, Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition v v v v v v v v v v
O’Meara Test Bank v v
Chapter 1 Immediate Postpartum Hemorrhage v v v v
MULTIPLE CHOICE v
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
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cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
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Which information regarding postprocedural care should the nurse emphasize in the discharge
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teaching?
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a. Any vaginal discharge should be immediately reported to her health care provider. v v v v v v v v v v v
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should
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c. The client will need to make arrangements for care at home, because her activity level will be restri
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d. The client will be scheduled for a cesarean birth. v v v v v v v v
ANS: B
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Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
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labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
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element of care. However, the woman may stand for periods of up to 90 minutes, which allows her the
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freedom to see her physician. Home uterine activity monitoring may be used to limit the womans
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need for visits and to monitor her status safely at home. The cerclage can be removed at 37 weeks of
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gestation (to prepare for 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 | Nursing Process: Implementation
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MSC: Client Needs: Health Promotion and Maintenance
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2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
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secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the
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next 12 months. What is the bestresponse by the nurse?
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If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if
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a. pregnancy, it would be better for you to use the most reliable method of contraception available. v v v v v v v v v v v v v v v
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by me
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hormone that your body produces during pregnancy. If you were to get pregnant, then it would mak
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b. this cancer more difficult. v v v
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy
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c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
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d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar preg AN
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B
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Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
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that the mole is completely gone. The chance of developing choriocarcinoma after the development
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of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human chorionic
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gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure the presence of
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the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after
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treatment for a hydatidiform mole. The rationale for avoiding pregnancy
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,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an
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intrauterine device (IUD) is acceptable.
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DIF: Cognitive Level: Apply REF: dm. 679
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TOP: Nursing Process: Planning | Nursing Process: Implementation
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MSC: Client Needs: Physiologic Integrity
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3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is
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most often used for which obstetric complication?
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a. Complete hydatidiform mole v v
b. Missed abortion v
c. Unruptured ectopic pregnancy v v
d. Abruptio placentae v
ANS: C
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Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable womanv v v v v v v v v v v
whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is not
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indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed
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abortion, or for abruptio placentae.
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DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: 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 pregnant when she
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experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
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procedure will the client most likely have performed?
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a. Amniocentesis for fetal lung maturity v v v v
b. Transvaginal ultrasound for placental location v v v v
c. Contraction stress test (CST) v v v
d. Internal fetalmonitoring v v
ANS: B
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The presence of painless bleeding should always alert the health care team to the possibility of
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placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed
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on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus is presumed
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to have immature lungs at this gestational age, and the mother is given corticosteroids to aid in fetal
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lung maturity. A CST is not performed at a preterm gestational age. Furthermore, bleeding is a
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contraindication to a CST. Internal fetal monitoring is also contraindicated in the presence of
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bleeding.
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DIF: Cognitive Level: Apply REF: dm. 680
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TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
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5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
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fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No
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change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after
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the ROM. The nurse should suspect the possibility of what condition?
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a. Placenta previa v
b. Vasa previa v
c. Severe abruptio placentae v v
, d. Disseminated intravascular coagulation (DIC) v v v
ANS: B
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Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels
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are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels thus
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are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden
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appearance of bright red blood at the time of ROM and a sudden change in the FHR without other
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known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence
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of placenta previa most likely would be ascertained before labor and is considered a risk factor for
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this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be
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allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the
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uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is 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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internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk
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factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)
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syndrome. This woman did not have any prior risk factors.
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DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: Diagnosis
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MSC: Client Needs: Physiologic Integrity
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6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal
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fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
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ecchymotic blueness around the womans umbilicus. What does this finding indicate?
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a. Normal integumentary changes associated with pregnancy v v v v v
b. Turner sign associated with appendicitis v v v v
c. Cullen sign associated with a ruptured ectopic pregnancy v v v v v v v
d. Chadwick sign associated with early pregnancy v v v v v
ANS: C
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Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
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associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
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abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
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pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often
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associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or
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around the eighth week of pregnancy.
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DIF: Cognitive Level: Analyze REF: dm. 676
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TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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7. The nurse who elects to practice in the area of womens health must have a thorough
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understanding of miscarriage. Which statement regarding this condition is most accurate?
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a. A miscarriage is a natural pregnancy loss before labor begins. v v v v v v v v v
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
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c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing If
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miscarriage occurs before the 12th week of pregnancy, then it may be observed only as modera
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d. blood loss. v
ANS: D v
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week, more
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severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
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