In Partial Fulfillment of the Requirements

for NCM 107

Portfolio in MCN

Prepared by:
KENT FERRY D. FUENTES
Bachelor of Science in Nursing
2-3

Presented to:
MARY JOY I. REYES, RN, MAN
Classroom Instructor

February 2021

AUTOBIOGRAPHY
Entering college life is what I’m afraid most. Why? It’s because of the great adjustment I’m
going to make. New environment, new classmates, new friends, new teachers/instructors and a
new life. It is far from being just a typical high school student. Also, given the fact that choosing
your course in college has always been one of the most important and wisest decisions that you
have to decide because you have to choose the best course that does not only matches your
interest because you have to choose the best because your future depends on it. August 5, 2020-
It was the day I was waiting for, the day that will start my new life, my chosen field and my
future. That was the day that I thought the start of my dreams but also the start of not ending
study, learning and challenges. Finally, I stepped up and came to my new home Aklan State
University. I walked around and found my first room. Then I saw my new classmates some of
them are familiar and the rest are all new faces in my eyes. So far, I’ve met so many new and
wonderful people, and built up a friend group of people who are struggling with the same things
as I am; we support each other, and they’re always there for me. I feel so accomplished when I’m
able to walk up to someone in the cafeteria and say hi! At the beginning of the school year, I was
lost in a sea of strangers, but now I recognize so many faces.
By the way, I am Kent Ferry D. Fuentes, Level II nursing student. I am 20 years old and I live in
Laguinbanua East, Numancia, Aklan. I graduated as Class Valedictorian (2012-2013) at
Laguinbanua Elementary School and With Honors (2018-2019) at Regional Science High School
for Region VI. My favorite subjects are science and history while my favorite colors are
aquamarine and sea green. I used to be an active contestant in different school activities (e.g.,
essay writing, poem writing, poster making, etc.), a boy scout, lyre men leader, varsity team
volleyball captain, SSG president and others. Ten words that best describe me are thoughtful,
caring, intelligent, friendly, sporty, benevolent, generous, intimidating, talkative and finicky type
of person. I want to travel around the globe especially in my dream destinations and own a
Lamborghini car. I want to be a successful person someday and I hope I get the things I’ve
prayed for myself, my family and all my loved ones. My motto in life is “Smell the roses along
the way” because for me, appreciating and recognizing the source of goodness in our lives are
healthy for our soul. It gives me encouragement to live life with a deeper gratefulness for all the
things around me. That motto serves as a reminder to slow down and take notice of the people
and events of the day, to be present in every moment, seeing beyond the ordinary and perceive
the movement of God. It means consciously directing your mind to be aware and attentive to the
present moment to be able to experience and enjoy more of the world surrounding us.
As a college student, the reason why I chose nursing is that being a nurse is a very influential and
rewarding profession. Nurses care for people through illness, injury, pain, loss, dying, grieving,
birth, growth, aging and health. They not only care for people through illness, but they also
promote health, prevent diseases and educate the public. As a nurse, you not only see people at
their worst but you have the chance to see people at their best and know that you were a part of
their growth. We all know that nursing is a field that is concerned with helping people, yet I
believe that in becoming a nurse, a person needs more than that desire to succeed. It is essential
for a nurse to be open, strong, determined, thoughtful and caring. These qualities would reflect
on the nurse and would make caring for the patient easier. I believe that I belong to this field
because ever since I was a child, I’ve always wanted to make a positive influence in people’s
lives. I always felt the need to care for someone since I know that I have the power and the
compassion to do so. I believe that I will have an exciting future and career because I chose
nursing as a profession.
Nursing is one of the few careers that does not only help others but it also helps yourself. It is a
profession that is exciting, ever changing, diverse, and allows opportunity for learning something
new every day. The work is tough but in the end of the day, I will say that this is that path that I
chose and I am proud of it, then I will remember that feeling of helping a complete stranger and
at that moment, I will feel rewarded. I believe that the nursing profession will open many
opportunities and I am greatly looking forward to the unique challenge that each will provide.
ACTIVITY 1
A. Give at least 2 examples of the following:
1. Health promotion:
 Smoking cessation programs such as 'quit' activities and 'brief interventions'
 Promoting child and family nutrition

2. Health maintenance:
 Breast cancer screening counseling
 Prostate exams

3. Health restoration:
 Administering an antibiotic every day
 Assessing a client’s surgical incision

4. Health rehabilitation:
 Exercises to regain the ability to swallow or upper-limb retraining to regain
coordination, dexterity and movement of an affected limb following a stroke.
 Cognitive behavioral therapy and interventions aiming to increase exercise for an
individual with depression.

B. What is the 5-leading cause of the following in the Philippines (2010 and Up). Site your
reference.
FETAL DEATH

Disorders related to short gestation and low birth weight, not elsewhere classified is at its
prime having 4,445 cases or more than half of the total figure. Intrauterine hypoxia came in
second with only 621 fetal mortalities or 7.7 percent. Other congenital malformations, not
elsewhere classified, which is third in rank, accounted only 290 (3.6%) death cases. In 23 of
the 42 cases or 54.8%, the cause was cord accidents. In 11/42 or 26.2% of cases, the cause of
 fetal death was severe asphyxia due to abruption of placenta, severe toxemia giving rise to
placental insufficiency, or obstructed labor.
Reference: Philippine Statistics Authority (2015). Fetal Deaths: Philippines.
https://psa.gov.ph/content/fetal-deaths-philippines-2010. September 7, 2020
NEONATAL MORTALITY

The leading cause of neonatal mortality in the Philippines was preterm birth complications in the
top spot with 31% followed by intra-partum related events being in second at 24%. Third in rank
was sepsis/tetanus with 14% and congenital abnormalities with 17% in fourth. Other conditions
related came in fifth having 8%.
Reference: Healthy Newborn Network (2017). Leading Causes of Neonatal Deaths in the
Philippines. https://www.healthynewbornnetwork.org/country/philippines/.
September 7, 2020
INFANT MORTALITY

In Philippines, the main causes of neonatal deaths in 2015 were prematurity (32.7 percent), birth
asphyxia and trauma (23.1 percent) and congenital anomalies (17.2 percent). Sudden infant death
syndrome was ranked in fourth and injuries (e.g., Suffocation) came fifth.
Reference: UNICEF (2015). Maternal and Newborn Health Disparities.
https://webcache.googleusercontent.com/search?q=cache:yow1uC90vZ8J:https://dat
a.unicef.org/wp- content/uploads/country profiles/Philippines/country%2520profile
PHL.pdf+&cd=15&hl=en&ct=clnk&gl=ph. September 7, 2020
MATERNAL MORTALITY

Various factors are responsible for the high rate of maternal mortality that the Philippines face.
According to the IRIN, some of the main causes of maternal deaths are hemorrhages, sepsis,
obstructed labor, hypertensive disorders during pregnancy and complications associated with
unsafe abortions.
Reference: Rau, A. (2015). Maternal Mortality in the Philippines.
https://borgenproject.org/maternal-mortality philippines/#:~:text=Various%20factors
%20are20%responsible%20for,complications%20associated%20with%20unsafe%20
abortions. September 7, 2020
 CHILDHOOD MORTALITY

According to the Department of Health’s data, pneumonia, diarrhea, congenital anomalies,

septicemia and other diseases of the nervous system are the leading causes of death among
children below 5 years of age as of 2010.
Reference: Department of Health (2014). Leading Cause of Child Mortality.
https://www.doh.gov.ph/Statistics/Leading-Causes-of-Child-Mortality.
September 7, 2020

CHILDHOOD MORBIDITY

Just five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account
for nearly half of these deaths and malnutrition is often the underlying condition.
Reference: Department of Health (2010). Integrated Management of Childhood Illness (IMCI).
https://www.doh.gov.ph/integrated-management-of-childhood-illness?fbclid
=IwAR24UAqOZgaF2W288REC5bVwaHbPMQl76J9aF9kuep6gM KJFiZd2Gq1
FiU#:~:text=Just%20five%20diseases%20. September 7, 2020
STUDY ACTIVITIES
1. Research a current policy, bill, or issue being debated with regard to women’s health in
the Philippines. Summarize the major facts, supporting or opposing arguments and prepare a
written report of your findings.
TOPIC: Adolescents in the Philippines, both unmarried and married, face many sexual and
reproductive health risks stemming from early, unprotected, and/or unwanted sexual activity.
Adolescent girls are particularly vulnerable to unintended pregnancies and maternal morbidity
and mortality, including sequel arising from unsafe abortions. Young parents often have to stop
their education, limiting employment opportunities as adults. Among women between age 15–
19, 10.1% report having been pregnant in 2013, up from 6.5% in 1993. The annual birth rate in
this age group has remained almost constant in the last 20 years— from 50 births per 1000 in
1993 to 57 in 2013. In sharp contrast, all other age groups recorded steady declines in the same
period. The country’s teen birth rate is currently higher than the average of 40 per 1000 for the
South East Asian region and 15 per 1000 for the Western Pacific region. Adolescents are
particularly at risk because they have less access to contraceptive services. Adolescent
pregnancies have been shown to contribute to early childhood deaths. According to the 2013
demographic and health survey (DHS), mother’s age less than 18 (risk ratio = 2.13) is the single
factor most associated with increased risk of under-5 mortality in the Philippines.
The RH law envisions the inclusion of adolescents in the RH program, but mainly through
education and counseling. While the law mentions RH services, it is silent on contraception for
adolescents. There is a strong mandate to provide comprehensive RH education in all
mainstream and alternative schools. The curriculum must be age- and development- appropriate.
The comprehensive and developmental approach would correct the old practice of doing isolated
lessons in specific grades, such as teaching contraceptive methods in Grade 10. The law
identifies critical subjects that should be taught but does not explicitly include sexuality and
contraception. It advises flexibility in deciding topics and methodology based on consultations
with stakeholders like parents and other “interest” groups. Two reasons can explain this caution.
In 2009, the education department was stopped and brought to court by a pro-life group for pilot-
testing a high school sexuality education module. Though the education department eventually
won the case, it never reintroduced the module. In 2014, pro-life groups argued that sexuality
education violates the primary duty of parents over their children, which makes the RH law
unconstitutional. The Supreme Court dismissed this argument for being premature as there was
no curriculum yet to oppose. Pro-life groups could revive their case once a comprehensive
curriculum is released.
SUMMARY REPORT: Many Philippine norms are in agreement with adolescents’ human
rights to contraceptive information and services as recommended by the WHO. However, a
significant number are restrictive, reflecting the strong influence of conservative religious
beliefs. High infant mortality rate, high maternal mortality rate and a number of HIV cases are
not the only problems that the Philippines is experiencing in relation to reproductive health.
Because of the lack of a concrete reproductive health and family planning policy and program in
the country, unwanted pregnancy incidences become high. Due to this, Filipino women are
forced to undergo induced abortion as one of the methods that they use to meet their reproductive
goals. Although abortion is illegal in the Philippines, and despite the potential harmful
consequences of an unsafe abortion for women’s health and life, many women resort to abortion
to meet their family-size goals or to space births. The polarization of Philippine society over the
Reproductive Health Bill has been a source of discouragement and discontent among Filipinos. It
is unfortunate that the debate has focused only on whether the Bill should be passed or rejected
in its present form. Either option would not be good for Filipinos. The Church sees in the
proposed Bill serious flaws that can lead to violations of human rights and freedom of
conscience. Total rejection of the Bill, however, will not change the status quo of high rates of
infant mortality, maternal deaths, and abortions. It is a moral imperative that such dehumanizing
conditions should not be allowed to continue. What is needed is a third option: critical and
constructive engagement. By working together to amend the objectionable provisions of the Bill
and retain the provisions that actually improve the lives of Filipinos, both the proponents and
opponents of the Bill can make a contribution to protection of the dignity of Filipinos and an
improvement of their quality of life.
2. What is your stand on the following statement: “should access to health care be a right or a
privilege”? Discuss your answer.
Ans: The enjoyment of the highest attainable standard of health is one of the fundamental rights
of every human being without distinction of race, religion, a political belief, economic or social
condition. The right to health for all people means that everyone should have access to the health
services they need, when and where they need them, without suffering financial hardship. No
one should get sick and die just because they are poor, or because they cannot access the health
services they need.
ACTIVITY 2
I. Multiple Choice. Encircle the correct answer.
1. The predominant anterior pituitary hormones that Orchestrate the menstrual cycle include:
a. Thyroid-stimulating hormone (TSH)
b. Follicle-stimulating hormone (FSH)
c. Corticotropin-releasing hormone (CRH)
d. Gonadotropin-releasing hormone (GnRH)
2. Which glands are located on either side of the female urethra and secrete mucus to keep the
opening moist and lubricated for urination?
a. Cowper’s
b. Bartholin’s
c. Skene’s
d. Seminal
3. What event occurs during the proliferative phase of the menstrual cycle?
a. Menstrual flow starts
b. Growth hormone is secreted
c. Ovulation occurs
d. Progesterone secretion peaks
4. Which hormone is produced in high levels to prepare the endometrium for implantation just
after ovulation by the corpus luteum?
a. Estrogen
b. Prostaglandins
c. Prolactin
d. Progesterone
5. Sperm maturation and storage in the male reproductive system occur in the:
a. Testes
b. Vas deferens
c. Epididymis
d. Seminal vesicles
Critical Thinking Exercise
1. The school nurse was asked to speak to a 10th-grade biology class about menstruation. The
teacher felt that the students did not understand this monthly event and wanted to dispel some
myths about it. After the nurse explains the factors influencing the menses, one girl asks, “Could
someone get pregnant if she had sex during her period?”
a. How should the nurse respond to this question?
Ans: The nurse should respond by explaining to the student that conception is achieved only
during the time of ovulation, which occurs at mid-cycle and not during menstruation. Further
explanation might outline the phases of the menstrual cycle and how each phase contributes to
the preparation of the endometrial lining if conception were to take place. If conception does not
occur, sloughing of the prepared endometrial lining takes place, and this is what is shed during
menstruation.
b. What factor regarding the menstrual cycle was not clarified?
Ans: The student apparently did not understand the concept of ovulation and the potential
uniting of sperm and ovum. At ovulation, bodily changes occur that assist the sperm to
impregnate the ovum that was released from the ovary. It is only during this mid-cycle period
that the sperm can find the ovum and begin a pregnancy.
c. What additional topics might this question lead to that might be discussed?
Ans: Sexually transmitted infections and barrier protection; abstinence until marriage and
personal responsibility; responsibilities and outcomes of becoming a young parent; self-esteem
and taking pride in their bodies; future educational and career goals.
Study Activities
1. Should sex education be taught in public schools, and if so, what topics should be addressed?
Debate the pros and cons of teaching this and then outline which topics should be covered.
Ans: This answer will vary depending on which website the student selects and which topic of
interest he or she researches. With luck, a variety of topics will be presented and lend themselves
to a lively class discussion. Like for example, respond to the following as a topic sentence:
“When I was growing up, talking about sexual matters with my parents was …because…. Now
the situation is …? Responses will be individualized, not generalized.

2. List the predominant hormones and their function in the menstrual cycle.
Ans: The predominant hormones involved in the menstrual cycle are gonadotropin-releasing
hormone (GnRH), which is responsible for reproductive hormone control and timing of the
cycle; follicle-stimulating hormone (FSH), which stimulates the ovary to produce estrogen and
follicles in the ovary that will mature; luteinizing hormone (LH), which induces the mature ovum
to burst from the ovary and stimulate production of corpus luteum; estrogen, which induces
growth and thickening of the endometrial lining; progesterone, which prepares the endometrial
lining for implantation; and prostaglandins, which help to free the mature ovum inside the
graafian follicle.
4. Sperm cells and the male hormone testosterone are made in which of the following structures?
Select all that apply.
a. Vas deferens e. Prostate gland
b. Penis f. Testes
c. Scrotum g. Seminiferous tubules
d. Ejaculatory ducts h. Bulbourethral glands
Ans: The correct responses are F (testes) and G (seminiferous tubules). Sperm is produced in the
seminiferous tubules of the testes. A is incorrect: the vas deferens is a cord-like duct that
transports sperm from the epididymis and has no role in making sperm cells. B is incorrect: the
penis is the organ for copulation and serves as the outlet for sperm, but it plays no role in the
manufacture of sperm cells or testosterone. C is incorrect: the scrotum serves as the climate
control system for the testes to allow for normal sperm development, but it plays no direct role in
their manufacture. D is incorrect: the ejaculatory ducts secrete fluids to help nourish the sperm,
but do not play a part in their development. E is incorrect: the prostate gland produces fluid that
nourishes the sperm but does not participate in the production of sperm cells. H is incorrect: the
bulbourethral glands (Cowper’s glands) secrete a mucus-like fluid that provides lubrication
during the sex act.
Activity 3
1. After teaching a group of students about fertilization, the instructor determines that the
teaching was successful when the group identifies which is the usual site of fertilization?
a. Fundus of the uterus
b. Endometrium of the uterus
c. Upper portion of fallopian tube
d. Follicular tissue of the ovary

2. The nurse is counseling a couple, one of whom is affected by an autosomal dominant disorder.
They express concerns about the risk of transmitting the disorder. What is the best response by
the nurse regarding the risk that their baby may have the disease?
a. “You have a one in four (25%) chance.”
b. “The risk is 12.5%, or a one in eight chance.”
c. “The chance is 100%.”
d. “Your risk is 50%, or a one in two chance.”
3. What is the first step in determining a couple’s risk for a genetic disorder?
a. Observing the client and family over time
b. Conducting extensive psychological testing
c. Obtaining a thorough family health history
d. Completing an extensive exclusionary list
4. A nurse is working in a women’s health clinic. Genetic counseling would be most appropriate
for the woman who:
a. Just had her first miscarriage at 10 weeks
b. Is 30 years old and planning to conceive
c. Has a history that reveals a close relative with Down syndrome
d. Is 18 weeks pregnant with a normal triple screen result
5. Suzanne Alvarez’s child is born with Down syndrome. What is the common physical feature
of newborns with this disorder that the nurse would want all of the team members to recognize?
a. Spastic neck muscle
b. An unusual pattern of palm creases
c. A white plaque of forehead hair
d. Wrinkles on the soles of the feet
CRITICAL THINKING EXERCISE:
a. What information/education should this couple consider before deciding whether to have the
test?
1. Mr. and Mrs. Martin wish to start a family, but they can’t agree on something important: Mr.
Martin wants his wife to be tested for cystic fibrosis (CF) to see if she is a carrier. Mr. Martin
had a brother with CF and watched his parents struggle with the hardship and the expense of
caring for him for years, and he doesn’t want to experience it in his own life. Mr. Martin has
found out he is a CF carrier. Mrs. Martin doesn’t want to have the test because she figures that
once a baby is in their arms, they will be glad, no matter what.
Ans: The nurse needs to outline the facts about genetic inheritance such as:
 Cystic Fibrosis is a recessive disorder that affects 1 in every 2,500 babies.
 It is predominantly seen in white infants and is less common in other races.
 Since it’s a recessive disorder, Mrs. Martin must also be a carrier to pass it on to their
offspring.
 If Mrs. Martin is a carrier, their chance of having a child with cystic fibrosis is one in
four.
 The risk is the same each time they have a child.
 Information about the characteristics of cystic fibrosis.

b. How can you assist this couple in their decision-making process?

Ans: If I am the nurse, I can assist the couple in their decision making by providing all the facts
about the nature of inheritance risk. Also, I will outline all options so the couple can come up
with an informed decision. These said options include the following:
 The couple does not receive genetic testing and take their chances.
 If Mrs. Martin is a CF carrier, then they could choose not to have children or adopt a
baby.
 Prenatal testing could be done on the fetus to determine whether both its genes carry a CF
mutation. If so, the couple could elect to abort the pregnancy.
 Use an ovum or sperm from a donor who does not carry CF.
 Make a referral to a reproductive technology health facility for the couple to become
educated regarding alternatives to maximize their outcome.
 Be realistic with this couple about not having any guarantees that another genetic
disorder might not occur.
 Discuss the expense involved in genetic testing and in vitro fertilization, which probably
will not be covered by health insurance.

c. What is your role in this situation if you don’t agree with their decision?
 Ans: As a nurse, my role is to provide the facts and allow the couple to make their own
decision about what they wish to do. They, not me as nurse, must live with their decision. My
role is to respect and support whatever this couple decides to do.
STUDY ACTIVITIES

After examining the inheritance pattern of our family history, I have discovered that I have a
75% chance of acquiring hypertension and no chance of having diabetes. This is because both of
my parents have hypertension and is the most dominant illness in our family.
Activity 4
MULTIPLE-CHOICE QUESTIONS: Encircle the correct answer.
1. A couple is considered infertile after how many months of trying to conceive?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
2. A couple reports that their condom broke while they were having sexual intercourse last
night. What would you advise to prevent pregnancy?
a. Inject a spermicidal agent into the woman’s vagina immediately.
b. Obtain emergency contraceptives and take them immediately.
c. Douche with a solution of vinegar and hot water tonight.
d. Take a strong laxative now and again at bedtime.
3. Which of the following activities will increase a woman’s risk of cardiovascular disease
if she is taking oral contraceptives?
a. Eating a high-fiber diet
b. Smoking cigarettes
c. Taking daily multivitamins
d. Drinking alcohol
4. What comment by a woman would indicate that a diaphragm is not the best contraceptive
device for her?
a. “My husband says it is my job to keep from getting pregnant.”
b. “I have a hard time remembering to take my vitamins daily.”
c. “Hormones cause cancer and I don’t want to take them.”
d. “I am not comfortable touching myself down there.”
5. Non-contraceptive benefits of combined oral contraceptives include which of the following?
Select all that apply.
a. Protection against ovarian cancer
b. Protection against endometrial cancer
c. Protection against breast cancer
d. Reduction in incidence of ectopic pregnancy
e. Prevention of functional ovarian cysts
f. Reduction in deep venous thrombosis
g. Reduction in the risk of colorectal cancer
CRITICAL THINKING EXERCISE
1. Ms. Corona, age 25, comes to your family planning clinic requesting to have an intrauterine
contraceptive (IUC) inserted because “birth control pills give you cancer.” In reviewing her
history, you note she has been into the STI clinic three times in the past year with vaginal
infections and was hospitalized for pelvic inflammatory disease (PID) last month. When you
question her about her sexual history, she reports having sex with multiple partners and not
always using protection.

a. Is an IUC/IUD the most appropriate method for her? Why or why not?
Ans: This is not the appropriate method to use because the risk of having a pelvic infection is
higher if she had more than one sexual partner. Also, IUC/IUD is not advisable to use for women
who had pelvic inflammatory disease because it may lead to infertility and for those who change
sexual partners often because it doesn’t serve protection from getting AIDS or other sexually
transmitted diseases.
b. What myths/misperceptions will you address in your counseling session?
Ans: Those women who currently taking birth control pills; especially the combined pill has a
slightly increased risk of breast cancer. Taking the combined pill for only a short time may not
have any effect on risk of cervical cancer. But, those who have been using it for 5 years or more
have an increased risk of getting cervical cancer than those who have never used the combined
pill. The increased risk of breast and cervical cancer falls back down again once the combined
pill stops being taken. About 10 years after stopping, a person’s risk is no longer affected.
Another myth that I want to address is that the IUD is a big commitment and it’s best for women
who are older, married, or already have kids.
c. Outline the safer sex discussion you plan to have with her.
 Limit your sexual activity to only one partner who is having sex only with you to reduce
exposure to disease-causing organisms.
 Use condoms that are made of polyurethane every time you have sex.
 Women should not douche after intercourse--it does not protect against STIs. And, it
could spread an infection farther into the reproductive tract.
 Have regular Pap tests, pelvic exams, and periodic tests for STIs

Activity 5
MULTIPLE CHOICE QUESTIONS
1. What factors would change during a pregnancy if the hormone progesterone were
reduced or withdrawn?
a. The woman’s gums would become red and swollen and would bleed easily.
b. The uterus would contract more and peristalsis would increase.
c. Morning sickness would increase and would be prolonged.
d. The secretion of prolactin by the pituitary gland would be inhibited.
 2. Which of the following is a presumptive sign or symptom of pregnancy?
a. Restlessness
b. Elevated mood
c. Urinary frequency
d. Low backache
3. When obtaining a blood test for pregnancy, which hormone would the nurse expect the
test to measure?
a. Human chorionic gonadotropin (hCG)
b. Human placental lactogen (hPL)
c. Follicle-stimulating hormone (FSH)
d. Luteinizing hormone (LH)
4. During pregnancy, which of the following should the expectant mother reduce or avoid?
a. Raw meat or uncooked shellfish
b. Fresh, washed fruits and vegetables
c. Whole grains
d. Protein and iron from meat sources
5. A feeling expressed by most women upon learning they are pregnant is:
a. Acceptance
b. Depression
c. Jealousy
d. Ambivalence
1. When interviewing a woman at her first prenatal visit, the nurse asks about her feelings. The
woman replies, “I’m frightened and confused. I don’t know whether I want to be pregnant or not.
Being pregnant means changing our whole life, and now having somebody to care for all the
time. I’m not sure I would be a good mother. Plus, I’m a bit afraid of all the changes that would
happen to my body. Is this normal? Am I okay?
a. How should the nurse answer this question?
Ans: The nurse should respond in a positive way providing emotional comfort to the client that
what she feels is normal for first time moms. Also, the nurse may educate the client about
anxiety which is a feeling of worry or fear over things that might happen. She should also give
encouragement to the client by motivating her to focus in the bright side of life and that
everything’s going to be okay. The nurse should help the client understand the connection
between immediate events and the feelings they elicit. She should also help the patient realize
that negative feelings do not represent rejection of the child.

b. What specific information is needed to support the client during this pregnancy?
Ans: The feelings of the client will be a big factor in order for the nurse to devise effective
interventions during her pregnancy. Therefore, nurses must be particularly concerned with the
reduction of anxiety. In this way, the goal is to help the patient become aware of her reactions
and coping behavior. Also, the nurse must know the variables which affect the degree of anxiety
experienced during childbirth because the client should not feel that she is losing control of the
situation but should be kept aware of what is happening, why it is happening, and what the
outcome will be.
2. Sally, age 23, is 9 weeks pregnant. At her clinic visit she says, “I’m so tired I can barely make
it home from work. Then once I’m home, I don’t have the energy to make dinner.” She says she
is so sick in the morning that she is frequently late to work and spends much of the day in the
bathroom. Sally’s current lab work is within normal limits.
a. What explanation can the nurse offer Sally about her discomforts?
Ans: With regards to fatigue, the nurse should explain that the body is producing hormones at an
increased level, especially progesterone, and that this increase is partially responsible for feeling
tired. The nurse should also explain that while pregnant, the body requires more nutrition, and
failure to keep up with the nutritional needs of the mother and baby can cause fatigue. As for the
morning sickness, the nurse can explain to Sally that morning sickness is a symptom in a
majority of pregnant women. The nurse can also reassure Sally that it is normal for morning
sickness to occur at her current week of pregnancy, because the highest incidence usually occurs
between 6-12 weeks. In addition, the nurse should tell Sally, in a way that she would understand,
why the morning sickness is occurring, level of hormones and other chemicals circulating in the
body.
b. What interventions can the nurse offer to Sally?
Ans: The nurse should educate Sally on proper nutrition to follow during pregnancy and how it
can help curve the feelings of fatigue. For the morning sickness, the nurse can offer guidance to
Sally as to what medications she can take to treat this symptom; those are safe to take while
pregnant. These medications include doxylamine succinate and pyridoxine hydrochloride.
Activity 7
A. Multiple choice: Select the letter of the correct answer.
1. A nurse is assigned to work in the delivery room and is assisting in caring for a client
who has just delivered a newborn infant. The nurse is monitoring for signs of
placental separation knowing that which of the following indicates that the placenta
has separated?
a. Shortening of the umbilical cord
b. Decrease in blood loss from introitus
c. Change in the uterine contour
d. Sudden sharp abdominal pain
2. A woman in active labor has contractions every 2 to 3 minutes lasting 45 seconds.
The fetal heart rate between contractions is 100 beats per minute. Based on these
findings, the priority nursing intervention is to:
a. Notify the physician immediately.
b. Encourage relaxation and breathing techniques between contractions
c. Continue monitoring labor and fetal heart rate.
d. Monitor maternal vital signs.
3. A primigravida’s membranes rupture spontaneously. The nurse’s first action is to:
a. Monitor contraction pattern
b. Determine the fetal heart rate
c. Note the amount, color, and odor of the amniotic fluid
d. Prepare for immediate delivery
4. A nurse is caring for a client in labor. The nurse rechecks the client’s blood pressure
and notes that it has dropped. To decrease the incidence of supine hypotension, the
nurse should encourage the client to remain in which position?
a. Left lateral
b. Semi-Fowler’s
c. Dorsal Recumbent position
d. Lithotomy position
 5. A nurse is asked to assist the primary health care provider in performing Leopold
maneuvers on a client. Which nursing intervention should be implemented before this
procedure is performed?
a. Local fetal heart tones
b. Have the client drink 8 ounces of water
c. Warm the sonogram gel
d. Have the client empty her bladder

B. CRITICAL THINKING EXERCISES

Carrie, a 20-year-old primigravida at term, comes to the birthing center in active labor
(dilation 5 cm andn80% effaced, –1 station) with ruptured membranes. She states she wants
an “all-natural” birth without medication. Her partner is with her and appears anxious but
supportive. On the admission assessment, Carrie’s prenatal history is unremarkable; vital
signs are within normal limits; FHR via Doppler ranges between 140 and 144 bpm and is
regular.
a. Based on your assessment data and the woman’s request not to have medication, what
nonpharmacologic interventions could you offer her?
Ans: The nonpharmacologic interventions that I can offer her are the following:
• Progressive relaxation techniques of locating, then releasing tension from one muscle group at
a time until the entire body is relaxed.
• Visual imagery such as taking a journey in the woman's mind to a relaxing place that is far
away from the discomfort of labor.
• Music to bring about a calming effect as well as a distraction or attention focusing to divert
attention away from the laboring process; focusing on sound or rhythm helps release tension and
promote relaxation.
• Massage/acupressure to enhance relaxation, improve circulation, and reduce pain in labor;
counterpressure on the lower back to help relieve back pain.
• Breathing techniques for effective attention-focusing strategies to enhance coping mechanisms
during labor.
b. What positions might be suggested to facilitate fetal descent?
Ans: The positions suggested to facilitate fetal descent are the following:
• Upright positions such as walking, swaying, slow-dancing with her partner, or leaning over a
birthing ball will all enhance comfort and use the force of gravity to facilitate fetal descent.
• Kneeling and leaning forward will help relieve back pain.
• Pelvic rocking on hands and knees and lunging with one foot elevated on a chair may help with
internal fetal rotation and speed a slow labor.
1. Several hours later, Carrie complains of nausea and turns to her partner and angrily tells
him to not touch her and to go away.

a. What assessment needs to be done to determine what is happening?

Ans: The nurse should perform a vaginal examination to validate that Carrie is in the transition
phase (8 to 10 cm dilated).
b. What explanation can you offer Carrie’s partner regarding her change in behavior?
Ans: Explain to her partner that she is in the transition phase of the first stage of labor and that
her behavior is typical, since she is having hard contractions frequently. Reassure him not to take
Carrie's comments personally, but to stay and be supportive to her.
Activity 8
1. Jennifer Lopez, a 34-year-old single primipara, left the hospital after a 36-hour stay with
her newborn son. She lives alone in a one-bedroom walk-up apartment. As the
postpartum home health nurse visiting her 2 days later, you find the following:
• Tearful client pacing the floor holding her crying son
• Home cluttered and in disarray
• Fundus firm and displaced to right of midline
• Moderate lochia rubra; episiotomy site clean, dry, and intact Vital signs within
normal range; pain rating less than 3 points on scale of 1 to 10
• Breasts engorged slightly; supportive bra on
• Newborn assessment within normal limits
• Distended bladder upon palpation; reporting urinary frequency
a. Which of these assessment findings warrants further investigation? 3pts
Ans: Fundus firm and displaced to the right of midline, distended bladder upon palpation,
reporting urinary frequency, tearful client and pacing the floor holding her crying son.
b. What interventions are appropriate at this time, and why? 3pts
Ans: Mom seems to the overwhelmed with her new role. This is a normal finding. She also
seems to be experiencing some postpartum blues which we can expect, and should resolve. As
the nurse, assessment of mom’s support system and if none available, collaborate with social
worker to help with assistance in terms of a home aid. The bladder and fundus are abnormal
findings, and could be as a result of a urinary tract infection. This would cause the frequent
urination and displacement of the uterus. A clean catch urine specimen should be collected, also
a dipstick test for bacteria. Patient should increase fluid intake and add cranberry juice to her
diet.

c. What health teaching is needed before you leave this home? 3pts
Ans: This patient needs teaching on how to cope with a newborn. Encourage her to nap when the
baby naps, and try to accomplish self-care during baby down times. Try to bundle newborn care
(e.g., doing feedings, diaper changes etc.) together. Mom needs to be reassured that she’s doing a
good job, the baby is healthy. We need to arrange support for mom, and also educate her about
postpartum blues. She should be assured that it should resolve, and also in-formation about
further deterioration (e.g., if she wants to hurt herself or the newborn. She should be given
resources to reach out to. A follow up appointment should be made.
2. The nurse walks into the room of Lisa Drew, a 24-yearold primigravida. She asks the nurse to
hand her the bottle sitting on the bedside table, stating, “I’m going to finish it off because my
baby only ate half of it 3 hours ago when I fed him.”
a. What response by the nurse would be appropriate at this time? 3pts.
Ans: The nurse should inform mom that the formula may be contaminated since it has not been
refrigerated. It is not appropriate to feed the infant. The nurse should use a non-judgmental
approach.
b. What action should the nurse take? 3pts.
Ans: The nurse should replace the old bottle with a new bottle for feeding the infant.
c. What health teaching is needed for Lisa prior to discharge? 5pts.
Ans: The mom needs instruction on safely handling and preparing formula for the newborn.
Instructions should be given about refrigerating the formula that not being used and discarding
any formula that has be out of the refrigerator. It’s best to discard any formula left over from
feeding.
Activity 9
Amy Perez a mother who delivered her first baby and is on the mother–baby unit, calls the
nursery nurse into her room and expresses concern about how her daughter looks. Ms. Scott tells
the nurse that her baby’s head looks like a “banana” and is mushy to the touch, and she has
“white spots” all over her nose. In addition, there appear to be “big bluish bruises” all over her
baby’s buttocks. She wants to know what is wrong with her baby and whether these problems
will go away.
a. How should the nurse respond to Ms. Perez questions? 5pts
Ans: The nurse should address the mother’s concerns. Explain that the “blue bruises on the
buttocks” are Mongolian spots which are congenital birthmarks seen most commonly over the
lumbosacral area. The “banana” shaped head is due to the baby’s skull compressing in order to
pass through the birth canal. She should be assured that this will correct itself. The “white spots”
on the nose are white sebaceous glands called milia that are present in most newborns, and
should not be squeezed. The “mushy” head is caput succedaneum which is edema or swelling of
the scalp as a result of the delivery process. This condition is harmless.

b. What additional newborn instruction might be appropriate at this time? 5pts.

Ans: It is best for the nurse to do a complete assessment of the newborn indicating to the mom
all normal and abnormal findings to help reassure her.
c. What reassurance can be given to Ms. Perez regarding her daughter’s appearance?
Ans: The nurse can reassure the new mother that all of the conditions she pointed out with her
newborn will all resolve over time. She should be assured that they are not permanent conditions.
QUIZ 1
1. It refers to the number of maternal deaths per 100,000 live births that occur as a direct result of
reproductive process.
a. Fetal death rate
b. Perinatal death rate
c. Maternal maternity rate
d. Infant mortality rate
2. Which of the following is not included in the UN global health goals
a. Promote gender equality and empower women
b. End poverty and hunger
c. Reduce child mortality
d. Providing people all their needs to address health issues
3. Who’s theory stresses that an important role of a nurse is to help patients adapt to change
caused by illness or other stressors.
a. Dorothea Orem
b. Calista Roy
c. Patricia Benner
d. Florence Nightingale
4. Which of the following best exemplifies health promotion?
a. Teaching the women the importance of rubella immunization before pregnancy.
b. Teaching parents the importance of safeguarding their home childproofing against poisoning
c. Administering medication to a pregnant woman with diabetes
d. Encouraging a child with renal transplant to continue taking necessary medications
5. It is considered a good index of general health because it measures the quality of pregnancy
care, overall nutrition, and sanitation as well as infant health and available care.
a. Neonatal death rate
b. Infant mortality rate
c. Maternal mortality rate
d. Child morbidity rate
6. Mr. Tamado ‘s doctor as told her that her baby’s most dangerous time will be until the
perinatal
period ends. When does the perinatal period take place?
a. From the day of birth until 1 month afterward
b. During the time the infant will be on ventilator support
c. From the 20th week of pregnancy to 4 to 6 weeks after birth
d. Until the infant’s body temperature stabilizes following birth
7. Suzanne tells the nurse she’s worried she might be subfertile because both breast development
and her first menstrual period occurred later than most of her friends. To increased self esteem
and meet her learning needs, the nurse could assure her of what?
a. Adrenarche, the development of breast, typically occurs before the first menstrual period
b. Breast development, termed mamarche, is not fully complete until about 25 years.
c. The time for development of breast varies a great deal and is termed the larche.
d. Menarche the term for breast development typically occurs before 12 years of age.
8. It means helping prevent complication from illness
a. Health promotion
b. Health maintenance
c. Health restoration
d. Heath rehabilitation
9. What is the primary goal of maternal and child health nursing?
a. Achieve universal primary education
b. To reduce child mortality
c. To promote and maintain optimal family health
d. To promote gender equality and empower women
10. This is the term that refers to development of pubic and axillary hair because of androgen
stimulation.
a. Thelarche
b. Menarche
c. Adrenarche
d. Mamarche
QUIZ 2
1. A pregnant client ask the nurse about the hormone that causes milk production. The nurse tells
the client that the primary hormone that stimulates the secretion of milk is:
a. Testosterone
b. Oxytocin
c. Prolactin
d. Progesterone
2. A maternity instructor ask a nursing student to identify the hormones that are produced by
ovaries. Which of the following, if identified by the student, indicates an understanding of the
hormones produced by this endocrine gland?
a. Estrogen and progesterone
b. Follicle- stimulating hormone (FSH)
c. Luteinizing hormone (LH)
d. Oxytocin
3. A nurse is conducting a session on the process of fertilization with a group of nursing students.
The nurse midwife asks a student to identify the structure where fertilization of an ovum takes
place. Which of the following, if identified by the student, indicates an understanding of this
process?
a. fallopian tube
b. Fundus of the uterus
c. in the ovary
d. in the copus of the uterus

4. A nursing student is conducting a clinical conference regarding the hormones that are related
to pregnancy. The instructor asks the student about the function of progesterone. Which of the
following responses, if made by the student, indicates an understanding of the function of this
hormone?
a. “It softens the muscles and joints of the pelvis
b. “It is the primary hormone of milk production”
c. “It increases during pregnancy to stimulate the basal metabolic rate.”
d. “It maintains the uterine lining for implantation and relaxes all smooth muscles including the
uterus
5. A nurse is reinforcing teaching to a pregnant woman about the physiological effects and
hormone changes that occur in pregnancy. The woman asks the nurse about the purpose of
estrogen. The nurse bases the response on which of the following purpose of estrogen?
a. It maintains the uterine lining for implantation.
b. it stimulates metabolism of glucose and converts the glucose to fat
c. It prevent the involution of the corpus luteum and maintains the production of progesterone
until the placenta is formed
d. It stimulates uterine development to provide an environment for the fetus and stimulates the
breasts to prepare for lactation
6. A maternity nurse is describing the ovarian cycle to a group of nursing student to identify the
phases of the cycle. Which phase, if stated by the nursing student, indicates a need to further
research this area?
a. Follicular phase
b. ovulatory phase
c. luteal phase
d. Proliferative phase
7. A nursing student is asked to describe the size of the uterus in a nonpregnant client. Which of
the following responses, if made by the student, indicates an understanding of the anatomy of
this structure?
a. “The uterus weighs about 2 ounces.”
b. “The uterus weighs 2.2 pounds.”
c. “The uterus has a capacity of about 50ml.”
d. “The uterus is round in shape and weighs approximately 1000 grams.”
8. A nurse is collecting a data from a pregnant client. The client asks the nurse about the purpose
of the fallopian tubes. The nurse responds to the client. Knowing that the fallopian tubes:
a. Secretes estrogen and progesterone
b. Are the organ of copulation
c. Are where the fetus develops
d. Are where fertilization occurs
9. A nursing student is assigned to care for an adolescent female client in the health care clinic.
The instructor reviews the menstrual cycle with the student. The instructor determines that the
student understands the process of secretion of the follicle-stimulating hormone (FSH) and the
luteinizing hormone (LH) if the student states:
a. “FSH and LH are released from the anterior pituitary gland.”
b. “FSH and LH are secreted by the corpus luteum of the ovary.”
c. “FSH and LH are secreted by the adrenal glands.”
d.” FSH and LH stimulate the formation of milk during pregnancy.”
10. A nurse working in a prenatal clinic reviews a client’s chart and notes that the physician
documents that the client has a gynecoid pelvis. Based on this documentation, the nurse
determines that this type of pelvis is:
a. Not favorable for labor
b. Seen in 25% of women
c. A wide pelvis with a short diameter
d. The most favorable for the labor and birth
QUIZ 3
1. Amy Perez, 26 years old, is pregnant with her first child and is experiencing significant stress
following her recent diagnostic findings that the baby has a down syndrome. The nurse would
be providing high quality care if completing which of the following.
a. Provided Amy with hope and downplaying the potential for negative outcomes.
b. Referred Amy to website and journals in the field of genetics
c. Described the most serious consequences of genetic disorders
d. Described genetics in a way that directly meets her learning needs
2. Sickle cell anemia is transmitted to a child through what method?
a. The father must have the condition and the mother must have the trait.
b. The mother must have the condition and the father must have the trait.
c. Both the father and mother must have either the sickle cell trait or condition.
d. Either the father or mother can pass on the dominant gene to cause sickle cell.
3. The following disorders are related to chromosomal number abnormalities which disorder is
not.
a. Fragile X syndrome
b. Down syndrome
c. Patau syndrome
d. Turners syndrome
4. What is the reason genetic testing is performed for family members when a baby is born with
thalassemia?
a. It is important to discover the location of the gene for thalassemia so the infant can be cured.
b. Siblings are at risk for being carriers and should have this information when planning a family.
c. One parent must carry the dominant gene so the other parent may want to find a new partner
so that the thalassemia gene will not be passed on.
d. The mother can be shown the danger of passing thalassemia to her sons on the X-chromosome
and the trait to her daughters.
5. Which newborn would be at the highest risk for having Down syndrome?
a. The daughter of a woman who is 25 years old
b. The newborn who is exposed to rubella
c. The newborn who received high-caloric intake
d. The son of a woman who is 43 years old
6. The following types of genetic disorders follows X-linked recessive inheritance patterns
include which one is not.
a. Haemophilia
b. color blindness
c. Duchenne muscular dystrophy
d. Sickle cell anemia
7. The following disorders are related to structural abnormalities of chromosomes which one is
not.
a. Cri du chat syndrome
b. Fragile X syndrome
c. Patau syndrome
d. Klinefelter syndrome
8. Cleft lip, cleft palate, spina bifida, pyloric stenosis, clubfoot, developmental hip dysplasia, and
cardiac defects are considered under which type of genetic disorders.
a. Multifactorial inheritance disorders
b. Autosomal dominant inheritance
c. X- linked disorders
d. Autosomal recessive inheritance
9. Fertilization of the ovum leads to the formation of
a. Blastocyst
b. Zygote
c. Embryo
d. Thropoblast cells
10. A proteolytic enzyme released by the spermatozoa that dissolves the layer of cells protecting
the ovum.
a. Protease
b. Amylase
c. Hyaluronidase
d. Lipase
QUIZ 4
Direction: Select the terms being describe by the statement below.

Anteflexion Retroversion Thelarche Heterosexual Menarche Transgender Adrenarche

Retroflexion Transgender Bisexual Cisgender Homosexual Anteversion

1. A condition in which the body of the uterus is bent sharply forward at the junction with the
cervix.
- Anteflexion
2. This development of pubic and axillary hair because of androgen stimulation is termed.
- Adrenarche
3. When an individual feels their gender and their sex match
- Cisgender
4. A condition in which the body is bent sharply back just above the cervix.
- Retroflexion
5. A condition in which the entire uterus is tipped far forward.
- Anteversion
6. Is someone who finds sexual fulfillment with a member of his or her own sex.
- Homosexual
7. A condition in which the entire uterus is tipped backward.
- Retroversion
8. When an individual feels their gender and their sex do not match
- Transgender
9. Someone who finds sexual fulfillment with a member of the opposite gender
- Heterosexual
10. They achieve sexual satisfaction from both same-sex and heterosexual relationships.
- Bisexual

REFLECTION PAPER
This subject has increased my knowledge across most of the health education and Maternal and
Child Health (MCH) competencies, which are all of high priority to me. It broadened my
knowledge and understanding, stimulated my thinking and made me think critically, by
introducing me to new ideas. I learned that improving the well-being of mothers, infants, and
children is an important public health goal. Their well-being determines the health of the next
generation and can help predict future public health challenges for families, communities, and
the health care system. The objectives of the Maternal, Infant, and Child Health topic area
address a wide range of conditions, health behaviors, and health systems indicators that affect the
health, wellness, and quality of life of women, children, and families. I also learned that the risk
of maternal and infant mortality and pregnancy-related complications can be reduced by
increasing access to quality preconception (before pregnancy), prenatal (during pregnancy), and
interconception (between pregnancies) care. Moreover, healthy birth outcomes and early
identification and treatment of developmental delays and disabilities and other health conditions
among infants can prevent death or disability and enable children to reach their full potential.
Furthermore, the determinants that influence maternal health also affect pregnancy outcomes and
infant and child health. Racial and ethnic disparities exist in infant mortality and can be partly
attributed to disparities in social determinants of health. I also learned that child health status
varies by both race and ethnicity, as well as by family income and related factors, including
educational attainment among household members and health insurance coverage. Child health
status and well-being can also be influenced by access to high-quality health care, such as that
received through a medical home and maternity care practices that promote breastfeeding18 and
safe sleep environments. Meanwhile, the cognitive and physical development of infants and
children may be influenced by the health, nutrition, and behaviors of their mothers during
pregnancy and early childhood. Consumption of recommended amounts of folic acid before and
during pregnancy can reduce the risk for neural tube defects. Breast milk is widely
acknowledged to be the most complete form of nutrition for most infants, with a range of
benefits for their health, growth, immunity, and development. Furthermore, children reared in
safe and nurturing families and neighborhoods, free from maltreatment and other adverse
childhood experiences, are more likely to have better outcomes as adults.