1. A client asks the nurse what a third degree laceration is.

She was informed that she had one. The nurse explains that this is: a. that extended their anal sphincter b. through the skin and into the muscles c. that involves anterior rectal wall d. that extends through the perineal muscle. 2. Betina 30 weeks AOG discharged with a diagnosis of placenta previa. The nurse knows that the client understands her care at home when she says: a. I am happy to note that we can have sex occasionally when I have no bleeding. b. I am afraid I might have an operation when my due comes c. I will have to remain in bed until my due date comes d. I may go back to work since I stay only at the office. 3. The uterus has already risen out of the pelvis and is experiencing farther into the abdominal area at about the: a. 8th week of pregnancy b. 10th week of pregnancy c. 12th week of pregnancy d. 18th week of pregnancy 4. Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester: a. frequency b. dysuria c. incontinence d. burning 5. Mrs. Jimenez went to the health center for pre-natal check-up. the student nurse took her weight and revealed 142 lbs. She asked the student nurse how much should she gain weight in her pregnancy. a. 20-30 lbs b. 25-35 lbs c. 30- 40 lbs d. 10-15 lbs 6. The nurse is preparing Mrs. Jordan for cesarean delivery. Which of the following key concept should the nurse consider when implementing nursing care? a. Explain the surgery, expected outcome and kind of anesthetics. b. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth. c. Arrange for a staff member of the anesthesia department to explain what to expect post-operatively. d. Instruct the mothers support person to remain in the family lounge until after the delivery. 7. Bettine Gonzales is hospitalized for the treatment of severe preecplampsia. Which of the following represents an unusual finding for this condition?

a. generalized edema b. proteinuria 4+ c. blood pressure of 160/110 d. convulsions 8. Nurse Geli explains to the client who is 33 weeks pregnant and is experiencing vaginal bleeding that coitus: a. Need to be modified in any way by either partner b. Is permitted if penile penetration is not deep. c. Should be restricted because it may stimulate uterine activity. d. Is safe as long as she is in side-lying position. 9. Mrs. Precilla Abuel, a 32 year old mulripara is admitted to labor and delivery. Her last 3 pregnancies in short stage one of labor. The nurses decide to observe her closely. The physician determines that Mrs. Abuels cervix is dilated to 6 cm. Mrs. Abuel states that she is extremely uncomfortable. To lessen Mrs. Abuels discomfort, the nurse can advise her to: a. lie face down b. not drink fluids c. practice holding breaths between contractions d. assume Sims position 10. Which is true regarding the fontanels of the newborn? a. The anterior is large in shape when compared to the posterior fontanel. b. The anterior is triangular shaped; the posterior is diamond shaped. c. The anterior is bulging; the posterior appears sunken. d. The posterior closes at 18 months; the anterior closes at 8 to 12 months. 11. Mrs. Quijones gave birth by spontaneous delivery to a full term baby boy. After a minute after birth, he is crying and moving actively. His birth weight is 6.8 lbs. What do you expect baby Quijones to weigh at 6 months? a. 13 -14 lbs b. 16 -17 lbs c. 22 -23 lbs d. 27 -28 lbs 12. During the first hours following delivery, the post partum client is given IVF with oxytocin added to them. The nurse understands the primary reason for this is: a. To facilitate elimination b. To promote uterine contraction c. To promote analgesia d. To prevent infection 13. Nurse Luis is assessing the newborns heart rate. Which of the following would be considered normal if the newborn is sleeping? a. 80 beats per minute b. 100 beats per minute c. 120 beats per minute d. 140 beats per minute

14. The infant with Down Syndrome should go through which of the Eriksons developmental stages first? a. Initiative vs. Self doubt b. Industry vs. Inferiority c. Autonomy vs. Shame and doubt d. Trust vs. Mistrust 15. The child with phenylketonuria (PKU) must maintain a low phenylalanine diet to prevent which of the following complications? a. Irreversible brain damage b. Kidney failure c. Blindness d. Neutropenia 16. Which age group is with imaginative minds and creates imaginary friends? a. Toddler b. Preschool c. School d. Adolescence 17. Which of the following situations would alert you to a potentially developmental problem with a child? a. Pointing to body parts at 15 months of age. b. Using gesture to communicate at 18 months. c. Cooing at 3 months. d. Saying mama or dada for the first time at 18 months of age. 18. Isabelle, a 2 year old girl loves to move around and oftentimes manifests negativism and temper tantrums. What is the best way to deal with her behavior? a. Tell her that she would not be loved by others is she behaves that way.. b. Withholding giving her toys until she behaves properly. c. Ignore her behavior as long as she does not hurt herself and others. d. Ask her what she wants and give it to pacify her. 19. Baby boy Villanueva, 4 months old, was seen at the pediatric clinic for his scheduled check-up. By this period, baby Villanueva has already increased his height by how many inches? a. 3 inches b. 4 inches c. 5 inches d. 6 inches 20. Alice, 10 years old was brought to the ER because of Asthma. She was immediately put under aerosol administration of Terbutaline. After sometime, you observe that the child does not show any relief from the treatment given. Upon assessment, you noticed that both the heart and respiratory rate are still elevated and the child shows difficulty of exhaling. You suspect:

a. Bronchiectasis b. Atelectasis c. Epiglotitis d. Status Asthmaticus 21. Nurse Jonas assesses a 2 year old boy with a tentative diagnosis of nephroblastoma. Symptoms the nurse observes that suggest this problem include: a. Lymphedema and nerve palsy b. Hearing loss and ataxia c. Headaches and vomiting d. Abdominal mass and weakness 22. Which of the following danger sings should be reported immediately during the antepartum period? a. blurred vision b. nasal stuffiness c. breast tenderness d. constipation 23. Nurse Jacob is assessing a 15 month old child with acute otitis media. Which of the following symptoms would the nurse anticipate finding? a. periorbital edema, absent light reflex and translucent tympanic membrane b. irritability, purulent drainage in middle ear, nasal congestion and cough c. diarrhea, retracted tympanic membrane and enlarged parotid gland d. Vomiting, pulling at ears and pearly white tympanic membrane 24. Which of the following is the most appropriate intervention to reduce stress in a preterm infant at 33 weeks gestation? a. Sensory stimulation including several senses at a time b. tactile stimulation until signs of over stimulation develop c. An attitude of extension when prone or side lying d. Kangaroo care 25. The parent of a client with albinism would need to be taught which preventive healthcare measure by the nurse: a. Ulcerative colitis diet b. Use of a high-SPF sunblock c. Hair loss monitoring d. Monitor for growth retardation 1. (A) that extended their anal sphincter Third degree laceration involves all in the second degree laceration and the external sphincter of the rectum. Options B, C and D are under the second degree laceration. 2. (C) I will have to remain in bed until my due date comes Placenta previa means that the placenta is the presenting part. On the first and second trimester there is spotting. On the third trimester there is bleeding that is sudden, profuse and painless. 3. (D) 18th week of pregnancy

On the 8th week of pregnancy, the uterus is still within the pelvic area. On the 10th week, the uterus is still within the pelvic area. On the 12th week, the uterus and placenta have grown, expanding into the abdominal cavity. On the 18th week, the uterus has already risen out of the pelvis and is expanding into the abdominal area. 4. (A) frequency Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. Dysuria, incontinence and burning are symptoms associated with urinary tract infection. 5. (B) 25-35 lbs A weight gain of 11. 2 to 15.9 kg (25 to 35 lbs) is currently recommended as an average weight gain in pregnancy. This weight gain consists of the following: fetus- 7.5 lb; placenta- 1.5 lb; amniotic fluid- 2 lb; uterus- 2.5 lb; breasts- 1.5 to 3 lb; blood volume- 4 lb; body fat- 7 lb; body fluid- 7 lb. 6. (B) Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth. A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available. 7. (D) convulsions Options A, B and C are findings of severe preeclampsia. Convulsions is a finding of eclampsiaan obstetrical emergency. 8. (C) Should be restricted because it may stimulate uterine activity. Coitus is restricted when there is watery discharge, uterine contraction and vaginal bleeding. Also those women with a history of spontaneous miscarriage may be advised to avoid coitus during the time of pregnancy when a previous miscarriage occurred. 9. (D) assume Sims position When the woman is in Sims position, this puts the weight of the fetus on bed, not on the woman and allows good circulation in the lower extremities. 10. (A) The anterior is large in shape when compared to the posterior fontanel. The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond shaped closes at 18 month, whereas the posterior fontanel, which is triangular in shape closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increases ICP or sunken, which may indicate hydration. 11. (A) 13 -14 lbs The birth weight of an infant is doubled at 6 months and is tripled at 12 months. 12. (B) To promote uterine contraction Oxytocin is a hormone produced by the pituitary gland that produces intermittent uterine contractions, helping to promote uterine involution. 13. (B) 100 beats per minute The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute. 14. (D) Trust vs. Mistrust

The child with Down syndrome will go through the same first stage, trust vs. mistrust, only at a slow rate. Therefore, the nurse should concentrate on developing on bond between the primary caregiver and the child. 15. (A) Irreversible brain damage The child with PKU must maintain a strict low phenylalanine diet to prevent central nervous system damage, seizures and eventual death. 16. (B) Preschool During preschool, this is the time when children do imitative play, imaginative playthe occurrence of imaginative playmates, dramatic play where children like to act, dance and sing. 17. (D) Saying mama or dada for the first time at 18 months of age. A child should say mama or dada during 10 to 12 months of age. Options A, B and C are all normal assessments of language development of a child. 18. (C) Ignore her behavior as long as she does not hurt herself and others. If a child is trying to get attention or trying to get something through tantrumsignore his/her behavior. 19. (B) 4 inches From birth to 6 months, the infant grows 1 inch (2.5 cm) per month. From 6 to 12 months, the infant grows inch (1.25 cm) per month. 20. (D) Status Asthmaticus Status asthmaticus leads to respiratory distress and bronchospasm despite of treatment and interventions. Mechanical ventilation maybe needed due to respiratory failure. 21. (D) Abdominal mass and weakness Nephroblastoma or Wilms tumor is caused by chromosomal abnormalities, most common kidney cancer among children characterized by abdominal mass, hematuria, hypertension and fever. 22. (A) blurred vision Danger signs that require prompt reporting are leaking of amniotic fluid, blurred vision, vaginal bleeding, rapid weight gain and elevated blood pressure. Nasal stuffiness, breast tenderness, and constipation are common discomforts associated with pregnancy. 23. (B) irritability, purulent drainage in middle ear, nasal congestion and cough Irritability, purulent drainage in middle ear, nasal congestion and cough, fever, loss of appetite, vomiting and diarrhea are clinical manifestations of otitis media. Acute otitis media is common in children 6 months to 3 years old and 8 years old and above. Breast fed infants have higher resistance due to protection of Eustachian tubes and middle ear from breast milk. 24. (D) Kangaroo care Kangaroo care is the use of skin-to-skin contact to maintain body heat. This method of care not only supplies heat but also encourages parentchild interaction. 25. (B) Use of a high-SPF sunblock Without melanin production, the child with albinism is at risk for severe sunburns. Maximum sun protection should be taken, including use of hats, long sleeves, minimal time in the sun and high-SPF sunblock, to prevent any problems.

1. Nurse Bella explains to a 28 year old pregnant woman undergoing a non-stress test that the test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with: a. Fetal lie b. Fetal movement c. Maternal blood pressure d. Maternal uterine contractions 2. During a 2 hour childbirth focusing on labor and delivery process for primigravida. The nurse describes the second maneuver that the fetus goes through during labor progress when the head is the presenting part as which of the following: a. Flexion b. Internal rotation c. Descent d. External rotation 3. Mrs. Jovel Diaz went to the hospital to have her serum blood test for alpha-fetoprotein. The nurse informed her about the result of the elevation of serum AFP. The patient asked her what was the test for: a. Congenital Adrenal Hyperplasia b. PKU c. Down Syndrome d. Neural tube defects 4. Fetal heart rate can be auscultated with a fetoscope as early as: a. 5 weeks of gestation b. 10 weeks of gestation c. 15 weeks of gestation d. 20 weeks of gestation 5. Mrs. Bendivin states that she is experiencing aching swollen, leg veins. The nurse would explain that this is most probably the result of which of the following: a. Thrombophlebitis b. PIH c. Pressure on blood vessels from the enlarging uterus d. The force of gravity pulling down on the uterus 6. Mrs. Ella Santoros is a 25 year old primigravida who has Rheumatic heart disease lesion. Her pregnancy has just been diagnosed. Her heart disease has not caused her to limit physical activity in the past. Her cardiac disease and functional capacity classification is: a. Class I b. Class II c. Class III d. class IV 7. The client asks the nurse, When will this soft spot at the top of the head of my baby will close? The nurse should instruct the mother that the neonates anterior fontanel will normally close by age: a. 2-3 months b. 6-8 months c. 10-12 months d. 12-18 months

8. When a mother bleeds and the uterus is relaxed, soft and non-tender, you can account the cause to: a. Atony of the uterus b. Presence of uterine scar c. Laceration of the birth canal d. Presence of retained placenta fragments 9. Mrs. Pichie Gonzaless LMP began April 4, 2010. Her EDD should be which of the following: a. February 11, 2011 b. January 11, 20111 c. December 12, 2010 d. Nowember 14, 2010 10. Which of the following prenatal laboratory test values would the nurse consider as significant? a. Hematocrit 33.5% b. WBC 8,000/mm3 c. Rubella titer less than 1:8 d. One hour glucose challenge test 110 g/dL 11. Aling Patricia is a patient with preeclampsia. You advise her about her condition, which would tell you that she has not really understood your instructions? a. I will restrict my fat in my diet. b. I will limit my activities and rest more frequently throughout the day. c. I will avoid salty foods in my diet. d. I will come more regularly for check-up. 12. Mrs. Grace Evangelista is admitted with severe preeclampsia. What type of room should the nurse select this patient? a. A room next to the elevator. b. The room farthest from the nursing station. c. The quietest room on the floor. d. The labor suite. 13. During a prenatal check-up, the nurse explains to a client who is Rh negative that RhoGAM will be given: a. Weekly during the 8th month because this is her third pregnancy. b. During the second trimester, if amniocentesis indicates a problem. c. To her infant immediately after delivery if the Coombs test is positive. d. Within 72 hours after delivery if infant is found to be Rh positive. 14. A baby boy was born at 8:50pm. At 8:55pm, the heart rate was 99 bpm. She has a weak cry, irregular respiration. She was moving all extremities and only her hands and feet were still slightly blue. The nurse should enter the APGAR score as: a. 5 b. 6

c. 7 d. 8 15. Billy is a 4 year old boy who has an IQ of 140 which means: a. average normal b. very superior c. above average d. genius 16. A newborn is brought to the nursery. Upon assessment, the nurse finds that the child has short palpebral fissures, thinned upper lip. Based on this data, the nurse suspects that the newborn is MOST likely showing the effects of: a. Chronic toxoplasmosis b. Lead poisoning c. Congenital anomalies d. Fetal alcohol syndrome 17. A priority nursing intervention for the infant with cleft lip is which of the following: a. Monitoring for adequate nutritional intake b. Teaching high-risk newborn care c. Assessing for respiratory distress d. Preventing injury 18. Nurse Jacob is assessing a 12 year old who has hemophilia A. Which of the following assessment findings would the nurse anticipate? a. an excess of RBC b. an excess of WBC c. a deficiency of clotting factor VIII d. a deficiency of clotting factor IX 19. Celine, a mother of a 2 year old tells the nurse that her child cries and has a fit when I have to leave him with a sitter or someone else. Which of the following statements would be the nurses most accurate analysis of the mothers comment? a. The child has not experienced limit-setting or structure. b. The child is expressing a physical need, such as hunger. c. The mother has nurtured overdependence in the child. d. The mother is describing her childs separation anxiety. 20. Mylene Lopez, a 16 year old girl with scoliosis has recently received an invitation to a pool party. She asks the nurse how she can disguise her impairment when dressed in a bathing suit. Which nursing diagnosis can be justified by Mylenes statement? a. Anxiety b. Body image disturbance c. Ineffective individual coping d. Social isolation 21. The foul-smelling, frothy characteristic of the stool in cystic fibrosis results from the presence of large amounts of which of the following:

a. sodium and chloride b. undigested fat c. semi-digested carbohydrates d. lipase, trypsin and amylase 22. Which of the following would be a disadvantage of breast feeding? a. involution occurs rapidly b. the incidence of allergies increases due to maternal antibodies c. the father may resent the infants demands on the mothers body d. there is a greater chance of error during preparation 23. A client is noted to have lymphedema, webbed neck and low posterior hairline. Which of the following diagnoses is most appropriate? a. Turners syndrome b. Downs syndrome c. Marfans syndrome d. Klinefelters syndrome 24. A 4 year old boy most likely perceives death in which way: a. An insignificant event unless taught otherwise b. Punishment for something the individual did c. Something that just happens to older people d. Temporary separation from the loved one. 25. Catherine Diaz is a 14 year old patient on a hematology unit who is being treated for sickle cell crisis. During a crisis such as that seen in sickle cell anemia, aldosterone release is stimulated. In what way might this influence Catherines fluid and electrolyte balance? a. sodium loss, water loss and potassium retention b. sodium loss, water los and potassium loss c. sodium retention, water loss and potassium retention d. sodium retention, water retention and potassium loss 1. (B) Fetal movement Non-stress test measures response of the FHR to the fetal movement. With fetal movement, FHR increase by 15 beats and remain for 15 seconds then decrease to average rate. No increase means poor oxygenation perfusion to fetus. 2. (A) Flexion The 6 cardinal movements of labor are descent, flexion, internal rotation, extension, external rotation and expulsion. 3. (D) Neural tube defects Alpha-fetoprotein is a substance produces by the fetal liver that is present in amniotic fluid and maternal serum. The level is abnormally high in the maternal serum if the fetus has an open spinal or abdominal defect because the open defect allows more AFP to appear. 4. (D) 20 weeks of gestation The FHR can be auscultated with a fetoscope at about 20 weeks of gestation. FHR is usually auscultated at the midline suprapubic region with Doppler ultrasound at 10 to 12 weeks of gestation. FHR cannot be heard any earlier than 10 weeks of gestation. 5. (C) Pressure on blood vessels from the enlarging uterus

Pressure of the growing fetus on blood vessels results in an increase risk for venous stasis in the lower extremities. Subsequently, edema and varicose vein formation may occur. 6. (A) Class I Clients under class I has no physical activity limitation. There is a slight limitation of physical activity in class II, ordinary activity causes fatigue, palpitation, dyspnea or angina. Class III is moderate limitation of physical activity; less than ordinary activity causes fatigue. Unable to carry on any activity without experiencing discomfort is under class IV. 7. (D) 12-18 months Anterior fontanel closes at 12-18 months while posterior fontanel closes at birth until 2 months. 8. (A) Atony of the uterus Uterine atony, or relaxation of the uterus is the most frequent cause of postpartal hemorrhage. It is the inability to maintain the uterus in contracted state. 9. (B) January 11, 20111 Using the Nagels rule, he use this formula ( -3 calendar months + 7 days). 10. (C) Rubella titer less than 1:8 A rubella titer should be 1:8 or greater. Thus, a finding of a titer less than 1:8 is significant, indicating that the client may not possess immunity to rubella. A hematocrit of 33.5%, WBC of 8,000/mm3, and a 1 hour glucose challenge test of 110 g/dL are within normal parameters. 11. (B) I will limit my activities and rest more frequently throughout the day. Pregnant woman with preeclampsia should be in a complete bed rest. When body is in recumbent position, sodium tends to be excreted at a faster rate. It is the best method of aiding increased excretion of sodium and encouraging diuresis. Rest should always be in a lateral recumbent position to avoid uterine pressure on the vena cava and prevent supine hypotension. 12. (C) The quietest room on the floor. A loud noise such as a crying baby, or a dropped tray of equipment may be sufficient to trigger a seizure initiating eclampsia, a woman with severe preeclampsia should be admiotted to a private room so she can rest as undisturbed as possible. Darken the room if possible because bright light can trigger seizures. 13. (D) Within 72 hours after delivery if infant is found to be Rh positive. RhoGAM is given to Rh-negative mothers within 72 hours after birth of Rh-positive baby to prevent development of antibodies in the maternal blood stream, which will be fata to succeeding Rh-positive offspring. 14. (B) 6 Heart rate of 99 bpm-1; weak cry-1; irregular respiration-1; moving all extremities-2; extremities are slightly blue-1; with a total score of 6. 15. (D) genius IQ= mental age/chronological age x 100. Mental age refers to the typical intelligence level found for people at a give chronological age. OQ of 140 and above is considered genius. 16. (D) Fetal alcohol syndrome The newborn with fetal alcohol syndrome has a number of possible problems at birth. Characteristics that mark the syndrome include pre

and postnatal growth retardation; CNS involvement such as cognitive challenge, microcephally and cerebral palsy; and a distinctive facial feature of a short palpebral fissure and thin upper lip. 17. (A) Monitoring for adequate nutritional intake The infant with cleft lip is unable to create an adequate seal for sucking. The child is at risk for inadequate nutritional intake as well as aspiration. 18. (C) a deficiency of clotting factor VIII Hemophillia A (classic hemophilia) is a deficiency in factor VIII (an alpha globulin that stabilizes fibrin clots). 19. (D) The mother is describing her childs separation anxiety. Before coming to any conclusion, the nurse should ask the mother focused questions; however, based on initial information, the analysis of separation anxiety would be most valid. Separation anxiety is a normal toddler response. When the child senses he is being sent away from those who most provide him with love and security. Crying is one way a child expresses a physical need; however, the nurse would be hasty in drawing this as first conclusion based on what the mother has said. Nurturing overdependence or not providing structure for the toddler are inaccurate conclusions based on the information provided. 20. (B) Body image disturbance Mylene is experiencing uneasiness about the curvative of her spine, which will be more evident when she wears a bathing suit. This data suggests a body image disturbance. There is no evidence of anxiety or ineffective coping. The fact that Mylene is planning to attend a pool party dispels a diagnosis of social isolation. 21. (B) undigested fat The client with cystic fibrosis absorbs fat poorly because of the think secretions blocking the pancreatic duct. The lack of natural pancreatic enzyme leads to poor absorption of predominantly fats in the duodenum. Foul-smelling, frothy stool is termed steatorrhea. 22. (C) the father may resent the infants demands on the mothers body With breast feeding, the fathers body is not capable of providing the milk for the newborn, which may interfere with feeding the newborn, providing fewer chances for bonding, or he may be jealous of the infants demands on his wife time and body. Breast feeding is advantageous because uterine involution occurs more rapidly, thus minimizing blood loss. The presence of maternal antibodies in breast milk helps decrease the incidence of allergies in the newborn. A greater chance for error is associated with bottle feeding. No preparation required for breast feeding. 23. (A) Turners syndrome Lymphedema, webbed neck and low posterior hairline, these are the 3 key assessment features in Turners syndrome. If the child is diagnosed early in age, proper treatment can be offered to the family. All newborns should be screened for possible congenital defects. 24. (D) Temporary separation from the loved one. The predominant perception of death by preschool age children is that death is temporary separation. Because that child is losing someone significant and will not see that person again, its inaccurate to infer death is insignificant, regardless of the childs response. 25. (D) sodium retention, water retention and potassium loss

Stress stimulates the adrenal cortex to increase the release of aldosterone. Aldosterone promotes the resorption of sodium, the retention of water and the loss of potassium.