# Situation: A nurse works in the labor room of a government birthing facility that provides basic emergency obstetric and newborn care (BEmONC). Two midwives and a nursing attendant share the night shift with the nurse. A new midwife asks when a registered nurse may perform an internal examination on a woman in labor. Under the Philippine Nursing Act of 2002 (RA 9173), what condition applies to this nursing function?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629406  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the labor room of a government birthing facility that provides basic emergency obstetric and newborn care (BEmONC). Two midwives and a nursing attendant share the night shift with the nurse.

A new midwife asks when a registered nurse may perform an internal examination on a woman in labor. Under the Philippine Nursing Act of 2002 (RA 9173), what condition applies to this nursing function?

## 보기

1. Only when a physician is present in the facility
2. Only after the membranes have ruptured
3. Only in the absence of antenatal bleeding **✔ 정답**
4. Only after the pregnancy has reached 37 weeks

**정답: 3**

## 해설

The Philippine Nursing Act of 2002 (RA 9173) includes in the scope of nursing practice the internal examination during labor in the absence of antenatal bleeding, and delivery. Bleeding before birth may come from a low-lying placenta, where a vaginal examination could provoke severe hemorrhage, so such a woman needs medical evaluation instead.

## 심화 해설

The question asks about the legal condition under which a registered nurse may perform an internal examination during labor, as defined by the Philippine Nursing Act of 2002 (RA 9173). The correct answer is that this function may be performed only in the absence of antenatal bleeding.

The scope of nursing practice under RA 9173 explicitly includes the performance of an internal examination during labor, but it attaches a critical safety qualifier: the woman must not be experiencing antenatal bleeding. This is not an arbitrary restriction. The underlying clinical rationale is that vaginal bleeding before or during early labor can signal a low-lying placenta or placenta previa. In such cases, the placenta is implanted over or very near the cervical os. Inserting fingers or instruments through the cervix during a vaginal examination can disrupt this placental tissue and provoke severe, potentially life-threatening hemorrhage. Therefore, a woman with antenatal bleeding requires prompt medical evaluation and management by a physician, not a routine nursing internal examination.

The other options do not reflect the legal condition in RA 9173. The presence of a physician is not required for the nurse to perform this delegated nursing function. Rupture of membranes is not a prerequisite; in fact, an internal examination is often performed precisely to assess cervical dilation and effacement before or after membrane rupture. Likewise, reaching 37 weeks of gestation is not a legal condition for the examination itself, as the procedure may be indicated earlier in certain clinical situations, provided there is no bleeding.

Key point! The qualifier “in the absence of antenatal bleeding” is the only condition specified in RA 9173 for a nurse performing an internal examination during labor. Watch out! Do not confuse this with the conditions for other obstetric nursing functions, such as the administration of oxytocin or the conduct of delivery, which may carry different legal or institutional requirements. The presence of bleeding changes the clinical picture entirely, shifting the priority from routine labor assessment to emergency evaluation for placental pathology.

The provided reference materials do not contain data on Philippine nursing law or obstetric examination protocols, so they do not alter or expand the core legal and clinical explanation. The conclusion remains grounded in the statutory language and the pathophysiologic risk associated with vaginal examination in the context of antepartum hemorrhage.

## 임상 시나리오

Safe Internal Examination in LaborRA 9173 Legal Condition and Clinical Safety
Under RA 9173, a registered nurse may perform an internal examination during labor only in the absence of antenatal bleeding.

Antenatal bleeding may indicate placenta previa or a low-lying placenta, where vaginal examination can provoke severe hemorrhage.

CautionAny woman with antenatal bleeding needs prompt medical evaluation by a physician, not a routine nursing internal examination.

## 핵심 개념

- **RA 9173** — Philippine Nursing Act of 2002 defining scope of nursing practice, including internal examination during labor in the absence of antenatal bleeding.
- **Antenatal bleeding** — Vaginal bleeding before or during early labor that may indicate placenta previa and contraindicates routine vaginal examination by a nurse.
- **Placenta previa** — Placenta implanted over or near the cervical os; vaginal examination can provoke severe hemorrhage.
- **Internal examination** — Vaginal examination during labor to assess cervical dilation and effacement, permitted for nurses under RA 9173 only without antenatal bleeding.
- **BEmONC** — Basic Emergency Obstetric and Newborn Care; a facility level providing essential obstetric interventions.

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