, MaternityNewbornandWomen’sHealthNursingACase-BasedApproach1stEditionO’Meara b b b b b b b b b
TestBank b b
Chapter1ImmediatePostpartumHemorrhage b b b b
MULTIPLECHOICE b
1. Apregnantwomanisbeingdischargedfromthehospitalaftertheplacementofacervical
b b b b b b b b b b b b b b
cerclage becauseofa history ofrecurrent pregnancy loss,secondarytoanincompetent cervix.
b b b b v
Which informationregardingpostprocedural careshould thenurseemphasizein thedischarg
b v v
e teaching?
b
a. Anyvaginaldischarge shouldbeimmediately reported toherhealthcareprovider. b b b b b
b. Thepresenceofanycontractions,ruptureofmembranes(ROM),orsevereperinealpressureshould b b b b b b b b b b
c. Theclientwillneedtomakearrangementsforcareathome,becauseheractivitylevelwillberestri b b b b b b b b b b b
d. Theclientwillbescheduledforacesareanbirth.
bANS:B b
Nursing careshouldstress theimportance ofmonitoring forthe signsandsymptoms ofpreterm
b b b b b b
labor. Vaginal bleeding needs to be reported to her primary health careprovider. Bed rest is an
b b b b b b b b b b b b b b b
belementofcare.However,thewomanmaystandforperiodsofupto90minutes,whichallowsherthe
b b b b b b b b b b b b b b b b b
freedom to see her physician. Home uterine activitymonitoring may be used to limit the womans
b b b b b b b b b b b b b b b
needforvisitsandtomonitorherstatussafely at home. Thecerclage can beremoved at 37 weeks of
b b b b b b b b b b
bgestation(toprepareforavaginalbirth),oracesareanbirthcanbeplanned.
b b b b b b b b b b b
DIF:CognitiveLevel:ApplyREF:dm.675
b b b b b b
TOP:Nursing Process:Planning|NursingProcess: Implementation v
bMSC:ClientNeeds:HealthPromotionandMaintenance
b b b b b
2. Aperinatalnurseisgivingdischargeinstructionstoawoman, statuspostsuction, andcurettage b b
bsecondarytoahydatidiformmole.Thewomanaskswhyshemusttakeoralcontraceptivesfor thenext
b b b b b b b b b b b b bb b
12months.Whatisthebestresponsebythenurse?
b b b b b b b b
Ifyougetpregnantwithin1year,thechanceofasuccessfulpregnancyisverysmall.Therefore,if b b b b b b b b b b b b b
a. pregnancy,it wouldbebetter foryouto usethemost reliablemethod ofcontraception available. b b b b b b b
Themajorrisktoyouafteramolarpregnancyisatypeofcancerthatcanbediagnosedonlybyme hormone
b b b b b b b b b b b b b b b b
that yourbodyproduces during pregnancy. If youweretoget pregnant, thenitwouldmak
b b b b b b b b b
b. thiscancermoredifficult.b b b
Ifyoucanavoidapregnancyforthenextyear,thechanceofdevelopingasecondmolarpregnancy
b b b b b b b b b b b b
c. improveyourchanceofasuccessfulpregnancy,notgettingpregnantatthistimeisbest. b b b b b b b b b b
d. Oralcontraceptivesaretheonlyformofbirthcontrolthatwillpreventarecurrence ofamolarpreg ANS: bb b bb b
B
Betahumanchorionicgonadotropin(beta-hCG)hormonelevelsaredrawnfor1yeartoensure b b b b b b b b b
thatthemoleiscompletelygone.Thechanceofdevelopingchoriocarcinomaafterthedevelopment of a
b b b b b b b b b b b b b b
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
thepotentiallycarcinogeniccells.Womenshouldbeinstructedtousebirthcontrolfor1yearafter
b b b b b b b b b b b b b b b
btreatmentforahydatidiformmole.Therationaleforavoidingpregnancy b b b b b b b
,for1 yearistoensurethatcarcinogeniccellsarenotpresent. Anycontraceptivemethodexcept an
b b b
intrauterinedevice(IUD)isacceptable.
b b b b b
DIF:CognitiveLevel:ApplyREF:dm.679
b b b b b b
TOP:Nursing Process:Planning|NursingProcess:Implementation v b
bMSC:ClientNeeds:PhysiologicIntegrity
b b b b
3. Thenurseispreparingtoadministermethotrexatetotheclient. Thishazardousdrug is b b
mostoftenusedforwhichobstetriccomplication?
b b b b
a. Completehydatidiformmole
b. Missedabortion
c. Unrupturedectopicpregnancy b
d. Abruptioplacentae v
ANS:C
b b
Methotrexateis aneffective nonsurgicaltreatmentoptionforahemodynamically stable woman b b b b b
whoseectopic pregnancyisunrupturedand measures less than 4cmindiameter.Methotrexate isnot b b v b b b b
indicated or recommended as a treatment optionfora complete hydatidiform mole, fora missed
b b b b b b b b b b b b
abortion,orforabruptioplacentae.
b b b b
DIF:CognitiveLevel:ApplyREF:dm.677TOP:NursingProcess:PlanningMSC:Client
b b b b b b b b b b b b
Needs:PhysiologicIntegrity
b b b
4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnantwhen she
b b b b b b b b b b b b
experiences bright red,painless vaginal bleeding.Onher arrivalatthehospital,whichdiagnostic
b v b b b b b b
procedurewilltheclientmostlikelyhaveperformed?
b b b b b b b
a. Amniocentesisforfetallungmaturity b b
b. Transvaginalultrasoundforplacentallocation b b b
c. Contractionstresstest(CST) b b
d. Internalfetalmonitoring
ANS:B
b b
Thepresenceofpainlessbleedingshouldalwaysalertthehealthcareteamtothepossibilityof
b b b b b b b b b
placentaprevia,whichcanbeconfirmedthroughultrasonography.Amniocentesisisnotperformed ona
b b b b b b b b b b b b b
womanwhoisexperiencingbleeding.Intheeventofanimminentdelivery,thefetusispresumedtohave
b b b b b b b b b b b b b b b b b
immaturelungsatthisgestationalage,andthemotherisgivencorticosteroidstoaidinfetal lung maturity.
b b b b b b b b b b b b b
A CST is not performed at apreterm gestationalage.Furthermore,bleedingisa contraindication to a
b v v b b b b b b b b b
CST. Internal fetal monitoringis also contraindicated in the presence of bleeding.
b b b b b b b b b b b
DIF:CognitiveLevel:ApplyREF:dm.680
b b b b b b
TOP:NursingProcess:AssessmentMSC:ClientNeeds:HealthPromotionandMaintenance
b b b b b b b b b
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
b b b b b b b b b b b b
fluid consists ofbright red blood.Her contractions areconsistent with hercurrent stageoflabor.No
b v b b
changeinuterinerestingtonehasoccurred.Thefetalheartrate(FHR)beginstodeclinerapidlyafterthe
b b b b b b b b b b b b b b b b b b
ROM.Thenurseshouldsuspectthepossibilityofwhatcondition?
b b b b b b b b b
a. Placentaprevia b
b. Vasaprevia b
c. Severeabruptioplacentae b
, d. Disseminated intravascularcoagulation(DIC) v
ANS:B
b b
Vasapreviaistheresultofavelamentousinsertionoftheumbilicalcord.Theumbilicalvessels
b b b b b b b b b
arenotsurroundedbyWhartonjellyandhavenosupportivetissue.Theumbilicalbloodvesselsthusare
b b b b b b b b b b b b b b b
at riskforlacerationatany time,but laceration occurs most frequently duringROM.Thesudden
b v b b b b b b b
appearanceofbrightredbloodatthe timeofROMandasuddenchangeintheFHR withoutother known
b b b b b b b b b b b b b b b b v b b
riskfactorsshouldimmediatelyalertthenursetothepossibilityofvasaprevia.Thepresenceofplacenta
b b b b b b b b b b b b b b b
previamostlikelywouldbeascertainedbeforelaborandisconsideredariskfactorfor this pregnancy. In
b b b b b b b b b b b b b b b b b b
addition, if the woman had aplacenta previa, it is unlikely that she would be allowed to pursuelabor
b b b b b b b b b b b b b b b b b
and a vaginal birth. Withthepresence of severeabruptioplacentae, the uterinetonicitytypically is
b b b b b b b b b b
tetanus(i.e., aboardlikeuterus). DICis a pathologic form of diffuse clotting that consumes large
b b b b b b b b b b b b
amounts of clotting factors, causing widespread external bleeding, internalbleeding,orboth.DICis
b b b b b b b b b b b b b b
alwaysasecondarydiagnosis,oftenassociatedwithobstetricrisk factors such as the hemolysis,
b b b b b b b b b b b b b b
elevated liver enzyme levels, and low platelet levels (HELLP) syndrome.Thiswomandidnothave
b b b b b b b b b b b b b b
anypriorriskfactors.
b b b b
DIF:CognitiveLevel:AnalyzeREF:dm.684TOP:NursingProcess:Diagnosis
b b b b b b b b b b
MSC:ClientNeeds:PhysiologicIntegrity
b b b b b
6. Awomanarrivesforevaluationofsignsandsymptomsthatincludeamissedperiod, adnexal b
fullness, tenderness, and dark red vaginal bleeding. On examination, the nursenotices an
b b b b b b b b b b b b
ecchymoticbluenessaroundthewomansumbilicus.Whatdoesthisfindingindicate?
b b b b b b b b b
a. Normalintegumentarychangesassociatedwithpregnancy b b b b
b. Turnersignassociatedwithappendicitis b b b b
c. Cullensignassociatedwitharupturedectopicpregnancy b b b b
d. Chadwicksignassociated withearlypregnancy v
ANS:C
b b
Cullensign,theblueecchymosisobservedintheumbilicalarea,indicateshematoperitoneum b b b b b b
associatedwithanundiagnosedrupturedintraabdominalectopicpregnancy.Lineanigraonthe
b b b b b b b b b b b
abdomenisthenormalintegumentarychangeassociatedwithpregnancyandexhibitsabrown
b b b b b b b b b b b b b
pigmented,verticallineon thelowerabdomen.Turnersign isecchymosis intheflank area,often
b b b v b
associatedwithpancreatitis.AChadwicksignisablue-purplecervixthatmaybeseenduringor
b b b b b b b b b b b b b b b
aroundtheeighthweekofpregnancy.
b b b b b
DIF:CognitiveLevel:AnalyzeREF:dm.676
b b b b b b
TOP:NursingProcess:AssessmentMSC:ClientNeeds:PhysiologicIntegrity
b b b b b b b b
7. Thenursewhoelectstopracticeintheareaofwomenshealthmusthaveathorough
b b b b b b b b b b b b b b
understandingofmiscarriage.Whichstatement regarding thiscondition ismostaccurate?
b b v v b
a. Amiscarriageisanaturalpregnancy loss beforelaborbegins. b b b b b
b. Itoccursinfewerthan5%ofallclinicallyrecognizedpregnancies.
b b b b b b b b
c. Carelessmaternalbehavior,suchaspoornutritionorexcessiveexercise,canbeafactorincausingIfa
b b b b b b b b b b b b b b b b b
miscarriageoccurs before the12th week ofpregnancy,thenit maybeobserved onlyasmodera
b b b v b b
d. bloodloss. b
ANS:D b
Beforethesixthweek,theonlyevidencemightbeaheavymenstrualflow.Afterthe12thweek,more
b b b b b b b b b b b b b b b b
severepain,similartothatoflabor,islikely.Miscarriageisanaturalpregnancyloss,butit
b b b b b
