Test Bank for Maternity Newborn and Women’s Health
Nursing: A Case-Based Approach 1st Edition O’Meara
Chapter 1 Immediate Postpartum Hemorrhage
26 year old G1P0 at 39wks, adequate pelvis on clinical pelvimetry,
nonimmune rubella status is in labor. cervix changed from 4cm to 7cm
over 2hr with uterine contractions noted every 7-10 min. next step in
management? - ANSWER>> continue to observe the labor. immune
pt for rubella postpartum (MMR is live vaccine so CI during
pregnancy)
pt is in active phase of labor (>4cm dilated). nulliparous pt cervix dilate
at least 1.2cm/hr. change in cervix per time and NOT uterine
contraction pattern dictates normalcy in labor. bc pt in normal labor ->
management is to observe pt without intervention
define the follow terms:
1. labor
2. latent phase
3. active phase
4. protraction of active phase - ANSWER>> 1. labor: cervical change
+ regular uterine contractions
2. latent phase: initial stage of labor during which cervix mainly effaces
(thins) rather than dilates (usually <4cm)
3. active phase: part of labor where dilation is more rapid, dilates
>4cm
4. protraction of active phase: cervical dilation in active phase that is
less than expected (nulliparous >1.2cm/hr. multiparous >1.5cm/hr)
what are the 3 stages of labor - ANSWER>> 1st: onset of labor to
complete dilation of cervix
2nd: complete cervical dilation to delivery of infant
3rd: delivery of infant to delivery of placenta
,what is clinically adequate uterine contractions (3)? - ANSWER>>
contractions every 2-3min, firm on palpation and lasting for at least 40-
60sec
characteristic of anthropoid pelvis? predisposes to what fetal position?
- ANSWER>> pelvis with an anteriorposterior diameter greater than
the transverse diameter with prominent ischial spines and narrow
anterior segment. predisposes to persistent occiput posterior position
31yo G2P1 at 40wks progressed in labor from 5cm to 6cm cervical
dilation over 2 hr. what phase of labor is she in? - ANSWER>>
protracted active phase: some progress but less than expected
(normal: 1.5cm/hr for multip and 1.2cm/hr for prime)
24yo G2P1 at 39wks present with painful uterine contractions.
complains of dark, vaginal blood mixed with some mucus. etiology of
bleeding? - ANSWER>> blood show or loss of cervical mucus plus is
sign of impending labor. sticky mucus admixed with blood can
differentiate bloody show from antepartum bleeding-placenta previa,
placental abruption, and vasa previa
18yo at 7wks gestation by LMP complains of 2-day history of vaginal
spotting and lower abdomen pain. PE shows 4wk size uterus and
unremarkable adnexa. b-HCG is 700mlU/mL, no intrauterine
gestational sac on TVUS. next step? - ANSWER>> F/U b-HCG in
48hr
female of reproductive age c abdominal pain and vaginal spotting has
ectopic pregnancy until proven otherwise. b-HCG is below threshold
whereby TVUS would reveal intrauterine pregnancy (b-HCG 1500-
2000). Goal is to determine whether this is normal or abnormal
pregnancy. after 48hr, if hCG rises at least 66% then pt had normal
intrauterine pregnancy. if hCG doesn't rise by 66% then pt has
abnormal pregnancy. subnormal rise does not indicate whether
abnormal pregnancy is in uterus or tube
,when is a women considered for IM methotrexate - ANSWER>>
asymptomatic and small (<3.5cm) ectopic pregnancy
how is nonviable intrauterine pregnancy managed expectantly (2) -
ANSWER>> surgical: D&C
medically: vaginal misoprostol
32yo dx with ectopic (abnormal hCG + no chorionic vill on uterine
curettage) gets 50mg methotrexate IM. 5 days later, has increase
lower abdominal pain. HB and HR normal. abdomen is tender in lower
quadrants without guarding or rebound. best course of action? -
ANSWER>> observation
pt tx with methotrexate will have mild abdominal pain, may be
observed in absence of severe peritoneal signs, hypotension, over
signs of rupture
22yo at 5wks gestation complains of severe lower abdominal pain. BP
is 86/44, HR is 120. tender abdomen. pelvic exam can't be perform
due to guarding. hCG is 500. TVUS shows no intrauterine sac and no
adnexal mass, free fluid in cul-de-sac. best management? -
ANSWER>> surgery is best therapy for pt with early pregnancy who is
hypotensive with adnexal pain (hypotensive + tachy = most likely
ruptured ectopic)
2 criteria for ectopic pregnancy? - ANSWER>> hCG above threshold
and no intrauterine pregnancy on TVUS
35yo G5P4 at term with prior hx of myomectomy and c-section
undergo vaginal delivery. retained placenta is firmly adherent to uterus
upon attempt at manual extraction. dx? next step in management? -
ANSWER>> dx: placente accreta
next step: hysterectomy (prevent hemorrhage and death)
placenta accreta is associated with defect in what? placenta increta?
placenta percreta? - ANSWER>> decidua basalis where the placenta
villi are attached to myometrium. if placenta penetrates into
, myometrium it is placenta increta. placenta percreta (placenta
penetrate entirely through myometrium to the serosa)
risk factors associated with placenta accreta (3) - ANSWER>> 1. prior
uterine incision (ie myomectomy affective the endometrium)
2. previous placenta previa
3. previous c-section
are females with history of myomectomy of subserosal fibroids at an
increased risk of placenta accreta - ANSWER>> No! since these
incisions are out the surface of the uterus and the endometrium is not
disturbed
22yo nonpregnant nulliparous female complains of vaginal discharge
and postcoital spotting. purulent vaginal discharge on gram stain
shows intracellular G(-) diplococci. what is the most likely dx? next
step in therapy? complications of this problem? - ANSWER>> 1. dx:
gonococcal cervicitis
2. next step: IM ceftriaxone for Gn and oral azithromycin (or
doxycycline) for Cl infection
3. complication: salpingitis which lead to infertility or increased risk of
ectopic. disseminated gonorrhea is possible
ddx-cervicitis-chlamydia, trichomonas vaginitis, vaginitis due to HSV2
IM ceftriaxone 125-150 mg
azithro 1g orally or doxy 100mg BID 7-10d
chlamydial and gonorrhea has propensity for which type of cells? how
does patient present - ANSWER>> propensity for columnar cells of
endocervix causing erythema and friability of endocervix ->postcoital
bleed
another name for PID - ANSWER>> acute salpingitis
22yo female, use barrier methods has lower abdominal tenderness
and dyspareunia. laparoscopy shows hyperemic fallopian tubes. most
Nursing: A Case-Based Approach 1st Edition O’Meara
Chapter 1 Immediate Postpartum Hemorrhage
26 year old G1P0 at 39wks, adequate pelvis on clinical pelvimetry,
nonimmune rubella status is in labor. cervix changed from 4cm to 7cm
over 2hr with uterine contractions noted every 7-10 min. next step in
management? - ANSWER>> continue to observe the labor. immune
pt for rubella postpartum (MMR is live vaccine so CI during
pregnancy)
pt is in active phase of labor (>4cm dilated). nulliparous pt cervix dilate
at least 1.2cm/hr. change in cervix per time and NOT uterine
contraction pattern dictates normalcy in labor. bc pt in normal labor ->
management is to observe pt without intervention
define the follow terms:
1. labor
2. latent phase
3. active phase
4. protraction of active phase - ANSWER>> 1. labor: cervical change
+ regular uterine contractions
2. latent phase: initial stage of labor during which cervix mainly effaces
(thins) rather than dilates (usually <4cm)
3. active phase: part of labor where dilation is more rapid, dilates
>4cm
4. protraction of active phase: cervical dilation in active phase that is
less than expected (nulliparous >1.2cm/hr. multiparous >1.5cm/hr)
what are the 3 stages of labor - ANSWER>> 1st: onset of labor to
complete dilation of cervix
2nd: complete cervical dilation to delivery of infant
3rd: delivery of infant to delivery of placenta
,what is clinically adequate uterine contractions (3)? - ANSWER>>
contractions every 2-3min, firm on palpation and lasting for at least 40-
60sec
characteristic of anthropoid pelvis? predisposes to what fetal position?
- ANSWER>> pelvis with an anteriorposterior diameter greater than
the transverse diameter with prominent ischial spines and narrow
anterior segment. predisposes to persistent occiput posterior position
31yo G2P1 at 40wks progressed in labor from 5cm to 6cm cervical
dilation over 2 hr. what phase of labor is she in? - ANSWER>>
protracted active phase: some progress but less than expected
(normal: 1.5cm/hr for multip and 1.2cm/hr for prime)
24yo G2P1 at 39wks present with painful uterine contractions.
complains of dark, vaginal blood mixed with some mucus. etiology of
bleeding? - ANSWER>> blood show or loss of cervical mucus plus is
sign of impending labor. sticky mucus admixed with blood can
differentiate bloody show from antepartum bleeding-placenta previa,
placental abruption, and vasa previa
18yo at 7wks gestation by LMP complains of 2-day history of vaginal
spotting and lower abdomen pain. PE shows 4wk size uterus and
unremarkable adnexa. b-HCG is 700mlU/mL, no intrauterine
gestational sac on TVUS. next step? - ANSWER>> F/U b-HCG in
48hr
female of reproductive age c abdominal pain and vaginal spotting has
ectopic pregnancy until proven otherwise. b-HCG is below threshold
whereby TVUS would reveal intrauterine pregnancy (b-HCG 1500-
2000). Goal is to determine whether this is normal or abnormal
pregnancy. after 48hr, if hCG rises at least 66% then pt had normal
intrauterine pregnancy. if hCG doesn't rise by 66% then pt has
abnormal pregnancy. subnormal rise does not indicate whether
abnormal pregnancy is in uterus or tube
,when is a women considered for IM methotrexate - ANSWER>>
asymptomatic and small (<3.5cm) ectopic pregnancy
how is nonviable intrauterine pregnancy managed expectantly (2) -
ANSWER>> surgical: D&C
medically: vaginal misoprostol
32yo dx with ectopic (abnormal hCG + no chorionic vill on uterine
curettage) gets 50mg methotrexate IM. 5 days later, has increase
lower abdominal pain. HB and HR normal. abdomen is tender in lower
quadrants without guarding or rebound. best course of action? -
ANSWER>> observation
pt tx with methotrexate will have mild abdominal pain, may be
observed in absence of severe peritoneal signs, hypotension, over
signs of rupture
22yo at 5wks gestation complains of severe lower abdominal pain. BP
is 86/44, HR is 120. tender abdomen. pelvic exam can't be perform
due to guarding. hCG is 500. TVUS shows no intrauterine sac and no
adnexal mass, free fluid in cul-de-sac. best management? -
ANSWER>> surgery is best therapy for pt with early pregnancy who is
hypotensive with adnexal pain (hypotensive + tachy = most likely
ruptured ectopic)
2 criteria for ectopic pregnancy? - ANSWER>> hCG above threshold
and no intrauterine pregnancy on TVUS
35yo G5P4 at term with prior hx of myomectomy and c-section
undergo vaginal delivery. retained placenta is firmly adherent to uterus
upon attempt at manual extraction. dx? next step in management? -
ANSWER>> dx: placente accreta
next step: hysterectomy (prevent hemorrhage and death)
placenta accreta is associated with defect in what? placenta increta?
placenta percreta? - ANSWER>> decidua basalis where the placenta
villi are attached to myometrium. if placenta penetrates into
, myometrium it is placenta increta. placenta percreta (placenta
penetrate entirely through myometrium to the serosa)
risk factors associated with placenta accreta (3) - ANSWER>> 1. prior
uterine incision (ie myomectomy affective the endometrium)
2. previous placenta previa
3. previous c-section
are females with history of myomectomy of subserosal fibroids at an
increased risk of placenta accreta - ANSWER>> No! since these
incisions are out the surface of the uterus and the endometrium is not
disturbed
22yo nonpregnant nulliparous female complains of vaginal discharge
and postcoital spotting. purulent vaginal discharge on gram stain
shows intracellular G(-) diplococci. what is the most likely dx? next
step in therapy? complications of this problem? - ANSWER>> 1. dx:
gonococcal cervicitis
2. next step: IM ceftriaxone for Gn and oral azithromycin (or
doxycycline) for Cl infection
3. complication: salpingitis which lead to infertility or increased risk of
ectopic. disseminated gonorrhea is possible
ddx-cervicitis-chlamydia, trichomonas vaginitis, vaginitis due to HSV2
IM ceftriaxone 125-150 mg
azithro 1g orally or doxy 100mg BID 7-10d
chlamydial and gonorrhea has propensity for which type of cells? how
does patient present - ANSWER>> propensity for columnar cells of
endocervix causing erythema and friability of endocervix ->postcoital
bleed
another name for PID - ANSWER>> acute salpingitis
22yo female, use barrier methods has lower abdominal tenderness
and dyspareunia. laparoscopy shows hyperemic fallopian tubes. most
