Chapter 28 Hemorrhagic Disorders

Chapter 28  Hemorrhagic Disorders

Complete Chapter Questions And Answers
 

Sample Questions

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 discharge teaching?
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 be reported.
c.
The client will need to make arrangements for care at home, because her activity level will be restricted.
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 woman’s need for visits and to monitor her status safely at home. The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.

DIF: Cognitive Level: Apply REF: p. 675
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance

2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the best response by the nurse?
a.
“If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available.”
b.
“The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult.”
c.
“If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to 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 pregnancy.”

ANS: B
Beta–human 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 obscure the 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 except an intrauterine device (IUD) is acceptable.

DIF: Cognitive Level: Apply REF: p. 679
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication?
a.
Complete hydatidiform mole
b.
Missed abortion
c.
Unruptured ectopic pregnancy
d.
Abruptio placentae

ANS: 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 is not 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: p. 677 TOP: Nursing Process: Planning
MSC: 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 diagnostic procedure 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 monitoring

ANS: 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: p. 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. The sudden 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 is a 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 any prior risk factors.

DIF: Cognitive Level: Analyze REF: p. 684 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Physiologic Integrity