GYNECOLOGY TEST QUESTIONS a.

20111
b. 21111
Situation: During an Anatomy and Physiology
c. 30111
class, the lecturer discussed about the female
d. 31111
reproductive system.
7. Discomforts during pregnancy are discussed
1. Estrogen, one of the hormones regulating
by the nurse to the Mrs. Donna. Which of the
cyclic activities in female reproductive system is
following, when complained by the client would
responsible for which effect?
alert the nurse?
a. Increases the quantity and pH of cervical
a. Easy fatigability
mucus, causing it to become thin and watery and
b. Nausea and vomiting
can be stretched to a distance of 10-13 cm.
c. Edema of the lower extremities
b. Inhibits the production of LH
d. Heartburn
c. Increases endometrial tortuosity
d. All of the above 8. Psychological and emotional responses of
pregnant women differ. However, general
2. Jessa, 17 years old, is bleeding between
emotional response has been noted during
periods of less than two weeks. This condition is an
pregnancy based on their gestational age. Mrs.
abnormality in the menstrual cycle known as:
Donna will most likely have which emotional
a. Metrorrhagia
response towards her pregnancy?
b. Menorrhagia
a. Presents denial disbelief and sometimes
c. Amenorrhea
repression.
d. Dysmenorrheal
b. Has personal identification of the baby and
3. One factor of having a normal delivery is the realistic plans for future of the child.
size of the pelvis. Pelvis serves as the passageway c. Fantasizes the appearance of the baby.
for the passenger (fetus) during childbirth. The d. Verbalizes fear of death during childbirth.
most ideal pelvis for childbirth is:
9. The nurse assisted Mrs. Donna to a dorsal
a. Android
recumbent position and is about to assess the fetal
b. Anthropoid
heart rate (FHR). Which of the following
c. Platypelloid
apparatus should the nurse use in auscultating for
d. Gynecoid
the FHR?
4. An important landmark of the pelvis that a. Doppler apparatus
determines the distance of the descent of the head b. Fetoscope
is known as: c. Ultrasound
a. Linea terminalis d. Stethoscope
b. Sacrum
10. Mrs. Donna asked the nurse, when a fetal
c. Ischial spines
heart starts beating. The nurse correctly
d. Ischial tuberosities
responded by stating:
5. The permanent cessation of menstruation is: a. 3 weeks AOG
a. Amenorrhea b. 8 weeks AOG
b. Menopause c. 12 weeks AOG
c. Oligomenorrhea d. 20 weeks AOG
d. Hypomenorrhea
Situation: Mrs. Dela Cruz is in labor and is
Situation: Mrs. Donna, pregnant for 16 weeks age brought to the emergency room with a ruptured
of gestation (AOG), visits the health care facility bag of water.
for her prenatal check-up with her only son, Mark.
11. The nurse’s initial action once the bag of
During assessment the client told the nurse that
water has ruptured is:
previously she got pregnant twice. The first was
a. Take the fetal heart tones
with her only child, Mark, who was delivered at 35
b. Put the client to the bed immediately
weeks AOG and the other pregnancy was
c. Perform an IE
terminated at about 20 weeks AOG.
d. Take the woman’s temperature
6. Based on the data obtained, Mrs. Donna’s
12. Mrs. Dela Cruz’s has contractions growing
GTPAL score is:
stronger which lasts for 40-60 seconds and occur
approximately every 3-5 minutes. The doctor is
about to perform an IE, the nurse expects that the
client’s cervical dilatation will be:
a. 0-3 cm
b. 4-7 cm
c. 8-10 cm
d. 11-13 cm
13. The doctor informed the woman that she is on
station -1. Mrs. Dela Cruz asked the nurse, what
does 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
the presenting 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
the client 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
should the 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 adenosine
triphosphate and the influence some hormones.
Which of the following least likely contributes to
the occurrence of uterine contractions?
a. Oxytocin
b. Estrogen
c. Prolactin
d. All of the above
17. Dysfunctional labor may be caused by which
of the following?
a. Excessive or too early analgesia administration
b. Exhausted mother
c. Overdistention of the uterus
d. All of the above
18. The client’s uterine contractions are
hypotonic. The nurses top priority with hypotonic
contractions during the intrapartal period is:
a. Pain relief
b. Psychological support
c. Monitoring the lochia for possible bleeding
d. Infection control
19. For a woman experiencing hypotonic
contractions, what should be done initially?
a. Obtain an ultrasonic result
b. Infusion of oxytocin
c. Administration of analgesia
d. Amniotomy
20. The most important nursing consideration in
a postpartal woman with a hypotonic contraction
is:
a. Assessment for infection
b. Assessment for bleeding
c. Assessment for FHR
d. Assessment for woman’s coping mechanism
Situation: 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
placenta previa and abruption placenta is that
placenta previa has:
a. Painful bleeding
b. Rigid abdomen
c. Bright-red blood
d. Blood filled with clots
22. In caring for a client diagnosed with
placenta previa, the nurse should avoid which of
the following?
a. Inspecting the perineum
b. Performing a Kleihauer-Betke test
c. Performing a pelvic examination
d. All of the above
23. For the nurse to distinguish that the
bleeding of the patient is placenta previa or
abruption placenta what should she ask the
woman?
a. Whether there was accompanying pain
b. What she has done for bleeding
c. Estimation of blood loss
d. All of the above
24. Continued bleeding may result to fetal
distress. The nurse knows that the fetus is being
compromised when she observed or note which
of the following:
a. Fetal tachycardia
b. Fetal bradycardia
c. Fetal thrashing
d. All of the above
25. A woman in labor is diagnosed with abruption
placenta. The nurse would expect which findings in
the client’s history that may contribute to the
occurrence of the complication?
a. Age of 24 years old
b. Cigarette smoking
c. Sleeping 8 hours per night
d. Sitting for long period
ANSWERS AND RATIONALES:
1. 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 be stretched 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 tubes
2. Answer: A
Abnormalities of Menstruation
1. Amenorrhea – absence of menstrual flow
2. Dysmenorrhea – painful menstruation
3. Oligomenorrhea – scanty menstruation
4. Menorrhagia -excessive menstrual bleeding
5. Metrorrhagia – bleeding between periods of
less than 2 weeks
3. Answer: D. Gynecoid is the “normal” female
pelvis. The inlet is well rounded. This is the most
ideal pelvis for childbirth.
• Android – “male” pelvis. Inlet has a narrow,
shallow posterior portion and pointed anterior
portion.
• Anthropoid – transverse diameter is narrow and physiologic anemia of pregnancy (physiologic
anteroposterior (AP) diameter of this pelvis is
larger than normal.
• Platypelloid – inlet is oval while AP diameter of upper extremities not the lower extremities
this pelvis is shallow.
4. Answer: C. Ischial spines are the point of
reference in determining the station (relationship of during pregnancy is due to the increase
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 regurgitation of the stomach contents through the
ischial spines it is -1 and if 1 cm below the ischial cardiac sphincter into the esophagus, causing
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 viability). 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, 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
meaning it is normally expected during
pregnancy, thus A is incorrect). Edema of the
should alert the nurse because of the possibility
of toxemia, hence C is incorrect. Heartburn
progesterone which decreases gastric motility
causing a reversed peristaltic wave leading to
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 child’s 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. Donna’s 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.)
11. Answer: B. The keyword is INITIAL
ACTION. The important consideration before
answering the question is to take a look at the
situation. SITUATION: THE WOMAN IS IN THE
Emergency Room or is seeking admission.
A woman in labor seeking admission to the hospital
(in the ER) and saying that her BOW has ruptured
should BE PUT TO BED IMMEDIATELY and the
fetal heart tones taken consequently. If a woman in
the Labor Room says that her membranes have
ruptured, the initial nursing action is to take the
fetal heart tone.
12. Answer: B. The nurse would expect that the
client’s cervical dilatation is 4-7 cm as the
contraction duration and interval is noted for clients • Oxytocin
who are in the active phase of the first stage of
labor. The maximum 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 and occurring approximately every 5-10
minutes.
• Active phase – 4-7 cm cervical dilatation;
contractions grow stronger, lasting 40-60 seconds
and occur at approximately every 3-5 minutes.
• Transition phase – 8-10 cm cervical dilatation;
contractions reach their peak of intensity, occurring
every 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 the statement of nurse is describing the
occurrence of engagement that is again station 0.
Prior to engagement the fetus is said to be
"floating" or ballottable, thus letter C is the best
option. Letter D, is describing 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 in multiparas dilatation may proceed
before effacement is completed. Effacement must
occur at the end of dilatation, however, before the
fetus can be safely pushed through the cervical
canal; otherwise, cervical tearing 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
uterine contractions.
16. Answer: C. Prolactin is the hormone that
produces milk in mammary glands. Uterine
contractions can occur because of the interplay of
the contractile enzyme adenosine triphosphate
and the influence some hormones and major
electrolytes which are the following:
• Calcium
• Sodium
• Potassium
• Specific contractile proteins (actin and
myosin)
• Epinephrine and norepinephrine
• Estrogen and progesterone
• Prostaglandins
17. 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
a client 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 status
18. Answer: D. When the contractions are • Chronic hypertensive disease
hypotonic, the length of labor is increased. When • PIH
the cervix is dilated for a long period of time, both • Direct trauma
the uterus and fetus are at greater risk of infection. • Vasoconstriction from cocaine or cigarette use
Hypotonic contractions are not exceedingly painful
because of their lack of intensity. Monitoring of
bleeding through evaluation 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 or
cephalopelvic 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 of uterine 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 labor
20. Answer: B. During the postpartum period, the
uterus should be palpated and lochia should be
assessed 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 to frighten a woman. With abruption
placenta, the bleeding is painful, the abdomen is
rigid or board-like and the blood is dark-red or
filled with clots.
22. Answer: C. Never attempt a pelvic or rectal
examination with painless bleeding late in
pregnancy because 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 perenial
pads. An Apt or Kleihauer-Betke test (test strip
procedures) can be used to detect whether the blood
is of fetal or maternal origin.
23. Answer: A. placenta previa presents bleeding
without pain whilst the bleeding in abruptio
placenta is painful.
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