FINAL COACHING

in MATERNAL NURSING
Haydee S. Bacani, RM RN MAN (c)
FOR THE WIN!
SITUATION:
FEMALE REPRODUCTION
1.Ordinarily, the body of the
uterus tips slightly forward.
Positional deviations of the
uterus that are commonly seen
including the body of the uterus
bent sharply forward at the
junction with the cervix which
is called:
a.Anteversion
b.Retroversion
c.Retroflexion
d.Anteflexion
2. A 19 year old client, Lilian is
having her menstrual period every
2 weeks that last for 1 week. This
type of menstrual pattern is bets
defined as:
a. Menorrhagia
b. Metrorrhagia
c. Dyspareunia
d. Amenorrhea
Menorrhagia- (80,1:1,ABCDEF)

v 80
v 1:1
v Anemia, Abortion, Adolescent near puberty
v Blood Dyscrasia
v Contraceptive pills (breakthrough bleeding)
v Device Intrauterine, Disease: PID
v Endometriosis
v Fibroid (myoma) tumor
Metrorrhagia

● M-ittle staining
● E-ndometrial sloughing
● T-aking pills (breakthrough bleeding)
● R-eproductive tract irritation/infection
● O-vulation
Dysmenorrhea- (PEM)
prostaglandins released from tissue destruction
during ischemic phase

P-

M
3. Endometriosis is characterized
by:
a.Amennorrhea and dyspareunia
b.Ecchymoses and petechiae
c.Painful menstruation and
backache
d.Early osteoporosis and pelvic
inflammation
Endometriosis
WHAT
Abnormal growth of extrauterine cells similar to endometrial cells

WHERE: CUL-de-ULO
Cul-de-sac of the peritoneal cavity
Uterine Ligaments
Ovaries

EFFECTS: PPP
Painful Mens
Painful Sex
Pregnancy Difficulty
4. On physical examination, Suzanne Matthews
is found to have a cystocele. The nurse
should confirm that the midwife who is
contributing to Suzanne’s care knows that a
cystocele can cause which of the following?
a. A fear of developing cancer from the
sebaceous vulvar cyst that develops
b. Nagging pain from protrusion of the lower
intestine into the posterior vagina
c. Bleeding from the prolapse of the uterine
body and cervix into the distal vagina
d. Urinary infection from the pocket caused
by pressure against the anterior vaginal wall
5. Recommendations for Pap smear for women
according to age and risks are the following,
which is correct?:
a. Screening for cervical cancer in women ages 21 to 65
years with cytology (Pap smear) every 3 years
b. Screening with a combination of cytology and HPV
testing every 5 years for women ages 40 to 65 years
who want to lengthen the screening interval
c. Cervical cancer in women older than age 65 years who
have had adequate prior screening and are not
otherwise at high risk for cervical cancer
d. Cervical cancer with HPV testing, alone or in
combination with cytology, in women younger than age
30 year
Papanicolaou (Pap) smear

● - 29

21-29 yrs old=

30-64 yo=
USPSTF recommends against screening for

• PAP smear below 21 years

• PAP smear >65 years with adequate prior screening not
high risk for cervical cancer
• Pap smear who had hysterectomy with removal of the
cervix , no history of a high-grade precancerous lesion (i.e.,
cervical intraepithelial neoplasia [CIN] grade 2 or 3) or
cervical cancer
Pap smear with HPV testing, alone or in combination with
cytology, <30 y.o.
Situation 2: MENSTRUAL CYCLE
6. After menarche, the periodic
discharge of blood, fluid and
endometrial cellular debris from
the uterus is called ______
A. menstruation
B. menopause
C. menarche
D. telarche
7. After the menstrual bleeding,
the regeneration of the new inner
lining of the uterus happens to
create a proliferative endometrium
due to the action of ______
A. leutinizing hormone
B. progesterone
C. growth hormone
D. estrogen
8.After the proliferative phase of
the cycle, the ovulation that
follows is the result of the
sudden rise of the __________
hormone
A. Estrogen
B. Leutinizing
C. Gonadotrophin-Releasing
D. Follicle-Stimulating
9.If pregnancy does not happen in
this cycle, the secretion of
progesterone and estrogen begins
to fall because of the
degeneration of the ________
A. Anterior pituitary gland
B. Corpus Luteum
C. Graafian Follicles
D. Corpus Albicans
10.One menstrual cycle is counted from
the __________
A. last day of the menstrual flow to
first day of next flow
B. first day of the menstrual to
first day of the next flow
C first day of the menstrual flow to
last day of next flow
D. first day of moderate menstrual
flow to the first day of next flow
SITUATION:
FAMILY PLANNING
11. Which of the following
methods would be avoided for a
woman who is 38 years old, has
3 children and smokes a pack
of cigarette per day?
A.Oral contraceptives
B.Cervical cap
C.Diaphragm
D.IUD
 IUD

ü Small plastic device inserted in uterus

ü Pre-coitus & post-mens
ü Spotting /cramping 2-3wks
ü Nulliparous -fitted
ü Vaginal string no fluid conduction

v Distorted uterus - perforation

v Dysmenorrhea
v Dami mens
DIAPHRAGM – 8P’s

● Prescribed and fitted

● Pregnancy, miscarriage, cervical
surgery
● Pounds- 15lbs change
● Prior coitus
● Put spermicide (inside rim,
center)
● Placed for 6-24H
● Protective case
● Palitan – 2 yrs
TSS
● T-emperature high
● S-unburn-like rash
● S-ymptoms of GI (diarrhea, vomiting)
CERVICAL CAP
Ø Can dislodge
ü Kept longer (48H)

CAN’T USE: CCCAAA

§ Cervix long or short

§ Cervicitis, cervix infection
§ Cancer
§ Allergy to latex/spermicide
§ Abnormal Papsmear
§ Abnormal bleeding
ORAL CONTRACEPTIVES

4 Ways to Start: • Contraception 1st

1) Sunday
2) Quick week
3) First-day • Calendar/alarm
4) After Delivery: Day or • Can be seen easily
Sunday closest to 2 weeks • Caution children
after birth • Clotting
5) After Abortion: chosen day • Caffeine,
or the first Sunday Corticosteroid
REPORT!!! 4S CONTRAINDICATIONS:
Breastfeeding
● SOB Less than 6 weeks postpartum
● Stroke-features Arterial-CVD
Smoking
● Severe leg pain
● Sight changes 35 and up
INTRAMUSCULAR INJECTIONS (ABCDEF)

● Alters endometrium, Almost 100%

● BONE density loss
● Cervical Mucus thickens
● Depot medroxyprogesterone acetate (DMPA,depo-
provera), Deep IM, Don’t massage
● Every 3 mos
● Fifth day
12. A woman using diaphragm for
contraception should be instructed
to leave it in place for at least
how long after intercourse?
A.1 hour
B.6 hours
C.12 hours
D.24 hours
13. When assessing semenalysis
for conception to occur, which
of the following is the most
helpful criterion?
A.Sperm count
B.Sperm motility
C.Sperm maturity
D.Semen volume
FERTILITY TESTING

● Semen analysis
● Ovulation monitoring
● Tubal patency
Minimum Sperm Count

ü 33-46 MILLIONS/mL of seminal fluid, or

50M per ejac
ü 50% normal MOTILITY
ü 30% normal MORPHOLOGY
STEPS

1. sexually abstinent 2 to 4 days

2. ejaculates by masturbation into a
clean, dry specimen jar
3. 1 hr
14. To evaluate a woman’s understanding about
the use of diaphragm for family planning,
Midwife Trish asks her to explain how she
will use the appliance. Which response
indicates a need for further health teaching?
A. “I should check the diaphragm carefully for
holes every time I use it”
B. “I may need a different size of diaphragm if I
gain or lose weight more than 20 pounds”
C. “The diaphragm must be left in place for atleast
6 hours after intercourse”
D. “I really need to use the diaphragm and jelly
most during the middle of my menstrual cycle”.
SITUATION: PRENATAL CARE
Symptoms of pregnancy tend to
cause discomforts to a woman.
Providing empathetic and sound
advice about measures to
relieve these discomforts help
promote overall health and
well-being.
15. Heartburn and flatulence,
common in the second trimester,
are most likely the result of
which of the following?
A.Increased plasma HCG levels
B.Decreased intestinal
motility
C.Decreased gastric acidity
D.Elevated estrogen levels
16. She complained of leg cramps, which
usually occurs at night. To provide
relief, the midwife tells Diane to:
A.Dorsiflex the foot while extending
the knee when the cramps occur
B.Dorsiflex the foot while flexing the
knee when the cramps occurs
C.Plantar flex the foot while flexing
the knee when the cramps occur
D.Plantar flex the foot while extending
the knee when the cramp occur
LEG CRAMPS

CAUSE:
● Calcium 1g/day
● Mg lactate or citrate AM & PM
● Elevate legs
● Avoid leg extension, toes pointed
17. A primigravida client at 26
weeks gestation visits the clinic
and tells the midwife that her
lower back aches when she arrives
home from work. The nurse suggest
that the client perform:
a.Tailor sitting
b.Pelvic Floor Contraction
c.Pelvic Rocking
d.Kegel exercises
TAILOR SITTING

● stretches perineal muscles

● at least 15 minutes every day
SQUATTING

stretches the perineal muscles

about 15 minutes a day
Pelvic Floor Contractions (Kegel Exercises)

♥ tightens perineal muscles

♥ helpful in the postpartum period to reduce pain
♥ promote perineal healing
♥ increasing sexual responsiveness
♥ helping prevent stress incontinence (bowel and bladder)
Pelvic Rocking

● relieve backache during

pregnancy and early labor
by making the lumbar spine
more flexible

● position is held for 1 minute

and then the back is relaxed
and hollowed
18. When the nurse instructs a pregnant
client with a history of varicose veins
about strategies to promote comfort,
which of the following client
statements indicates that the teaching
has been successful?
a.“Lying down with my feet elevated should
help”
b.“Support hose can be put on just before
bedtime”
c.“Restricting milk intake may provide some
relief”
d.“Wearing knee-high stockings is better than
pantyhose”
VARICOSE VEINS

● Sims position
● Back with legs raised against wall
(small firm pillow under right hip)
● Elevate on footstool for 15-20mins
BID
● No crossed-legs or knees-bent
● No constrictive knee-high hose or
Spanx
● Vitamins C, A, and B complex
19. In the later part of the 3rd
trimester, the mother may experience
shortness of breath. This complaint
maybe explained as:
a.A normal occurrence in pregnancy
because the fetus is using more oxygen
b.The fundus of the uterus is high
pushing the diaphragm upward
c.The woman is having allergic reaction
to the pregnancy and its hormones
d.The woman maybe experiencing
complication of pregnancy
20. Agatha has hemorrhoids in pregnancy
aggravated by constipation. Which
statement by her would reveal that she
understands how to address this EXCEPT?
a.“I will put hot compress to relieve
the pain”
b.“I will insert the varicosed rectal
veins using my fingers”
c.“I’ll rest in a modified Sim’s
position to take pressure off”
d.“I will do knee-chest position 10-15
mins”
Hemorrhoids

● Daily defecation
● Docusate sodium (Colace)

● Modified Sims
● Knee–chest position 10-15min

● Gentle finger pressure

● Witch hazel
● Cold compress
● Hemorrhoid cream
Situation: Pregnancy is
officially diagnosed on
the basis of the symptoms
reported by the woman and
the signs elicited by the
healthcare provider.
21. Cervical softening and
uterine souffle are classified
as which of the following?
a.Diagnostic signs
b.Presumptive signs
c.Probable signs
d.Positive signs
Goodell’s Sign
22.The nurse documents positive
ballottement in the client's prenatal
record. The nurse understands that this
indicates which of the following?
a.Contractions palpable on the abdomen
b.Passive movement of the unengaged
fetus
c.Fetal kicking felt by the client
d.Enlargement and softening of the
uterus
BALLOTTEMENT

When: 16-20 wks AOG

How:
B
B
B
23. The client has completed an at-
home pregnancy test with positive
results. Which of the following
indicates the client understands the
meaning of the test results?
a.“I understand that this means I
have ovulated in the past 24 hours.”
b.“I understand that this means I am
not pregnant.”
c.“I understand that this means I
might be pregnant.”
d.“I understand that this means I am
pregnant.”
PROBABLE SIGNS OF PREGNANCY

P
R
O
Ba
B
L
E
24. The client has come to the
clinic because she suspects that
she is pregnant. Which of the
following would be the most
definitive way to confirm the
diagnosis?
a.Amenorrhea for 3 months
b.Positive Serum Pregnancy Test
c.Striae Gravidarum and Ballotement
d.Palpation of fetal movement by
nurse
POSITIVE SIGNS OF PREGNANCY

UWIAN NAAAAAAA!
H
O
M E
S
Situation: Prenatal care,
essential for ensuring the
overall health of newborns
and their mothers, is a
major strategy for helping
to reduce complications of
pregnancy.
25. The nurse prepares a care plan for the
patient. Based on Ramona Mercer’s becoming a
mother (BAM) theory, Which of the following
statements fosters the process of becoming a
Mother?
A.The woman becomes comfortable with her
identity as a married individual .
B.It encompasses the dynamic transformation
and evolution of a woman’s person
C.A woman learns mothering behavior prior as
early as a teenager
D.It accurately reflects the transitional
process from being single to a married
relationship
Mid-range Maternal Role Attainment Theory

Reva Rubin
Ramona Mercer

STAGES: anticipatory, formal, informal, and personal

Sign a parent is beginning effective attachment:

● En face position
● Engrossment
26. From the 33rd week of
gestation until term, a
healthy mother should have
prenatal check up every:
a.week
b.2 weeks
c.3 weeks
d.4 weeks
NEW WHO GUIDELINE (2016)
● 1st contact in 1st 12 wks
● 20
● 26
● 30
● 34
● 36
● 38
● 40
27. What event occurring in
the second trimester helps
the expectant mother to
accept the pregnancy?
a.Lightening
b.Ballotement
c.Pseudocyesis
d.Quickening
PSYCHOLOGICAL TASKS IN PREGNANCY

1st Trim
Emotion: Task:

2nd Tri
Emotion: Task:

3rd Tri
Emotion: Task:
NUTRITION IN PREGNANCY
28. The nurse in the prenatal clinic
should provide nutritional counseling
to all newly pregnant women because:
a.Most weight gain during pregnancy is
fluid retention
b.Dietary allowances should not
increase during pregnancy
c.Pregnant women must adhere to a
specific pregnancy diet
d.Different sources of essential
nutrients are favored by different
cultural groups
29. A primigravida woman in her 10th week of
gestation is concerned because she has read
that nutrition during pregnancy is important
for the growth and development of the fetus.
She wants to know something about the food
she should eat. The RN should:
a.Instruct her to increase her protein intake
b.Assess what she eat by taking a diet
history
c.Give her a list of food to help her better
plan her meals
d.Emphasize the importance of restricting
salt and highly seasoned food
 Nutrition

1. Preconception nutrition patterns

2. Cultural, environmental, social
lifestyles
3. 24-hour recall history followed by a
physical examination to document
weight and vitality-best ways to secure
necessary information, confirm well-
balanced nutrition, and identify areas for
teaching and learning.
30. A client is concerned about
gaining weight during pregnancy.
The RN explains that the largest
part of weight gain during
pregnancy is because of:
a.The fetus
b.Fluid retention
c.Metabolic alterations
d.Increased blood volume
WEIGHT GAIN

SINGLETON:
Normal BMI (18.5 to 24.9) =25 to 35 lb
Underweight = 28 to 40 lb
Overweight = 15 to 25 lb
Obese = 11 to 20 lb

MULTIPLE PREG:
Normal BMI = 37 to 54 lb.
OVERWT = 31 to 50 lb.
OBESE: 25 to 42 lb
31. A patient who is 20 weeks
pregnant tells the nurse that her
prenatal vitamin makes her sick.
Which is the best suggestion?
a.Take the vitamin with
breakfast
b.Stop taking the vitamin for a
few days and then resume
c.Take the vitamin at bedtime
d.Take the vitamin with milk
between meals
IRON

● 27 mg of iron as prophylactic therapy

● eat diets high in iron and vitamins (green leafy, meat,
nuts)
● iron-deficiency anemia = 65 mg elemental iron per day or
every other day (ferrous sulfate or ferrous gluconate)
● constipation – increase roughage
● gastric irritation - taking the pills with food
● stools black
32. The expected weight
gain in a normal pregnancy
during the 3rd trimester is
a.1 pound a week
b.2 pounds a week
c.10 lbs a month
d.10 lbs total weight gain in
the 3rd trimester
WEIGHT GAIN DISTRIBUTION
33. The main reason for an expected increased
need for iron in pregnancy is:
a.The mother may have physiologic anemia due
to the increased need for red blood cell mass
as well as the fetal requires iron
b.The mother may suffer anemia because of
poor appetite in first trimester of pregnancy
c.The fetus has an increased need for RBC
which the mother must supply
d.The mother may have a problem of digestion
because of decreased GI motility
Situation 3 - Evelyn a
multigravida, in her 20th
weeks of gestation visited the
community clinic with
complaints of dizziness ,
vertigo, and heartburns. After
the physical assessment, Nurse
Harper finds the patient as
malnourished.
34. Iron supplementation was prescribed
because of her low hemoglobin level. Which
statement if made by Evelyn would indicate an
understanding of health instructions?
A.“My body has all the iron it needs and I
don't need to take supplements.”
B.“Meat does not provide iron and should be
avoided.”
C.“”The iron is best absorbed if taken on an
empty stomach.”
D.“Iron supplements will give green color to
my stool.
35. Evelyn was given iron as a supplement
vitamin to prevent maternal anemia. She asks if
it will not be affected because she is
regularly taking vitamin C. Which of the
following would be the BEST response of the
nurse?
A.“Take two other vitamins separately .”
B.“Take the iron after a full meal.”
C.“Absorption of iron is enhanced with vit C.”
D.“Drink milk when taking the iron
supplement.”
36. Evelyn was also advised to
take calcium supplements on the
2nd 3rd trimester of pregnancy.
Which of the following would
ENHANCE her intestinal absorption
of calcium?
A.Fat-soluble vitamins
B.Proteins
C.Minerals
D.Water soluble vitamins
Calcium Vitamin D

● Calcification of fetal bones § Aids calcium absorption

§ Formation of bones/teeth
● Milk, cheese, yogurt, leafy
§ Immune function
greens, almonds § Low birth weight
● Adolescents—1,300 mg § preeclampsia
● Adults—1,000 mg
● reduces risk of § Fortified milk, eggs, salmon
preeclampsia § Suggested: 600 IU daily
§ Fat-soluble vitamin
37. Nurse Harper observes Evelyn
has a knowledge deficit regarding
fetal nutrition. Nurse harper has
to explain that the MAIN SOURCE of
nutrition for the baby is which of
the following?
A.Amniotic fluid
B.Uterus
C.Placenta
D.Chorionic villi
PLACENTA
● 15 -20 cm in diameter, 2 -3 cm
depth
● covers ½ surface area of the
internal uterus at term
● Most drugs cross
● 30 or more partitions or septa
● 50 mL /min 10wks
● 500mL/min at 10mos
● 500g at term
● most efficient when lies on their
left side
38. Nurse Harper provides health
instruction to the patient
experiencing heartburn. Which
statement by the patient indicates
a NEED for further instructions? I
have to _____
A.Drink milk between meals
B.Eat small frequent meals
C.Avoid fatty or spicy foods
D.Lie down after eating
HEARTBURN/PYROSIS
Normal:
CAUSES:

MNGT: 5S
S
S
S
Should wait
Slow chewing

AVOID: AB-KFC (AlkaSeltzer, Baking Soda, KAMATIS-FRIED-CITRUS/CABBAGE)

Situation: Be certain to reserve
sufficient time at prenatal visits
to care can be thorough and there
is enough time to set realistic
goals and expect outcomes with
both a woman and her partner, if
desired. The following obstetric
calculations are needed to
determine fetal well-being.
39.Mrs. Santos is on her 7th pregnancy
and is carrying twins, AOG 32weeks. She
had a history of 2 miscarriage in her
first and 4th pregnancy. She had 2 sets
of twins in her second and fifth
pregnancies, and triplets in her 6th
pregnancy, all delivered pre-term. Her
third delivery is stillborn. Her
Obstetrical History is therefore
documented by the nurse as:
a.G 7 T P 3 A2 L3 M2
b.G 6 T1 P7 A2 L7 M3
c.G 7 T2 P7 A2 L3 M2
d.G 7 T1 P3 A2 L7 M3
GTPALM
40. When the level of the
fundus is midway between the
symphysis and umbilicus, the
estimated age of gestation
(AOG) in weeks is:
a. 20 weeks
b. 12 weeks
c. 16 weeks
d. 24 weeks
BARTHOLOMEW’S RULE
41. The following are ways
of determining expected
date of delivery (EDD) when
the LMP is unknown EXCEPT:
a.Naegele’s rule
b.Quickening
c.McDonald’s rule
d.Batholomew’s rule of 4
NAEGEL’S RULE
42. If the LMP is February
25, 2023, the expected
date of delivery (EDD) is
a.November 3, 2015
b.October 2016
c.November 3, 2016
d.December 4, 2015
43. If Mrs. Medina comes to you for
check-up on June 2, her EDD is June 11,
what do you expect during assessment?
a.Fundic height 2 fingers below xiphoid
process, engaged
b.Cervix close, uneffaced, FH midway
between the umbilicus and symphysis
pubis
c.Cervix open, fundic height 2 fingers
below xiphoid process, floating
d.Fundal height at least at the level
of the xiphoid process,
44. The patient was ordered for
the Cardiff Method of Fetal
Movement monitoring. She should
report feeling the required fetal
movement number in:
a. 100 minutes
b. 90 minutes
c. 60 minutes
d. 120 minutes
FETAL MOVEMENT

16-20 weeks
20-24 weeks
28-38 weeks
Rate:
Position:
If below 10,

CARDIFF
SANDOVSKY
45. Elena, 30 years of age, shows the
nurse the birth plan that she has drafted.
Which statement by her would help assure
the midwife that she has a workable plan?
a. “I’ve written down everything I have
to have to make labor a success.”
b. “I didn’t include anything my
boyfriend wanted; I’m the one having the
baby.”
c. “My mother strongly suggested I ask
for morphine like she did, so I’m going
to add that.”
d. “I’ve tried to keep it flexible
because I know circumstances can change.
The Childbirth Plan

● wish in labor ü at least 1 month pre

● positions EDD
● medication ü flexibile
● immediate postpartum ü centered on ultimate
● baby care goal of childbirth
● family visitation ü healthy baby and
parents
To give them a better sense of control
46. Which of the following is the
MOST common emotional response
among women during the first
trimester of pregnancy?
A. Ambivalence
B. Depression
C. Acceptance
D. Jealousy
47. Olivia mentioned that she can
experience uttering squeezing.
Which of the following signs of
normal pregnancy should the nurse
consider?
A. Braxton-Hicks contractions
B. Hegar’s sign
C. Ballottement
D. Labor contractions
BRAXTON HICKS CONTRACTIONS
48. Nurse Emma advised the
patient to quit smoking
because nicotine will
contribute to___.
A. low birth weight infant
B. ectopic tubal pregnancy
C. congenital anomalies
D. large for gestation age infants
Nicotine – CPL NICO

○ Category C drug
○ Preterm and Stillbirth
○ LBW / VLBW
○ NO BREASTFEEDING
○ INCREASED ABRUPTIO
○ CLEFTS
○ O2 POOR EXCHANGE
Alcohol

HIGH RISK: 6 oz or more/d)

1 oz (2 drinks) absolute alcohol 2x/wk:

v Spontaneous Abortion (2-4 X)

v Fetal alcohol syndrome (FAS):
F-acial features altered
A-bnormal tone & coor (Poor)
S-mall (weight and HC)

-others display only fetal alcohol effect (FAE).

Caffeine -PETUS
§ Placental blood flow LOW
§ Epinephrine up after 30min (2 cups)
§ Toxic to embryo - >6-8 cups/d
§ Unknown teratogenicity
§ Spontaneous Abortion
49. Emotional lability is common
to pregnant women. Identify which
of the following reaction is
accepted as part of a normal
pregnancy?
A. Feelings are easily hurt by
remarks
B. Mood swing
C. Amusing or even charming
situation
D. Narcissism
SITUATION: OB-DIAGNOSTICS
50. A 40-year-old patient who
is 8 weeks pregnant and
desires fetal testing is able
to have the following test at
this time:
a.Biophysical profile
b.Chorionic villus sampling
c.Amniocentesis
d.Alpha-fetoprotein test
BPP - (MTBAR)

v Chorionic villus sampling

v Amniocentesis

v Alpha-fetoprotein test
51. Which is not an
indication of amniocentesis?
a.Previous pregnancy with
chromosomal abnormal fetus
b.Down syndrome in siblings
c.Pregnancies in women over
35 years old
d.At 8 weeks gestation for
chromosomal study
52. Which of the following statement
about L/S ratio in amniotic fluid is
correct?
a.A slight variation in technique does
not significantly affect the accuracy
of result
b.A L/S ratio of 2:1 is incompatible
with life
c.A L/S ratio of less than 1:0 is
compatible with fetal survival
d.When L/S ratio is 2:1 below,
majority of infants develop
respiratory distress
53. What is the primary
reason an ultrasound is
done in the second
trimester except?
a.Evaluate fetal structure
b.Measure amniotic fluid
c.Determine sex
d.Confirm pregnancy
ULTRASOUND

● 1st Trimester 1. EDUCATE

2. PREPARE PATIENT
● 2nd Trimester
3. FULL BLADDER
4. SUPINE WITH
ROLLED TOWEL
● 3rd Trimester - Labor RIGHT HIP
54. Rhina is a primipara
hospitalized due to
preeclampsia. The doctor
decided to perform NST. The
NURSE should apply the fetal
transducer over the fetus:
a. upper chest
b. upper back
c. mid-back
d. lower back
55. Rachel, a diabetic woman at 36
weeks gestation is scheduled for
biophysical profile in order to:
a.Ascertain correct gestational
age
b.Determine fetal lung maturity
c.Determine fetal well-being
d.Determine fetal size and
obvious congenital anomaly
56. A nurse is providing instructions
to a pregnant client who is scheduled
for an amniocentesis. The nurse tells
the client that:
a.Strict bed rest is required after the
procedure
b.An informed consent needs to be
signed before the procedure
c.Hospitalization is necessary for 24
hours after the procedure
d.A fever is expected after the
procedure because of the trauma to the
abdomen
57. Patient Presley who is
ordered for diagnostic pelvic
ultrasounds ask at preparation
she’ll take. Appropriate
preparations for this
procedure include___.
A. explanation of the
procedure
B. NPO 6 hours before
C. Informed consent
D. voiding
58. Pelvic ultrasound can detect,
which of the following?
A. Congenital defects in the
structure, fetal gender, H-mole
B. Fetal sex, number, and lung
maturity
C. Fetal DM, multiple pregnancies,
fetal age of gestation
D. Fetal congenital defects,
placenta previa, fetal lung
maturity
59. The labor progress and
the physician performed
amniotomy. Nurse Hope should
FIRST assess for:
A. bladder distention
B. maternal blood pressure
C. cervical dilatation
D. fetal heart rate (FHR)
pattern
60. A physician has prescribed an
ultrasound for a client in the first
trimester of pregnancy and the client
asks a nurse about the procedure. The RN
tells the client that:
a.The procedure takes about 2 hours
b.It will be necessary to drink 1 to 2
quarts of water before the examination
c.Gel is spread over the abdomen, and a
round disk transducer will be moved
over the abdomen to obtain the picture
d.The probe that will be inserted into
the vagina will be covered with a
disposable cover and coated with a gel
61. External monitoring of
contractions and fetal heart rate
of a multigravida in labor reveal
a variable deceleration pattern on
the fetal heart rate. Which of the
following should the RN do first?
a.Notify the physician
b.Change the client’s position
c.Administer oxygen at 2 LPM via
mask
d.Prepare for CS delivery
EARLY DECELERATION

● gradual decline and recovery in the heart rate that coincide with the onset
and recovery of the contraction.
LATE DECELERATIONS

● gradual decline in the heart rate that starts at or after the contraction’s
peak and recovers after the end of the contraction
Variable Decelerations
● abrupt drop in the heart rate, and its onset commonly varies with successive
contractions. The deceleration depth measures ≥15 bpm, lasts ≥15 seconds, and
has an onset-to-nadir phase
62. The purpose of
ultrasound taking during
first trimester:
a.Confirm pregnancy
b.Determine multiple
gestation
c.Determine AOG
d.All of the choices
63 An episiotomy is a surgical incision of the
perineum made to do the following except:
a. prevent tearing of the perineum,
b. release pressure on the fetal head with birth,
c. shorten the last portion of the second stage of
labor
d. Median cut has less danger of a rectal mucosal
tear
Episiotomy

● intended incision of perineum to enlarge vaginal opening for birth.

EPISIOTOMY CARE -DAWN

● Discomfort 5- 6 days
● Dissolve in 10 days
● Anesthetic cream/spray, cortisone-based cream
● Analgesic (hydrocodone) first 24H
● Acetaminophen (milder) remainder of 1st wk.
● Warm sitz bath -inflammation , tension
● Witch hazel–impregnated pads (Tucks) - mainstay for relief of
perineal and hemorrhoidal discomfort (cooling)
● No to aspirin
64. Amniotomy is the artificial rupturing of membranes
during labor if they do not rupture spontaneously to allow
the fetal head to contact the cervix more directly, which
possibly increases the efficiency of contractions and
therefore increases the speed of labor. The ff are true except;
a. The woman is asked to assume a dorsal recumbent
position and an amniohook or a hemostat is passed
vaginally.
b. An advantage is it prevents fetus momentarily at risk for
cord prolapse
c. It is only to be performed an if the fetal head is well
applied to the cervix.
d. Nurse is expected to measure the FHR immediately after
the rupture of membranes
AMNIOTOMY (ABCDEF)

• Artificial rupturing of membranes Ø Risk for cord prolapse

• Amniohook (a long, thin crochet-
hooklike instrument) or a Ø Perform only if the fetal
head is well applied to the
hemostat passed vaginally
cervix.
• Breaks/tears Membranes
• Contractions increased Ø Always check FHR
• Dorsal recumbent position immediately
• Escape of fluid
• Fetal descend
65. In a non-stress test, if a 20-minute period passes
without any fetal movement, it can mean that the fetus
is sleeping, although other reasons for lessened
variability are maternal smoking, drug use, or
hypoglycemia. The ff can be done confirm is the fetus is
only sleeping except:
a. Although not yet evidence based, you can give the
woman orange juice
b. The fetus also may be stimulated by a vibroacoustic
stimulation to cause movement.
c. Ask the woman to ambulate
d. Let the mother listen to music
STIMULATIONS

● Fetal scalp puncture for blood pH test

● Fetal scalp pinching
● Vibroacoustic stimulation
● Scalp Stimulation
66. What test
differentiates fetal blood
from maternal blood?
a.Indirect Coomb’s test
b.Kleihauer- Betke Test
c.Blood typing
d.Direct Coomb’s test
KB or Apt Test
67. You performed the Leopold’s
maneuver and found the following:
breech presentation, fetal back at
the right side of the mother.
Based on these findings, you can
hear the fetal heart beat (PMI)
BEST in which location?
a.Left lower quadrant
b.Right lower quadrant
c.Left upper quadrant
d.Right upper quadrant
68. In Leopold’s maneuver step #
3 you palpated a hard round
movable mass at the supra pubic
area. The correct interpretation
is that the mass palpated is:
a.The buttocks because the
presentation is breech.
b.The mass palpated is the
head.
c.The mass is the fetal back.
d.The mass palpated is a fetal
small part
Third maneuver: Pawlick’s Grip
69. You want to perform a
pelvic examination on one of
your pregnant clients. You
prepare your client initially
for the procedure by:
a.Position in dorsal
recumbent
b.Taking her vital signs and
recording the readings
c.Warming the hands
d.Asking her to void
Pelvic Examination

● Explain
● Void
● Lithotomy
70. Nurse Minda is reviewing the
record of a pregnant client for
her first prenatal visit. Which of
the following data, if noted on
the client’s record, would alert
the nurse that the client is at
risk for a spontaneous abortion?
a. Age 36 years
b. History of syphilis
c. History of genital herpes
d. History of diabetes mellitus
History of syphilis

History of genital herpes

History of diabetes mellitus

1st trimester
“CCSS” At Birth
“HHHR”
Congenital anomaly Hypoglycemia
Caudal regression syndrome Hypocalcemia
Spontaneous miscarriage Hyperbilirubinemia
Stillbirth Respiratory Distress
71. Nurse Hazel is preparing to care
for a client who is newly admitted to
the hospital with a possible diagnosis
of ectopic pregnancy. Midwife Hazel
develops a plan of care for the client
and determines that which of the
following nursing actions is the
priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
ECTOPIC PREGNANCY

implantation occurred outside the uterine cavity

TRIAD:
DX:
WOF:
Mngt:
72.Nurse Gina is aware that
the most common condition
found during the second-
trimester of pregnancy is:
a.Metabolic alkalosis
b.Respiratory acidosis
c.Mastitis
d.Physiologic anemia
Pseudo or Physiologic Anemia

● Blood volume (mL) from 4,000 to 5,250mL in Pregnancy

-Compensate for blood loss at birth

-Ensure transport of nutrients to fetus

TRUE ANEMIA
1st & 3rd Trimester:
2nd Trimester:
73. The patient asked you what is the
iron for? You answer:
Strong evidence supplementation of
iron reduces the ff incidents :
a.maternal anemia, puerperal sepsis,
low birth weight, and preterm birth
b.maternal and fetal anemia,
poyhydramnios, post term birth
c.multigestation pregnancy, maternal
anemia and spina bifida
d.hypertensive disorders, excessive
weight gain and maternal anemia
SITUATION: ANTEPARTAL BLEEDING
Nadya 32, G4P3 consulted because
of vaginal spotting of a few hours
duration with mild hypogastric
pains. Her last menstrual period
was 12 weeks ago. She had a
previous miscarriage. A pregnancy
test done two weeks ago was
positive
Bleeding is ______
Has the TRIAD
That has bleeding and pain
Menstruation stopped
And __________ the name
________to _________months
Or else Abortion can happen
If something’s happened
Second or the First Trim with you
Fetus or Heartbeat is gone
HCG’s few

All bleeding though _________

I should be telling MD
If something’s happened
Second or the First Trim with you
Fetus or Heartbeat is gone
HCG’s few

All bleeding though _________

I should be telling MD
SECOND TRIMESTRAL BLEEDING

Second Trimester here but some cervix bad

___________ these _________ cervix,
So baby wont fall out

Yes I know, in _________

HCG is not falling
THIRD TRIMESTER

Bleeding is darker, ____________’s Upper place

Previa is____________, and pain______
in _________ place
Yet ___________ bounds, sticks,
Implanted so __________
(In ___________, baby)
NURSING

If she’s bleedings
If preggy, BLEEDING IS ______
_____ trim bleeding, IE or RE IS BAD
______dripping , ______ is flowing, should have
______________ turn
MANTRA

But i don’t care, bashers say

I'll be RN its true
My doubts and fears are away
I'll pass and that's the truth
My heart won’t cripple
For the dreams that I keep on reaching…
WHO’LL BE IN TOP 10 IS I !!!
74. Patient arrives at the health care
clinic. She also tells the nurse that a
home pregnancy test was positive, but
she began to have mild cramps and is
now having moderate vaginal bleeding.
During the physical examination of the
client, the nurse notes that Nadya has
a dilated cervix. The nurse determines
that she is experiencing which type of
abortion?
a. Inevitable
b. Incomplete
c. Threatened
d. Missed
ABORTION

Loss or interruption of Pregnancy before AOV

Generally Accepted:
Range:
TYPES:
MNGT:
75. The definite management
for this type of abortion with
open cervix and retained
tissues is __________
A. progesterone tablets
B. observation and rest
C. duphaston tablets
D. completion curettage
76. Midwife Michelle is
assessing a 24-year-old client
with a diagnosis of hydatidiform
mole. She is aware that one of
the following is unassociated
with this condition?
a. Excessive fetal activity.
b. Larger than normal uterus for
gestational age.
c. Vaginal bleeding
d. Elevated levels of human
chorionic gonadotropin
HMOLE 4F, 4P

● Fundic ht larger
● Fast Fresh Flow
● Four Months (usually)= 16 wks AOG
● Fluid-filled clear vesicles
● Peaked HCG
● Prune-juice color
● Pattern of Snowflake without fetal growth in UTZ
● PIH sx early

● MNGT: SUCTION CURETTAGE

77. Another patient came,
Mylene in her third trimester
arrives at the emergency room
with painless vaginal bleeding.
Which of the following
conditions is suspected?
a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease
PREVIA- “before”
implanted somewhere in the lower uterine
segment
(over or very near the internal cervical os)
P
R
E
V
I
A
78. Which of the following
procedures will the nurse expect
to be performed to diagnose the
suspected problem of patient
Mylene?
a. Amniocentesis
b. Digital or speculum examination
c. External fetal monitoring
d. Ultrasound
79. You will teach a woman who had a
termination of pregnancy. Which among
the following statements of the patient
shows that the client understood your
teaching?
a.I should call the doctor if I will
have slight vaginal spotting in 2
weeks with cramping .
b.I will use tampons for my bleeding
and douche to prevent infection.
c.I can resume coitus after 7 days
d.I can resume regular activities but
avoid heavy lifting or strenuous
exercise for 3 days.
Situation: The majority of women
who enter pregnancy in good health
expect to complete a pregnancy and
birth without complications. In a
few women, however, for reasons
that usually are unclear,
unexpected deviations or
complications from the course of
normal pregnancy occur.
80. A nurse is assessing a
woman suspected of abruption
placenta. Which of the
following assessment findings
would the nurse to expect in
this condition?
a.Soft abdomen
b.Uterine tenderness
c.Absence of abdominal pain
d.Red vaginal bleeding
ABRUPTIO PLACENTA- “rendering asunder of the placenta,”

(premature separation of the normally implanted placenta)

A-dvancing age and Parity,

B-rown,dark
R-igid
U-terine TENDERNESS, sharp to dull, fundal area
P-rior Hx, Premature separation
T-ension, Trauma, Third Trim
I-ntravascular Coagulation (DIC)
O-ccult,Hidden- COUVALAIRE UTERUS
N-o IE, RE, AE
81. Which of the following
factors would influence the
client to the development of
placenta previa?
a.Multiple gestation
b.Uterine anomalies
c.Abdominal trauma
d.Renal or vascular disease
82. A 36-year-old client is
admitted with a possible
ruptured ectopic pregnancy. When
planning the client’s care,
which of the following
procedures should the nurse
anticipate in preparing the
client for soon after admission?
a.D&C
b.Ultrasound
c.Evacuation of uterus
d.Salphingectomy
83. A 24-year-old client
admitted to the hospital is
having pain, vaginal bleeding
with history of 2 missed
periods. Upon admission,
which of the following would
be most important to assess?
a.Abortion
b.Use of IUD
c.Preterm labor
d.Ectopic Pregnancy
84. An expected finding to a
client diagnosed with ruptured
ectopic pregnancy is:
a.Sharp, bilateral abdominal
pain
b.Heavy bright red bleeding
with the passage of large clots
c.Tender abdominal mass
d.Elevated BP and slow bounding
pulse
85. Which of the following
signs and symptoms will most
likely make the nurse suspect
that the patient is having
hydatidiform mole?
a.Slight bleeding
b.Passage of clear vesicular
mass per vagina
c.Absence of fetal heart beat
d.Enlargement of the uterus
86. Upon assessment the nurse found the
following: fundus at 2 fingerbreadths
above the umbilicus, last menstrual
period (LMP) 5 months ago, fetal heart
beat (FHB) not appreciated. Which of
the following is the most possible
diagnosis of this condition?
a.Hydatidiform mole
b.Polyhydramnios
c. Macrosomia
d. Abortion
87.Nurse Lou assesses a 1st
trimestral patient with dark
brown vaginal discharge and a
negative pregnancy test, what
type of abortion is
attributed?
a.Threatened
b.Abruptio Placenta
c.Missed
d.IUFD
88. Which of the following would be
most important to include in the
discharge teaching plan for a
client who had a suction curettage
evacuation of the uterus for
hydatidiform molar pregnancy?
a.Continuation of prenatal
vitamins for 6 weeks
b.Psychological support for grief
counseling
c.Importance of follow-up care
d.Hormonal contraceptive pills to
prevent pregnancy
TEACHING (HETO NAMAN PAPAPANSIN)

H
2
N
M
1
PPP
C
Situation– Patient Norma,
who is in the third
trimester, arrives at the
hospital with vaginal
bleeding. She states that
she snorted cocaine
approximately 2 hours ago.
89. Which defined complication
is MOST likely causing the
client’s vaginal bleeding?
a.Premature separation of
normally implanted placenta
b.Pregnancy outside the
uterus
c.Termination of pregnancy
before the age of viability
d.Abnormal lower implantation
of the placenta
90. The abdominal pain
associated with abruption
placentae may be INITIALLY
caused by which of the
following?
a.Disseminated intravascular
coagulation
b.Blood in the myometrium
c.Hemorrhagic shock
d.Concealed haemorrhage
91. Patient Juana presents in her
38th week of pregnancy. She has
history of increased parity, with
previous uterine surgery, and is
cocaine dependent. She complains of
sudden, sharp fundal pain and then
a continuing dull pain and vaginal
bleeding. The nurses suspects:
a. Preterm Labor
b. Placenta Previa
c. Ruptured Uterus
d. Abruptio Placenta
92. Patient Athelfled has Increased
parity, advanced maternal age, had
past cesarean births, past uterine
curettage, with twins, and fetus are
male. She has all associated with
this fresh bleeding in third
trimester and is thought to occur
whenever the placenta is forced to
spread to find an adequate exchange
surface. The RN suspects:
a. Preterm Labor
b. Placenta Previa
c. Ruptured Uterus
d. Abruptio Placenta
SITUATION- RH ISOIMMUNIZATION
ABO INCOMPATIBILITY RHESUS (ANTIGEN D)
● Antigens A & B are
Antibodies are IgM

● Mild Hemolysis
93. Rh isoimmunization in a pregnant client
develops during which of the following
conditions?
a.Rh-positive maternal blood crosses into
fetal blood, stimulating fetal antibodies.
b.Rh-positive fetal blood crosses into
maternal blood, stimulating maternal
antibodies.
c.Rh-negative fetal blood crosses into
maternal blood, stimulating maternal
antibodies.
d.Rh-negative maternal blood crosses into
fetal blood, stimulating fetal antibodies.
94. All are correct regarding exchange
transfusion for newborns with blood
incompatibility except which one?
a.Before the procedure, the baby’s
stomach is aspirated
b.umbilical vein is catheterized as
the site for transfusion
c.involves alternatively withdrawing
small amounts (2–10 mL) of the
infant’s blood and then replacing it
with 50% amount of donor blood
d.the procedure takes 1 to 3 hours
and is a lengthy procedure
95. Windy gave birth to a
term baby with yellowish skin
and sclera. Blood type of the
baby is B+. The baby is
placed on phototherapy. The
treatment is effective when
blood test shows:
a.Low serum bilirubin
b.O2 level of 99%
c.Normal RBC and WBC count
d.Low platelet count
96. Because of the fast
increase of bilirubin level,
exchange transfusion was
performed on Erica’s newborn.
The nurse understands that
the blood to be transfused to
the baby should be:
a.Type B, Rh +
b.Type O, Rh –
c.ABO compatible, RH –
d.Type B, Rh –
EXCHANGE TRANSFUSION
● Small amounts withdrawn from umbilical vein
● Replaced with equal amounts of donor blood.
● INDICATONS: Hyperbilirubinemia,polycythemia
● Blood incompatibility-removes 85% of sensitized red cells
● Radiant heat warmer -lengthy procedure.
● Commercial blood warmer
● O- given (even if the neonate’s blood type is positive)
● Vital signs
● Bleeding and inflammation
● Bilirubin levels x 2-3 days
97. Immediately after delivery of
Erica’s baby, the midwife should
remember to:
a.Delay clamping of the cord to
provide the newborn with more blood
b.Cut immediately after birth of the
baby
c.Administer RhoGAM to the NB
immediately on the 3rd stage of labor
d.Place the NB in an isolette for
phototherapy
98. With Rh incompatibility, the following
are correct statement except:
a. Infants with blood incompatibility are
pale at birth caused by red cell destruction
that occurred in utero because of the
accelerated production of red cells during
the last few months in utero
b. Splenomegaly or hepatomegaly can be
assessed
c. Severe anemia can result in heart failure
d.Hydrops fetalis can happen where there is
pathologic accumulation of at least two or
more cavities with a collection of fluid in
the fetus.
99. Which of the following is TRUE in
Rh incompatibility?
a.The condition can occur if the mother
is Rh(+) and the fetus is Rh(-)
b.Every pregnancy of an Rh(-) mother
will result to erythroblastosis fetalis
c.On the first pregnancy of the Rh(-)
mother, the fetus can also be affected
d.RhoGam can be given anytime to RH-
mother during the first pregnancy to
prevent RH incompatibility
100. After an Rh(-) mother has delivered her
Rh (+) baby, the mother is given RhoGam. This
is done in order to:
2a.Prevent the recurrence of Rh(+) baby 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 that future pregnancies will not
lead to maternal illness
d.To prevent the newborn from having problems
of incompatibility when it breastfeeds
Recap na pang FTW!!!
NANAY
Nanay, kamusta ka na?
Kapag ang ________
ng iyong Blood
___________cya
Bata,___________ ba cya
Kapag din kase
_________ blood escape
ay masama
Wag ka nang gagawa ((RH-D ikalma)
'wag ka nang gagawa ('Antibodies wala)
Ngayon

Bibigyan kita ng ___________, Blood nyo di, mag-

aaway
Mother di mag-form ang ____________ mo
Bibigyan kita ng IM rhoGam, Blood nyo di mag-aaway
Baby di destroyed mga____________ mo
Nanay, __________ na ba?
_________ probs
__________ ba , nagawa

______________, buti na lang

Nariyan ka,
____________ nya
Di malikha
'Wag ka nang Gagawa
(RH-D ikalma)
Wag ka nang gagawa
('Antibodies wala)
Ngayon
Bibigyan kita ng __________, Blood nyo di, mag-
aaway
____________di mag-form ang ____________ mo

Bibigyan kita ng IM _______,

___ days di magpa-pass by
______ di destroyed mga RBC mo
Situation : DM IN PREG
101. The nurse suspects DM in
pregnancy with the following
history except:
a. Obesity, Age above 25 years ,
History of large babies
b. History of unexplained fetal or
perinatal loss
c. History of congenital anomalies
in previous pregnancies and
polycystic ovary syndrome
d. Family history of DM and member
of a population from Australian,
Caucasian, Mediterranean race
102. Emily has gestational
diabetes and it is usually
managed by which of the
following therapy?
a. Diet
b. Long-acting insulin
c. Oral hypoglycemic
d. Oral hypoglycemic drug and
insulin
DIABETES IN PREGNANCY

Type 1- Insulin Def

Type 2- Insulin resistance
GDM – Appeared in Pregnancy
Impaired glucose homeostasis - between “normal” and “DM”

ASS: 1-Hr GTT

100g GTT
DIET

● A 1800- 2400 calorie divided in 3 meals + 3 snacks

● 20% from CHON
● 40-50% from CHO
● 30% Low saturated fats, cholesterol
● High fiber
Exercise- ABCDE

● Atleast 12H effect (glucose regulation)

● Begin pre-pregnancy

● CHON or complex CHO pre-exercise

● Daily consistent program- 30 min walking/d

● Extreme exercise = hyperglycemia+ketoacidosis

(if glucose poorly controlled)

INSULIN
GDM- normal by 24H
● Uncontrolled w/ diet/oral
therapy Type1,2-
● Reg/ Reg+NPH IMMEDIATE
● 1st TRI: less POSTPARTUM:none
● 2nd-3rd TRI: increased
● Eat ASAP p injecting FEW DAYS LATER:
● Rotate on same site return to the
prepregnant insulin
LABOR: requirements
103.The midwife is assessing a pregnant client
with type 1 DM about her understanding
regarding changing insulin needs during
pregnancy. The nurse determines that teaching
is needed if the client makes which statement?
a.“I will need to increase my insulin dosage
during the first 3 months of pregnancy”
b.“My insulin dose will likely need to be
increased during the second and third
trimester”
c.“Episodes of hypoglycemia are more likely to
occur during the first 3 months of pregnancy”
d.“My insulin needs should return to normal
within 7 to 10 days after birth if I am bottle-
feeding”\
104.A nurse in the OB clinic is reviewing current
prenatal history of a pregnant client who is being seen
for a routine prenatal visit. She discovers the client’s
1-hour OGCT result to be 163 mg/dL. The nurse’s best
response to the client would be:
a.“Your OGCT results indicate that you are positive for
gestational diabetes. You will be scheduled for a
dietitian consultation to plan your daily dietary
intake”
b.“The OGCT is a screening tool for gestational
diabetes, and you will need further testing to confirm a
diagnosis due to your results being elevated”
c.“Your OGCT results are within normal limits, but
continuing your prenatal visits remains essential in
order to monitor fetal growth and development”
d.“Your OGCT results indicate that your baby is at high
risk for macrosomia and special considerations mat be
necessary at delivery”
105. The nurse is caring for a woman at 37 weeks
gestation. The client was diagnosed with insulin
dependent diabetes mellitus (IDDM) at age 7. The
client states, “I am so thrilled that I will be
breastfeeding my baby.” Which of the following
responses by the RN is BEST?
a.“You will probably need less insulin while you
are breastfeeding
b.“You will need to initially increase your
insulin after the baby is born.”
c.“You will be able to take an oral hypoglycemic
instead of insulin after the baby is born.”
d.“You will probably require the same dose of
insulin that you are now taking.”
106. Because blood glucose levels near normal help
minimize the risk of maternal and fetal complications,
both women with gestational diabetes and those with overt
diabetes need more frequent prenatal visits than usual to
ensure close monitoring of their condition and that of
the fetus. The ff are correct except:
a. Early in pregnancy, insulin needs may be less. Later in
pregnancy, increased insulin may be needed.
b. Women should eat immediately after injecting insulin to
avoid hypoglycemia
c. She should have some simple sugars like fruit juice
instead of carbohydrate rich food, like crackers, and a
protein, like milk if hypoglycemia occurs
d. She can use insulin pump and the patient should clean the
site daily and cover it with a dressing to keep it clean.
107.Exercise is another mechanism that lowers serum
glucose levels and, therefore, the need for insulin. The
following are correct about exercise in DM in pregnancy.
Which is incorrect?
a. It is best if she begins her exercise program before
pregnancy, when glucose fluctuation can be evaluated and
food and snacks adjusted accordingly before a fetus is
involved
b. If the arm in which a woman injected insulin is actively
exercised, the insulin is released so quickly that it can
cause hypoglycemia, so should eat a snack before exercise
c. she should do aerobic exercises one day and then none the
next, instead of 30 minutes of walking every day.
d. In a woman with poor blood glucose control, extreme
exercise will cause hyperglycemia and ketoacidosis so she
should avoid exercise
108. What is the route of
administration for
insulin during pregnancy?
a.Intravenous
b.oral
c.Subcutaneous
d.IM
109. Considering Maureen’s
condition, Nurse Lerie will
anticipate what effect to the
fetus? The condition will be
having _______.
a.Above 3500g in weight
b.Large for Gestational Age
c.Appropriate for Gestational Age
d.Low Birth Weight
110. On the first postpartum
day, which of the following
requirements for insulin will
be anticipated by the midwife
to be ordered by the physician?
a.Remain unchanged
b.Decrease sharply and suddenly
c.Increase rapidly
d.Decrease slowly and steady
Situation; HTN IN
PREGNANCY
Pregnancy- Induced
Hypertension: Melanie a 33
year-old patient G1P0 at
32 weeks AOG is admitted
to the hospital with the
diagnosis of PIH.
111. Which of the following changes in
Melanie’s BP would a nurse not expect?
a.It tends to be highest in sitting
b.BP may increase a little in the
second trimester
c.It should be taken at every visit at
the clinic
d.It is normal for blood pressure to
increase as much as 33 in systolic in
the third trimester when a woman is
near delivery
112. A pregnant client is receiving
magnesium sulfate for severe
pregnancy induced hypertension
(PIH). The clinical findings that
would warrant use of the antidote ,
calcium gluconate is:
a. Urinary output 90 cc in 2 hours.
b. Absent patellar reflexes.
c. Rapid respiratory rate above
40/min.
d. Rapid rise in blood pressure.
113. Magnesium sulfate is
given to Maureen with
preeclampsia to prevent which
of the following condition?
a. Hemorrhage
b. Hypertension
c. Hypomagnesemia
d. Seizure
114. Maureen was diagnosed with
severe preeclampsia is now
receiving I.V. magnesium sulfate.
The adverse effects associated
with magnesium sulfate is:
a. Anemia
b. Oliguria
c. Hyperreflexia
d. Tachypnea
115. Which of the
following drugs is he
antidote for magnesium
toxicity?
a. Kalcinate
b. Apresoline
c. Narcan
d. RhoGAM
116. A pregnant client is reviewing
magnesium sulfate for the management
of preeclampsia. A midwife determines
that the client is experiencing
toxicity from the medication if which
of the following is noted on the
assessment?
a.Proteinuria of +3
b.RR 10 bpm
c.DTR +2
d.Serum magnesium level of 8 mEq/L
117. What lab work is ordered on
a pregnant patient suspected of
having HELLP syndrome?
a.Glucose screen and CBC
b.Liver biopsy and liver enzymes
d.CBC, platelet count, and liver
enzymes
d.Nonstress test and a
biophysical profile
118. The expectant mother at the
greatest risk for pregnancy-included
hypertension would be a:
a.22-year-old RH-negative
multigravida
b.17-year-old primigravida with a
positive roll-over test
c.25-year-old anemic primigravida
d.28-year-old slightly obesed
primigravida
119.The primary
differentiating factor
between preeclampsia and
eclampsia is the presence of:
a. Edema in the face
B. Epigastric pain
C. Convulsion
D. Proteinuria
SITUATION PTL- Presley enters
the labor and delivery unit
in probable preterm labor at
36 weeks’ gestation. The
patient was informed that the
fetus is in breech
presentation. She has a
catheterized urine specimen
ordered.
120. Patient Presley asks the nurse why such a
diagnostic procedure is required. What is the
MOST APPROPRIATE answer can the nurse give?
A. Urinary tract infections are strongly
associated with the occurrence of preterm
labor.
B. Reduced sensation to urinate usually occur
during preterm labor.
C. Preterm labor treatment usually causes women
bladder infection because of restricted fluid
intake.
D. Catheterized urine is usually ordered for
any woman admitted to the labor and delivery
unit.
122. Suppose a sonogram shows Marites, who is beginning
preterm labor, has a placenta previa. The nurse identifies
which measure as the priority to ensure her safety?
a. Keep her physically active to avoid a deep vein
thrombosis
. b. Perform a daily vaginal exam to assess the extent of the
previa.
c. Assess for vaginal bleeding and clear fluid leakage every
shift.
d. Keep her nothing by mouth (NPO) as she will need an
emergency cesarean birth.
SITUATION; 1ST STAGE OF LABOR
123. The psychosexual method of childbirth was
developed in England during the 1950s. The
method stresses prenancy, labor and birth, and
the early newborn period are some of the most
important points in a woman’s life. It includes
a program of conscious relaxation and levels of
progressive breathing that encourage a woman to
“flow with” rather than struggle against
contractions. This is called the:
A.Dick- Read method
B.Kitzinger method
C.Bradley method
D.Lamaze method
124. EBP from a study conducted on data
from the Stockholm-Gotland Obstetric
Database, which included 113,279
singleton spontaneous vaginal births
showed that the lowest risk for OASIs
(obstetric anal sphincter injuries),
with which of the following position?
a.in the standing position
b.In the lithotomy position
c.Squatting
d.birth seat position
125. One additional technique to encourage
relaxation and displace pain in the Lamaze
method a “light abdominal massage”; it is
done with just enough pressure to avoid
tickling. To do this, a woman traces a
pattern on her abdomen with her fingertips
and serves as a distraction technique and
decreases sensory stimuli transmission from
the abdominal wall, helping limit local
discomfort.
a.Petrissage
B.Tapotement
C.Effleurage
D.Vibrations
Petrissage refers to a series of slow and rhythmical movements that use deep
pressure to compress muscles and tissues against each other, Squeezing the
muscles against the bones or each other helps to stretch and loosen the muscle
fibers.

Tapotement is a specific technique used in Swedish massage. It is a

rhythmic percussion, most frequently administered with the edge of the
hand, a cupped hand or the tips of the fingers.

Vibration massage is a technique that involves shaking or trembling

movements on the body or muscles, using hands, fingers, or electronic
devices
126. Your patient in labor chose this
childbirth method, where the birthing room is
darkened so there is no sudden contrast in
light; the environment is kept pleasantly warm,
not chilled; soft music is played, or at least
harsh noises are kept to a minimum; the infant
is handled gently; the cord is cut late; and
the infant is placed immediately after birth
into warm bath water.
a.Leboyer Method
b.Lamaze Mehtod
c.Natural Childbirth
d.Waterbirth
127. Commonly used nonpharmacologic techniques
for pain relief in labor are the following,
Select All That Applies :

i. conscious relaxation
ii.consciously controlled breathing
iii.effleurage
iv.focusing
v. imagery
vi.hydrotherapy

a. I, II, VI
b. I and II only
c. I, II, and III
d. I, II, III, IV, V, VI
128. It is the relationship between the
long (cephalocaudal) axis of the fetal
body and the long (cephalocaudal) axis
of a woman’s body—in other words,
whether the fetus is lying in a
horizontal or a vertical position.
a. Attitude
b. Station
c. Presentation
d. Lie
129. Labor is traditionally divided into three stages: Which
stage has incorrect description?
a. The first stage of dilatation, which begins with the
initiation of true labor contractions and ends when
the cervix is fully dilated
b. The second stage, extending from the time of full
dilatation until the infant is ready to be born
c. The third or placental stage, lasting from the time
the infant is born until after the delivery of the
placenta
d. The first 1 to 4 hours after birth of the placenta is
sometimes termed the “fourth stage” to emphasize the
importance of close maternal observation needed at
this time
NORMAL LABOR IN HOURS

I.A Latent: onset to 4 cm II. Second stage: 10cm-to

PRIMI: 8.6 – 20hr birth
MULTI: 5- 14 hr PRIMI: 1hr- 2 hr w/o epidural;
<3 hr w/ epidural
I.B. Active-Transitional phase: MULTI: 0.5 hr -1 hr w/o
4 -10cm epidural; <2 hr w/ epidural
PRIMI: 5-12hrs (min 1.2 cm/hr )
III. Third Stage : Placenta
MULTI : 2.5-6 hrs (min 1.5
Both =
cm/hr)
130. Timing the administration of narcotics during
labor is especially important but which of the
following is INCORRECT statement regarding
narcotics use in labor?
a.They should be given early (before 3 cm
cervical dilatation), to control pain earlier.
b.Narcotics are preferably given when the mother
is more than 3 hours away from birth.
c.They all begin to work 15 to 30 minutes after
intramuscular administration or about 5 minutes
after intravenous (IV) administration
d.Opioid analgesics used in labor include
butorphanol tartrate (Stadol), morphine sulfate,
nalbuphine (Nubain), meperidine (Demerol), and
fentanyl (Sublimaze).
Situation: Mrs. Calamares
G2P1 1001, comes out of the
labor and delivery room and
reports ruptured amniotic
membranes and contractions
that occur every 3 minutes
lasting 50-60 seconds. The
fetus is in LOA position.
131. When asked to describe the amniotic
fluid, Mrs. Calamares states that it is
“green-tinged”. This indicates that:
a.The fetus had infection
b.At some point, the fetus experienced
oxygen deprivation
c.The fetus is in distress and should be
delivered immediately via CS
d.The fetus is not experiencing any
undue stress and is expected for term
babies
132. With variable type of
deceleration, a nurse’s first
action should be to:
a.Document, since this is normal
occurrence
b.Call the physician immediately
c.Position the patient on her
left side
d.Continue monitoring the FHR
133.Which of the following may
happen if the uterus becomes over
stimulated by oxytocin during
induction of labor?
a.Weak contractions prolonged to
more than 70 seconds
b.Tetanic contractions prolonged for
more than 90 seconds
c.Increased pain with bright red
vaginal bleeding
d.Increased restlessness
 1. Hyperstimulation
● >5 in 10 mins LEFT LATERAL TURN
IVF BOLUS
● Duration >2 minutes O2 8-10LPM
● Frequency: within 60 TERBUTALINE
seconds of each other
SUREST WAY:
____________
2. Water Intoxication

● headache and vomiting- 1st manifestation

● seizures, coma, and death- severe
NURSING:
STOP
● I&O, USG CALL MD
● 150mL/hr <2.5mL/min
CONTRACTIONS= O2
● <q2min frequency
● <15mmHg resting pressure
TERBUTALINE
● <50mmHg intensity
● <70sec duration
Hypertonic Contractions

● increase in resting tone to more than 15 mm Hg

134. After the rupture of bag of
water, the nurse assess for cord
prolapsed. In case of cord
prolapsed, the first action is:
a.Check fetal heart tone
b.Cover with sterile wet dressing
c.Position the mother to
trendelenburg
d.Call the doctor very quick
CORD PROLAPSE

● loop of the umbilical cord slips down in front of the presenting fetal part
EMERGENCY!!! - ECOT-CC

GOAL:

Elevating fetal head

Knee– chest / Trendelenburg
O2 @ 10LPM
Tocolytic
Cover
CS
135. The following are the therapeutic actions of
a nurse in case of cord prolapse, SATA:
I. Placing a gloved hand in the vagina and
manually elevating the fetal head off the cord
II.Placing the woman in a knee–chest
III.Placing the woman in Trendelenburg position
IV.A tocolytic agent may be given
V. Amnioinfusion to relieve pressure on the cord
VI.attempt to push any exposed cord back into the
vagina
a. I, II, IV
b. III,only
c. III, VI
d. I, II, III, IV, V
136. The primary indication for
using tocolytic agent in preterm
labor is:
a. preterm contractions every
20 minutes
b. The cervix is 2-3 cm dilated
c. Uterus feels globularly firm
d. AOG is 38 weeks
137. During vaginal examination of Janah
who is in labor, the presenting part is
at station plus two. Nurse, correctly
interprets it as:
a. Presenting part is 2 cm above the
plane of the ischial spines.
b. Biparietal diameter is at the level
of the ischial spines.
c. Presenting part in 2 cm below the
plane of the ischial spines.
d. Biparietal diameter is 2 cm above the
ischial spines.
138. A pregnant client is receiving
oxytocin (Pitocin) for Induction of
labor. A condition that warrants to
discontinue I.V. infusion of Pitocin is:
a. Contractions every 90 seconds lasting
70-80 seconds.
b. Maternal temperature 101.2 F
c. Early decelerations in the fetal
heart rate.
d. The resting pressure between
contractions should 10mmHg by monitor
139. Side effects of Oxytocin
infusion that a nurse has to
watch out for are the
following except:
a.Hypertension
b.Water Intoxication
c.Oliguria
d.Tetanic Contractions
SITUATION: GRAVIDOCARDIAC WOMAN
AND INDUCTION OF LABOR - Lily,
23-year-old pregnant woman, 37th
week’s gestation, is admitted
in the intensive care
unit due paroxysmal ventricular
tachycardia. The patients is
conscious; cervix is open so
they decided to induce labor.
140. When the patient was informed about
induction, she ask Nurse Aurora what is it
all about. Which of the following statement
by the nurse is correct? Inductions is a____
A. local anesthesia used for blocking pain
during episiotomy stimulate labor
B. deliberate initiation of uterine
contractions that stimulates labor
C. medication injected into the subarachnoid
space and has a rapid onset of action
D. procedure performed by artificial rupture
of the membranes
141. Which of the following
statement is NOT an indication
for any uterine stimulants
(Oxytocin)?
A. Preinducting cervical ripening
B. Controlling postpartum
bleeding
C. Inducing or augmenting labor
D. Manages an incomplete abortion
142. Oxytocin drip was started to induce labor.
Which assessment findings should cause the
nurse to IMMEDIATELY discontinue the oxytocin
infusion?
(SELECT ALL THAT APPLY)
I. Fatigue and drowsiness
II. Early decelerations of the petal heart rate
III. Uterine hyper stimulation
IV. Late decelerations of the fetal heart rate
A. III and IV
B. II and III
C. I and III
D. I and II
143. Simultaneous with the oxytocin
drip (left arm) is the prescribed
intravenous (IV) lidocaine
(Xylocaine). Nurse Aurora should
dilute the concentrated solution of
lidocaine (right arm) with which
solution?
A. 5 percent Dextrose in water
B. Normal saline 0.99 percent
C. Normal saline 0.45 percent
D. Lactated Ringer’s
144. Take home medications given to
patient Lily includes digitalis
therapy which was given to patient
since she was pregnant. Which of the
following would the nurse anticipate
with patient’s drug therapy?
A. Switching to a more potent drug
B. Continuation of the same dosage
C. Need for change in medication
D. Addition of diuretic to the
regimen
Situation 2ND STAGE OF LABOR: Discomfort
during labor can be minimized if a
woman comes into labor informed about
what is happening and prepared with
breathing exercises to use during
contractions. In childbirth classes,
therefore, a woman learns about her
body’s response in labor, the
mechanisms involved in childbirth, and
breathing exercises she can use to aid
in relaxation.
145. The following are
natural childbirth
procedures EXCEPT:
a.Lamaze method
b.Dick-Read method
c.Ritgen’s maneuver
d.Psychoprophylactic method
Ritgen’s maneuver

gloved fingers grasp the fetal

chin just behind or in the anus
and exert upward pressure
between contractions.

As a counter, the other hand

presses against the occiput to
control forces against the
perineum
146. Latent phase of Labor is described as
the following, which does not?
a. Begins at the onset of regularly perceived uterine contractions
and ends when rapid cervical dilatation begins.
b. Contractions during this phase are moderate and longer lasting
40 -60 seconds.
c. Cervical effacement occurs, and the cervix dilates minimally
d. Encourage women to continue to walk about and make
preparations for birth, such as doing last minute packing for her
stay at the hospital or birthing center
Latent / Early Phase - PAPA

● Mild
● 20 - 40 sec

● Preparations
● Ambulate
● Pain relief alternatives
● Active
147. The patient has cervical dilatation
occuring more rapidly. Contractions grow
stronger, lasting 40 to 60 seconds, and occur
approximately every 3 to 5 minutes. She is in
which part of labor?
a.Latent Phase
b.Transitional Phase
c.Active Phase
d.Second Stage
Active phase

● Rapid dilation
● Stronger contraction
● 40-60s
● Increased Show
● SROM can happen

● Position
● Participation
● Exciting & Frightening
Transition phase

● Contractions peak
● q2-3 mins
● 60-70sec
● Intense discomfort w/ N/V
● loss of control, anxiety, panic, and/or irritability
● irresistible urge to push
148. Which of the following best describes
the effectiveness of childbirth education?
a.It provides expectant parents with
knowledge and skills necessary to cope with
pregnancy
b.It prepares expectant parents to be
informed consumers of birthing attendants
and facilities
c.It provides a long time for expectant
parents to express their concerns and fears
d.It improves newborn health, parent-
newborn bonding, and ability to cope with
labor
Situation: Labor is a
series of events by which
uterine contractions and
abdominal pressure expel a
fetus and placenta from a
woman’s body. The
following questions apply.
149. The multigravida client with
a history of rapid labor who is in
active labor calls out to the
nurse, “The baby is coming!” Which
of the following should be the
nurse’s first action?
a.Inspect the perineum
b.Time the contractions
c.Auscultate FHR
d.Contact the physician
150. While caring for a multigravida
in active labor with no anesthesia,
the midwife determines that the
client’s cervix is completely
dilated. The midwife should instruct
the client to deliver the fetal head
by pushing:
a.As soon as a contraction begins
b.When she has an urge to push
c.Near the end of a contraction
d.Between contractions
151. The overlapping of skull bones along
the suture lines, which causes a change in
the shape of the fetal skull to one long
and narrow, a shape that facilitates
passage through the rigid pelvis. It is
caused by the force of uterine
contractions as the vertex of the head is
pressed against the not yet dilated
cervix:
a. Engagement
b. Lightening
c. Molding
d. External Rotation
MOLDING
● to fit the cervix contours
during labor

● appears prominent and

asymmetric

● head will evolve to a

more rounded shape
within a few days of birth
152. The cervical dilatation taken at 6:00
AM in a G1P0 patient was 6 centimeters. A
repeat I.E. done at 9 A. M. showed that
cervical dilation was 7 cm. The correct
interpretation of this result is:
a.Labor is progressing as expected
b.The latent phase of Stage 1 is prolonged
c.The active phase of Stage 1 is
protracted
d.The duration of labor is normal
153. The mechanisms involved in
fetal delivery is:
a.Descent, extension, flexion,
external rotation
b.Descent, flexion, internal
rotation, extension, external
rotation
c.Flexion, internal rotation,
external rotation, extension
d.Internal rotation, extension,
external rotation, flexion
Mechanisms (Cardinal Movements) of Labor
154. The primary power involved
in labor and delivery is:
a.Bearing down ability of
mother
b.Cervical effacement and
dilatation3
c.Uterine contraction
d.Valsalva technique
155.During an internal examination,
the midwife 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
156. The time between
uterine contractions
is:
a.Intensity
b.Interval
c.Duration
d.Frequency
157. In the second stage of
labor, expulsion of the
fetus from birth canal
depends on which important
factor?
a.Maternal bearing down
b.Cervical dilatation
c.Uterine contractions
d.Adequate pelvic size
SITUATION; 3RD and 4th STAGE OF LABOR
158. When separation begins at
the center of the placenta and
slides down the birth canal like
a folded umbrella this is
referred as:
a. Duncan mechanism
b. Shultz mechanism
c. Brandt Andrews mechanism
d. Ritgen’s maneuver
159. Which of the following is not true
regarding the third stage of labor?

a. Care should be taken in the administration

of bolus of oxytocin because it can cause
hypertension
b. Signs of placental separation are
lengthening of the cord, sudden gush of blood
and sudden change in shape of the uterus
c. It ranges from the time of expulsion of
the fetus to the delivery of the placenta
d. The placenta is delivered approximately 5-
15 minutes after delivery of the baby
Situation POSTPARTUM -A
postpartum mother newly
delivered her baby per
vagina. She keeps on asking
the nurse when the basic
physiologic changes occur as
her body returns to a
prepregnant state.
SITUATION 7 - Lillian 2-
week postpartum mother is
seen in the health
center. Redness on the
left breast, and the
mother is diagnosed with
mastitis.
MASTITIS ENGORGEMENT
160. During the normal postpartum
course, when would the nurse
expect to note the fundal
assessment that will be in line
with the umbilicus?
A.Immediately after the delivery
B.4 days after the delivery
C.When the client’s bladder is
full
D.The day after the delivery
161. A postpartum patient asks nurse
adalynn when she may safely resume
sexual activity. Which of the following
information should the nurse tell the
patient on resumption of sexual
Activity?
A.In 2 to 4 weeks
B.At any time
C.After the 6-weeks physician check-up
D.When her normal menstrual period has
resumed
162.Which additional finding
confirms the diagnosis that
the patient has has mastitis?
A. Enlarged glands in the
axilla
B. Normal temperature
C. Engorged both breasts
D. Hard mass and reddened area
163. Lillian asks the nurse the cause of
this ailments. Which of the following would
the nurse explain as predisposing factors
of mastitis? (Select all that apply)
I. Milk stasis
II. Nipple trauma
III. Using alcohol in cleaning nipples
IV. Baby’s sitting position

A. II and IV
B. I and IV
C. I and II
D. II and III
164. Bailey Cheshire develops
endometritis. When planning nursing
care, which activity would be best to
advise for Bailey?
a. Walking around her room listening
to music
b. Lying supine with a cold cloth on
her forehead
c. Reading while resting in a slight
Trendelenburg position
d. Alternating between prone and supine
positions
 165. The nurse assesses the
uterine fundus of the mother.
Which part of the abdomen
will the nurse begin?
A.Symphysis pubis
B.Midline
C.Umbilicus
D.Sides of the abdomen
166. The FIRST PRIORITY nursing
intervention during the immediate
postpartum period is focused on
_____
A.Monitoring urinary output
B.Taking the vital signs every 4
hours
C.Observing postpartum hemorrhage
D.Checking level of responsiveness
167.Which assessment finding
would lead the nurse to
suspect a postpartum
hemorrhage? Blood loss of
______
A.Less than 300 ml/24 hours
B.More than 500 ml/1hour
C.Less than 200 ml/2 hours
D.More than 500 ml/ 24 hours
168. Which of the following is
caused by the markedly distended
uterus and intermittent uterine
contraction within 2 to 3 days
after birth?
A.Retained placenta
B.Uterine atony
C.Afterpains
D.Boggy uterus
169. Nurse Adalynn explains to the
mothers that early indication for
hypovolemia caused by postpartum
hemorrhage is ____
A.Increasing pulse and decreasing blood
pressure
B.Altered mental status and level of
consciousness
C. Dizziness and increasing respiratory
rate
D.Cool, clammy skin, and pale mucous
membranes
170. FOR THE WIN, The nurse
educator Adalynn reviewed the
risk factors for postpartum
hemorrhage for the Mothers .
Which of the following factors is
NOT included_____?
A.Ruptured uterus
B.Uterine atony
C.Overdistended uterus
D.Retroversion of the uterus
Thank you, May 2023 RNs!!!

TOP THE BOARD EXAM!!!

FOR THE WIN!!!