, MaternityNewbornandWomen’sHealthNursingACase-BasedApproach1stEdition O’Meara
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Test Bank b b
Chapter1 Immediate Postpartum Hemorrhage
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MULTIPLE CHOICE b
1. A pregnant woman is being discharged from thehospital after the placement of a cervical
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cerclagebecauseofahistoryofrecurrentpregnancyloss, secondarytoanincompetentcervix.
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Whichinformationregardingpostproceduralcareshould thenurseemphasizein thedischarge
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bteaching?
a. Anyvaginaldischarge shouldbe immediately reported toherhealthcare provider. b b b b b
b. Thepresenceofany contractions,ruptureofmembranes (ROM), orsevere perineal pressureshouldb b b b b b b b b b
c. Theclientwill need tomake arrangements forcare at home, because heractivitylevel will be restri
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d. Theclientwillbescheduledforacesareanbirth.
bANS:B b
Nursing careshouldstresstheimportance ofmonitoring forthe signsandsymptoms ofpreterm
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labor. Vaginal bleeding needs to be reported to her primary health careprovider. Bed rest is an elementof
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care.However,thewomanmaystandforperiodsofupto90minutes,whichallowsherthe freedom to see
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her physician. Home uterine activitymonitoring may be used to limit the womans
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bneedforvisitsandtomonitorherstatussafely at home. Thecerclage can beremoved at 37 weeks of b b b b b b b b b
bgestation (topreparefor a vaginal birth), or a cesarean birth can be planned.
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DIF: Cognitive Level: Apply REF: dm.675
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TOP:Nursing Process:Planning|NursingProcess:Implementation
v
b MSC: Client Needs: Health Promotionand Maintenance
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2. Aperinatalnurseisgivingdischargeinstructionstoawoman,statuspostsuction,andcurettage b b
bsecondarytoahydatidiformmole.Thewomanaskswhyshemusttakeoralcontraceptivesfor the
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bnext 12 months. Whatis the bestresponse by the nurse?
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Ifyou get pregnant within1 year,thechanceofasuccessful pregnancy isverysmall. Therefore, if
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a. pregnancy, it wouldbebetter foryouto usethemost reliablemethod ofcontraception available. b b b b b b b
The major risk to youaftera molar pregnancy isa type ofcancer that can be diagnosed onlyby me hormo
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that yourbodyproduces during pregnancy. If youweretoget pregnant, then itwouldmak
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b. thiscancermoredifficult.b b b
Ifyou can avoid apregnancy forthenext year, the chance ofdeveloping asecond molar pregnancy
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c. improveyour chance ofa successful pregnancy, notgettingpregnant at this time isbest. b b b b b b b b b b
d. Oralcontraceptivesaretheonlyformofbirthcontrolthatwillpreventarecurrence ofamolarpreg AN b b
B
Betahumanchorionicgonadotropin (beta-hCG)hormonelevels aredrawnfor1yeartoensure
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that the moleis completely gone. The chance of developing choriocarcinoma after the development of a
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bhydatidiformmole is increased. Therefore, the goal is toachieve a zero human chorionic b b b b b b b b b b b
bgonadotropin(hCG)level. Ifthe womanweretobecomepregnant, thenitmayobscure the presence of b b b b b b
bthe potentially carcinogenic cells. Women should beinstructed to use birth control for 1 year after
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btreatment fora hydatidiform mole. The rationale foravoiding pregnancy
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,for1 yearistoensurethatcarcinogeniccellsarenotpresent.Anycontraceptivemethodexcept an
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bintrauterine device (IUD) is acceptable. b b b b
DIF: Cognitive Level: Apply REF: dm.679
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TOP:Nursing Process:Planning|NursingProcess:Implementation v b
bMSC: Client Needs: Physiologic Integrity
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3. Thenurseispreparingtoadministermethotrexatetotheclient. Thishazardousdrug is b b b
most often used forwhichobstetric complication?
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a. Completehydatidiformmole
b. Missedabortion
c. Unrupturedectopic pregnancy b
d. Abruptio placentae v
ANS:C
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Methotrexateis an effective nonsurgicaltreatmentoptionforahemodynamically stable woman b b b b b
whoseectopicpregnancy is unrupturedand measures less than 4 cmin diameter. Methotrexateis not b b v b b b b
indicated or recommended as a treatment optionfora complete hydatidiform mole, fora missed
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abortion, or forabruptio placentae.
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DIF:CognitiveLevel:ApplyREF:dm.677TOP:NursingProcess:Planning MSC:
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Client Needs: Physiologic Integrity
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4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnantwhen she
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experiences bright red, painlessvaginalbleeding. On herarrival at thehospital, whichdiagnostic
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procedurewill the client most likely have performed?
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a. Amniocentesis forfetallung maturity b b
b. Transvaginal ultrasound forplacental location b b b
c. Contractionstress test (CST) b b
d. Internalfetalmonitoring
ANS:B
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The presence of painlessbleeding shouldalways alert thehealthcareteamto the possibility of
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placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on
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awomanwhoisexperiencingbleeding.Intheeventofanimminentdelivery,thefetusispresumed to have
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immature lungs at this gestational age, and the mother is given corticosteroidstoaidinfetal
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lungmaturity. ACSTisnotperformed at a pretermgestational age. Furthermore, bleeding is a
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contraindication to a CST. Internal fetal monitoringis also contraindicated in the presence of bleeding.
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DIF: Cognitive Level: Apply REF: dm.680
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TOP:NursingProcess:AssessmentMSC:ClientNeeds:HealthPromotionandMaintenance
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5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
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fluid consists ofbrightred blood.Hercontractionsareconsistentwithhercurrentstageoflabor. No
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bchangeinuterinerestingtonehas occurred. Thefetal heart rate(FHR)begins todeclinerapidly after the
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ROM. The nurseshould suspect the possibility of what condition?
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a. Placenta previa b
b. Vasaprevia b
c. Severeabruptio placentae b
, d. Disseminated intravascularcoagulation(DIC) v
ANS:B
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Vasa previais theresult ofa velamentous insertionoftheumbilical cord.The umbilical vessels
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arenotsurroundedbyWhartonjellyandhavenosupportivetissue.Theumbilicalbloodvesselsthus are
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at risk forlaceration at anytime, butlacerationoccursmostfrequentlyduring ROM. The sudden
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appearance of bright red blood at thetime of ROM and a sudden change in the FHR without other
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knownriskfactorsshouldimmediatelyalertthenursetothepossibilityofvasaprevia.Thepresence of
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placenta previa most likely wouldbe ascertained before labor and is considered a risk factor for this
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pregnancy. In addition, if the woman had aplacenta previa, it is unlikely that she would be allowed to
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pursuelabor and a vaginal birth. Withthepresence of severeabruptioplacentae, the
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uterinetonicitytypically is tetanus(i.e., aboardlikeuterus). DICis a pathologic form of diffuse
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clotting that consumes large amounts of clotting factors, causing widespread external bleeding,
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internalbleeding,orboth.DICisalwaysasecondarydiagnosis,oftenassociatedwithobstetricrisk
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factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)
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syndrome. This womandid not have any prior risk factors.
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DIF:CognitiveLevel:AnalyzeREF:dm.684TOP:NursingProcess:Diagnosis MSC:
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Client Needs: Physiologic Integrity
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6. Awomanarrivesforevaluationofsignsandsymptomsthatincludeamissedperiod,adnexal b
b fullness, tenderness, and dark red vaginal bleeding. On examination, the nursenotices an
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becchymotic blueness around the womans umbilicus. What does thisfindingindicate?
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a. Normal integumentary changes associated withpregnancy b b b b
b. Turnersign associated with appendicitis b b b b
c. Cullensignassociated with aruptured ectopic pregnancy b b b b
d. Chadwicksignassociated withearlypregnancy v
ANS:C
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Cullensign, theblueecchymosis observed intheumbilical area, indicates hematoperitoneum
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associatedwithanundiagnosedrupturedintraabdominalectopicpregnancy.Lineanigraonthe
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babdomenisthenormalintegumentary changeassociated with pregnancy and exhibits abrown
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bpigmented,verticallineonthelowerabdomen. Turnersign isecchymosis intheflank area,often
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b associatedwithpancreatitis.AChadwicksignisablue-purplecervixthatmaybeseenduringor around
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the eighth week ofpregnancy.
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DIF: Cognitive Level: AnalyzeREF: dm. 676
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TOP:Nursing Process: Assessment MSC:Client Needs: Physiologic Integrity
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7. The nursewho elects to practice in the area of womens health must have a thorough
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bunderstandingofmiscarriage. Whichstatement regarding thiscondition ismostaccurate? b v v b
a. Amiscarriage is anaturalpregnancy loss beforelabor begins. b b b b b
b. Itoccursinfewer than5%ofall clinically recognized pregnancies.
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c. Careless maternal behavior,such as poornutritionorexcessiveexercise, can beafactorincausing Ifa
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miscarriageoccursbeforethe 12thweekofpregnancy, thenitmaybeobserved only as modera
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d. bloodloss. b
ANS: D b
Beforethesixthweek,theonlyevidencemightbeaheavymenstrualflow.Afterthe12thweek,more
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severepain, similartothatoflabor, islikely. Miscarriageisanaturalpregnancyloss, butit
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