Test Bank for Maternity Newborn and Women’s Health Nursing: A Case-Based Approach 2nd Edition O’Meara||ISBN NO-10,1975209028||ISBN NO-13,978-1975209025||Complete Chapters||Latest Guide

MATERNITY NEWBORN AND WOMEN’S HEALTH
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NURSING A CASE-BASED APPROACH 2ND
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EDITIONO’MEARA’S TEST BANK
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Chapter: 1 Immediate Postpartum Hemorrhage
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MULTIPLE CHOICE n1

,1. An expectant woman is being discharged from the health center after the
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placementof a cervical cerclage because of a history of recurrent gestation/pregnancy
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loss, secondary to an incompetent cervix. Which information regarding post procedural
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care 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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provider.b. The presence of any contractions, rupture of membranes (ROM), or severe
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perineal pressure should be reported
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c. The client will need to make arrangements for care at home, because her
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activitylevel will be restricted
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d. The client will be scheduled for a cesarean n1 n1 n1 n1 n1 n1 n1



birth.ACCURATE CHOICE:-B
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Reasoning:->>>>Nursing care should stress the importance of monitoring for the signs n1 n1 n1 n1 n1 n1 n1 n1 n1 n1



and symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary
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health care provider. Bed rest is an element of care. However, the woman may stand for
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periods of up to 90 minutes, which allows her the freedom to see her physician. Home
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uterine activity monitoring may be used to limit the womans need for visits and to
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n1monitor her status safely at home. The cerclage can be removed at 37 weeks of
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n1gestation (to prepare for a vaginal 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
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Needs:HealthPromotion and Maintenance
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2. A perinatal nursing attendant is giving discharge instructions to a woman,
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n1status postsuction,and curettage secondary to a hydatidiform mole. The woman asks why
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she must take oral contraceptives for the next 12 months. What is the best response by
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the nursing attendant?
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a. If you get expectant within 1 year, the chance of a successful
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n 1gestation/pregnancy is very small. Therefore, if gestation/pregnancy, it would be n1 n 1 n1 n1 n1 n1 n1 n1 n1



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
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you 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
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of amolar gestation/pregnancy
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ACCURATE CHOICE:-B n1



Reasoning:->>>>Betahuman chorionic gonadotropin (beta-hCG) hormone levels are n 1 n1 n1 n 1 n1 n 1



n1drawn for1 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,
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the goal is to achieve azero
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,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then
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it 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
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are not present. Any contraceptive method except an intrauterine device (IUD) is
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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
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Needs:Physiologic Integrity
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3. The nursing attendant is preparing to administer methotrexate to the client.
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This hazardousdrug is most often used for which obstetric complication?
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a. Complete hydatidiform mole n1 n1



b. Missed abortion n1



c. Unruptured ectopic gestation/pregnancy n1 n1



d. Abruptio
placentaeACCURATE
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CHOICE:-C
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Reasoning:->>>>Methotrexate is an effective nonsurgical treatment option for a n1 n1 n1 n1 n1 n1 n1 n1



hemodynamically stable woman whose ectopic gestation/pregnancy is unruptured and
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n1measures 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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placentae.
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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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whenshe experiences bright red, painless vaginal bleeding. On her arrival at the
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health center, which diagnostic procedure will the client most likely have
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performed?
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a. Amniocentesis for fetal lung maturity n1 n1 n1 n1



b. Transvaginal ultrasound for placental location n1 n 1 n1 n1



c. Contraction stress test (CST) n1 n1 n1



d. Internal fetal n1



monitoringACCURATE
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CHOICE:-B
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Reasoning:->>>>The presence of painless bleeding should always alert the health care n1 n1 n1 n1 n1 n1 n1 n1 n1 n1



teamto the possibility ofplacenta previa, which can be confirmed through
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ultrasonography.
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Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of
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animminent delivery, the fetus is presumed to have immature lungs at this gestational
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age, andthe mother is given corticosteroids to aid in fetal lung maturity. A CST is not
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performed at a preterm gestational age. Furthermore, bleeding is a contraindication to a
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CST. Internal fetal 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
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ROM. The fluid consists of bright red blood. Her contractions are consistent with her
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current stage oflabor. No change in uterine resting tone has occurred. The fetal heart rate
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(FHR) begins to decline rapidly after the ROM. The nursing attendant should suspect the
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possibility of what condition?
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a. Placenta previa n1

, b. Vasa previa n1



c. Severe abruptio placentae n1 n1



d. Disseminated intravascular coagulation n1 n1



(DIC)ACCURATE CHOICE:-B
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Reasoning:->>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. n1 n1 n1 n1 n1 n1 n1 n1 n1 n1 n1 n1



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
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occurs most frequently during ROM. The sudden appearance of bright red blood at the
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time of ROM and a sudden change in the FHR without other known risk factors should
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immediately alert the nursing attendant to the possibility of vasa previa. The presence of
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placenta previa most likely would be ascertained before labor andis considered a risk
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factor for this gestation/pregnancy. In addition, if thewoman had a placenta previa, itis
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unlikely that she would be allowed to pursue labor and a vaginal birth. With the
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presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a
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boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large
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amounts of clotting factors, causing widespread external bleeding, internal bleeding, or
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both. DIC is always a secondary diagnosis, often associated with obstetric risk factors
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such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)
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syndrome. This woman did not have any prior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC:
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ClientNeeds: 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
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b. Turner sign associated with appendicitis n1 n1 n1 n1



c. Cullen sign associated with a ruptured ectopic gestation/pregnancy
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d. Chadwick sign associated with early n1 n1 n1 n1



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
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intraabdominal ectopic gestation/pregnancy.Linea nigra on theabdomen is the normal
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n 1integumentary change associated with gestation/pregnancy and exhibits a brown n 1 n 1 n 1 n 1 n1 n1 n1 n1



pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank
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area, often associated with pancreatitis. A Chadwick sign is a blue- purple cervix that
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may be seen during or around the 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
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must have a thorough understanding of miscarriage. Which statement regarding
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this condition is mostaccurate?
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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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observed only asmoderate blood loss
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ACCURATE CHOICE:-D n1