SECTION 1: POSTPARTUM ASSESSMENT
Question 1
A nurse is assessing a postpartum client who is 2 hours after a vaginal delivery. The
fundus is boggy, deviated to the right, and the client has saturated two peripads in 30
minutes. What is the nurse's priority action?
A) Document the findings and continue to monitor
B) Notify the healthcare provider immediately
C) Have the patient void, then reassess the fundus
D) Administer oxytocin as prescribed
Rationale: A full bladder is a common cause of uterine displacement and atony. A
boggy, deviated fundus with heavy bleeding indicates possible postpartum hemorrhage.
Having the patient void allows the uterus to contract effectively. After voiding, the nurse
should reassess fundal firmness and bleeding. Documenting without intervening is
inappropriate; notifying the provider before attempting a simple intervention delays
care .
Question 2
A nurse is assessing a postpartum client's fundus on the third day after delivery. Which
finding would be expected?
A) Fundus at the umbilicus
B) Fundus two fingerbreadths below the umbilicus
C) Fundus three fingerbreadths above the umbilicus
D) Fundus not palpable
Rationale: The fundus descends approximately one fingerbreadth (about 1 cm) per day.
At 2 days postpartum, the fundus should be about two fingerbreadths below the
umbilicus. This is an expected finding and requires no intervention .
,Question 3
A nurse is assessing a postpartum client's lochia on the third day after delivery. Which
finding would be expected?
A) Lochia rubra
B) Lochia serosa
C) Lochia alba
D) Lochia with a foul odor
Rationale: Lochia rubra is dark red and is the expected type of lochia for the first 3 to 4
days postpartum. Lochia serosa (pinkish-brown) appears from days 4-10. Lochia alba
(creamy white) appears from days 10-14. Foul odor indicates infection and is not
expected .
Question 4
A nurse is caring for a postpartum client who is experiencing afterpains. The client is
breastfeeding her newborn. Which statement accurately explains the relationship
between breastfeeding and afterpains?
A) Breastfeeding suppresses the release of oxytocin, reducing afterpains
B) Breastfeeding stimulates the release of oxytocin, which increases afterpains
C) Breastfeeding has no effect on the intensity of afterpains
D) Breastfeeding causes the release of prolactin, which decreases afterpains
Rationale: Breastfeeding stimulates the release of oxytocin from the posterior pituitary,
which causes uterine contractions. These contractions, which are necessary for
involution, can be perceived as afterpains. This is more common in multiparous clients .
Question 5
What is the purpose of the REEDA assessment in postpartum care?
,A) To assess uterine involution
B) To inspect the perineum for healing and complications
C) To evaluate newborn adaptation
D) To monitor maternal vital signs
Rationale: REEDA is an acronym used to guide perineal inspection to evaluate healing
and complications: Redness, Edema, Ecchymosis, Discharge, Approximation. This
assessment is performed on postpartum clients to monitor for signs of infection or poor
healing .
SECTION 2: POSTPARTUM COMPLICATIONS
Question 6
A postpartum client complains of perineal pain and pressure. The nurse notes a firm
fundus and moderate vaginal bleeding. What is the likely cause?
A) Uterine atony
B) Vaginal hematoma
C) Retained placental fragments
D) Endometritis
Rationale: A firm uterus with localized pain and swelling suggests a hematoma rather
than uterine atony. A boggy fundus with heavy bleeding is more consistent with uterine
atony. Retained fragments would cause a boggy, non-contracted uterus; endometritis
presents with fever and foul-smelling lochia .
Question 7
A postpartum client is 4 days postpartum and reports breast tenderness, redness, and a
fever of 101.2°F (38.4°C). Which condition is the client most likely experiencing?
A) Breast engorgement
B) Mastitis
, C) Plugged milk duct
D) Postpartum blues
Rationale: Mastitis is an infection of the breast tissue, often caused by Staphylococcus
aureus. It is characterized by localized breast pain, redness, swelling, and systemic signs
like fever and malaise. Engorgement is bilateral and typically without fever; a plugged
duct is a localized tender lump without systemic symptoms .
Question 8
A postpartum client is experiencing severe perineal pain and a sensation of needing to
defecate but cannot pass stool. What action by the nurse is best?
A) Administer a stool softener
B) Document findings in chart
C) Offer a warm sitz bath
D) Palpate the perineal area
Rationale: Severe perineal pain and pressure with a sensation of needing to defecate
may indicate a vaginal hematoma. The nurse should palpate the perineal area to assess
for swelling, discoloration, or a mass that would indicate a hematoma. This finding
requires immediate notification of the provider .
Question 9
A nurse notes foul-smelling lochia and uterine tenderness in a postpartum client. Which
condition is suspected?
A) Mastitis
B) Endometritis
C) Cystitis
D) Thrombophlebitis
Rationale: Foul odor and uterine tenderness postpartum indicate uterine infection
(endometritis). Endometritis is an infection of the uterine lining, often associated with
Question 1
A nurse is assessing a postpartum client who is 2 hours after a vaginal delivery. The
fundus is boggy, deviated to the right, and the client has saturated two peripads in 30
minutes. What is the nurse's priority action?
A) Document the findings and continue to monitor
B) Notify the healthcare provider immediately
C) Have the patient void, then reassess the fundus
D) Administer oxytocin as prescribed
Rationale: A full bladder is a common cause of uterine displacement and atony. A
boggy, deviated fundus with heavy bleeding indicates possible postpartum hemorrhage.
Having the patient void allows the uterus to contract effectively. After voiding, the nurse
should reassess fundal firmness and bleeding. Documenting without intervening is
inappropriate; notifying the provider before attempting a simple intervention delays
care .
Question 2
A nurse is assessing a postpartum client's fundus on the third day after delivery. Which
finding would be expected?
A) Fundus at the umbilicus
B) Fundus two fingerbreadths below the umbilicus
C) Fundus three fingerbreadths above the umbilicus
D) Fundus not palpable
Rationale: The fundus descends approximately one fingerbreadth (about 1 cm) per day.
At 2 days postpartum, the fundus should be about two fingerbreadths below the
umbilicus. This is an expected finding and requires no intervention .
,Question 3
A nurse is assessing a postpartum client's lochia on the third day after delivery. Which
finding would be expected?
A) Lochia rubra
B) Lochia serosa
C) Lochia alba
D) Lochia with a foul odor
Rationale: Lochia rubra is dark red and is the expected type of lochia for the first 3 to 4
days postpartum. Lochia serosa (pinkish-brown) appears from days 4-10. Lochia alba
(creamy white) appears from days 10-14. Foul odor indicates infection and is not
expected .
Question 4
A nurse is caring for a postpartum client who is experiencing afterpains. The client is
breastfeeding her newborn. Which statement accurately explains the relationship
between breastfeeding and afterpains?
A) Breastfeeding suppresses the release of oxytocin, reducing afterpains
B) Breastfeeding stimulates the release of oxytocin, which increases afterpains
C) Breastfeeding has no effect on the intensity of afterpains
D) Breastfeeding causes the release of prolactin, which decreases afterpains
Rationale: Breastfeeding stimulates the release of oxytocin from the posterior pituitary,
which causes uterine contractions. These contractions, which are necessary for
involution, can be perceived as afterpains. This is more common in multiparous clients .
Question 5
What is the purpose of the REEDA assessment in postpartum care?
,A) To assess uterine involution
B) To inspect the perineum for healing and complications
C) To evaluate newborn adaptation
D) To monitor maternal vital signs
Rationale: REEDA is an acronym used to guide perineal inspection to evaluate healing
and complications: Redness, Edema, Ecchymosis, Discharge, Approximation. This
assessment is performed on postpartum clients to monitor for signs of infection or poor
healing .
SECTION 2: POSTPARTUM COMPLICATIONS
Question 6
A postpartum client complains of perineal pain and pressure. The nurse notes a firm
fundus and moderate vaginal bleeding. What is the likely cause?
A) Uterine atony
B) Vaginal hematoma
C) Retained placental fragments
D) Endometritis
Rationale: A firm uterus with localized pain and swelling suggests a hematoma rather
than uterine atony. A boggy fundus with heavy bleeding is more consistent with uterine
atony. Retained fragments would cause a boggy, non-contracted uterus; endometritis
presents with fever and foul-smelling lochia .
Question 7
A postpartum client is 4 days postpartum and reports breast tenderness, redness, and a
fever of 101.2°F (38.4°C). Which condition is the client most likely experiencing?
A) Breast engorgement
B) Mastitis
, C) Plugged milk duct
D) Postpartum blues
Rationale: Mastitis is an infection of the breast tissue, often caused by Staphylococcus
aureus. It is characterized by localized breast pain, redness, swelling, and systemic signs
like fever and malaise. Engorgement is bilateral and typically without fever; a plugged
duct is a localized tender lump without systemic symptoms .
Question 8
A postpartum client is experiencing severe perineal pain and a sensation of needing to
defecate but cannot pass stool. What action by the nurse is best?
A) Administer a stool softener
B) Document findings in chart
C) Offer a warm sitz bath
D) Palpate the perineal area
Rationale: Severe perineal pain and pressure with a sensation of needing to defecate
may indicate a vaginal hematoma. The nurse should palpate the perineal area to assess
for swelling, discoloration, or a mass that would indicate a hematoma. This finding
requires immediate notification of the provider .
Question 9
A nurse notes foul-smelling lochia and uterine tenderness in a postpartum client. Which
condition is suspected?
A) Mastitis
B) Endometritis
C) Cystitis
D) Thrombophlebitis
Rationale: Foul odor and uterine tenderness postpartum indicate uterine infection
(endometritis). Endometritis is an infection of the uterine lining, often associated with
