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PAUL UNIVERSITY QUEZON CITY Midterm Examinations - First Semester 2013-2014 NCM 01C Care of Mother, Child and Family (Mrs. Cres P. Quinzon and Mr. Jeffrey Layosa) Name: ______________________________ Date: _____________ Score:________________ DIRECTION: Shade the letter of the correct answer on the answer sheet. Situation A : Maternal and child health nursing can be visualized within a framework in which nurses care for families during childbearing and childrearing years through the different phases of health care. 1. A program designed to decrease the infant mortality rate in the Philippines would probably make the greatest impact if it focused on which of the following? A) Changing genetic traits. B) Reducing the number of home births. C) Increasing the education level of parents. D) Increasing the number of women receiving prenatal care. 2. Which of the following is a trend in child health care today? A) Children are hospitalized for observation more than previously. B) Health promotion rather than health restoration is stressed. C) Child health care is moving out of regional centers. D) Nursing roles are decreasing because of the increasing role of families. 3. An important change in maternal and child health care that nurses must often explain is the new emphasis on ambulatory care. This change in emphasis is meant to achieve: A) Prevention of the separation of children from parents. B) Reduction of the number of hospitals needed. C) Decrease of responsibility on parents. D) Reduction in the number of drug interactions. 4. Which of the following statements correctly defines the term perinatal death rate? A) Number of deaths in utero of a fetus 500 g or more per 1,000 live births. B) Number of deaths per 1,000 live births occurring in the first 28 days of life. C) Number of deaths per 1,000 live births occurring at birth or in the first 12 months of life. D) Number of deaths per 1,000 live births beginning when the fetus reaches 500 g and ending 28 days after birth. 5. Which of the following best describes the pattern of maternal mortality since World War II? A) It has steadily decreased. B) It has remained constant. C) It has steadily increased. D) After decreasing until the 1960s, it has increased steadily. 6. Which of the following may occur in nuclear families at a greater level than in some other types of families? A) Financial difficulties. B) Problems with allocation of resources. C) Formation of a poor parentchild relationship. D) Lack of support people in a crisis. Scenario B: Miguel and Concepcion were both married before. Miguel has two children from his previous marriage while Concepcion has a 4 year old boy, Nicolo from her previous marriage. You are the community health nurse assigned to her. Questions 7 to_________ refer to this scenario. 7. Nicolo, Concepcions only child tells you that his mother is a psychologist and that his father is unemployed. His mother is the one who reminds him to take his medicine and also comforts his sister when she cries. Analyzing this description of his parents' roles, you would conclude that: A) his mother is the provider and nurturer.

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B) his father is the health supervisor and nurturer. C) his father is the peacemaker. D) his mother is the decision maker. When Miguel and Concepcion combine their families, they become what type of family? A) Double unit. B) Blended. C) Single unit. D) Extended. Miguel and Concepcion spoke with you about trying to conceive, you teach them about the changes in cervical mucous near the time of ovulation, you should advise them: A) The mucous is thin and copious related to the elevated estrogen levels B) The mucous is thick and tacky related to the reduced estrogen levels C) The mucous is scant due to the elevated progesterone levels D) The mucous is thin related to the reduced progesterone levels care for a client who has a retroverted uterus. You would explain that this means A) her uterus is bent sharply backward at the cervix. B) her cervix is located behind the Douglas cul-de-sac. C) her entire uterus is tipped backward. D) her uterus is anterior to the bladder. The 14-year old gymnast, Miguels daughter, Perla,is confused with her sexuality. You explained to her about following statements that best defines her sexual identity? A) The chosen activities a person uses to express masculinity or femininity. B) The feeling of being male or female. C) The male or female characteristics determined by genetic factors. D) The male or female characteristics encouraged by the culture. Perla also voices concerns that she has not begun menstruation. She states all of her friends have started. How will you respond to her concerns? A) Advise her to share her concerns with the doctor as this is certainly an abnormal occurrence. B) Explain that it is not unusual for menstruation not to have begun yet. C) Report these findings immediately to the physician for further evaluation. D) Encourage the use of hormone supplements to promote puberty. Concepcion is trying to locate her fertile days using the calendar method, you would teach her to subtract A) 14 from 28. B) 18 from her shortest period and 11 from her longest. C) The length of her average period from the ideal of 28. D) 18 from the longest period and 11 from her shortest. Furthermore, you also teach Concepcion that the characteristic of cervical mucus during ovulation is: A) High viscosity and alkalinity. B) Properties of acidity and ferning. C) Thin and watery. D) Increased number of leukocytes. Scenario C: Milagros, a 30-year old pregnant woman comes to you at the health center Inquiring about her pregnancy. She is interested about what is going on inside her; how the baby is growing and what should she do to have a normal pregnancy and delivery. The following questions relate to this scenario.

15. You teach Milagros that her baby was conceived and started to implant on the uterine surface during: A) The 14th day of a typical menstrual cycle. B) Eight days after ovulation. C) Ten days after the start of the menstrual flow. D) Four days after ovulation. 16. She also asked you what causes her pregnancy test to be positive. You tell her that hormones are released and one of the hormone released is the human chorionic gonadotropin (hCG) hormone. The purpose of this hormone is to: A) ensure chorionic somatomammotropin hormone production.

B) permit the uterus to increase in size. C) prolong the life of the corpus luteum. D) ensure oxygen transport across the placenta. 17. You also informed her that fetus is able to maintain blood circulation in utero by the presence of circulatory shunts. The ductus arteriosus in utero shunts blood from A) the left to right heart atria. B) the aorta to the pulmonary veins. C) the right ventricle to the aorta. D) the pulmonary artery to the aorta. 18. Furthermore, you teach her that a fetus is capable of producing antibodies. The finding of IgM antibodies in an infant at birth implies that A) antibodies were transferred to the fetus during pregnancy. B) the fetus contracted an infection during intrauterine life. C) the fetus's liver has reached developmental maturity. D) the mother contracted an infection during pregnancy. Scenario D: Sandra, is a 29-year old woman, 24 weeks pregnant, who comes to Nurse Carla for a first prenatal visit. She is concerned about prenatal care that would help her ensure a healthy outcome for her and her baby. The following questions refer to this scenario . 19. Nurse Carla counsels her that in early pregnancy, a sonogram is done for detection of the gestational sac. Sandra is scheduled for an ultrasound and as part of your instructions before this study, you would tell her A) not to drink any fluid 1 hour before the study. B) to be prepared for a catheter to be inserted before the study. C) to empty her bladder just before the study. D) to drink a large amount of fluid before the study. 20. To ensure that her baby is healthy, Sandra is being prepared for an amniocentesis, which precaution would nurse Carla take with Sandra following an amniocentesis? A) Remind her not to raise her head for 4 hours. B) Assess fetal heart rate and possible uterine contractions. C) Perform a vaginal examination for a ferning pattern. D) Assess for increased abdominal distention. 21. And which of the following nursing interventions is appropriate when preparing Sandra for an amniocentesis? A) Inform her that a narcotic premedication will be given to prevent pain during needle insertion. B) Be certain she knows that there is a slight risk for complication, such as premature labor, from amniocentesis. C) Instruct her not to empty her bladder before the procedure. D) Suggest that she take a deep breath and hold it during needle insertion. 22. Finally, amniocentesis revealed an elevated bilirubin level. When evaluating the results from an amniocentesis, elevated levels of bilirubin in the specimen may be associated with A) a fetus of a diabetic mother. B) blood incompatibility. C) fetal lung maturity. D) reduced immunoglobulin production in the fetus. 23. Sandra is also scheduled for a nonstress test. Nurse Carla explains that this is an assessment test based on what phenomenon? A) Braxton Hicks contractions cause fetal heart rate alterations. B) Fetal heart rate slows in response to a uterine contraction. C) Fetal movement causes an increase in maternal heart rate. D) Fetal heart sounds increase in connection with fetal movement. 24. Nurse Carla also examined her fundal height. Sandras fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age? A) 12 weeks. B) 20 weeks. C) 24 weeks.

D) 36 weeks. 25. Upon examination of fundal height, the fetal heart rate of the baby was also taken. Nurse Carla explained that the normal range for a fetal heart rate is A) 80 to 120 beats/minute. B) 100 to 140 beats/minute. C) 120 to 160 beats/minute. D) 130 to 180 beats/minute. 26. Sandra is worried that her 4-year old son is not accepting her pregnancy. Nurse Carla suggests Sandra that in order to prepare his 4-year-old son for a new baby, she would use one of the following statements: A) The new baby will need your bed so we're buying you a new one. B) It will be fun to have a sister or brother to give your old toys to. C) A new baby will make our family bigger but not change our love for you. D) Mother will need to spend a lot of time with the new baby. 27. Sandra revealed to you that at first, she did not want this pregnancy. She states, Feeling the baby move made me realize theres someone inside me. Nurse Carla explained that there are tasks she has to undergo while pregnant and the most important task during the first trimester is A) Accepting the pregnancy. B) Accepting a coming child. C) Making plans for the baby. D) Sharing time with a significant other. Scenario E: Leah and Robin are first time couple. They come to visit the out patient department for pre-natal check up. Leah is in her first trimester of pregnancy. Nurse Lyn attends to them. The following questions refer to this scenario. 28. Nurse Lyn teaches Leah that one of the following is a positive sign of pregnancy? A) Positive pregnancy test. B) Fetal movement felt by examiner. C) Hegar's sign. D) Uterine contractions. 29. Leah tells Nurse Lyn, Im constipated all the time! Which of the following would Nurse Lyn recommend? . A) Daily enemas B) Laxatives C) Increased finer intake D) Decreased fluid intake 30. Leah is bothered by her frequent urination, Nurse Lyn educates her that early in pregnancy, frequent urination results mainly from which of the following? A) Pressure on the bladder from the uterus. B) Increased concentration of urine. C) Addition of fetal urine to maternal urine. D) Decreased glomerular selectivity. 31. Leah, still curious on how much longer she will have urinary frequency, Nurse Lyn answers her based upon her knowledge, she advise her: A) Urinary frequency is a common complaint during the first trimester and again later in the third trimester. B) Urinary frequency is a common concern reported during the entire pregnancy. C) Urinary frequency will subside after the first trimester. D) Urinary frequency is a concern until the last trimester of pregnancy. 32. As Nurse Lyn examines Leah on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because A) her cerebral arteries are growing congested with blood. B) the uterus requires more blood in a supine position. C) blood is trapped in the vena cava in a supine position. D) sympathetic nerve responses cause dyspnea when a woman lies supine. 33. Nurse Lyn continues to assess Leah. At the first trimester, which of the following findings related to breast

changes would you expect to assess? A) Slack, soft breast tissue. B) Deeply fissured nipples. C) Enlarged lymph nodes. D) Darkened breast areolas. 34. As Nurse Lyn interviews Leah, she asks why was a Papanicolaou smear should be done at the first prenatal visit? A) It predicts whether cervical cancer will occur. B) It helps to date the pregnancy. C) It detects if uterine cancer is present. D) It identifies abnormal cervical cells. Scenario F; Laura is a teacher who comes in to the clinic for her initial check-up. She tells Nurse Anna that she missed her period 4 weeks ago and immediately took a pregnancy test And was happy to find it positive. The following questions refer to this scenario. 35. As nurse Anna is obtaining her gynecologic history, which of the following questions is most important to include in a review of systems for a pregnant woman? A) Have you ever had a heart attack? B) Do you have a peptic ulcer? C) Have you had any urinary tract infections? D) Have you had any neurologic diseases? 36. As Nurse Anna obtained Lauras gynecologic history, you recorded that she is 18 weeks pregnant. This is her fourth pregnancy. She delivered one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks' gestation. Utilizing the GTPAL system to classify a woman who is currently 18 weeks pregnant. A) 3, 2, 1, 2, 1. B) 4, 2, 2, 1, 1. C) 3, 2, 1, 1, 1. D) 4, 1, 1, 1, 1. 37. Laura asked you if its still important to do a breast self examination. Which of the following would Nurse Anna advise a woman about breast self-examination during pregnancy? A) There is no reason to continue this during pregnancy. B) Self-exams are nonproductive during pregnancy. C) She should choose a date each month to do this. D) She should do it weekly, because she no longer has menstrual periods. 38. Laura was advised to perform urine tests. Which two tests are generally performed on urine at a prenatal visit? A) Protein and sodium. B) pH and glucose. C) Occult blood and protein. D) Protein and glucose. 39. Upon taking her pelvis measurement, her diagonal conjugate measured 10.5 cm. You would interpret that her pelvis is which of the following? A) Adequate for childbearing. B) Narrow anterior-posterior. C) Narrow transversely. D) Larger than normal. 40. During the interview portion of her first prenatal visit, Anna reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick and greenish yellow and that she is very uncomfortable. She reports she thinks it is yeast. Based upon your knowledge, Nurse Anna replies: A) You are describing gonorrhea. B) Yeast is usually a thick cheesy white discharge so we will need to evaluate it during the pelvic exam. C) You have a sexually transmitted disease. D) You may have Chlamydia infection, so we will need to perform a pelvic exam.

41. Laura reports some signs and symptoms that might have a negative effect on her pregnancy. Which of the following findings from a Lauras initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a physician for management? A) Episodes of double vision. B) Increased lumbar curvature. C) Nasal congestion and swollen nasal membranes. D) Palpitations when lying on her back. 42. Nurse Anna also discussed rest and sleep with Laura, which of the following positions would Nurse Anna suggest that Laura use for napping? A) On her stomach with a pillow under her breasts. B) On her side with the weight of the uterus on the bed. C) On her back with a pillow under her knees and hips. D) On her back with a pillow under her head. 43. Laura is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should Nurse Anna give her? A) Travel no more than 50 miles daily. B) Do not use a lap seatbelt. C) Stop and walk every hour. D) Avoid riding in a pick-up truck. Scenario G: Aling Julia, a 32 year old fish vendor came to see you at the prenatal clinic. She brought with her all her three children, Maye, 1 year and 6 months, Joy, 3 and Dan, 7 years old. She cannot remember her LMP. The following questions refer to this scenario 44. Which of the following would be useful in calculating Aling Julias EDC? A. Appearance of linea nigra B. First FHT be fetoscope C. Increase pulse rate D. Presence of edema 45. Which hormone is necessary for a positive pregnancy test? A., Progesterone B. HCG C. Estrogen D. Placental Lactogen 46. In explaining the development of her baby, you identified in chronological order the growth of the fetus as it occurs in pregnancy as A. Ovum, embryo, zygote, fetus, infant B. Zygote, ovum, embryo, fetus, infant C. Ovum, zygote, embryo, fetus, infant D. Zygote, ovum, fetus, embryo, infant 47. The best advise you can give Aling Julia regarding prevention of of varicosities is A. Raise legs while in upright position and put it against the wall several times B. Lay flat for most hours of the day C. Use garters with nylon stocking D. Wear support hose 48. In a 32 day menstrual cycle, ovulation usually occurs on the th A. 14 day after menses th B. 18 day after menses th C. 20 day after menses th D. 24 day after menses 49. In evaluating the weight gain of Aling Julia, you know the minimum weight gain during pregnancy is A. 2 lbs/wk B. 5 lbs/wk C. 7 lbs/wk D. 10 lbs/wk 50. To determine the fetal position using Leopolds maneuver with Aling Julia, the first maneuver

A. Determine degree of cephalic flexion and engagement B. Determine part of fetus presenting into the pelvis C. Locate back, arms and legs D. Determine what part of fetus is in the fundus