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,TEST BANK FOR Maternity, Newborn, and Women's Health Nursing: A Case-
Based Approach First Edition by Dr. Amy O'Meara
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Table of Contents
Chapter 1 Immediate Postpartum Hemorrhage
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Chapter 2 Later Postpartum Hemorrhage
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Chapter 3 Gestational Diabetes, Deep Vein Thrombosis, and Postpartum Pulmonary Embolism
Chapter 4 Preeclampsia
Chapter 5 Cord Prolapse and Nonreassuring Fetal Status
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Chapter 6 Placental Abruption and Fetal Loss
Chapter 7 Chorioamnionitis and Neonatal Sepsis
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Chapter 8 Preterm Premature Rupture of Membranes and Neonatal Respiratory Distress
Syndrome
Chapter 9 Gestational Diabetes, Macrosomia, and Neonatal Cephalhematoma
Chapter 10 Advanced Maternal Age, HELLP Syndrome, and Neonatal Necrotizing Enterocolitis
Chapter 11 Migraine With Aura, Shoulder Dystocia, and Brachial Plexus Palsy
Chapter 12 Intimate Partner Violence, Formula Feeding, and Postpartum Depression
Chapter 13 Gestational Trophoblastic Disease (Molar Pregnancy) and Advanced Maternal Age
Chapter 14 Before Conception
Chapter 15 Pregnancy
Chapter 16 Labor and Delivery
,Chapter 17 After Delivery
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,Chapter 18 The Newborn
Chapter 19 Conditions Existing Before Conception
Chapter 20 Conditions Occurring During Pregnancy
Chapter 21 Complications Occurring Before Labor and Delivery
Chapter 22 Complications Occurring During Labor and Delivery
Chapter 23 Conditions Occurring After Delivery
Chapter 24 Conditions in the Newborn Related to Gestational Age, Size, Injury, and Pain
Chapter 25 Acquired Conditions and Congenital Abnormalities in the Newborn
Chapter 26 Wellness and Health Promotion Chapter
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27 Common Gynecologic ConditionsChapter 28
Infections
Chapter 29 Family Planning Chapter 30
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Vulnerable Populations
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,Complete Test Bank with Questions and Answers
Chapter 1: Immediate Postpartum Hemorrhage
MULTIPLE CHOICE
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
Which information regarding postprocedural care should the nurse 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 sho
c. The client will need to make arrangements for care at home, because her activity level will be re
d. The client will be scheduled for a cesarean birth.
ANS: B
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
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 at37 weeks of
gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
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TOP: Nursing Process: Planning | Nursing Process: ImplementationMSC:
Client Needs: Health Promotion and Maintenance
2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
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secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next
12 months. What is the bestresponse by the nurse?
If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore,
a. pregnancy, it would be better for you to use the most reliable method of contraception available.
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only byhormone
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that your body produces during pregnancy. If you were to get pregnant, then it would
b. this cancer more difficult.
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregna
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c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar p
ANS: B
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 humanchorionic
gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscurethe 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 exceptan
intrauterine device (IUD) is acceptable.
DIF: Cognitive Level: Apply REF: dm. 679
TOP: Nursing Process: Planning | Nursing Process: ImplementationMSC:
Client Needs: Physiologic Integrity
3. The nurse 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 pregnancy
d. Abruptio placentae
ANS: C
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 isnot
indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed
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abortion, or for abruptio placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: PlanningMSC:
Client Needs: Physiologic Integrity
4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
procedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity
b. Transvaginal ultrasound for placental location
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c. Contraction stress test (CST)
d. Internal fetal monitoring
ANS: B
The presence of painless bleeding should always alert the health care team to the possibility of
placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on
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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
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contraindication to a CST. Internal fetal monitoring is also contraindicated in the presence of bleeding.
DIF: Cognitive Level: Apply REF: dm. 680
TOP: 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 nurse should suspect the possibility of what condition?
a. Placenta previa
b. Vasa previa
c. Severe abruptio placentae
, d. Disseminated intravascular coagulation (DIC)
ANS: B
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. Thesudden
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 nurse 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 isa 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 TOP: Nursing Process: DiagnosisMSC:
Client Needs: Physiologic Integrity
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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 nurse notices an ecchymotic
blueness around the womans umbilicus. What does this finding indicate?
a. Normal integumentary changes associated with pregnancy
b. Turner sign associated with appendicitis
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c. Cullen sign associated with a ruptured ectopic pregnancy
d. Chadwick sign associated with early pregnancy
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ANS: C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
abdomen 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
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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
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TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. The nurse 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 causiIf a
miscarriage occurs before the 12th week of pregnancy, then it may be observed only as mod
d. blood loss.
ANS: D
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,more
severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
,occurs, by definition, before 20 weeks of gestation, before the fetus is viable. Miscarriages occurin
approximately 10% to 15% of all clinically recognized pregnancies. Miscarriages can be caused by a
number of disorders or illnesses outside the mothers control or knowledge.
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TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
8. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which
differential diagnosis would not be applicable for this client?
a. Placenta previa
b. Abruptio placentae
c. Spontaneous abortion
d. Cord insertion
ANS: C
Spontaneous abortion is another name for miscarriage; it occurs, by definition, early in
pregnancy. Placenta previa is a well-known reason for bleeding late in pregnancy. The premature
separation of the placenta (abruptio placentae) is a bleeding disorder that can occur late in pregnancy.
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Cord insertion may cause a bleeding disorder that can also occur late in pregnancy.
DIF: Cognitive Level: Understand REF: dm. 669TOP:
Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity, Physiologic Adaptation
9. With regard to hemorrhagic complications that may occur during pregnancy, what information
is most accurate?
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a. An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies
b. Incidences of ectopic pregnancy are declining as a result of improved diagnostic techniques.
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c. One ectopic pregnancy does not affect a womans fertility or her likelihood of having a normal p
d. Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic mali
ANS: A
Short labors and recurring losses of pregnancy at progressively earlier gestational ages are
characteristics of reduced cervical competence. Because diagnostic technology is improving,more
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ectopic pregnancies are being diagnosed. One ectopic pregnancy places the woman at increased
risk for another one. Ectopic pregnancy is a leading cause of infertility. Once invariably fatal, GTN
now is the most curable gynecologic malignancy.
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DIF: Cognitive Level: Understand REF: dm. 675
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
10. The management of the pregnant client who has experienced a pregnancy loss depends on the
type of miscarriage and the signs and symptoms. While planning care for a client who desires
outpatient management after a first-trimester loss, what would the nurse expect the plan to include?
a. Dilation and curettage (D&C)
b. Dilation and evacuation (D&E)
c. Misoprostol
d. Ergot products
ANS: C
, Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of
misoprostol for up to 2 days. If the bleeding is uncontrollable, vital signs are unstable, or signs of
infection are present, then a surgical evacuation should be performed. D&C is a surgical procedure that
requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy.
This procedure is commonly performed to treat inevitable or incomplete abortion and should be
performed in a hospital. D&E is usually performed after 16 weeks of pregnancy. The cervix is widely
dilated, followed by removal of the contents of the uterus. Ergotproducts such as Methergine or
Hemabate may be administered for excessive bleeding after miscarriage.
DIF: Cognitive Level: Apply REF: dm. 672 TOP: Nursing Process: PlanningMSC:
Client Needs: Physiologic Integrity
11. Which laboratory marker is indicative of DIC?
a. Bleeding time of 10 minutes
b. Presence of fibrin split products
c. Thrombocytopenia
d. Hypofibrinogenemia
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ANS: B
Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the bodys
vasculature. Bleeding time in DIC is normal. Low platelets may occur but are not indicative of DIC
because they may be the result from other coagulopathies. Hypofibrinogenemia occurs withDIC.
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12. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of
gestation)?
a. 12 to 14
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b. 6 to 8
c. 23 to 24
d. After 24
ANS: A
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A prophylactic cerclage is usually placed at 12 to 14 weeks of gestation. The cerclage is
electively removed when the woman reaches 37 weeks of gestation or when her labor begins. Sixto 8
weeks of gestation is too early to place the cerclage. Cerclage placement is offered if the cervical
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length falls to less than 20 to 25 mm before 23 to 24 weeks. Although no consensus has been reached,
24 weeks is used as the upper gestational age limit for cerclage placement.
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Client Needs: Health Promotion and Maintenance
13. In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her
intravenous (IV) site. The client would be closely monitored for which clotting disorder?
a. DIC
b. Amniotic fluid embolism (AFE)
c. Hemorrhage
