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

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

Chapter 1 Immediate Postpartum Hemorrhage q o q o q o qo




MULTIPLE CHOICE q o




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
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cervix.Which information regarding postprocedural care should the nurse emphasize in the
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dischargeteaching?
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a. Any vaginal discharge should be immediately reported to her healthiicare provider. q o q o q o q o q o q o qo q o q o q o




b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure
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should qo




c. The client will need to make arrangements for care at home, because her activity level will b restri
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d. The client will be scheduled for a cesarean qo qo qo qo qo qo qo




birth.ANS: B
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Nursing care should stress the importance of monitoringiiforiithe signs and symptoms of preterm
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labor. Vaginal bleeding needs to be reported to her primaryiihealth care provider. Bed rest is an
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element of care. However, the woman may standiiforiiperiods of up to 90 minutes, which allows
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q her the freedom to see her physician. Home uterine activity monitoring may be used to limit
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q the womans need for visits and to monitor her status safely at home. The cerclage can be
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removed at37 weeks of gestation (toiiprepare for a vaginal birth), or a cesarean birth can be
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planned.
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DIF: Cognitive Level: Apply REF: dm. 675q o q o q o q o q o q o




TOP: Nursing Process: Planning |iiNursing Process:
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ImplementationiiMSC:Client Needs:iiHealth Promotionand Maintenance qo qo qo qo qo qo




2. A perinatal nurse is givingiidischarge instructions to a woman, status postsuction, and
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curettageiisecondary toiiaiihydatidiform mole. The woman asks why she must take oral
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contraceptives foriitheiinext 12 months. What is the bestresponse by the nurse?
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If youiiget pregnant within 1 year, the chance of a successful pregnancy is very small. Theref q o q o q o q o q o q o q o q o qo q o q o q o q o qo q o




if qo




a. pregnancy, it would be better for you to use the most reliable method of contraception availa q o q o q o q o q o q o qo q o q o q o q o q o q o q o q o




The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only me
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hormone that your body produces during pregnancy. If you were to get pregnant, then it woul makqo qo qo qo qo qo qo qo qo qo qo qo qo qo qo q o




b. this cancer more difficult. q o q o q o




If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy
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c. improve your chance of a successful pregnancy, not getting pregnant at this time is best. q o q o q o qo q o q o q o q o q o q o q o q o q o q o




d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a mola qo q o qo qo q o qo qo qo qo q o qo q o qo qo qo q o




pregANS: B
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Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure q o q o q o q o q o q o q o q o q o q o q o q o




that the mole is completely gone. The chance of developing choriocarcinoma after the development
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q of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero
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human chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may
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obscurethe presence of the potentially carcinogenic cells. Women should be instructed to use birth
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qcontrol for 1 year after treatment for a hydatidiform mole. The rationale for avoiding
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pregnancy
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for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method exceptan
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intrauterine device (IUD) is acceptable.
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DIF: Cognitive Level: Apply REF: dm. 679 q o q o q o q o q o q o




TOP: Nursing Process: Planning | Nursing Process:
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ImplementationMSC: Client Needs: Physiologic Integrity q o q o q o q o




3. The nurse is preparing to administer methotrexate to the client. This hazardous
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drugiiis most often used for which obstetric complication?
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a. Complete hydatidiform mole q o q o




b. Missed abortion q o




c. Unruptured ectopic pregnancy q o q o




d. Abruptio
placentaeiiANS: C
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Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman q o q o q o q o q o q o q o qo q o q o q o




whose ectopic pregnancy is unruptured and measures less than 4 cm iniidiameter. Methotrexate isiinot
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qindicated 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:
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PlanningMSC: Client Needs: Physiologic Integrity
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4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1,iiis 28 weeks pregnant when she
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experiences bright red, painless vaginal bleeding.iiOniiheriiarrival at the hospital, which
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diagnosticiiprocedure will the client most likely haveiiperformed?
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a. Amniocentesis for fetal lung maturity q o q o qo q o




b. Transvaginal ultrasoundiiforiiplacental location q o qo q o




c. Contraction stress test (CST) qo q o q o




d. Internalfetal qo




monitoringiiANS: 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 beiiconfirmed through ultrasonography. Amniocentesis is not performed
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on a womaniiwho is experiencing bleeding. In the event of an imminent delivery, the fetus is
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presumediitoiihave immature lungs at this gestational age, and the mother is given corticosteroids
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iitoiiaidiiin fetal lung maturity. A CST is not performed at a preterm gestational age.Furthermore,
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iibleeding is a contraindication to a CST. Internal fetal monitoring is also contraindicatediiin the
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presence of bleeding.
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DIF: Cognitive Level: Apply REF: dm. 680 q o q o q o q o q o q o




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
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q ROM. The fluid consists of bright red blood. Her contractions are consistent with her
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qcurrent stage of labor.No change in uterine resting tone has occurred. The fetal heart rate (FHR)
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begins to decline rapidly after the ROM. The nurse should suspect the possibility of what
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q condition?
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a. Placenta previa q o




b. Vasa previa q o




c. Severe abruptio placentae q o q o




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d. Disseminated intravascular coagulation qo qo




(DIC)iiANS: 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
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vessels thus are at risk for laceration at any time, but laceration occurs most frequently during
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ROM. Theiisudden appearance of bright red blood at the time of ROM and a sudden change in the
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q FHR without other known risk factors should immediately alert the nurse to the
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possibility of vasa previa. The presence of placenta previa most likely would be ascertained before
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q labor and is considered a risk factor for this pregnancy. In addition, if the woman had a
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placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth.
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With the presence of severe abruptio placentae, the uterine tonicity typically isiitetanus (i.e., a
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q boardlike uterus). DIC isiia pathologic form of diffuse clotting that consumesiilargeiiamounts of
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clotting factors, causing widespread external bleeding, internal bleeding,iior both. DIC is
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always a secondary diagnosis, often associated with obstetric risk factorsiisuch as the
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hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)iisyndrome. This woman
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did not have any prior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOP: NursingiiProcess:
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DiagnosisiiMSC: Client Needs: Physiologic Integrity qo qo qo qo




6. A woman arrives for evaluation of signs and symptoms thatiiinclude a missed period,
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adnexaliifullness, tenderness, and dark red vaginal bleeding.iiOn examination, the nurse
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notices an ecchymotic blueness around the womansiiumbilicus. What does this finding
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indicate?
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a. Normal integumentary changesiiassociated with pregnancy q o q o q o q o




b. Turner sign associated withiiappendicitis q o q o q o




c. Cullen sign associated withiiaiiruptured ectopic pregnancy q o q o q o qo q o q o




d. Chadwick sign associated with early qo qo qo qo




pregnancyANS: C
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Cullen sign, the blue ecchymosisiiobserved in the umbilical area, indicates hematoperitoneum
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associated with an undiagnosediiruptured intraabdominal ectopic pregnancy. Linea nigra on the qo qo qo qo qo qo qo qo qo qo




abdomen is the normaliiintegumentary change associated with pregnancy and exhibits a brown
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q pigmented, verticaliilineiion the lower abdomen. Turner sign is ecchymosis in the flank area,
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q ofteniiassociated withiipancreatitis. A Chadwick sign is a blue-purple cervix that may be seen
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during or aroundiithe eighth week of pregnancy.
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DIF: CognitiveiiLevel: Analyze REF: dm. 676
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TOP: NursingiiProcess: 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
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accurate?
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a. A miscarriage is a natural pregnancy loss before labor begins. q o q o q o q o q o q o q o q o q o




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 causing q o qo qo qo qo qo qo qo qo qo qo qo qo qo qo




q o If a miscarriage occurs before the 12th week of pregnancy, then it may be observed
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only as modera q o q o




d. blood loss. q o




ANS: D q o




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