Obstetrics and Gynecological Nursing Department Course Codes (301- Nursing)

Reproductive Health Nursing

Final Exam for 3rd Year Students

Date: 25 / 12 /2017 time allowed: 3 hours total marks: 80

Important instruction for all students: please read carefully

Allocated time 3 hours

Total allocated marks (80 marks)

Number of papers 10

Numbers of questions (6 questions )

How to answer Choose the correct answer for MCQ, true/ false,

matching & write the answers for the questions below

(Incomplete , Essay & Situation)

Attention All questions are to be answered

‫ امتحان الشفوى سوف يعقد فى نفس اليوم عقب االنتهاء من االمتحان التحريرى بالدور‬: ‫ملحوظة هامة‬
‫الثالث بقسم تمريض صحة المرآة و التوليد‬

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I.Choose the best answer: Marks (25)

1- The ovaries: corresponding to the ………….in male

a. prostate
b. tests
c. Penis
d. vagina
2- The length of the Posterior vaginal wall is … …………

a. 7.5cm
b. 10cm
c -12cm
d- 8cm
3- During which of the following phase of the menstrual cycle is it ideal for
implantation of a fertilized egg to occur?
a. Ischemic phase

b. Menstrual phase

c. Proliferative phase

d. Secretory phase

4-Which of the following is derived from mesoderm?

a. lining of the GI tract
b. liver
c. brain
d. skeletal system
5-Pregnancy effects on the physiology of the kidney include the following
except:

a. There is a 40 per cent increase in renal plasma flow rate

[Link] is an increase in glomerular filtration rate(GFR)
c. The urea and creatinine are higher than in the non – pregnant state.
[Link] kidneys increase in size.
6-The nurse is caring for a client who is 24 weeks pregnant. The client tells the
nurse that she has been secreting colostrum for the past few days. The nurse
should instruct the client that colostrum secretion

a. Does not normally occur until delivery of the baby

b. May be indicative of a problem with the breasts
c. Is normal for some women in the second and third trimesters

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 d. May be indicative of preterm labor ensuing
7-One cardiac change that commonly occurs in a pregnant client is

a. An increase in maternal blood volume by 40% to 50%

b. A decrease in plasma volume by 20%
c. Physiologic hypertension that stabilizes by 24 weeks' gestation
d. A decrease in the heart rate of the client.
8- In threatened abortion, the size of uterus
a. Smaller than expected.
b. Larger than expected.
c. Corresponds to duration of amenorrhea.
d. None of the above.
9- A32 year old gravida 3 para 0 at 13 weeks gestation presents to the emergency
room with profuse vaginal bleeding after coitus. She also has mild abdominal
cramps. Examination shows soft abdomen and the cervical os to be more than 2
cm in diameter and the presence of clots and tissues in the vaginal vault. U/S
shows products of conception still present in the uterus. The most probable
diagnosis in this case is:
a. Inevitable abortion
b. Threatened abortion
c. Incomplete abortion
d. Placental abruption
10-Conservative treatment of placenta previa indicated in all of them except:

a. Delayed termination of pregnancy till (37- 38th w).

b. Indicated in presentations after the 37th week
c. If baby is alive, small amount of bleeding
d. Patient not in labor.
11-A 35-year-old gravida 3, para 2 woman who is 38 weeks pregnant presents to
the emergency department (ED) with painless, bright red vaginal bleeding that
started 2 hours ago. The bleeding has now stopped. Her vital signs are stable. Past
medical history is significant for 2 prior cesarean sections. Which of the following
is contraindicated in the acute management of this patient?

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 a. Digital pelvic examination
b. Fetal cardio-tocography
c. Intravenous (IV) access
d. Trans-vaginal or trans-abdominal ultrasound
12- A pregnant women suffering from heart disease gets breathless and excessive
fatigue on doing ordinary activity but is comfortable at rest. Her cardiac
function status is

a. Class 1
b. Class 2
c. Class3
d. Class 4
13- Which of the following contraceptive method is contraindicated in a woman
with heart disease?

a. Combined Oral Contraceptive Pills

b. Intra Uterine Device
c. Diaphragm
d. condom
14-The most common type of anemia during pregnancy is due to which of the
following:

a. Iron deficiency.
b. Folic acid deficiency.
c. Sickle cell anemia
d- Hemolytic anemia.
15-All the following are physiological method of family planning all except:

a. Lactation amenorrhea method

b. Fertility awareness method

c. Female condom

d. Coital interruption method

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16- All the following are mode of action of IUCD except:

a- Act as mechanical barriers preventing ovum implantation in the

endometrium
b- Increase uterine and tubal motility
c- It can initiate sterile inflammatory reaction
d- Decrease endometrial prostaglandin
17-Which of the following indication of IUCD :

a. Previous ectopic pregnancy

b. Malignant diseases
c. Severe anemia
d. None of the above
18- When developing a plan of care for a client newly diagnosed with gestational
diabetes, which of the following instructions would be the priority?

a. Dietary intake b. Medication

c. Exercise d. Glucose monitoring

19-The standard test for diagnosis of diabetes mellitus is

a. Glucose tolerance test

b. Glucose challenge test
c. Fasting blood sugar
d. Glycosylated hemoglobin A1c

20- All of the following risk factors of diabetes mellitus except:

a. Obesity
b. Polyhydrominos.
c. Mother over 45 years of age and less than 20years
d. primipara
21- On which of the postpartum days can the client expect lochia serosa
a. Days 3 to 4 postpartum
b. Days 3 to 10 postpartum
c. Days 10-14 postpartum
d. Days 14 to 42 postpartum

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22-Which type of milk is present in the breasts 7 to 10 days PP?

a. Colostrum b- hind milk

c- Mature milk d- Transitional milk

23- A Postpartum nurse is providing instructions to a woman after delivery

of a healthy newborn infant the nurse instructs the mother that she should
expect normal bowel elimination to return

a. One the day of the delivery

b. 3days Postpartum

c. 7days Postpartum

d. Within 2weeks Postpartum

24-The nurse is assessing the lochia on a 1 day postpartum women. The nurse
notes that the lochia is red and has a foul-smelling odor. The nurse determines
that this assessment finding is:

a. Normal
b. Indicates the presence of infection
c. Indicates the need for increasing oral fluids
d. Indicates the need for increasing ambulation
25- Which of the following complications may be indicated by continuous seepage
of blood from the vagina of a postpartum woman, when palpation of the uterus
reveals a firm uterus 1 cm below the umbilicus?

a. Retained placental fragments

b. Urinary tract infection

c. Cervical laceration

d. Uterine atony

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II . Circle (T) if the statement is true, (F) if the statement is false

Marks (10)

1- Mitosis is the process by which the cells replicate T F

2- Oogenesis is cyclical T F

3- The ovary is under the influence of FSH in the secretory phase T F

4- Ovulation always occurs in the early menstrual cycle and around T F

menopause.
5- Lung capacity increase during pregnancy T F

6- Pain is the first sign in ectopic pregnancy T F

7- Neonatal hypobilirubinemia is fetal complication of diabetes Mellitus T F

8- Genital prolapse is defined as descent of one or more of the genital T F

organs above their normal position.
9- If the front wall of the vagina is prolapsing below the bladder is called T F
Cystocele
10- Infertility is absolute condition T F

1 2 3 4 5 6 7 8 9 10

T T F F F T F F T F

III. Match of the following: Marks (10)

Column (A) Column (B)

1- occipital posterior position A- Abruptio placenta

2- face presentation B-Uterine contractions felt during bimanual
examination , early in pregnancy
3- Ectopic pregnancies are C-Vertex presentation with fetal back posteriorly
commonly called

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 4- Premature separation of normally D-The head down position the head hyperextend
situated placenta
5-Effacement E- Uterine contractions detected during abdominal
examination , late in pregnancy
6-Vesicular mole F-Is shortening of uterine muscle that persists after
a contraction
7- palmer's sign G-"tubal pregnancies
8- Braxton hick's contractions H-The first sensation of the fetal movement
9- Retraction I- Taking up of the cervix.
10-Quickening J- It is a benign neoplasm of the chorionic villi

1 2 3 4 5 6 7 8 9 10

C D G A I J B E F H

IV. Complete the following: Marks (10)

1-Perineum extends from fourchette anteriorly to …anus……posteriorly

2-Types of decidua 1-Deciduas basalis.2- Deciduas capsularis.3 -Deciduas Vera

3-- Cardinal symptom of placenta previa is1- painless2- causeless 3- recurrent 2nd
or 3rd trimester vaginal bleeding

4- Risk factor of preeclampsia

1. age: very young or very old

2. parity: primigravida specially the elderly

3. chronic hypertension

4. chronic nephritis

5. Uterine over distension: DM, polyhydraminos, multiple pregnancies, vesicular mole.

6. Fetal hydrops: fetus characterized by generalized edema, pleural effusion and ascites.

7. obesity: (overweight)

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 8. Low socioeconomic standard and malnutrition: deficient protein, multivitamins and
minerals (calcium and magnesium) intake.

[Link] history of pre-eclampsia

5 - Types of breech presentation

1. Frank breech (extended knees, flexed hips). It occurs in 65%.
2. - Incomplete or flooting breech (extended knees, extended hips)it occurs in 25% of
breech presentation.
[Link] breech (flexed knees, flexed hips). It occurs in 10% of breech presentation.

6- Etiology of primary postpartum hemorrhage 1 Uterine atony

2. Retained placental tissue 3. Obstetric laceration.4- Coagulation

Defects

7-Types of infertility are Primary infertility and Secondary infertility

V. Essay Marks (10)

1. List effect of anemia on pregnancy?

Mother Fetus

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 Antenatal: In antenatal:
●preterm labor – abortion. ●IU hypoxia.
●Ant partum hemorrhage. ●Impaired uteroplacental
●infection. oxygen.
●placental separation and ●Growth retardation.
bleeding. *In labor:
●Tires easily. ●Stillbirth.
●Cardiac failure in severe ●Prematurity
anemia.
* Postnatal:
●postpartum hemorrhage.
●Infection.

2-Role of nurse in family planning methods?

Counseling through GATHER

G: greet client-1

A: ask about family planning needs-2

T: tell client about different methods-3

H: help client to select-4

E: explain how to use the methods-5

6-R: return for follow up

3-Differentiate between infertility and sterility?

Infertility: inability to conceive due to (curable) cause as tubal adhesion ,habitual

abortion
*Sterility: inability to conceive due to (incurable) cause as absent uterus,tubal ligation
4-Discuss prevention of puerperal sepsis?

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Antepartum:

• Correction of predisposing factors: Malnutrition (anemia) infections

(respiratory, urinary, or genital).

• Treatment of any septic focus located in teeth, gums, tonsils, middle

ear or skin.

• Health education on personal hygiene

• Avoid contact with persons having communicable diseases.

Intrapartum:

• Follow strict asepsis during conduct of labor.

• Isolate women with infection.

• Minimize vaginal examinations.

• Preserve membranes as long as possible.

• Repair lacerations of genital tract promptly.

• Replace excess blood loss to improve general body resistance.

• Prophylactic antibiotics in premature rupture of membranes,

prolonged labor and operative delivery.

Postpartum:

• Follow strict asepsis while caring for the perineal wound.

• Avoid too many visitors.

• Frequent changing of sanitary pads.

• Swab vulva and perineum using antiseptic solution after each

voiding or defecation.

• Maintain proper environmental sanitation.

VI. Answer the following situation: Marks (15)

A 26 year old G1 P0 woman at 39 weeks gestation is admitted to the hospital in

labor she is noted to have uterine contraction every 2 to 3 minutes. On vaginal

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examination she has been noted to have a change in cervical examinations from
4cm dilation to 5cm over the last 2 hours

1- Differentiate between false and true uterine contraction?

True Versus False Labor

False Labor (Braxton-Hicks

Type of Change True Labor contractions)

Timing of Are regular and, as time goes on, Often are irregular and do not
contractions get closer together consistently get closer together

Change with Contractions continue, despite Contractions may stop when you
movement movement walk or rest, or may even stop
with a change of position

Location of Usually felt in the back and Often felt in the abdomen
contractions move around to the front, but
may be felt in the front first

Strength of Increase in strength steadily Usually weak and do not get

contractions much stronger

2- List characteristics of normal labor?

It is the spontaneous expulsion of single mature living fetus, presenting

by the vertex, through the natural birth canal within a reasonable time
(more than three hours and less than sixteen hours) without assistance and
without complications to the mother or the fetus.

3- Rearrange mechanism of normal labor?

1) Engagement 2) Descent 3) Flexion

4) Internal rotation 5) crowning 6) extension

7) Restitution 8) external rotation 9) Delivery of the Shoulders

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4-Discuss nursing care should be provided for parturient during first stage of
labor?

The preparation of the mother for the process of parturition begins well before the onset of
labor. It is important for the mother and her partner to understand what actually happens
during the various stages of labour.

* The first stage of labour is all waiting, coping with pain and hoping one gets there soon.

* If the mother is in early labour, the nurse should encourageher to take a shower and to
empty her bowels and bladder.

* Trimming of the pubic hair is no longer considered necessary unless there is a likelihood of
delivery by caesarean section.

* The nurse should advise the mother to come into hospital, when contractions are at regular
10–15 minute intervals, when there is a show and when the membranes rupture.

* Delayed gastric emptying may result in vomiting and inhalation of vomitus if general
anesthesia for operative delivery is needed.

* Giving some fluids and light nutrition orally if labor is progressing normally and a vaginal
delivery can be anticipated.

* Intravenous fluid replacement should be considered after 6 hours in labour if delivery is not
imminent. (The major cause of acidosis and ketosis is dehydration).

* If delivery is not imminent at the end of 6 hours, an intravenous infusion should be

commenced with the alternative administration of normal saline 500 ml alternating with 500
ml of Hartmann’s solution, the total not exceeding 1500 ml in 12 hours.

* Pain-relieving drugs can be used to supplement the mother’s own efforts.

* Proper preparation and psychological support.

* Inhalational agents are often used too late such as oxygen (50%). They can be highly
effective and appear safe for mother and baby.

On admission, the nurse should perform the following examination:

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*Examination for general condition, including temperature, pulse, respiration, blood
pressure and state of hydration; the urine should be tested for glucose, ketone bodies and
protein.

* Woman is allowed to walk during the early first stage particularly with intact membranes.

*Ask her to micturate every 2-3 hours, if she cannot use a catheter. It prevents uterine inertia
and helps descent of the presenting part.

* If rest is needed lies on her left lateral position to prevent inferior vena cava compression
and hence placental insufficiency and foetal distress.

*Examination for the abdomen includes obstetrical examination:

As inspection, palpation and auscultation to determine the fetal lie, presentation and position,
and the station of the presenting part, as well as to determine the presence of a fetal heartbeat

*Examination for the Vagina: should be performedonly after cleansing of the vulva and
introitus and using an aseptic technique with sterile gloves and an antiseptic cream. Once the
examination is started, the fingers should not be withdrawn from the vagina until the
examination is completed.

The nurse should observe the following:

• The consistency, effacement and dilatation of the cervix.

• Whether the membranes are intact or ruptured and, if ruptured, the color of the amniotic
fluid.

• The nature and presentation of the presenting part and its relationship to the level of the
ischial spines.

• Observation of the women in the first stage of labor by the use of the partogram:

Good Luck
With Best Wishes
Obstetrics and Women’s Health Nursing Department

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 Prepared BY

Staff Members of Obstetrics and Gynecological Nursing Department

Faculty of Nursing
Benha University

DR. Amel Ahmed Hassan. Professor of Obstetrics and Gynecological Nursing & vice
Dean of Postgraduate studies & research

Dr. Soad Abd Elsalam Ass. Prof. &Chairman of Department of Obstetrics and
Gynecological Nursing

Dr. Azeza Ibrahim Ass. Prof of Obstetrics and Gynecological Nursing

Dr. Hend Abdalla Ass. Prof of Obstetrics and Gynecological Nursing

Dr. Rehab Abd Elhady Lecturer of Obstetrics and Gynecological Nursing

Dr. Eman Mohammed Abdelhakam Lecturer of Obstetrics and Gynecological

Nursing

[Link] Ouda Abd Elmoniem Lecturer of Obstetrics and Gynecological Nursing

[Link] Abd Elhaleem Lecturer of Obstetrics and Gynecological Nursing

[Link] Emam Lecturer of Obstetrics and Gynecological Nursing

Dr. Amira Refat Lecturer of Obstetrics and Gynecological Nursing

Dr. Hemmat Mostafa Lecturer of Obstetrics and Gynecological Nursing

Dr. Rehab Soliman Lecturer of Obstetrics and Gynecological Nursing

Dr. Amira salama Lecturer

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