Test Bank for Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition ; O’Meara Test Bank | Complete Chapters 1 - 30|Comprehensive Companion Gold Rated

,Chapter 1 Immediate Postpartum Hemorrhage df df df df




MULTIPLE CHOICE df



1. A pregnant woman is being discharged from the hospital after the placement of a cervical c
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erclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Whic
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h information regarding postprocedural care should the nurse emphasize in the discharge teaching?
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a. Any vaginal discharge should be immediately reported to her health care provider.df df df df df df df df df df df




b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure sho
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c. The client will need to make arrangements for care at home, because her activity level will be re
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d. The client will be scheduled for a cesarean birth. df df df df df df df df df




ANS: B df



Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
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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 t
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o see her physician. Home uterine activity monitoring may be used to limit the womans need for visits a
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nd to monitor her status safely at home. The cerclage can be removed at37 weeks of gestation (to prepar
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e for a vaginal birth), or a cesarean birth can be planned.
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DIF: Cognitive Level: Apply REF: dm. 675
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TOP: Nursing Process: Planning | Nursing Process: ImplementationMSC:
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Client Needs: Health Promotion and Maintenance
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2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage s
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econdary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12
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months. What is the bestresponse by the nurse?
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If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, df df df df df df df df df df df df df df df df



a. pregnancy, it would be better for you to use the most reliable method of contraception available. df df df df df df df df df df df df df df df




The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only byhormone th
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at your body produces during pregnancy. If you were to get pregnant, then it would df df df df df df df df df df df df df df



b. this cancer more difficult. df df df




If you can avoid a pregnancy for the next year, the chance of developing a second molar pregna
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c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
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d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar p A df df df df df df df df df df df df df df df df df df




NS: B df



Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
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that the mole is completely gone. The chance of developing choriocarcinoma after the development of a
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hydatidiform mole is increased. Therefore, the goal is to achieve a zero humanchorionic gonadotropin (
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hCG) level. If the woman were to become pregnant, then it may obscurethe presence of the potentially c
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arcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydati
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diform mole. The rationale for avoiding pregnancy
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,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method exceptan i
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ntrauterine device (IUD) is acceptable. df df df df



DIF: Cognitive Level: Apply REF: dm. 679
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TOP: Nursing Process: Planning | Nursing Process: ImplementationMSC: Client
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Needs: Physiologic Integrity
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3. The nurse is preparing to administer methotrexate to the client. This hazardous drug i
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s most often used for which obstetric complication?
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a. Complete hydatidiform mole df df




b. Missed abortion df




c. Unruptured ectopic pregnancy df df




d. Abruptio placentae df df




ANS: C df



Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman
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whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate isnot indi
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cated or recommended as a treatment option for a complete hydatidiform mole, for a missed abortion, o
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r for abruptio placentae.
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DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: PlanningMSC: Client
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Needs: Physiologic Integrity
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4. A 26-year-old pregnant woman, gravida 2, para 1-0-0- df df df df df df df



1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival
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at the hospital, which diagnostic procedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity df df df df




b. Transvaginal ultrasound for placental location df df df df




c. Contraction stress test (CST) df df df




d. Internal fetal monitoring df df df




ANS: B df



The presence of painless bleeding should always alert the health care team to the possibility of
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placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on a
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woman who is experiencing bleeding. In the event of an imminent delivery, the fetus is presumed to hav
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e immature lungs at this gestational age, and the mother is given corticosteroids to aid in fetal lung matu
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rity. A CST is not performed at a preterm gestational age.Furthermore, bleeding is a contraindication to
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a CST. Internal fetal monitoring is also contraindicated in the presence of bleeding. DIF: Cognitive Leve
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l: Apply REF: dm. 680
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TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
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5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fl
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uid consists of bright red blood. Her contractions are consistent with her current stage of labor.No chan
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ge in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the R
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OM. The nurse should suspect the possibility of what condition?
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a. Placenta previa df




b. Vasa previa df




c. Severe abruptio placentae df df

, d. Disseminated intravascular coagulation (DIC) df df df df




ANS: B df



Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical 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 risk for laceration at any time, but laceration occurs most frequently during ROM. Thesudden appeara
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nce of bright red blood at the time of ROM and a sudden change in the FHR without other known risk fac
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tors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa
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most likely would be ascertained before labor and is considered a risk factor for this pregnancy. In additi
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on, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vagi
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nal birth. With the presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a b
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oardlike uterus). DIC isa pathologic form of diffuse clotting that consumes large amounts of clotting fact
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ors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnos
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is, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and lo
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w platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: DiagnosisMSC: Cli
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ent Needs: Physiologic Integrity
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6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal f
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ullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic bl
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ueness around the womans umbilicus. What does this finding indicate?
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a. Normal integumentary changes associated with pregnancy df df df df df




b. Turner sign associated with appendicitis df df df df




c. Cullen sign associated with a ruptured ectopic pregnancy
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d. Chadwick sign associated with early pregnancy df df df df df df




ANS: C df



Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
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associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the ab
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domen is the normal integumentary change associated with pregnancy and exhibits a brown pigme
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nted, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often associat
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ed with pancreatitis. A Chadwick sign is a blue-
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purple cervix that may be seen during or around the eighth week of pregnancy.
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DIF: Cognitive Level: Analyze REF: dm. 676
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TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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7. The nurse who elects to practice in the area of womens health must have a thorough u
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nderstanding of miscarriage. Which statement regarding this condition is most accurate?
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a. A miscarriage is a natural pregnancy loss before labor begins. df df df df df df df df df




b. It occurs in fewer than 5% of all clinically recognized pregnancies.
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c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causiIf a m
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iscarriage occurs before the 12th week of pregnancy, then it may be observed only as mod
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d. blood loss. df




ANS: D df



Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,more sev
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ere pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
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