Test bank maternity newborn and women s health nursing a case based approach 1st edition

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MATERNITY NEWBORN AND WOMAN’S HEALTH Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition O’Meara Test Bank Chapter 1 Immediate Postpartum Hemorrhage MULTIPLE CHOIC... E 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 beimmediately reported to her health careprovider. b. The presence ofany contractions, rupture of membranes (ROM), or severe perineal pressure should c. The client will need to make arrangements for care athome, 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. Thecerclage can be removedat37 weeks of gestation (to prepare fora 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 ofa successfulpregnancy is very small. Therefore, if a. pregnancy, it would be better for youto use the most reliable method of contraceptionavailable. The major risk to you after a molar pregnancy is a type of cancer that canbediagnosed only by me hormone that your bodyproduces during pregnancy. If you were to get pregnant, then it would mak b. this cancer more difficult. If you can avoid a pregnancy for thenext year, the chance ofdevelopinga second molar pregnancy c. improve your chance ofa successful pregnancy, not getting pregnantat 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 drawnfor 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 becomepregnant, then it may obscurethe presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment fora hydatidiform mole. The rationale for avoidingpregnancy MATERNITY NEWBORN AND WOMAN’S HEALTH 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. Completehydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentaeANS: C Methotrexate is an effectivenonsurgical treatmentoptionforahemodynamically stable woman whose ectopic pregnancy is unruptured and measures less than4 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. Contractionstress test (CST) d. Internal fetal monitoringANS: B The presence of painlessbleeding shouldalways alert the healthcare 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 MATERNITY NEWBORN AND WOMAN’S HEALTH d. Disseminated intravascular coagulation (DIC)ANS: B Vasa previa is the result ofa velamentous insertion of the umbilical cord. Theumbilical 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 placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is 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 isa 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 anyprior risk factors. DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: DiagnosisMSC: Client Needs: Physiologic Integrity 6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexalfullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. What does this finding indicate? a. Normal integumentary changes associated with pregnancy b. Turner signassociated with appendicitis c. Cullen sign associated with aruptured ectopic pregnancy d. Chadwick sign associated with early pregnancyANS: C [Show More]

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