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 |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 |previa |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 |t ypically |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 |notices |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 |causi |If
a |miscarriage |occurs |before |the |12th |week |of |pregnancy, |then |it |may|be |observed |only |as |mod
|
d. 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
|
, 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 |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 |previa |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 |t ypically |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 |notices |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 |causi |If
a |miscarriage |occurs |before |the |12th |week |of |pregnancy, |then |it |may|be |observed |only |as |mod
|
d. 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
