OBSTETRICS

INSTRUCTION: SELECT THE CORRECT ANSWER FOR EACH OF THE FOLLOWING QUESTIONS.
MARK ONLY ONE ANSWER FOR EACH ITEM BY SHADING THE BOX CORRESPONDING TO THE
LETTER OF YOUR CHOICE ON THE ANSWER SHEET PROVIDED. STRICTLY NO ERASURES
ALLOWED. USE PENCIL NO. ONE ONLY.

MULTIPLE CHOICE:
1. This refers to the distance between the surfaces of the lower margin of the symphysis pubis to anterior surface of
sacral promontory.
a. True conjugate
b. Ob conjugate
c. Diagonal conjugate
d. Oblique diameter
2. The zygote is commonly implanted in what part of the uterus?
a. Fundus
b. Cervix
c. Corpus
d. Fallopian tube
3. Which of the following breast structures is responsible for milk production.
a. Acini cells
b. Nipples
c. Lactiferous gland
d. Areola
4. Fertilization occurs normally in which portion of the fallopian tube?
a. Interstitial segment
b. Ampulla
c. Infundibulum
d. Isthmus
5. The diameter which is usually the smallest measuring 10 cm or more?
a. Anteroposterior diameter
b. Diagonal conjugate
c. Transverse diameter
d. Oblique diameter
6. The ovary produces estrogen duing menstrual cycle and is eliminated by which of the following pituitary
hormones
a. FSH
b. Gonadotropin releasing hormone
c. HCG
d. LH
7. Mimi recievd her 3rd dose of TT. She asked you how ling will she be protected. Your response should be?
a. 3 years
b. 5 years
c. A lifetime 1 year
8. GnRH is released to stimulate the APG to produce LH and FSH. GnRH is regulated by?
a. Hypothalamus
b. Ovaries
c. Pineal Gland
d. PPG

9. A baby was born with AOG of 43 weeks. This newborn is classified as?
a. Premature
b. Mature
c. Term
d. Posterm
10. Which of the following Leopold’s Maneuver is performed by the midwife when she grasp the fundus of the client
to determine the fetal presentation?
a. First maneuver
b. Second maneuver
c. Third maneuver
d. Fourth maneuver
11. Uterine growth is measured in centimeters. The midwife measures the fundic height using the distance between
the fundus to the?
a. Umbilicus
b. Xyphoid process
c. Symphysis Pubis
d. Vagina
12. Sally is 24 weeks pregnant. The midwife saw Sally smoking a cigarette. Which of the following should the
midwife provide as health teaching regarding effects of cigarette smoking?
a. Smoking relieves tension for both mother and fetus
b. Vasoconstriction will affect fetal blood vessels and can cause low birth weight
c. Smoking is ok since fetal and maternal circulation is separated by the placental barrier
13. Jenny is 6 months pregnant and complains of varicosities on her legs. You should provide her teachings to avoid
certain items of clothing which includes?
a. Panty hose
b. Knee high hose
c. Flat shoes with adequate support
d. Compression stockings
14. Constipation is a discomfort during pregnancy and is best treated by?
a. Daily use of laxatives
b. Increase bulk and fluid in the diet
c. Limit excessive weight gain
d. Increase food intake
15. The relationship of the long axis of the mother and long axis of the fetus is known as?
a. Fetal lie
b. Fetal attitude
c. Fetal presentation
d. Fetal position
16. Jane has numerous signs and symptoms associated with pregnancy. Which of the following signs indicates she is
probably pregnant?
a. Amenorrhea
b. Tender breast/frequent voiding
c. Goodells sign
d. Tingling sensation on the breast
17. Jane LMP was June 6, 2018. The expected date of delivery is?
a. March 13, 2019
b. March 6, 2019
c. March 12, 2019
d. April 13, 2019
18. The midwife should instruct Jane to notify her physician immediately if she has the following symptoms?
a. Presence of chloasma
b. Swelling of face
c. Frequent urination
d. Gradual weight gain
19. Jenny was treated for syphilis during first trimester with penicillin. Which of the following complications can
occur?
a. Still born
b. Normal infant
c. Premature newborn
 d. Congenital syphilis
20. Jenny wants to get pregnant. She has a history of 28 days regular menstrual cycle. At which point in Jenny’s cycle
will mature ovum released from ovarian follicle?
a. On the 10th day
b. On the 1st day
c. On the 14th day
d. Release of ovum is unpredictable
21. The midwife determines that Jenny is on her 10th week of pregnancy. Which of the following signs of pregnancy
would the midwife expect to observe?
a. Dependent edema
b. Quickening
c. Breast tenderness
d. Fetal movement
22. Madelline, 40 weeks pregnant, calls the clinic to report that she is having labor contractions. Which of the
following signs would indicate that she is having true labor?
a. Walking ease discomforts
b. Contraction are increasing in frequency
c. She has urinary frequency
d. Discomfort is chiefly on the lower abdomen
23. Which gland is responsible for initiating the menstrual cycle?
a. APG
b. PPG
c. Ovary
d. Hypothalamus
24. In a 28 day menstrual cycle, the serum estrogen level is highest in what day?
a. 14th day
b. 13th day
c. 1st day
d. End of menstrual cycle
25. A women wants to avoid pregnancy. History reveals that she s a smoker. Which of the following forms of
contraception should be avoided?
a. IUD
b. Cervical cap
c. Oral contraceptive
d. Diaphragm

26. Cervical softening and uterine soufflé are signs of pregnancy which are classified as which of the following?
a. Presumptive sign
b. Probable sign
c. Positive sign
d. Subjective signs
27. An ultrasound which is performed during the third trimester is done for which of the following reason?
a. To evaluate fetal deformities
b. To confirm AOG
c. To determine fetal position
d. To confirm possibility of multiple gestation
28. The mother is 20 weeks pregnant. Which of the following options is appropriate in detecting fetal heart rate?
a. Doppler UTZ
b. Fetoscope
c. Stethoscope
d. Abdominal ultrasound
29. Which of the following areas would the midwife expect to observe chloasma?
a. Cheeks, forehead, nose
b. Abdomen, breast
 c. Arms, legs
d. Breast, areola, nipples
30. A pregnant women on her first trimester of pregnancy frequently experience which of the following urinary
symptoms?
a. Frequency
b. Dysuria
c. Incontinence
d. Burning sensation
31. A midwife is teaching a pregnant client how to distinguish false from true labor contractions. Which statement is
correct regarding false labor?
a. The contractions occur at regular interval
b. Pain is confined on the lower abdomen
c. Contraction intensifies overtime
d. Discomfort not relieved by walking
32. A pregnant mother on her first month of pregnancy asks the midwife on duty on when will the sex of infant can be
determined? The midwife knows that the gender can be distinguished on the?
a. 8th week of gestation
b. 12th week of gestation
c. 16th week of gestation
d. 20th week of gestation
33. All but one among the following is seen during the 8th week of gestation.
a. Arms and legs have developed
b. Organogenesis is completed
c. Present Babinski reflex
d. Discernable facial nature
34. Mother Lily is on her first trimester of pregnancy and sometimes feels ambivalent about being pregnant. The
midwife expect mother Lily to accomplish which of the following psychological task?
a. Accepting pregnancy
b. Choosing a name for the baby
c. Preparing for parenthood
d. Preparing for delivery
35. Midwife Annie expects the following emotional reaction to occur during the second trimester of pregnancy?
a. Surprise and ambivalence
b. Narcissism and introversion
c. Ambivalence and introversion
d. Fear and fantasy
36. An expecting mother asks you about the positive sign of pregnancy. Which of the following is a correct response?
a. Uterine growth
b. Fetal heart tone heard using Doppler
c. Fetal movement felt by the mother
d. Positive pregnancy test
37. A mother who is pregnant asks you the reason behind during her pregnancy. Your answer should be based on the
knowledge that?
a. The mother may suffer anemia because of poor appetite.
b. The fetus needs RBC which the mother must supply
c. The mother may have a problem in nutrition because of pica
d. The mother may have physiologic anemia due to the increase need for RBC
38. The midwife gave instructions to a pregnant mother regarding her ankle edema which occurs by the end of each
day. Which of the following statements indicates her understanding of the cause?
a. I’ll rest in a left side lying position to take pressure off my feet.
b. I’ll try to walk more to relieve my ankle edema
c. I’ll notify the doctor right away since it might be the beginning of a complication
d. I’ll decrease my salt intake since it can lead to having ankle edema.
39. The following signs and symptoms are a normal discomfort in pregnancy except?
 a. Ankle edema
b. Constipation
c. Blurring of vision
d. Nausea and vomiting
40. Emma’s prenatal teaching includes danger signs of pregnancy that need immediate referral. Which of the
following when verbalized by Emma needs further teaching?
a. Abdominal or chest pain, sudden weight gain, dyspnea
b. Ankle edema, backache, whitish vaginal discharge
c. Edema of hands and face, chest pains
d. Vaginal bleeding, sudden weight gain, fever
41. Normal menstrual cycles and ovarian function are regulated by what hormones?
a. FSH and LH
b. LH and progesterone
c. FSH and progesterone
d. Estrogen and progesterone
42. Which intervention has the highest priority when caring for a patient who is receiving blood transfusion?
a. Instruct client to notify the midwife it itching, swelling and dyspnea occurs
b. Inform the client that the BT usually takes 1 – 2 hours.
c. Document the BT of the client.
d. Assess client’s vital signs when transfusion is completed
43. You are teaching fifth and sixth grade girls about menstruation. You explain that menarche usually occurs between
ages of eleven and fourteen and that the first periods are usually irregular because
a. The endometrium is too scanty
b. The ovaries are not mature
c. The first periods are anovulatory
d. None of the above
44. Urinary pregnancy test are based on the presence of:
a. Estrogen
b. Progesterone
c. Testosterone
d. Human Chorionic Gonadotrophin
45. The pregnancy test is positive and the mother tells you she has morning sickness. You would advise her to:
a. Drink a glass of milk at bedtime
b. Eat a piece of toast or cracker before getting out of bed in the morning
c. Omit breakfast
d. A and B
46. On the second day postpartum you would normally expect the fundus to be
a. Slightly boggy and below the umbilicus
b. Firm and deviated to either the right or left
c. Firm and one to three fingerbreadths below the umbilicus
d. None of the above
47. You would consider all the following normal characteristics of an episiotomy two days postpartum except:
a. Inflammation along the suture line
b. Bruising
c. Mild edema
d. Mild tenderness
48. The most common causes of early postpartum hemorrhage are related to all the following except:
a. Uterine atony
b. Lacerations of the cervix or vagina
c. Mild edema
d. Mild tenderness
49. You instruct your patient to call her physician immediately if she has any of the following danger signs of
pregnancy except
a. Vaginal bleeding
b. Fatigue and drowsiness
 c. Blurred vision
d. Persistent headache
50. All of the following may be characteristics of preeclampsia except
a. Edema of the hands
b. Proteinuria
c. Hypertension
d. Polyuria
51. Which of the best statement regarding vaginal examinations of a pregnant woman suspected of placenta previa?
a. They should never be performed
b. They should be performed only twice during labor
c. They should be done only by the physician
d. They should be done in only a double set up situation in the operating room
52. Because of the high discomfort level during the transition phase of labor, nursing care should be directed toward:
a. Administering medications
b. Helping the client maintain control
c. Decreasing the rate of intravenous fluid
d. Having the client breathe in uniform patterns
53. A client is taking oral contraceptives. The midwife should inform the client to stop taking the contraceptive and
report to the physician immediately if she experiences.
a. Vertigo and nausea
b. Weight loss and breast pain
c. Hypotension and amenorrhea
d. Headaches and visual disturbances
54. A pregnant client is experiencing nausea and vomiting. The midwife is aware that this discomfort:
a. Is present during early pregnancy
b. Will disappear when lightening occurs
c. Is a common response to an unwanted pregnancy
d. May be related to the human chorionic gonadotropin (HCG) level
55. A primigravida complains of morning sickness. The midwife should plan to teach her to:
a. Increase her fluid intake
b. Eat three small meals a day
c. Increase the calcium in her diet
d. Avoid long periods without food
56. The client is experiencing labored and SOB as a RR of 28. The bed is currently in flat position. The best
intervention is putting the bed in?
a. Fowler’s
b. Trendelenburg
c. Semi – fowler’s
d. Reverse trendelenburg
57. Folic acid supplements are prescribed for a prenatal client. The midwife is aware that these are necessary to
prevent:
a. Phenylketonuria
b. Down syndrome
c. Neural tube defects
d. Erythroblastosis fetalis
58. The midwife understands that an ultrasound examination ordered for a pregnant client in the first trimester is used
primarily to:
a. Estimate fetal age
b. Detect hydrocephalus
c. Rule out congenital defects
d. Approximate fetal linear growth
59. A pregnant client’s blood test reveals an elevated alpha-fetoprotein (AFP). The midwife is aware that this test
result ma indicate the presence of:
a. Cystic fibrosis
b. Phenylketonuria
 c. Down syndrome
d. Neural tube defect
60. During early labor a client’s membranes rupture. Her cervix is 4 cm dilated and 50% effaced. The fluid is clear
and the fetal heart rate is stable. The midwife should anticipate
a. The second stage of labor will be prolonged
b. The delayed effacement will result in a difficult birth
c. Birth of the fetus will probably occur within the next 24 hours
d. An oxytocin infusion will be required to further stimulate labor

61. A midwife helps a client to the bathroom to void several times during the first stage of labor. This is done because
a full bladder:
a. Is often injured during labor
b. May inhibit the progress of labor
c. Jeopardize the status of the fetus
d. Predispose the client to urinary tract infection
62. As the midwife inspects the perineum of the client who has been admitted in active labor, the client suddenly
turns pale and says she feels as if she is going to faint even though she is lying flat on her back. The midwife
should:
a. Elevate her feet
b. Elevate her head
c. Turn her on her left side
d. Start oxygen via face mask
63. During a labor, a client begins to experience dizziness and tingling in her hands. The midwife instructs the client
to:
a. Pant during the next contractions
b. Hold her breath with next contraction
c. Use a fast, deep, shallow breathing pattern
d. Breath into her cupped hands on paper bag
64. A client in an active labor states “I feel all wet. I think I urinated.” The midwife should first:
a. Give a bedpan
b. Change the bed linens
c. Inspect the perineal area
d. Ausculate the fetal heart rate
65. A primigravida at term is admitted to the birthing room in active labor. Later, when the client is 8 cm dilated, she
tells the midwife that she has the urge to push. The midwife instructs her to pant blow at this time because
pushing can:
a. Prolapsed cord
b. Rupture of the uterus
c. Cause cervical edema
d. Lead to precipitous birth
66. A primipara about to be discharged with her newborn asks the midwife many questions regarding the baby’s care.
Her questions demonstrate that she has started the phase known as:
a. Let go
b. Taking in
c. Taking hold
d. Early parenting
67. The post partum client has rapid weak pulse; urine output less than 30 ml/hr, and decreased BP. The client’s skin
is cool and clammy. What complication is expected?
a. Thrombophlebitis
b. Aspiration pneumonia
c. Hypovolemic shock
d. Wound dehiscence
68. The client is ambulating for the first time after surgery. The client tells you “I feel faint”. The best action would
be?
 a. Find anyone to help
b. Return client to room immediately
c. Tell client to take rapid shallow breaths
d. Assist client to nearby chair
69. A client has an order for a stool culture. Which would be avoided?
a. Wearing gloves
b. Using sterile container
c. Refrigerating specimen
d. Sending immediately to the lab
70. A client is admitted to the hospital after receiving a radium implant for cervical cancer. The midwife takes which
of the following action in the care of the client?
a. Encourage frequent rest periods
b. Admits client to private ward
c. Encourage family to visit
d. Place the client on reverse isolation
71. A client is in extreme pain. The midwife administers a narcotic subQ to relieve pain. After SQ administration, the
midwife takes what action?
a. Tell client to exercise arm to absorb drug
b. Check name on bracelet ID card
c. Put side rails up on bed
d. Dim light of the room
72. The client requests pain medication and an IM injection was done to administer drug. After administration, the
best action is?
a. Massage injection site
b. Remove gloves
c. Washes hands
d. Place syringe on puncture resistant box.
73. A midwife is assigned to care for a client with pre eclampsia. Which of the following promotes safety?
a. Turn room lights off and draw window blinds
b. Maintain NA restrictions
c. Take VS every 4 hours
d. Encourage visits from loved ones
74. A primigravida with pregestational type I diabetes is at her fist prenatal visit. When discussing changes in insulin
needs during pregnancy and after birth, the midwife explains that based on her blood glucose level she should
expect to increase her insulin dosage between the:
a. 10th and 12th weeks of gestations
b. 18th and 22nd weeks of gestations
c. 24th and 28th weeks of gestations
d. 36th weeks of gestations and the time o birth
75. A client at her first visit to the prenatal clinic states that she has missed three menstrual periods and thinks she is
carrying twins because her abdomen is too large, but has started to have a brownish vaginal discharge. Her BP is
elevated, indicating that she may have gestational hypertension. The midwife must perform a further assessment
because client may have:
a. Renal failure
b. Placenta previa
c. H. mole
d. Abruption placentae
76. After an amniocentesis, the priority care should include:
a. Giving perineal care
b. Encouraging fluid every hour
c. Changing the abdominal dressing
d. Observe for signs of uterine contractions
77. A client who is having a difficult labor is diagnosed with cephalopelvic disproportion. The midwife should
question the medical order that states:
 a. Maintain NPO status
b. Start perineal IV of ¼ NS
c. Record fetal heart rate every 15 minutes
d. Add 10 units of oxytocin to 1000 ml of IV solution
78. The position that the midwife should encourage a client with cardiac disease to assume during labor is:
a. Supine
b. High fowler’s
c. Semi – fowler’s
d. Trendelenburg
79. When a breech presentation is suspected, the midwife should diligently observe the client for signs of:
a. Precipitate labor
b. Cord prolapsed
c. Progression of labor
d. Primary uterine inertia
80. A midwife is instructing a pregnant client regarding measures to increase iron in the diet. The midwife tells the
client to consume which food that contains the highest source of iron delivery:
a. Milk
b. Potatoes
c. Cantaloupe
d. Dark green leafy vegetables

81. When teaching a childbirth education class on infection prevention after delivery, the midwife would instruct the
woman to perform perineal care how often?
a. After each voiding or defecation
b. Every 8 hours
c. Once each day
d. When she has perineal pain

82. To prevent mastitis in the lactating woman, the midwife should instruct to do which of the following?
a. Clean the breasts daily with antibacterial soap
b. Feed the baby formula during the night hours
c. Position the infant correctly for breast-feeding
d. Wear a supportive bra with cotton straps
83. A client who is formula-feeding her infant tells the midwife, “My breasts are really getting big and sore.” The
midwife should instruct the mother in which of the following?
a. Applying warm towels to her breasts for 30 minutes four times daily
b. Taking acetaminophen (Tylenol) every 4 hours for pain
c. Using a breast pump to remove some milk from each breast
d. Wearing a snug-fitting brassiere 24 hours a day
84. Which of the following interventions would be of primary importance when providing emotional support to a
client of 30 weeks’ gestation admitted for the treatment of preeclampsia?
a. Assuring her that preeclampsia will not usually occur in future pregnancies
b. Discussing with her that there is a high probability of a healthy infant
c. Explaining the procedures and treatments associated with the plan of care
d. Suggesting that relaxation and inner calm can prevent complications
85. Which of the following patterns of weight gain is normal for a client who weighed 100 pounds before becoming
pregnant?
 a. 110 pounds by 10 weeks’ gestation
b. 112 pounds by 20 weeks’ gestation
c. 115 pounds by 30 weeks’ gestation
d. 135 pounds by 40 weeks’ gestation
86. At what point in the pregnancy would the midwife expect to administer a 1-hour, 50-gram
glucose-screening test to low to moderate risk client?
a. 12-20 weeks’ gestation
b. 24-28 weeks’ gestation
c. 34-38 weeks’ gestation
d. 8-12 weeks’ gestation
87. In which of the following clients would the midwife suspect anemia?
a. Client in her first trimester with a hemoglobin level of 12 g/dl
b. Client in her second trimester with a hemoglobin level of 11 g/dl
c. Client in her third trimester with a hemoglobin level of 8 g/dl
d. Client in her first trimester with a hemoglobin of 10.5 g/dl
88. Which of the following statements best describes hyperemesis gravidarum?
a. Severe anemia leading to electrolyte, metabolic, and nutritional imbalances in the
absence of other medical problems
b. Severe nausea and vomiting leading to electrolyte, metabolic and nutritional imbalances
in the absence of other medical problems
c. Loss of appetite and continuous vomiting that commonly results in dehydration and
ultimately decreasing maternal nutrients
d. Severe nausea and diarrhea that can cause GI irritation and possibly internal bleeding
89. A midwife has developed a plan of care for a client experiencing dystocia and includes a plan of
care. The midwife prioritizes the plan of care and selects the intervention as the highest priority?
a. Providing comfort measures
b. Monitoring the fetal heart rate
c. Changing the clients positions frequently
d. Keeping the significant others informed of the progress of the labor
90. The midwife is monitoring a post partum client in the fourth stage of labor. Which of the
following findings, if noted by the midwife will indicate the complication of laceration of the
birth canal?
a. The presence of dark red lochia
b. The saturation of more than one peripad per hour and continuous trickling of blood
c. Palpation of the uterus as firm contracted ball
d. Palpation of the uterus at the level of the umbilicus
91. Which of the following best signals early puerperal infection?
a. Temperature elevation of 38 C (100.4 F) or higher after the first 24 hours postpartum
b. Local infections of the vagina, vulva, and the perineum after the 24 hours postpartum
c. Elevated temperature, dyspnea, hypovolemia, and malaise after the first 12 hours
postpartum
d. Lower abdominal pain, inability to void, and anxiety following the first postpartum week.
92. The midwife has just admitted a client in the labor-and-delivery unit who has been diagnosed by
her physician as having DM. Which of the following measures is most appropriate for this
situation?
a. Ask the client about her most recent blood glucose level
b. Prepare oral hypoglycemic medications for administration during labor
c. Notify the neonatal intensive care unit that you will be admitting a client with DM
d. Prepare the client for cesarean delivery
93. A midwife teaches a multipara who has just delivered a large baby, what to do to maintain a
contracted uterus. The midwife recognizes that teaching has been effective when the client states:
 a. “If I start to bleed I will call for help”
b. “I will gently massage my uterus to keep it firm”
c. “If I urinate frequently, my uterus will stay contracted”
d. “I will call you every 15 min. to massage my uterus”
94. Delay in receiving immediate care among parturients is contributory to the number of maternal
deaths. One of the following delays is not included among the “Three Delays” that served as
barriers in accessing healthcare on time.
a. Delay in deciding to seek care
b. Delay in notifying the midwife for home call.
c. Delay in identifying and reaching the appropriate facility
d. Delay in receiving appropriate and adequate care at the health facility
95. Tetanus is one of the leading causes of morbidity and even mortality among pregnant mothers. If
a mother is on her 24th week of pregnancy, the midwife is aware that this mother already received
which of the following TT?
a. TT1 only
b. TT1 and TT2
c. TT1, TT2 and TT3
d. TT1 to TT4
96. During after delivery, the first post-partum visit should be conducted at?
a. 2-3 days
b. 7 days
c. 4-6 weeks
d. Not needed
97. Which of the following should be given to a pregnant mother in order to prevent neural tube
defects?
a. Ferrous sulphate
b. Folic acid
c. Vitamin A
d. Vitamin B
98. How will you classify a laboring women when her cervix 6 cm dilated?
a. Not in labor
b. Early active labor
c. Late active labor
d. Imminent labor
99. In monitor labor progress, maternal fetal and maternal condition the use of partograph is an
important tool that the midwife should use. When will the midwife start using the partograph?
a. As soon as the cervix dilates
b. When the cervix is 3 cm dilated
c. When the cervix is 4 cm dilated
d. When the cervix 5 cm dilated.
100. Jane is on her active stage of labor and wishes to eat since she haven’t eaten anything
since she was admitted. Which of the following is appropriate response of the midwife?
a. Refer the request of Jane to the doctor on duty.
b. She should not be allowed to eat anything
c. Allow her to eat and drink
d. Do not response to her question but make sure to record in the patient’s chart