Chapter 28: Hemorrhagic Disorders
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 should be reported.
c. The client will need to arrange for care at home, because her activity level will be
restricted.
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 woman’s 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.
PTS: 1 DIF:NUCRoS
gnIitN
ivG
eTLB
ev.
elCOpMply
:A
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 post-suction, 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 nurse?
a. “If you get pregnant within 1 year, the chance of a successful pregnancy is very
small. Therefore, if you desire a future 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 pregnancy is a type of cancer that can be
diagnosed only by measuring the same hormone that your body produces during
pregnancy. If you were to get pregnant, then it would make the diagnosis of this
cancer more difficult.”
c. “If you can avoid a pregnancy for the next year, the chance of developing a second
molar pregnancy is rare. Therefore, to 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 pregnancy.”
ANS: B
, Beta–human 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.
PTS: 1 DIF: Cognitive Level: Apply
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.
PTS: 1 DIF:NUCRoS gnIitN
ivG
eTLB
ev.
elC
:AOpMply
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.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
, 5. A woman arrives for evaluation of signs and symptoms that include a missed period,
adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse
notices an ecchymotic blueness around the woman’s umbilicus. What does this finding
indicate?
a. Normal integumentary changes associated with pregnancy
b. Turner sign associated with appendicitis
c. Cullen sign associated with a ruptured ectopic pregnancy
d. Chadwick sign associated with early pregnancy
ANS: C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates
hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic
pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with
pregnancy and exhibits 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 pregnancy.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
6. Which statement regarding the condition referred to as a miscarriage is most accurate?
a. A miscarriage is a natural 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 causing a miscarriage.
d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed
only as moderate discom foR
NU rt S
anIdNbG
loT
odBl.
osCs.OM
ANS: D
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th
week, more severe pain, like that of labor, is likely. Miscarriage is a natural pregnancy loss,
but it occurs, by definition, before 20 weeks of gestation, before the fetus is viable.
Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies.
Miscarriages can be caused by several disorders or illnesses outside the mother’s control or
knowledge.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which
differential diagnosis would not be applicable for this client?
a. Placenta previa
b. Abruptio placentae
c. Spontaneous abortion
d. Cord insertion
ANS: C
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 should be reported.
c. The client will need to arrange for care at home, because her activity level will be
restricted.
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 woman’s 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.
PTS: 1 DIF:NUCRoS
gnIitN
ivG
eTLB
ev.
elCOpMply
:A
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 post-suction, 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 nurse?
a. “If you get pregnant within 1 year, the chance of a successful pregnancy is very
small. Therefore, if you desire a future 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 pregnancy is a type of cancer that can be
diagnosed only by measuring the same hormone that your body produces during
pregnancy. If you were to get pregnant, then it would make the diagnosis of this
cancer more difficult.”
c. “If you can avoid a pregnancy for the next year, the chance of developing a second
molar pregnancy is rare. Therefore, to 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 pregnancy.”
ANS: B
, Beta–human 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.
PTS: 1 DIF: Cognitive Level: Apply
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.
PTS: 1 DIF:NUCRoS gnIitN
ivG
eTLB
ev.
elC
:AOpMply
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.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
, 5. A woman arrives for evaluation of signs and symptoms that include a missed period,
adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse
notices an ecchymotic blueness around the woman’s umbilicus. What does this finding
indicate?
a. Normal integumentary changes associated with pregnancy
b. Turner sign associated with appendicitis
c. Cullen sign associated with a ruptured ectopic pregnancy
d. Chadwick sign associated with early pregnancy
ANS: C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates
hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic
pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with
pregnancy and exhibits 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 pregnancy.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
6. Which statement regarding the condition referred to as a miscarriage is most accurate?
a. A miscarriage is a natural 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 causing a miscarriage.
d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed
only as moderate discom foR
NU rt S
anIdNbG
loT
odBl.
osCs.OM
ANS: D
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th
week, more severe pain, like that of labor, is likely. Miscarriage is a natural pregnancy loss,
but it occurs, by definition, before 20 weeks of gestation, before the fetus is viable.
Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies.
Miscarriages can be caused by several disorders or illnesses outside the mother’s control or
knowledge.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which
differential diagnosis would not be applicable for this client?
a. Placenta previa
b. Abruptio placentae
c. Spontaneous abortion
d. Cord insertion
ANS: C
