TEST BANK
, Maternity 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 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
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?
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 by
hormone 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
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 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 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 placentae
, d. Disseminated intravascular coagulation (DIC)
ANS: B
Vasa iprevia iis ithe iresult iof ia ivelamentous iinsertion iof ithe iumbilical icord. iThe iumbilical ivessels
are inot isurrounded iby iWharton ijelly iand ihave ino isupportive itissue. iThe iumbilical iblood
ivessels ithus iare iat irisk ifor ilaceration iat iany itime, ibut ilaceration ioccurs imost ifrequently iduring
iROM. iThe isudden iappearance iof ibright ired iblood iat ithe itime iof iROM iand ia isudden ichange
iin ithe iFHR iwithout iother iknown irisk ifactors ishould iimmediately ialert ithe inurse ito ithe
ipossibility iof ivasa iprevia. iThe ipresence iof iplacenta iprevia imost ilikely iwould ibe iascertained
ibefore ilabor iand iis iconsidered ia irisk ifactor ifor ithis ipregnancy. iIn iaddition, iif ithe iwoman ihad
ia iplacenta iprevia, iit iis iunlikely ithat ishe iwould ibe iallowed ito ipursue ilabor iand ia ivaginal
ibirth. iWith ithe ipresence iof isevere iabruptio iplacentae, ithe iuterine itonicity itypically iis itetanus
i(i.e., ia iboardlike iuterus). iDIC iis ia ipathologic iform iof idiffuse iclotting ithat iconsumes ilarge
iamounts iof iclotting ifactors, icausing iwidespread iexternal ibleeding, iinternal ibleeding, ior iboth.
iDIC iis ialways ia isecondary idiagnosis, ioften iassociated iwith iobstetric irisk ifactors isuch ias ithe
ihemolysis, ielevated iliver ienzyme ilevels, iand ilow iplatelet ilevels i(HELLP) isyndrome. iThis
iwoman idid inot ihave iany iprior irisk ifactors.
DIF: iCognitive iLevel: iAnalyze iREF: idm. i684 iTOP: iNursing iProcess: iDiagnosis
iMSC: iClient iNeeds: iPhysiologic iIntegrity
6. A iwoman iarrives ifor ievaluation iof isigns iand isymptoms ithat iinclude ia imissed iperiod,
iadnexal ifullness, itenderness, iand idark ired ivaginal ibleeding. iOn iexamination, ithe inurse
inotices ian iecchymotic iblueness iaround ithe iwomans iumbilicus. iWhat idoes ithis ifinding
iindicate?
a. Normal iintegumentary ichanges iassociated iwith ipregnancy
b. Turner isign iassociated iwith iappendicitis
c. Cullen isign iassociated iwith ia iruptured iectopic ipregnancy
d. Chadwick isign iassociated iwith iearly
ipregnancy iANS: iC
Cullen isign, ithe iblue iecchymosis iobserved iin ithe iumbilical iarea, iindicates ihematoperitoneum
associated iwith ian iundiagnosed iruptured iintraabdominal iectopic ipregnancy. iLinea inigra ion
ithe iabdomen iis ithe inormal iintegumentary ichange iassociated iwith ipregnancy iand iexhibits ia
ibrown ipigmented, ivertical iline ion ithe ilower iabdomen. iTurner isign iis iecchymosis iin ithe iflank
iarea, ioften iassociated iwith ipancreatitis. iA iChadwick isign iis ia iblue-purple icervix ithat imay ibe
iseen iduring ior iaround ithe ieighth iweek iof ipregnancy.
DIF: iCognitive iLevel: iAnalyze iREF: idm. i676
TOP: iNursing iProcess: iAssessment iMSC: iClient iNeeds: iPhysiologic iIntegrity
7. The inurse iwho ielects ito ipractice iin ithe iarea iof iwomens ihealth imust ihave ia
ithorough iunderstanding iof imiscarriage. iWhich istatement iregarding ithis icondition iis
imost iaccurate?
a. A imiscarriage iis ia inatural ipregnancy iloss ibefore ilabor ibegins.
b. It ioccurs iin ifewer ithan i5% iof iall iclinically irecognized ipregnancies.
c. Careless imaternal ibehavior, isuch ias ipoor inutrition ior iexcessive iexercise, ican ibe ia ifactor iin
icausi iIf ia imiscarriage ioccurs ibefore ithe i12th iweek iof ipregnancy, ithen iit imay ibe iobserved
ionly ias imod
d. ANS: iD
, Maternity 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 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
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?
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 by
hormone 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
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 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 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 placentae
, d. Disseminated intravascular coagulation (DIC)
ANS: B
Vasa iprevia iis ithe iresult iof ia ivelamentous iinsertion iof ithe iumbilical icord. iThe iumbilical ivessels
are inot isurrounded iby iWharton ijelly iand ihave ino isupportive itissue. iThe iumbilical iblood
ivessels ithus iare iat irisk ifor ilaceration iat iany itime, ibut ilaceration ioccurs imost ifrequently iduring
iROM. iThe isudden iappearance iof ibright ired iblood iat ithe itime iof iROM iand ia isudden ichange
iin ithe iFHR iwithout iother iknown irisk ifactors ishould iimmediately ialert ithe inurse ito ithe
ipossibility iof ivasa iprevia. iThe ipresence iof iplacenta iprevia imost ilikely iwould ibe iascertained
ibefore ilabor iand iis iconsidered ia irisk ifactor ifor ithis ipregnancy. iIn iaddition, iif ithe iwoman ihad
ia iplacenta iprevia, iit iis iunlikely ithat ishe iwould ibe iallowed ito ipursue ilabor iand ia ivaginal
ibirth. iWith ithe ipresence iof isevere iabruptio iplacentae, ithe iuterine itonicity itypically iis itetanus
i(i.e., ia iboardlike iuterus). iDIC iis ia ipathologic iform iof idiffuse iclotting ithat iconsumes ilarge
iamounts iof iclotting ifactors, icausing iwidespread iexternal ibleeding, iinternal ibleeding, ior iboth.
iDIC iis ialways ia isecondary idiagnosis, ioften iassociated iwith iobstetric irisk ifactors isuch ias ithe
ihemolysis, ielevated iliver ienzyme ilevels, iand ilow iplatelet ilevels i(HELLP) isyndrome. iThis
iwoman idid inot ihave iany iprior irisk ifactors.
DIF: iCognitive iLevel: iAnalyze iREF: idm. i684 iTOP: iNursing iProcess: iDiagnosis
iMSC: iClient iNeeds: iPhysiologic iIntegrity
6. A iwoman iarrives ifor ievaluation iof isigns iand isymptoms ithat iinclude ia imissed iperiod,
iadnexal ifullness, itenderness, iand idark ired ivaginal ibleeding. iOn iexamination, ithe inurse
inotices ian iecchymotic iblueness iaround ithe iwomans iumbilicus. iWhat idoes ithis ifinding
iindicate?
a. Normal iintegumentary ichanges iassociated iwith ipregnancy
b. Turner isign iassociated iwith iappendicitis
c. Cullen isign iassociated iwith ia iruptured iectopic ipregnancy
d. Chadwick isign iassociated iwith iearly
ipregnancy iANS: iC
Cullen isign, ithe iblue iecchymosis iobserved iin ithe iumbilical iarea, iindicates ihematoperitoneum
associated iwith ian iundiagnosed iruptured iintraabdominal iectopic ipregnancy. iLinea inigra ion
ithe iabdomen iis ithe inormal iintegumentary ichange iassociated iwith ipregnancy iand iexhibits ia
ibrown ipigmented, ivertical iline ion ithe ilower iabdomen. iTurner isign iis iecchymosis iin ithe iflank
iarea, ioften iassociated iwith ipancreatitis. iA iChadwick isign iis ia iblue-purple icervix ithat imay ibe
iseen iduring ior iaround ithe ieighth iweek iof ipregnancy.
DIF: iCognitive iLevel: iAnalyze iREF: idm. i676
TOP: iNursing iProcess: iAssessment iMSC: iClient iNeeds: iPhysiologic iIntegrity
7. The inurse iwho ielects ito ipractice iin ithe iarea iof iwomens ihealth imust ihave ia
ithorough iunderstanding iof imiscarriage. iWhich istatement iregarding ithis icondition iis
imost iaccurate?
a. A imiscarriage iis ia inatural ipregnancy iloss ibefore ilabor ibegins.
b. It ioccurs iin ifewer ithan i5% iof iall iclinically irecognized ipregnancies.
c. Careless imaternal ibehavior, isuch ias ipoor inutrition ior iexcessive iexercise, ican ibe ia ifactor iin
icausi iIf ia imiscarriage ioccurs ibefore ithe i12th iweek iof ipregnancy, ithen iit imay ibe iobserved
ionly ias imod
d. ANS: iD
