Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition O’Meara Test Bank (All chapters complete, Question and Answers With Rationale) Newly Updated 2021

TESTBANK
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, MaternityNewbornandWomen’sHealthNursingACase-BasedApproach 1stEdition k k k k k k k k k k




O’Meara Test Bank k k k




Chapter1 Immediate PostpartumHemorrhage k k k k




MULTIPLECHOICE k




1. A pregnant woman is being discharged from the hospital after the placement of a cervical
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cerclagebecauseof ahistoryof recurrent pregnancyloss,secondaryto anincompetent cervix. Which
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informationregardingpostprocedural careshouldthenurseemphasizeinthedischarge teaching?
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a. Anyvaginal discharge should be immediatelyreported to herhealth care provider. k k k k k k k k k k k




b. Thepresenceofanycontractions, rupture ofmembranes (ROM), orsevere perineal pressuresho
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c. Theclient will need to makearrangements for careat home,because her activitylevel will be re
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d. Theclientwillbescheduledforacesareanbirth. k k k k k k k k




ANS: B
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Nursingcareshould stress the importance ofmonitoringforthesigns andsymptoms ofpreterm
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labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an element
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of care. However, the woman may stand for periods of up to 90 minutes, which allows her the freedom
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to see her physician. Home uterine activity monitoring may be used to limit the womans need for visits
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and to monitor her status safely at home. The cerclage can be removed at 37 weeks of gestation (to
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prepare for a vaginal birth), or a cesarean birth can be planned.
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DIF:Cognitive Level:ApplyREF:dm. 675
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TOP:NursingProcess:Planning|NursingProcess: Implementation
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MSC: Client Needs: Health Promotion and Maintenance
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2. Aperinatalnurseis givingdischargeinstructionstoawoman,statuspostsuction,andcurettage
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secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next
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12 months. What is the bestresponse by the nurse?
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If you get pregnant within 1 year,thechanceofa successful pregnancyis verysmall. Therefore, k k k k k k k k k k k k k k k k




a. pregnancy,it wouldbebetterfor youto usethemost reliablemethod ofcontraception available. k k k k k k k k k k k k k k k




Themajorrisk to you after amolar pregnancyis a typeof cancer that can bediagnosed onlyby hormone
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that your bodyproduces duringpregnancy. If you were to get pregnant, thenit would
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b. this cancermoredifficult. k k k




If you can avoid apregnancyforthenext year,the chanceofdevelopingasecond molar pregna
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c. improveyourchanceofa successful pregnancy, not gettingpregnant at this timeisbest. k k k k k k k k k k k k k k




d. Oralcontraceptives aretheonlyformofbirth control thatwillprevent arecurrenceofamolarp ANS: B k k k k k k k k k k k k k k k k k k k




Betahumanchorionic gonadotropin (beta-hCG)hormonelevels aredrawn for1 yearto ensure k k k k k k k k k k k k




that the mole is completely gone. The chance of developing choriocarcinoma after the development ofa
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hydatidiform moleisincreased. Therefore, the goal is toachieveazero human chorionicgonadotropin
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(hCG)level. Ifthewoman weretobecomepregnant, thenitmayobscure the presence of the potentially
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carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a
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hydatidiform mole. The rationale for avoiding pregnancy
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,for1 yearistoensurethat carcinogeniccells arenot present.Anycontraceptivemethodexcept an
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intrauterine device (IUD) is acceptable.
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DIF:Cognitive Level:ApplyREF:dm. 679
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TOP:NursingProcess:Planning|NursingProcess: Implementation
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MSC: Client Needs: Physiologic Integrity
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3. Thenurseispreparingto administermethotrexatetotheclient. Thishazardousdrug is
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most often used for which obstetric complication?
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a. Completehydatidiform mole k k




b. Missed abortion k




c. Unrupturedectopicpregnancy k k




d. Abruptioplacentae k




ANS: C
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Methotrexateis an effectivenonsurgical treatment optionforahemodynamicallystable woman k k k k k k k k k k k




whoseectopicpregnancyisunrupturedand measures lessthan4 cmindiameter.Methotrexateis not
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indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed
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abortion, or for abruptio placentae.
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DIF:Cognitive Level:ApplyREF:dm.677TOP:NursingProcess:Planning MSC:
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Client Needs: Physiologic Integrity
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4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences
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brightred,painlessvaginal bleeding. Onherarrival atthehospital,whichdiagnostic procedure will the
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client most likely have performed?
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a. Amniocentesis forfetal lungmaturity k k k k




b. Transvaginalultrasound forplacental location k k k k




c. Contractionstress test (CST) k k k




d. Internalfetalmonitoring k k




ANS: B
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Thepresenceofpainless bleedingshould always alert the health careteam to the possibilityof
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placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on
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a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus is presumed to
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have immature lungs at this gestational age, and the mother is given corticosteroidstoaidinfetallung
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maturity.ACSTisnotperformedatapreterm gestationalage. Furthermore, bleeding is a
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contraindication to a CST. Internal fetal monitoring is also contraindicated in the presence of bleeding.
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DIF:Cognitive Level: ApplyREF:dm.680
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TOP:NursingProcess: AssessmentMSC:ClientNeeds: HealthPromotionand Maintenance
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5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid
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consistsofbrightredblood.Hercontractionsareconsistentwithhercurrentstageoflabor. No change in
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uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM.
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The nurse should suspect the possibility of what condition?
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a. Placentaprevia k




b. Vasaprevia k




c. Severeabruptio placentae k k

, d. Disseminatedintravascularcoagulation(DIC) k k k




ANS: B
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Vasapreviais theresult ofavelamentous insertion oftheumbilical cord.Theumbilical vessels
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are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels thus are
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at riskforlaceration at anytime,but laceration occurs most frequentlyduringROM.The sudden
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appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known
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risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of
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placenta previa most likely would be ascertained before labor and is considered a risk factor for this
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pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to
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pursue labor and a vaginal birth. With the presence of severe abruptioplacentae, theuterinetonicity
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typicallyistetanus (i.e.,aboardlikeuterus). DIC is a pathologic form of diffuse clotting that consumes
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large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both.
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DIC is always a secondary diagnosis, often associated with obstetric risk factors such as the hemolysis,
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elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. This woman did not have any
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prior risk factors.
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DIF:Cognitive Level:AnalyzeREF:dm.684TOP:NursingProcess:Diagnosis MSC:
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Client Needs: Physiologic Integrity
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6. Awomanarrives forevaluationofsigns and symptoms thatincludeamissedperiod,adnexal
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fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic
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blueness around the womans umbilicus. What does this finding indicate?
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a. Normalintegumentarychanges associated with pregnancy k k k k k




b. Turnersign associated with appendicitis k k k k




c. Cullensignassociated with aruptured ectopicpregnancy k k k k k k k




d. Chadwicksignassociatedwithearlypregnancy k k k k k




ANS: C
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Cullensign,theblueecchymosis observed intheumbilical area,indicates hematoperitoneum
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associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on thek k k k k k k k k k k




abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
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pigmented,vertical lineonthelowerabdomen.Turnersignisecchymosis in theflankarea,often
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associated with pancreatitis. A Chadwick sign is a blue-purple cervix that maybe seen during or around
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the eighth week of pregnancy.
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DIF:Cognitive Level:AnalyzeREF: dm.676
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TOP:NursingProcess: AssessmentMSC:ClientNeeds: Physiologic Integrity
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7. The nurse who elects to practice in the area of womens health must have a thorough
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understandingofmiscarriage.Whichstatementregardingthisconditionismostaccurate?
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a. Amiscarriage is anatural pregnancyloss beforelaborbegins. k k k k k k k k k




b. Itoccursin fewerthan5%ofall clinicallyrecognized pregnancies.
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c. Careless maternalbehavior,suchaspoor nutrition orexcessiveexercise, canbeafactorincausi If a k k k k k k k k k k k k k k k k k




miscarriage occurs before the12th week ofpregnancy, then it maybeobserved onlyas mod
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d. blood loss. k




ANS:D k




Beforethe sixth week, theonlyevidencemight be aheavymenstrual flow. Afterthe 12th week, more
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severepain, similarto thatoflabor,is likely. Miscarriage isanatural pregnancyloss, but it
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