TEST BANK
!!
, Maternity !!Newborn !!and !!Women’s !!Health !!Nursing !!A !!Case-Based !!Approach !!1st !!Edition
!!O’Meara !!Test !! Bank
Chapter !!1 !!Immediate !!Postpartum !!Hemorrhage
MULTIPLE !!CHOICE
1. A !!pregnant !!woman !!is !!being !!discharged !!from !!the !!hospital !!after !!the !!placement !!of !!a
!!cervical !!cerclage !!because !!of !!a !!history !!of !!recurrent !!pregnancy !!loss, !!secondary !!to !!an
!!incompetent !!cervix. !!Which !!information !!regarding !!postprocedural !!care !!should !!the !!nurse
!!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 !!sho
c. The !!client !!will !!need !!to !!make !!arrangements !!for !!care !!at !!home, !!because !!her !!activity!level
!!will !!be !!re
d. The !!client !!will !!be !!scheduled !!for !!a !!cesarean
!!birth. !!ANS: !!B
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
TOP: !!Nursing !!Process: !!Planning !!| !!Nursing !!Process:
!!Implementation !!MSC: !! Client !!Needs: !!Health !!Promotion !!and
!!Maintenance
2. A !!perinatal !!nurse !!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 !!bestresponse !!by !!the !!nurse?
If !!you !!get !!pregnant !!within !!1 !!year, !!the !!chance !!of !!a !!successful !!pregnancy !!is !!very!!small. !!Therefore,
a. pregnancy, !!it !!would !!be !!better !!for !!you !!to !!use !!the !!most !!reliable !!method !!of !!contraception !!available.
The !!major !!risk !!to !!you !!after !!a !!molar !!pregnancy !!is !!a !!type !!of !!cancer !!that !!can !!be !!diagnosed
!!only !!by !!hormone !!that !!your !!body !!produces !!during !!pregnancy. !!If !!you !!were !!to !!get
!!pregnant, !!then !!it !!would
b. this !!cancer !!more !!difficult.
If !!you !!can !!avoid !!a !!pregnancy !!for !!the !!next !!year, !!the !!chance !!of !!developing !!a !!second !!molar
!!pregna
c. improve !!your !!chance !!of !!a !!successful !!pregnancy, !!not !!getting !!pregnant !!at !!this !!time !!is !!best.
d. Oral !!contraceptives !!are !!the !!only !!form !!of !!birth !!control !!that !!will !!prevent !!a !!recurrence !!of !!a
!!molar !!p !!ANS: !!B
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 !!pregnant, !!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 !!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
TOP: !!Nursing !!Process: !!Planning !!| !!Nursing !!Process:
!!Implementation !!MSC: !! Client !!Needs: !!Physiologic !!Integrity
3. The !!nurse !!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 !!pregnancy
d. Abruptio
!!placentae !!ANS: !!C
Methotrexate !!is !!an !!effective !!nonsurgical !!treatment !!option !!for !!a !!hemodynamically !!stable !!woman
whose !!ectopic !!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 !!a !!missed !!abortion, !!or !!for !!abruptio !!placentae.
DIF: !!Cognitive !!Level: !!Apply !!REF: !!dm. !!677 !!TOP: !!Nursing !!Process: !!Planning
!!MSC: !!Client !!Needs: !!Physiologic !!Integrity
4. A !!26-year-old !!pregnant !!woman, !!gravida !!2, !!para !!1-0-0-1, !!is !!28 !!weeks !!pregnant !!when
!!she !!experiences !!bright !!red, !!painless !!vaginal !!bleeding. !!On !!her !!arrival !!at !!the !!hospital, !!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 !!ANS: !!B
The !!presence !!of !!painless !!bleeding !!should !!always !!alert !!the !!health !!care !!team !!to !!the !!possibility!of
placenta !!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
TOP: !!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 !!nurse !! should !!suspect !!the
!!possibility !!of !!what !!condition?
a. Placenta !!previa
b. Vasa !!previa
c. Severe !!abruptio !!placentae
!!
, Maternity !!Newborn !!and !!Women’s !!Health !!Nursing !!A !!Case-Based !!Approach !!1st !!Edition
!!O’Meara !!Test !! Bank
Chapter !!1 !!Immediate !!Postpartum !!Hemorrhage
MULTIPLE !!CHOICE
1. A !!pregnant !!woman !!is !!being !!discharged !!from !!the !!hospital !!after !!the !!placement !!of !!a
!!cervical !!cerclage !!because !!of !!a !!history !!of !!recurrent !!pregnancy !!loss, !!secondary !!to !!an
!!incompetent !!cervix. !!Which !!information !!regarding !!postprocedural !!care !!should !!the !!nurse
!!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 !!sho
c. The !!client !!will !!need !!to !!make !!arrangements !!for !!care !!at !!home, !!because !!her !!activity!level
!!will !!be !!re
d. The !!client !!will !!be !!scheduled !!for !!a !!cesarean
!!birth. !!ANS: !!B
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
TOP: !!Nursing !!Process: !!Planning !!| !!Nursing !!Process:
!!Implementation !!MSC: !! Client !!Needs: !!Health !!Promotion !!and
!!Maintenance
2. A !!perinatal !!nurse !!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 !!bestresponse !!by !!the !!nurse?
If !!you !!get !!pregnant !!within !!1 !!year, !!the !!chance !!of !!a !!successful !!pregnancy !!is !!very!!small. !!Therefore,
a. pregnancy, !!it !!would !!be !!better !!for !!you !!to !!use !!the !!most !!reliable !!method !!of !!contraception !!available.
The !!major !!risk !!to !!you !!after !!a !!molar !!pregnancy !!is !!a !!type !!of !!cancer !!that !!can !!be !!diagnosed
!!only !!by !!hormone !!that !!your !!body !!produces !!during !!pregnancy. !!If !!you !!were !!to !!get
!!pregnant, !!then !!it !!would
b. this !!cancer !!more !!difficult.
If !!you !!can !!avoid !!a !!pregnancy !!for !!the !!next !!year, !!the !!chance !!of !!developing !!a !!second !!molar
!!pregna
c. improve !!your !!chance !!of !!a !!successful !!pregnancy, !!not !!getting !!pregnant !!at !!this !!time !!is !!best.
d. Oral !!contraceptives !!are !!the !!only !!form !!of !!birth !!control !!that !!will !!prevent !!a !!recurrence !!of !!a
!!molar !!p !!ANS: !!B
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 !!pregnant, !!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 !!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
TOP: !!Nursing !!Process: !!Planning !!| !!Nursing !!Process:
!!Implementation !!MSC: !! Client !!Needs: !!Physiologic !!Integrity
3. The !!nurse !!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 !!pregnancy
d. Abruptio
!!placentae !!ANS: !!C
Methotrexate !!is !!an !!effective !!nonsurgical !!treatment !!option !!for !!a !!hemodynamically !!stable !!woman
whose !!ectopic !!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 !!a !!missed !!abortion, !!or !!for !!abruptio !!placentae.
DIF: !!Cognitive !!Level: !!Apply !!REF: !!dm. !!677 !!TOP: !!Nursing !!Process: !!Planning
!!MSC: !!Client !!Needs: !!Physiologic !!Integrity
4. A !!26-year-old !!pregnant !!woman, !!gravida !!2, !!para !!1-0-0-1, !!is !!28 !!weeks !!pregnant !!when
!!she !!experiences !!bright !!red, !!painless !!vaginal !!bleeding. !!On !!her !!arrival !!at !!the !!hospital, !!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 !!ANS: !!B
The !!presence !!of !!painless !!bleeding !!should !!always !!alert !!the !!health !!care !!team !!to !!the !!possibility!of
placenta !!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
TOP: !!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 !!nurse !! should !!suspect !!the
!!possibility !!of !!what !!condition?
a. Placenta !!previa
b. Vasa !!previa
c. Severe !!abruptio !!placentae
