Name: Date:

Test I. Multiple choice.

1. While attending a basketball game , woman who is nine months pregnant goes into labor an delivers her baby
with in 5 mins. What is the most appropriate course of action for the midwife to take?
a. Place the naked body on the mothers bare chest ,cover both and encourage breast feeding
b. Tie the cord with shoelace and cut the cod with a penknife
c. Have mother’s friend hold the baby until an ambulance arrives
d. Ask people to clear so more air can circulate around mother
2. A woman is 4 cm dilated and wants to walk around the labor and delivery midwife unit. Which of the following
criteria will help the midwife determine whether she should walk
a. Whether her membranes are intact c. The fetal station
b. Her contraction frequency d. The fetal position
3. The midwife is caring for woman in labor. The woman is irritable, complains of nausea and vomits, and has
heavier show, the membranes ruptured. The midwife understands that his indicate that:
a. The woman is having a complication and the doctor should be notified
b. The woman is in transition stage of labor
c. Labor is lowing down and the woman may need oxytocin
d. The woman is emotionally distraught and needs assistance in dealing
4. Two hours after delivery, the midwife finds that the woman’s fundus is firm, shifted to the right, and two fingers
above the umbilicus, this would indicate
a. A full bladder b. retained placenta c. impending bleeding d. all of these
5. After delivery, when checking her vital signs, the midwife should normally find
a. Tachycardia c. Slight lowering basal temp
b. An elevated basal temp d. Bradycardia with no change in respiration
6. 8 hrs after delivery the midwife notices that she is voiding frequently in small amounts. Intake and output are
important in the early postpartum period, since small amounts of output,
a. Are commonly voided and should cause no alarm c. indicative of glumeronephritis
b. May indicate urine retention with overflow d. common bec less fluid is excreted postdelivery
7. A woman begins labor close to her EDD and is admitted. The midwife notices a gush of fluid from the client’s
vagina. after checking the FHR the midwife should
a. Notify physician immediately c. inspect the perineum
b. Keep client flat on bed d. monitor FHR
8. The midwife knows at the client has begun the transitional phase of labor when she:
a. Complains of severe pain in the back c. states that the pain has lessened
b. Perspires and flushed skin d. assumes lithotomy position
9. Shortly following delivery, she says she feels like she’s bleeding. On checking the fundus the midwife finds a
steady tricking of blood from the vagina. The first action should be to:
a. Hold the fundus firmly and massage it gently c. call physician immediately
b. Check her BP and pulse d. take no action bec it’s normal
10. A G2P1 client is admitted to the labor unit by ambulance and delivery is imminent. She keeps bearing down
after two contractions the baby’s head is crowning. The midwife should:
a. Tell her to breath through her mouth and pant during contractions
b. Tell her to pant while supporting the perineum with the hand to prevent tearing
c. Tell her to breath through her mouth and bear down
d. Transfer immediately by stretcher to delivery room
11. With the next contraction she delivers a large baby boy spontaneously. The midwife’ s initial action should be:
a. Ascertain the condition of the fetus c. move mother and baby to delivery room
b. Quickly tie and cut the umbilical cord d. establish an airway for the baby
12. The physician arrives and cares for the baby and delivers the placenta. Oxytocin, is administered. Since she had
a precipitous delivery, it is important to observe for
a. Elevation of BP b. chilling c. Bleeding and infection d. respiratory insufficiency
13. If involution is progressing normally, immediately after birth the midwife should expect the fundus to be
located
a. 3 meters above umbilicus b. 2 c below umbilicus c. at the level of umbilicus d. anywhere
14. During contraction, the midwife observes a 15 bpm deceleration of FHR below the baseline rate. The most
appropriate action would be to
a. Prepare for immediate delivery c . call the physician immediately
b. Record this normal fetal response d . turn client to left side
15. The client begins to experience contraction 2- 3 mins apart that last about 45 seconds. Between contractions,
the midwife records a fetal hear rate of 100 bpm. The midwife should
a. Continue monitor FHR c. chart as normal findings
b. Closely monitor maternal V/S d. Notify the physician immediately
16. During delivery, episiotomy was performed. When caring for the client during post- partum period, the midwife
encourages sitz bathtid for 15 mins. Sitz bath primarily aid in healing process by:
a. Promoting vasodilation c. softening the incision
b. Cleansing the perineal area d. tightening the perineal sphincter
17. When preparing client to care for her episiotomy after discharge, the midwife should include, as a priority,
instructions to:
a. Continue sitz bath tid if it provides comfort c. discontinue sitz bath once she is at home
b. Avoid stair climbing few days after discharge d. continue perineal care until healing occurs
18. Perineal laceration is a common complication of precipitate delivery. In addition to regular perineal care, client
should include
a. Encourage early and frequent ambulation c. encourage perineal exercise
b. Providing high protein diet d. telling the client to expect a slower healing
19. The admitting vaginal exam reveals that the client cervix is 6 cm dilated and 100% effaced. The fetus is at 1 +
station and left occiput anterior. She is having difficulty coping with her contractions, which are occurring
every 3 mins. Which of these midwife action is appropriate during next contraction?
a. Encourage her to bear down with the contraction c. check perineum for crowning
b. Provide direct coaching using abdominal- chest breath d. apply firm pressure at sacral area
20. The midwife know that client is entering the transitional phase of labor when she
a. Becomes irritable and frightened c. begins accelerated breathing
b. Request pain medication d. request sacral pressure
21. The client is in thee transitional phase of labor. Her contractions are lasting 75 secs and occurring q 2 mins. She
begins to grunt and says she has to push. Upon vaginal exam, the midwife finds her cervix is 9 cm. what ios the
most appropriate action?
a. Roll her on her side and tell her to breath slowly
b. Tell her to blow out until the urge passes
c. Explain the pushing will cause the cervix to swell and delay dilatation
d. Tell her to push with each contraction
22. Client has an uneventful vaginal delivery with a midline episiotomy done under local anesthesia. During fourth
stage of labor, the midwife should include which of the following in the midwife care plan?
a. Massage the fundus constantly c. palpate the uterus to check muscle tone every 15 mins
b. Monitor temp d. monitor BP
23. The client is in the second stage of labor. which of the following patterns would necessitate immediate action?
a. Baseline FHR between 120 and 130
b. FHR drops to 100 during contractions and return to baseline when the contractions end
c. an increase in baseline FHR to 150 just prior to contraction
d. FHR drops to 120 during the contractions and returns to baseline 1 minute after the end of contraction
24. A 41 y/o client is admitted to the labor unit at 4 pm. While taking the history, the midwife notes the following:
G8P7, 41 wks AOG, membranes ruptured at 10 am, contractions occur every 3 mins. What midwife action
would take the highest priority at this time.
a. get blood and urine samples c. determine extent of cervical dilatation
b. do perineal prep and give enema d. attach monitors to client
25. She has a normal spontaneous delivery. Why would she be considered at risk for development of post partal
hemorrhage?
a. massage the fundus constantly c. monitor temp
b. palpate uterus to check muscle tone d. monitor BP
26. A 28 y/o multigravida client is admitted to the labor room in active labor. Her cervix is 90% effaced and the
fetus is LOP position, with FHR of 136 . The cervix is 4 cm dilated and is + 1. Which type of breathing and
relaxation technique would be appropriate at this time?
a. slow abdominal b. panting c. candle blowing d. accelerated
27. Fetal heart rate is being evaluated by the use of a stethoscope. When is the most appropriate time to listen to
fetal heart sound?
a. during uterine contraction c. 60 seconds after uterine contraction
b. during and following uterine contraction d. immediately after contraction
28. She complains of severe back pain. Which midwife action would be the best?
a. apply warm pad to sacral area c. turn her to sims position and apply sacral pressure
b. encourage her to bear down d. keep her flat with pillow under her head
29. Her membranes ruptured spontaneously. In addition to assessing the color of the fluid. What is the most
important midwife action at this time?
a. call the physician b. time the contraction c. move to DR d. take FHT
30. Which of the following most likely indicates the third stage of labor is coming to an end?
a. the episiotomy is being performed c. dilatation and effacement are complete
b. the birth of the baby is completed d. there is a gush of blood and cord lengthens
31. Which of the following behavior would indicate client is in the taking hold phase of the postpartum period?
a. asking to do a return demo of cord and circumcision care of the baby
b. talking about the details of her labor and delivery experience
c. asking questions about growth and development
d. requesting the midwife to return the baby to the midwifery
32. instruction 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. pours sterile water over the perineum after elimination
d. perform perineal care only if an episiotomy is performed
33. Which of the following behavior would indicates the client understood the midwife’s instructions to prevent
cracked nipples while breastfeeding?
a. she uses an alcohol rub to cleanse nipples prior to breastfeeding
b. she allows the baby to midwife 15 minutes on each breast on her first postpartum day
c. she cleanses her nipples daily with soap and water
d. she air dries nipples 15 mins after feeding
34. When the midwife is obtaining an admission history, the client felt contractions for the past several weeks, but
they were not painful. When entering fact in the client’s history the midwife can use the term:
a. Braxton hicks contraction c. hegar sign
b. chadwicks sign d. goodell’s sign
35. The client is having uterine contractions. Which one of the following questions that the midwife asks on
admission is least pertinent?
a. when did you last eat? b .have you ever has an enema? c. have your membranes ruptured?
36. On client’s admission record the physician writes that she is in the early stage of labor. To develop a plan of
care the midwife must know that the first stage of labor may be describe as the:
a. onset of irregular and mild contraction c. beginning of Braxton hicks contraction
b. dilatation of the cervix to 8- 10 cm d. movement of the fetus toward the pelvic inlet
37. When reviewing her admission records, the midwife notes that the physician has determined the station of the
fetus as -2. To develop a plan of care the midwife should know that this term describes as the:
a. anatomic position of the fetus c. height of the uterus
b. placement of the uterine fundus d. degree of descent of the fetal head or presenting part
38. 8 hrs after admission the midwife in charge perform a vaginal examination on the client and records that the
cervix is dilated 4 cm. The midwife interpretation of this finding is correct when the midwife judges that the
term of cervical dilatation the client is:
a. at a very early stage of dilatation c. approaching half of the total amount of dilatation
b. nearing total dilatation d. in labor but will most likely require a drug
39. The client requires fetal monitoring. To evaluate and correctly report the results to this procedure, the midwife
should know that the FHR normally:
a. slows at the onset of contraction c. slows at the peak of the contraction
b. remains unchanged during contraction d. slows immediately after contraction
40. During which of the following stages of labor should the midwife anticipate that the client will ordinarily need
the most encouragement and support?
a. during the early part offstage 1 c. during stage 2
b. during stage 3 d. during the transition phase
41. Which of the following midwife measure is least appropriate at the end of the first stage of labor?
a. having the client push with each contraction c. encouraging the client to void
b. urging the client to breath deeply d. having the client on her left side
42. The midwife plans to check the client’s bladder. The rationale for this action is that the urinary bladder should
not be allowed to become distended primarily because a full bladder tends to:
a. prevent the descent of the fetus into the birth canal
b. increase the risk of urinary incontinence
c. predispose to a prolapsed cord
d. interfere with observation of uterine contraction
43. The physician orders the client on bed rest. To prevent bladder distention the midwife can:
a. offer the bedpan in frequent intervals c. limit her fluid intake
b. decrease the rate of flow of IVF d. suggest that client eat solid food instead of fluids
44. Accurate recording of progress during labor is essential. The term used to described the period when the uterus
begins a contraction until the contraction ends is called the:
a. interval b. frequency c. duration d. intensity
45. The midwife judges the FHR to be normal when the rate per minute is between:
a. 80- 100 b. 100- 120 c. 160- 190 d. 120- 160
46. The midwife plans to check the color and amount of lochia. Shortly after delivery you would expect that lochia
should be:
a. pink b. brown c. dark or bright red d. yellow
47. Thirty minutes after delivery , the midwife changes perineal pad and notes that the lochia consist several large
clots and the perineal pad is saturated. The midwife should document the amount of the lochia:
a. Slight b. light c. heavy d. moderate
48. When changing perineal pads, the midwife checks perineum for hematoma, the most common signs of which
are:
a. Heavy and foul smelling lochia
b. Separation of and purulent drainage from the episiotomy
c. Irritated perineum and bloody vaginal discharge
d. Swelling and discoloration of the skin around the perineum
49. Locha is normal and the physician allows the patient to ambulate. The midwife should encourage ambulation
because this activity is beneficial to help prevent problems associated with:
a. return to sexual activity c. fluid balance
b. Milk producing ability d. Circulatory system
50. If client is allowed to have an over distended bladder, she is at risk for developing a:
a. Hematoma b. bladder infection c. hernia d. thrombophlebitis
51. The physician orders IFC to be inserted before cesarian section. The midwife can briefly explain to the client
that the purpose of the catheter is to:
a. Make her comfortable during the surgery c. Provide safe way to collect urine specimen
b. Prevent bladder infection d. Keep the bladder empty during the surgical procedure
52. Client has return from surgery and is receiving intravenous therapy. Which of the following would indicate that
the client is in shock?
a. Drop in the pulse rate and rise of BP c. decrease in the amount of lochia
b. increase in urinary output d. Rise in pulse rate and drop in BP
53. The midwife notes that the intravenous solution is labeled as containing an oxytoxic drug. When assessing the
client the midwife should know that the purpose of this drug is to:
a. Increase the amount of lochia c. keep the blood pressure stable
b. aid in healing the incision d. Help the uterus contract
54. Client complains of inability to defecate in spite of taking regular meals and frequent ambulation. The following
recommended to reestablish her regular defecation, which one is least priority?
a. Milk of magnesia c. high roughage food
b. Adequate fluid intake d. do manual retraction
55. She must report to the midwife if she observes that her lochial discharge:
a. Contains mucus and particles of cellular debris c. Has musty odor
th
b. Is bright red on the 5 day p/ p d. Disappears after the 3rd week
56. She remarks, “ do you think I have enough milk of my baby?” this signals what phase of the puerperium?
a. Taking hold b. post partum psychosis c. Post partum d. Taking in
57. Which of the following will best initiate the secretion of milk?
 a. Manuel breast expression c. Use breast pump in expressing milk
b. allow the infant suck each breast alternately d. Adequate fluid intake
58. The midwife plans to teach the client about perineal care. The correct method of cleansing the perineum with
soft wipes is to cleanse the area gently:
a. in a circular motion b. from front to back c. from side to side d. from back to front
59. When evaluating clients in the first stage of labor, the midwife must report any contractions that:
a. are more frequent than every 8 mins c. start in front of the abdomen
b. are 2mins or longer d. are accompanied by pain
60. When evaluating the client in labor the midwife must know that primipara normally are not taken to the
delivery room until:
a. the cervix is dilated to 6- 8 cm c. contractions are 3-5 mins
b. the intensity of contraction increase d. the perineum is buldging

Problem Solving:

1. A patient came to the ER with complain of labor pains, upon assessment the patient has an LMP of August 8,
2023. What is EDD/ EDC of the patient? What is AOG?
2. One client has an LMP of October 25, 2023. What is EDD/ EDC of the patient? What is AOG?
3. One client has an LMP of December 10, 2023. What is EDD/ EDC of the patient? What is AOG?

“ A great man shows his greatness by the way he treats little men”
THOMAS CARLYLE

Prepared By:

Ms. Frenee Lyn S. Erasquin