MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING
= = = = = =
A CASE- =
BASED APPROACH 2ND EDITIONO’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=in
competent=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=pressur
e= should= be= reported
c. The=client=will=need=to=make=arrangements=for=care=at=home,=because=her=activity=level=wil
l= be=restricted
d. The=client=will=be=scheduled=for=a=cesarean=birth.=AC
CURATE=CHOICE:-B
Reasoning:-
>>>>Nursing=care=should=stress=the=importance=of=monitoring=for=the=signs=and=symptoms=of=preter
m=labor.=Vaginal=bleeding=needs=to=be=reported=to=her=primary=health=care=provider.=Bed=rest=is=an=e
lement=of=care.=However,=the=woman=may=stand=for=periods=of=up=to=90=minutes,=which=allows=her=t
he=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 =an
d=Maintenance
2. A= perinatal= nursing=attendant= is= giving= discharge= instructions= to= a= woman,= status= postsuctio
n,=and=curettage=secondary=to=a=hydatidiform=mole.=The=woman=asks=why=she=must=take=oral=contrace
ptives=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= ver
y=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=diagnos
ed=only=by=me=hormone=that=your=body=produces=during=gestation/pregnancy.=If=you=were=to=get=e
xpectant,=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=e
xpectant=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=o
f=developing=choriocarcinoma=after=the=development=of=a=hydatidiform=mole=is=increased.=Therefor
e,=the=goal=is=to=achieve=a=zero
,human=chorionic=gonadotropin=(hCG)=level.=If= the=woman=were= to=become=expectant,=then= it=may= obs
cure= the= presence= of= the= potentially= carcinogenic= cells.= Women= should= be= instructed= to=use=birth=contr
ol=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= i
ntrauterine= 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= woma
n= whose= ectopic= gestation/pregnancy= is= unruptured= and= measures= less= than=4=cm=in=diameter.=Methotre
xate=is=not=indicated=or=recommended=as=a=treatment=option=for=a=complete=hydatidiform=mole,=for=ami
ssed=abortion,=or=for=abruptio= placentae.
DIF:=Cognitive=Level:=Apply=REF:=dm.=677=TOPIC=Nursing=Process:=Planning=MSC:=Client=Needs:=Physi
ologic= 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=arr
ival=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=A
CCURATE=CHOICE:-B
Reasoning:-
>>>>The=presence=of=painless=bleeding=should=always=alert=the=health=care=team=to=the=possibilit
y=ofplacenta=previa,=which=can=be=confirmed=through= ultrasonography.
Amniocentesis=is=not=performed=on=a=woman=who=is=experiencing=bleeding.=In=the=event=of=an=immine
nt=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= contrain
dicated= 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=fl
uid=consists=of=bright=red=blood.=Her=contractions=are=consistent=with=her=current=stage=of=labor.=No=ch
ange=in=uterine=resting=tone=has=occurred.=The=fetal=heart=rate=(FHR)=begins=to=decline=rapidly=after=t
he=ROM.=The=nursing=attendant=should=suspect=the=possibility=of=what=condition?
a. Placenta= previa
, b. Vasa=previa
c. Severe=abruptio= placentae
d. Disseminated=intravascular=coagulation=(DIC)=AC
CURATE=CHOICE:-B
Reasoning:-
>>>>Vasa=previa=is=the=result=of=a=velamentous=insertion=of=the=umbilical=cord.=The=umbilical=vessels=
are=not=surrounded=by=Wharton=jelly=and=have=no=supportive=tissue.=The=umbilical=blood=vessels=thus=
are=at=risk=for=laceration=at=any=time,=but=laceration=occurs=most=frequently=during=ROM.=The=sudden
= appearance = of = bright =red= blood= at =the=time= of = ROM = and= a=sudden=change =in=the=FHR=without =other
=known=risk=factors =should =immediately =alert =the=nursing=attendant =to=the=possibility =of =vasa=previa. =T
he=presence=of=placenta=previa=most=likely=would=be=ascertained=before=labor=andis=considered=a=ri
sk=factor=for=this=gestation/pregnancy.=In=addition,=if=the=woman=had=a=placenta=previa,=itis=unlikely=t
hat=she=would=be=allowed=to=pursue=labor=and=a=vaginal=birth.=With=the=presence=of=severe=abrupti
o=placentae,=the=uterine=tonicity=typically=is=tetanus=(i.e.,=a=boardlike=uterus).=DIC=is=a=pathologic=for
m=of=diffuse=clotting=that=consumes=large=amounts=of=clotting=factors,=causing=widespread=external=bl
eeding,=internal=bleeding,=or=both.=DIC=is=always=a=secondary=diagnosis,=often=associated=with=obste
tric=risk=factors=such=as=the=hemolysis,=elevated=liver=enzyme=levels,=and=low=platelet=levels=(HELLP)=s
yndrome.=This=woman=did=not=have=any=prior=risk=factors.
DIF:=Cognitive= Level:=Analyze= REF:= dm.= 684= TOPIC=Nursing=Process:= Diagnosis= MSC:=Client=Needs:=P
hysiologic= Integrity
6. A=woman=arrives=for=evaluation=of=signs=and=symptoms=that=include=a=missed=period,=adne
xal=fullness,=tenderness,=and=dark=red=vaginal=bleeding.=On=examination,=the=nursing=attendant=notice
san=ecchymotic=blueness=around=the=womans=umbilicus.=What=does=this=finding=indicate?
a. Normal= integumentary= changes= associated= with= gestation/pregnancy
b. Turner= sign= associated= with= appendicitis
c. Cullen=sign=associated=with=a=ruptured=ectopic=gestation/pregnancy
d. Chadwick=sign=associated=with=early=gestation/pr
egnancy=ACCURATE=CHOICE:-C
Cullen=sign,=the=blue=ecchymosis=observed=in=the=umbilical=area,=indicates=hematoperitoneum=Reasoni
ng:-
>>>>associated=with=an=undiagnosed=ruptured=intraabdominal=ectopic=gestation/pregnancy.=Linea=nigr
a=on=theabdomen=is=the= normal= integumentary= change= associated= with= gestation/pregnancy=and=exh
ibits=a=brown=pigmented,=vertical=line=on=the=lower=abdomen.=Turner=sign=is=ecchymosis=in=the=flank=
area,=often=associated=with=pancreatitis.=A=Chadwick=sign=is=a=blue-
=purple=cervix=that =may=be=seen=during=or =around = the= eighth= week= of = gestation/pregnancy.
DIF:=Cognitive=Level:=Analyze= REF:=dm.=676
TOPIC=Nursing=Process:=Assessment=MSC:=Client=Needs:=Physiologic=Integrity
7. The=nursing=attendant=who=elects=to=practice=in=the=area=of=womens=health=must=have=a=th
orough=understanding= of= miscarriage.= Which= statement= regarding= this= condition= is= most=accurate?
a. A= miscarriage= is= a= natural= gestation/pregnancy= loss= before= labor= begins.
b. It= occurs= in= fewer= than= 5%= of= all= clinically= recognized= pregnancies.
c. Careless= maternal= behavior,= such= as= poor= nutrition= or= excessive= exercise,=can= be=a= factor=in= ca
using=miscarriage
d. If= a= miscarriage= occurs= before= the= 12th= week= of= gestation/pregnancy,= then= it= may= be= observed=
only= as=moderate= blood=loss
ACCURATE=CHOICE:-D
= = = = = =
A CASE- =
BASED APPROACH 2ND EDITIONO’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=in
competent=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=pressur
e= should= be= reported
c. The=client=will=need=to=make=arrangements=for=care=at=home,=because=her=activity=level=wil
l= be=restricted
d. The=client=will=be=scheduled=for=a=cesarean=birth.=AC
CURATE=CHOICE:-B
Reasoning:-
>>>>Nursing=care=should=stress=the=importance=of=monitoring=for=the=signs=and=symptoms=of=preter
m=labor.=Vaginal=bleeding=needs=to=be=reported=to=her=primary=health=care=provider.=Bed=rest=is=an=e
lement=of=care.=However,=the=woman=may=stand=for=periods=of=up=to=90=minutes,=which=allows=her=t
he=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 =an
d=Maintenance
2. A= perinatal= nursing=attendant= is= giving= discharge= instructions= to= a= woman,= status= postsuctio
n,=and=curettage=secondary=to=a=hydatidiform=mole.=The=woman=asks=why=she=must=take=oral=contrace
ptives=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= ver
y=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=diagnos
ed=only=by=me=hormone=that=your=body=produces=during=gestation/pregnancy.=If=you=were=to=get=e
xpectant,=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=e
xpectant=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=o
f=developing=choriocarcinoma=after=the=development=of=a=hydatidiform=mole=is=increased.=Therefor
e,=the=goal=is=to=achieve=a=zero
,human=chorionic=gonadotropin=(hCG)=level.=If= the=woman=were= to=become=expectant,=then= it=may= obs
cure= the= presence= of= the= potentially= carcinogenic= cells.= Women= should= be= instructed= to=use=birth=contr
ol=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= i
ntrauterine= 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= woma
n= whose= ectopic= gestation/pregnancy= is= unruptured= and= measures= less= than=4=cm=in=diameter.=Methotre
xate=is=not=indicated=or=recommended=as=a=treatment=option=for=a=complete=hydatidiform=mole,=for=ami
ssed=abortion,=or=for=abruptio= placentae.
DIF:=Cognitive=Level:=Apply=REF:=dm.=677=TOPIC=Nursing=Process:=Planning=MSC:=Client=Needs:=Physi
ologic= 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=arr
ival=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=A
CCURATE=CHOICE:-B
Reasoning:-
>>>>The=presence=of=painless=bleeding=should=always=alert=the=health=care=team=to=the=possibilit
y=ofplacenta=previa,=which=can=be=confirmed=through= ultrasonography.
Amniocentesis=is=not=performed=on=a=woman=who=is=experiencing=bleeding.=In=the=event=of=an=immine
nt=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= contrain
dicated= 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=fl
uid=consists=of=bright=red=blood.=Her=contractions=are=consistent=with=her=current=stage=of=labor.=No=ch
ange=in=uterine=resting=tone=has=occurred.=The=fetal=heart=rate=(FHR)=begins=to=decline=rapidly=after=t
he=ROM.=The=nursing=attendant=should=suspect=the=possibility=of=what=condition?
a. Placenta= previa
, b. Vasa=previa
c. Severe=abruptio= placentae
d. Disseminated=intravascular=coagulation=(DIC)=AC
CURATE=CHOICE:-B
Reasoning:-
>>>>Vasa=previa=is=the=result=of=a=velamentous=insertion=of=the=umbilical=cord.=The=umbilical=vessels=
are=not=surrounded=by=Wharton=jelly=and=have=no=supportive=tissue.=The=umbilical=blood=vessels=thus=
are=at=risk=for=laceration=at=any=time,=but=laceration=occurs=most=frequently=during=ROM.=The=sudden
= appearance = of = bright =red= blood= at =the=time= of = ROM = and= a=sudden=change =in=the=FHR=without =other
=known=risk=factors =should =immediately =alert =the=nursing=attendant =to=the=possibility =of =vasa=previa. =T
he=presence=of=placenta=previa=most=likely=would=be=ascertained=before=labor=andis=considered=a=ri
sk=factor=for=this=gestation/pregnancy.=In=addition,=if=the=woman=had=a=placenta=previa,=itis=unlikely=t
hat=she=would=be=allowed=to=pursue=labor=and=a=vaginal=birth.=With=the=presence=of=severe=abrupti
o=placentae,=the=uterine=tonicity=typically=is=tetanus=(i.e.,=a=boardlike=uterus).=DIC=is=a=pathologic=for
m=of=diffuse=clotting=that=consumes=large=amounts=of=clotting=factors,=causing=widespread=external=bl
eeding,=internal=bleeding,=or=both.=DIC=is=always=a=secondary=diagnosis,=often=associated=with=obste
tric=risk=factors=such=as=the=hemolysis,=elevated=liver=enzyme=levels,=and=low=platelet=levels=(HELLP)=s
yndrome.=This=woman=did=not=have=any=prior=risk=factors.
DIF:=Cognitive= Level:=Analyze= REF:= dm.= 684= TOPIC=Nursing=Process:= Diagnosis= MSC:=Client=Needs:=P
hysiologic= Integrity
6. A=woman=arrives=for=evaluation=of=signs=and=symptoms=that=include=a=missed=period,=adne
xal=fullness,=tenderness,=and=dark=red=vaginal=bleeding.=On=examination,=the=nursing=attendant=notice
san=ecchymotic=blueness=around=the=womans=umbilicus.=What=does=this=finding=indicate?
a. Normal= integumentary= changes= associated= with= gestation/pregnancy
b. Turner= sign= associated= with= appendicitis
c. Cullen=sign=associated=with=a=ruptured=ectopic=gestation/pregnancy
d. Chadwick=sign=associated=with=early=gestation/pr
egnancy=ACCURATE=CHOICE:-C
Cullen=sign,=the=blue=ecchymosis=observed=in=the=umbilical=area,=indicates=hematoperitoneum=Reasoni
ng:-
>>>>associated=with=an=undiagnosed=ruptured=intraabdominal=ectopic=gestation/pregnancy.=Linea=nigr
a=on=theabdomen=is=the= normal= integumentary= change= associated= with= gestation/pregnancy=and=exh
ibits=a=brown=pigmented,=vertical=line=on=the=lower=abdomen.=Turner=sign=is=ecchymosis=in=the=flank=
area,=often=associated=with=pancreatitis.=A=Chadwick=sign=is=a=blue-
=purple=cervix=that =may=be=seen=during=or =around = the= eighth= week= of = gestation/pregnancy.
DIF:=Cognitive=Level:=Analyze= REF:=dm.=676
TOPIC=Nursing=Process:=Assessment=MSC:=Client=Needs:=Physiologic=Integrity
7. The=nursing=attendant=who=elects=to=practice=in=the=area=of=womens=health=must=have=a=th
orough=understanding= of= miscarriage.= Which= statement= regarding= this= condition= is= most=accurate?
a. A= miscarriage= is= a= natural= gestation/pregnancy= loss= before= labor= begins.
b. It= occurs= in= fewer= than= 5%= of= all= clinically= recognized= pregnancies.
c. Careless= maternal= behavior,= such= as= poor= nutrition= or= excessive= exercise,=can= be=a= factor=in= ca
using=miscarriage
d. If= a= miscarriage= occurs= before= the= 12th= week= of= gestation/pregnancy,= then= it= may= be= observed=
only= as=moderate= blood=loss
ACCURATE=CHOICE:-D
