, Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition ji ji ji ji ji ji ji ji ji ji
O’Meara Test Bank ji ji
Chapter 1 Immediate Postpartum Hemorrhage ji ji ji ji
MULTIPLE CHOICE ji
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
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cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent
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cervix.Which information regarding postprocedural care should the nurse emphasize in the
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dischargeteaching?
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a. Any vaginal discharge should be immediately reported to her health care provider. ji ji ji ji ji ji ji ji ji ji ji
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure shoul
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c. The client will need to make arrangements for care at home, because her activity level will be restr
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d. The client will be scheduled for a cesarean ji ji ji ji ji ji ji
birth.ANS: B
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Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
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labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
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element of care. However, the woman may stand for periods of up to 90 minutes, which allows
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her the freedom to see her physician. Home uterine activity monitoring may be used to limit the
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womans need for visits and to monitor her status safely at home. The cerclage can be removed
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at37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
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DIF: Cognitive Level: Apply REF: dm. 675
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TOP: Nursing Process: Planning | Nursing Process:
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ImplementationMSC: Client Needs: Health Promotion and
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Maintenance
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2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and
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curettagesecondary to a hydatidiform mole. The woman asks why she must take oral
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contraceptives for the next 12 months. What is the bestresponse by the nurse?
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If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if
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a. pregnancy, it would be better for you to use the most reliable method of contraception available. ji ji ji ji ji ji ji ji ji ji ji ji ji ji ji
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by me
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hormone that your body produces during pregnancy. If you were to get pregnant, then it would ma
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b. this cancer more difficult. ji ji ji
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy
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c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
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d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar ji ji ji ji ji ji ji ji ji ji ji ji ji ji ji ji
pregANS: B
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Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
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that the mole is completely gone. The chance of developing choriocarcinoma after the
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development of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human
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chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may
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obscurethe presence of the potentially carcinogenic cells. Women should be instructed to use birth
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control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy
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,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method
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exceptan intrauterine device (IUD) is acceptable.
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DIF: Cognitive Level: Apply REF: dm. 679
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TOP: Nursing Process: Planning | Nursing Process:
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ImplementationMSC: Client Needs: Physiologic Integrity
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3. The nurse is preparing to administer methotrexate to the client. This hazardous
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drugis most often used for which obstetric complication?
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a. Complete hydatidiform mole ji ji
b. Missed abortion ji
c. Unruptured ectopic pregnancy ji ji
d. Abruptio
placentaeANS: C
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Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman ji ji ji ji ji ji ji ji ji ji ji
whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate
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isnot indicated or recommended as a treatment option for a complete hydatidiform mole, for a
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missed abortion, or for abruptio placentae.
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DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process:
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PlanningMSC: Client Needs: Physiologic Integrity
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4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
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experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which
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diagnosticprocedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity ji ji ji ji
b. Transvaginal ultrasound for placental location ji ji ji ji
c. Contraction stress test (CST) ji ji ji
d. Internal fetal ji
monitoringANS: B
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The presence of painless bleeding should always alert the health care team to the possibility of
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placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not
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performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the
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fetus is presumed to have immature lungs at this gestational age, and the mother is given
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corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational
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age.Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also
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contraindicated in the presence of bleeding.
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DIF: Cognitive Level: Apply REF: dm. 680
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TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
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5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
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fluid consists of bright red blood. Her contractions are consistent with her current stage of
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labor.No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
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rapidly after the ROM. The nurse should suspect the possibility of what condition?
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a. Placenta previa ji
b. Vasa previa ji
c. Severe abruptio placentae ji ji
, d. Disseminated intravascular coagulation ji ji
(DIC)ANS: B
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Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels
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are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels
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thus are at risk for laceration at any time, but laceration occurs most frequently during ROM.
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Thesudden appearance of bright red blood at the time of ROM and a sudden change in the FHR
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without other known risk factors should immediately alert the nurse to the possibility of vasa
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previa. The presence of placenta previa most likely would be ascertained before labor and is
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considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is
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unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe
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abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC isa
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pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
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widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
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often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels,
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and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process:
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DiagnosisMSC: Client Needs: Physiologic Integrity
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6. A woman arrives for evaluation of signs and symptoms that include a missed period,
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adnexalfullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
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ecchymotic blueness around the womans umbilicus. What does this finding indicate?
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a. Normal integumentary changes associated with pregnancy ji ji ji ji ji
b. Turner sign associated with appendicitis ji ji ji ji
c. Cullen sign associated with a ruptured ectopic pregnancy ji ji ji ji ji ji ji
d. Chadwick sign associated with early ji ji ji ji
pregnancyANS: C
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Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
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associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
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abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
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pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area,
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oftenassociated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen
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during or around the eighth week of pregnancy.
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DIF: Cognitive Level: Analyze REF: dm. 676
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TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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7. The nurse who elects to practice in the area of womens health must have a thorough
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understanding of miscarriage. Which statement regarding this condition is most accurate?
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a. A miscarriage is a natural pregnancy loss before labor begins. ji ji ji ji ji ji ji ji ji
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
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c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing
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a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as modera
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d. blood loss. ji
ANS: D ji
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,
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more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
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