Category Archives: Obstetrics and gynaecology

Sex education: These 4 facts about virginity will bust all myths

By: Aishwarya Chopra

There have been a lot of misconceived myths about virginity, which are accepted as the truth. It is time to bust these myths and know the real facts.

Untouched by the world of sexual experiences, there exists a unicorn land where virgin women tightly-hold onto their hymen as a mark of their character. Right? Wrong.

It’s time to shun the wrong perception that songs, movies and gossip sessions on ‘virginity-par-charcha‘ have fed us. Let’s talks virginity myths and facts in this chapter of sex education 101:

1. Your “cherry” can’t be popped! 
We all seem to have false ideas about what the hymen ( a.k.a cherry ) is. It is often assumed that the hymen is a thin membrane that goes over the vagina. After penetrative sex, this hymen is broken, which results in bleeding. Its ‘absence’ is seen to signify a lack of virginity.

All of this is FALSE! The hymen doesn’t completely cover the vagina. This thin elastic membrane sits either outside the vagina or just inside of it. So the first time you experience sexual intercourse, you aren’t popping anything but just stretching the membrane a little bit.

So, always remember ladies: the hymen isn’t a sign of your virginity. It is significantly elastic and can be penetrated without breaking–but fragile enough to be affected by intense physical activity too.

2. Stop believing in absurd virginity tests!
The hymen doesn’t disappear forever after your first sexual intercourse. In fact, it stays in the body forever. Yet, many cultures have ritualized displaying bloody sheets after a married couple gets intimate for the first time to show that the young woman was a virgin.

Yet, what really is the connection between losing one’s virginity and bleeding? According to medical professionals, many women do not experience tearing or bleeding of the hymen the first time they have sex. This myth has a negative impact on women soon to experience sex.

The fear of pain or the anticipation of bleeding makes it harder for the muscles around the opening of the vagina to be relaxed. The feelings attached to the probable pain of penetration spread through the myth are the real culprits rather than the experience itself.

3. A visit to the gynaecologist won’t affect your virginity
Going for your first gynaecologist exam often brings anxiety, yet there is also a misconception that surrounds it. Similar to tampons, gynaecological exams are there to ensure reproductive health.

Gentle inspection of the external genitals is recommended by the Ministry of Health and Family Welfare as a routine part of health care for kids and teens.

In a Pap smear test, an exam used to detect precancerous cells from the cervix, an instrument called a speculum is used to spread the walls of the stretchy hymen and vagina. However, the speculum‘s movement is wrongly considered to be an equivalent to sexual penetration–which often discourages women from taking the Pap test, leaving the potential diseases go unnoticed.

4. Your sexual partner can’t tell whether you’re a virgin or a not with certainty
If an experienced gynaecologist can’t tell if a woman has had intercourse by examining her hymen, then how on earth can your partner? On the other hand, to practice healthy sexual health it is essential to build relationships of trust with your partner. Being open with them about your sexual history can build deeper connections and keep you both healthy and happy.

Our ‘Lashman rekha’ of virginity is based on elastic scrunchies aka hymen that are built and evolve into different anatomic variations with different experiences. The intent in talking about virginity myths and facts is to shift the focus of the collective from just the status of the hymen to the entire knowledge of intimate health.

Reference:

https://www.healthshots.com/intimate-health/sexual-health/virginity-myths-and-facts/

 

Obstetrical Nursing- MCQs

1. Contains FSH to stimulate the ovaries to perform oogenesis or gametogenesis?
a. MOM               c. Syntocinon
b. Clomid            d. Methergin

2. This is given to contract uterus and remove retained secundines to prevent bleeding and infection?
a. Yutopar                                        c. Prednisone
b. Methylergonovine maleate     d. Tamoxifen

3. One of this medication counteracts oxytocin to stop preterm labor?
a. Pitocin            c. Methergin
b. Syntocinon     d. Terbutaline

4. Anti-estrogen helps suppress growth of breast tumor that is supported by estrogen?
a. Teslac             c. Nolvadex
b. Halostiten     d. Methergix

5. Helps relieve severe labor pain, best given at 6-7 cm cervical dilatation or at active phase of the 1st stage of labor?
a. Allopurinol    c. Dolfenal
b. Demerol       d. Indomethacin

6. Sim’s Hunher test is ordered after a normal semen analysis. Which two of the following results are normal?
I. 15-20 live motile sperm per hpf
II. Mucus stretches 8-10 cms per hpf
III. Less than 15 live motile sperm per hpf
IV. Mucus stretches 5-7 cms

  1. II and III
  2. I and II
  3. I and IV
  4. II and IV

7. What method of delivery is based on the theory of stimulus-response conditioning to reduce pain sensation during labor?
a. Lamaze        c. Leboyer
b. Bradley        d. Natural childbirth

8. Which of the following is not observed in Leboyer method?
a. Birth occurs in a well-lighted and quiet room
b. The cord is cut after the pulsation ceases
c. Neonate is placed immediately on the mother’s abdomen
d. Neonate is emerged in a tub of warm water

9. Jenny, a severe pre-eclamptic, has been on IV magnesium sulfate for 12 hours. Which of the following is not a sign overdose?
a. Absence of deep tendon reflexes
b. Respiration rate slower than 12 per minute
c. Urinary output less than 30 cc per hour
d. Decrease BP

10. Ritodrine hydrochloride has been infusing IV for several hours to stop Jane’s preterm labor. Since there are no contraindications for inhibiting labor and Jane is 30 weeks gestation, what other standard tocolytic therapy might the nurse use in place of ritodrine?
a. Indomethacin
b. Demerol and Vistaril IM
c. Magnesium sulfate
d. Morphine sulfate

11. Pat has a history of genital herpes during pregnancy. She is now term, in labor. Her cervical cultures for the last 2 months were negative. She delivers vaginally. The day after delivery, Pat has lesion on her labia majora. What medication can the nurse use to help alleviate the pain.
a. Acyclovir
b. T-stat (erythromycin lotion)
c. Hydrocortisone cream
d. Ampicillin

12. During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea and her skin becomes pale and clammy. The nurse’s immediate reaction is to:
a. Notify the physician
b. Elevate the client’s legs
c. Check for vaginal bleeding
d. Monitor the FHR every 3 minutes

13. A client who was admitted inactive labor has only progressed from 2-3 cm in 8 hours. She is diagnosed having hypotonic dystocia and is given oxytocin (Pitocin) to augment her contractions. The most important aspect of nursing at this time is to:
a. Monitor the FHR
b. Check the perineum for bulging
c. Time and record length of contractions
d. Preparing for an emergency ceasarian delivery

14. A client in the midphase of labor becomes very uncomfortable and asks for medication. Meperidine (Demerol) 50 mg and Phenergan 50mg are ordered. These medications:
a. Act to produce anesthesia
b. Act as preliminary anesthetics
c. Induce sleep until the time of delivery
d. Increase the client’s pain threshold, resulting in relaxation

15. Overstretching of perineal supporting tissues as a result of childbirth can bring about a rectocele. The most common symptom is:
a. Crampy abdominal pain
b. A bearing down sensation
c. Urinary stress incontinence
d. Recurrent urinary tract infection

16. During pregnancy, the uterine musculature hypertrophies and is greatly stretched as the fetus grows. This stretching:
a. By itself inhibits uterine contraction until oxytocin stimulates the birth process
b. Is prevented from stimulating uterine contraction by high levels of estrogen during late pregnancy
c. Inhibits uterine contraction along with combined inhibitory effects of estrogen and progesterone
d. Would ordinarily stimulate contraction but is prevented by high levels of progesterone during pregnancy

17. The nurse would suspect an ectopic pregnancy if the client complained of:
a. An adherent painful ovarian mass
b. Sharp lower left abdominal pain radiating to the shoulder
c. Leukorrhea and dysuria a few days after the first missed period
d. Sharp lower left or right abdominal pain radiating to the shoulder

18. When obtaining the nursing history from a client with diagnosis of ruptured tubal pregnancy, the nurse should expect the client to indicate that her symptoms of pain in the lower abdomen and vaginal bleeding started:
a. About 6th week of pregnancy
b. At the beginning of the last trimester
c. Midway through the second trimester
d. Immediately after implantation

19. A client is on magnesium sulfate therapy for severe preeclampsia. The nurse must be alert for the first sign of an excessive blood magnesium level, which is:
a. Change in level of consciousness
b. Severe persistent headache
c. Epigastric pain
d. Disappearance of the knee-jerk reflex

20. A client with preeclampsia with two preschool children is prescribed bed rest at home. To help stimulate compliance plans for the client’s care should include:
a. A suggestion to find a housekeeper
b. An explanation as to why bed rest is necessary
c. A warning of the risks involved in non-compliance
d. A contract that 4 hours of nap time will neet the requirement

21. A post partum mother with diagnosis of thrombophlebitis has been placed on Coumadin therapy. The nurse knows the client understands teaching about Coumadin when she states:
a. “If I miss a dose, I will double the next dose.”
b. “I should eat plenty of green leafy vegetables.”
c. “If my arthritis flares up again, I’ll take only 2 aspirins every 6 hours.”
d. “I will use a soft toothbrush and stop flossing my teeth.”

22. Warfarin sodium (Coumadin) is ordered for a client along with the medications listed below. Which of the following medications should the nurse question before administering the drug?
a. Ascorbic acid (Vitamin C)      c. Cimetidine
b. Secobarbital (Seconal)          d. Psyllium

23. Which nursing care measure is not appropriate for client with thrombophlebitis?
a. Careful leg massages     c. Elevating the legs
b. Elastic stockings             d. Leg exercises

24. Which of the following the postpartum mother with diagnosis of thrombophlebitis should avoid?
a. Helping the client avoid straining at stool
b. Telling the client to avoid sudden movements
c. Assisting the client to dangle on the side of the bed 3 times a day
d. Teaching the client to avoid bumping the legs against other objects

25. A client with deep vein thrombosis is started on Heparin therapy. Which nursing action is not indicated during heparin administration?
a. Having vitamin K available if bleeding occurs
b. Observing for hematoma at IV puncture site
c. Suggesting that the client use a soft bristled toothbrush
d. Using an IV control device for drug administration

26. A client has thrombophlebitis. Heparin SC q 8hrs is prescribed. Nursing interventions related to the administration of heparin include:
a. Monitoring the client’s UO
b. Checking the client’s INR before administration
c. Checking the client for ecchymosis
d. Informing the client that NSAIDS may be taken for discomfort

27. The patient who has a deep vein thrombosis has been receiving heparin sodium. Which of these findings will evidence the desired effect of heparin therapy?
a. A reduction of pedal edema
b. A rapid capillary refill after squeezing the big toe
c. An increase in blood sedimentation rate
d. An elevation of the prothrombin time

28. Which statement by the client with thrombophlebitis indicates a need for further instructions?
a. I can cross my legs at the knee but not the ankle
b. I need to elevate the foot of the bed during sleep
c. I need to avoid prolonged sitting or standing
d. I should continue to wear elastic hose for at least 6-8 weeks

29. All of the following measures may be performed when a patient with diagnosis of previa is being admitted to the labor room except:
a. Auscultating the FHT with a fetoscope
b. Performing Leopold maneuvers
c. Determined cervical dilatation
d. Checking the vaginal discharge with nitrazine paper

30. Which of these comments, if made by the woman would indicate accurate knowledge of the non stress test?
a. “I know that I can’t eat anything after midnight on the day of the test.”
b. “I hope that they can find a vein for the test. Often my veins seem to disappear.”
c. “I hope that my baby is active when I come to the clinic for the test.”
d. “I’ll have to drink about 4 glasses of water within the hour before the test.”

31. Which sign helped confirm the diagnosisof severe PIH?
a. Proteinuria +3 on reagent strip
b. Elevated BP 155/98
c. Marked edema of lower extremities (+2)
d. Deep tendon hyperreflexia (+3)

32. During labor the woman is receiving magnesium sulfate IV. It is essential the nurse have which of the following drugs available to counteract the potential adverse effect?
a. Oxytocin (Pitocin)
b. Sodium bicarbonate
c. Phenytoin sodium (Dilantin)
d. Calcium gluconate

33. Which of the following position is best indicated in woman with diagnosis of PIH?
a. Semi-fowler’s, alternating sides
b. Left lateral position
c. Supine with head elevated on a small pillow
d. Right lateral Sim’s

34. A woman with diagnosis of PIH tells the nurse that she has severe headache and asks for medication to relieve it. The nurse should:
a. Notify the physician immediately
b. Explain that headaches are common in PIH
c. Offer some tea and toast
d. Administer prescribed prn pain medications

35. Twenty-fours after delivery the woman with history of PIH has BP of 150/100mmhg. The nurse should recognize that:
a. PIH can continue for 48 hours after delivery
b. This may be precursor of chronic hypertension
c. Kidney damage has probably occurred
d. There is no longer a danger of a convulsion

36. A woman who has PIH is receiving magnesium sulfate therapy. Which of the following manifestations would the nurse expect the woman to have if the magnesium sulfate is having the desired effect?
a. Reduction in patellar reflex response from +4 to +2
b. Decreased in urine output from 100ml/hr to 50 ml/hr
c. Increase in frequency of contractions from every 5 minutes to every 3 minutes
d. Increase in respiratory rate from 12/minute to 18/minute

37. A 26 year old woman is brought to the emergency room, complaining of severe left lower quadrant pain. She tells the nurse that she performed a home pregnancy test and believes that she is 8 weeks pregnant. On the admission the patient’s v/s are: pulse 90, BP 110/70, respirations 20. a half hour later her v/s are pulse 120, BP 85/50, respirations 26. The nurse interprets the change in the patient’s v/s to mean that:
a. The patient’s pain may have increased
b. The patient may be bleeding internally
c. The patient may be frightened
d. The patient may have an infection

38. A 23 year old woman comes to the clinic at 32 weeks gestation. A diagnosis of PIH is made. The nurse performs teaching. Which of the following statements made by the patient indicates to the nurse that further teaching is required?
a. “Lying in bed on my left side is likely to increase my urinary output.”
b. “If the bed rest works. I may lose a pound of two in the next few days.”
c. “I should be sure to maintain a diet that has a good amount of protein.”
d. “I will have to keep my room darkened and not watch much television.”

39. A 30 week pregnant attending the prenatal clinic has symptoms of PIH. Which of the following findings is indicative of this condition?
a. The woman has been getting short of breath when climbing the second flight of stairs in the family’s apartment
b. The woman has a craving for salty foods lately
c. The woman has a BP of 124/80mmhg, compared with 90/60mmhg a month ago
d. The woman has gained 3 lbs (1.4kgs) during the past month

40. At 33 weeks gestation, a woman who has been treated for PIH is admitted to the hospital because her condition has not improved. She is placed on bed rest and started on magnesium sulfate therapy. Which of the following assessment is essential for the nurse to make?
a. Obtaining the woman’s weight daily
b. Assessing the woman’s abdominal circumference daily
c. Observing the woman for jaundice
d. Checking the equality of the woman’s femoral pulse

41. A patient with history of abruptio placenta bleeds continuously after delivery. A diagnosis of Couvelaire uterus is mad. The nurse should:
a. Prepare the client for a uterine examination and insertion of vaginal packing.
b. Return the client to the DR for curettage
c. Add 10U of oxytocin (Pitocin) to the IV infusion
d. Ask the client to sign consent for a hysterectomy

42. While in the recovery room a patient with history of abruptio placenta begins to hemorrhage after delivery. Which is the most likely cause of hemorrhage?
a. Her uterus was not massaged adequately
b. She developed hypofibrinogenemia, a coagulation defect
c. Her rigid abdomen resulted in atony of the uterine muscles
d. Placental fragments remained in her uterus

43. A 34 yearl old G4P2 is admitted in active labor. She complains of severe pain that does not subside between contractions and her abdomen has become rigid. A diagnosis of abruption placenta is made. The priority nursing actions for the patient is/are to prepare for a blood transfusion and:
a. Observe for changes in her v/s and skin color
b. Obtain a clean catch urine specimen for culture and sensitivity
c. Prepare a solution of calcium gluconate for IV infusion
d. Maintain her in supine position

44. A woman who is hospitalized because of abruptio placenta would be carefully monitored for which of the following complications?
a. Toxic shock syndrome
b. Pulmonary embolism
c. Cerebrovascular accident
d. Disseminated intravascular coagulation

45. In which type of high risk pregnancy would abruptio placenta most likely occur?
a. Cardiac disease                    c. Drug addiction
b. Chronic hypertension         d. Hyperthyroidism

46. The fetal monitoring strip shows an FHR deceleration occurring midway during contraction; the FHR return to baseline midway between contractions. With this type of deceleration; the nurse’s first action should be to:
a. Place the woman in trendelenburg or knee-chest position
b. Call the physician
c. Position the woman in labor on the left side
d. Stop infusion of oxytocin

47. A woman in labor with complete cervical dilatation begins pushing during contractions, the FHR drops to approximately 90 BPM and then quickly returns to the baseline when she stops pushing. This sudden change is probably the result of:
a. Maternal position
b. Decreased utero-placental perfusion
c. Fetal distress
d. Umbilical cord compression

48. The fetal monitor strips shows an FHR deceleration occurring during the increment of a contraction, reaching its lowest point at the acme of the contraction, and returning to baseline during the decrement of the contraction. This type of deceleration indicates:
a. Fetal distress
b. Uteroplacental perfusion
c. Fetal vagal nerve stimulation
d. Umbilical cord compression

49. The fetal monitor strips shows an FHR deceleration occurring during the increment of contraction, reaching its lowest point at the acme of the contraction, and returning to baseline during the decrement of the contraction. This type of deceleration indicates:
a. Maternal hypoxia                c. Fetal movement
b. Fetal lung maturity             d. Fetal well-being

50. The electric monitor tracing shows the FHR is not smooth and straight between contractions. This indicates that:
a. The monitor cannot record the FHR accurately
b. The fetus is jumpy between contractions
c. The healthy FHR has beat to beat variability and should be not smooth
d. Application of internal monitor is necessary

51. Which of the following FHR patterns would indicate to the nurse that the fetus may be experiencing distress?
a. A baseline rate of 140-150 between contractions with moderate variability.
b. Consistent heart rate accelerations that coincide with the fetal movements
c. A heart rate that slows midway during contraction and returns to baseline 30 seconds after the contraction ends
d. Gradual slowing of the heart rate that begins with the onset of the contraction and return quickly to the baseline

52. An electronic fetal monitor is attached. The fetal monitoring strip shows an FHR deceleration occurring about 30 seconds after each contraction begins and the FHR return to baseline after the contraction is over. This type of deceleration is caused by:
a. Fetal head compression
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Cardiac anomalies

53. Which one would clue the nurse to suspect pregnancy in a woman with history of diabetes mellitus since she was 10 years old and hospitalization for DKA?
a. Nausea and vomiting             c. Listless and fatigue
b. Urinary frequency                  d. Breast sensitivity

54. A woman who is 20 weeks pregnant has history IDDM. The nurse understands that her insulin dosage has been increased to her prepregnant dose and will probably be further increased as her pregnancy progresses in order to:
a. Utilize the increase caloric intake of the second half of pregnancy
b. Limit the total pregnancy weight gain to 12.5 kg (27.5 lbs)
c. Meet the increasing glucose demands of the rapidly growing fetus
d. Counteract the effects of insulin antagonists produced by the placenta

55. When discussing diet with a newly diagnosed pregnant woman who is diabetic and taking insulin, the nurse should:
a. Emphasize the normalcy of pregnancy and the fact that her prescribed pregnancy diet will be suitable
b. Explain that pregnancy increases the need for protein and calcium but that will be the only needed diet adjustment
c. Confirm that dietary and insulin needs may vary throughout the pregnancy thus requiring close follow-up
d. Instruct her to self-regulate her diet and insulin based on daily urine tests for glucose

56. The woman is 6 weeks pregnant. She has history of IDDM. Her insulin dosage has been lowered at this time because:
a. Fetal insulin crosses the immature placent and enters maternal circulation
b. Increasing fetal demands deplete maternal blood glucose levels
c. Diabetic dietary needs decrease and less insulin is required
d. Maternal glucose levels decrease in direct proportion to increased maternal metabolism

57. Before amniocentesis, the amniotic sac should be located with the aid of:
a. Ultrasonography          c. Amniography
b. X-ray photography      d. Fetoscopy

58. Physical preparation for the amniocentesis includes:
a. No solid food between the previous midnight and the time of the procedure
b. Ingestion of 8 glasses of water 2 hours before the procedure
c. An enema on the morning of the procedure
d. Emptying the bladder just before the procedure

59. The woman is admitted with diagnosis of placenta previa. She is taken to the delivery room for a double set-up examination. Nursing responsibilities include preparing the woman for regional or inhalation anesthesia and:
a. vaginal or rectal examination
b. vaginal delivery or ceasarian section
c. ceasarian section
d. hysterectomy

60. Which ultrasound finding helped confirm the diagnosis of H-mole?
a. Multiple gestation of at least 4 fetuses
b. No discernible fetal skeleton or soft parts
c. Fetal anencephaly with hydrocephalus
d. Large fetal meningomyelocele

61. After removal of H-mole by D&C, which of the following finding would indicate that it would be safe to start another pregnancy?
a. Albumin/globulin ratio of 2:1
b. Negative HCG
c. Blood urea nitrogen of 18 mg/dl
d. Negative-C reactive protein

62. Fifteen minutes after the administration of epidural anesthesia the nurse observes decelerations of the FHR midway during contractions. The nurse should first:
a. Notify the physician
b. Administer O2
c. Record the findings q 5mins
d. Assess the maternal BP

63. In the patient’s chart, the nurse notes doctor’s order of Ergonovine maleate (Ergotrate) 0.4mg 4 x a day. The primary reason for the nurse to question the order of Ergonovine maleate to the post partum with history of RHD is that Ergotrate:
a. Can be administered either by oral or IM route
b. Is rarely ordered more than 2 days with a maximum of 1 week
c. Is usually prescribed in a dosage of 0.2 mg 4 x a day
d. Is usually contraindicated for cardiac clients

64. A teenager who is 4 months pregnant verbalizes that she has herpes genitalis. She asks if her baby will have the virus. The best response by the nurse should be:
a. If treatment is started during pregnancy, her baby will probably protected
b. That is one of the few vaginal diseases that does no affect the baby before, during or after delivery
c. If she has an active infection at term, a CS will probably protect her baby
d. Her baby will be protected by vaccine that will be administered immediately after delivery

65. A woman with diagnosis of PIH is placed on bed rest. An IV of LR has been started. The nurse has started an indwelling catheter to measure urine output because:
a. Incontinence may occur if preeclampsia progresses to eclampsia
b. Some urine may be lost when voiding on a bedpan
c. UO should be measured hourly to detect increasing oliguria
d. A 24hour urine collection is needed to measure total daily protein excretion

66. Which of the following side effect of ritodrine administration that would require physician’s notification?
a. Diuresis of 100ml/hr
b. Maternal tachycardia of over 120 bpm
c. Nausea followed by projectile vomiting
d. Fetal bradycardia of 110 bpm

67. Betamethasone (Celestone) a glucocorticoid is ordered to patient with premature labor because this medication:
a. Acts as mild tranquilizer during pregnancy and will enhance uterine relaxation
b. Promotes fetal lung maturity, which can prevent respiratory distress syndrome in a premature infant
c. Is an anti-inflammatory agent and will decrease the irritability of her uterine muscles
d. Elevates maternal blood glucose levels, which could lessen hypoglycemia in the premature infant

68. Which of the following responses would a nurse expect to find in a reactive non-stress test?
a. Acceleration of the fetal heart rate with fetal movement
b. Deceleration of the FHR without fetal movement
c. No change in the FHR with fetal movement
d. No change in FHR without fetal movement

69. Which of the following symptoms would be most significant when assessing a woman who has PIH?
a. Severe headache
b. Urine output of 200ml in the last 4 hours
c. Dependent edema
d. Patellar reflex of +2

70. A woman who is at 34 weeks pregnant is experiencing a sudden painless bright red vaginal bleeding. A nurse observes a colleague taking all of the following measures with the woman. Which one would the nurse question?
a. Palpating uterine firmness
b. Performing Leopold maneuvers
c. Preparing a vaginal exam
d. Preparing a non-stress test

71. Which of the following clients would the nurse prepare for an emergency CS?
a. A woman who has prolapsed cord
b. A woman with twin gestation
c. A woman who has meconium-stained amniotic fluid
d. A woman who has a non-reactive non-stress test

Mrs. Dantes, gravida 2 para 1 is admitted to the labor unit by ambulance and deliver is imminent. She keeps bearing down and after two contractions the baby’s head is crowning.

72. The nurse should:
a. Tell her to breathe through her mouth and pant during contractions
b. Tell her to breathe through her mouth the not to bear down
c. Transfer her immediately by stretcher to the delivery room
d. Tell her to pant while supporting the perineum with the hand to prevent tearing

73. With the nest contraction Mrs. Dantes delivers a large baby boy spontaneously. The nurse’s initial action should be:
a. Ascertain the condition of the fundus
b. Establish airway for the baby
c. Quickly tie and cut the umbilical cod
d. Move mother and baby to the delivery room.

74. The physician arrives and cares for the baby and delivers the placenta. Pitocin, an oxytocic drug, is administered IM. Since Mrs. Dantes has had a precipitous delivery, it is important to observe for:
a. Bleeding
b. Sudden chilling
c. Elevation of RR
d. Respiratory insufficiency in the baby

75. If involution is progressing normally, few hours after birth the nurse should expect the fundus to be located:
a. Three cm above the umbilicus
b. At the level of the umbilicus
c. 2 cm below the umbilicus
d. 2 cm above the symphysis pubis

Mrs. Roldan was admitted to the OB ward in active labor.

76. During contraction, the nurse observes a 15-beat per minute deceleration of the FHR. The most appropriate action would be to:
a. Prepare for immediate delivery because the fetus is in distress
b. Call the physician immediately and await the orders
c. Turn Mrs. Roldan on her left side to increase venous return
d. Record this normal fetal response to contractions in the chart.

77. The patient begins to experience contractions 2-3 minutes apart that last about 45 seconds. Between contractions, the nurse records a fetal heart rate of 100 bpm. The nurse should:
a. Closely monitor maternal vital signs
b. Chart the rate as a normal response to contractions
c. Notify the physician immediately
d. Continue to monitor the fetal heart rate

78. During delivery, episiotomy was performed. When caring for the patient during the post partum period, the nurse encourages sitz bath TID for 15 mins. Sitz baths primarily aid the healing process by:
a. Softening the incision site
b. Promoting vasodilation
c. Cleansing the perineal area
d. Tightening the perineal sphincter

79. When preparing Mrs. Roldan to care for her episiotomy after discharge, the nurse should include, as a priority, instructions to:
a. Continue the Sitz bath TID if it provides comfort
b. Discontinue the sitz bath once she is at home
c. continue perineal care after toileting until healing occurs
d. avoid stair climbing for at least a few days after discharge

Mrs. Walang, a 32 year old G3P2, spontaneously delivers a 4082g baby boy in route after a brief labor.

80. The nurse should be aware that the chief hazard to a child in precipitate delivery is:
a. Brachial palsy                     c. Dislocated hip
b. Intracranial hemorrhage d. Fractured clavicle

81. Perineal laceration is a common complication of precipitate delivery. In addition to regular perineal care, Mrs. Walang’s nursing care should include:
a. Encouraging early and frequent ambulation
b. Encouraging perineal exercises to strengthen the muscles
c. Telling the client to expect slower healing
d. Providing a high protein, high roughage diet

82. Baby Walang sustained a tear in the tentorial membrane which leads to intracranial bleeding. The nurse should expect the baby to display:
a. Extreme lethargy
b. Weak, timorous cry
c. Abnormal respirations
d. Generalized purpura

83. Nursing care of Baby Walang should include:
a. Stimulating frequently to monitor level of consciousness
b. Elevating his head higher than his hips
c. Checking reflexes every 15 minutes
d. Weighing him daily before feeding

84. The nurse who has been caring for the baby decides on a plan of care for the mother as well. The plan calls for:
a. Setting up a schedule for teaching the mother how to care for her baby.
b. Discussing the matter with her in a non-threatening way
c. Showing by example how to care for the infant and satisfy her own needs
d. Supplying emotional support to the mother and encouraging her dependence.

Mercedes, age 41, is admitted to the labor and delivery unit at 4:00 pm. While taking the history, the nurse notes the following: gravida 8, para 7, 41 weeks AOG, membranes ruptures at 10:00 am that day, contractions occur every 3 minutes; strong intensity with a duration of 60seconds.

85. What nursing action would take the highest priority at this time?
a. Get blood and urine samples
b. Do perineal prep and give enema
c. Attach monitor to the client
d. Determine extent of cervical dilation

86. Mercedes has just been given epidural anesthesia. What is the most important assessment at this time?
a. Maternal blood pressure
b. Fetal heart rate
c. Maternal level of consciousness
d. Fetal position

87. Mercedes had a normal spontaneous delivery. Why would she be considered at risk for development of postpartal hemorrhage?
a. Grand multiparity
b. Premature rupture of membranes
c. Post term delivery
d. Anesthesia

Sylvia Mariano has just delivered a 10-lb girl.

88. In assessing Sylvia immediately after delivery, which of the following would the nurse most likely to find?
a. Fundus located halfway between the symphysis pubis and umbilicus, lochia rubra
b. Fundus displaced to the right and 3 cm above the umbilicus, lochia serosa
c. Fundus located at the umbilicus, lochia rubra
d. Fundus located halfway between the symphysis pubis and the umbilicus, lochia serosa

89. Sylvia is having vaginal bleeding of bright red blood that is continuously trickling from the vagina. Her fundus is firm and in the midline. What is the most likely cause of this bleeding?
a. Lacerations
b. Subinvolution
c. Uterine atony
d. Retained placental fragment

90. Which of the following conditions predispose a client to postpartal hemorrhage?
a. Twin pregnancy
b. Breech presentation
c. Premature rupture of membranes
d. Ceasarian section

91. After 24 hours, Sylvia has a temperature of 38 degrees Celsius, has voided 2,000ml since delivery, and her skin is diaphoretic. Nursing actions should include which of the following?
a. Notify the physician of the findings
b. Notify the nursery to feed the baby in the nursery, as the mother has a fever
c. Explain to Sylvia that these symptoms are very normal for a woman who has just delivered
d. Suspect a postpartal infection and isolate the mother and the newborn

92. Sylvia’s sister warned her to suspect afterpains. The nurse’s teaching is based on the knowledge that the most likely candidate for afterpains is the:
a. Primipara who is bottle-feeding
b. Grand multipara who is breast feeding twin boys
c. Primipara who delivered prematurely and who is pumping her breasts
d. Adolescent primipara who is breastfeeding

93. Sylvia is using bottlefeeding for her baby and asks when she should expect her first menses. The appropriate response would be:
a. It usually takes at least 3 months before menstruation resumes after delivery
b. “As you aren’t breastfeeding, it should occur in 4-6 weeks.”
c. Two weeks is the average time for menses to return
d. “Ask your doctor. I’m sure that after doing a pelvic exam, she can tell you.”

Sheila, 32 weeks AOG, enters the emergency room complaining of premature labor.

94. Which of the following nursing actions is appropriate when caring for Sheila?
a. Prepare for an oxytocin challenge test to determine fetal status
b. Prepare for application of an internal monitor
c. Give frequent analgesia to relieve anxiety and promote comfort
d. Discuss the potential problems and preparations being made for the infant

95. Bed rest is prescribed for Sheila primarily because:
a. It will keep the pressure of the fetus off the cervix
b. May stop the labor by decreasing uterine irritability
c. Will promote and reduce anxiety
d. Will reduce fetal activity

96. A tocolytic agent is administered to suppress her labor. Which of the following nursing actions would be most appropriate in preventing side effects from this type of drug?
a. Side lying, anitembolic stockings, adequate hydration
b. Reduction in extraneous stimuli, frequent assessment of FHT
c. Use of side rails, frequent monitoring of uterine contractions
d. Frequent monitoring of BP and pulse

97. Which of the following drugs is considered a tocolytic agent?
a. Levallorphan            c. Phenobarbital
b. Terbutaline               d. Betamethasone

98. Attempts to stop labor were unsuccessful and a baby boy was born weighing 4lb 2 oz. Which of the following observations of the baby suggest a gestational age of less than 40 weeks?
a. Small amounts of lanugo and vernix, testes descended, palmar and plantar creases
b. Parchment-like skin, no lanugo, full areola in breast
c. Upper pinna of ear well curbed with instant recoil, small amounts of lanugo, pink in color
d. Dark red skin, testes undescended with few rugae, abundant lanugo

99. Which of the following is an important difference between a premature and a term infant?
a. Owing to size, a premature infant will have a more efficient metabolic rate for heat productions and maintenance
b. In proportion to size, the premature infant will have more lanugo, and more vernix than a full-term infant
c. GI motility is decreased in preterm infant. Stools may be infrequent resulting in abdominal distention
d. Heat production is low in premature infant because of the greater boy surface related to weight and lack of subcutaneous fat

Situation: Susan delivered her first child, a boy, 24 hours ago. She had a normal vaginal delivery with midline episiotomy and is breast feeding.

100. Instructions to Susan regarding care of the perineal area should include which of the following?
a. Separate the labia while cleansing
b. Cleanse the perineum with soap and water after elimination
c. Pour sterile water over the perineum after elimination
d. Perform perineal care only if an episiotomy is performed

Abortion

Ending of pregnancy, either spontaneous (miscarriage) or induced (termination of pregnancy) before 22 weeks LMP.

In countries where termination of pregnancy is legally restricted, induced abortions are often performed under poor conditions (non-sterile equipment, inappropriate equipment and/or substances, unqualified health care personnel, etc.). Complications (trauma, bleeding and severe infection) are common and may be life-threatening.

https://static.timesofisrael.com/atlantajewishtimes/uploads/2019/06/fetal-development.jpg

Diagnosis

Signs and symptoms

– Threatened abortion or missed abortion: light bleeding, abdominal pain, closed cervix.

– Incomplete abortion: more or less severe bleeding, abdominal pain, uterine contractions, expulsion of products of conception, open cervix.

– Trauma to the vagina or cervix or the presence of a foreign bodies are strongly suggestive of unsafe abortion. Look for complications, especially infection.

Additional investigations

– A pregnancy test is useful if the history and clinical examination are inconclusive.

– Ultrasound is useful for confirming failed pregnancy or the presence of retained products of conception after incomplete abortion.

Differential diagnosis

The main differential diagnoses are: ectopic pregnancy, cervicitis, ectropion (eversion of the cervical mucosa, which is more fragile and may bleed easily on contact, especially after a vaginal examination or sexual intercourse), cervical polyp, and functional uterine bleeding.

Management

Threatened abortion

– Advise the patient to reduce activity. Either the threat of abortion recedes, or abortion is inevitable.

– Look for a possible infectious cause (malaria or sexually transmitted infection) and treat it.

– Treat pain according to severity.

Missed abortion

If there are no signs of infection and/or no heavy bleeding, there is no urgency to perform uterine evacuation.

– Before 13 weeks LMP

Uterine evacuation can be performed by:

  • medication: misoprostol 600 micrograms sublingually or 800 micrograms vaginally (in the posterior fornix). Bleeding and cramping can be expected to start within 3 hours. If expulsion has not started within 3 hours, administer additional doses of misoprostol every 3 hours; max. 3 doses in total.

or

  • manual vacuum aspiration.

– Between 13 and 22 weeks LMP

mifepristone PO: 200 mg single dose, and 1 to 2 day later, misoprostol 400 micrograms sublingually

or intravaginally (into the posterior fornix), every 4 to 6 hours until labour starts, to be repeated if necessary the following day

or

misoprostol alone 400 micrograms sublingually or intravaginally (into the posterior fornix), every 4 to 6 hours until labour starts, to be repeated if necessary the following day

In case of 2 or more previous uterine scars or grand multiparity or overdistention of the uterus:

  • Preferably use the combined regimen mifepristone + misoprostol, as fewer numbers of misoprostol doses are required.
  • Reduce the dose of misoprostol to 200 micrograms every 6 hours.
  • Closely monitor the mother for possible signs of impending rupture (heart rate, blood pressure, uterine contractions, pain).

Ongoing or incomplete abortion without signs of infection

General measures

– Measure heart rate, blood pressure, temperature; assess severity of bleeding.

– In the event of heavy bleeding:

  • insert an IV line (16-18G catheter) and administer Ringer lactate;
  • closely monitor heart rate, blood pressure, bleeding;
  • prepare for a possible transfusion: determine the patient’s blood type, select potential donors or ensure that blood is available. If transfusion is necessary, only use blood that has been screened (HIV-1, HIV-2, hepatitis B, hepatitis C, syphilis, and malaria in endemic areas).

– Treat pain according to severity.

– Remove products of conception from the vagina and cervix, if present.

– Look for a cause (e.g. malaria or sexually transmitted infections) and treat it.

– Afterwards, provide iron + folic acid supplementation or, in the event of severe anaemia, a blood transfusion.

Uterine evacuation

– Before 13 weeks LMP

Uterine evacuation is usually required due to retained products of conception, which can cause bleeding and infection. There are 2 options:

  • Instrumental evacuation: manual vacuum aspiration or, if not available, instrumental curettage. Aspiration under local anaesthesia is the method of choice. It is technically easier to perform, less traumatic and less painful than curettage.
  • Medication: misoprostol 400 micrograms sublingually or 600 micrograms PO single dose

– Between 13 and 22 weeks LMP

  • Instrumental evacuation in case of haemorrhage: manual vacuum aspiration or instrumental curettage or digital curettage.
  • Medication: misoprostol 400 micrograms sublingually every 3 hours until expulsion. In the absence of expulsion after 3 additional doses, consider instrumental evacuation.

In case of 2 or more previous uterine scars or grand multiparity or overdistention of the uterus: same precautions as for missed abortion (see above).

Septic abortion

In the event of septic abortion (fever, abdominal pain, tender uterus, foul-smelling discharge), as above

AND:

– Remove foreign bodies from the vagina and cervix, if present; clean wounds.

– Perform uterine evacuation as soon as possible, irrespective of gestational age.

– Administer antibiotherapy as soon as possible:

amoxicillin/clavulanic acid IV (dose expressed in amoxicillin): 1 g every 8 hours + gentamicin IM: 5 mg/kg once daily

or

ampicillin IV: 2 g every 8 hours + metronidazole IV: 500 mg every 8 hours + gentamicin IM: 5 mg/kg once daily

Continue until the fever disappears (at least 48 hours), then change to:

amoxicillin/clavulanic acid PO (dose expressed in amoxicillin) to complete 5 days of treatment

Ratio 8:1: 3000 mg daily (= 2 tablets of 500/62.5 mg 3 times daily)

Ratio 7:1: 2625 mg daily (= 1 tablet of 875/125 mg 3 times daily)

or

amoxicillin PO: 1 g 3 times daily + metronidazole PO: 500 mg 3 times daily, to complete 5 days of treatment

For very severe infection (infected perforated uterus or peritonitis), treat for 10 days.

– Check and/or update tetanus immunisation (Table 2.1).

Table – Tetanus prophylaxis

Immunisation status Spontaneous abortion Unsafe abortion, with wound or foreign bodies
Not immunised
or
Immunisation status unknown
Begin immunisation against tetanus Begin immunisation against  tetanus
+
Human tetanus immune globulin
Incompletely immunised Tetanus booster Tetanus booster 
+
Human tetanus immune globulin
Fully immunised Last booster dose:
< 5 years No prophylaxis No prophylaxis
5 to 10 years No prophylaxis Tetanus booster
> 10 years Tetanus booster Tetanus booster
+
Human tetanus immune globulin

 

Virginity, Difference between True Virgin and False Virgin

Virginity

  • Also known as Virgo Intacta.
  • Definition: Virgin is a female who has not experienced sexual intercourse.

Signs of virginity :

  1. Extra genital signs (in breast)
  2. Genital signs

Difference between Virginity and Defloration

features virginity Defloration
1.Basic difference No experience of sexual intercourse Have experience of sexual intercourse
2.hymen Intact Torn except in false virgin
3.introitus Does not admit more than tip of little finger, it is painful May admit 2 fingers , it is painless
4.vagina. Marked rugosity on wall

Full length of a finger cannot be admitted

Rugosity diminishes

Full length of finger can be admitted

5.Fossa navicularis Less conspicuous More conspicuous after sexual intercourse
6.Fourchette Intact Healed tear
7.Labia minora Smaller pinkish, covered with majora enlarged, pigmented, not covered
8.Labia majora Thick, fleshy, both majora are in close apposition Less fleshy, not in full apposition
9.Breasts Smaller, firm, pinkish smaller areola, and small nipple Larger, flabby, pendulous, wider areola, large and raised nipple

Other conditions which may affect signs of virginity 

  • Trauma or Accident
  • Surgical operation or Gynaecological examination
  • Sanitary tampons
  • Foreign body – sola pith (APTAE VARIS)
  • Scratching due to irritation from uncleaniness
  • Masturbation
  • Ulceration – d/t diphtheria , fungus, etc. 

False Virgins

  • Hymen is intact but the woman has had sexual intercourse.

Difference between True Virgin and False Virgin

Point of  difference

True virgin

False virgin

1.Basic difference The woman has no experience of sexual intercourse Has experience of sexual intercourse
2.Hymen Not ruptured. It is thin flap of tissue of regular shape and appearance Not ruptured. It is thick , fleshy or fibrous elastic with folds
3.Introitus Does not admit more than the tip of little finger, it is painful May admit 2 fingers, it is not painful
4.Vagina. Marked rugosity on wall

Full length of a finger cannot be admitted

Rugosity diminishes

Full length of finger can be admitted

5.Fossa navicularis Less conspicuous More conspicuous after sexual intercourse
6.Fourchette Intact Healed tear
7.Labia minora Smaller pinkish, covered with majora enlarged, pigmented, not covered
8.Labia majora Thick, fleshy, both majora are in close apposition Less fleshy, not in full apposition
9.Breasts Smaller, firm, pinkish smaller areola and small nipple Larger, flabby,  pendulous, wider areola,  large and raised nipple