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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 gestation/pregnancy loss, secondary
to an incompetent cervix. Which information regarding post procedural care should the
nursing attendantemphasize 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 client will need to make arrangements for care at home, because her activity
level will be restricted
d. The client will be scheduled for a cesarean birth.
ACCURATE CHOICE:-B
Reasoning:->>>>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: Client Needs:
HealthPromotion and Maintenance
2. A perinatal nursing attendant 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 nursing
attendant?
a. If you get expectant within 1 year, the chance of a successful gestation/pregnancy is
very small. Therefore, if gestation/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 gestation/pregnancy is a type of cancer that can be
diagnosed only by me hormone that your body produces during gestation/pregnancy. If you
were to get expectant, then itwould make this cancer more difficult.
c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a
second molar gestation/pregnancy improve your chance of a successful gestation/pregnancy,
not getting expectant at this timeisbest.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a
molar gestation/pregnancy
ACCURATE CHOICE:-B
Reasoning:->>>>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
gestation/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: Client Needs:
Physiologic Integrity
3. The nursing attendant is preparing to administer methotrexate to the client. This
hazardous drug is most often used for which obstetric complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic gestation/pregnancy
d. Abruptio placentae
ACCURATE CHOICE:-C
Reasoning:->>>>Methotrexate is an effective nonsurgical treatment option for a
hemodynamically stable woman whose ectopic gestation/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: Client 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 client 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
ACCURATE CHOICE:-B
Reasoning:->>>>The presence of painless bleeding should always alert the health care
teamto 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: Client 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 nursing attendant should suspect the possibility of what
condition?
a. Placenta previa
, b. Vasa previa
c. Severe abruptio placentae
d. Disseminated intravascular coagulation (DIC)
ACCURATE CHOICE:-B
Reasoning:->>>>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
nursing attendant to the possibility of vasa previa. The presence of placenta previa most likely
would be ascertained before labor andis considered a risk factor for this gestation/pregnancy.
In addition, if thewoman had a placenta previa, itis 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: Client
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 nursing
attendant noticesan ecchymotic blueness around the womans umbilicus. What does this
finding indicate?
a. Normal integumentary changes associated with gestation/pregnancy
b. Turner sign associated with appendicitis
c. Cullen sign associated with a ruptured ectopic gestation/pregnancy
d. Chadwick sign associated with early
gestation/pregnancy ACCURATE CHOICE:-C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
Reasoning:->>>>associated with an undiagnosed ruptured intraabdominal ectopic
gestation/pregnancy.Linea nigra on theabdomen is the normal integumentary change
associated with gestation/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 gestation/pregnancy.
DIF: Cognitive Level: Analyze REF: dm. 676
TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. The nursing attendant who elects to practice in the area of womens health must
have a thorough understanding of miscarriage. Which statement regarding this condition
is mostaccurate?
a. A miscarriage is a natural gestation/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 gestation/pregnancy, then it may be
observed only asmoderate blood loss
ACCURATE CHOICE:-D
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