NCLEX Questions on Gynecology, Obstetrics Answers and Rationale

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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
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.

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.

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.

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


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