TEST BANK
MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING: A
CASE BASED APPROACH
,chapter 1 immediate postpartum hemorrhage
multiple choice
1. a pregnant woman is being discharged from the hospital afterithe placement of a cervical ce
rclage because ofia historyiof recurrent pregnancyiloss, secondaryito aniincompetent cervix. which i
nformation regardingipostprocedural care should the nurseiemphasize in the discharge teaching?
a. anyvaginal discharge should be immediately reported to her health care provider.
b. the presence of anyicontractions, ruptureiof membranes (rom), or severeiperineal pressure sho
c. the client will needito make arrangements for care at home, because heriactivityilevel will be re
d. the client will be scheduled foria cesarean birth.
Ans: b
nursingicare should stress the importance of monitoring for the signs and symptoms ofipreterm
labor. vaginal bleeding needs to be reported to heriprimaryihealth care provider. bed rest is an element o
f care. however, the woman may stand foriperiods of up to 90 minutes, which allows her the freedom to s
ee her physician. home uterine activityimonitoringimayibe used to limit the womans need forivisits and t
o monitoriher status safely at home. the cerclage can be removediat37 weeks of gestation (to prepare fori
a vaginal birth), or a cesarean birth can be planned.
dif: cognitive level: apply ref: dm. 675
top: nursing process: planningi| nursing process: implementationmsc:
client needs: health promotion and maintenance
2. a perinatal nurse is givingidischarge instructions to aiwoman, status postsuction, andicurettage se
condaryito a hydatidiform mole. the woman asks whyishe must take oral contraceptives forithe next 12 m
onths. what is the bestresponse by the nurse?
if you get pregnant within 1 year, the chance of a successful pregnancyis verysmall. therefore
a. pregnancy, it wouldibe better foriyou toiuse the most reliable method of contraception available
the major risk to you after a molaripregnancyiis a type of cancer that can be diagnosed onlyibyhormone tha
tiyour bodyiproduces during pregnancy. ifiyou wereito getipregnant, then it would
b. this cancer more difficult.
if you can avoid a pregnancy for the next year, the chance ofideveloping a second molar pregna
c. improve yourichance of a successful pregnancy, not getting pregnant at this time is best.
i
d. oral contraceptives are the only form of birth control that will prevent a recurrence of a molar p a
ns: b
betahuman chorionic gonadotropin (beta-hcg) hormone levels are drawn for 1 yearito ensure
that the mole is completelyigone. the chance of developingichoriocarcinoma afterithe development of a
hydatidiform mole is increased. therefore, the goal is to achieve a zero humanchorionic gonadotropin (
hcg)ilevel. if the woman were to become pregnant, theniitimayiobscurethe presence of the potentially ca
rcinogenic cells. women should be instructed to use birth control fori1 yeariafter treatment foria hydatidi
form mole. the rationaleifor avoiding pregnancy
,for 1 yeariis to ensure that carcinogenic cells are not present. any contraceptive method exceptan in
trauterine device (iud) is acceptable.
dif: cognitive level: apply ref: dm. 679
top: nursing process: planning | nursingiprocess: implementationmsc: client
needs: physiologic integrity
3. the nurse is preparing to administer methotrexate to the client. this hazardous drugiis
most often used foriwhich obstetric complication?
a. complete hydatidiform mole
b. missed abortion
c. unrupturediectopic 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 4icm in diameter. methotrexate isnot indi
cated orirecommended as a treatment option foria complete hydatidiform mole, foria missed abortion, or
for abruptio placentae.
dif: cognitive level: apply ref: dm. 677 top: nursingiprocess: planningmsc: 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 heriarrival a
t the hospital, whichidiagnostic procedure will the client most likelyihave performed?
a. amniocentesis for fetal lungimaturity
b. transvaginal ultrasoundifor 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 possibilityiof
placenta previa, which canibe confirmed through ultrasonography. amniocentesis is not performed on a
woman who is experiencingibleeding. in the event of an imminentidelivery, the fetus is presumed to have
immature lungs at this gestational age, and the motheriis given corticosteroids to aid in fetal lung maturit
y. a cst is not performed at aipreterm gestational age.furthermore, bleedingiis aicontraindicationito aic st.
internal fetal monitoring is also contraindicatediin the presence of bleeding. dif: cognitiveilevel: a
pplyiref: dm. 680
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
5. a laboring woman with no known riskifactors suddenlyiexperiences spontaneous rom. the fl
uid consists of brightired blood. her contractions are consistent withiher current stage of labor.no chan
ge in uterine resting tone has occurred. the fetal heart rate (fhr) begins to decline rapidlyiafterithe ro
m. theinurse should suspect the possibility of what condition?
a. placenta previa
b. vasa previa
c. severe abruptio placentae
, d. disseminated intravascularicoagulation (dic)
ans: b
vasa previa is the result of a velamentous insertion of the umbilical cord. the umbilical vessels
areinot surrounded byiwharton jellyiand have no supportive tissue. the umbilical blood vessels thus are a t
riskifor laceration at anyitime, but laceration occurs most frequently duringirom. thesudden appearanc e
ofibright red blood at the time of rom and a sudden change in the fhr without other known risk factor
s should immediately alertithe nurse to the possibilityiof vasaiprevia. the presence of placenta previaimos
t likely would be ascertained before laboriand is considered a risk factoriforithis pregnancy. iniaddition, if
theiwoman had a placenta previa, it is unlikelyithatishe would be allowed to pursueilaboriand aivaginal bir
th. withithe presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlik
e uterus). dic isa pathologic formiof diffuse clotting thaticonsumes large amounts oficlotting factors, cau
sing widespread external bleeding, internal bleeding, oriboth. dic is always a secondary diagnosis, ofteni
associated with obstetric risk factors such as the hemolysis, elevated liver enzymeilevels, and low platelet
levels (hellp) syndrome. this woman did not have any prioririsk factors.
dif: cognitive level: analyze ref: dm. 684 top: nursingiprocess: diagnosismsc: cli
entineeds: physiologic integrity
6. a woman arrives for evaluation of signs and symptoms that include aimissed period, adnexal fu
llness, tenderness, and dark red vaginal bleeding. on examination, the nurseinotices an ecchymotic blue
ness around the womans umbilicus. what does this finding indicate?
a. normal integumentaryichanges associated with pregnancy
b. turner sign associated with appendicitis
c. cullen signiassociated with a rupturediectopic pregnancy
d. chadwick sign associated with earlyipregnancyi
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 abd
omen is the normal integumentaryichange associated with pregnancy and exhibits a brown pigment
ed, vertical line onithe lower abdomen. turnerisign is ecchymosis inithe flank area, often associated
withipancreatitis. a chadwick sign is a blue-
purpleicervix that may be seen duringior around the eighth week of pregnancy.
dif: cognitive level: analyze ref: dm. 676
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
7. the nurse who elects to practice in the area ofiwomens health mustihave a thorough un
derstanding of miscarriage. which statement regarding this condition is mostiaccurate?
a. a miscarriage is a natural pregnancyloss before labor begins.
b. itioccurs in fewer thani5% of all clinicallyirecognized pregnancies.
c. careless maternal behavior, such as poor nutrition oriexcessive exercise, canibe aifactoriin causiifia m
iscarriage occurs before the 12th week ofipregnancy, theniitimayibe observed only as mod
d. bloodiloss.
ans: d
before the sixth week, the onlyievidence might be a heavyimenstrual flow. afterithe 12th week,more sev
ere pain, similar to that of labor, is likely. miscarriage is a natural pregnancyiloss, but it
,occurs, byidefinition, before 20 weeks of gestation, before the fetus is viable. miscarriages occurin appro
ximately 10% to 15% ofiall clinicallyirecognized pregnancies. miscarriages can be causedibyia numberio
f disorders oriillnesses outside the mothers control oriknowledge.
dif: cognitive level: understand ref: dm. 670
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
8. a woman who is 30 weeks of gestation arrives at the hospital with bleeding. whichidi
fferential diagnosis would not be applicable forithis client?
a. placenta previa
b. abruptio placentae
c. spontaneous abortion
d. cord insertion
ans: c
spontaneous abortion is another name for miscarriage; it occurs, bydefinition, early in
pregnancy. placenta previa is a well-
known reason foribleeding late in pregnancy. the premature separation of the placenta (abruptio placent
ae) is a bleedingidisorder that can occurilate in pregnancy. cord insertion mayicause a bleeding disorderit
hatican also occur late in pregnancy.
dif: cognitive level: understand ref: dm. 669top:
nursingiprocess: assessment
msc: client needs: physiologic integrity, physiologic adaptation
9. with regard to hemorrhagic complications that mayioccur during pregnancy, what information is
most accurate?
a. an incompetent cervix is usuallyinot diagnosed until the woman has lost one or two pregnancies
b. incidences of ectopic pregnancyiare declining as a result of improved diagnostic techniques.
c. one ectopic pregnancy does not affect a womans fertilityior her likelihood of havingia normal p
d. gestational trophoblastic neoplasia (gtn) is oneiofithe persistentlyiincurable gynecologic ma li a
ns: a
short labors and recurring losses of pregnancyiat progressivelyiearlier gestational ages are
characteristics of reduced cervical competence. because diagnostic technology is improving,more ec
topic pregnancies are being diagnosed. one ectopic pregnancyiplaces the woman at increased riskifor
another one. ectopic pregnancyiis aileading cause of infertility. once invariablyifatal, gtn now is th e
most curable gynecologic malignancy.
dif: cognitive level: understand ref: dm. 675
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
10. the management of the pregnant client who has experienced a pregnancyiloss depends onithe ty
pe ofimiscarriage and the signs and symptoms. while planning care foria client who desires outpatientima
nagementiafter a first-trimesteriloss, what would the nurse expect the plan to include?
a. dilationiandicurettagei(d&c)
b. dilation and evacuation (d&e)
c. misoprostol
d. ergot products
ans: c
,outpatientimanagement of a first-
trimesteriloss is safelyiaccomplished by the intravaginal use of misoprostol for up to 2 days. if the bleedin
g is uncontrollable, vital signs are unstable, orisigns of infectioniare present, then a surgical evacuation sh
ould be performed. d&c is a surgical procedure that requires dilation of the cervix and scrapingiof the ute
rine walls to remove the contents of pregnancy.
this procedure is commonlyiperformed to treatiinevitable oriincomplete abortion and should be perform
ed in a hospital. d&e is usuallyiperformediafter 16 weeks of pregnancy. the cervix is widelyidilated, foll
owed by removal of the contents of the uterus. ergotproducts such as methergine or hemabate may be ad
ministered for excessive bleedingiafter miscarriage.
dif: cognitive level: apply ref: dm. 672 top: nursingiprocess: planningmsc: clienti needs:
physiologic integrity
11. which laboratoryimarker is indicative of dic?
a. bleedingitime of 10 minutes
b. presence of fibrin split products
c. thrombocytopenia
d. hypofibrinogenemia
ans: b
degradation of fibrin leads to the accumulation ofimultiple fibrin clots throughoutithe bodys
vasculature. bleeding time in dic is normal. low platelets may occuribut are not indicative of dic bec
ause they may be the result from other coagulopathies. hypofibrinogenemia occurs withdic. dif: co
gnitive level: remember ref: dm. 684
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
12. when is a prophylactic cerclage forian incompetent cervix usually placed (iniweeks of g
estation)?
a. 12 to 14
b. 6 to 8
c. 23 to 24
d. after 24
ans: a
a prophylactic cerclageiis usuallyiplaced at 12 to 14 weeks of gestation. theicerclage is
electivelyiremovediwhen the woman reaches 37 weeks of gestation or when her laboribegins. sixto 8 we
eks of gestation is tooiearlyito place the cerclage. cerclage placement is offerediif the cervical length falls
to less than 20ito 25 mm beforei23 to 24 weeks. although no consensus has been reached, 24 weeks is us
ed as the upper gestational age limit foricerclage placement.
dif: cognitive level: apply ref: dm. 674itop: nursingiprocess: planningmsc: clienti needs: health
promotion and maintenance
13. in caring forianiimmediate postpartumiclient, the nurse notes petechiae and oozing fromiher in
travenous (iv) site. the client wouldibe closelyimonitored for which clotting disorder?
a. dic
b. amniotic fluidiembolism (afe)
c. hemorrhage
, d. hellp syndrome
ans: a
the diagnosis of dic is made according toiclinical findings and laboratory markers. a physical
examination reveals unusual bleeding. petechiae mayiappear around a blood pressureicuff on the womans
arm. excessive bleedingimayioccur from the site of slight trauma suchias venipuncture sites. these sympt
oms are not associated with afe, nor is afe a bleeding disorder. hemorrhageoccurs foria varietyiof reaso ns
in the postpartum client. these symptoms are associated withidic. hemorrhage would be a finding ass
ociatediwith dic andiis not a clotting disorderiin and ofitself. hellp syndrome is notia clotting disorder, but
it may contribute to the clotting disorder dic.
dif: cognitive level: understand ref: dm. 685 top: nursing process: planningmsc: c lient
needs: physiologic integrity
14. in caring for the woman with dic, which orderishould the nurse anticipate?
a. administration of blood
b. preparationiof the client foriinvasive hemodynamic monitoring
c. restriction of intravascular fluids
d. administration ofsteroids
ans: a
primaryimedical managementiin all cases of dic involves a correctioniof the underlying cause,
volume replacement, blood component therapy, optimization of oxygenation and perfusion status, an
d continued reassessment ofilaboratory parameters. central monitoring would not beinitially ordered
in a client with dic because it could contribute to more areas of bleeding.
managementiofidic wouldiinclude volume replacement, not volume restriction. steroids are not in
dicatedifor the management ofidic.
dif: cognitive level: apply ref: pp. 685-
686 top: nursing process: planningmsc: client needs: physiologic integrity
15. a woman arrives at the emergency department with complaints of bleeding and cramping. t
he initial nursing history is significant foria last menstrual period 6 weeks ago. on sterile speculum exa
mination, theiprimaryicare provider finds that the cervix is closed. the anticipatedplan oficareiforithis w
omaniwould be based on a probable diagnosis of which type of spontaneous abortion?
a. incomplete
b. inevitable
c. threatened
d. septic
ans: c
a woman with a threatened abortion has spotting, mild cramps, and no cervical dilation. a woman with
an incomplete abortion would have heavy bleeding, mild-to-
severe cramping, and cervical dilation. aniinevitable abortion demonstrates the same symptoms as an in
complete abortion: heavy bleeding, mild-to-
severe cramping, and cervical dilation. a woman with a septicabortion has malodorous bleeding and typ
icallyia dilated cervix.
dif: cognitive level: understand ref: dm. 670 top: nursing process: planningmsc: c lient
needs: physiologic integrity
,16. in contrast to placenta previa, what is the most prevalenticlinical manifestation of abruptio pl
acentae?
a. bleeding
b. intense abdominal pain
c. uterine activity
d. cramping
ans: b
pain is absentiwith placenta previa and mayibe agonizing with abruptio placentae. bleeding mayibe
present in varyingidegrees for both placental conditions. uterine activity and cramping maybe pres
entiwith both placental conditions.
dif: cognitive level: understand ref: dm. 683 top: nursing process: diagnosismsc: client
needs: physiologic integrity
17. which maternal condition always necessitates deliverybycesarean birth?
a. marginal placenta previa
b. complete placenta previa
c. ectopic pregnancy
d. eclampsia
ans: b
in complete placenta previa, the placenta completelyicovers the cervical os. a cesarean birth is
the acceptable method ofidelivery. the risk of fetal death occurringiis due to preterm birth. ifitheprevia is
marginal (i.e., 2 cm or greateriaway from the cervical os), then laborican be attempted. a cesarean birth is
not indicatedifor an ectopic pregnancy. labor can be safelyiinduced if the eclampsia is undericontrol.
dif: cognitive level: understand ref: dm. 681
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
18. what is the correct definition ofia spontaneous termination of a pregnancy (abortion)?
a. pregnancyis less than 20 weeks.
b. fetus weighs less than 1000 g.
c. products of conception are passed intact.
d. no evidence exists of intrauterine infection.
ans: a
aniabortion is the termination of pregnancyibefore theiage of viabilityi(20 weeks). the weight of
the fetus is not considered because some older fetuses mayihave ailow birth weight. a spontaneous aborti
on may be complete oriincomplete andimayibe caused by manyiproblems, onebeingiintrauterine infection
.
dif: cognitive level: remember ref: dm. 669
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
19. what is the correct terminologyiforian abortion iniwhich the fetus dies but is retained within th
e uterus?
a. inevitable abortion
b. missed abortion
, c. incomplete abortion
d. threatened abortion
ans: b
missed abortion refers to theiretention of a dead fetus in the uterus. an inevitable abortion means
that the cervix is dilating with the contractions. an incomplete abortion means that not all ofithe product
s of conception were expelled. with a threatened abortion, the woman has crampingiand bleedingibut no
cervical dilation.
dif: cognitive level: remember ref: dm. 670
top: nursingiprocess: assessment msc: client needs: physiologic integrity
20. what conditioniindicates concealed hemorrhage when the client experiences abruptio p
lacentae?
a. decrease in abdominal pain
b. bradycardia
c. hard, boardlike abdomen
d. decrease in fundal heighti
ans: c
concealed hemorrhage occurs when the edges of the placenta do not separate. the formation of a
hematoma behind the placenta and subsequent infiltration of the blood into the uterineimuscle results i
n a very firm, boardlike abdomen. abdominal pain mayiincrease. the client will haveshockisymptoms
that include tachycardia. as bleeding occurs, the fundal height increases.
dif: cognitive level: analyze ref: dm. 683
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
21. what is the highest priority nursingiintervention when admitting a pregnant womaniwho hase
xperienced a bleedingiepisode in late pregnancy?
a. assessing fhriand maternal vital signs
b. performing a venipuncture for hemoglobin and hematocrit levels
c. placing clean disposable pads to collect anyidrainage
d. monitoring uterine contractions
ans: a
assessmentiof the fhr and maternal vital signs will assist the nurse in determining the degree of
the blood loss and its effect on the mother andifetus. the mostiimportantiassessment is to check the we
ll-
beingiofiboth the mother and the fetus. the blood levels canibe obtained later. assessingfuture bleedin g
is important; however, the top priorityiremains mother/fetal well-being.
monitoringiuterine contractions is importantibut not a top priority.dif: cognitiv e
level: applyiref: dm. 681
top: nursingiprocess: implementationimsc: client needs: health promotion and maintenance
22. which orderishould the nurse expectifor a client admitted withia threatened abortion?
a. bed rest
b. administration of ritodrine iv
c. nothingibyimouth (nil perios [npo]) narcotic
d. analgesia everyi3 hours, as needed
, ans: a
decreasing the womans activityilevel mayialleviate the bleeding andiallowithe pregnancyito continue.
ritodrine is not the firstidrugiof choice for tocolytic medications. havingitheiwoman placedion npo is
unnecessary. at times, dehydration may produce contractions; therefore, hydration is important. narco
tic analgesia will not decrease the contractions and may maskitheseverityiofithe contractions.
dif: cognitive level: understand ref: pp. 671-
672 top: nursing process: planningmsc: client needs: health promotioniand maintenance
23. which finding onia prenatal visit at 10 weeks of gestation mightisuggest a hydatidiform m
ole?
a. complaint of frequent mild nausea
b. blood pressure of 120/80 mm hg
c. fundal height measurement of 18 cm
d. historyiof bright redispotting fori1 day, weeks ago
ans: c
theiuterus inia hydatidiform molar pregnancyis often largerithan would be expected on theibasis
of the duration of the pregnancy. nausea increases in a molaripregnancyibecause of the increased product
ion ofihcg. a woman with a molaripregnancyimayihave early-onset pregnancy-
induced hypertension. in the clients history, bleeding is normallyidescribed as brownish.
dif: cognitive level: analyze ref: dm. 678
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
24. a 32-year-
old primigravida is admitted with a diagnosis of ectopic pregnancy. which information assists the
nurse in developing the plan of care?
a. bedirest andianalgesics are the recommended treatment.
b. she will be unable to conceive in the future.
c. a d&c will be performed to remove theiproducts of conception.
d. hemorrhage is the primaryiconcern.
ans: d
severe bleedingioccurs if the fallopian tube ruptures. the recommended treatment is to remove
the pregnancy before rupture to prevent hemorrhaging. if the tube mustibe removed, then the womans f
ertility will decrease; however, she will not be infertile. a d&c is performed on theinside of the uterine
cavity. the ectopic pregnancyiis locatediwithin the tubes.
dif: cognitive level: apply ref: dm. 676 top: nursingiprocess: planningmsc: client needs:
physiologic integrity
multiple response
1. a client whoihas undergone a d&c foriearly pregnancy loss is likelyito be discharged the same d
ay. the nurse must ensure that herivital signs are stable, that bleedingihas been controlled,and that the wo
manihas adequatelyirecovered fromithe administration of anesthesia. to promote anioptimal recovery, wh
atiinformationishould discharge teaching include? (selectiall thatiapply.)
a. iron supplementation
b. resumption ofiintercourse at 6 weeks postprocedure
c. referral to aisupport group, if necessary
MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING: A
CASE BASED APPROACH
,chapter 1 immediate postpartum hemorrhage
multiple choice
1. a pregnant woman is being discharged from the hospital afterithe placement of a cervical ce
rclage because ofia historyiof recurrent pregnancyiloss, secondaryito aniincompetent cervix. which i
nformation regardingipostprocedural care should the nurseiemphasize in the discharge teaching?
a. anyvaginal discharge should be immediately reported to her health care provider.
b. the presence of anyicontractions, ruptureiof membranes (rom), or severeiperineal pressure sho
c. the client will needito make arrangements for care at home, because heriactivityilevel will be re
d. the client will be scheduled foria cesarean birth.
Ans: b
nursingicare should stress the importance of monitoring for the signs and symptoms ofipreterm
labor. vaginal bleeding needs to be reported to heriprimaryihealth care provider. bed rest is an element o
f care. however, the woman may stand foriperiods of up to 90 minutes, which allows her the freedom to s
ee her physician. home uterine activityimonitoringimayibe used to limit the womans need forivisits and t
o monitoriher status safely at home. the cerclage can be removediat37 weeks of gestation (to prepare fori
a vaginal birth), or a cesarean birth can be planned.
dif: cognitive level: apply ref: dm. 675
top: nursing process: planningi| nursing process: implementationmsc:
client needs: health promotion and maintenance
2. a perinatal nurse is givingidischarge instructions to aiwoman, status postsuction, andicurettage se
condaryito a hydatidiform mole. the woman asks whyishe must take oral contraceptives forithe next 12 m
onths. what is the bestresponse by the nurse?
if you get pregnant within 1 year, the chance of a successful pregnancyis verysmall. therefore
a. pregnancy, it wouldibe better foriyou toiuse the most reliable method of contraception available
the major risk to you after a molaripregnancyiis a type of cancer that can be diagnosed onlyibyhormone tha
tiyour bodyiproduces during pregnancy. ifiyou wereito getipregnant, then it would
b. this cancer more difficult.
if you can avoid a pregnancy for the next year, the chance ofideveloping a second molar pregna
c. improve yourichance of a successful pregnancy, not getting pregnant at this time is best.
i
d. oral contraceptives are the only form of birth control that will prevent a recurrence of a molar p a
ns: b
betahuman chorionic gonadotropin (beta-hcg) hormone levels are drawn for 1 yearito ensure
that the mole is completelyigone. the chance of developingichoriocarcinoma afterithe development of a
hydatidiform mole is increased. therefore, the goal is to achieve a zero humanchorionic gonadotropin (
hcg)ilevel. if the woman were to become pregnant, theniitimayiobscurethe presence of the potentially ca
rcinogenic cells. women should be instructed to use birth control fori1 yeariafter treatment foria hydatidi
form mole. the rationaleifor avoiding pregnancy
,for 1 yeariis to ensure that carcinogenic cells are not present. any contraceptive method exceptan in
trauterine device (iud) is acceptable.
dif: cognitive level: apply ref: dm. 679
top: nursing process: planning | nursingiprocess: implementationmsc: client
needs: physiologic integrity
3. the nurse is preparing to administer methotrexate to the client. this hazardous drugiis
most often used foriwhich obstetric complication?
a. complete hydatidiform mole
b. missed abortion
c. unrupturediectopic 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 4icm in diameter. methotrexate isnot indi
cated orirecommended as a treatment option foria complete hydatidiform mole, foria missed abortion, or
for abruptio placentae.
dif: cognitive level: apply ref: dm. 677 top: nursingiprocess: planningmsc: 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 heriarrival a
t the hospital, whichidiagnostic procedure will the client most likelyihave performed?
a. amniocentesis for fetal lungimaturity
b. transvaginal ultrasoundifor 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 possibilityiof
placenta previa, which canibe confirmed through ultrasonography. amniocentesis is not performed on a
woman who is experiencingibleeding. in the event of an imminentidelivery, the fetus is presumed to have
immature lungs at this gestational age, and the motheriis given corticosteroids to aid in fetal lung maturit
y. a cst is not performed at aipreterm gestational age.furthermore, bleedingiis aicontraindicationito aic st.
internal fetal monitoring is also contraindicatediin the presence of bleeding. dif: cognitiveilevel: a
pplyiref: dm. 680
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
5. a laboring woman with no known riskifactors suddenlyiexperiences spontaneous rom. the fl
uid consists of brightired blood. her contractions are consistent withiher current stage of labor.no chan
ge in uterine resting tone has occurred. the fetal heart rate (fhr) begins to decline rapidlyiafterithe ro
m. theinurse should suspect the possibility of what condition?
a. placenta previa
b. vasa previa
c. severe abruptio placentae
, d. disseminated intravascularicoagulation (dic)
ans: b
vasa previa is the result of a velamentous insertion of the umbilical cord. the umbilical vessels
areinot surrounded byiwharton jellyiand have no supportive tissue. the umbilical blood vessels thus are a t
riskifor laceration at anyitime, but laceration occurs most frequently duringirom. thesudden appearanc e
ofibright red blood at the time of rom and a sudden change in the fhr without other known risk factor
s should immediately alertithe nurse to the possibilityiof vasaiprevia. the presence of placenta previaimos
t likely would be ascertained before laboriand is considered a risk factoriforithis pregnancy. iniaddition, if
theiwoman had a placenta previa, it is unlikelyithatishe would be allowed to pursueilaboriand aivaginal bir
th. withithe presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlik
e uterus). dic isa pathologic formiof diffuse clotting thaticonsumes large amounts oficlotting factors, cau
sing widespread external bleeding, internal bleeding, oriboth. dic is always a secondary diagnosis, ofteni
associated with obstetric risk factors such as the hemolysis, elevated liver enzymeilevels, and low platelet
levels (hellp) syndrome. this woman did not have any prioririsk factors.
dif: cognitive level: analyze ref: dm. 684 top: nursingiprocess: diagnosismsc: cli
entineeds: physiologic integrity
6. a woman arrives for evaluation of signs and symptoms that include aimissed period, adnexal fu
llness, tenderness, and dark red vaginal bleeding. on examination, the nurseinotices an ecchymotic blue
ness around the womans umbilicus. what does this finding indicate?
a. normal integumentaryichanges associated with pregnancy
b. turner sign associated with appendicitis
c. cullen signiassociated with a rupturediectopic pregnancy
d. chadwick sign associated with earlyipregnancyi
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 abd
omen is the normal integumentaryichange associated with pregnancy and exhibits a brown pigment
ed, vertical line onithe lower abdomen. turnerisign is ecchymosis inithe flank area, often associated
withipancreatitis. a chadwick sign is a blue-
purpleicervix that may be seen duringior around the eighth week of pregnancy.
dif: cognitive level: analyze ref: dm. 676
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
7. the nurse who elects to practice in the area ofiwomens health mustihave a thorough un
derstanding of miscarriage. which statement regarding this condition is mostiaccurate?
a. a miscarriage is a natural pregnancyloss before labor begins.
b. itioccurs in fewer thani5% of all clinicallyirecognized pregnancies.
c. careless maternal behavior, such as poor nutrition oriexcessive exercise, canibe aifactoriin causiifia m
iscarriage occurs before the 12th week ofipregnancy, theniitimayibe observed only as mod
d. bloodiloss.
ans: d
before the sixth week, the onlyievidence might be a heavyimenstrual flow. afterithe 12th week,more sev
ere pain, similar to that of labor, is likely. miscarriage is a natural pregnancyiloss, but it
,occurs, byidefinition, before 20 weeks of gestation, before the fetus is viable. miscarriages occurin appro
ximately 10% to 15% ofiall clinicallyirecognized pregnancies. miscarriages can be causedibyia numberio
f disorders oriillnesses outside the mothers control oriknowledge.
dif: cognitive level: understand ref: dm. 670
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
8. a woman who is 30 weeks of gestation arrives at the hospital with bleeding. whichidi
fferential diagnosis would not be applicable forithis client?
a. placenta previa
b. abruptio placentae
c. spontaneous abortion
d. cord insertion
ans: c
spontaneous abortion is another name for miscarriage; it occurs, bydefinition, early in
pregnancy. placenta previa is a well-
known reason foribleeding late in pregnancy. the premature separation of the placenta (abruptio placent
ae) is a bleedingidisorder that can occurilate in pregnancy. cord insertion mayicause a bleeding disorderit
hatican also occur late in pregnancy.
dif: cognitive level: understand ref: dm. 669top:
nursingiprocess: assessment
msc: client needs: physiologic integrity, physiologic adaptation
9. with regard to hemorrhagic complications that mayioccur during pregnancy, what information is
most accurate?
a. an incompetent cervix is usuallyinot diagnosed until the woman has lost one or two pregnancies
b. incidences of ectopic pregnancyiare declining as a result of improved diagnostic techniques.
c. one ectopic pregnancy does not affect a womans fertilityior her likelihood of havingia normal p
d. gestational trophoblastic neoplasia (gtn) is oneiofithe persistentlyiincurable gynecologic ma li a
ns: a
short labors and recurring losses of pregnancyiat progressivelyiearlier gestational ages are
characteristics of reduced cervical competence. because diagnostic technology is improving,more ec
topic pregnancies are being diagnosed. one ectopic pregnancyiplaces the woman at increased riskifor
another one. ectopic pregnancyiis aileading cause of infertility. once invariablyifatal, gtn now is th e
most curable gynecologic malignancy.
dif: cognitive level: understand ref: dm. 675
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
10. the management of the pregnant client who has experienced a pregnancyiloss depends onithe ty
pe ofimiscarriage and the signs and symptoms. while planning care foria client who desires outpatientima
nagementiafter a first-trimesteriloss, what would the nurse expect the plan to include?
a. dilationiandicurettagei(d&c)
b. dilation and evacuation (d&e)
c. misoprostol
d. ergot products
ans: c
,outpatientimanagement of a first-
trimesteriloss is safelyiaccomplished by the intravaginal use of misoprostol for up to 2 days. if the bleedin
g is uncontrollable, vital signs are unstable, orisigns of infectioniare present, then a surgical evacuation sh
ould be performed. d&c is a surgical procedure that requires dilation of the cervix and scrapingiof the ute
rine walls to remove the contents of pregnancy.
this procedure is commonlyiperformed to treatiinevitable oriincomplete abortion and should be perform
ed in a hospital. d&e is usuallyiperformediafter 16 weeks of pregnancy. the cervix is widelyidilated, foll
owed by removal of the contents of the uterus. ergotproducts such as methergine or hemabate may be ad
ministered for excessive bleedingiafter miscarriage.
dif: cognitive level: apply ref: dm. 672 top: nursingiprocess: planningmsc: clienti needs:
physiologic integrity
11. which laboratoryimarker is indicative of dic?
a. bleedingitime of 10 minutes
b. presence of fibrin split products
c. thrombocytopenia
d. hypofibrinogenemia
ans: b
degradation of fibrin leads to the accumulation ofimultiple fibrin clots throughoutithe bodys
vasculature. bleeding time in dic is normal. low platelets may occuribut are not indicative of dic bec
ause they may be the result from other coagulopathies. hypofibrinogenemia occurs withdic. dif: co
gnitive level: remember ref: dm. 684
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
12. when is a prophylactic cerclage forian incompetent cervix usually placed (iniweeks of g
estation)?
a. 12 to 14
b. 6 to 8
c. 23 to 24
d. after 24
ans: a
a prophylactic cerclageiis usuallyiplaced at 12 to 14 weeks of gestation. theicerclage is
electivelyiremovediwhen the woman reaches 37 weeks of gestation or when her laboribegins. sixto 8 we
eks of gestation is tooiearlyito place the cerclage. cerclage placement is offerediif the cervical length falls
to less than 20ito 25 mm beforei23 to 24 weeks. although no consensus has been reached, 24 weeks is us
ed as the upper gestational age limit foricerclage placement.
dif: cognitive level: apply ref: dm. 674itop: nursingiprocess: planningmsc: clienti needs: health
promotion and maintenance
13. in caring forianiimmediate postpartumiclient, the nurse notes petechiae and oozing fromiher in
travenous (iv) site. the client wouldibe closelyimonitored for which clotting disorder?
a. dic
b. amniotic fluidiembolism (afe)
c. hemorrhage
, d. hellp syndrome
ans: a
the diagnosis of dic is made according toiclinical findings and laboratory markers. a physical
examination reveals unusual bleeding. petechiae mayiappear around a blood pressureicuff on the womans
arm. excessive bleedingimayioccur from the site of slight trauma suchias venipuncture sites. these sympt
oms are not associated with afe, nor is afe a bleeding disorder. hemorrhageoccurs foria varietyiof reaso ns
in the postpartum client. these symptoms are associated withidic. hemorrhage would be a finding ass
ociatediwith dic andiis not a clotting disorderiin and ofitself. hellp syndrome is notia clotting disorder, but
it may contribute to the clotting disorder dic.
dif: cognitive level: understand ref: dm. 685 top: nursing process: planningmsc: c lient
needs: physiologic integrity
14. in caring for the woman with dic, which orderishould the nurse anticipate?
a. administration of blood
b. preparationiof the client foriinvasive hemodynamic monitoring
c. restriction of intravascular fluids
d. administration ofsteroids
ans: a
primaryimedical managementiin all cases of dic involves a correctioniof the underlying cause,
volume replacement, blood component therapy, optimization of oxygenation and perfusion status, an
d continued reassessment ofilaboratory parameters. central monitoring would not beinitially ordered
in a client with dic because it could contribute to more areas of bleeding.
managementiofidic wouldiinclude volume replacement, not volume restriction. steroids are not in
dicatedifor the management ofidic.
dif: cognitive level: apply ref: pp. 685-
686 top: nursing process: planningmsc: client needs: physiologic integrity
15. a woman arrives at the emergency department with complaints of bleeding and cramping. t
he initial nursing history is significant foria last menstrual period 6 weeks ago. on sterile speculum exa
mination, theiprimaryicare provider finds that the cervix is closed. the anticipatedplan oficareiforithis w
omaniwould be based on a probable diagnosis of which type of spontaneous abortion?
a. incomplete
b. inevitable
c. threatened
d. septic
ans: c
a woman with a threatened abortion has spotting, mild cramps, and no cervical dilation. a woman with
an incomplete abortion would have heavy bleeding, mild-to-
severe cramping, and cervical dilation. aniinevitable abortion demonstrates the same symptoms as an in
complete abortion: heavy bleeding, mild-to-
severe cramping, and cervical dilation. a woman with a septicabortion has malodorous bleeding and typ
icallyia dilated cervix.
dif: cognitive level: understand ref: dm. 670 top: nursing process: planningmsc: c lient
needs: physiologic integrity
,16. in contrast to placenta previa, what is the most prevalenticlinical manifestation of abruptio pl
acentae?
a. bleeding
b. intense abdominal pain
c. uterine activity
d. cramping
ans: b
pain is absentiwith placenta previa and mayibe agonizing with abruptio placentae. bleeding mayibe
present in varyingidegrees for both placental conditions. uterine activity and cramping maybe pres
entiwith both placental conditions.
dif: cognitive level: understand ref: dm. 683 top: nursing process: diagnosismsc: client
needs: physiologic integrity
17. which maternal condition always necessitates deliverybycesarean birth?
a. marginal placenta previa
b. complete placenta previa
c. ectopic pregnancy
d. eclampsia
ans: b
in complete placenta previa, the placenta completelyicovers the cervical os. a cesarean birth is
the acceptable method ofidelivery. the risk of fetal death occurringiis due to preterm birth. ifitheprevia is
marginal (i.e., 2 cm or greateriaway from the cervical os), then laborican be attempted. a cesarean birth is
not indicatedifor an ectopic pregnancy. labor can be safelyiinduced if the eclampsia is undericontrol.
dif: cognitive level: understand ref: dm. 681
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
18. what is the correct definition ofia spontaneous termination of a pregnancy (abortion)?
a. pregnancyis less than 20 weeks.
b. fetus weighs less than 1000 g.
c. products of conception are passed intact.
d. no evidence exists of intrauterine infection.
ans: a
aniabortion is the termination of pregnancyibefore theiage of viabilityi(20 weeks). the weight of
the fetus is not considered because some older fetuses mayihave ailow birth weight. a spontaneous aborti
on may be complete oriincomplete andimayibe caused by manyiproblems, onebeingiintrauterine infection
.
dif: cognitive level: remember ref: dm. 669
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
19. what is the correct terminologyiforian abortion iniwhich the fetus dies but is retained within th
e uterus?
a. inevitable abortion
b. missed abortion
, c. incomplete abortion
d. threatened abortion
ans: b
missed abortion refers to theiretention of a dead fetus in the uterus. an inevitable abortion means
that the cervix is dilating with the contractions. an incomplete abortion means that not all ofithe product
s of conception were expelled. with a threatened abortion, the woman has crampingiand bleedingibut no
cervical dilation.
dif: cognitive level: remember ref: dm. 670
top: nursingiprocess: assessment msc: client needs: physiologic integrity
20. what conditioniindicates concealed hemorrhage when the client experiences abruptio p
lacentae?
a. decrease in abdominal pain
b. bradycardia
c. hard, boardlike abdomen
d. decrease in fundal heighti
ans: c
concealed hemorrhage occurs when the edges of the placenta do not separate. the formation of a
hematoma behind the placenta and subsequent infiltration of the blood into the uterineimuscle results i
n a very firm, boardlike abdomen. abdominal pain mayiincrease. the client will haveshockisymptoms
that include tachycardia. as bleeding occurs, the fundal height increases.
dif: cognitive level: analyze ref: dm. 683
top: nursingiprocess: assessment msc: clientineeds: physiologic integrity
21. what is the highest priority nursingiintervention when admitting a pregnant womaniwho hase
xperienced a bleedingiepisode in late pregnancy?
a. assessing fhriand maternal vital signs
b. performing a venipuncture for hemoglobin and hematocrit levels
c. placing clean disposable pads to collect anyidrainage
d. monitoring uterine contractions
ans: a
assessmentiof the fhr and maternal vital signs will assist the nurse in determining the degree of
the blood loss and its effect on the mother andifetus. the mostiimportantiassessment is to check the we
ll-
beingiofiboth the mother and the fetus. the blood levels canibe obtained later. assessingfuture bleedin g
is important; however, the top priorityiremains mother/fetal well-being.
monitoringiuterine contractions is importantibut not a top priority.dif: cognitiv e
level: applyiref: dm. 681
top: nursingiprocess: implementationimsc: client needs: health promotion and maintenance
22. which orderishould the nurse expectifor a client admitted withia threatened abortion?
a. bed rest
b. administration of ritodrine iv
c. nothingibyimouth (nil perios [npo]) narcotic
d. analgesia everyi3 hours, as needed
, ans: a
decreasing the womans activityilevel mayialleviate the bleeding andiallowithe pregnancyito continue.
ritodrine is not the firstidrugiof choice for tocolytic medications. havingitheiwoman placedion npo is
unnecessary. at times, dehydration may produce contractions; therefore, hydration is important. narco
tic analgesia will not decrease the contractions and may maskitheseverityiofithe contractions.
dif: cognitive level: understand ref: pp. 671-
672 top: nursing process: planningmsc: client needs: health promotioniand maintenance
23. which finding onia prenatal visit at 10 weeks of gestation mightisuggest a hydatidiform m
ole?
a. complaint of frequent mild nausea
b. blood pressure of 120/80 mm hg
c. fundal height measurement of 18 cm
d. historyiof bright redispotting fori1 day, weeks ago
ans: c
theiuterus inia hydatidiform molar pregnancyis often largerithan would be expected on theibasis
of the duration of the pregnancy. nausea increases in a molaripregnancyibecause of the increased product
ion ofihcg. a woman with a molaripregnancyimayihave early-onset pregnancy-
induced hypertension. in the clients history, bleeding is normallyidescribed as brownish.
dif: cognitive level: analyze ref: dm. 678
top: nursingiprocess: assessment msc: clientineeds: health promotioniand maintenance
24. a 32-year-
old primigravida is admitted with a diagnosis of ectopic pregnancy. which information assists the
nurse in developing the plan of care?
a. bedirest andianalgesics are the recommended treatment.
b. she will be unable to conceive in the future.
c. a d&c will be performed to remove theiproducts of conception.
d. hemorrhage is the primaryiconcern.
ans: d
severe bleedingioccurs if the fallopian tube ruptures. the recommended treatment is to remove
the pregnancy before rupture to prevent hemorrhaging. if the tube mustibe removed, then the womans f
ertility will decrease; however, she will not be infertile. a d&c is performed on theinside of the uterine
cavity. the ectopic pregnancyiis locatediwithin the tubes.
dif: cognitive level: apply ref: dm. 676 top: nursingiprocess: planningmsc: client needs:
physiologic integrity
multiple response
1. a client whoihas undergone a d&c foriearly pregnancy loss is likelyito be discharged the same d
ay. the nurse must ensure that herivital signs are stable, that bleedingihas been controlled,and that the wo
manihas adequatelyirecovered fromithe administration of anesthesia. to promote anioptimal recovery, wh
atiinformationishould discharge teaching include? (selectiall thatiapply.)
a. iron supplementation
b. resumption ofiintercourse at 6 weeks postprocedure
c. referral to aisupport group, if necessary
