3rd Year GNM Nursing KARNATAKA MIDWIFERY AND GYNAECOLOGICAL NURSING DECEMBER 2024
KARNATAKA STATE DIPLOMA IN NURSING EXAMINATION BOARD
GNM THEORY EXAMINATION – DECEMBER 2024
3rd YEAR - BEHAVIOURAL SCIENCES - PAPER – II
(MIDWIFERY AND GYNAECOLOGICAL NURSING)
I. Give the meaning of the following
Answer :
1. Zygote
- A zygote is the fertilized
ovum (egg) formed when the male sperm unites with the female ovum.
- It is the first stage of
human development after fertilization.
2. Lie
- Lie refers to the relationship
of the long axis of the fetus to the long axis of the mother’s uterus.
- Types:
- Longitudinal Lie – fetus parallel to
mother’s spine
- Transverse Lie – fetus lies sideways
- Oblique Lie – fetus is at an angle
3. Bregma
- Bregma is the anterior
fontanelle of the fetal skull.
- It is the point where coronal
and sagittal sutures meet.
4. Lochia
- Lochia is the vaginal
discharge after childbirth.
- It contains blood, mucus,
and uterine tissue.
- Types:
- Lochia rubra (red) –
1–3 days
- Lochia serosa
(pinkish/brown) – 4–10 days
- Lochia alba
(whitish) – after 10 days up to 6 weeks
II. Fill in the blanks
Answer :
5. The normal length of umbilical cord is 50 cms.
6. Craving for special food items during pregnancy
is called as Pica.
7. Excessive liquor amnii is called as Polyhydramnios.
8. Partograph is the graphic representation
to assess the progress of labour.
III. Write short notes for any FOUR of the following
Answer :
9. Fetal Circulation
- Fetal circulation is the
blood circulation in the fetus before birth.
- The placenta acts as lung,
kidney & GIT for gaseous exchange, waste removal & nutrition.
- Oxygenated blood enters
fetus through the umbilical vein.
- Important fetal shunts:
- Foramen Ovale – between right & left
atrium
- Ductus Arteriosus – connects pulmonary
artery to aorta
- Ductus Venosus – connects umbilical vein
to inferior vena cava
- Deoxygenated blood returns
to placenta via umbilical arteries.
- After birth these shunts
close, and normal circulation begins.
10. Exclusive Breastfeeding
- Exclusive breastfeeding
means giving only breast milk to the baby — no other food, water or
formula, except medicines if needed.
- Recommended for first 6
months of life by WHO.
- Benefits to baby: provides
immunity, prevents infections, reduces diarrhea & malnutrition, ideal
composition.
- Benefits to mother: helps
uterine involution, reduces postpartum bleeding, prevents breast cancer,
natural contraception (LAM).
- Colostrum is rich in
antibodies (IgA) & should not be discarded.
11. Ectopic Pregnancy
- It is implantation of
fertilized ovum outside the uterine cavity.
- Most common site = fallopian
tube (ampulla).
- Risk factors: PID, tubal
surgery, previous ectopic pregnancy, IUD use, infertility treatment.
- Symptoms: amenorrhea,
abdominal pain, vaginal spotting, shoulder tip pain (if rupture/bleeding).
- Management:
- Medical – Methotrexate
- Surgical – salpingectomy /
salpingostomy
- It is a life-threatening
emergency due to risk of rupture & hemorrhage.
12. Genetic Counseling
- Genetic counseling is
educating and guiding individuals/families about hereditary disorders.
- Aim: prevent genetic
diseases & help in informed decision making.
- Done before marriage (premarital),
antenatal, and in couples with history of congenital anomalies.
- Involves:
- risk assessment
- genetic screening / testing
- explanation of inheritance
patterns
- Helps in prevention of
chromosomal disorders like Down syndrome, Thalassemia, hemophilia etc.
13. Minor Disorders in Pregnancy
- These are common
discomforts that occur due to physiological changes in pregnancy.
- Examples:
- Nausea & vomiting
- Heartburn
- Constipation
- Leg cramps
- Backache
- Oedema of feet
- Varicose veins
- Management is mainly
supportive:
- small frequent meals, avoid
spicy foods (for N&V)
- high fiber diet &
fluids (for constipation)
- proper posture &
exercise (for backache)
- avoid prolonged standing
(for varicose veins)
- Nurse gives health education
& reassurance.
IV. Answer the following
V. State the following statement is True / False
Answer :
14. Define Fertilization (1 mark)
Fertilization is the process by which the male sperm unites with the female
ovum to form the zygote.
15. What are the abnormalities of
placenta? (2 marks)
Common abnormalities:
·
Placenta previa
·
Abruptio placentae
·
Placenta succenturiata
·
Battledore placenta
·
Circumvallate placenta
·
Adherent placenta (accreta / increta / percreta)
·
Vasa praevia
16. Functions of Placenta (4 marks)
Functions of Placenta:
1. Respiratory
function – exchange of oxygen & carbon dioxide
2. Nutrition
– transfer of glucose, amino acids, fatty acids, vitamins
3. Excretory
– removal of fetal waste (urea, uric acid)
4. Protective
– maternal antibodies (IgG) pass to fetus → immunity
5. Endocrine
function – secretes hormones like
o
hCG
o
hPL
o
Estrogen
o
Progesterone
6. Storage
– stores glycogen, iron etc.
7. Barrier
function – prevents some infections/toxins (though few cross)
17. Define Mechanism of Labour (2
marks)
Mechanism of labour refers to the series of positional changes
of the fetus during passage through the birth canal during labour.
18. Explain Normal Mechanism of Labour
(5 marks)
Normal mechanism of labour in vertex presentation includes the following
steps:
1. Engagement
– biparietal diameter enters pelvic inlet
2. Descent
– fetal head moves downward into pelvis
3. Flexion
– fetal chin moves to chest, presenting the smallest diameter
4. Internal
Rotation – occiput rotates anteriorly toward symphysis pubis
5. Extension
– head is born by extension at perineum
6. Restitution
– head realigns with shoulders
7. External
Rotation – shoulders rotate to AP diameter of pelvis
8. Expulsion
– delivery of shoulders and then whole body
VI. Write short notes for any THREE of the following
Answer :
23. Preterm Labour
- Preterm labour is onset of
labour before 37 completed weeks of gestation.
- Causes:
- Infection (UTI, vaginitis)
- Multiple pregnancy
- Polyhydramnios
- Cervical incompetence
- Placenta previa / Abruptio
placentae
- Signs & symptoms:
- Uterine contractions
- Pelvic pressure
- Low backache
- Cervical effacement &
dilatation
- Management:
- Bed rest / Hydration
- Tocolytics (Nifedipine,
Isoxsuprine) to stop contractions
- Steroids (Betamethasone) to
mature fetal lungs
- Treat underlying infection
24. Oxytocin
- Oxytocin is a hormone
secreted by the posterior pituitary gland.
- It stimulates uterine
contractions during labour and helps in milk ejection reflex during
breastfeeding.
- Uses in obstetrics:
- Induction and augmentation
of labour
- Control of postpartum
hemorrhage
- To help uterine involution
after delivery
- Nursing considerations:
- Give as IV infusion with
monitoring
- Watch for hypertonic contractions
- Monitor fetal heart rate
- Side effects: uterine
hyperstimulation, fetal distress, water intoxication (rare)
25. Breast Abscess
- Breast abscess is a
localized collection of pus within breast tissue.
- Commonly occurs in lactating
women due to cracked nipples → infection (Staphylococcus aureus).
- Symptoms:
- Painful, swollen lump in
breast
- Fever
- Tenderness, redness, warmth
- Management:
- Antibiotics
- Incision & drainage
(I&D)
- Supportive bra
- Continue breastfeeding from
unaffected breast (or express milk)
- Nurse gives hygiene
education and nipple care to prevent recurrence.
26. MTP Act 1971
- MTP = Medical Termination of
Pregnancy.
- Law passed in India in 1971,
amended 2021.
- Legal indications for MTP:
- Risk to mother’s life
(medical)
- Rape pregnancy
- Contraceptive failure
(married & now includes unmarried)
- Fetal abnormalities
- Legal gestational age limit:
- Up to 20 weeks
(general)
- Up to 24 weeks for
special categories (amendment 2021)
- Procedure must be done by a registered
medical practitioner in approved place.
VII. Answer the following
Answer :
27. Define Uterine Prolapse & list
the types (3 marks)
Definition:
Uterine prolapse is the downward displacement of the uterus
from its normal position into the vagina due to weakness of pelvic floor
muscles & ligaments.
Types / Degrees:
1. 1st
degree – uterus descends but cervix remains inside vagina
2. 2nd
degree – cervix appears at the vaginal opening
3. 3rd
degree (procidentia) – uterus lies completely outside the vaginal
opening
28. Management of patient with
hysterectomy (4 marks)
Pre-operative care
·
Explain procedure & reduce anxiety
·
Baseline investigations (Hb, coagulation, ECG,
USG)
·
Bowel preparation
·
Shaving perineal area & bladder emptying
Post-operative care
·
Monitor vital signs, bleeding & drainage
·
Maintain fluid & electrolyte balance
·
Pain relief & antibiotics as ordered
·
Early ambulation to prevent DVT
·
Perineal hygiene & catheter care
·
Health education: avoid heavy lifting, sexual
rest for 6 weeks
29. Define breech presentation (3
marks)
Breech presentation is a fetal presentation where the buttocks or
feet are presenting at the lower pole of the uterus instead of the
head.
Types:
·
Frank breech
·
Complete / flexed breech
·
Footling breech
30. Nursing management for mother with
breech presentation (4 marks)
·
Admit & observe → assess fetal heart rate,
uterine contractions
·
Position mother in left lateral to improve
placental circulation
·
Prepare for external cephalic version (if
indicated & before labour)
·
Prepare mother for assisted breech delivery /
Cesarean section if necessary
·
Keep neonatal resuscitation equipment ready
(risk of asphyxia)
·
Emotional support, reassurance & explanation
of procedure
·
During labour → monitor labour progress, avoid
premature pushing
