maternity-newborn-and-womens-health-nursing-a-case-based-approach-2nd-edition-omearas-test-bank

MATERNITY NEWBORN AND WOMEN’S HEALTH
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k NURSING A CASE-BASED APPROACH 2ND EDITION
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O’MEARA’S TEST BANK
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Chapter: 1 Immediate Postpartum Hemorrhage
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MULTIPLE CHOICE k

,1. An expectant woman is being discharged from the health center after the
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kplacementof a cervical cerclage because of a history of recurrent gestation/pregnancy
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kloss, secondary to an incompetent cervix. Which information regarding post procedural
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kcare should the nursing attendantemphasize in the discharge teaching?
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a. Any vaginal discharge should be immediately reported to her health care
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kprovider.b. The presence of any contractions, rupture of membranes (ROM), or severe
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kperineal pressure should be reported
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c. The client will need to make arrangements for care at home, because her activity
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level will be restricted
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d. The client will be scheduled for a cesarean birth.
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ACCURATE CHOICE:-B
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Reasoning:->>>>Nursing care should stress the importance of monitoring for the signs and k k k k k k k k k k k


ksymptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care
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kprovider. Bed rest is an element of care. However, the woman may stand for periods of up
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kto 90 minutes, which allows her the freedom to see her physician. Home uterine activity
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kmonitoring may be used to limit the womans need for visits and to monitor her status
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ksafely at home. The cerclage can be removed at 37 weeks of gestation (to prepare for a
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kvaginal birth), or a cesarean birth can be planned.
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DIF: Cognitive Level: Apply REF: dm. 675
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TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
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HealthPromotion and Maintenance
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2. A perinatal nursing attendant is giving discharge instructions to a woman, status
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kpostsuction,and curettage secondary to a hydatidiform mole. The woman asks why she must
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take oral contraceptives for the next 12 months. What is the best response by the nursing
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attendant?
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a. If you get expectant within 1 year, the chance of a successful
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kgestation/pregnancy is very small. Therefore, if gestation/pregnancy, it would be k k k k k k k k k


better for you to use the most reliable methodof contraception available.
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b. The major risk to you after a molar gestation/pregnancy is a type of cancer that can be
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diagnosed only by me hormone that your body produces during gestation/pregnancy. If you
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were to get expectant, then itwould make this cancer more difficult.
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c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a
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second molar gestation/pregnancy improve your chance of a successful
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gestation/pregnancy, not getting expectant at this timeisbest.
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d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a
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molar gestation/pregnancy
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ACCURATE CHOICE:-B k


Reasoning:->>>>Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn k k k k k k k


kfor1 year to ensure that the mole is completely gone. The chance of developing
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choriocarcinomaafter the development of a hydatidiform mole is increased. Therefore, the
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goal is to achieve azero
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,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
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may obscure the presence of the potentially carcinogenic cells. Women should be
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instructed to use birth control for 1 year after treatment for a hydatidiform mole. The
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rationale for avoiding gestation/pregnancy for 1 year is to ensure that carcinogenic cells are
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not present. Any contraceptive method except an intrauterine device (IUD) is acceptable.
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DIF: Cognitive Level: Apply REF: dm. 679
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TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
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Physiologic Integrity
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3. The nursing attendant is preparing to administer methotrexate to the client. This
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khazardousdrug is most often used for which obstetric complication?
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a. Complete hydatidiform mole k k


b. Missed abortion k


c. Unruptured ectopic gestation/pregnancy k k


d. Abruptio
placentaeACCURATE
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CHOICE:-C
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Reasoning:->>>>Methotrexate is an effective nonsurgical treatment option for a k k k k k k k k


hemodynamically stable woman whose ectopic gestation/pregnancy is unruptured and
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kmeasures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a
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treatment option for a complete hydatidiform mole, for amissed abortion, or for abruptio
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kplacentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client
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Needs: Physiologic Integrity
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4. A 26-year-old expectant woman, gravida 2, para 1-0-0-1, is 28 weeks expectant
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kwhenshe experiences bright red, painless vaginal bleeding. On her arrival at the health
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kcenter, which diagnostic procedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity k k k k


b. Transvaginal ultrasound for placental location k k k k


c. Contraction stress test (CST) k k k


d. Internal fetal k


kmonitoringACCURATE k


kCHOICE:-B
Reasoning:->>>>The presence of painless bleeding should always alert the health care k k k k k k k k k k


kteamto the possibility ofplacenta previa, which can be confirmed through ultrasonography.
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Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an
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imminent delivery, the fetus is presumed to have immature lungs at this gestational age, and
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the mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at
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ka preterm gestational age. Furthermore, bleeding is a contraindication to a CST. Internal
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kfetal monitoring is also contraindicated in the presence of bleeding.
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DIF: Cognitive Level: Apply REF: dm. 680
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TOPIC 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.
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The fluid consists of bright red blood. Her contractions are consistent with her current stage
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oflabor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to
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decline rapidly after the ROM. The nursing attendant should suspect the possibility of what
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condition?
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a. Placenta previa k

, b. Vasa previa k


c. Severe abruptio placentae k k


d. Disseminated intravascular coagulation k k


(DIC)ACCURATE CHOICE:-B
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Reasoning:->>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. k k k k k k k k k k k k


Theumbilical vessels are not surrounded by Wharton jelly and have no supportive tissue.
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The umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs
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most frequently during ROM. The sudden appearance of bright red blood at the time of
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kROM and a sudden change in the FHR without other known risk factors should immediately
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alert the nursing attendant to the possibility of vasa previa. The presence of placenta previa
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most likely would be ascertained before labor andis considered a risk factor for this
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gestation/pregnancy. In addition, if thewoman had a placenta previa, itis unlikely that she
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would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio
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placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a
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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
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diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver
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enzyme levels, and low platelet levels (HELLP) syndrome. This woman did not have any
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kprior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: Client
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Needs: Physiologic Integrity
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6. A woman arrives for evaluation of signs and symptoms that include a missed
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period,adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the
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nursing attendant noticesan ecchymotic blueness around the womans umbilicus. What
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does this finding indicate?
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a. Normal integumentary changes associated with gestation/pregnancy k k k k k


b. Turner sign associated with appendicitis k k k k


c. Cullen sign associated with a ruptured ectopic gestation/pregnancy
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d. Chadwick sign associated with early k k k k


gestation/pregnancyACCURATE CHOICE:-C
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Cullen sign, the blue ecchymosis observed in the umbilical area, indicates
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hematoperitoneum Reasoning:->>>>associated with an undiagnosed ruptured intraabdominal
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ectopic gestation/pregnancy.Linea nigra on theabdomen is the normal integumentary change
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k associated with gestation/pregnancy and exhibits a brown pigmented, vertical line on the
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lower abdomen. Turner sign is ecchymosis in the flank area, often associated with
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pancreatitis. A Chadwick sign is a blue- purple cervix that may be seen during or around
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kthe eighth week of gestation/pregnancy.
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DIF: Cognitive Level: Analyze REF: dm. 676
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TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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7. The nursing attendant who elects to practice in the area of womens health must
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have a thorough understanding of miscarriage. Which statement regarding this
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kcondition is mostaccurate? k k k


a. A miscarriage is a natural gestation/pregnancy loss before labor begins.
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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
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factorin causing miscarriage
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d. If a miscarriage occurs before the 12th week of gestation/pregnancy, then it may be
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kobserved only asmoderate blood loss k k k k k


ACCURATE CHOICE:-D k