Test Bank for Maternity Newborn and Women’s Health Nursing: A Case-Based Approach 2nd Edition O’Meara

MATERNITY NEWBORN AND WOMEN’S HEALTH
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NURSING A CASE-BASED APPROACH 2ND EDITION
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O’MEARA’S TEST BANKh h h




Chapter: 1 Immediate Postpartum Hemorrhage
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MULTIPLE CHOICE h

,1. An expectant woman is being discharged from the health center after the placementof
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a cervical cerclage because of a history of recurrent gestation/pregnancy loss, secondary to
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an incompetent cervix. Which information regarding post procedural care should the nursing
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attendantemphasize in the discharge teaching?
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a. Any vaginal discharge should be immediately reported to her health care provider. b.h h h h h h h h h h h h




The presence of any contractions, rupture of membranes (ROM), or severe perineal h h h h h h h h h h h




pressure should be reported
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c. The client will need to make arrangements for care at home, because her activitylevel
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will be restricted
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d. The client will be scheduled for a cesarean birth. h h h h h h h h




ACCURATE CHOICE:-B
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Reasoning:->>>>Nursing care should stress the importance of monitoring for the signs and h h h h h h h h h h h




symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care
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provider. Bed rest is an element of care. However, the woman may stand for periods of up to 90
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minutes, which allows her the freedom to see her physician. Home uterine activity monitoring
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hmay be used to limit the womans need for visits and to monitor her status safely at home. The
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cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean
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birth can be planned.
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DIF: Cognitive Level: Apply REF: dm. 675
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TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
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HealthPromotion and Maintenance
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2. A perinatal nursing attendant is giving discharge instructions to a woman, status
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postsuction,and curettage secondary to a hydatidiform mole. The woman asks why she must
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take oral contraceptives for the next 12 months. What is the best response by the nursing
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attendant?
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a. If you get expectant within 1 year, the chance of a successful gestation/pregnancy is
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hvery small. Therefore, if gestation/pregnancy, it would be better for you to use the most
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reliable methodof contraception available.
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b. The major risk to you after a molar gestation/pregnancy is a type of cancer that can be
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diagnosed only by me hormone that your body produces during gestation/pregnancy. If you
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were to get expectant, then itwould make this cancer more difficult.
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c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a second
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molar gestation/pregnancy improve your chance of a successful gestation/pregnancy, not
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getting expectant at this timeisbest.
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d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a
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molar gestation/pregnancy
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ACCURATE CHOICE:-B h




Reasoning:->>>>Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn h h h h h h h




for1 year to ensure that the mole is completely gone. The chance of developing choriocarcinoma
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after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a
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zero
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,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it may
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obscure the presence of the potentially carcinogenic cells. Women should be instructed to use
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birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding
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gestation/pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any
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contraceptive method except an intrauterine device (IUD) is acceptable.
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DIF: Cognitive Level: Apply REF: dm. 679
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TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:
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Physiologic Integrity
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3. The nursing attendant is preparing to administer methotrexate to the client. This
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hazardousdrug is most often used for which obstetric complication?
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a. Complete hydatidiform mole h h




b. Missed abortion h




c. Unruptured ectopic gestation/pregnancy h h




d. Abruptio placentae h




ACCURATE CHOICE:-C
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Reasoning:->>>>Methotrexate is an effective nonsurgical treatment option for a h h h h h h h h




hemodynamically stable woman whose ectopic gestation/pregnancy is unruptured and
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measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment
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option for a complete hydatidiform mole, for amissed abortion, or for abruptio placentae.
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DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client Needs:
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Physiologic Integrity
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4. A 26-year-old expectant woman, gravida 2, para 1-0-0-1, is 28 weeks expectant when
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she experiences bright red, painless vaginal bleeding. On her arrival at the health center,
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which diagnostic procedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity h h h h




b. Transvaginal ultrasound for placental location h h h h




c. Contraction stress test (CST) h h h




d. Internal fetal monitoring h h




ACCURATE CHOICE:-B
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Reasoning:->>>>The presence of painless bleeding should always alert the health care team h h h h h h h h h h h




to the possibility ofplacenta previa, which can be confirmed through ultrasonography.
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Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an h h h h h h h h h h h h h h h




imminent delivery, the fetus is presumed to have immature lungs at this gestational age, andthe
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mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a
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preterm gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal
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monitoring is also contraindicated in the presence of bleeding.
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DIF: Cognitive Level: Apply REF: dm. 680
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TOPIC 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.
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The fluid consists of bright red blood. Her contractions are consistent with her current stage of
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labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
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rapidly after the ROM. The nursing attendant should suspect the possibility of what condition?
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a. Placenta previa h

, b. Vasa previa h




c. Severe abruptio placentae h h




d. Disseminated intravascular coagulation (DIC) h h h




ACCURATE CHOICE:-B
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Reasoning:->>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. The h h h h h h h h h h h h h




umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The
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umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs most
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frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a
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sudden change in the FHR without other known risk factors should immediately alert the
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nursing attendant to the possibility of vasa previa. The presence of placenta previa most likely
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would be ascertained before labor andis considered a risk factor for this gestation/pregnancy. In
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addition, if thewoman had a placenta previa, itis unlikely that she would be allowed to pursue
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labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity
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typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that
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consumes large amounts of clotting factors, causing widespread external bleeding, internal
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bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk
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factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)
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syndrome. This woman did not have any prior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: Client
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Needs: Physiologic Integrity
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6. A woman arrives for evaluation of signs and symptoms that include a missed period,
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adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nursing
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attendant noticesan ecchymotic blueness around the womans umbilicus. What does this
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finding indicate?
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a. Normal integumentary changes associated with gestation/pregnancy h h h h h




b. Turner sign associated with appendicitis h h h h




c. Cullen sign associated with a ruptured ectopic gestation/pregnancy h h h h h h h




d. Chadwick sign associated with early h h h h




gestation/pregnancyACCURATE CHOICE:-C
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Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
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Reasoning:->>>>associated with an undiagnosed ruptured intraabdominal ectopic
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gestation/pregnancy.Linea nigra on theabdomen is the normal integumentary change
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hassociated with gestation/pregnancy and exhibits a brown pigmented, vertical line on the
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lower abdomen. Turner sign is ecchymosis in the flank area, often associated with pancreatitis.
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A Chadwick sign is a blue- purple cervix that may be seen during or around the eighth week of
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gestation/pregnancy.
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DIF: Cognitive Level: Analyze REF: dm. 676
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TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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7. The nursing attendant who elects to practice in the area of womens health must have a
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thorough understanding of miscarriage. Which statement regarding this condition is most
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accurate?
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a. A miscarriage is a natural gestation/pregnancy loss before labor begins.
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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 h h h h h h h h h h h h h




in causing miscarriage
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d. If a miscarriage occurs before the 12th week of gestation/pregnancy, then it may be
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observed only asmoderate blood loss
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ACCURATE CHOICE:-D h