MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’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 incompetent 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
pressure should be reported
c. The client will need to make arrangements for care at home, because her activity
level will be restricted
d. The client will be scheduled for a cesarean birth.
ACCURATE CHOICE:-B
Reasoning:->>>>Nursing care should stress the importance of monitoring for the signs and
symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care
provider. Bed rest is an element of care. However, the woman may stand for periods of up to
90 minutes, which allows her the 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 and Maintenance
2. A perinatal nursing attendant is giving discharge instructions to a woman, status
postsuction,and curettage secondary to a hydatidiform mole. The woman asks why she must
take oral contraceptives 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
very 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
diagnosed only by me hormone that your body produces during gestation/pregnancy. If you
were to get expectant, 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 expectant at this timeisbest.
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 of developing choriocarcinoma
after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a
zero
,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
may obscure the presence of the potentially carcinogenic cells. Women should be instructed to
use birth control 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 intrauterine 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 woman whose ectopic gestation/pregnancy is unruptured and
measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a
treatment option for a complete hydatidiform mole, for amissed abortion, or for abruptio
placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client Needs:
Physiologic 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 arrival 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
ACCURATE CHOICE:-B
Reasoning:->>>>The presence of painless bleeding should always alert the health care
teamto the possibility ofplacenta previa, which can be confirmed through ultrasonography.
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an
imminent 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 contraindicated 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 fluid consists of bright red blood. Her contractions are consistent with her current stage of
labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to
decline rapidly after the 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)
ACCURATE sCHOICE:-B
Reasoning:->>>>Vasa sprevia sis sthe sresult sof sa svelamentous sinsertion sof sthe sumbilical scord.
sThesu mbilical svessels sare snot ssurrounded sby sWharton sjelly sand shave sno ssupportive stissue.
sThe sumbilical sblood svessels sthus sare sat srisk sfor slaceration sat sany stime, sbut slaceration soccurs
smost sfrequently sduring sROM. s The ssudden s appearance s of s bright sred sblood sat sthe stime s of
sROM s and s a ssudden s change sin sthe sFHR swithout sother sknown srisk sfactors sshould
simmediately salert sthe snursing sattendant sto sthe spossibility s of svasa sprevia. sThe spresence sof
splacenta sprevia smost slikely swould sbe sascertained sbefore slabor sandis sconsidered sa srisk sfactor
sfor sthis sgestation/pregnancy. sIn saddition, sif stheswoman shad sa splacenta sprevia, sitis sunlikely
sthat sshe swould sbe sallowed sto spursue slabor sand sa svaginal sbirth. s With sthe spresence sof ssevere
sabruptio splacentae, sthe suterine stonicity stypically sis stetanus s(i.e., sa sboardlike s uterus). s DIC sis sa
spathologic sform s of sdiffuse sclotting sthat sconsumes slarge samounts sof sclotting sfactors, scausing
swidespread sexternal sbleeding, sinternal sbleeding, sor s both. s DIC sis salways sa ssecondary
sdiagnosis, soften sassociated swith sobstetric srisk sfactors ssuch sas sthe s hemolysis, s elevated sliver
senzyme slevels, sand slow splatelet slevels s(HELLP) ssyndrome. sThis swoman sdid snot shave sany
sprior srisk sfactors.
DIF: sCognitive s Level: sAnalyze sREF: sdm. s684 sTOPIC sNursing sProcess: s Diagnosis sMSC: sClient
sNeeds: sPhysiologic s Integrity
6. A swoman sarrives sfor sevaluation sof ssigns sand ssymptoms sthat sinclude sa smissed
speriod,sadnexal sfullness, stenderness, sand sdark sred svaginal sbleeding. sOn sexamination, sthe
snursing sattendant snoticesan secchymotic s blueness saround sthe swomans sumbilicus. sWhat
sdoes sthis sfinding s indicate?
a. Normal s integumentary s changes s associated s with s gestation/pregnancy
b. Turner s sign s associated s with s appendicitis
c. Cullen ssign sassociated swith sa sruptured sectopic sgestation/pregnancy
d. Chadwick ssign sassociated swith searly
sgestation/pregnancysACCURATE sCHOICE:-C
Cullen ssign, sthe sblue secchymosis sobserved sin sthe sumbilical sarea, sindicates
shematoperitoneum sReasoning:->>>>associated swith san sundiagnosed sruptured sintraabdominal
sectopic sgestation/pregnancy.sLinea snigra son stheabdomen sis sthe s normal s integumentary
s change s associated s with s gestation/pregnancy sand sexhibits sa sbrown spigmented, svertical
sline s on sthe slower sabdomen. s Turner ssign sis s ecchymosis sin sthe sflank sarea, s often sassociated
swith spancreatitis. sA sChadwick ssign sis sa sblue- spurple scervix sthat smay sbe sseen sduring sor
saround s the s eighth s week s of s gestation/pregnancy.
DIF: sCognitive sLevel: sAnalyze sREF: sdm. s676
TOPIC sNursing sProcess: sAssessment sMSC: sClient sNeeds: sPhysiologic sIntegrity
7. The snursing sattendant swho selects sto spractice sin sthe sarea sof swomens shealth smust
shave sa sthorough sunderstanding s of s miscarriage. s Which s statement s regarding s this
s condition s is s mostsaccurate?
a. A s miscarriage s is s a s natural s gestation/pregnancy s loss s before s labor s begins.
b. It s occurs s in s fewer s than s 5% s of s all s clinically s recognized s pregnancies.
c. Careless smaternal s behavior, s such s as s poor s nutrition s or s excessive s exercise, scan s be sa
s factorsin s causing s miscarriage
d. If sa s miscarriage s occurs s before s the s 12th s week s of s gestation/pregnancy, s then s it s may s be
s observed s only s assmoderate s blood s loss
ACCURATE sCHOICE:-D
NURSING A CASE-BASED APPROACH 2ND EDITION
O’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 incompetent 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
pressure should be reported
c. The client will need to make arrangements for care at home, because her activity
level will be restricted
d. The client will be scheduled for a cesarean birth.
ACCURATE CHOICE:-B
Reasoning:->>>>Nursing care should stress the importance of monitoring for the signs and
symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care
provider. Bed rest is an element of care. However, the woman may stand for periods of up to
90 minutes, which allows her the 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 and Maintenance
2. A perinatal nursing attendant is giving discharge instructions to a woman, status
postsuction,and curettage secondary to a hydatidiform mole. The woman asks why she must
take oral contraceptives 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
very 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
diagnosed only by me hormone that your body produces during gestation/pregnancy. If you
were to get expectant, 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 expectant at this timeisbest.
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 of developing choriocarcinoma
after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a
zero
,human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it
may obscure the presence of the potentially carcinogenic cells. Women should be instructed to
use birth control 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 intrauterine 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 woman whose ectopic gestation/pregnancy is unruptured and
measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a
treatment option for a complete hydatidiform mole, for amissed abortion, or for abruptio
placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client Needs:
Physiologic 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 arrival 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
ACCURATE CHOICE:-B
Reasoning:->>>>The presence of painless bleeding should always alert the health care
teamto the possibility ofplacenta previa, which can be confirmed through ultrasonography.
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an
imminent 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 contraindicated 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 fluid consists of bright red blood. Her contractions are consistent with her current stage of
labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to
decline rapidly after the 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)
ACCURATE sCHOICE:-B
Reasoning:->>>>Vasa sprevia sis sthe sresult sof sa svelamentous sinsertion sof sthe sumbilical scord.
sThesu mbilical svessels sare snot ssurrounded sby sWharton sjelly sand shave sno ssupportive stissue.
sThe sumbilical sblood svessels sthus sare sat srisk sfor slaceration sat sany stime, sbut slaceration soccurs
smost sfrequently sduring sROM. s The ssudden s appearance s of s bright sred sblood sat sthe stime s of
sROM s and s a ssudden s change sin sthe sFHR swithout sother sknown srisk sfactors sshould
simmediately salert sthe snursing sattendant sto sthe spossibility s of svasa sprevia. sThe spresence sof
splacenta sprevia smost slikely swould sbe sascertained sbefore slabor sandis sconsidered sa srisk sfactor
sfor sthis sgestation/pregnancy. sIn saddition, sif stheswoman shad sa splacenta sprevia, sitis sunlikely
sthat sshe swould sbe sallowed sto spursue slabor sand sa svaginal sbirth. s With sthe spresence sof ssevere
sabruptio splacentae, sthe suterine stonicity stypically sis stetanus s(i.e., sa sboardlike s uterus). s DIC sis sa
spathologic sform s of sdiffuse sclotting sthat sconsumes slarge samounts sof sclotting sfactors, scausing
swidespread sexternal sbleeding, sinternal sbleeding, sor s both. s DIC sis salways sa ssecondary
sdiagnosis, soften sassociated swith sobstetric srisk sfactors ssuch sas sthe s hemolysis, s elevated sliver
senzyme slevels, sand slow splatelet slevels s(HELLP) ssyndrome. sThis swoman sdid snot shave sany
sprior srisk sfactors.
DIF: sCognitive s Level: sAnalyze sREF: sdm. s684 sTOPIC sNursing sProcess: s Diagnosis sMSC: sClient
sNeeds: sPhysiologic s Integrity
6. A swoman sarrives sfor sevaluation sof ssigns sand ssymptoms sthat sinclude sa smissed
speriod,sadnexal sfullness, stenderness, sand sdark sred svaginal sbleeding. sOn sexamination, sthe
snursing sattendant snoticesan secchymotic s blueness saround sthe swomans sumbilicus. sWhat
sdoes sthis sfinding s indicate?
a. Normal s integumentary s changes s associated s with s gestation/pregnancy
b. Turner s sign s associated s with s appendicitis
c. Cullen ssign sassociated swith sa sruptured sectopic sgestation/pregnancy
d. Chadwick ssign sassociated swith searly
sgestation/pregnancysACCURATE sCHOICE:-C
Cullen ssign, sthe sblue secchymosis sobserved sin sthe sumbilical sarea, sindicates
shematoperitoneum sReasoning:->>>>associated swith san sundiagnosed sruptured sintraabdominal
sectopic sgestation/pregnancy.sLinea snigra son stheabdomen sis sthe s normal s integumentary
s change s associated s with s gestation/pregnancy sand sexhibits sa sbrown spigmented, svertical
sline s on sthe slower sabdomen. s Turner ssign sis s ecchymosis sin sthe sflank sarea, s often sassociated
swith spancreatitis. sA sChadwick ssign sis sa sblue- spurple scervix sthat smay sbe sseen sduring sor
saround s the s eighth s week s of s gestation/pregnancy.
DIF: sCognitive sLevel: sAnalyze sREF: sdm. s676
TOPIC sNursing sProcess: sAssessment sMSC: sClient sNeeds: sPhysiologic sIntegrity
7. The snursing sattendant swho selects sto spractice sin sthe sarea sof swomens shealth smust
shave sa sthorough sunderstanding s of s miscarriage. s Which s statement s regarding s this
s condition s is s mostsaccurate?
a. A s miscarriage s is s a s natural s gestation/pregnancy s loss s before s labor s begins.
b. It s occurs s in s fewer s than s 5% s of s all s clinically s recognized s pregnancies.
c. Careless smaternal s behavior, s such s as s poor s nutrition s or s excessive s exercise, scan s be sa
s factorsin s causing s miscarriage
d. If sa s miscarriage s occurs s before s the s 12th s week s of s gestation/pregnancy, s then s it s may s be
s observed s only s assmoderate s blood s loss
ACCURATE sCHOICE:-D
