MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING
A CASE-BASED APPROACH 2ND EDITIONO’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 time isbest.
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 team to 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 CHOICE:-B
Reasoning:->>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. The
umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical
blood vessels thus are at risk for laceration at any time, but laceration occurs most frequently during
ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the
FHR without other known risk factors should immediately alert the nursing attendant to the possibility
of vasa previa. The presence of placenta previa most likely would be ascertained before labor
andis considered a risk factor for this gestation/pregnancy. In addition, if the woman had a placenta
previa, itis unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence
of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is
a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and
low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: Client Needs:
Physiologic Integrity
6. 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 nursing attendant
noticesan ecchymotic blueness around the womans umbilicus. What does this finding indicate?
a. Normal integumentary changes associated with gestation/pregnancy
b. Turner sign associated with appendicitis
c. Cullen sign associated with a ruptured ectopic gestation/pregnancy
d. Chadwick sign associated with early
gestation/pregnancy ACCURATE CHOICE:-C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
Reasoning:->>>>associated with an undiagnosed ruptured intraabdominal ectopic gestation/pregnancy.
Linea nigra on theabdomen is the normal integumentary change associated with gestation/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 gestation/pregnancy.
DIF: Cognitive Level: Analyze REF: dm. 676
TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. The nursing attendant who elects to practice in the area of womens health must have a
thorough understanding of miscarriage. Which statement regarding this condition is most
accurate?
a. A miscarriage is a natural gestation/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 miscarriage
d. If a miscarriage occurs before the 12th week of gestation/pregnancy, then it may be observed
only as moderate blood loss
ACCURATE CHOICE:-D
A CASE-BASED APPROACH 2ND EDITIONO’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 time isbest.
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 team to 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 CHOICE:-B
Reasoning:->>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. The
umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical
blood vessels thus are at risk for laceration at any time, but laceration occurs most frequently during
ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the
FHR without other known risk factors should immediately alert the nursing attendant to the possibility
of vasa previa. The presence of placenta previa most likely would be ascertained before labor
andis considered a risk factor for this gestation/pregnancy. In addition, if the woman had a placenta
previa, itis unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence
of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is
a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and
low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: Client Needs:
Physiologic Integrity
6. 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 nursing attendant
noticesan ecchymotic blueness around the womans umbilicus. What does this finding indicate?
a. Normal integumentary changes associated with gestation/pregnancy
b. Turner sign associated with appendicitis
c. Cullen sign associated with a ruptured ectopic gestation/pregnancy
d. Chadwick sign associated with early
gestation/pregnancy ACCURATE CHOICE:-C
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
Reasoning:->>>>associated with an undiagnosed ruptured intraabdominal ectopic gestation/pregnancy.
Linea nigra on theabdomen is the normal integumentary change associated with gestation/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 gestation/pregnancy.
DIF: Cognitive Level: Analyze REF: dm. 676
TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. The nursing attendant who elects to practice in the area of womens health must have a
thorough understanding of miscarriage. Which statement regarding this condition is most
accurate?
a. A miscarriage is a natural gestation/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 miscarriage
d. If a miscarriage occurs before the 12th week of gestation/pregnancy, then it may be observed
only as moderate blood loss
ACCURATE CHOICE:-D
