Deck 28: Hemorrhagic Disorders

Question 1

A woman who is 30 weeks of gestation arrives at the hospital with bleeding.Which differential diagnosis would not be applicable for this client?

A) Placenta previa
B) Abruptio placentae
C) Spontaneous abortion
D) Cord insertion

Answer 1

Spontaneous abortion

Question 2

The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms.While planning care for a client who desires outpatient management after a first-trimester loss,what would the nurse expect the plan to include?

A) Dilation and curettage (D&C)
B) Dilation and evacuation (D&E)
C) Misoprostol
D) Ergot products

Answer 2

Misoprostol

Question 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

Answer 3

Unruptured ectopic pregnancy

Question 4

With regard to hemorrhagic complications that may occur during pregnancy,what information is most accurate?

A) An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies.
B) Incidences of ectopic pregnancy are declining as a result of improved diagnostic techniques.
C) One ectopic pregnancy does not affect a woman's fertility or her likelihood of having a normal pregnancy the next time.
D) Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic malignancies.

Question 5

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?

A) Inevitable abortion
B) Missed abortion
C) Incomplete abortion
D) Threatened abortion

Question 6

In contrast to placenta previa,what is the most prevalent clinical manifestation of abruptio placentae?

A) Bleeding
B) Intense abdominal pain
C) Uterine activity
D) Cramping

Question 7

The nurse who elects to practice in the area of women's health must have a thorough understanding of miscarriage.Which statement regarding this condition is most accurate?

A) A miscarriage is a natural pregnancy loss before labor begins.
B) It occurs in fewer than 5% of all clinically recognized pregnancies.
C) Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing a miscarriage.
D) If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.

Question 8

Which laboratory marker is indicative of DIC?

A) Bleeding time of 10 minutes
B) Presence of fibrin split products
C) Thrombocytopenia
D) Hypofibrinogenemia

Question 9

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.

Question 10

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."

Question 11

In caring for the woman with DIC,which order should the nurse anticipate?

A) Administration of blood
B) Preparation of the client for invasive hemodynamic monitoring
C) Restriction of intravascular fluids
D) Administration of steroids

Question 12

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

Question 13

A woman arrives for evaluation of signs and symptoms that include a missed period,adnexal fullness,tenderness,and dark red vaginal bleeding.On examination,the nurse notices an ecchymotic blueness around the woman's umbilicus.What does this finding indicate?

A) Normal integumentary changes associated with pregnancy
B) Turner sign associated with appendicitis
C) Cullen sign associated with a ruptured ectopic pregnancy
D) Chadwick sign associated with early pregnancy

Question 14

A woman arrives at the emergency department with complaints of bleeding and cramping.The initial nursing history is significant for a last menstrual period 6 weeks ago.On sterile speculum examination,the primary care provider finds that the cervix is closed.The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

A) Incomplete
B) Inevitable
C) Threatened
D) Septic

Question 15

What condition indicates concealed hemorrhage when the client experiences abruptio placentae?

A) Decrease in abdominal pain
B) Bradycardia
C) Hard, boardlike abdomen
D) Decrease in fundal height

Question 16

Which maternal condition always necessitates delivery by cesarean birth?

A) Marginal placenta previa
B) Complete placenta previa
C) Ectopic pregnancy
D) Eclampsia

Question 17

In caring for an immediate postpartum client,the nurse notes petechiae and oozing from her intravenous (IV)site.The client would be closely monitored for which clotting disorder?

A) DIC
B) Amniotic fluid embolism (AFE)
C) Hemorrhage
D) HELLP syndrome

Question 18

When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?

A) 12 to 14
B) 6 to 8
C) 23 to 24
D) After 24

Question 19

What is the correct definition of a spontaneous termination of a pregnancy (abortion)?

A) Pregnancy is less than 20 weeks.
B) Fetus weighs less than 1000g.
C) Products of conception are passed intact.
D) No evidence exists of intrauterine infection.

Question 20

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)

Question 21

A client who has undergone a D&C for early pregnancy loss is likely to be discharged the same day.The nurse must ensure that her vital signs are stable,that bleeding has been controlled,and that the woman has adequately recovered from the administration of anesthesia.To promote an optimal recovery,what information should discharge teaching include?

A) Iron supplementation
B) Resumption of intercourse at 6 weeks postprocedure
C) Referral to a support group, if necessary
D) Expectation of heavy bleeding for at least 2 weeks
E) Emphasizing the need for rest

Question 22

Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole?

A) Complaint of frequent mild nausea
B) Blood pressure of 120/80 mm Hg
C) Fundal height measurement of 18 cm
D) History of bright red spotting for 1 day, weeks ago

Question 23

What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?

A) Assessing FHR and maternal vital signs
B) Performing a venipuncture for hemoglobin and hematocrit levels
C) Placing clean disposable pads to collect any drainage
D) Monitoring uterine contractions

Question 24

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy.Which information assists the nurse in developing the plan of care?

A) Bed rest and analgesics are the recommended treatment.
B) She will be unable to conceive in the future.
C) A D&C will be performed to remove the products of conception.
D) Hemorrhage is the primary concern.

Question 25

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage.What are possible causes of early miscarriage?

A) Chromosomal abnormalities
B) Infections
C) Endocrine imbalance
D) Systemic disorders
E) Varicella

Question 26

The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades.Causes include the increase in sexually transmitted infections (STIs)accompanied by tubal infection and damage.The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy.The nurse suspects that a client has early signs of ectopic pregnancy.The nurse should be observing the client for which signs or symptoms?

A) Pelvic pain
B) Abdominal pain
C) Unanticipated heavy bleeding
D) Vaginal spotting or light bleeding
E) Missed period

Question 27

Which order should the nurse expect for a client admitted with a threatened abortion?

A) Bed rest
B) Administration of ritodrine IV
C) Nothing by mouth (nil per os [NPO])
D) Narcotic analgesia every 3 hours, as needed