Test Bank for Maternity Newborn and Women’s Health Nursing: A Case-Based Approach 2nd Edition O’Meara

, MaternityNewbornandWomen’sHealthNursingACase-BasedApproach1stEditionO’Meara b b b b b b b b b




TestBank b b




Chapter1ImmediatePostpartumHemorrhage b b b b




MULTIPLECHOICE b




1. Apregnantwomanisbeingdischargedfromthehospitalaftertheplacementofacervical
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cerclage becauseofa history ofrecurrent pregnancy loss,secondarytoanincompetent cervix.
b b b b v




Which informationregardingpostprocedural careshould thenurseemphasizein thedischarg
b v v




e teaching?
b




a. Anyvaginaldischarge shouldbeimmediately reported toherhealthcareprovider. b b b b b




b. Thepresenceofanycontractions,ruptureofmembranes(ROM),orsevereperinealpressureshould b b b b b b b b b b




c. Theclientwillneedtomakearrangementsforcareathome,becauseheractivitylevelwillberestri b b b b b b b b b b b




d. Theclientwillbescheduledforacesareanbirth.
bANS:B b




Nursing careshouldstress theimportance ofmonitoring forthe signsandsymptoms ofpreterm
b b b b b b




labor. Vaginal bleeding needs to be reported to her primary health careprovider. Bed rest is an
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belementofcare.However,thewomanmaystandforperiodsofupto90minutes,whichallowsherthe
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freedom to see her physician. Home uterine activitymonitoring may be used to limit the womans
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needforvisitsandtomonitorherstatussafely at home. Thecerclage can beremoved at 37 weeks of
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bgestation(toprepareforavaginalbirth),oracesareanbirthcanbeplanned.
b b b b b b b b b b b




DIF:CognitiveLevel:ApplyREF:dm.675
b b b b b b




TOP:Nursing Process:Planning|NursingProcess: Implementation v




bMSC:ClientNeeds:HealthPromotionandMaintenance
b b b b b




2. Aperinatalnurseisgivingdischargeinstructionstoawoman, statuspostsuction, andcurettage b b




bsecondarytoahydatidiformmole.Thewomanaskswhyshemusttakeoralcontraceptivesfor thenext
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12months.Whatisthebestresponsebythenurse?
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Ifyougetpregnantwithin1year,thechanceofasuccessfulpregnancyisverysmall.Therefore,if b b b b b b b b b b b b b




a. pregnancy,it wouldbebetter foryouto usethemost reliablemethod ofcontraception available. b b b b b b b




Themajorrisktoyouafteramolarpregnancyisatypeofcancerthatcanbediagnosedonlybyme hormone
b b b b b b b b b b b b b b b b




that yourbodyproduces during pregnancy. If youweretoget pregnant, thenitwouldmak
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b. thiscancermoredifficult.b b b




Ifyoucanavoidapregnancyforthenextyear,thechanceofdevelopingasecondmolarpregnancy
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c. improveyourchanceofasuccessfulpregnancy,notgettingpregnantatthistimeisbest. b b b b b b b b b b




d. Oralcontraceptivesaretheonlyformofbirthcontrolthatwillpreventarecurrence ofamolarpreg ANS: bb b bb b




B
Betahumanchorionicgonadotropin(beta-hCG)hormonelevelsaredrawnfor1yeartoensure b b b b b b b b b




thatthemoleiscompletelygone.Thechanceofdevelopingchoriocarcinomaafterthedevelopment of a
b b b b b b b b b b b b b b




bhydatidiformmole is increased. Therefore, the goal is toachieve a zero human chorionic b b b b b b b b b b b




bgonadotropin(hCG)level. Ifthe womanweretobecomepregnant, thenitmayobscure the presence of b b b b b b




thepotentiallycarcinogeniccells.Womenshouldbeinstructedtousebirthcontrolfor1yearafter
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btreatmentforahydatidiformmole.Therationaleforavoidingpregnancy b b b b b b b

,for1 yearistoensurethatcarcinogeniccellsarenotpresent. Anycontraceptivemethodexcept an
b b b




intrauterinedevice(IUD)isacceptable.
b b b b b




DIF:CognitiveLevel:ApplyREF:dm.679
b b b b b b




TOP:Nursing Process:Planning|NursingProcess:Implementation v b




bMSC:ClientNeeds:PhysiologicIntegrity
b b b b




3. Thenurseispreparingtoadministermethotrexatetotheclient. Thishazardousdrug is b b




mostoftenusedforwhichobstetriccomplication?
b b b b




a. Completehydatidiformmole
b. Missedabortion
c. Unrupturedectopicpregnancy b




d. Abruptioplacentae v




ANS:C
b b




Methotrexateis aneffective nonsurgicaltreatmentoptionforahemodynamically stable woman b b b b b




whoseectopic pregnancyisunrupturedand measures less than 4cmindiameter.Methotrexate isnot b b v b b b b




indicated or recommended as a treatment optionfora complete hydatidiform mole, fora missed
b b b b b b b b b b b b




abortion,orforabruptioplacentae.
b b b b




DIF:CognitiveLevel:ApplyREF:dm.677TOP:NursingProcess:PlanningMSC:Client
b b b b b b b b b b b b




Needs:PhysiologicIntegrity
b b b




4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnantwhen she
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experiences bright red,painless vaginal bleeding.Onher arrivalatthehospital,whichdiagnostic
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procedurewilltheclientmostlikelyhaveperformed?
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a. Amniocentesisforfetallungmaturity b b




b. Transvaginalultrasoundforplacentallocation b b b




c. Contractionstresstest(CST) b b




d. Internalfetalmonitoring
ANS:B
b b




Thepresenceofpainlessbleedingshouldalwaysalertthehealthcareteamtothepossibilityof
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placentaprevia,whichcanbeconfirmedthroughultrasonography.Amniocentesisisnotperformed ona
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womanwhoisexperiencingbleeding.Intheeventofanimminentdelivery,thefetusispresumedtohave
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immaturelungsatthisgestationalage,andthemotherisgivencorticosteroidstoaidinfetal lung maturity.
b b b b b b b b b b b b b




A CST is not performed at apreterm gestationalage.Furthermore,bleedingisa contraindication to a
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CST. Internal fetal monitoringis also contraindicated in the presence of bleeding.
b b b b b b b b b b b




DIF:CognitiveLevel:ApplyREF:dm.680
b b b b b b




TOP:NursingProcess:AssessmentMSC:ClientNeeds:HealthPromotionandMaintenance
b b b b b b b b b




5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
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fluid consists ofbright red blood.Her contractions areconsistent with hercurrent stageoflabor.No
b v b b




changeinuterinerestingtonehasoccurred.Thefetalheartrate(FHR)beginstodeclinerapidlyafterthe
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ROM.Thenurseshouldsuspectthepossibilityofwhatcondition?
b b b b b b b b b




a. Placentaprevia b




b. Vasaprevia b




c. Severeabruptioplacentae b

, d. Disseminated intravascularcoagulation(DIC) v




ANS:B
b b




Vasapreviaistheresultofavelamentousinsertionoftheumbilicalcord.Theumbilicalvessels
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arenotsurroundedbyWhartonjellyandhavenosupportivetissue.Theumbilicalbloodvesselsthusare
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at riskforlacerationatany time,but laceration occurs most frequently duringROM.Thesudden
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appearanceofbrightredbloodatthe timeofROMandasuddenchangeintheFHR withoutother known
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riskfactorsshouldimmediatelyalertthenursetothepossibilityofvasaprevia.Thepresenceofplacenta
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previamostlikelywouldbeascertainedbeforelaborandisconsideredariskfactorfor this pregnancy. In
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addition, if the woman had aplacenta previa, it is unlikely that she would be allowed to pursuelabor
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and a vaginal birth. Withthepresence of severeabruptioplacentae, the uterinetonicitytypically is
b b b b b b b b b b




tetanus(i.e., aboardlikeuterus). DICis a pathologic form of diffuse clotting that consumes large
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amounts of clotting factors, causing widespread external bleeding, internalbleeding,orboth.DICis
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alwaysasecondarydiagnosis,oftenassociatedwithobstetricrisk factors such as the hemolysis,
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elevated liver enzyme levels, and low platelet levels (HELLP) syndrome.Thiswomandidnothave
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anypriorriskfactors.
b b b b




DIF:CognitiveLevel:AnalyzeREF:dm.684TOP:NursingProcess:Diagnosis
b b b b b b b b b b




MSC:ClientNeeds:PhysiologicIntegrity
b b b b b




6. Awomanarrivesforevaluationofsignsandsymptomsthatincludeamissedperiod, adnexal b




fullness, tenderness, and dark red vaginal bleeding. On examination, the nursenotices an
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ecchymoticbluenessaroundthewomansumbilicus.Whatdoesthisfindingindicate?
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a. Normalintegumentarychangesassociatedwithpregnancy b b b b




b. Turnersignassociatedwithappendicitis b b b b




c. Cullensignassociatedwitharupturedectopicpregnancy b b b b




d. Chadwicksignassociated withearlypregnancy v




ANS:C
b b




Cullensign,theblueecchymosisobservedintheumbilicalarea,indicateshematoperitoneum b b b b b b




associatedwithanundiagnosedrupturedintraabdominalectopicpregnancy.Lineanigraonthe
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abdomenisthenormalintegumentarychangeassociatedwithpregnancyandexhibitsabrown
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pigmented,verticallineon thelowerabdomen.Turnersign isecchymosis intheflank area,often
b b b v b




associatedwithpancreatitis.AChadwicksignisablue-purplecervixthatmaybeseenduringor
b b b b b b b b b b b b b b b




aroundtheeighthweekofpregnancy.
b b b b b




DIF:CognitiveLevel:AnalyzeREF:dm.676
b b b b b b




TOP:NursingProcess:AssessmentMSC:ClientNeeds:PhysiologicIntegrity
b b b b b b b b




7. Thenursewhoelectstopracticeintheareaofwomenshealthmusthaveathorough
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understandingofmiscarriage.Whichstatement regarding thiscondition ismostaccurate?
b b v v b




a. Amiscarriageisanaturalpregnancy loss beforelaborbegins. b b b b b




b. Itoccursinfewerthan5%ofallclinicallyrecognizedpregnancies.
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c. Carelessmaternalbehavior,suchaspoornutritionorexcessiveexercise,canbeafactorincausingIfa
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miscarriageoccurs before the12th week ofpregnancy,thenit maybeobserved onlyasmodera
b b b v b b




d. bloodloss. b




ANS:D b




Beforethesixthweek,theonlyevidencemightbeaheavymenstrualflow.Afterthe12thweek,more
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severepain,similartothatoflabor,islikely.Miscarriageisanaturalpregnancyloss,butit
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