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MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING A CASE-BASED APPROACH 2ND EDITION O’MEARA’S TEST BANK
MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING A CASE-BASED APPROACH 2ND EDITION O’MEARA’S TEST BANK
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MATERNITY NEWBORN AND WOMEN’S HEALTHNURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
,Chapter: 1 Immediate Postpartum Hemorrhage
MULTIPLE CHOICE
1. An expectant woman is being discharged from the health center after the placement
of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an
incompetent cervix. Which information regarding post procedural care should the caregiver
emphasize in the discharge teaching?
a. Any vaginal discharge should be immediately reported to her health care provider.
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal
pressure should be reported
c. The patient will need to make arrangements for care at home, because her activity
level will be restricted
d. The patient will be scheduled for a cesarean birth.
RIGHT CHOICE:-B
Rationale :->>>>Nursing care should stress the importance of monitoring for the signs and
symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care
provider. Bed rest is an element of care. However, the woman may stand for periods of up to
90 minutes, which allows her the freedom to see her physician. Home uterine activity
monitoring may be used to limit the womans need for visits and to monitor her status safely at
home. The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or
a cesarean birth can be planned.
DIF: Cognitive Level: Apply REF: dm. 675
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Patient Needs:
HealthPromotion and Maintenance
2. A perinatal caregiver is giving discharge instructions to a woman, status postsuction,
and curettage secondary to a hydatidiform mole. The woman asks why she must take oral
contraceptives for the next 12 months. What is the best response by the caregiver?
a. If you get expectant within 1 year, the chance of a successful pregnancy is very
small. Therefore, if pregnancy, it would be better for you to use the most reliable method
of contraception available.
b. The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only
by me hormone that your body produces during pregnancy. If you were to get expectant, then
itwould make this cancer more difficult.
c. If you can avoid a pregnancy for the next year, the chance of developing a second molar
pregnancy improve your chance of a successful pregnancy, not getting expectant at this time
isbest.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a
molar pregnancy
RIGHT CHOICE:-B
Rationale :->>>>Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for
1 year to ensure that the mole is completely gone. The chance of developing choriocarcinoma
after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a
zero
,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
may obscure the presence of the potentially carcinogenic cells. Women should be instructed to
use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding
pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive
method except an intrauterine device (IUD) is acceptable.
DIF: Cognitive Level: Apply REF: dm. 679
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Patient Needs:
Physiologic Integrity
3. The caregiver is preparing to administer methotrexate to the patient. This hazardous
drug is most often used for which obstetric complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentae
RIGHT CHOICE:-C
Rationale :->>>>Methotrexate is an effective nonsurgical treatment option for a
hemodynamically stable woman whose ectopic pregnancy is unruptured and measures less than
4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a
complete hydatidiform mole, for amissed abortion, or for abruptio placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Patient
Needs: Physiologic Integrity
4. A 26-year-old expectant woman, gravida 2, para 1-0-0-1, is 28 weeks expectant when
she experiences bright red, painless vaginal bleeding. On her arrival at the health center,
which diagnostic procedure will the patient most likely have performed?
a. Amniocentesis for fetal lung maturity
b. Transvaginal ultrasound for placental location
c. Contraction stress test (CST)
d. Internal fetal monitoring
RIGHT CHOICE:-B
Rationale :->>>>The presence of painless bleeding should always alert the health care team
to the possibility ofplacenta previa, which can be confirmed through ultrasonography.
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an
imminent delivery, the fetus is presumed to have immature lungs at this gestational age, and
the mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a
preterm gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal
monitoring is also contraindicated in the presence of bleeding.
DIF: Cognitive Level: Apply REF: dm. 680
TOPIC Nursing Process: Assessment MSC: Patient Needs: Health Promotion and Maintenance
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM.
The fluid consists of bright red blood. Her contractions are consistent with her current stage of
labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to
decline rapidly after the ROM. The caregiver should suspect the possibility of what condition?
a. Placenta previa
, b. Vasa previa
c. Severe abruptio placentae
d. Disseminated intravascular coagulation (DIC)
RIGHT CHOICE:-B
Rationale :->>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. The
umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The
umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs most
frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a
sudden change in the FHR without other known risk factors should immediately alert the
caregiver to the possibility of vasa previa. The presence of placenta previa most likely would
be ascertained before labor and is considered a risk factor for this pregnancy. In addition, if the
woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a
vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity typically is
tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes
large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or
both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as
the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. This
woman did not have any prior risk factors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: Patient
Needs: Physiologic Integrity
6. A woman arrives for evaluation of signs and symptoms that include a missed period,
adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the caregiver
noticesan ecchymotic blueness around the womans umbilicus. What does this finding
indicate?
a. Normal integumentary changes associated with pregnancy
b. Turner sign associated with appendicitis
c. Cullen sign associated with a ruptured ectopic pregnancy
d. Chadwick sign associated with early pregnancy
RIGHT CHOICE:-C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
Rationale :->>>>associated with an undiagnosed ruptured intraabdominal ectopic pregnancy.
Linea nigra on theabdomen is the normal integumentary change associated with pregnancy
and exhibits a brown pigmented, vertical line on the lower abdomen. Turner sign is
ecchymosis in the flank area, often associated with pancreatitis. A Chadwick sign is a blue-
purple cervix that may be seen during or around the eighth week of pregnancy.
DIF: Cognitive Level: Analyze REF: dm. 676
TOPIC Nursing Process: Assessment MSC: Patient Needs: Physiologic Integrity
7. The caregiver who elects to practice in the area of womens health must have a
thorough understanding of miscarriage. Which statement regarding this condition is most
accurate?
a. A miscarriage is a natural pregnancy loss before labor begins.
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor
in causing miscarriage
d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as
moderate blood loss
RIGHT CHOICE:-D
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