PN 136-01 Maternal Health Nursing Exam at Nightingale College

Explanation
Secondary powers refer to the voluntary bearing-down efforts made by the mother during the second stage of labor, which aid in expelling the fetus. These powers work in conjunction with uterine contractions (primary powers) and are expulsive in nature, generated by increased intra-abdominal pressure from the diaphragm and abdominal muscles. The effectiveness of secondary powers largely determines the progress of fetal descent and delivery.

Explanation
Oxytocin (Pitocin) is the first-line medication used to treat uterine atony, which is the failure of the uterus to contract effectively after childbirth—a major cause of postpartum hemorrhage. Oxytocin stimulates the smooth muscle of the uterus, promoting strong, rhythmic contractions that compress blood vessels and reduce bleeding. It can be given intravenously (IV) or intramuscularly (IM) and is usually administered immediately after delivery of the placenta as part of active management of the third stage of labor.

Explanation
Iron supplements commonly cause gastrointestinal side effects, the most significant being constipation. Iron slows intestinal motility by binding with digestive enzymes, which reduces peristalsis. Pregnant women are especially prone to constipation due to progesterone-induced smooth muscle relaxation. Therefore, the nurse recommends high-fiber foods (whole grains, bran, vegetables, and nuts) and adequate fluid intake to promote bowel regularity and minimize discomfort.

Explanation
A. Improve access to skilled attendants at birth​
Skilled birth attendants (midwives, nurses, physicians) recognize and manage the leading direct causes of maternal death—postpartum hemorrhage, hypertensive emergencies, sepsis, and obstructed labor. They can perform active management of the third stage of labor, administer uterotonics, start magnesium sulfate, initiate antibiotics, and escalate care for timely cesarean delivery when indicated. Their presence also ensures continuous risk assessment, partograph use, sterile technique, neonatal resuscitation readiness, and rapid referral/transfer systems—each step breaking the “three delays” (seeking, reaching, receiving care) that drive maternal mortality.
B. Provide postabortion care​
Comprehensive postabortion care (PAC) addresses hemorrhage, infection, retained products, and anemia—the immediate complications that can be fatal if untreated. PAC includes emergency treatment (manual vacuum aspiration or medical management), pain control, antibiotics when indicated, and counseling about return of fertility. Integrating same-day contraception (LARC or short-acting methods) reduces repeat unintended pregnancies. PAC also screens for intimate-partner violence, mental health concerns, and provides follow-up, thereby decreasing both short-term mortality and longer-term morbidity such as infertility and chronic pelvic pain.
D. Provide adolescents with better reproductive health services​
Adolescents have higher risks of eclampsia, puerperal infection, obstructed labor, and low-birth-weight infants. Youth-friendly services—confidential counseling, comprehensive sexuality education, contraception access (including LARC), and early, respectful prenatal care—reduce unintended pregnancy and enable early detection of complications. Addressing social barriers (stigma, cost, consent requirements, distance) and keeping girls in school delays first pregnancy, improves nutritional and anemia status, and increases care-seeking behaviors. Antenatal supplements, screening for GBV, and birth preparedness further lower adverse outcomes in this high-risk group.
E. Improve family planning services
Modern contraception prevents unintended and closely spaced pregnancies, reducing exposure to the risks of pregnancy and delivery. Family planning lowers unsafe abortion, decreases grand multiparity and advanced maternal age pregnancies, and allows spacing for recovery from anemia or prior cesarean. High-quality programs ensure method mix (including LARC), same-day initiation, management of side effects, postpartum and postabortion contraception, and community outreach. Integrating FP with HIV/STI services and routine maternal care strengthens continuity, autonomy, and equitable access—key drivers of reduced maternal mortality.

Explanation
At around 20 weeks of gestation and beyond, the enlarging uterus can compress the inferior vena cava when the woman lies flat on her back. This causes supine hypotensive syndrome, leading to dizziness, pallor, and lightheadedness due to decreased venous return and cardiac output. The side-lying (especially left lateral) position prevents this compression, promotes optimal blood flow to the heart and placenta, and relieves dizziness.

Explanation
Bladder distention displaces the uterus upward and to the side, preventing effective uterine contraction. A relaxed (boggy) uterus cannot compress blood vessels at the placental site, leading to excessive postpartum bleeding or hemorrhage. Prompt bladder emptying—either through spontaneous voiding or catheterization—restores uterine tone and position, reducing the risk of hemorrhage and promoting normal postpartum recovery.

Explanation
Combining relaxation with gentle movements such as walking, slow dancing, or rocking encourages optimal fetal positioning and helps the baby rotate through the pelvis during labor. These rhythmic motions promote pelvic mobility and alignment, allowing gravity to assist in fetal descent. Relaxation prevents muscle tension that can hinder labor progress, while movement facilitates uterine contractions and improves maternal comfort, supporting a smoother, more efficient labor process.

Explanation
A foul or offensive odor from vaginal discharge (lochia) after childbirth is an abnormal finding and typically indicates a uterine or vaginal infection, such as endometritis. Normally, lochia has a fleshy or musty odor, but never a strong or foul smell. Infection may also be accompanied by fever, uterine tenderness, and increased lochia volume. The nurse should notify the healthcare provider immediately for evaluation and treatment with antibiotics to prevent complications like sepsis.

Explanation
Magnesium sulfate can cause respiratory depression when serum magnesium levels become toxic. A respiratory rate below 12 breaths per minute indicates potential magnesium toxicity and requires immediate discontinuation of the drug. The nurse should notify the provider, stop the infusion, and administer calcium gluconate as the antidote if ordered. Continuous monitoring of reflexes, respiratory rate, and urine output is critical during magnesium sulfate therapy to ensure maternal safety.