Test Bank for Maternity Newborn and Women’s Health Nursing: A Case-Based Approach 2nd Edition O’Meara 2025/2026!!!!

, Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition
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O’Meara Test Bank v v




Chapter 1 Immediate Postpartum Hemorrhage
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MULTIPLE CHOICE v


1. A pregnant woman is being discharged from the hospital after the placement of a cervical
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cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
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Which information regarding postprocedural care should the nurse emphasize in the discharge
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teaching?
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a. Any vaginal discharge should be immediately reported to her health care provider.
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b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure sho
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c. The client will need to make arrangements for care at home, because her activity level will be res
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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
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labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
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velement of care. However, the woman may stand for periods of up to 90 minutes, which allows
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vher the freedom to see her physician. Home uterine activity monitoring may be used to limit the
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vwomans need for visits and to monitor her status safely at home. The cerclage can be removed at
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v37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
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DIF: Cognitive Level: Apply REF: dm. 675
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TOP: Nursing Process: Planning | Nursing Process: Implementation
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vMSC: Client Needs: Health Promotion and Maintenance
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2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
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vsecondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for
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vthe next 12 months. What is the bestresponse by the nurse?
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If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore,
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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
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hormone that your body produces during pregnancy. If you were to get pregnant, then it would m
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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
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c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
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d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pre
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vANS: B v


Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
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that the mole is completely gone. The chance of developing choriocarcinoma after the
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vdevelopment of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human
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vchorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure
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vthe presence of the potentially carcinogenic cells. Women should be instructed to use birth
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vcontrol for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy
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,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except
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an intrauterine device (IUD) is acceptable.
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DIF: Cognitive Level: Apply REF: dm. 679
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TOP: Nursing Process: Planning | Nursing Process: Implementation
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MSC: Client Needs: Physiologic Integrity
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3. The nurse is preparing to administer methotrexate to the client. This hazardous drug
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is most often used for which obstetric complication?
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a. Complete hydatidiform mole v v



b. Missed abortion v



c. Unruptured ectopic pregnancy v v



d. Abruptio placentae v



ANS: C
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Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman
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whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is
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not indicated or recommended as a treatment option for a complete hydatidiform mole, for a
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missed abortion, or for abruptio placentae.
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DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: Planning
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MSC: Client Needs: Physiologic Integrity
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4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
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experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
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procedure will the client most likely have performed?
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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
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The presence of painless bleeding should always alert the health care team to the possibility of
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placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not
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performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the
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fetus is presumed to have immature lungs at this gestational age, and the mother is given
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corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age.
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Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also
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contraindicated in the presence of bleeding.
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DIF: Cognitive Level: Apply REF: dm. 680
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TOP: 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. The
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fluid consists of bright red blood. Her contractions are consistent with her current stage of labor.
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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 nurse should suspect the possibility of what condition?
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a. Placenta previa v



b. Vasa previa v



c. Severe abruptio placentae v v

, d. Disseminated intravascular coagulation (DIC) v v v



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



ANS: C
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Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
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associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
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abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
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pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often
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associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or
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around the eighth week of pregnancy.
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DIF: Cognitive Level: Analyze REF: dm. 676
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TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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7. The nurse who elects to practice in the area of womens health must have a thorough
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understanding of miscarriage. Which statement regarding this condition is most accurate?
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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.
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c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causi
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If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as mode
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d. blood loss. v



ANS: D v


Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,
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more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
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