MaternityzNewbornzandzWomen’szHealthzNursingzAzCase-
BasedzApproachz1stzEditionzO’MearazTestzBank
Chapterz1zImmediatezPostpartumzHemorrhage
MULTIPLEzCHOICE
1. Azpregnantzwomanziszbeingzdischargedzfromzthezhospitalzafterzthezplacementzofzazcer
vicalz cerclagez becausez ofz az historyz ofz recurrentz pregnancyz loss,z secondaryz toz anz incompetentzce
rvix.zWhichzinformationzregardingzpostzproceduralzcarezshouldztheznursezemphasizezinzthezd
ischargez teaching?
a. Anyzvaginalzdischargezshouldzbezimmediatelyzreportedztozherzhealthzcarezprovider
.zb.
Thezpresencezofzanyzcontractions,zrupturezofzmembranesz(ROM),zorzseverezperinea
lzpressurezshouldz bezreported
c. Thez clientz willz needz toz makez arrangementsz forz carez atz home,z becausez herz activityz leve
lzwillz bezrestricted
d. Thezclientzwillzbezscheduledzforzazcesareanzbirth.z
ANS:zB
Nursingzcarezshouldzstresszthezimportancezofzmonitoringzforzthezsignszandzsymptomszofzpret
ermzlabor.zVaginalzbleedingzneedsztozbezreportedztozherzprimaryzhealthzcarezprovider.z Bedzrestzis
zanzelementzofzcare.zHowever,zthezwomanzmayz standzforzperiodszofzupz toz 90zminutes,z whichza
llowszherzthezfreedomztozseezherzphysician.zHomezuterinezactivityzmonitoringzmayzbezusedzto
zlimitzthezwomanszneedzforzvisitszandztozmonitorzherzstatuszsafelyzatzhome.zThezcerclagezcanz be
z removedz atz 37z weeksz ofz gestationz (toz preparez forz az vaginalz birth),z orz az cesareanz birthz canzbez pl
anned.
DIF:zCognitivez Level:zApplyzREF:zdm.z675
TOP:z Nursingz Process:z Planningz|z Nursingz Process:z Implementationz MSC:z ClientzNeeds:zHealthzP
romotionzandzMaintenance
2. Az perinatalz nursez isz givingz dischargez instructionsz toz az woman,z statusz postsuction,z an
dzcurettagezsecondaryztozazhydatidiformzmole.zThezwomanzaskszwhyzshezmustztakezoralzcontrac
eptiveszforz thez nextz 12z months.zWhatzisz thezbestz responsez byz thez nurse?
a. Ifz youz getz pregnantz withinz 1z year,z thez chancez ofz az successfulz pregnancyz isz veryz small
.zTherefore,zifzpregnancy,zitzwouldzbezbetterzforzyouztozusezthezmostzreliablezmethodzofzco
ntraceptionzavailable.
b. Thezmajorzriskztozyouzafterzazmolarzpregnancyziszaztypezofzcancerzthatzcanzbezdiagnosedzonl
yzbyzmezhormonezthatzyourzbodyzproduceszduringzpregnancy.zIfzyouzwereztozgetzpregnant,zthe
nzitzwouldzmakezthiszcancerzmorezdifficult.
c. Ifzyouzcanzavoidzazpregnancyzforztheznextzyear,zthezchancezofzdevelopingzazsecondzmolarzp
regnancyzimprovezyourzchancezofzazsuccessfulzpregnancy,znotzgettingzpregnantzatzthisztimezisz
best.
d. Oralz contraceptivesz arez thez onlyz formz ofz birthz controlz thatz willz preventz az recurrencez ofz
azmolarzpregnancy
ANS:zB
Betahumanz chorionicz gonadotropinz (beta-
hCG)z hormonez levelsz arez drawnz forz 1z yearz toz ensurezthatzthezmoleziszcompletelyzgone.zThezch
ancezofzdevelopingzchoriocarcinomazafterzthezdevelopmentzofzazhydatidiformzmoleziszincreas
ed.zTherefore,zthezgoalzisztozachievezazzero
IfzyouzneedzanyzotherzTestzBankszorzeTextbookszcontactzus:
m
,humanzchorioniczgonadotropinz (hCG)zlevel.z Ifz thezwomanzwerez tozbecomezpregnant,zthenz itzm
ayz obscurez thez presencez ofz thez potentiallyz carcinogenicz cells.z Womenz shouldz bez instructedz toz
usezbirthzcontrolzforz1zyearzafterztreatmentzforzazhydatidiformzmole.zThezrationalezforzavoidingzp
regnancyz forz 1z yearz isz toz ensurez thatz carcinogenicz cellsz arez notz present.z Anyz contraceptivezmet
hodz exceptzanz intrauterinez devicez (IUD)ziszacceptable.
DIF:zCognitivez Level:zApplyz REF:zdm.z 679
TOP:z Nursingz Process:z Planningz|z NursingzProcess:z Implementationz MSC:z ClientzNeeds:zPhys
iologiczIntegrity
3. Thez nursez isz preparingz toz administerz methotrexatez toz thez client.z Thisz hazardousz drugz i
szmostzoftenzusedzforzwhichzobstetriczcomplication?
a. Completezhydatidiformzmole
b. Missedzabortion
c. Unrupturedzectopiczpregnancy
d. Abruptiozplacentaez
ANS:z C
Methotrexateziszanzeffectiveznonsurgicalztreatmentzoptionzforzazhemodynamicallyzstablezwomanzw
hosezectopiczpregnancyziszunrupturedzandzmeasureszlesszthanz4zcmzinzdiameter.zMethotrexatezi
sznotzindicatedzorzrecommendedzaszaztreatmentzoptionzforzazcompletezhydatidiformzmole,zforzaz
missedzabortion,zorzforzabruptiozplacentae.
DIF:zCognitivezLevel:zApplyzREF:zdm.z677zTOP:zNursingzProcess:zPlanningzMSC:zClientzNeeds:z
PhysiologiczIntegrity
4. Az 26-year-oldz pregnantz woman,z gravidaz 2,z paraz 1-0-0-
1,z isz 28z weeksz pregnantz whenz shezexperienceszbrightzred,zpainlesszvaginalzbleeding.zOnzherza
rrivalzatzthezhospital,zwhichzdiagnosticzprocedurez willzthezclientzmostzlikelyzhavezperformed?
a. Amniocentesiszforzfetalzlungzmaturity
b. Transvaginalz ultrasoundz forz placentalz location
c. Contractionz stressz testz (CST)
d. Internalzfetalzmonitoringz
ANS:zB
Thezpresencezofzpainlesszbleedingzshouldzalwayszalertzthezhealthzcarezteamztozthezpossibilityz
ofzplacentazprevia,zwhichzcanzbezconfirmedzthroughzultrasonography.zAmniocentesiszisznotzper
formedzonzazwomanzwhoziszexperiencingzbleeding.zInzthezeventzofzanzimminentzdelivery,zthezfet
usziszpresumedztozhavezimmaturezlungszatzthiszgestationalzage,zandzthezmotherziszgivenzcortic
osteroidsztozaidzinzfetalzlungzmaturity.zAzCSTzisznotzperformedzatzazpretermzgestationalzage.zFu
rthermore,zbleedingziszazcontraindicationztozazCST.zInternalzfetalzmonitoringziszalsozcontraindi
catedzinzthezpresencezofz bleeding.
DIF:zCognitivez Level:zApplyzREF:zdm.z680
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zHealthz Promotionz andzMaintenance
5. AzlaboringzwomanzwithznozknownzriskzfactorszsuddenlyzexperienceszspontaneouszROM
.zThezfluidzconsistszofzbrightzredzblood.zHerzcontractionszarezconsistentzwithzherzcurrentzstagez
ofzlabor.zNozchangezinzuterinezrestingztonezhaszoccurred.zThezfetalzheartzratez(FHR)zbeginsztozd
eclinezrapidlyzafterzthezROM.zTheznursezshouldzsuspectzthezpossibilityzofzwhatzcondition?
a. Placentazprevia
IfzyouzneedzanyzotherzTestzBankszorzeTextbookszcontactzus:
m
,b. Vasazprevia
c. Severez abruptioz placentae
d. Disseminatedzintravascularzcoagulationz(DIC)z
ANS:zB
Vasazpreviaziszthezresultzofzazvelamentouszinsertionzofzthezumbilicalzcord.zThezumbilicalzvessel
szareznotzsurroundedzbyzWhartonzjellyzandzhaveznozsupportiveztissue.zThezumbilicalzbloodzvess
elszthuszarezatzriskzforzlacerationzatzanyztime,zbutzlacerationzoccurszmostzfrequentlyzduringzRO
M.zThezsuddenzappearancez ofzbrightzredz bloodzatztheztimezofzROMzandz azsuddenz changezinzthe
zFHRzwithoutzotherzknownzriskzfactorszshouldzimmediatelyzalertztheznurseztozthez possibilityzof
zvasaz previa.zThezpresencezofzplacentazpreviazmostzlikelyzwouldz bezascertainedzbeforezlaborzan
dziszconsideredzazriskzfactorzforzthiszpregnancy.zInzaddition,zifzthezwomanzhadzazplacentazprevia
,zitziszunlikelyzthatzshezwouldzbezallowedztozpursuezlaborzandzazvaginalzbirth.zWithzthezpresence
zofzseverezabruptiozplacentae,zthezuterineztonicityztypicallyzisz tetanusz(i.e.,zazboardlikezuterus).z
DICziszazpathologiczformzofzdiffusezclottingzthatzconsumeszlargezamountszofzclottingzfactors,zca
usingzwidespreadzexternalzbleeding,zinternalzbleeding,zorzboth.zDICziszalwayszazsecondaryzdiag
nosis,zoftenzassociatedzwithzobstetriczriskzfactorszsuchzaszthezhemolysis,zelevatedzliverzenzyme
zlevels,zandzlowzplateletzlevelsz(HELLP)z syndrome.zThiszwomanzdidznotzhavezanyzpriorzriskzfact
ors.
DIF:zCognitivez Level:zAnalyzez REF:z dm.z 684z TOP:zNursingz Process:z Diagnosisz MSC:z ClientzNe
eds:zPhysiologicz Integrity
6. Azwomanzarriveszforzevaluationzofzsignszandzsymptomszthatzincludezazmissedzperiod,z
adnexalzfullness,ztenderness,zandzdarkzredzvaginalzbleeding.zOnzexamination,ztheznurseznotice
szanzecchymoticzbluenesszaroundzthezwomanszumbilicus.zWhatzdoeszthiszfindingzindicate?
a. Normalz integumentaryz changesz associatedz withz pregnancy
b. Turnerz signz associatedz withz appendicitis
c. Cullenzsignzassociatedzwithzazrupturedzectopiczpregnancy
d. Chadwickzsignzassociatedzwithzearlyzpregnanc
yzANS:zC
Cullenzsign,zthezbluezecchymosiszobservedzinzthezumbilicalzarea,zindicateszhematoperitoneumz
associatedzwithzanzundiagnosedzrupturedzintraabdominalzectopiczpregnancy.zLineaznigrazonzth
ezabdomenzisztheznormalzintegumentaryzchangezassociatedzwithzpregnancyzandzexhibitszazbro
wnzpigmented,zverticalzlinezonzthezlowerzabdomen.zTurnerzsignziszecchymosiszinzthezflankzare
a,zoftenzassociatedzwithzpancreatitis.zAzChadwickzsignziszazblue-
purplezcervixzthatzmayzbezseenzduringzorzaroundz thez eighthzweekz ofzpregnancy.
DIF:zCognitivez Level:zAnalyzezREF:zdm.z676
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zPhysiologiczIntegrity
7. Thez nursez whoz electsz toz practicez inz thez areaz ofz womensz healthz mustz havez az thoroug
hzunderstandingz ofz miscarriage.z Whichz statementz regardingz thisz conditionz isz mostz accurate?
a. Azmiscarriageziszaznaturalzpregnancyzlosszbeforezlaborzbegins.
b. Itz occursz inz fewerz thanz 5%z ofz allz clinicallyz recognizedz pregnancies.
c. Carelessz maternalz behavior,z suchz asz poorz nutritionz orz excessivez exercise,z canz bez az facto
rzinzcausingzmiscarriage
d. Ifz az miscarriagez occursz beforez thez 12thz weekz ofz pregnancy,z thenz itz mayz bez observedz onlyz a
szmoderatezbloodzloss
ANS:zD
IfzyouzneedzanyzotherzTestzBankszorzeTextbookszcontactzus:
m
, Beforezthezsixthzweek,zthezonlyzevidencezmightzbezazheavyzmenstrualzflow.zAfterzthez12thzweek
,zmorezseverezpain,zsimilarztozthatzofzlabor,ziszlikely.zMiscarriageziszaznaturalzpregnancyzloss,zbut
zitzoccurs,z byz definition,z beforez 20z weeksz ofz gestation,z beforez thez fetusz isz viable.z Miscarriagesz occ
urzinzapproximatelyz10%ztoz15%zofzallzclinicallyzrecognizedzpregnancies.zMiscarriageszcanzbez
causedzbyzaznumberzofzdisorderszorzillnesseszoutsidezthezmotherszcontrolzorzknowledge.
DIF:zCognitivezLevel:zUnderstandzREF:zdm.z670
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zPhysiologiczIntegrity
8. Azwomanzwhozisz30zweekszofzgestationzarriveszatzthezhospitalzwithzbleeding.zWhic
hzdifferentialzdiagnosisz wouldznotzbezapplicablezforzthiszclient?
a. Placentazprevia
b. Abruptiozplacentae
c. Spontaneousz abortion
d. Cordzinsertionz
ANS:z C
Spontaneouszabortionziszanotherznamezforzmiscarriage;zitzoccurs,zbyzdefinition,zearlyzinzpreg
nancy.zPlacentazpreviaziszazwell-
knownzreasonzforzbleedingzlatezinzpregnancy.zThezprematurez separationz ofzthez placentaz (abru
ptioz placentae)z isz az bleedingz disorderz thatz canz occurzlatezinzpregnancy.zCordzinsertionzmayzca
usezazbleedingzdisorderzthatzcanzalsozoccurzlatezinzpregnancy.
DIF:zCognitivezLevel:zUnderstandzREF:zdm.z669zTOP:zNursingzProcess:zAssessmen
tzMSC:zClientzNeeds:zPhysiologicz Integrity,z Physiologicz Adaptation
9. Withzregardztozhemorrhagiczcomplicationszthatzmayzoccurzduringzpregnancy,zwha
tzinformationziszmostzaccurate?
a. Anzincompetentzcervixziszusuallyznotzdiagnosedzuntilzthezwomanzhaszlostzonezorztw
ozpregnancies.
b. Incidenceszofzectopiczpregnancyzarezdecliningzaszazresultzofzimprovedzdiagnosti
cztechniques.
c. Onezectopiczpregnancyzdoesznotzaffectzazwomanszfertilityzorzherzlikelihoodzofzhavingz
aznormalzpregnancy
d. Gestationalztrophoblasticzneoplasiaz(GTN)ziszonezofzthezpersistentlyzincurablezg
ynecologiczmaligna
ANS:zA
Shortzlaborszandzrecurringzlosseszofzpregnancyzatzprogressivelyzearlierzgestationalzageszarezc
haracteristicszofzreducedzcervicalzcompetence.zBecausezdiagnosticztechnologyziszimproving,zmor
ezectopiczpregnancieszarezbeingzdiagnosed.zOnezectopiczpregnancyzplaceszthezwomanzatzincre
asedzriskzforzanotherzone.zEctopiczpregnancyziszazleadingzcausezofzinfertility.zOncezinvariably
zfatal,z GTNznowz isz thez mostzcurablez gynecologicz malignancy.
DIF:zCognitivezLevel:zUnderstandzREF:zdm.z675
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zHealthzPromotionzandzMaintenance
10. Thezmanagementzofz thezpregnantzclientzwhozhaszexperiencedz az pregnancyzlossz dependsz
onztheztypezofzmiscarriagezandzthezsignszandzsymptoms.zWhilezplanningzcarezforzazclientzwhozdesir
esz outpatientz managementz afterz az first-
trimesterz loss,z whatz wouldz thez nursez expectz thez planztozinclude?
IfzyouzneedzanyzotherzTestzBankszorzeTextbookszcontactzus:
m
BasedzApproachz1stzEditionzO’MearazTestzBank
Chapterz1zImmediatezPostpartumzHemorrhage
MULTIPLEzCHOICE
1. Azpregnantzwomanziszbeingzdischargedzfromzthezhospitalzafterzthezplacementzofzazcer
vicalz cerclagez becausez ofz az historyz ofz recurrentz pregnancyz loss,z secondaryz toz anz incompetentzce
rvix.zWhichzinformationzregardingzpostzproceduralzcarezshouldztheznursezemphasizezinzthezd
ischargez teaching?
a. Anyzvaginalzdischargezshouldzbezimmediatelyzreportedztozherzhealthzcarezprovider
.zb.
Thezpresencezofzanyzcontractions,zrupturezofzmembranesz(ROM),zorzseverezperinea
lzpressurezshouldz bezreported
c. Thez clientz willz needz toz makez arrangementsz forz carez atz home,z becausez herz activityz leve
lzwillz bezrestricted
d. Thezclientzwillzbezscheduledzforzazcesareanzbirth.z
ANS:zB
Nursingzcarezshouldzstresszthezimportancezofzmonitoringzforzthezsignszandzsymptomszofzpret
ermzlabor.zVaginalzbleedingzneedsztozbezreportedztozherzprimaryzhealthzcarezprovider.z Bedzrestzis
zanzelementzofzcare.zHowever,zthezwomanzmayz standzforzperiodszofzupz toz 90zminutes,z whichza
llowszherzthezfreedomztozseezherzphysician.zHomezuterinezactivityzmonitoringzmayzbezusedzto
zlimitzthezwomanszneedzforzvisitszandztozmonitorzherzstatuszsafelyzatzhome.zThezcerclagezcanz be
z removedz atz 37z weeksz ofz gestationz (toz preparez forz az vaginalz birth),z orz az cesareanz birthz canzbez pl
anned.
DIF:zCognitivez Level:zApplyzREF:zdm.z675
TOP:z Nursingz Process:z Planningz|z Nursingz Process:z Implementationz MSC:z ClientzNeeds:zHealthzP
romotionzandzMaintenance
2. Az perinatalz nursez isz givingz dischargez instructionsz toz az woman,z statusz postsuction,z an
dzcurettagezsecondaryztozazhydatidiformzmole.zThezwomanzaskszwhyzshezmustztakezoralzcontrac
eptiveszforz thez nextz 12z months.zWhatzisz thezbestz responsez byz thez nurse?
a. Ifz youz getz pregnantz withinz 1z year,z thez chancez ofz az successfulz pregnancyz isz veryz small
.zTherefore,zifzpregnancy,zitzwouldzbezbetterzforzyouztozusezthezmostzreliablezmethodzofzco
ntraceptionzavailable.
b. Thezmajorzriskztozyouzafterzazmolarzpregnancyziszaztypezofzcancerzthatzcanzbezdiagnosedzonl
yzbyzmezhormonezthatzyourzbodyzproduceszduringzpregnancy.zIfzyouzwereztozgetzpregnant,zthe
nzitzwouldzmakezthiszcancerzmorezdifficult.
c. Ifzyouzcanzavoidzazpregnancyzforztheznextzyear,zthezchancezofzdevelopingzazsecondzmolarzp
regnancyzimprovezyourzchancezofzazsuccessfulzpregnancy,znotzgettingzpregnantzatzthisztimezisz
best.
d. Oralz contraceptivesz arez thez onlyz formz ofz birthz controlz thatz willz preventz az recurrencez ofz
azmolarzpregnancy
ANS:zB
Betahumanz chorionicz gonadotropinz (beta-
hCG)z hormonez levelsz arez drawnz forz 1z yearz toz ensurezthatzthezmoleziszcompletelyzgone.zThezch
ancezofzdevelopingzchoriocarcinomazafterzthezdevelopmentzofzazhydatidiformzmoleziszincreas
ed.zTherefore,zthezgoalzisztozachievezazzero
IfzyouzneedzanyzotherzTestzBankszorzeTextbookszcontactzus:
m
,humanzchorioniczgonadotropinz (hCG)zlevel.z Ifz thezwomanzwerez tozbecomezpregnant,zthenz itzm
ayz obscurez thez presencez ofz thez potentiallyz carcinogenicz cells.z Womenz shouldz bez instructedz toz
usezbirthzcontrolzforz1zyearzafterztreatmentzforzazhydatidiformzmole.zThezrationalezforzavoidingzp
regnancyz forz 1z yearz isz toz ensurez thatz carcinogenicz cellsz arez notz present.z Anyz contraceptivezmet
hodz exceptzanz intrauterinez devicez (IUD)ziszacceptable.
DIF:zCognitivez Level:zApplyz REF:zdm.z 679
TOP:z Nursingz Process:z Planningz|z NursingzProcess:z Implementationz MSC:z ClientzNeeds:zPhys
iologiczIntegrity
3. Thez nursez isz preparingz toz administerz methotrexatez toz thez client.z Thisz hazardousz drugz i
szmostzoftenzusedzforzwhichzobstetriczcomplication?
a. Completezhydatidiformzmole
b. Missedzabortion
c. Unrupturedzectopiczpregnancy
d. Abruptiozplacentaez
ANS:z C
Methotrexateziszanzeffectiveznonsurgicalztreatmentzoptionzforzazhemodynamicallyzstablezwomanzw
hosezectopiczpregnancyziszunrupturedzandzmeasureszlesszthanz4zcmzinzdiameter.zMethotrexatezi
sznotzindicatedzorzrecommendedzaszaztreatmentzoptionzforzazcompletezhydatidiformzmole,zforzaz
missedzabortion,zorzforzabruptiozplacentae.
DIF:zCognitivezLevel:zApplyzREF:zdm.z677zTOP:zNursingzProcess:zPlanningzMSC:zClientzNeeds:z
PhysiologiczIntegrity
4. Az 26-year-oldz pregnantz woman,z gravidaz 2,z paraz 1-0-0-
1,z isz 28z weeksz pregnantz whenz shezexperienceszbrightzred,zpainlesszvaginalzbleeding.zOnzherza
rrivalzatzthezhospital,zwhichzdiagnosticzprocedurez willzthezclientzmostzlikelyzhavezperformed?
a. Amniocentesiszforzfetalzlungzmaturity
b. Transvaginalz ultrasoundz forz placentalz location
c. Contractionz stressz testz (CST)
d. Internalzfetalzmonitoringz
ANS:zB
Thezpresencezofzpainlesszbleedingzshouldzalwayszalertzthezhealthzcarezteamztozthezpossibilityz
ofzplacentazprevia,zwhichzcanzbezconfirmedzthroughzultrasonography.zAmniocentesiszisznotzper
formedzonzazwomanzwhoziszexperiencingzbleeding.zInzthezeventzofzanzimminentzdelivery,zthezfet
usziszpresumedztozhavezimmaturezlungszatzthiszgestationalzage,zandzthezmotherziszgivenzcortic
osteroidsztozaidzinzfetalzlungzmaturity.zAzCSTzisznotzperformedzatzazpretermzgestationalzage.zFu
rthermore,zbleedingziszazcontraindicationztozazCST.zInternalzfetalzmonitoringziszalsozcontraindi
catedzinzthezpresencezofz bleeding.
DIF:zCognitivez Level:zApplyzREF:zdm.z680
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zHealthz Promotionz andzMaintenance
5. AzlaboringzwomanzwithznozknownzriskzfactorszsuddenlyzexperienceszspontaneouszROM
.zThezfluidzconsistszofzbrightzredzblood.zHerzcontractionszarezconsistentzwithzherzcurrentzstagez
ofzlabor.zNozchangezinzuterinezrestingztonezhaszoccurred.zThezfetalzheartzratez(FHR)zbeginsztozd
eclinezrapidlyzafterzthezROM.zTheznursezshouldzsuspectzthezpossibilityzofzwhatzcondition?
a. Placentazprevia
IfzyouzneedzanyzotherzTestzBankszorzeTextbookszcontactzus:
m
,b. Vasazprevia
c. Severez abruptioz placentae
d. Disseminatedzintravascularzcoagulationz(DIC)z
ANS:zB
Vasazpreviaziszthezresultzofzazvelamentouszinsertionzofzthezumbilicalzcord.zThezumbilicalzvessel
szareznotzsurroundedzbyzWhartonzjellyzandzhaveznozsupportiveztissue.zThezumbilicalzbloodzvess
elszthuszarezatzriskzforzlacerationzatzanyztime,zbutzlacerationzoccurszmostzfrequentlyzduringzRO
M.zThezsuddenzappearancez ofzbrightzredz bloodzatztheztimezofzROMzandz azsuddenz changezinzthe
zFHRzwithoutzotherzknownzriskzfactorszshouldzimmediatelyzalertztheznurseztozthez possibilityzof
zvasaz previa.zThezpresencezofzplacentazpreviazmostzlikelyzwouldz bezascertainedzbeforezlaborzan
dziszconsideredzazriskzfactorzforzthiszpregnancy.zInzaddition,zifzthezwomanzhadzazplacentazprevia
,zitziszunlikelyzthatzshezwouldzbezallowedztozpursuezlaborzandzazvaginalzbirth.zWithzthezpresence
zofzseverezabruptiozplacentae,zthezuterineztonicityztypicallyzisz tetanusz(i.e.,zazboardlikezuterus).z
DICziszazpathologiczformzofzdiffusezclottingzthatzconsumeszlargezamountszofzclottingzfactors,zca
usingzwidespreadzexternalzbleeding,zinternalzbleeding,zorzboth.zDICziszalwayszazsecondaryzdiag
nosis,zoftenzassociatedzwithzobstetriczriskzfactorszsuchzaszthezhemolysis,zelevatedzliverzenzyme
zlevels,zandzlowzplateletzlevelsz(HELLP)z syndrome.zThiszwomanzdidznotzhavezanyzpriorzriskzfact
ors.
DIF:zCognitivez Level:zAnalyzez REF:z dm.z 684z TOP:zNursingz Process:z Diagnosisz MSC:z ClientzNe
eds:zPhysiologicz Integrity
6. Azwomanzarriveszforzevaluationzofzsignszandzsymptomszthatzincludezazmissedzperiod,z
adnexalzfullness,ztenderness,zandzdarkzredzvaginalzbleeding.zOnzexamination,ztheznurseznotice
szanzecchymoticzbluenesszaroundzthezwomanszumbilicus.zWhatzdoeszthiszfindingzindicate?
a. Normalz integumentaryz changesz associatedz withz pregnancy
b. Turnerz signz associatedz withz appendicitis
c. Cullenzsignzassociatedzwithzazrupturedzectopiczpregnancy
d. Chadwickzsignzassociatedzwithzearlyzpregnanc
yzANS:zC
Cullenzsign,zthezbluezecchymosiszobservedzinzthezumbilicalzarea,zindicateszhematoperitoneumz
associatedzwithzanzundiagnosedzrupturedzintraabdominalzectopiczpregnancy.zLineaznigrazonzth
ezabdomenzisztheznormalzintegumentaryzchangezassociatedzwithzpregnancyzandzexhibitszazbro
wnzpigmented,zverticalzlinezonzthezlowerzabdomen.zTurnerzsignziszecchymosiszinzthezflankzare
a,zoftenzassociatedzwithzpancreatitis.zAzChadwickzsignziszazblue-
purplezcervixzthatzmayzbezseenzduringzorzaroundz thez eighthzweekz ofzpregnancy.
DIF:zCognitivez Level:zAnalyzezREF:zdm.z676
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zPhysiologiczIntegrity
7. Thez nursez whoz electsz toz practicez inz thez areaz ofz womensz healthz mustz havez az thoroug
hzunderstandingz ofz miscarriage.z Whichz statementz regardingz thisz conditionz isz mostz accurate?
a. Azmiscarriageziszaznaturalzpregnancyzlosszbeforezlaborzbegins.
b. Itz occursz inz fewerz thanz 5%z ofz allz clinicallyz recognizedz pregnancies.
c. Carelessz maternalz behavior,z suchz asz poorz nutritionz orz excessivez exercise,z canz bez az facto
rzinzcausingzmiscarriage
d. Ifz az miscarriagez occursz beforez thez 12thz weekz ofz pregnancy,z thenz itz mayz bez observedz onlyz a
szmoderatezbloodzloss
ANS:zD
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, Beforezthezsixthzweek,zthezonlyzevidencezmightzbezazheavyzmenstrualzflow.zAfterzthez12thzweek
,zmorezseverezpain,zsimilarztozthatzofzlabor,ziszlikely.zMiscarriageziszaznaturalzpregnancyzloss,zbut
zitzoccurs,z byz definition,z beforez 20z weeksz ofz gestation,z beforez thez fetusz isz viable.z Miscarriagesz occ
urzinzapproximatelyz10%ztoz15%zofzallzclinicallyzrecognizedzpregnancies.zMiscarriageszcanzbez
causedzbyzaznumberzofzdisorderszorzillnesseszoutsidezthezmotherszcontrolzorzknowledge.
DIF:zCognitivezLevel:zUnderstandzREF:zdm.z670
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zPhysiologiczIntegrity
8. Azwomanzwhozisz30zweekszofzgestationzarriveszatzthezhospitalzwithzbleeding.zWhic
hzdifferentialzdiagnosisz wouldznotzbezapplicablezforzthiszclient?
a. Placentazprevia
b. Abruptiozplacentae
c. Spontaneousz abortion
d. Cordzinsertionz
ANS:z C
Spontaneouszabortionziszanotherznamezforzmiscarriage;zitzoccurs,zbyzdefinition,zearlyzinzpreg
nancy.zPlacentazpreviaziszazwell-
knownzreasonzforzbleedingzlatezinzpregnancy.zThezprematurez separationz ofzthez placentaz (abru
ptioz placentae)z isz az bleedingz disorderz thatz canz occurzlatezinzpregnancy.zCordzinsertionzmayzca
usezazbleedingzdisorderzthatzcanzalsozoccurzlatezinzpregnancy.
DIF:zCognitivezLevel:zUnderstandzREF:zdm.z669zTOP:zNursingzProcess:zAssessmen
tzMSC:zClientzNeeds:zPhysiologicz Integrity,z Physiologicz Adaptation
9. Withzregardztozhemorrhagiczcomplicationszthatzmayzoccurzduringzpregnancy,zwha
tzinformationziszmostzaccurate?
a. Anzincompetentzcervixziszusuallyznotzdiagnosedzuntilzthezwomanzhaszlostzonezorztw
ozpregnancies.
b. Incidenceszofzectopiczpregnancyzarezdecliningzaszazresultzofzimprovedzdiagnosti
cztechniques.
c. Onezectopiczpregnancyzdoesznotzaffectzazwomanszfertilityzorzherzlikelihoodzofzhavingz
aznormalzpregnancy
d. Gestationalztrophoblasticzneoplasiaz(GTN)ziszonezofzthezpersistentlyzincurablezg
ynecologiczmaligna
ANS:zA
Shortzlaborszandzrecurringzlosseszofzpregnancyzatzprogressivelyzearlierzgestationalzageszarezc
haracteristicszofzreducedzcervicalzcompetence.zBecausezdiagnosticztechnologyziszimproving,zmor
ezectopiczpregnancieszarezbeingzdiagnosed.zOnezectopiczpregnancyzplaceszthezwomanzatzincre
asedzriskzforzanotherzone.zEctopiczpregnancyziszazleadingzcausezofzinfertility.zOncezinvariably
zfatal,z GTNznowz isz thez mostzcurablez gynecologicz malignancy.
DIF:zCognitivezLevel:zUnderstandzREF:zdm.z675
TOP:zNursingzProcess:zAssessmentzMSC:zClientzNeeds:zHealthzPromotionzandzMaintenance
10. Thezmanagementzofz thezpregnantzclientzwhozhaszexperiencedz az pregnancyzlossz dependsz
onztheztypezofzmiscarriagezandzthezsignszandzsymptoms.zWhilezplanningzcarezforzazclientzwhozdesir
esz outpatientz managementz afterz az first-
trimesterz loss,z whatz wouldz thez nursez expectz thez planztozinclude?
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