MATERNAL AND PEDIATRIC NURSING – MIDTERM AND
ACTUAL FINAL EXAMS COMBINED WITH MULTIPLE
CHOICES QUESTIONS AND VERIFIED ANSWERS,
DISTINCTION GRADE BOOST
(RATIONALES PROVIDED)
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The perinatal nurse's assessment while caring for a woman in the immediate post
birth period reveals that the woman is experiencing profuse bleeding. What is the
most likely etiology for her bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration - ANSWER ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of
postpartum hemorrhage. Uterine inversion may lead to hemorrhage but it is not
the most likely source of this woman's bleeding. Furthermore if the woman were
experiencing a uterine inversion it would be evidenced by the presence of a large
red rounded mass protruding from the introitus. A vaginal hematoma may be
associated with hemorrhage. However the most likely clinical finding would be
pain not the presence of profuse bleeding. A vaginal laceration may cause
hemorrhage but it is more likely that profuse bleeding would result from uterine
atony. A vaginal laceration should be suspected if vaginal bleeding continues in
the presence of a firm contracted uterine fundus.
,Which is a primary nursing responsibility when caring for a woman experiencing
an obstetrical hemorrhage associated with uterine atony?
a. Establish venous access.
b. Perform fundal massage.
c. Prepare the woman for surgical intervention.
d. Catheterize the bladder. - ANSWER ANS: B
The initial management of excessive postpartum bleeding is firm massage of the
uterine fundus. Although establishing venous access may be a necessary
intervention the initial intervention would be fundal massage. The woman may
need surgical intervention to treat her postpartum hemorrhage but the initial
nursing intervention would be to assess the uterus. After uterine massage the
nurse may want to catheterize the patient to eliminate any bladder distension that
may be preventing the uterus from contracting properly.
Which is the most likely cause of late postpartum hemorrhage (PPH)?
a. Subinvolution of the placental site
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders - ANSWER ANS: A
Late PPH may be the result of subinvolution of the uterus pelvic infection or
retained placental fragments. Late PPH is not typically a result of defective
vascularity of the decidua cervical lacerations or coagulation disorders.
What woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman being prepared for an emergency Caesarean birth for
fetal distress
b. A woman with severe pre-eclampsia on magnesium sulphate whose labour is
being induced
,c. A multiparous woman with an 8-hour labour
d. A primigravida in spontaneous labour with preterm twins - ANSWER ANS: B
Magnesium sulphate administration during labour poses a risk for PPH.
Magnesium acts as a smooth muscle relaxant thereby contributing to uterine
relaxation and atony. Although many causes and risk factors are associated with
PPH the primiparous woman being prepared for an emergency Caesarian birth the
multiparous woman with 8-hour labour and the primigravida in spontaneous
labour are not at risk for early PPH.
What is the initial priority nursing intervention when a nurse observes profuse
postpartum bleeding?
a. Call the woman's primary health care provider.
b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure (BP) and pulse for signs of hypovolemic shock. -
ANSWER ANS: C
The initial management of excessive postpartum bleeding is firm massage of the
uterine fundus. Although calling the health care provider administering an
oxytocic and assessing maternal BP are appropriate interventions the primary
intervention should be to assess the uterus. Uterine atony is the leading cause of
postpartum hemorrhage.
What is the most objective and least invasive assessment of adequate organ
perfusion and oxygenation when caring for a postpartum woman experiencing
hemorrhagic shock?
a. Absence of cyanosis in the buccal mucosa
b. Cool dry skin
c. Diminished restlessness
, d. Urinary output of at least 30 mL/hr - ANSWER ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in
which the perfusion of body organs may become severely compromised and
death may occur. The presence of adequate urinary output indicates adequate
tissue perfusion. The assessment of the buccal mucosa for cyanosis can be
subjective in nature. The presence of cool pale clammy skin would be an indicative
finding associated with hemorrhagic shock. Hemorrhagic shock is associated with
lethargy not restlessness.
Which is one of the first symptoms of puerperal infection to assess for in the
postpartum woman?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal bleeding with ambulation
d. Temperature of 38.6° C - ANSWER ANS: D
Postpartum or puerperal infection is any clinical infection of the genital canal that
occurs within 28 days after miscarriage induced abortion or childbirth. A
temperature greater than 38° C warrants further investigation for a puerperal
infection. Fatigue would be a late finding associated with infection. Pain with
voiding may indicate a urinary tract infection but it is not typically one of the
earlier symptoms of infection. Profuse lochia may be associated with endometritis
but it is not the first symptom associated with infection.
The perinatal nurse assisting with establishing lactation is aware that which action
can minimize acute mastitis?
a. Washing the nipples and breasts with mild soap and water once a day
b. Using proper breastfeeding techniques
c. Wearing a nipple shield for the first few days of breastfeeding
d. Wearing a supportive bra 24 hours a day - ANSWER ANS: B
ACTUAL FINAL EXAMS COMBINED WITH MULTIPLE
CHOICES QUESTIONS AND VERIFIED ANSWERS,
DISTINCTION GRADE BOOST
(RATIONALES PROVIDED)
We are a team of academic experts, email us at for all Nursing and Medical
academic services, revision exams, testbanks, flashcards, other course attendance you might need. This
is what we do full time. GUARANTEED HIGH GRADES!!
The perinatal nurse's assessment while caring for a woman in the immediate post
birth period reveals that the woman is experiencing profuse bleeding. What is the
most likely etiology for her bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration - ANSWER ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of
postpartum hemorrhage. Uterine inversion may lead to hemorrhage but it is not
the most likely source of this woman's bleeding. Furthermore if the woman were
experiencing a uterine inversion it would be evidenced by the presence of a large
red rounded mass protruding from the introitus. A vaginal hematoma may be
associated with hemorrhage. However the most likely clinical finding would be
pain not the presence of profuse bleeding. A vaginal laceration may cause
hemorrhage but it is more likely that profuse bleeding would result from uterine
atony. A vaginal laceration should be suspected if vaginal bleeding continues in
the presence of a firm contracted uterine fundus.
,Which is a primary nursing responsibility when caring for a woman experiencing
an obstetrical hemorrhage associated with uterine atony?
a. Establish venous access.
b. Perform fundal massage.
c. Prepare the woman for surgical intervention.
d. Catheterize the bladder. - ANSWER ANS: B
The initial management of excessive postpartum bleeding is firm massage of the
uterine fundus. Although establishing venous access may be a necessary
intervention the initial intervention would be fundal massage. The woman may
need surgical intervention to treat her postpartum hemorrhage but the initial
nursing intervention would be to assess the uterus. After uterine massage the
nurse may want to catheterize the patient to eliminate any bladder distension that
may be preventing the uterus from contracting properly.
Which is the most likely cause of late postpartum hemorrhage (PPH)?
a. Subinvolution of the placental site
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders - ANSWER ANS: A
Late PPH may be the result of subinvolution of the uterus pelvic infection or
retained placental fragments. Late PPH is not typically a result of defective
vascularity of the decidua cervical lacerations or coagulation disorders.
What woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman being prepared for an emergency Caesarean birth for
fetal distress
b. A woman with severe pre-eclampsia on magnesium sulphate whose labour is
being induced
,c. A multiparous woman with an 8-hour labour
d. A primigravida in spontaneous labour with preterm twins - ANSWER ANS: B
Magnesium sulphate administration during labour poses a risk for PPH.
Magnesium acts as a smooth muscle relaxant thereby contributing to uterine
relaxation and atony. Although many causes and risk factors are associated with
PPH the primiparous woman being prepared for an emergency Caesarian birth the
multiparous woman with 8-hour labour and the primigravida in spontaneous
labour are not at risk for early PPH.
What is the initial priority nursing intervention when a nurse observes profuse
postpartum bleeding?
a. Call the woman's primary health care provider.
b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure (BP) and pulse for signs of hypovolemic shock. -
ANSWER ANS: C
The initial management of excessive postpartum bleeding is firm massage of the
uterine fundus. Although calling the health care provider administering an
oxytocic and assessing maternal BP are appropriate interventions the primary
intervention should be to assess the uterus. Uterine atony is the leading cause of
postpartum hemorrhage.
What is the most objective and least invasive assessment of adequate organ
perfusion and oxygenation when caring for a postpartum woman experiencing
hemorrhagic shock?
a. Absence of cyanosis in the buccal mucosa
b. Cool dry skin
c. Diminished restlessness
, d. Urinary output of at least 30 mL/hr - ANSWER ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in
which the perfusion of body organs may become severely compromised and
death may occur. The presence of adequate urinary output indicates adequate
tissue perfusion. The assessment of the buccal mucosa for cyanosis can be
subjective in nature. The presence of cool pale clammy skin would be an indicative
finding associated with hemorrhagic shock. Hemorrhagic shock is associated with
lethargy not restlessness.
Which is one of the first symptoms of puerperal infection to assess for in the
postpartum woman?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal bleeding with ambulation
d. Temperature of 38.6° C - ANSWER ANS: D
Postpartum or puerperal infection is any clinical infection of the genital canal that
occurs within 28 days after miscarriage induced abortion or childbirth. A
temperature greater than 38° C warrants further investigation for a puerperal
infection. Fatigue would be a late finding associated with infection. Pain with
voiding may indicate a urinary tract infection but it is not typically one of the
earlier symptoms of infection. Profuse lochia may be associated with endometritis
but it is not the first symptom associated with infection.
The perinatal nurse assisting with establishing lactation is aware that which action
can minimize acute mastitis?
a. Washing the nipples and breasts with mild soap and water once a day
b. Using proper breastfeeding techniques
c. Wearing a nipple shield for the first few days of breastfeeding
d. Wearing a supportive bra 24 hours a day - ANSWER ANS: B
