ديعسروب ةعماج
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Year 2013/2014
Final Term Exam
Date: 8 /6/2014
Time allowed: 3 hours
Critical Obstetrics &Gynecology Nursing
Third year
Total Marks: 60
DR/ Nagat Salah -Dr.Seham Shehata
I- Choose the best correct answer ( 10 mark)
1 A client who’s 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. Which action should the nurse take first ? a.Perform a pelvic examination. b. Assess the client’s blood pressure c.Assess the fetal heart rate (FHR). d.Order a stat hemoglobin and hematocrit.
2 Which client would the nurse identify as being at highest risk for developing complications during pregnancy? a.
A 25-year-old gravida client b. A client with the placenta implanted on the fundus of the uterus c.A client who has nausea and vomiting during the first trimester d.A 35-year-old gravida client
3 The nurse correctly instructs the client to contact the physician immediately under which circumstance? a.When the first fetal movement is felt b. If vaginal bleeding occurs d. If the breasts become tender d.When experiencing frequent urination
4 When assessing a client with a history of pregnancy-induced hypertension (PIH), the nurse should thoroughly explore which finding at each visit? a.An unexpected weight gain b.A decrease in urine protein level c.An increase in urine output d.A decrease in pulse rate
5 Which assessment finding is most indicative of mild pregnancy-induced hypertension (PIH)? a.A 15 mm Hg rise in the baseline systolic blood pressure b.A +1 protein measured with a urine reagent test strip c.A weight gain of 1 pound per week in the second trimester d.The presence of frequent ankle edema
6 If the client develops a complete abruption, which nursing action is most appropriate? a.Obtain a written consent for an immediate cesarean birth. b.Give the client an enema and prepare the abdomen c.Place the client in Trendelenburg’s position. d.Prepare the client for a contraction stress test.
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7 Which assessment findings are considered predisposing factors for the development of abruptio placentae? Select all that apply. a.Gestational diabetes c.Hyperemesis gravidarum b.Pregnancy-induced hypertension d.Reports of crack cocaine use
8 The nurse correctly informs the participants that women who smoke during pregnancy have a greater risk of which problem? a. Having a premature delivery c. Having a large, overweight baby b. Having a cesarean birth d. Non of the above
9 All of the following cause labor dystocia Except a. Occipto –anterior. c. Contracted pelvis b. Shoulder dystocia d. Macrosomia
10 Treatments of first stage disorders Which Is True ? a.Prolonged latent phase: question if false labor, treat with observation and sedation if needed b.
Protraction disorder of active phase: augment with amniotomy or oxytocin c.
Arrest disorder with adequate contractions: C-section d.
All of the above
11 In performing post partum fundal assessment, a nurse finds that a client’s fundus is boggy. What should the nurse do first? a.Call the physician. b. Massage the fundus. c. Assess lochia flow. d.Obtain an order for Methergine.
12 The commonest cause of postpartum hemorrhage is: a. Laceration of the genital tract. b. Rupture of the uterus. c. Retained placental tissues. d. Uterine atony.
13 A female patient presents with signs of severe pre ‐ eclampsia, she is in the 34 th week gestation. Her management includes all the following except: a. Plan of delivery c. Give her prophylaxis of pre ‐ eclampsia b. Lower her blood pressure d. Admit her to the labour and de livery room
14 which of the followi ng are complications of pre ‐ eclampsia : a. Abruptioplacenta. b. Placenta previa. c. Puerperal sepsis. d. Abortion
15 Significant proteinuria in pregnancy would be: a. >300g/dl. c. >100g/dl. b. >200g/dl. d. >15 0g/dl.
16 All of the following are S&S of incomplete abortion except - a. Sever bleeding c.Parts of product are expelled b.Cervical os is completely closed d.Uterus is soft &smaller than expected period of pregnancy
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17 Regarding breech presentation: a.The standard management is to do C/S b.Meconium aspiration is a common complication c.Breech extraction for safe vaginal delivery d. None of the above
18 A client is admitted for preterm labor and is stable. She is sent home on oral terbutaline. The purpose of the drug for use in preterm labor is to------- a) decrease the chance of pulmonary edema b) relax uterine muscles and inhibit uterine contractions c) acts a bronchodilator d) decrease tachycardia from anxiety caused by preterm labo
19 A woman has been in preterm labor. She is 28 weeks pregnant. It seems inevitable that she will delivery soon. Which of the following medications would the nurse prepare to give this patient? a) celestone c) magnesium sulfate b) Pitocin d) terbutaline
20 - Which of the following circumstances is most likely to cause uterine atony, leading to postpartum hemorrhage? a. Hypertension b. Cervical and vaginal tears c. Urine retention d. Endometritis
II-put (T) on correct answer and (f) on the false answer (5marks)
21 Capet succedaneum disappearing within few weeks
22-
23-
Menorrhagia is irregular cyclic prolonged or excessive amount
Intracranial Hemorrhage caused by marked compression by
24-
25-
26-
27- forceps or in cephalopelvic disproportion
Erb's palsy is the common, due to injury to C7 and C8 roots
Multiple pregnancy is a Factor affecting efficient of uterine contraction &retraction
A miscarriage is a pregnancy that ends before 30 weeks of pregnancy
An ectopic pregnancy is a pregnancy in whichA fertilized egg is
28-
29-
30- implanted outside the uterus
Recognized complications of dystocia include fetal death, and respiratory depression
Placenta praevia increases the risk of Preterm birth and postpartum haemorrhage
In a frank breech both knees and hips are flexed, and the baby's buttocks or feet may enter the birth canal first
( × )
( × )
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III- Read This Situations Carefully And Answer The Following Questions
Situation 1: (25 Marks)
Case 1 : 32 years G1P0 36 weeks presented with contractions. Looks uncomfortable, cervix is 2 cm and 50% effaced. Was seen the previous day with similar complaints and findings.
Case 2: 24 years P1001 39 weeks presented in labor. Contracting every 3 minutes but looks comfortable. Progressed from 4 to 6 centimeters in 6 hours. Membranes intact. Estimated fetal weight – 3000 grams. Pelvis adequate on examination.
Vertex presentation
Questions
Q.1 - What are your diagnosis of each case? (5marks)
Case 1prolonged latent phase
Case 2: protracted active phase
Q.2 - Design a nursing care plan for each woman? (10marks) a. Therapeutic rest : given a 15 mg does of morphine sulphate to assure the woman in labour or not . if sleep for a few hours and awake without contractions she i n false labor. If continue with contractions and show cervical changes after the sleeping period, she in latent phase b. Oxytocin stimulation.
Reassure mother.
Take complete history
* Previous obstetric history.
* Time of onset of labor.
* BP: low.
* Pulse: 120 h/in.
* Temp: 38 co or more.
* Respiration rate: rapid
Help patient to adopt a comfortable position.
Perform the abdominal palpation to note: fetal lie, attitude by vaginal examination.
Locate FHS frequently afte r the contraction.
Record the findings.
Report any abnormalities
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Monitor the progress of labor and plot it on the pantograph.

Vaginal examination to determine:

Contraction (frequency, intensity, duration).

Cervical dilation, effacement and position.

Descent of the presenting part.

Membrane / intact / rupture presence of meconium.
Observe the patient for the following

Dry tongue/soreness around the mouth (dehydration).

Pallor.

Restlessness/exhaustion.
 Cervical and vaginal edema.
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Severe pain.
Observe IV f luids.
Blood is cross matched.
Record fluids intake and output.
Encourage frequent evacuation of the bladder.
Urine analysis for ketones and acidosis.
Evacuate the rectum.
Administer the prescribed drugs (antibiotics, analgesics).
Observe si gns of shock.
Prepare mother for instrumental delivery.
- Provide comfort measures to relieve pain.
- Breathing exercise.
- Prepare patient for C.S. if necessary.
Q.3 -Mention causes of obstructed labor. (5marks)
• Etiology :
Faults in the passages:
abnormal pelvic shape, contracted pelvis, soft tissue dystocia due to pelvic tumor, placenta preavia centralize ,scarring of the birth canal,or congenital anomalies
Faults in the passengers
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* Malposition & presentation especially in: D.T.A(deep transverse arrest), oblige O.P, brow, face (if mentoposterior), transverse or oblige lie ,compound presentation.
*Fetal macrosomia as in D.M. , Rh isoimunization
*Fetal malformation
*Locked twins n Pathological retraction ring and constriction ring?
Faults in powers:
• Uterine dystocia mean abnormalities in force or coordination of uterine contractility that include:
*Uterine hypertonic dysfunction
*Uterine incoordinate action.
Q.4 Differentiate between Pathological retraction ring and constriction ring?
(5marks)
nd
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)
Situation 2: 10 Marks)
A 23yr old woman presents on admission with history of abdominal pain of 4 hours duration and PV bleeding, seven weeks of amenorrhea and a positive pregnancy test.
Questions
Q.1 What are your likely diagnosis? (3marks)
Ectopic pregnancy; miscarriage
Q.2 List the possible causes for vaginal bleeding during pregnancy. (5marks)
• Abortion
• Vesicular mole.
•
Ectopic pregnancy
• Local lesions
Fetal causes
Chromosomal abnormalities
2-Diseases of fetus
3-Hypoxia
Maternal causes
A] General conditions B] Local conditions
1- Acute febrile (fever) 1-Trauma to the abdomen
2- Chronic nephritis 2-Incompitant cervix
4- Drugs. 3- Uterine malformation
5- lower uterine implantation
6- Psychological disturbances .
7- Endocrine dysfunctions.
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8- RH incompatibility
Q.3 What treatment options are available for your diagnosis? (2marks) a) Ectopic – Medical (MTX), Surgical (salpingectomy)
Miscarriage - expectant, medical (misoprostol), surgical (ERPC)
IV- Give short account on the following: (10 marks)
Q.1 Causes of abnormal uterine bleeding (5marks)
Q.2 Indications for emergency CS (5marks)
With my best wishes
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