MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
Chapter: 1 Immediate Postpartum Hemorrhage
MULTIPLE CHOICE
,1. An expectant woman is being discharged from the health center after the
placement of a cervical cerclage because of a history of recurrent gestation/pregnancy
loss, secondary to an incompetent cervix. Which information regarding post procedural
care should the nursing attendant emphasize in the discharge teaching?
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 should be reported
c. The client will need to make arrangements for care at home, because her
activity level will be restricted
d. The client will be scheduled for a cesarean
birth. ACCURATE CHOICE:-B
Reasoning:->>>>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 care. However, the woman may stand for
periods of up to 90 minutes, which allows her the freedom to see her physician. Home
uterine activity monitoring may be used to limit the womans need for visits and to monitor
her status safely at home. The cerclage can be removed at 37 weeks of gestation (to
prepare for a vaginal birth), or a cesarean birth can be planned.
DIF: Cognitive Level: Apply REF: dm. 675
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
HealthPromotion and Maintenance
2. A perinatal nursing attendant is giving discharge instructions to a woman, status
postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she
must take oral contraceptives for the next 12 months. What is the best response by the
nursing attendant?
a. If you get expectant within 1 year, the chance of a successful
gestation/pregnancy is very small. Therefore, if gestation/pregnancy, it would be
better for you to use the most reliable method of contraception available.
b. The major risk to you after a molar gestation/pregnancy is a type of cancer that can be
diagnosed only by me hormone that your body produces during gestation/pregnancy. If
you were to get expectant, then itwould make this cancer more difficult.
c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a
second molar gestation/pregnancy improve your chance of a successful
gestation/pregnancy, not getting expectant at this time isbest.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence
of a molar gestation/pregnancy
ACCURATE CHOICE:-B
Reasoning:->>>>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 hydatidiform mole is increased. Therefore,
the goal is to achieve a zero
,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
may obscure the presence of the potentially carcinogenic cells. Women should be
instructed to use birth control for 1 year after treatment for a hydatidiform mole. The
rationale for avoiding gestation/pregnancy for 1 year is to ensure that carcinogenic cells
are not present. Any contraceptive method except an intrauterine device (IUD) is
acceptable.
DIF: Cognitive Level: Apply REF: dm. 679
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
Physiologic Integrity
3. The nursing attendant is preparing to administer methotrexate to the client. This
hazardous drug is most often used for which obstetric complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic gestation/pregnancy
d. Abruptio
placentae ACCURATE
CHOICE:-C
Reasoning:->>>>Methotrexate is an effective nonsurgical treatment option for a
hemodynamically stable woman whose ectopic gestation/pregnancy is unruptured and
measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a
treatment option for a complete hydatidiform mole, for amissed abortion, or for abruptio
placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client
Needs: Physiologic Integrity
4. A 26-year-old expectant woman, gravida 2, para 1-0-0-1, is 28 weeks expectant
when she experiences bright red, painless vaginal bleeding. On her arrival at the
health center, 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 ACCURATE
CHOICE:-B
Reasoning:->>>>The presence of painless bleeding should always alert the health care
team to the possibility ofplacenta previa, which can be confirmed through
ultrasonography.
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event
of an imminent delivery, the fetus is presumed to have immature lungs at this gestational
age, and the mother is given corticosteroids to aid in fetal lung maturity. A CST is not
performed at a preterm gestational age. Furthermore, bleeding is a contraindication to a
CST. Internal fetal monitoring is also contraindicated in the presence of bleeding.
DIF: Cognitive Level: Apply REF: dm. 680
TOPIC 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 of bright red blood. Her contractions are consistent with her
current stage of labor. No change in uterine resting tone has occurred. The fetal heart
rate (FHR) begins to decline rapidly after the ROM. The nursing attendant should suspect
the possibility of what condition?
, a. Placenta previa
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
Chapter: 1 Immediate Postpartum Hemorrhage
MULTIPLE CHOICE
,1. An expectant woman is being discharged from the health center after the
placement of a cervical cerclage because of a history of recurrent gestation/pregnancy
loss, secondary to an incompetent cervix. Which information regarding post procedural
care should the nursing attendant emphasize in the discharge teaching?
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 should be reported
c. The client will need to make arrangements for care at home, because her
activity level will be restricted
d. The client will be scheduled for a cesarean
birth. ACCURATE CHOICE:-B
Reasoning:->>>>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 care. However, the woman may stand for
periods of up to 90 minutes, which allows her the freedom to see her physician. Home
uterine activity monitoring may be used to limit the womans need for visits and to monitor
her status safely at home. The cerclage can be removed at 37 weeks of gestation (to
prepare for a vaginal birth), or a cesarean birth can be planned.
DIF: Cognitive Level: Apply REF: dm. 675
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
HealthPromotion and Maintenance
2. A perinatal nursing attendant is giving discharge instructions to a woman, status
postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she
must take oral contraceptives for the next 12 months. What is the best response by the
nursing attendant?
a. If you get expectant within 1 year, the chance of a successful
gestation/pregnancy is very small. Therefore, if gestation/pregnancy, it would be
better for you to use the most reliable method of contraception available.
b. The major risk to you after a molar gestation/pregnancy is a type of cancer that can be
diagnosed only by me hormone that your body produces during gestation/pregnancy. If
you were to get expectant, then itwould make this cancer more difficult.
c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a
second molar gestation/pregnancy improve your chance of a successful
gestation/pregnancy, not getting expectant at this time isbest.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence
of a molar gestation/pregnancy
ACCURATE CHOICE:-B
Reasoning:->>>>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 hydatidiform mole is increased. Therefore,
the goal is to achieve a zero
,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
may obscure the presence of the potentially carcinogenic cells. Women should be
instructed to use birth control for 1 year after treatment for a hydatidiform mole. The
rationale for avoiding gestation/pregnancy for 1 year is to ensure that carcinogenic cells
are not present. Any contraceptive method except an intrauterine device (IUD) is
acceptable.
DIF: Cognitive Level: Apply REF: dm. 679
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
Physiologic Integrity
3. The nursing attendant is preparing to administer methotrexate to the client. This
hazardous drug is most often used for which obstetric complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic gestation/pregnancy
d. Abruptio
placentae ACCURATE
CHOICE:-C
Reasoning:->>>>Methotrexate is an effective nonsurgical treatment option for a
hemodynamically stable woman whose ectopic gestation/pregnancy is unruptured and
measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a
treatment option for a complete hydatidiform mole, for amissed abortion, or for abruptio
placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client
Needs: Physiologic Integrity
4. A 26-year-old expectant woman, gravida 2, para 1-0-0-1, is 28 weeks expectant
when she experiences bright red, painless vaginal bleeding. On her arrival at the
health center, 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 ACCURATE
CHOICE:-B
Reasoning:->>>>The presence of painless bleeding should always alert the health care
team to the possibility ofplacenta previa, which can be confirmed through
ultrasonography.
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event
of an imminent delivery, the fetus is presumed to have immature lungs at this gestational
age, and the mother is given corticosteroids to aid in fetal lung maturity. A CST is not
performed at a preterm gestational age. Furthermore, bleeding is a contraindication to a
CST. Internal fetal monitoring is also contraindicated in the presence of bleeding.
DIF: Cognitive Level: Apply REF: dm. 680
TOPIC 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 of bright red blood. Her contractions are consistent with her
current stage of labor. No change in uterine resting tone has occurred. The fetal heart
rate (FHR) begins to decline rapidly after the ROM. The nursing attendant should suspect
the possibility of what condition?
, a. Placenta previa
