ATI Maternal Newborn Exam 5: Postpartum Care Study Guide 2026
|Questions |Answers |Rationales
1. A nurse is assessing a client 2 hours postpartum. The fundus is displaced to
the right and above the umbilicus. What is the priority nursing action?
A. Administer oxytocin
B. Document the findings
C. Massage the fundus
D. Encourage the client to void
Answer: D
Rationale: A fundus displaced to the right usually indicates a full bladder, which can
prevent the uterus from contracting and increase the risk of hemorrhage. Emptying the
bladder is the priority.
2. Which type of lochia is expected for the first 1 to 3 days after delivery?
A. Lochia rubra
B. Lochia alba
C. Lochia serosa
D. Lochia sangria
Answer: A
Rationale: Lochia rubra is dark red, bloody, and contains small clots. it typically lasts for 1
to 3 days postpartum.
,3. A postpartum client who is not breastfeeding reports breast engorgement.
Which intervention should the nurse recommend?
A. Wear a tight-fitting supportive bra
B. Express milk manually
C. Apply warm compresses
D. Stimulate the nipples under warm water
Answer: A
Rationale: For non-breastfeeding clients, a tight-fitting bra or breast binder helps suppress
lactation and provides support. Heat and stimulation should be avoided as they promote
milk production.
4. During which phase of maternal role attainment does the mother focus on
her own needs and rely on others for assistance?
A. Taking-hold phase
B. Letting-go phase
C. Taking-in phase
D. Bonding phase
Answer: C
Rationale: The taking-in phase occurs in the first 24-48 hours. The mother is passive,
dependent, and focuses on her own needs (food, sleep) and her birth experience.
5. A nurse is caring for a postpartum client who is Rh-negative and has an Rh-
positive newborn. Within what timeframe should Rho(D) immune globulin be
administered?
A. Within 24 hours
B. Within 48 hours
C. Within 1 week
D. Within 72 hours
Answer: D
, Rationale: Rho(D) immune globulin must be administered intramuscularly within 72
hours of delivery to prevent sensitization in the Rh-negative mother.
6. What is the most common cause of postpartum hemorrhage?
A. Lacerations
B. Retained placental fragments
C. Uterine atony
D. Hematomas
Answer: C
Rationale: Uterine atony, or the failure of the uterine muscle to contract firmly, is the
leading cause of postpartum hemorrhage.
7. A client is 4 days postpartum. Which color should the nurse expect the lochia
to be?
A. Bright red
B. Clear
C. Yellow-white
D. Pinkish-brown
Answer: D
Rationale: Lochia serosa occurs from day 4 to day 10 postpartum and is pinkish-brown in
color.
8. Which assessment finding should a nurse report to the provider as a possible
sign of a deep vein thrombosis (DVT)?
A. Bilateral pedal edema
B. Negative Homan’s sign
C. Unilateral calf warmth and tenderness
D. Generalized muscle aches
Answer: C
|Questions |Answers |Rationales
1. A nurse is assessing a client 2 hours postpartum. The fundus is displaced to
the right and above the umbilicus. What is the priority nursing action?
A. Administer oxytocin
B. Document the findings
C. Massage the fundus
D. Encourage the client to void
Answer: D
Rationale: A fundus displaced to the right usually indicates a full bladder, which can
prevent the uterus from contracting and increase the risk of hemorrhage. Emptying the
bladder is the priority.
2. Which type of lochia is expected for the first 1 to 3 days after delivery?
A. Lochia rubra
B. Lochia alba
C. Lochia serosa
D. Lochia sangria
Answer: A
Rationale: Lochia rubra is dark red, bloody, and contains small clots. it typically lasts for 1
to 3 days postpartum.
,3. A postpartum client who is not breastfeeding reports breast engorgement.
Which intervention should the nurse recommend?
A. Wear a tight-fitting supportive bra
B. Express milk manually
C. Apply warm compresses
D. Stimulate the nipples under warm water
Answer: A
Rationale: For non-breastfeeding clients, a tight-fitting bra or breast binder helps suppress
lactation and provides support. Heat and stimulation should be avoided as they promote
milk production.
4. During which phase of maternal role attainment does the mother focus on
her own needs and rely on others for assistance?
A. Taking-hold phase
B. Letting-go phase
C. Taking-in phase
D. Bonding phase
Answer: C
Rationale: The taking-in phase occurs in the first 24-48 hours. The mother is passive,
dependent, and focuses on her own needs (food, sleep) and her birth experience.
5. A nurse is caring for a postpartum client who is Rh-negative and has an Rh-
positive newborn. Within what timeframe should Rho(D) immune globulin be
administered?
A. Within 24 hours
B. Within 48 hours
C. Within 1 week
D. Within 72 hours
Answer: D
, Rationale: Rho(D) immune globulin must be administered intramuscularly within 72
hours of delivery to prevent sensitization in the Rh-negative mother.
6. What is the most common cause of postpartum hemorrhage?
A. Lacerations
B. Retained placental fragments
C. Uterine atony
D. Hematomas
Answer: C
Rationale: Uterine atony, or the failure of the uterine muscle to contract firmly, is the
leading cause of postpartum hemorrhage.
7. A client is 4 days postpartum. Which color should the nurse expect the lochia
to be?
A. Bright red
B. Clear
C. Yellow-white
D. Pinkish-brown
Answer: D
Rationale: Lochia serosa occurs from day 4 to day 10 postpartum and is pinkish-brown in
color.
8. Which assessment finding should a nurse report to the provider as a possible
sign of a deep vein thrombosis (DVT)?
A. Bilateral pedal edema
B. Negative Homan’s sign
C. Unilateral calf warmth and tenderness
D. Generalized muscle aches
Answer: C
