Maternity Newborn And Women’s Health Nursing A Case-Based Approach 2Nd Edition O’meara’s Test Bank

MATERNITY NEWBORN AND WOMEN’S HEALTHvr vr vr vr




vr NURSING A CASE-BASED APPROACH 2ND EDITION
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O’MEARA’S TEST BANK r
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Chapter: 1 Immediate Postpartum Hemorrhage
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MULTIPLE CHOICE vr

,1. An expectant woman is being discharged from the health center after the placement
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of a cervical cerclage because of a history of recurrent gestation/pregnancy loss, secondary
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to an incompetent cervix. Which information regarding post procedural care should the
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nursing attendantemphasize in the discharge teaching?
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a. Any vaginal discharge should be immediately reported to her health care provider.
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b.
rv The presence of any contractions, rupture of membranes (ROM), or severe perineal
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pressure should be reported
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c. The client will need to make arrangements for care at home, because her activity
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level will be restricted
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d. The client will be scheduled for a cesarean birth. vr vr vr vr vr vr vr vr




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




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
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90 minutes, which allows her the freedom to see her physician. Home uterine activity
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monitoring may be used to limit the womans need for visits and to monitor her status
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safely at home. The cerclage can be removed at 37 weeks of gestation (to prepare for a
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vaginal birth), or a cesarean 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
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is very small. Therefore, if gestation/pregnancy, it would be better for you to use the
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most 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
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second molar gestation/pregnancy improve your chance of a successful gestation/pregnancy,
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not 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 vr




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




for1 year to ensure that the mole is completely gone. The chance of developing
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choriocarcinomaafter the development of a hydatidiform mole is increased. Therefore, the
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goal is to achieve azero
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,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
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may obscure the presence of the potentially carcinogenic cells. Women should be
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instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale
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for avoiding gestation/pregnancy for 1 year is to ensure that carcinogenic cells are not
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present. Any 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 vr vr




b. Missed abortion vr




c. Unruptured ectopic gestation/pregnancy vr vr




d. Abruptio placentae vr




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




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
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treatment option for a complete hydatidiform mole, for amissed abortion, or for abruptio
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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
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whenshe experiences bright red, painless vaginal bleeding. On her arrival at the health
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center, which diagnostic procedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity v r vr v r v r




b. Transvaginal ultrasound for placental location v r v r v r v r




c. Contraction stress test (CST) vr vr vr




d. Internal fetal monitoring vr vr




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




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 vr vr vr vr vr vr vr vr vr vr vr vr vr vr vr




imminent delivery, the fetus is presumed to have immature lungs at this gestational age, and
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the 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
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decline rapidly after the ROM. The nursing attendant should suspect the possibility of what
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condition?
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a. Placenta previa vr

, b. Vasa previa vr




c. Severe abruptio placentae vr vr




d. Disseminated intravascular coagulation (DIC) vr vr vr




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




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.
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In addition, if thewoman had a placenta previa, itis unlikely that she would be allowed to
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pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine
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tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting
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that consumes large amounts of clotting factors, causing widespread external bleeding,
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internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric
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risk factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels
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(HELLP) 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 v r v r v r v r v r




b. Turner sign associated with appendicitis vr v r v r v r




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




d. Chadwick sign associated with early vr vr vr vr




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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v associated 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
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pancreatitis. A Chadwick sign is a blue- purple cervix that may be seen during or around the
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eighth week of 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
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have a thorough understanding of miscarriage. Which statement regarding this
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condition is mostaccurate?
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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 vr vr vr vr vr vr vr vr vr vr v r vr




factorin 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 vr