, Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition
v v v v v v v v v v
O’Meara Test Bank v v
Chapter 1 Immediate Postpartum Hemorrhage
v v v v
MULTIPLE CHOICE v
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
v v v v v v v v v v v v v v
cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
v v v v v v v v v v v v v v
Which information regarding postprocedural care should the nurse emphasize in the discharge
v v v v v v v v v v v v
teaching?
v
a. Any vaginal discharge should be immediately reported to her health care provider.
v v v v v v v v v v v
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure sho
v v v v v v v v v v v v v
c. The client will need to make arrangements for care at home, because her activity level will be res
v v v v v v v v v v v v v v v v v
d. The client will be scheduled for a cesarean birth. v v v v v v v v
vANS: B v
Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
v v v v v v v v v v v v v v
labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
v v v v v v v v v v v v v v v v
velement of care. However, the woman may stand for periods of up to 90 minutes, which allows
v v v v v v v v v v v v v v v v
vher the freedom to see her physician. Home uterine activity monitoring may be used to limit the
v v v v v v v v v v v v v v v v
vwomans need for visits and to monitor her status safely at home. The cerclage can be removed at
v v v v v v v v v v v v v v v v v
v37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
v v v v v v v v v v v v v v v v
DIF: Cognitive Level: Apply REF: dm. 675
v v v v v v
TOP: Nursing Process: Planning | Nursing Process: Implementation
v v v v v v v
vMSC: Client Needs: Health Promotion and Maintenance
v v v v v v
2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
v v v v v v v v v v v v v
vsecondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for
v v v v v v v v v v v v v v
vthe next 12 months. What is the bestresponse by the nurse?
v v v v v v v v v v
If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore,
v v v v v v v v v v v v v v v v
a. pregnancy, it would be better for you to use the most reliable method of contraception available. v v v v v v v v v v v v v v v
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by m
v v v v v v v v v v v v v v v v v v v v
hormone that your body produces during pregnancy. If you were to get pregnant, then it would m
v v v v v v v v v v v v v v v v
b. this cancer more difficult. v v v
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnan
v v v v v v v v v v v v v v v v v
c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
v v v v v v v v v v v v v v
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pre
v v v v v v v v v v v v v v v v v
vANS: B v
Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
v v v v v v v v v v v v
that the mole is completely gone. The chance of developing choriocarcinoma after the
v v v v v v v v v v v v
vdevelopment of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human
v v v v v v v v v v v v v v v
vchorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure
v v v v v v v v v v v v v v
vthe presence of the potentially carcinogenic cells. Women should be instructed to use birth
v v v v v v v v v v v v v
vcontrol for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy
v v v v v v v v v v v v v v
,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except
v v v v v v v v v v v v v v v
an intrauterine device (IUD) is acceptable.
v v v v v v
DIF: Cognitive Level: Apply REF: dm. 679
v v v v v v
TOP: Nursing Process: Planning | Nursing Process: Implementation
v v v v v v v
MSC: Client Needs: Physiologic Integrity
v v v v v
3. The nurse is preparing to administer methotrexate to the client. This hazardous drug
v v v v v v v v v v v v
is most often used for which obstetric complication?
v v v v v v v v
a. Complete hydatidiform mole v v
b. Missed abortion v
c. Unruptured ectopic pregnancy v v
d. Abruptio placentae v
ANS: C
v v
Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman
v v v v v v v v v v v
whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is
v v v v v v v v v v v v v v
not indicated or recommended as a treatment option for a complete hydatidiform mole, for a
v v v v v v v v v v v v v v v
missed abortion, or for abruptio placentae.
v v v v v v
DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: Planning
v v v v v v v v v v
MSC: Client Needs: Physiologic Integrity
v v v v v
4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
v v v v v v v v v v v v v
experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
v v v v v v v v v v v v v v
procedure will the client most likely have performed?
v v v v v v v v
a. Amniocentesis for fetal lung maturity v v v v
b. Transvaginal ultrasound for placental location v v v v
c. Contraction stress test (CST) v v v
d. Internal fetal monitoring v v
ANS: B
v v
The presence of painless bleeding should always alert the health care team to the possibility of
v v v v v v v v v v v v v v v
placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not
v v v v v v v v v v
performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the
v v v v v v v v v v v v v v v v
fetus is presumed to have immature lungs at this gestational age, and the mother is given
v v v v v v v v v v v v v v v v
corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age.
v v v v v v v v v v v v v v v v v
Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also
v v v v v v v v v v v v v
contraindicated in the presence of bleeding.
v v v v v v
DIF: Cognitive Level: Apply REF: dm. 680
v v v v v v
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
v v v v v v v v v v
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
v v v v v v v v v v v v
fluid consists of bright red blood. Her contractions are consistent with her current stage of labor.
v v v v v v v v v v v v v v v v
No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
v v v v v v v v v v v v v v v v
rapidly after the ROM. The nurse should suspect the possibility of what condition?
v v v v v v v v v v v v v
a. Placenta previa v
b. Vasa previa v
c. Severe abruptio placentae v v
, d. Disseminated intravascular coagulation (DIC) v v v
ANS: B
v v
Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels
v v v v v v v v v v v v v v v
are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels
v v v v v v v v v v v v v v
thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The
v v v v v v v v v v v v v v v v v
sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR
v v v v v v v v v v v v v v v v v v
without other known risk factors should immediately alert the nurse to the possibility of vasa
v v v v v v v v v v v v v v v
previa. The presence of placenta previa most likely would be ascertained before labor and is
v v v v v v v v v v v v v v v
considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is
v v v v v v v v v v v v v v v v v v
unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of
v v v v v v v v v v v v v v v v v
severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is
v v v v v v v v v v v v v v v
a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
v v v v v v v v v v v v v v
widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
v v v v v v v v v v v v v
often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels,
v v v v v v v v v v v v v v
and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
v v v v v v v v v v v v v v v
DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: Diagnosis
v v v v v v v v v v
MSC: Client Needs: Physiologic Integrity
v v v v v
6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal
v v v v v v v v v v v v v v
fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
v v v v v v v v v v v v v
ecchymotic blueness around the womans umbilicus. What does this finding indicate?
v v v v v v v v v v v
a. Normal integumentary changes associated with pregnancy v v v v v
b. Turner sign associated with appendicitis v v v v
c. Cullen sign associated with a ruptured ectopic pregnancy
v v v v v v v
d. Chadwick sign associated with early pregnancy v v v v v
ANS: C
v v
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
v v v v v v v v v v v
associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
v v v v v v v v v v v
abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
v v v v v v v v v v v v v
pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often
v v v v v v v v v v v v v v v v
associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or
v v v v v v v v v v v v v v v v
around the eighth week of pregnancy.
v v v v v v
DIF: Cognitive Level: Analyze REF: dm. 676
v v v v v v
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
v v v v v v v v
7. The nurse who elects to practice in the area of womens health must have a thorough
v v v v v v v v v v v v v v v
understanding of miscarriage. Which statement regarding this condition is most accurate?
v v v v v v v v v v v
a. A miscarriage is a natural pregnancy loss before labor begins. v v v v v v v v v
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
v v v v v v v v v v
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causi
v v v v v v v v v v v v v v v
If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as mode
v v v v v v v v v v v v v v v v v v
d. blood loss. v
ANS: D v
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,
v v v v v v v v v v v v v v v v
more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
v v v v v v v v v v v v v v v v v v
v v v v v v v v v v
O’Meara Test Bank v v
Chapter 1 Immediate Postpartum Hemorrhage
v v v v
MULTIPLE CHOICE v
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
v v v v v v v v v v v v v v
cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
v v v v v v v v v v v v v v
Which information regarding postprocedural care should the nurse emphasize in the discharge
v v v v v v v v v v v v
teaching?
v
a. Any vaginal discharge should be immediately reported to her health care provider.
v v v v v v v v v v v
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure sho
v v v v v v v v v v v v v
c. The client will need to make arrangements for care at home, because her activity level will be res
v v v v v v v v v v v v v v v v v
d. The client will be scheduled for a cesarean birth. v v v v v v v v
vANS: B v
Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
v v v v v v v v v v v v v v
labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
v v v v v v v v v v v v v v v v
velement of care. However, the woman may stand for periods of up to 90 minutes, which allows
v v v v v v v v v v v v v v v v
vher the freedom to see her physician. Home uterine activity monitoring may be used to limit the
v v v v v v v v v v v v v v v v
vwomans need for visits and to monitor her status safely at home. The cerclage can be removed at
v v v v v v v v v v v v v v v v v
v37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
v v v v v v v v v v v v v v v v
DIF: Cognitive Level: Apply REF: dm. 675
v v v v v v
TOP: Nursing Process: Planning | Nursing Process: Implementation
v v v v v v v
vMSC: Client Needs: Health Promotion and Maintenance
v v v v v v
2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
v v v v v v v v v v v v v
vsecondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for
v v v v v v v v v v v v v v
vthe next 12 months. What is the bestresponse by the nurse?
v v v v v v v v v v
If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore,
v v v v v v v v v v v v v v v v
a. pregnancy, it would be better for you to use the most reliable method of contraception available. v v v v v v v v v v v v v v v
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by m
v v v v v v v v v v v v v v v v v v v v
hormone that your body produces during pregnancy. If you were to get pregnant, then it would m
v v v v v v v v v v v v v v v v
b. this cancer more difficult. v v v
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnan
v v v v v v v v v v v v v v v v v
c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
v v v v v v v v v v v v v v
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pre
v v v v v v v v v v v v v v v v v
vANS: B v
Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
v v v v v v v v v v v v
that the mole is completely gone. The chance of developing choriocarcinoma after the
v v v v v v v v v v v v
vdevelopment of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human
v v v v v v v v v v v v v v v
vchorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure
v v v v v v v v v v v v v v
vthe presence of the potentially carcinogenic cells. Women should be instructed to use birth
v v v v v v v v v v v v v
vcontrol for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy
v v v v v v v v v v v v v v
,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except
v v v v v v v v v v v v v v v
an intrauterine device (IUD) is acceptable.
v v v v v v
DIF: Cognitive Level: Apply REF: dm. 679
v v v v v v
TOP: Nursing Process: Planning | Nursing Process: Implementation
v v v v v v v
MSC: Client Needs: Physiologic Integrity
v v v v v
3. The nurse is preparing to administer methotrexate to the client. This hazardous drug
v v v v v v v v v v v v
is most often used for which obstetric complication?
v v v v v v v v
a. Complete hydatidiform mole v v
b. Missed abortion v
c. Unruptured ectopic pregnancy v v
d. Abruptio placentae v
ANS: C
v v
Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman
v v v v v v v v v v v
whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is
v v v v v v v v v v v v v v
not indicated or recommended as a treatment option for a complete hydatidiform mole, for a
v v v v v v v v v v v v v v v
missed abortion, or for abruptio placentae.
v v v v v v
DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: Planning
v v v v v v v v v v
MSC: Client Needs: Physiologic Integrity
v v v v v
4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
v v v v v v v v v v v v v
experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
v v v v v v v v v v v v v v
procedure will the client most likely have performed?
v v v v v v v v
a. Amniocentesis for fetal lung maturity v v v v
b. Transvaginal ultrasound for placental location v v v v
c. Contraction stress test (CST) v v v
d. Internal fetal monitoring v v
ANS: B
v v
The presence of painless bleeding should always alert the health care team to the possibility of
v v v v v v v v v v v v v v v
placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not
v v v v v v v v v v
performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the
v v v v v v v v v v v v v v v v
fetus is presumed to have immature lungs at this gestational age, and the mother is given
v v v v v v v v v v v v v v v v
corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age.
v v v v v v v v v v v v v v v v v
Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also
v v v v v v v v v v v v v
contraindicated in the presence of bleeding.
v v v v v v
DIF: Cognitive Level: Apply REF: dm. 680
v v v v v v
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
v v v v v v v v v v
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
v v v v v v v v v v v v
fluid consists of bright red blood. Her contractions are consistent with her current stage of labor.
v v v v v v v v v v v v v v v v
No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
v v v v v v v v v v v v v v v v
rapidly after the ROM. The nurse should suspect the possibility of what condition?
v v v v v v v v v v v v v
a. Placenta previa v
b. Vasa previa v
c. Severe abruptio placentae v v
, d. Disseminated intravascular coagulation (DIC) v v v
ANS: B
v v
Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels
v v v v v v v v v v v v v v v
are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels
v v v v v v v v v v v v v v
thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The
v v v v v v v v v v v v v v v v v
sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR
v v v v v v v v v v v v v v v v v v
without other known risk factors should immediately alert the nurse to the possibility of vasa
v v v v v v v v v v v v v v v
previa. The presence of placenta previa most likely would be ascertained before labor and is
v v v v v v v v v v v v v v v
considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is
v v v v v v v v v v v v v v v v v v
unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of
v v v v v v v v v v v v v v v v v
severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is
v v v v v v v v v v v v v v v
a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
v v v v v v v v v v v v v v
widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
v v v v v v v v v v v v v
often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels,
v v v v v v v v v v v v v v
and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
v v v v v v v v v v v v v v v
DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: Diagnosis
v v v v v v v v v v
MSC: Client Needs: Physiologic Integrity
v v v v v
6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal
v v v v v v v v v v v v v v
fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
v v v v v v v v v v v v v
ecchymotic blueness around the womans umbilicus. What does this finding indicate?
v v v v v v v v v v v
a. Normal integumentary changes associated with pregnancy v v v v v
b. Turner sign associated with appendicitis v v v v
c. Cullen sign associated with a ruptured ectopic pregnancy
v v v v v v v
d. Chadwick sign associated with early pregnancy v v v v v
ANS: C
v v
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
v v v v v v v v v v v
associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
v v v v v v v v v v v
abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
v v v v v v v v v v v v v
pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often
v v v v v v v v v v v v v v v v
associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or
v v v v v v v v v v v v v v v v
around the eighth week of pregnancy.
v v v v v v
DIF: Cognitive Level: Analyze REF: dm. 676
v v v v v v
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
v v v v v v v v
7. The nurse who elects to practice in the area of womens health must have a thorough
v v v v v v v v v v v v v v v
understanding of miscarriage. Which statement regarding this condition is most accurate?
v v v v v v v v v v v
a. A miscarriage is a natural pregnancy loss before labor begins. v v v v v v v v v
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
v v v v v v v v v v
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causi
v v v v v v v v v v v v v v v
If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as mode
v v v v v v v v v v v v v v v v v v
d. blood loss. v
ANS: D v
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,
v v v v v v v v v v v v v v v v
more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
v v v v v v v v v v v v v v v v v v
