The document provides information on calculating estimated due dates (EDD) using Nagele's rule. It gives two examples of how to calculate the EDD for two pregnant women based on their last menstrual period dates. Nagele's rule involves adding 7 days to the first day of the last menstrual period, subtracting 3 months, and then adding 1 year to calculate the estimated date of confinement (EDD). The examples show applying this calculation method to determine the EDDs would be November 19, 2006 for patient A and July 11, 2007 for patient B.

1. GTPAL
GRAVIDITY =NUMBER OF TOTAL PREGNANCIES
G
TERM =TERM DELIVERIES [FULL] BIRTHS (38 WEEKS OR MORE)
T BIRTHS
PRETERM =PRETERM DELIVERIES (FROM VIABILITY UP TO 37 WEEKS)
P BIRTHS
ABORTIONS/MISCARRIAGES =ABORTIONS (BOTH SURGICAL ABORTIONS AND MISCARRIAGES)
A
LIVING =LIVING CHILDREN
L CHILDREN
A. May is 6 weeks pregnant. Her previous two pregnancies ended in a live birth at
41 weeks.
G T P A L
3 1 0 0 1
B. Susan is experiencing her fourth pregnancy. Her first pregnancy ended in a
spontaneous abortion at 8 weeks, the second resulted in the live birth of twin
boys at 38 weeks, and the third resulted in the live birth of a daughter at 34
weeks.
G T P A L
4 2 1 1 3
1. Using Nagele’s rule, calculate the expected date of delivery (EDD) for each of the
following pregnant women:
The rule estimates the expected date of delivery (EDD) (also called EDC, for estimated
date of confinement) from the first day of the woman's LMP by adding 1 year,
subtracting three months and adding seven days to that date. The result is
approximately 280 days (40 weeks) from the LMP.
Example:
LMP = 8 May 2009
+1 year = 8 May 2010
-3 months = 8 February 2010
+7 days = 15 February 2010
A. Susan had intercourse on February 12, 2006. She has not had a menstrual
period since the one that began on January 24, 2006, and ended 5 days later.
LMP = February 12, 2006
+1 year = February 12, 2007
-3 months = NOVEMBER 12, 2006
+7 days = (EDD) NOVEMBER 19, 2006

2. B. Dawn has regular 32-day cycles. Her last period began September 4, 2006 and
ended September 8, 2006.
LMP = September 4, 2006
+1 year = September 4, 2007
-3 months = July 4, 2007
+7 days = (EDD) July 11, 2007
Student Review Questions, Ricci-Kyle
Chapter 12: Nursing Management During Pregnancy
1.
MULTIPLE CHOICE
A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks
and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this
woman’s obstetric history as:
31021
*30111
21212
20111
The woman’s obstetric history would be documented as 30111, G (gravida) = 3 (current pregnancy), T (term
pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks
viability) = 1, and L (number of living children) = 1.
2.
MULTIPLE CHOICE
A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations?
Symphysis pubis
Between the symphysis and umbilicus
*At the umbilicus
Just below the ensiform cartilage
At 20 weeks’ gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks’ gestation is palpated at
the symphysis pubis. At 16 weeks’ gestation, the fundus is midway between the symphysis pubis and umbilicus. At
36 weeks’ gestation, the fundus can be palpated just below the ensiform cartilage.
3.
MULTIPLE CHOICE
The diagonal conjugate of a pregnant woman’s pelvis is measured. Which measurement would suggest a potential
problem?
*12.0 cm
12.5 cm

3. 13.0 cm
13.5 cm
The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The
diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head
occurs if it is too small.
4.
MULTIPLE CHOICE
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-
up visit every:
*4 weeks
3 weeks
2 weeks
1 week
The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks,
and then every week from 37 weeks to birth.
5.
MULTIPLE CHOICE
After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was
successful when the client states which of the following?
“I’ll do the count once a week on a morning that I’m not rushed for work.”
*“I’ll sit comfortably in a recliner or lie on my side when I do the counts.”
“I won’t expect more than three movements to happen in an hour.”
“I’ll do the counts while I’m sitting and watching my son’s basketball game.”
The client should perform the counts in a relaxed environment and a comfortable position, such as a semi-Fowler’s
or side-lying position. The woman needs to do fetal movement counts consistently, at approximately the same
time each day. A woman should report a count of less than three fetal movements in an hour. A relaxed
environment, a comfortable position, and consistency in performing the counts are important to identify changes.
6.
MULTIPLE CHOICE
A pregnant woman who is 26 weeks pregnant arrives for a follow-up visit. Which of the following assessments, in
addition to measuring fundal height and fetal heart rate, would the nurse expect to complete? Select all that apply.
*Blood pressure
*Weight
Edema

4. *Urine testing
*Blood glucose level
Up to 28 weeks’ gestation, follow-up visits involve assessment of the client’s blood pressure and weight, urine
testing for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a blood
glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks’ gestation.
7.
MULTIPLE CHOICE
The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported
immediately to her health care provider. Which of the following would the nurse include? Select all that apply.
*Headache with visual changes in the third trimester
Urinary frequency in the third trimester
*Sudden leakage of fluid during the second trimester
Nausea with vomiting during the first trimester
*Lower abdominal pain with shoulder pain in the first trimester
Backache during the second trimester
Danger signs and symptoms that need to be reported immediately include headache with visual changes and
sudden leakage of fluid in the third trimester, and lower abdominal pain accompanied by shoulder pain in the first
trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache
during the second trimester are common discomforts of pregnancy.
8.
MULTIPLE CHOICE
When providing preconception care to a client, which medication would the nurse identify as being safe to
continue during pregnancy?
Accutane
Lithium
Warfarin
*Famotidine
Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause
major birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be taken
during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during
pregnancy.
9.
MULTIPLE CHOICE
After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which
statement indicates the need for additional teaching?

5. “I’ll try to drink more fluids to help move things along.”
*“I’ll switch to chewing gum instead of using mints.”
“I’ll stay away from foods like cabbage and brussels sprouts.”
“I’ll increase my time spent on walking each day.”
Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas
build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions
should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.
10.
MULTIPLE CHOICE
When describing the role of a doula to a group of pregnant women, which of the following would the nurse
include?
The doula is a professionally trained nurse hired to provide physical and emotional support.
The doula can perform any necessary clinical procedures.
*The doula primarily focuses on providing continuous labor support.
The doula is capable of handling high-risk births and emergencies.
Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide
women and families with encouragement, emotional and physical support, and information through late
pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk
births and emergencies.
Silvestri, 3/e, ISBN 1-1460-0052-6
Chapter 018 (edited file)—"Obstetrical Assessment"
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21: Obstetrical Assessment
PRACTICE QUESTIONS
1. A client arrives at the prenatal clinic for the first prenatal assessment. The client tells the
nurse that the first day of her last menstrual period was September 19, 2007. Using Nägele’s
rule, the nurse determines the estimated date of confinement as:
1. July 26, 2008
2. June 12, 2008
3. June 26, 2008
4. July 12, 2008
Answer: 3
Rationale: Accurate use of Nägele’s rule requires that the woman have a regular 28-day
menstrual cycle. Add 7 days to the first day of the last menstrual period (LMP), subtract 3
months, and then add 1 year to that date. First day of the LMP: September 19, 2007; add 7 days:
September 26, 2007; subtract 3 months: June 26, 2007; add 1 year: June 26, 2008.
Test-Taking Strategy: Knowledge regarding the use of Nägele’s rule is required to answer this
question. Read all of the options carefully, noting the dates and years in the options, before
selecting an answer. Review Nägele’s rule if you had difficulty with this question.

6. Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 34.
2. A nurse is collecting data during an admission assessment of a client who is pregnant with
twins. The client has a healthy 5-year-old child who was delivered at 38 weeks, and tells the
nurse that she does not have a history of any type of abortion or fetal demise. The nurse would
document the GTPAL for this client as:
1. G = 3, T = 2, P = 0, A = 0, L = 1
2. G = 2, T = 0, P = 1, A = 0, L = 1
3. G = 1, T = 1, P = 1, A = 0, L = 1
4. G = 2, T= 0, P = 0, A = 0, L = 1
Answer: 2
Rationale: Pregnancy outcomes can be described with the GTPAL acronym: G=gravidity =
number of pregnancies; T=term births = number born at term (40 weeks); P=preterm births =
number born before 40 weeks’ gestation; A=abortions/miscarriages = number of
abortions/miscarriages (included in gravida if before 20 weeks’ gestation; included in para if past
20 weeks’ gestation); L=live births = number of live births or living children. Therefore, a
woman who is pregnant with twins and has a child has a gravida of 2. Because the child was
delivered at 38 weeks, the number of preterm births is 1 and number of term births is 0. The
number of abortions is 0 and number of live births is 1.
Test-Taking Strategy: Knowledge and understanding of the GTPAL acronym will direct you
to option 2. If you had difficulty answering this question, review this method of describing
pregnancy outcomes.

7. Silvestri, 3/e, ISBN 1-1460-0052-6
Chapter 018 (edited file)—"Obstetrical Assessment"
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Level of Cognitive Ability: Application
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: Wong, D., Perry, S., & Hockenberry, M. (2002). Maternal child nursing care (2nd).
St. Louis: Mosby, p. 168.
3. A nurse is collecting data during an admission assessment on a client who is pregnant with
twins. The client also has a 5-year-old child. The nurse would document which gravida and para
status on this client?
1. Gravida III, para II
2. Gravida II, para II
3. Gravida I, para I
4. Gravida II, para I
Answer: 4
Rationale: Gravida is a term that refers to a woman who is or has been pregnant, regardless of
the duration of the pregnancy. Para is a term that means the number of pregnancies that have
progressed past 20 weeks’ gestation. Parity does not reflect the number of fetuses or infants.
Option 1, 2, and 3 are incorrect based on the above definition.
Test-Taking Strategy: Knowledge of the terms gravida and para is necessary to answer this
question correctly. Review the description of these terms if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Communication and Documentation
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, pp. 33-
34.
4. A primipara is being evaluated in the clinic during her second trimester of pregnancy. Which
of the following would indicate an abnormal physical finding necessitating further testing?
1. Consistent increase in fundal height
2. Fetal heart rate of 180 beats per minute
3. Braxton Hicks contractions
4. Quickening
Answer: 2
Rationale: The fetal heart rate depends on gestational age. It is 160 to 170 beats per minute in
the first trimester and slows with fetal growth to approximately 110 or 120 to 160 beats per
minute. Options 1, 3, and 4 are normal expected findings.
Test-Taking Strategy: Use the process of elimination. Note the key words, indicates an
abnormal physical finding. Recalling the normal fetal heart rate will direct you to option 2.
Review normal assessment findings in pregnancy if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 78.

8. Silvestri, 3/e, ISBN 1-1460-0052-6
Chapter 018 (edited file)—"Obstetrical Assessment"
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5. A nurse is providing instructions to a pregnant client with genital herpes about the measures
that need to be implemented to protect the fetus. The nurse tells the client that:
1. Daily administration of acyclovir (Zovirax) is necessary during the entire pregnancy.
2. Total abstinence from sexual intercourse is necessary during the entire pregnancy.
3. Sitz baths need to be taken every 4 hours while awake if vaginal lesions are present.
4. A cesarean section will be necessary if vaginal lesions are present at the time of
labor. Answer: 4
Rationale: For women with active lesions, either recurrent or primary at the time of labor,
delivery should be by cesarean section to prevent the fetus from being in contact with the genital
herpes. The safety of acyclovir has not been established during pregnancy and should be used
only when a life-threatening infection is present. Clients should be advised to abstain from
sexual contact while the lesions are present. If this is an initial infection, they should continue to
abstain until they become culture-negative, because prolonged viral shedding may occur in such
cases. Keeping the genital area clean and dry will promote healing.
Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first because
of the absolute word “entire” in these options. From the remaining options, recalling that the
lesions should be kept clean and dry to promote healing will assist in eliminating option 3. If
you had difficulty with this question, review the content related to genital herpes as a maternal
risk factor.
Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Teaching/Learning
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 338.
6. A nurse is collecting data on a pregnant client who is at 28 weeks of gestation. The nurse
measures the fundal height in centimeters and expects the findings to be which of the following?
1. 22 cm
2. 28 cm
3. 36 cm
4. 40 cm
Answer: 2
Rationale: During the second and third trimesters (weeks 18 to 30), fundal height in centimeters
approximately equals the fetus’ age in weeks plus or minus 2 cm. At 16 weeks, the fundus can
be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the
fundus is at the umbilicus and, at 36 weeks, the fundus is at the xiphoid process.
Test-Taking Strategy: Use the process of elimination. Remember that during the second and
third trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus’
age in weeks plus or minus 2 cm. If you are unfamiliar with this data collection technique,
review this content area.
Level of Cognitive Ability: Comprehension
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
References: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 192.
Silvestri, 3/e, ISBN 1-1460-0052-6

9. Chapter 018 (edited file)—"Obstetrical Assessment"
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Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing
(3rd ed.). Philadelphia: W.B. Saunders, p. 425.
7. A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tells
the nurse that she is experiencing irregular contractions. The nurse determines that the client is
experiencing Braxton Hicks contractions. Based on this finding, which nursing action is
appropriate?
1. Instruct the client to maintain bed rest for the remainder of the pregnancy.
2. Instruct the client that these are common and may occur throughout the pregnancy.
3. Contact the physician.
4. Call the maternity unit and inform them that the client will be admitted in a
prelabor condition.
Answer: 2
Rationale: Braxton Hicks contractions are irregular, painless contractions that may occur
intermittently throughout pregnancy. Because Braxton Hicks contractions may occur and are
normal in some pregnant women during pregnancy, options 1, 3, and 4 are unnecessary and
inappropriate actions.
Test-Taking Strategy: Use the process of elimination. Options 3 and 4 are similar and can be
eliminated first. From the remaining options, knowing that Braxton Hicks contractions are
common and can occur throughout pregnancy will assist in directing you to option 2. If you had
difficulty with this question, review the physiology associated with Braxton Hicks contractions.
Level of Cognitive Ability: Application
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 83.
8. A nurse is reviewing the record of a client who has just been told that a pregnancy test is
positive. The physician has documented the presence of Goodell’s sign. The nurse determines
that this sign is indicative of:
1. A softening of the cervix
2. A soft blowing sound that corresponds to the maternal pulse while auscultating the uterus
3. The presence of human chorionic gonadotropin (hCG) in the urine
4. The presence of fetal movement
Answer: 1
Rationale: In the early weeks of pregnancy, the cervix becomes softer as a result of pelvic
vasoconstriction, which causes Goodell’s sign. Cervical softening is noted by the examiner
during pelvic examination. A soft blowing sound that corresponds to the maternal pulse may be
auscultated over the uterus and is due to blood circulation through the placenta. hCG is noted in
maternal urine in a positive urine pregnancy test. Goodell’s sign does not indicate the presence
of fetal movement.
Test-Taking Strategy: Use the process of elimination and knowledge regarding the physiological
findings in Goodell’s sign to answer this question. Remember that Goodell’s sign refers to a
softening of the cervix. If you had difficulty with this question, review the changes in the cervix
that occurs during pregnancy.
Level of Cognitive Ability: Comprehension

10. Silvestri, 3/e, ISBN 1-1460-0052-6
Chapter 018 (edited file)—"Obstetrical Assessment"
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Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing
(2nd ed.). St. Louis: Elsevier, p. 264.
9. A nursing instructor asks a nursing student to describe the process of quickening. Which of
the following statements, if made by the student, indicates an understanding of this term?
1. “It is the irregular, painless contractions that occur throughout pregnancy.”
2. “It is the soft blowing sound that can be heard when the uterus is auscultated.”
3. “It is the fetal movement that is felt by the mother.”
4. “It is the thinning of the lower uterine segment.”
Answer: 3
Rationale: Quickening is fetal movement and may occur as early as the 14th to 16th weeks of
gestation, when the expectant mother first notices subtle fetal movements that gradually increase
in intensity. A soft blowing sound that corresponds to the maternal pulse may be auscultated
over the uterus, which is known as uterine souffle. This sound is due to the blood circulation to
the placenta and corresponds to the maternal pulse. Braxton Hicks contractions are irregular,
painless contractions that may occur throughout pregnancy. A thinning of the lower uterine
segment occurs about the sixth week of pregnancy and is called Hegar’s sign.
Test-Taking Strategy: Use the process of elimination and knowledge regarding the term
quickening to answer this question. Remember that quickening is fetal movement. If you are
unfamiliar with this sign associated with pregnancy, review this content area.
Level of Cognitive Ability: Comprehension
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Content Area: Maternity/Antepartum
References: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 386.
Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing (3rd
ed.). Philadelphia: W.B. Saunders, p. 163.
10. A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus
move. The nurse responds by telling the mother that fetal movements will be noted between:
1. 6 to 8 weeks of gestation
2. 8 to 10 weeks of gestation
3. 10 to 12 weeks of gestation
4. 14 to 16 weeks of gestation
Answer: 4
Rationale: Quickening is fetal movement and may occur as early as the 14th to 16th weeks of
gestation. The expectant mother first notices subtle fetal movements during this time, which
gradually increase in intensity. Options 1, 2, and 3 are incorrect.
Test-Taking Strategy: Use the process of elimination and knowledge regarding the occurrence of
quickening. In this situation, it is best to select the option that indicates the greatest length of
gestational time. Review the process of quickening if you had difficulty with this question. Level
of Cognitive Ability: Application
Client Needs: Health Promotion and Maintenance

11. Silvestri, 3/e, ISBN 1-1460-0052-6
Chapter 018 (edited file)—"Obstetrical Assessment"
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Integrated Process: Teaching/Learning Content Area:
Maternit y/Antepartum R eference: Murra y, S ., McKinne y, E., &
Gorrie, T. (2002). Foundations of maternal-newborn nursing (3rd
ed.). Philadelphia: W.B. Saunders, p. 147.
<AQ>11. A nurse is assisting in performing an assessment on a client who suspects that she is
pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of
pregnancy.
____Uterine enlargement
____Fetal heart rate detected by a nonelectronic device
____Outline of fetus via radiography or ultrasound
____Chadwick's sign
Braxton Hicks contractions
____
Ballottement
____
Answers:
Uterine enlargement
Chadwick's sign
Braxton Hicks contractions
Ballottement
Rationale: The probable signs of pregnancy include uterine enlargement, Hegar's sign
(softening and thinning of the lower uterine segment that occurs at about week 6), Goodell's
sign (softening of the cervix that occurs at the beginning of the second month), Chadwick's sign
(bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs about
week 6), ballottement (rebounding of the fetus against the examiner's fingers on palpation),
Braxton Hicks contractions, and a positive pregnancy test measuring for human chorionic
gonadotropin (hCG). Positive signs of pregnancy include fetal heart rate detected by an
electronic device (Doppler transducer) at 8 to 12 weeks and by a nonelectronic device
(fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an
outline of the fetus via radiography or ultrasound.
Test-Taking Strategy: Focusing on the issue, probable signs of pregnancy, will assist in
answering this question. Remember that detection of the fetal heart rate and an outline of the
fetus via radiography or ultrasound are positive signs of pregnancy. Review the probable signs
of pregnancy if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn
nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 132.

12. 1. Estrogen, one of the hormones regulating cyclic activities in female reproductive system is
responsible for which effect?
a. Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be
stretched to a distance of 10-13 cm.
b. Inhibits the production of LH
c. Increases endometrial tortuosity
d. All of the above
2. Jessa, 17 years old, is bleeding between periods of less than two weeks. This condition is an
abnormality in the menstrual cycle known as:
a. Metrorrhagia
b. Menorrhagia
c. Amenorrhea
d. Dysmenorrheal
3. One factor of having a normal delivery is the size of the pelvis. Pelvis serves as the passageway for
the passenger (fetus) during childbirth. The most ideal pelvis for childbirth is:
a. Android
b. Anthropoid
c. Platypelloid
d. Gynecoid
4. An important landmark of the pelvis that determines the distance of the descent of the head is known
as:
a. Linea terminalis
b. Sacrum
c. Ischial spines
d. Ischial tuberosities
5. The permanent cessation of menstruation is:
a. Amenorrhea
b. Menopause
c. Oligomenorrhea
d. Hypomenorrhea
Situation: Mrs. Donna, pregnant for 16 weeks age of gestation (AOG), visits the health care facility for her
prenatal check-up with her only son, Mark. During assessment the client told the nurse that previously
she got pregnant twice. The first was with her only child, Mark, who was delivered at 35 weeks AOG and
the other pregnancy was terminated at about 20 weeks AOG.
6. Based on the data obtained, Mrs. Donna’s GTPAL score is:
a. 20111
b. 21111
c. 30111
d. 31111
7. Discomforts during pregnancy are discussed by the nurse to the Mrs. Donna. Which of the following,
when complained by the client would alert the nurse?
a. Easy fatigability

13. b. Nausea and vomiting
c. Edema of the lower extremities
d. Heartburn
8. Psychological and emotional responses of pregnant women differ. However, general emotional
response has been noted during pregnancy based on their gestational age. Mrs. Donna will most likely
have which emotional response towards her pregnancy?
a. Presents denial disbelief and sometimes repression.
b. Has personal identification of the baby and realistic plans for future of the child.
c. Fantasizes the appearance of the baby.
d. Verbalizes fear of death during childbirth.
9. The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heart
rate (FHR). Which of the following apparatus should the nurse use in auscultating for the FHR?
a. Doppler apparatus
b. Fetoscope
c. Ultrasound
d. Stethoscope
10. Mrs. Donna asked the nurse, when a fetal heart starts beating. The nurse correctly responded by
stating:
a. 3 weeks AOG
b. 8 weeks AOG
c. 12 weeks AOG
d. 20 weeks AOG
Situation: Mrs. Dela Cruz is in labor and is brought to the emergency room with a ruptured bag of water.
11. The nurse’s initial action once the bag of water has ruptured is:
a. Take the fetal heart tones
b. Put the client to the bed immediately
c. Perform an IE
d. Take the woman’s temperature
12. Mrs. Dela Cruz’s has contractions growing stronger which lasts for 40-60 seconds and occur
approximately every 3-5 minutes. The doctor is about to perform an IE, the nurse expects that the client’s
cervical dilatation will be:
a. 0-3 cm
b. 4-7 cm
c. 8-10 cm
d. 11-13 cm
13. The doctor informed the woman that she is on station -1. Mrs. Dela Cruz asked the nurse, what
does a station -1 means, the most appropriate response of the nurse is:
a. ―It means that engagement has already occurred.‖
b. ―The presenting part of your baby is at the entrance of the true pelvis or the largest diameter of the
presenting part into the true pelvis.‖
c. ―Your baby is still floating or ―ballotable‖
d. ―The presenting part of your baby is at the vulvar ring of your reproductive organ.‖

14. 14. The history of Mrs. Dela Cruz revealed that she is a multipara. When should the nurse transport the
client from the labor room to the delivery room?
a. When the cervical dilatation is 8 cm.
b. When the cervical dilatation is 10 cm.
c. When the cervical dilatation is 9 cm.
d. When the client feels the urge to push.
15. Monitoring contractions is very important during labor. To monitor uterine contractions, what should
the nurse do?
a. Observe for the client’s facial expression to know that the contraction has started or stopped.
b. Instruct the client take note of the duration of her contractions.
c. Offer ice chips to the woman.
d. Spread the fingers lightly over the fundus to monitor the contraction.
16. Uterine contractions can occur because of the interplay of the contractile enzyme adenosine
triphosphate and the influence some hormones. Which of the following least likely contributes to the
occurrence of uterine contractions?
a. Oxytocin
b. Estrogen
c. Prolactin
d. All of the above
17. Dysfunctional labor may be caused by which of the following?
a. Excessive or too early analgesia administration
b. Exhausted mother
c. Overdistention of the uterus
d. All of the above
18. The client’s uterine contractions are hypotonic. The nurses top priority with hypotonic contractions
during the intrapartal period is:
a. Pain relief
b. Psychological support
c. Monitoring the lochia for possible bleeding
d. Infection control
19. For a woman experiencing hypotonic contractions, what should be done initially?
a. Obtain an ultrasonic result
b. Infusion of oxytocin
c. Administration of analgesia
d. Amniotomy
20. The most important nursing consideration in a postpartal woman with a hypotonic contraction is:
a. Assessment for infection
b. Assessment for bleeding
c. Assessment for FHR
d. Assessment for woman’s coping mechanism
Situation: Bleeding during pregnancy is a serious case and should be managed immediately.

15. 21. Mrs. Diane is diagnosed with Placenta Previa. The main difference with the bleeding in placenta
previa and abruption placenta is that placenta previa has:
a. Painful bleeding
b. Rigid abdomen
c. Bright-red blood
d. Blood filled with clots
22. In caring for a client diagnosed with placenta previa, the nurse should avoid which of the following?
a. Inspecting the perineum
b. Performing a Kleihauer-Betke test
c. Performing a pelvic examination
d. All of the above
23. For the nurse to distinguish that the bleeding of the patient is placenta previa or abruption placenta
what should she ask the woman?
a. Whether there was accompanying pain
b. What she has done for bleeding
c. Estimation of blood loss
d. All of the above
24. Continued bleeding may result to fetal distress. The nurse knows that the fetus is being
compromised when she observed or note which of the following:
a. Fetal tachycardia
b. Fetal bradycardia
c. Fetal thrashing
d. All of the above
25. A woman in labor is diagnosed with abruption placenta. The nurse would expect which findings in
the client’s history that may contribute to the occurrence of the complication?
a. Age of 24 years old
b. Cigarette smoking
c. Sleeping 8 hours per night
d. Sitting for long period
1. Answer: A.
Effects of estrogen:
• Inhibits the production of FSH
• Causes hypertrophy of the myometrium
• Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be
stretched to a distance of 10-13 cm.
Effects of Progesterone
• Inhibits the production of LH
• Increases endometrial tortuosity
• Increased endometrial secretions
• Facilitates transport of the fertilized ovum through the fallopian tubes
2. Answer: A
Abnormalities of Menstruation

16. 1. Amenorrhea – absence of menstrual flow
2. Dysmenorrhea – painful menstruation
3. Oligomenorrhea – scanty menstruation
4. Menorrhagia -excessive menstrual bleeding
5. Metrorrhagia – bleeding between periods of less than 2 weeks
3. Answer: D. Gynecoid is the ―normal‖ female pelvis. The inlet is well rounded. This is the most ideal
pelvis for childbirth.
• Android – ―male‖ pelvis. Inlet has a narrow, shallow posterior portion and pointed anterior portion.
• Anthropoid – transverse diameter is narrow and anteroposterior (AP) diameter of this pelvis is larger
than normal.
• Platypelloid – inlet is oval while AP diameter of this pelvis is shallow.
4. Answer: C. Ischial spines are the point of reference in determining the station (relationship of the
fetal presenting part to the ischial spines). When the fetal head is at the level of the ischial spines the
station is zero. When it is 1 cm above the ischial spines it is -1 and if 1 cm below the ischial spines it is
+1.
5. Answer: B. The keyword here is ―permanent cessation‖. Thus, menopause is the correct answer.
Amenorrhea is a temporary cessation of menses. Oligomenorrhea is a menstruation with scanty blood
flow. Hypomenorrhea is an abnormally short duration of menstruation.
6. Answer: C.
• Gravida (G) – number of pregnancy
• Term (T) – number of full-term infants born (born at 37 weeks or after)
• Para (P) – number of preterm infants born (born before 37 weeks)
• Abortion (A) – number of spontaneous or induced abortions (pregnancy terminated before the age of
viability). Age of viability is 24 weeks.
• Living children (L) – number of living children.
• (Source: Maternal and Child Health Nursing by Adelle Pillitteri, 5th Ed. P.252)
Since Mrs Donna has two previous pregnancies and is presently pregnant (16 weeks), G is 3. Mark, her
only child was born at 35 weeks AOG which falls under the preterm category. Thus, T is zero and P is 1.
The other pregnancy was terminated at 20 weeks AOG which falls under abortion, hence A=1. Mark is
her only living child, thereby, L=1. Her GTPAL score is:
30111, G=3 T=0 P=1 A=1 L=1
7. Answer: B. Morning sickness characterized by nausea and vomiting is only noted during the FIRST
TRIMESTER of pregnancy (first 3 months). Excessive nausea and vomiting which persists more than 3
months is a condition called Hyperemesis gravidarum that requires immediate intervention to prevent
starvation and dehydration. Management for hyperemesis gravidarum includes the administration of
D5NSS 3L in 24 hours and complete bed rest.
Easy fatigability is a consequence of the physiologic anemia of pregnancy (physiologic meaning it is
normally expected during pregnancy, thus A is incorrect). Edema of the upper extremities not the lower
extremities should alert the nurse because of the possibility of toxemia, hence C is incorrect. Heartburn
during pregnancy is due to the increase progesterone which decreases gastric motility causing a reversed
peristaltic wave leading to regurgitation of the stomach contents through the cardiac sphincter into the
esophagus, causing irritation.

17. 8. Answer: C. The client is in her second trimester of pregnancy (16 weeks AOG or 4 months), thus, she
perceived the baby as a separate entity. Presenting denial and disbelief and sometime repression is the
psychological/emotional response of a pregnant woman on her first trimester. Identifying the fetus and
setting realistic plans for the child’s future is noted during the third trimester of pregnancy. It is during this
time also that the woman verbalizes fear of death.
9. Answer: A. Mrs. Donna’s gestational age is 16 weeks (4 months). During this time, the fetal heart rate
is audible with a Doppler apparatus. A fetal heart beat can be detected with a Doppler apparatus starting
at 12 weeks AOG. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. A fetal heart
beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn
Nursing by Murray and McKinney/Saunders 4th Ed.)
10. Answer: A. Fetal heart starts beating at 3 weeks AOG. The heart at this time is consisting of two
parallel tubes. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. During 12 weeks
AOG, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat is detectable with
fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and
McKinney/Saunders 4th Ed.)
11. Answer: B. The keyword is INITIAL ACTION. The important consideration before answering the
question is to take a look at the situation. SITUATION: THE WOMAN IS IN THE Emergency Room or is
seeking admission.
A woman in labor seeking admission to the hospital (in the ER) and saying that her BOW has ruptured
should BE PUT TO BED IMMEDIATELY and the fetal heart tones taken consequently. If a woman in the
Labor Room says that her membranes have ruptured, the initial nursing action is to take the fetal heart
tone.
12. Answer: B. The nurse would expect that the client’s cervical dilatation is 4-7 cm as the contraction
duration and interval is noted for clients who are in the active phase of the first stage of labor. The
maximum cervical dilatation is 10 cm, thus, letter D should be eliminated first. The first stage of labor
(stage of dilatation) is divided into three phases.
• Latent phase – 0-3 cm cervical dilatation; contractions are short and mild lasting 20-40 seconds and
occurring approximately every 5-10 minutes.
• Active phase – 4-7 cm cervical dilatation; contractions grow stronger, lasting 40-60 seconds and occur
at approximately every 3-5 minutes.
• Transition phase – 8-10 cm cervical dilatation; contractions reach their peak of intensity, occurring
every 2-3 minutes with a duration of 60-90 seconds.
13. Answer: C. Station -1 means that the fetal presenting part is above the level of the ischial spines.
Letter A is wrong because engagement is described as Station 0. Letter B is incorrect because the
statement of nurse is describing the occurrence of engagement that is again station 0. Prior to
engagement the fetus is said to be "floating" or ballottable, thus letter C is the best option. Letter D, is
describing crowning which is described as Station +3 or +4.
14. Answer: A. Multiparas are transported to the DR when the cervical dilatation is 7-8 cm because in
multiparas dilatation may proceed before effacement is completed. Effacement must occur at the end of
dilatation, however, before the fetus can be safely pushed through the cervical canal; otherwise, cervical
tearing could result. Primiparas are transported to the DR when the cervical dilatation is 9-10 cm.

18. 15. Answer: D. The nurse should spread his/her fingers lightly over the fundus to monitor the uterine
contractions.
16. Answer: C. Prolactin is the hormone that produces milk in mammary glands. Uterine contractions
can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence
some hormones and major electrolytes which are the following:
• Calcium
• Sodium
• Potassium
• Specific contractile proteins (actin and myosin)
• Epinephrine and norepinephrine
• Oxytocin
• Estrogen and progesterone
• Prostaglandins
17. Answer: D.
Dysfunctional Labor is caused by the ff:
• Inappropriate use of analgesia
• Pelvic bone contraction that has narrowed the pelvic diameter so that a client can’t pass (e.g. in a
client with rickets)
• Poor fetal position
• Extension rather then extension of the fetal head
• Overdistention of the uterus
• Cervical rigidity
• Presence of a full rectum or bladder
• Mother becoming exhausted from labor
• Primigravid status
18. Answer: D. When the contractions are hypotonic, the length of labor is increased. When the cervix
is dilated for a long period of time, both the uterus and fetus are at greater risk of infection. Hypotonic
contractions are not exceedingly painful because of their lack of intensity. Monitoring of bleeding through
evaluation of lochia is done during the postpartum period not the intrapartum period.
19. Answer: A. Initially, the nurse should obtain an ultrasonic confirmation ruling out a CPD or
cephalopelvic disproportion. Thus, A is the best answer. Oxytocin is infused after the CPD is ruled out,
because if CPD is present CS will be done. Analgesic administration will further decrease the intensity of
uterine contractions as its inappropriate use is one of the reasons why hypotonic contractions occur.
Amniotomy (artificial rupture of membrane) may be done after oxytocin is infused to speed up the labor
20. Answer: B. During the postpartum period, the uterus should be palpated and lochia should be
assessed because contractions after birth may also be hypotonic that will result to bleeding.
21. Answer: C. In placenta previa the bleeding that occurs is abrupt, painless, bright-red and sudden to
frighten a woman. With abruption placenta, the bleeding is painful, the abdomen is rigid or board-like and
the blood is dark-red or filled with clots.

19. 22. Answer: C. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy
because any agitation of the cervix when there is placenta previa may initiate massive hemorrhage,
possibly fatal to both the mother and the fetus.
The perineum should be assessed or observed or inspected for bleeding by looking over the perenial
pads. An Apt or Kleihauer-Betke test (test strip procedures) can be used to detect whether the blood is of
fetal or maternal origin.
23. Answer: A. placenta previa presents bleeding without pain whilst the bleeding in abruptio placenta is
painful.
24. Answer: D. Signs of fetal distress include: tachycardia, bradycardia, fetal thrashing and meconium-
stained amniotic fluid.
25. Answer: B. Predisposing factors for abruptio placenta:
• Advanced maternal age
• Short-umbilical cord
• Chronic hypertensive disease
• PIH
• Direct trauma
• Vasoconstriction from cocaine or cigarette use