, Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edi
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
recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural ca
emphasize in the dischargeteaching?
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 car
may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine a
be used to limit the womans need for visits and to monitor her status safely at home. The cerclage can be rem
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
The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by t
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 m
hormone that your body produces during pregnancy. If you were to get pregnant, then it would m
b. this cancer more difficult.
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnan
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 pr
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 hyda
increased. Therefore, the goal is to achieve a zero human chorionic gonadotropin (hCG) level. If the woman w
then it may obscurethe presence of the potentially carcinogenic cells. Women should be instructed to use birth
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
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 w
complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentaeANS: 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
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
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 wom
bleeding. In the event of an imminent delivery, the fetus is presumed to have immature lungs at this gestation
given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age. Furthe
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
contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The
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 ris
time, but laceration occurs most frequently during ROM. Thesudden appearance of bright red blood at the tim
change in the FHR without other known risk factors should immediately alert the nurse to the possibility of v
of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregna
woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. Wit
abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form o
consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both.
secondary diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme
levels (HELLP) syndrome. This woman did not have any prior risk factors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: DiagnosisMSC: Client Needs: Physiolo
Integrity
6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tende
vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. W
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 pregnancyANS: 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 th
change associated with pregnancy and exhibits a brown pigmented, vertical line on the lower abdomen. Turne
the flank area, oftenassociated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen du
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 misc
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
d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as mod
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
recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural ca
emphasize in the dischargeteaching?
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 car
may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine a
be used to limit the womans need for visits and to monitor her status safely at home. The cerclage can be rem
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
The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by t
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 m
hormone that your body produces during pregnancy. If you were to get pregnant, then it would m
b. this cancer more difficult.
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnan
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 pr
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 hyda
increased. Therefore, the goal is to achieve a zero human chorionic gonadotropin (hCG) level. If the woman w
then it may obscurethe presence of the potentially carcinogenic cells. Women should be instructed to use birth
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
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 w
complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentaeANS: 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
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
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 wom
bleeding. In the event of an imminent delivery, the fetus is presumed to have immature lungs at this gestation
given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age. Furthe
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
contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The
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 ris
time, but laceration occurs most frequently during ROM. Thesudden appearance of bright red blood at the tim
change in the FHR without other known risk factors should immediately alert the nurse to the possibility of v
of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregna
woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. Wit
abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form o
consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both.
secondary diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme
levels (HELLP) syndrome. This woman did not have any prior risk factors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: DiagnosisMSC: Client Needs: Physiolo
Integrity
6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tende
vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. W
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 pregnancyANS: 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 th
change associated with pregnancy and exhibits a brown pigmented, vertical line on the lower abdomen. Turne
the flank area, oftenassociated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen du
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 misc
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
d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as mod
