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M a t e r n i t y , N e w b o r n , a n d W o m e n ' s H e a l t h N u r s i n g A C a s e - B a s e d A p p r o a c h 1 s t E d i t i o n
Complete Test bank, All Chapters are included. WWW.THENURSINGMASTERY.COMMaternity Newborn and Women’s Health Nursing A Case -Based Approach 1st Edition O’Meara Test Bank 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 heal th care provider.
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be 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.
ANS: B 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
TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 2. A perinatal nurse 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 bestresponse by the nurse?
a. If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you 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 meas hormone that your body produces during pregnancy. If you were to get pregnant, then it would make this cancer more difficult. c. If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is
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 pregnancy.
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 human chorionic gonadotropin (hCG) level. If the woman were to become pregnant, 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 More Nursing Materials Visit: WWW.NURSYLAB.COM Page 1 of 584 WWW.THENURSINGMASTERY.COMfor 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 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: 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 is not indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed abortion, or for abruptio placentae. DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: Planning MSC: 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?
a. Amniocentesis for fetal lung maturity
b. Transvaginal ultrasound for placental location
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 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 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 placentaeFor More Nursing Materials Visit: WWW.NURSYLAB.COM Page 2 of 584 WWW.THENURSINGMASTERY.COMd. 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. 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 nurse to the possibility of vasa previa. The presence of placenta prev ia 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 TOP: 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 nurse notic es 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
c. Cullen sign associated with a ruptured ectopic pregnancy
d. Chadwick sign associated with early pregnancy
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 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 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 causing a d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate 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 For More Nursing Materials Visit: WWW.NURSYLAB.COM Page 3 of 584 WWW.THENURSINGMASTERY.COMoccurs, by definition, before 20 weeks of gestation, before the fetus is viable. Miscarriages occur in 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. DIF: Cognitive Level: Understand REF: dm. 670 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. Cord insertion may cause a bleeding disorder that can also occur late in pregnancy. DIF: Cognitive Level: Understand REF: dm. 669 TOP: 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?
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.
c. One ectopic pregnancy does not affect a womans fertility or her likelihood of having a normal pregnancy d. Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic malignanci 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 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. 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 For More Nursing Materials Visit: WWW.NURSYLAB.COM Page 4 of 584 WWW.THENURSINGMASTERY.COMOutpatient 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. Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage. DIF: Cognitive Level: Apply REF: dm. 672 TOP: Nursing Process: Planning MSC: 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
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 with DIC. DIF: Cognitive Level: Remember REF: dm. 684 TOP: Nursing Proces s: Assessment MSC: Client Needs: Physiologic Integrity 12. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of
gestation)?
a. 12 to 14
b. 6 to 8
c. 23 to 24
d. After 24
ANS: A 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. Six to 8 weeks of gestation is too early to place the cerclage. Cerclage placement is offered if the cervical 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. DIF: Cognitive Level: Apply REF: dm. 674 TOP: Nursing Process: Planning MSC: 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. HemorrhageFor More Nursing Materials Visit: WWW.NURSYLAB.COM Page 5 of 584 WWW.THENURSINGMASTERY.COMd. HELLP syndrome
ANS: A The diagnosis of DIC is made according to clinical findings and laboratory markers. A physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the womans arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the postpartum client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP syndrome is not a clotting disorder, but it may contribute to the clotting disorder DIC. DIF: Cognitive Level: Understand REF: dm. 685 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 14.In caring for the woman with DIC, which order should the nurse anticipate?
a. Administration of blood
b. Preparation of the client for invasive hemodynamic monitoring
c. Restriction of intravascular fluids
d. Administration of steroids
ANS: A Primary medical management in all cases of DIC involves a correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be initially ordered in a client with DIC because it could contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC. DIF: Cognitive Level: Apply REF: pp. 685-686 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 15. A woman arrives at the emergency department with complaints of bleeding and cramping.
The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile
speculum examination, the primary care provider finds that the cervix is closed. The anticipated
plan of care for this woman would be based on a probable diagnosis of which type of
spontaneous abortion?
a. Incomplete
b. Inevitable
c. Threatened
d. Septic
ANS: C A woman with a threatened abortion has spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would have heavy bleeding, mild- to-severe cramping, and cervical dilation. An inevitable abortion demonstrates the same symptoms as an incomplete abortion: heavy bleeding, mild- to-severe cramping, and cervical dilation. A woman with a septic abortion has malodorous bleeding and typically a dilated cervix. DIF: Cognitive Level: Understand REF: dm. 670 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity For More Nursing Materials Visit: WWW.NURSYLAB.COM Page 6 of 584 WWW.THENURSINGMASTERY.COM16.In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio
placentae?
a. Bleeding
b. Intense abdominal pain
c. Uterine activity
d. Cramping
ANS: B Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions. DIF: Cognitive Level: Understand REF: dm. 683 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity 17. Which maternal condition always necessitates delivery by cesarean birth?
a. Marginal placenta previa
b. Complete placenta previa
c. Ectopic pregnancy
d. Eclampsia
ANS: B In complete placenta previa, the placenta completely covers the cervical os. A cesarean birth is the acceptable method of delivery. The risk of fetal death occurring is due to preterm birth. If the previa is marginal (i.e., 2 cm or greater away from the cervical os), then labor can be attempted. A cesarean birth is not indicated for an ectopic pregnancy. Labor can be safely induced if the eclampsia is under control. DIF: Cognitive Level: Understand REF: dm. 681 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 18. What is the correct definition of a spontaneous termination of a pregnancy (abortion)?
a. Pregnancy is less than 20 weeks.
b. Fetus weighs less than 1000 g.
c. Products of conception are passed intact.
d. No evidence exists of intrauterine infection.
ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of the fetus is not considered because some older fetuses may have a low birth weight. A spontaneous abortion may be complete or incomplete and may be caused by many problems, one being intrauterine infection. DIF: Cognitive Level: Remember REF: dm. 669 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 19. What is the correct terminology for an abortion in which the fetus dies but is retained within
the uterus?
a. Inevitable abortion
b. Missed abortionFor More Nursing Materials Visit: WWW.NURSYLAB.COM Page 7 of 584 WWW.THENURSINGMASTERY.COMc. Incomplete abortion
d. Threatened abortion
ANS: B Missed abortion refers to the retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion, the woman has cramping and bleeding but no cervical dilation. DIF: Cognitive Level: Remember REF: dm. 670 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 20. What condition indicates concealed hemorrhage when the client experiences abruptio
placentae?
a. Decrease in abdominal pain
b. Bradycardia
c. Hard, boardlike abdomen
d. Decrease in fundal height
ANS: C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. Abdominal pain may incre ase. The client will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height increases. DIF: Cognitive Level: Analyze REF: dm. 683 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 21. What is the highest priority nursing intervention when admitting a pregnant woman who has
experienced a bleeding episode in late pregnancy?
a. Assessing FHR and maternal vital signs
b. Performing a venipuncture for hemoglobin and hematocrit levels
c. Placing clean disposable pads to collect any drainage
d. Monitoring uterine contractions
ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The most important assessment is to check the well-being of both the mother and the fetus. The blood levels can be obtained later. Assessing future bleeding is important; however, the top priority remains mother/fetal well-being. Monitoring uterine contractions is important but not a top priority. DIF: Cognitive Level: Apply REF: dm. 681 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 22. Which order should the nurse expect for a client admitted with a threatened abortion?
a. Bed rest
b. Administration of ritodrine IV
c. Nothing by mouth ( nil per os [NPO])
d. Narcotic analgesia every 3 hours, as neededFor More Nursing Materials Visit: WWW.NURSYLAB.COM Page 8 of 584 WWW.THENURSINGMASTERY.COMANS: A Decreasing the womans activity level may alleviate the bleeding and allow the pregnancy to continue. Ritodrine is not the first drug of choice for tocolytic medications. Having the woman placed on NPO is unnecessary. At times, dehydration may produce contractions; therefore, hydration is important. Narcotic analgesia will not decrease the contractions and may mask the severity of the contractions. DIF: Cognitive Level: Understand REF: pp. 671-672 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 23. Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform
mole?
a. Complaint of frequent mild nausea
b. Blood pressure of 120/80 mm Hg
c. Fundal height measurement of 18 cm
d. History of bright red spotting for 1 day, weeks ago
ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the clients history, bleeding is normally described as brownish. DIF: Cognitive Level: Analyze REF: dm. 678 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 24. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which
information assists the nurse in developing the plan of care?
a. Bed rest and analgesics are the recommended treatment.
b. She will be unable to conceive in the future.
c. A D&C will be performed to remove the products of conception.
d. Hemorrhage is the primary concern.
ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture to prevent hemorrhaging. If the tube must be removed, then the womans fertility will decrease; however, she will not be infertile. A D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes. DIF: Cognitive Level: Apply REF: dm. 676 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity MULTIPLE RESPONSE 1. A client who has undergone a D&C for early pregnancy loss is likely to be discharged the
same day. The nurse must ensure that her vital signs are stable, that bleeding has been controlled,
and that the woman has adequately recovered from the administration of anesthesia. To promote
an optimal recovery, what information should discharge teaching include? (Select all that apply.)
a. Iron supplementation
b. Resumption of intercourse at 6 weeks postprocedure
c. Referral to a support group, if necessaryFor More Nursing Materials Visit: WWW.NURSYLAB.COM Page 9 of 584
