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Test 1: Monitoring the condition of the mother during the first stage of labour

  1. What is a partogram?
    • A chart for recording cervical dilatation only
    • An observation chart to record the clinical findings during the antenatal period
    • A machine to record the fetal heart rate
    • A chart to record the progress of labour together with the maternal and fetal condition
  2. During the first stage of labour a partogram must be used:
    • On all patients
    • Only on high-risk patients
    • Only in level 1 clinics
    • Only in level 2 and 3 hospitals
  3. Which of the following indicates that the general condition of a patient in the first stage of labour is normal?
    • The patient’s temperature, pulse rate and blood pressure are normal.
    • The patient is at ease and relaxed between contractions and does not appear pale.
    • The urine output is normal and ketonuria is not present.
    • The patient’s blood pressure is normal and proteinuria is not present.
  4. The correct management of a 17-year-old primigravida patient who appears very anxious and complains of painful contractions in early labour is:
    • The patient must immediately receive analgesics.
    • A Caesarean section must be done.
    • The patient must be comforted and reassured and receive appropriate analgesia. If possible, someone she knows should stay with her.
    • The membranes must be ruptured to ensure a rapid progress of labour.
  5. What is the normal maternal temperature during labour?
    • 35.5–36.0 °C
    • 36.0–37.0 °C
    • 36.5–37.5 °C
    • 37.0–38.0 °C
  6. Why is maternal pyrexia an important complication during the first stage of labour?
    • Maternal pyrexia may cause maternal exhaustion and oliguria.
    • Maternal pyrexia may cause convulsions.
    • Maternal pyrexia may cause hypertension during labour.
    • Maternal pyrexia may be caused by an infection which could be dangerous to the patient.
  7. What is the normal maternal pulse rate during labour?
    • 60–80
    • 80–100
    • 100–120
    • 120–140
  8. What causes a rapid maternal pulse during labour?
    • Fetal distress
    • Hypertension
    • Pyrexia
    • Ketonuria
  9. How often should the blood pressure be monitored in a low-risk patient during the latent phase of labour?
    • Every 15 minutes
    • Every 30 minutes
    • Hourly
    • Two-hourly
  10. Which of the following may cause hypertension during labour?
    • Anxiety
    • Fetal distress
    • Chorioamnionitis
    • Anaemia
  11. Which of the following would be the best management if a patient’s blood pressure was 90/50 mm Hg while she was lying on her back?
    • The patient must change into the lateral position and the blood pressure measurement should be repeated after a further one to two minutes.
    • As maternal hypotension may cause fetal distress, the fetal heart rate must be checked immediately.
    • The patient should be reassured that some patients normally have a low blood pressure and, therefore, there is no need for concern.
    • As blood loss is the most likely cause for hypotension, active resuscitation must be started immediately.
  12. A common clinical sign of shock is:
    • Pyrexia
    • Bradycardia
    • Hypertension
    • A cold and sweaty skin
  13. The definition of oliguria is a urine output of less than:
    • 10 ml per hour
    • 20 ml per hour
    • 50 ml per hour
    • 100 ml per hour
  14. Oliguria is an important sign of:
    • Dehydration
    • Pyelonephritis
    • Anxiety
    • Heart failure
  15. Which of the following statements is correct?
    • All patients should receive an intravenous infusion from the time of admission to the labour ward.
    • Oral fluids must be given to all patients until full cervical dilatation is reached.
    • All patients to be delivered vaginally must be encouraged to take oral fluids while in the active phase of labour.
    • A 50 ml ampoule of 50% dextrose should be given intravenously as soon as ketonuria develops during labour.
  16. Infection of the urinary tract may cause:
    • 1+ proteinuria
    • 2+ proteinuria
    • 3+ proteinuria
    • 4+ proteinuria
  17. Ketonuria during labour:
    • Is always abnormal and must be treated
    • Is an important sign of fetal distress
    • May be seen in normal patients
    • Is a sign of renal disease
  18. Which of the following is a sign of maternal exhaustion during labour?
    • Bradycardia
    • Proteinuria
    • A dry mouth and oliguria
    • Pallor and hypotension
  19. What may cause maternal exhaustion during labour?
    • Chorioamnionitis
    • Preterm labour
    • Placenta praevia
    • Prolonged labour
  20. How should you treat a patient with maternal exhaustion?
    • Stop the contractions with hexoprenaline (Ipradol).
    • Give oxygen by face mask.
    • Give two litres of Ringer’s lactate with 5% dextrose by intravenous infusion.
    • Deliver the infant by Caesarean section.