs are folded onto the babys body. Babies in a footling breech position should not be delivered via vaginal birth. Immediately after birth, the child undergoes extensive physiological modifications as it acclimatizes to independent breathing. Several cardiac structures start regressing immediately after birth, such as the ductus arteriosus and the foramen ovale. The medical condition of the child is assessed with the Apgar score, based on five parameters. A good start refers to higher scores, while a child doing poorly will have low scores that do not improve rapidly over time. Third stage (placental) The last stage of labor occurs about a quarter to a half-hour after the baby is born; in this stage, the placenta or afterbirth is expelled.

After the birth

Usually soon after birth the parents assign the infant its given names. Many cultures feature initiation rites for newborns, such as circumcision or baptism, amongst others.

Variations
When the amniotic sac has not ruptured during labor or pushing, the infant can be born with the membranes intact. This is referred to as being born in the caul. The caul is harmless and easily wiped away by the doctor or person assisting with the childbirth. In medieval times, a caul was seen as a sign of good fortune for the baby, in some cultures was seen as protection against drowning, and the caul was often impressed onto paper and stored away as an heirloom for the child. With the advent of modern interventive obstetrics, premature artificial rupture of the membranes has become common and it is rare for infants to be born in the caul in Western births.

Pain control
Due to the relatively-large size of the human skull and the shape of the human pelvis forced by the erect posture, childbirth is more difficult and painful for human mothers than other mammals. Many methods are available to reduce the pain of labor, including psychological preparation, emotional support, epidural analgesia, spinal anesthesia, nitrous oxide and opioids, the Lamaze Technique. Each method has its own advantages and disadvantages.

Complications
Complications occasionally arise during childbirth; these generally require management by an obstetrician. Non-progression of labor (longterm contractions without adequate cervical dilation) is generally treated with cervical prostaglandin gel or intravenous synthetic oxytocin preparations. If this is ineffective, Caesarean section may be necessary. Fetal distress is the development of signs of distress by the child. These may include rising or decreasing heartbeat (monitored on cardiotocography/CTG), shedding of meconium in the amniotic fluid, and other signs. Non-progression of expulsion (the head or presenting parts are not delivered despite adequate contractions): this can require interventions such as vacuum extraction, forceps extraction and Caesarean section. In the past, a great many women died during or shortly after childbirth but modern medical techniques available in industrialized countries have greatly reduced this total.

REFERENCE:
http://nursing-resource.com/normal-spontaneous-vaginal-delivery/#stages