Maternity Newborn and Women’s Health Nursing A
Case-Based Approach 1st Edition
O’Meara Test Bank
Chapter 1 Immediate Postpartum
... [Show More] Hemorrhage
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 dischargeteaching?
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
c. The client will need to make arrangements for care at home, because her activity
level will be restri
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 womans need for visits and to
monitor her status safely at home. The cerclage can be removed at37 weeks of
gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
DIF: Cognitive Level: Apply REF: dm. 675
TOP: Nursing Process: Planning | Nursing Process:
ImplementationMSC: Client Needs: Health Promotion
and Maintenance
2. A perinatal nurse is giving discharge instructions to a woman, status postsuction,
and curettagesecondary to a hydatidiform mole. The woman asks why she must
take oral contraceptives for the next 12 months. What is the bestresponse by the
nurse?
If you get pregnant within 1 year, the chance of a successful pregnancy is very small.
Therefore, if
a. pregnancy, it would be better for you to use the most reliable method of
contraception available.
The major risk to you after a molar pregnancy is a type of cancer that can be
diagnosed only by me
hormone that your body produces during pregnancy. If you were to get pregnant,
then it would mak
b. this cancer more difficult.
If you can avoid a pregnancy for the next year, the chance of developing a second
molar pregnancy
c. 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 pregANS: B
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 pregnant, then it may obscurethe 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 exceptan intrauterine device (IUD) is acceptable.
DIF: Cognitive Level: Apply REF: dm. 679
TOP: Nursing Process: Planning | Nursing Process:
ImplementationMSC: Client Needs: Physiologic Integrity
3. The nurse is preparing to administer methotrexate to the client. This
hazardous drugis most often used for which obstetric complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio
placentaeANS: 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 isnot indicated or recommended as a treatment option for a complete
hydatidiform mole, for a missed abortion, or for abruptio placentae.
DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing
Process: PlanningMSC: 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 diagnosticprocedure 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
monitoringANS: 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.
DIF: Cognitive Level: Apply REF: dm. 680
TOP: 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
nurse should suspect the possibility of what condition?
a. Placenta previa
b. Vasa previa
c. Severe abruptio placentae
d. Disseminated intravascular coagulation
(DIC)ANS: B
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. Thesudden 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 nurse to the possibility of vasa previa. The presence of [Show Less]