Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz #5 | 80 Questions| 2022 update with rationales

Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz #5 | 80 Questions 1. 1. Question Mechanism of labor, also known as the cardinal movements, refers to the sequencing of events involved in posturing and positioning that allows the baby to find the easiest to come out of the birth canal. Arrange the following mechanisms of labor in the order during the course of labor and fetal delivery. View Answers: o Expulsion o Flexion o Extension o External rotation o Descent o Internal rotation o Engagement Incorrect The correct order is shown above. The mechanism of fetal delivery begins with descent into the pelvic inlet which may occur several days before true labor sets in the primigravida. Flexion, internal rotation, and extension are mechanisms that the fetus must perform as it accommodates through the passageway/birth canal. Eternal rotation is done after the head is delivered so that the shoulders will be easily delivered through the vaginal introitus. 2. 2. Question The first thing that a nurse must ensure when the baby’s head comes out is o A. The cord is intact o B. No part of the cord is encircling the baby’s neck o C. The cord is still attached to the placenta o D. The cord is still pulsating Incorrect Correct Answer: B. No part of the cord is encircling the baby’s neck The nurse should check right away for possible cord coil around the neck because if it is present, the baby can be strangled by it and the fetal head will have difficulty being delivered. • Option A: In a newborn who was born a few hours ago, the cord may look plump and pale yellow. One of the umbilical arteries may be visible and protruding from the cut edge. A normal cord has two arteries and one vein. • Option C: The cord is expelled from the mother within a half-hour after birth. It is still attached to the placenta, which is commonly called “the afterbirth.” With its function completed, it is no longer needed and so is discarded by the mother’s body. • Option D: Some cords may pulsate (the pulsation assists the transfer of your baby’s blood back into their body) for as long as 30 minutes or more, where others may stop pulsating at 5 minutes or less after the baby is born. 3. 3. Question To ensure that the baby will breathe as soon as the head is delivered, the nurse’s priority action is to • A. Slap the baby’s buttocks to make the baby cry. • B. Suction the nose and mouth to remove mucous secretions. • C. Clamp the cord about 6 inches from the base. • D. Check the baby’s color to make sure it is not cyanotic. Incorrect Correct Answer: B. Suction the nose and mouth to remove mucous secretions. Suctioning the nose and mouth of the fetus as soon as the head is delivered will remove any obstruction that may be present allowing for better breathing. Also, if mucus is in the nose and mouth, aspiration of the mucus is possible which can lead to aspiration pneumonia. (Remember that only the baby’s head has come out as given in the situation.) • Option A: Earlier, many doctors would hold the baby upside down firmly around his legs and then slap the butt gently. This not only causes slight pain to the child, but the motion also helps loosen any residues that might be obstructing the airways. Constantly doing so can irritate the child enough to begin crying. • Option C: Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births while initiating simultaneous essential neonatal care. Early umbilical cord clamping (less than 1 min after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation. • Option D: When a baby is first born, the skin is a dark red to purple color. As the baby starts to breathe air, the color changes to red. This redness normally starts to fade on the first day. A baby’s hands and feet may stay bluish in color for several days. This is a normal response to a baby’s underdeveloped blood circulation. But blue coloring of other parts of the body isn’t normal. 4. 4. Question When doing perineal care in preparation for delivery, the nurse should observe the following, except? • A. Use up-down technique with one stroke. • B. Clean from the mons veneris to the anus. • C. Use mild soap and warm water. • D. Paint the inner thighs going towards the perineal area. Incorrect Correct Answer: D. Paint the inner thighs going towards the perineal area Painting of the perineal area in preparation for delivery of the baby must always be done but the stroke should be from the perineum going outwards to the thighs. The perineal area is the one being prepared for the delivery and must be kept clean • Option A: Wipe the perineum in one stroke to prevent the transfer of infectious microorganisms from the anal area to the perineum. • Option B: Always wash from front to back to prevent spreading fecal matter from the anal area to the vagina or urethra. • Option C: Use mild soap and warm water. Mild soap would avoid killing the normal flora that lives in and around the perineum. 5. 5. Question What are the important considerations that the nurse must remember after the placenta is delivered? Select all that apply. • A. Check if the placenta is complete including the membranes • B. Check if the cord is long enough for the baby • C. Check if the umbilical cord has 3 blood vessels • D. Check if the cord has a meaty portion and a shiny portion Incorrect Correct Answer: A & C The nurse after delivering the placenta must ensure that all the cotyledons and the membranes of the placenta are complete. Also, the nurse must check if the umbilical cord is normal which means it contains the 3 blood vessels: 1 vein and 2 arteries. • Option B: At term, the typical umbilical cord is 55 to 60 cm in length, with a diameter of 2.0 to 2.5 cm. The structure should have abundant Wharton’s jelly, and no true knots or thromboses should be present. The total cord length should be estimated in the delivery room, since the delivering physician has access to both the placental and fetal ends. • Option C: The maternal surface of the placenta should be dark maroon in color and should be divided into lobules or cotyledons. The structure should appear complete, with no missing cotyledons. The fetal surface of the placenta should be shiny, gray and translucent enough that the color of the underlying maroon villous tissue may be seen. • Option D: The normal cord contains two arteries and one vein. During the placental examination, the delivering physician should count the vessels in either the middle third of the cord or the fetal third of the cord, because the arteries are sometimes fused near the placenta and are therefore difficult to differentiate. 6. 6. Question The following are correct statements about false labor, except? • A. The pain is irregular in intensity and frequency. • B. The duration of contraction progressively lengthens over time. • C. There is no bloody vaginal discharge. • D. The cervix is still closed. Incorrect Correct Answer: B. The duration of contraction progressively lengthens over time In false labor, the contractions remain to be irregular in intensity and duration while in true labor, the contractions become stronger, longer and more frequent. Braxton Hicks contractions can be described as tightening in the abdomen that comes and goes. These contractions do not get closer together, do not increase in how long they last or how often they occur, and do not feel stronger over time. They often come with a change of position and stop with rest. • Option A: In false labor, the pain concentrates in the lower abdomen and groin. It is irregular in intensity and frequency. The pain often ceases regardless of the mother’s activity. • Option C: There is no evidence of a bloody show. A bloody show or a “mucus plug” could mean a cervical change, which means labor is close. • Option D: Some women have painful contractions for days with no cervical changes while other women might feel only a little pressure and backache. 7. 7. Question The passageway in labor and delivery of the fetus include the following, except? • A. Distensibility of lower uterine segment • B. Cervical dilatation and effacement • C. Distensibility of vaginal canal and introitus • D. Flexibility of the pelvis Incorrect Correct Answer: D. Flexibility of the pelvis The pelvis is a bony structure that is part of the passageway but is not flexible. The lower uterine segment including the cervix as well as the vaginal canal and introitus are all part of the passageway in the delivery of the fetus. • Option A: As uterine contractions cause pressure on the membranes, the hydrostatic action of the amniotic sac in turn dilates the cervical canal like a wedge. In the absence of intact membranes, the pressure of the presenting fetal part against the cervix and lower uterine segment is similarly effective. • Option B: Effacement may be compared to a funneling process in which the whole length of a narrow cylinder is converted into a very obtuse, flaring funnel with a small circular opening. Because of increased myometrial activity during uterine preparedness for labor, appreciable effacement of a softened cervix sometimes is accomplished before active labor begins. Effacement causes expulsion of the mucous plug as the cervical canal is shortened. Because the lower segment and cervix have lesser resistance during a contraction, a centrifugal pull is exerted on the cervix and creates cervical dilatation. • Option C: The tailbone (sacrum or coccyx) needs to be sufficiently mobile to be gently pressed back out of the way when the baby moves through. The sacroiliac joint allows this nutation or counter-nutation of the sacrum. The symphysis pubis is a cartilaginous joint in the front of the pelvis. It also needs to be properly mobile to help the pelvis flex to allow the baby to pass through. The relaxin hormone in your body helps both the tailbone and the symphysis pubis become more mobile to facilitate birth. 8. 8. Question The normal umbilical cord is composed of: • A. 2 arteries and 1 vein • B. 2 veins and 1 artery • C. 2 arteries and 2 veins • D. None of the above Incorrect Correct Answer: A. 2 arteries and 1 vein Three vessels comprise the umbilical cord: two umbilical arteries and one umbilical vein. The umbilical cord is a soft, tortuous cord with a smooth outer covering of amnion. It extends from the umbilicus of the fetus to the center of the placenta. Its length ranges from 50 cm to 60 cm, with a diameter of about 1 cm.[6] The umbilical cord is composed of a gelatinous ground substance called Wharton’s jelly or substantia gelatinea funiculi umbilicalis. • Option B: The umbilical arteries carry deoxygenated blood from fetal circulation to the placenta. The two umbilical arteries converge together about at 5 mm from the insertion of the cord, forming a type of vascular connection called the Hyrtl’s anastomosis. The primary function of Hartl’s anastomosis is to equalize blood flow and pressure between the umbilical and placental arteries. • Option C: The two umbilical arteries arise from the internal iliac arteries of the fetus and enter the umbilical cord before further branching at the level of the placenta. At the placental level, each umbilical artery bifurcates into smaller arterioles that continue to branch further to distribute blood to the chorionic villi. The capillaries of the villi fuse to form venules that converge to form the umbilical vein. The umbilical vein carries oxygenated blood and nutrients from the mother to the fetus. • Option D: The umbilical cord is considered both the physical and emotional attachment between mother and fetus. This structure allows for the transfer of oxygen and nutrients from the maternal circulation into fetal circulation while simultaneously removing waste products from fetal circulation to be eliminated maternally. 9. 9. Question At what stage of labor and delivery does a primigravida differ mainly from a multigravida? • A. Stage 1 • B. Stage 2 • C. Stage 3 • D. Stage 4 Incorrect Correct Answer: A. Stage 1 In stage 1 during normal vaginal delivery of a vertex presentation, the multigravida may have about 8 hours of labor while the primigravida may have up to 12 hours labor. • Option B: The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate. In women who have delivered vaginally previously, whose bodies have acclimated to delivering a fetus, the second stage may only require a brief trial, whereas a longer duration may be required for a nulliparous female. • Option C: The third stage of labor commences when the fetus is delivered and concludes with the delivery of the placenta. Separation of the placenta from the uterine interface is hallmarked by three cardinal signs including a gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation. • Option D: During the fourth stage of labor, the baby is born, the placenta has delivered, and the woman and her partner will probably feel joy, relief, and fatigue. Most babies are ready to nurse within a short period after birth. Others wait a little longer. If the woman is planning to breastfeed, it is strongly encouraged to try to nurse as soon as possible after the baby is born. Nursing right after birth will help the uterus to contract and will decrease the amount of bleeding. 10. 10. Question The second stage of labor begins with ___ and ends with __? • A. Begins with full dilatation of cervix and ends with delivery of placenta. • B. Begins with true labor pains and ends with delivery of the baby. • C. Begins with complete dilatation and effacement of cervix and ends with delivery of the baby. • D. Begins with passage of show and ends with full dilatation and effacement of cervix. Incorrect Correct Answer: C. Begins with complete dilatation and effacement of cervix and ends with delivery of baby Stage 2 of labor and delivery process begins with full dilatation of the cervix and ends with the delivery of the baby. Stage 1 begins with true labor pains and ends with full dilatation and effacement of the cervix. • Option A: The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate. This was also defined as the pelvic division phase by Friedman. After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements. • Option B: The first stage of labor begins when labor starts and ends with full cervical dilation to 10 centimeters. Labor often begins spontaneously or may be induced medically for a variety of maternal or fetal indications. • Option D: During the latent phase, the cervix dilates slowly to approximately 6 centimeters. The latent phase is generally considerably longer and less predictable with regard to the rate of cervical change than is observed in the active phase. Active labor with more rapid cervical dilation generally starts around 6 centimeters of dilation. During the active phase, the cervix typically dilated at a rate of 1.2 to 1.5 centimeters per hour. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation. 11. 11. Question The following are signs that the placenta has detached, except? • A. Lengthening of the cord • B. Uterus becomes more globular • C. Sudden gush of blood • D. Mother feels like bearing down Incorrect Correct Answer: D. Mother feels like bearing down Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any effort from the mother. • Option A: The most reliable sign is the lengthening of the umbilical cord as the placenta separates and is pushed into the lower uterine segment by progressive uterine retraction. Placing a clamp on the cord near the perineum makes it easier to appreciate this lengthening. Never place traction on the cord without countertraction on the uterus above the symphysis; otherwise, one may mistake cord lengthening due to impending prolapse or inversion for that of uncomplicated placental separation. • Option B: The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta descends into the lower segment and the body of the uterus continues to retract. This change may be clinically difficult to appreciate. • Option C: As the placenta detaches, the spiral arteries are exposed in the placental bed; massive hemorrhage would occur if not for the structure of the uterus. The vessels supplying the placental bed traverse a latticework of crisscrossing muscle bundles that occlude and kink-off the vessels as they contract and retract following the expulsion of the placenta. 12. 12. Question When the shiny portion of the placenta comes out first is called which of the following mechanisms? • A. Marmets • B. Ritgens • C. Duncan • D. Schultze Incorrect Correct Answer: D. Schultze There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes out first, it is called the Schultze mechanism; while if the meaty portion comes out first, it is called the Duncan mechanism. • Option A: Developed by a mother who needed to express her milk over a long period of time for medical reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended method of expressing breastmilk by hand. • Option B: Ritgen’s maneuver means that the fetal chin is reached between the anus and the coccyx and pulled anteriorly while using the fingers of the other hand on the fetal occiput to control the speed of delivery and keep flexion of the fetal neck. • Option C: Duncan’s mechanism is the expulsion of the placenta with the presentation of the maternal rough side first, rather than the usual fetal side of the placenta. 13. 13. Question When the baby’s head is out, the immediate action of the nurse is • A. Cut the umbilical cord • B. Wipe the baby’s face and suction mouth first • C. Check if there is a cord coiled around the neck • D. Deliver the anterior shoulder Incorrect Correct Answer: C. Check if there is a cord coiled around the neck. The nurse should check if there is a cord coil because the baby will not be delivered safely if the cord is coiled around its neck. Normally the umbilical cord coils to the left. Regardless of its origin, umbilical coiling appears to confer turgor to the umbilical unit, producing a cord that is strong but flexible. The role of umbilical cord coiling is not clear; nonetheless, it is thought to play a role in protecting the umbilical cord from external forces such as tension, pressure, stretching or entanglement. • Option A: The World Health Organization currently recommends clamping the umbilical cord between one and three minutes after birth, “for improved maternal and infant health and nutrition outcomes,” while the American College of Obstetricians and Gynecologists recommends clamping within 30 to 60 seconds. • Option B: Wiping off the face should be done seconds after you have ensured that there is no cord coil but suctioning of the nose should be done after the mouth because the baby is a “nasal obligate” breather. If the nose is suctioned first before the mouth, the mucus plugging the mouth can be aspirated by the baby. • Option D: Anterior shoulder in obstetrics refers to that shoulder of the fetus that faces the pubic symphysis of the mother during delivery. Depending upon the original position of the fetus, either the left or the right shoulder can be the anterior shoulder. 14. 14. Question When delivering the baby’s head the nurse supports the mother’s perineum to prevent a tear. This technique is called • A. Marmet’s technique • B. Ritgen’s technique • C. Duncan maneuver • D. Schultze maneuver Incorrect Correct Answer: B. Ritgen’s technique Ritgen’s technique is done to prevent the perineal tear. This is done by the nurse by supporting the perineum with a sterile towel and pushing the perineum downward with one hand while the other hand is supporting the baby’s head as it goes out of the vaginal opening. • Option A: Developed by a mother who needed to express her milk over a long period of time for medical reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended method of expressing breastmilk by hand. • Option C: Duncan’s mechanism is the expulsion of the placenta with the presentation of the maternal rough side first, rather than the usual fetal side of the placenta. • Option D: There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes out first, it is called the Schultze mechanism; while if the meaty portion comes out first, it is called the Duncan mechanism. 15. 15. Question The basic delivery set for normal vaginal delivery includes the following instruments/articles, except? • A. 2 clamps • B. Pair of scissors • C. Kidney Basin • D. Retractor Incorrect Correct Answer: D. Retractor For normal vaginal delivery, the nurse needs only the instruments for cutting the umbilical cord such as 2 clamps (straight or curve) and a pair of scissors as well as the kidney basin to receive the placenta. The retractor is not part of the basic set. In the hospital setting, needle holders and tissue forceps are added especially if the woman delivering the baby is a primigravida wherein episiotomy is generally done. • Option A: The clamps are used for clamping the umbilical cord. After the cord has stopped pulsating, or after at least 1-3 minutes after birth, the first clamp is placed near the neonate’s umbilicus, then the other one just farther down the cord. • Option B: Using sterile scissors, cut between the two clamps. Keep in mind that the cord is thick and hard to cut. One pair will be used to cut the baby’s umbilical cord. Another will be used if there is a need for an episiotomy. In that case, the doctor will have to cut into the perineum (the skin between the vagina and anus) to help the baby fit through. • Option C: The kidney basin is used to receive the placenta. Inspect the placenta for completeness before disposing it properly. 16. 16. Question As soon as the placenta is delivered, the nurse must do which of the following actions? • A. Inspect the placenta for completeness including the membranes. • B. Place the placenta in a receptacle for disposal. • C. Label the placenta properly. • D. Leave the placenta in the kidney basin for the nursing aide to dispose properly. Incorrect Correct Answer: A. Inspect the placenta for completeness including the membranes. The placenta must be inspected for completeness to include the membranes because an incomplete placenta could mean that there is retention of placental fragments which can lead to uterine atony. If the uterus does not contract adequately, hemorrhage can occur. • Option B: During the examination, the size, shape, consistency and completeness of the placenta should be determined, and the presence of accessory lobes, placental infarcts, hemorrhage, tumors and nodules should be noted. Once deemed complete, it may be disposed of properly. • Option C: The placenta is not necessarily labeled. For inspection, keep in mind that the maternal surface of the placenta should be dark maroon in color and should be divided into lobules or cotyledons. The structure should appear complete, with no missing cotyledons. The fetal surface of the placenta should be shiny, gray, and translucent enough that the color of the underlying maroon villous tissue may be seen. • Option D: Before the proper disposal of the placenta, it should be assessed properly. Evaluating placental completeness is of critical, immediate importance in the delivery room. Retained placental tissue is associated with postpartum hemorrhage and infection. 17. 17. Question In vaginal delivery done in the hospital setting, the doctor routinely orders oxytocin to be given to the mother parenterally. The oxytocin is usually given after the placenta has been delivered and not before because: • A. Oxytocin will prevent bleeding. • B. Oxytocin can make the cervix close and thus trap the placenta inside. • C. Oxytocin will facilitate placental delivery. • D. Giving oxytocin will ensure complete delivery of the placenta. Incorrect Correct Answer: B. Oxytocin can make the cervix close and thus trap the placenta inside The action of oxytocin is to make the uterus contract as well make the cervix close. If it is given prior to placental delivery, the placenta will be trapped inside because the action of the drug is almost immediate if given parenterally. • Option A: Active management of the third stage of labor has been shown to reduce the risk of postpartum hemorrhage. It usually involves the administration of uterotonic drugs. Although active management has been shown to reduce the risk of postpartum hemorrhage, it may have an impact on the well-being of the mother and baby in terms of the amount of blood that has been transfused to the baby before the separation of the placenta. • Option C: In the United States, oxytocin is the uterotonic most often administered at birth. It is commonly administered after delivery of the placenta. However, it does not facilitate placental delivery. • Option D: For the prevention of postpartum hemorrhage, and in conjunction with the other components of active management of the third stage of labor, oxytocin can be administered with the delivery of the anterior shoulder or after the delivery of the placenta. 18. 18. Question In a gravido-cardiac mother, the first 2 hours postpartum (4th stage of labor and delivery) particularly in a cesarean section is a critical period because at this stage • A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart. • B. The maternal heart is already weak and the mother can die. • C. The delivery process is strenuous to the mother. • D. The mother is tired and weak which can distress the heart. Incorrect Correct Answer: A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart. During the pregnancy, there is an increase in maternal blood volume to accommodate the need of the fetus. When the baby and placenta have been delivered, there is a fluid shift back to the maternal circulation as part of physiologic adaptation during the postpartum period. In a cesarean section, the fluid shift occurs faster because the placenta is taken out right after the baby is delivered giving it less time for the fluid shift to gradually occur. • Option B: Heart rate increases in a linear fashion during pregnancy by 10 to 20 bpm over baseline and returns to pre-pregnant levels in 6 weeks postpartum. There is ventricular remodeling during pregnancy and left ventricular wall thickness and mass increase by 28% to 52% above pre-pregnancy values. Cardiac contractility and ventricular ejection fraction don’t undergo any significant change during the entire peripartum period. • Option C: There is generalized physical fatigue immediately after delivery. The pulse rate may be elevated a few hours after the childbirth, due to excitement or pain, and usually normalizes on the second day. The blood pressure could be elevated due to pain or excitement but is generally in the normal range • Option D: Cardiac output increases throughout pregnancy. However, in the immediate postpartum period, following delivery, there is an increase in circulating blood volume from the contraction of the uterus and an increase in preload from the relief of inferior vena cava obstruction, leading to an increase in stroke volume and heart rate leading to a 60 to 80% rise in cardiac output, which rapidly declines to pre-labor values in 1 to 2 hours following delivery and to pre-pregnancy values in two weeks postpartum. 19. 19. Question This drug is usually given parenterally to enhance uterine contraction: • A. Terbutaline • B. Pitocin • C. Magnesium sulfate • D. Lidocaine Incorrect Correct Answer: B. Pitocin The common oxytocin given to enhance uterine contraction is Pitocin. This is also the drug given to induce labor. • Option A: Terbutaline, sold under the brand name Bricanyl among others, is a ?2 adrenergic receptor agonist, used as a “reliever” inhaler in the management of asthma symptoms and as a tocolytic (anti-contraction medication) to delay preterm labor for up to 48 hours. • Option C: Magnesium sulfate is often quite effective in slowing contractions, although this effect and how long it lasts varies from woman to woman. Like all tocolytic medications, however, magnesium sulfate does not consistently prevent or delay preterm delivery for a significant period of time. The most common explanation is that magnesium lowers calcium levels in uterine muscle cells. Since calcium is necessary for muscle cells to contract, this is thought to relax the uterine muscle. • Option D: The local anesthetic is transferred to the fetus slowly, and its margin of safety is also increased. Considering how local anesthetics have small direct effects on the fetus even at submaximal doses, lidocaine may be considered relatively safe for use in pregnant women. 20. 20. Question The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following, except? • A. Vital signs • B. Fluid intake and output • C. Uterine contraction • D. Cervical dilatation Incorrect Correct Answer: B. Fluid intake and output Partograph is a monitoring tool designed by the World Health Organization for use by health workers when attending to mothers in labor, especially the high risk ones. For maternal parameters all of the above is placed in the partograph except the fluid intake since this is placed in a separate monitoring sheet. WHO further modified the partograph for the third time. This simplified partograph is color-coded. The area to the left of the alert line is colored green representing the normal progress. The area to the right of the action line is colored red indicating dangerously slow progress. The area between the alert and action line is colored amber indicating the need for greater vigilance • Option A: WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. All the recordings for the maternal condition are entered at the foot of the partograph below the recording of uterine contraction. Maternal vital signs such as temperature, pulse, BP, urine output and urine for protein and acetone are monitored. • Option C: Below the cervical dilatation, there is a space for recording uterine contractions per 10 min and the scale is numbered from 1 to 5. Each square represents one contraction. So if two contractions are felt in 10 min, two squares are shaded. • Option D: The central feature of the partogram is a graph where cervical dilatation is plotted. Along the left side, there are squares from 0 to 10, each representing 1-cm dilatation. Along the bottom of graph are numbers 0–24 each presenting 1 h. The first stage of labor is divided into latent and active phases. The latent phase is from 0 to 3 cm, and it lasts up to 8 h. The active phase is from 3 to 10 cm (full cervical dilatation). The dilatation of the cervix is plotted with “x.” 21. 21. Question The following are natural childbirth procedures, except? • A. Lamaze method • B. Dick-Read method • C. Ritgen’s maneuver • D. Psychoprophylactic method Incorrect Correct Answer: C. Ritgen’s maneuver Ritgen’s method is used to prevent perineal tear/laceration during the delivery of the fetal head. Lamaze method is also known as psychoprophylactic method and Dick-Read method are commonly known natural childbirth procedures which advocate the use of nonpharmacologic measures to relieve labor pain. • Option A: Lamaze breathing historically is considered the hallmark of Lamaze preparation for childbirth. Controlled breathing enhances relaxation and decreases the perception of pain. It is one of many comfort strategies taught in Lamaze classes. In restricted birthing environments, breathing may be the only non-pharmacological comfort strategy available to women. Conscious breathing and relaxation, especially in combination with a wide variety of comfort strategies, can help women avoid unnecessary medical intervention and have a safe, healthy birth. • Option B: The term ‘natural childbirth’ derives from the title of a short 1933 treatise by Grantly Dick-Read. In this and several other books and articles published over the next quarter-century, the British-born physician outlined an alternative to the anesthetized, medically controlled way of birth common among Western women of privilege, based on the premise that fear lay at the root of pain in labor. For Dick-Read, whether or not a mother experienced pain in labor depended not on some property inherent to the physiology of parturition but on cultural attitudes to childbirth. Through education and relaxation, women could overcome what he termed the ‘Fear–Tension–Pain’ cycle and labor in comfort without resorting to medical intervention. Preparation for labor meant providing pregnant women with detailed instruction, from their physician, midwife, or qualified childbirth educator, on the physiology of pregnancy and birth, nutrition, exercise, hygiene, and infant care. • Option D: In the late 1940s, Soviet scientists invented a new non-pharmacological method called the ‘psychoprophylactic method of painless childbirth’ (PPM), which later became well known as the Lamaze method in the West.1 This gift of Soviet science to the women of the world was based on the assumption that it was possible to eliminate the sensation of bodily pain during labor by training the mind of a pregnant woman before she gives birth. 22. 22. Question The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage? • A. Pelvic bone contraction • B. Full bladder • C. Extension rather than flexion of the head • D. Cervical rigidity Incorrect Correct Answer: B. Full bladder A full bladder can impede the descent of the fetal head. The nurse can readily manage this problem by doing a simple catheterization of the mother. • Option A: The narrower shape of the android pelvis can make labor difficult because the baby might move more slowly through the birth canal. Some pregnant women with an android pelvis may require a C-section. • Option C: Abnormal labor could also be secondary to the passenger, the size of the infant, and/or the presentation of the infant. In addition to problems caused by the differential in size between the fetal head and the maternal bony pelvis, the fetal presentation may include asynclitism or head extension. Asynclitism is malposition of the fetal head within the pelvis, which compromises the narrowest diameter through the pelvis. • Option D: According to the most recent evidence, arrest of labor in the first stage should be defined as more than or equal to 6cm dilation with ruptured membranes and one of the following: 4 hours or more of adequate contractions (>200 MVU) or 6 hours or more of inadequate contractions and no cervical change. 23. 23. Question At what stage of labor is the mother advised to bear down? • A. When the mother feels the pressure at the rectal area. • B. During a uterine contraction. • C. In between uterine contraction to prevent uterine rupture. • D. Anytime the mother feels like bearing down. Incorrect Correct Answer: B. During a uterine contraction The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing down during a contraction. • Option A: During the second stage of labor, the fetal presentation comes down and compression occurs in both the bladder and rectum, generating a reflex that causes a strong urge to bear down, or ‘push’. Therefore, the combination of involuntary intrauterine contractions and voluntary expulsive effort, through the abdominal and respiratory muscles, will help fetus delivery. • Option C: Maternal pushing during the second stage of labor is an important and indispensable contributor to the involuntary expulsive force developed by uterine contraction. • Option D: Waiting for the urge to push with an epidural does shorten the duration of pushing and increases spontaneous vaginal delivery, but lengthens the second stage and doubles the risk of low umbilical cord pH (based on data from one study). 24. 24. Question The normal dilatation of the cervix during the first stage of labor in a nullipara is • A. 1.2 cm./hr • B. 1.5 cm./hr. • C. 1.8 cm./hr • D. 2.0 cm./hr Incorrect Correct Answer: A. 1.2 cm./hr For nullipara, the normal cervical dilatation should be 1.2 cm/hr. If it is less than that, it is considered a protracted active phase of the first stage. For multipara, the normal cervical dilatation is 1.5 cm/hr. • Option B: For nulliparous women, Friedman (Friedman Studies) reported that the active phase of labor approximates the time from 2.5 cm cervical dilatation through complete dilatation, approximated at 10 cm. Use of 2.5 cm dilatation as the onset of active labor was an aggregate estimate and was, therefore, not strictly applicable to any individual woman. • Option C: Active phase labor was further divided into three sub-phases, i.e., an acceleration phase, a phase of maximum slope, and a deceleration phase. Friedman described the acceleration phase as a rapid change in the slope of cervical dilation approximating the time needed for the cervix to dilate from 2.5 cm to 4 cm, and the phase of maximum slope as a period of rapid cervical dilation progressing linearly from approximately 4 cm to 9 cm cervical dilatation. Friedman reported the mean and slowest-yet-normal (i.e., mean – 2 standard deviations) cervical dilation rates in the phase of maximum slope to be 3.0 and 1.2 cm/hr, respectively. • Option D: The deceleration phase was identified when the rate of dilation once again slowed as full dilatation was reached. For the aggregate of all labors, this phase approximated the time needed for the cervix to dilate from 9 cm to 10 cm. Friedman included data from some women without a spontaneous labor onset and some who were not low-risk by modern standards. 25. 25. Question When the fetal head is at the level of the ischial spine, it is said that the station of the head is • A. Station –1 • B. Station “0” • C. Station +1 • D. Station +2 Incorrect Correct Answer: B. Station “0” Determining is defined as the relationship of the fetal head and the level of the ischial spine. At the level of the ischial spine, the station is “0”. Above the ischial spine it is considered (-) station and below the ischial spine it is (+) station. • Option A: By 6 cm of dilation, the median station was 0 (95% CI ?2 to 1) for nulliparous and ?1 (95% CI ?3 to 0) for multiparous women. At 8 cm, 95% of nulliparous women were at ?1 station or lower. • Option C: The fetal head is already engaged in station +1. The difference between numbers in the score is equivalent to the length in centimeters. Moving from +1 to +2 is a movement of about 1 centimeter. • Option D: +2 to +3 station is crowning and beginning to emerge from the birth canal. 26. 26. Question During an internal examination, the nurse palpated the posterior fontanel to be at the left side of the mother at the upper quadrant. The interpretation is that the position of the fetus is: • A. LOA • B. ROP • C. LOP • D. ROA Incorrect Correct Answer: A. LOA The landmark used in determining fetal position is the posterior fontanel because this is the nearest to the occiput. So if the nurse palpated the occiput (O) at the left (L) side of the mother and at the upper/anterior (A) quadrant then the fetal position is LOA. • Option B: In the right occiput posterior position (ROP), the baby is facing forward and slightly to the right (looking toward the mother’s left thigh). This presentation may slow labor and cause more pain. • Option C: When facing forward, the baby is in the occiput posterior position. If the baby is facing forward and slightly to the left (looking toward the mother’s right thigh) it is in the left occiput posterior (LOP) position. This presentation can lead to more back pain (sometimes referred to as “back labor”) and slow progression of labor. • Option D: The right occiput anterior (ROA) presentation is also common in labor. In this position, the back of the baby is slightly off center in the pelvis with the back of the head toward the mother’s right thigh. In general, OA positions do not lead to problems or additional pain during labor or birth. 27. 27. Question The following are types of breech presentation, except: • A. Footling • B. Frank • C. Complete • D. Incomplete Incorrect Correct Answer: D. Incomplete Breech presentation means the buttocks of the fetus is the presenting part. If it is only the foot/feet, it is considered footling. If only the buttocks, it is a frank breech. If both the feet and the buttocks are presenting it is called complete breech. • Option A: The footling breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). • Option B: In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. • Option C: The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. 28. 28. Question When the nurse palpates the suprapubic area of the mother and found that the presenting part is still movable, the right term for this observation that the fetus is • A. Engaged • B. Descended • C. Floating • D. Internal Rotation Incorrect Correct Answer: C. Floating The term floating means the fetal presenting part has not entered/descended into the pelvic inlet. If the fetal head has entered the pelvic inlet, it is said to be engaged. • Option A: If the fetal head accommodates two fingerbreadths above pelvic brim, it is said to be engaged. • Option B: Using the rule of fifths, the distance between the base and vertex of the fetal head is divided into five equal parts. Each fifth corresponds to 2 cm or approximately one transverse fingerbreadth. • Option D: As the head descends, the presenting part, usually in the transverse position, is rotated about 45° to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet. 29. 29. Question The placenta should be delivered normally within how many minutes after the delivery of the baby? • A. 5 minutes • B. 30 minutes • C. 45 minutes • D. 60 minutes Incorrect Correct Answer: B. 30 minutes The placenta is delivered within 30 minutes from the delivery of the baby. If it takes longer, probably the placenta is abnormally adherent and there is a need to refer already to the obstetrician. • Option A: The absolute time limit for delivery of the placenta, without evidence of significant bleeding, remains unclear. Periods ranging from 30-60 minutes have been suggested. • Option C: Retained placenta can be defined as lack of expulsion of the placenta within 30 minutes of delivery of the infant. This is a reasonable definition in the third trimester when the third stage of labor is actively managed (ie, administration of a uterotonic agent before delivery of the placenta, controlled cord traction) because 98 percent of placentas are expelled by 30 minutes in this setting. • Option D: Physiologic management of the third stage (ie, delivery of the placenta without the use of uterotonic agents or cord traction) increases the frequency of retained placenta: only 80 percent of placentas are expelled by 30 minutes and it takes approximately 60 minutes before 98 percent of placentas are expelled. 30. 30. Question When shaving a woman in preparation for cesarean section, the area to be shaved should be from: • A. Under breast to mid-thigh including the pubic area. • B. The umbilicus to the mid-thigh. • C. Xiphoid process to the pubic area. • D. Above the umbilicus to the pubic area. Incorrect Correct Answer: A. Under breast to mid-thigh including the pubic area. Shaving is done to prevent infection and the area usually shaved should sufficiently cover the area for surgery, cesarean section. The pubic hair is definitely to be included in the shaving. • Option B: Infections of surgical incisions are the third most frequently reported hospital?acquired infections. Women who give birth by cesarean section are exposed to infection from germs already present on the mother’s own skin, or from external sources. The risk of infection following a cesarean section can be 10 times that of vaginal birth. Therefore, preventing infection by properly preparing the skin before the incision is made is an important part of the overall care given to women prior to cesarean birth. • Option C: The xiphoid process is definitely not included in shaving prior to cesarean section. The Centers for Disease Control and Prevention (CDC) estimates that 27 million surgical procedures are performed in the United States each year. The CDC’s National Nosocomial Infections Surveillance system reports that surgical site infections are the third most frequently reported nosocomial infection, accounting for 14% to 16% of all such infections (CDC 2005). Preventing infection by properly preparing the skin before the incision is thus a vital part of the overall care given to women during a cesarean birth. • Option D: Proper preparation of an incision site involves removing surface dirt and oil with a soap or detergent scrub plus applying a topical antimicrobial agent that will reduce the bacterial population to a minimal level. In surgical patients, the choice of surgical scrub and the duration of scrubbing have not been shown to make any significant difference in the rate of surgical site infection in either clean or clean?contaminated wounds (such as cesarean skin incision). 31. 31. Question During the postpartum period, the fundus of the uterus is expected to go down normally about how many centimeters per day? • A. 1.0 cm • B. 2.0 cm • C. 2.5 cm • D. 3.0 cm Incorrect Correct Answer: A. 1.0 cm The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery. • Option B: During the normal puerperium period, the uterine involution is defined by the changing indices of the uterine size, the uterine cavity inserts, and the uterine artery flow. Most of the studies publish the first ultrasound examination findings on the 1st, 2nd, and 3rd postpartum days, but there is not a single ultrasound study examining the uterus within the first two hours after delivery. • Option C: The most obvious postpartum change is involution of the uterus from a 1-kg structure with a 5- to 10-L volume to a 60-g structure holding 3 to 5 mL. This involution begins during the third stage of labor, accelerates after expulsion of the placenta, and continues over the next 5 to 6 weeks. Typically, the uterus is at the umbilicus after delivery of the placenta, and it decreases in height by about a centimeter a day until it again becomes a pelvic organ at about 12 days postpartum. Slower involution continues over the next several weeks until prepregnant size is attained. Restoration of the normal endometrial lining occurs by the 16th day postpartum. • Option D: The most intensive uterine involution period is the first month after delivery. The trend of involution in primiparous and multiparous women is similar; however, in multiparous women, it lasts longer than 6–8 weeks. 32. 32. Question The lochia on the first few days after delivery is characterized as • A. Pinkish with some blood clots • B. Whitish with some mucus • C. Reddish with some mucus • D. Serous with some brown tinged mucus Incorrect Correct Answer: C. Reddish with some mucus Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue, and mucus. Since it is not pure blood it is non-clotting. Lochia rubra (or cruenta) is the first discharge, Composed of blood, shreds of fetal membranes, decidua, vernix caseosa, lanugo and membranes. It is red in color because of the large amount of blood it contains. It lasts 1 to 4 days after birth, before easing to light “spotting”. • Option A: Lochia serosa is the term for lochia that has thinned and turned brownish or pink in color. It contains serous exudate, erythrocytes, leukocytes, cervical mucus, and microorganisms. This stage continues until around the tenth day after delivery. Lochia serosa which persists to some weeks after birth can indicate late postpartum hemorrhaging and should be reported to a physician. • Option B: Lochia alba (or purulenta) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth weeks after delivery. It contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, mucus and microorganisms. Continuation beyond a few weeks can indicate a genital lesion, which should be reported to a physician. • Option D: Between days four and seven, the blood should turn a pinkish or brownish color. Clots should get smaller or disappear. By the end of the first week, the discharge will likely be white or yellow in color. In three to six weeks, it should stop. 33. 33. Question Lochia normally disappears after how many days postpartum? • A. 5 days • B. 7-10 days • C. 18-21 days • D. 28-30 days Incorrect Correct Answer: B. 7-10 days Normally, lochia disappears after 10 days postpartum. What’s important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier every day. • Option A: Lochia for the first 3 days after delivery is dark red in color. A few small blood clots, no larger than a plum, are normal. • Option C: For the fourth through tenth day after delivery, the lochia will be more watery and pinkish to brownish in color. • Option D: From about the seventh to the tenth day through the fourteenth day after delivery, the lochia is creamy or yellowish in color. Moms who have cesarean sections may have less lochia after 24 hours than moms who had vaginal deliveries. The bleeding generally stops within 4 to 6 weeks after delivery. 34. 34. Question After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to: • A. Prevent the recurrence of Rh(+) babies in future pregnancies. • B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby. • C. Ensure those future pregnancies will not lead to maternal illness. • D. To prevent the newborn from having problems of incompatibility when it breastfeeds. Incorrect Correct Answer: B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby In Rh incompatibility, a Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen. • Option A: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. • Option C: RhoGAM prevents the Rh-negative mother from making antibodies directed against her baby’s Rh-positive red blood cells during her pregnancy. • Option D: Rho(D) immune globulin is immune globulin (IgG) rich in IgG antibodies against erythrocyte antigen Rho(D). IgG is a normal component of breastmilk. Rho(D) immune globulin is frequently used in nursing mothers and no adverse effects have been reported in breastfed infants. No special precautions are required. 35. 35. Question To enhance milk production, a lactating mother must do the following interventions, except: • A. Increase fluid intake including milk. • B. Eat foods that increase lactation which is called galactagogues. • C. Exercise adequately like aerobics. • D. Have adequate nutrition and rest. Incorrect Correct Answer: C. Exercise adequately like aerobics. All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation. • Option A: It is widely assumed that milk production requires a high fluid intake on the part of the mother, yet the evidence suggests that lactating women can tolerate a considerable amount of water restriction and that supplemental fluids have little effect on milk volume. However, thirst may sometimes function too slowly to prevent dehydration among women with high fluid losses resulting from exercise or high ambient temperature (experienced by many women without air conditioning in the summer). • Option B: A galactagogue or galactogogue (pronounced gah-lak´tah-gog) is something that can help a breastfeeding mother to increase her breast milk supply. The word itself is a combination of the Greek terms “galact-” meaning milk, and “-agogue” meaning leading to or promoting. Herbs are commonly used to boost low milk supply, but certain actions, foods, and medications can help a breastfeeding mom make more breast milk as well. • Option D: Maternal anxiety and stress, which may be exacerbated by poor lactation management, are believed to influence milk production by inhibiting the milk-ejection reflex. This reflex usually operates well in women who are relaxed and confident of their ability to breastfeed. In tense women, however, the reflex may be impaired. Early studies in humans by Gopalan (1958) and Edozien et al. (1976) suggest the same relationship: milk output of women in India and Nigeria increased when protein intake was increased from 50 to 60 g/day to approximately 100 g/day. 36. 36. Question The nursing intervention to relieve pain in breast engorgement while the mother continues to breastfeed is • A. Apply cold compress on the engorged breast. • B. Apply warm compress on the engorged breast. • C. Massage the breast. • D. Apply analgesic ointment. Incorrect Correct Answer: B. Apply warm compress on the engorged breast Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold. • Option A: Using cold packs on the affected breast can help reduce swelling and relieve pain. Use warm packs just before a feed (for up to a few minutes) to help trigger the let-down reflex to help clear the blockage and may relieve pain. • Option C: Gentle massage by stroking toward the nipple while the baby feeds may help in draining the breast of too much milk. • Option D: The doctor may recommend an over-the-counter pain reliever, such as acetaminophen or ibuprofen. Ointments may interfere with the infant’s breastfeeding. 37. 37. Question A woman who delivered normally per vaginam is expected to void within how many hours after delivery? • A. 3 hrs • B. 4 hrs • C. 6-8 hrs • D. 12-24 hours Incorrect Correct Answer: C. 6-8 hrs A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don’t work, the nurse may decide to catheterize the woman. • Option A: The precise pathophysiology of PPUr is still unknown; however, it is likely to be multifactorial, including physiological, neurological, and mechanical processes in the postpartum period • Option B: Postpartum urinary retention has been classified into overt and covert retention by Yip et al. Women who are unable to micturate spontaneously within 6 h after vaginal delivery are categorized as having overt (symptomatic) urinary retention. Covert (asymptomatic) urinary retention is defined as having a postvoid residual bladder volume (PVRBV) of more than 150 mL, detected by ultrasound or by catheterization, with no symptoms of urinary retention. • Option D: Postpartum urinary retention (PPUR) is an upsetting condition that has no standard literature definition. It has been variably defined as the abrupt onset of aching or inability to completely micturate, requiring urinary catheterization, over 12 h after giving birth or not to void spontaneously within 6 h of vaginal delivery. 38. 38. Question To ensure adequate lactation the nurse should teach the mother to: • A. Breastfeed the baby on self-demand day and night. • B. Feed primarily during the day and allow the baby to sleep through the night. • C. Feed the baby every 3-4 hours following a strict schedule. • D. Breastfeed when the breasts are engorged to ensure adequate supply. Incorrect Correct Answer: A. Breastfeed the baby on self-demand day and night Feeding on self-demand means the mother feeds the baby according to the baby’s need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation. • Option B: Some newborns wake up and breastfeed every 2 to 3 hours like clockwork, but that’s not always the case. The baby may want to breastfeed many times in a short period, and then he might sleep for a little longer. This type of feeding is called cluster or bunch feeding. Other babies are sleepy, especially in the very early days, so the mother may have to wake the baby up to breastfeed. All of these patterns are normal. As long as the child is getting enough breast milk and growing well, there is nothing to worry. • Option C: On average, a breastfed newborn eats approximately every 2 to 3 hours around the clock. That’s about 8 to 12 times in a 24-hour period. Newborn have little stomachs and ?breast milk is easily digested, so they should breastfeed often. • Option D: In the beginning, breastfeed the newborn for as long as she will stay on the breast. Continue to breastfeed until there are signs that the child is satisfied. This way, the mother can be sure that the baby is getting enough breast milk at each feeding. Plus, keeping the baby breastfeeding longer, stimulates milk production and helps the mother to build up her breast milk supply. 39. 39. Question An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is: • A. Encourage the mother to ambulate to relieve the pain in the leg. • B. Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow. • C. Apply warm compress on the affected leg to relieve the pain. • D. Elevate the affected leg and keep the patient on bedrest. Incorrect Correct Answer: D. Elevate the affected leg and keep the patient on bed rest. If the mother already has thrombophlebitis, the nursing intervention is bed rest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation. • Option A: During pregnancy, an increase in most procoagulant factors and a reduction in fibrinolytic activity occurs. Plasma fibrinogen levels gradually increase after the third month of pregnancy, to double those of the nonpregnant state. In the second half of pregnancy, levels of factors VII, VIII, IX, and X also increase. Decreased fibrinolytic activity is probably related to a decrease in the level of circulating plasminogen activator. In addition, a 68% reduction in protein S levels is measured during pregnancy and in the postpartum period. Protein S levels do not return to the reference range until 12 weeks after delivery. These changes are necessary to prevent hemorrhage during placental separation. • Option B: The routine use of graduated support stockings (class I or II), especially when the patient is confined on an airplane or otherwise, is extremely important. • Option C: A warm water compress is valuable in the treatment of phlebitis, and could decrease the degree of phlebitis both effectively and inexpensively. 40. 40. Question The nurse should anticipate that hemorrhage related to uterine atony may occur postnatally if this condition was present during the delivery: • A. Excessive analgesia was given to the mother. • B. Placental delivery occurred within thirty minutes after the baby was born. • C. An episiotomy had to be done to facilitate delivery of the head. • D. The labor and delivery lasted for 12 hours. Incorrect Correct Answer: A. Excessive analgesia was given to the mother. Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus. • Option B: The absolute time limit for delivery of the placenta, without evidence of significant bleeding, remains unclear. Periods ranging from 30-60 minutes have been suggested. • Option C: An episiotomy is a minor incision made during childbirth to widen the opening of the vagina. A perineal tear or laceration often forms on its own during a vaginal birth. Rarely, this tear will also involve the muscle around the anus or the rectum. Both episiotomies and perineal lacerations require stitches to repair and ensure the best healing. Both are similar in recovery time and discomfort during healing. • Option D: Normal labor usually begins within 2 weeks (before or after) the estimated delivery date. In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours. 41. 41. Question According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the postpartum period. These stages are: • A. Going through, adjustment period, adaptation period • B. Taking-in, taking hold and letting-go • C. Attachment phase, adjustment phase, adaptation phase • D. Taking-hold, letting-go, attachment phase Incorrect Correct Answer: B. Taking-in, taking-hold and letting-go Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role. • Option A: The taking-in phase usually sets 1 to 2 days after delivery. This is the time of reflection for the woman because within the 2 to 3 day period, the woman is passive. The taking-in phase provides time for the woman to regain her physical strength and organize her rambling thoughts about her new role. • Option C: The taking hold phase starts 2 to 4 days after delivery. The woman starts to initiate actions on her own and makes decisions without relying on others. She starts to focus on the newborn instead of herself and begins to actively participate in newborn care. The woman still needs positive reinforcements despite the independence that she is already showing because she might still feel insecure about the care of her child. • Option D: During the letting go phase, the woman finally accepts her new role and gives up her old roles like being a childless woman or just a mother of one child. This is the phase where postpartum depression may set in. Readjustment of relationships is needed for an easy transition to this phase. 42. 42. Questio