HESI
Obstetrics/Maternity
Case Study
(NGN-Style & Case Scenario)
Below is a :
set of structured questions aligned
with the NCLEX Next-Generation (NGN)
style, complete with scenarios, vital
signs,questions, answer choices,
correct answers, and expert
rationales
,Scenario 1
Scenario: Fifteen minutes after the initial assessment, the nurse
finds the client disoriented and lying on her back in a pool of
vaginal blood, with the sheets beneath her saturated with blood.
Vital Signs:
- Blood Pressure: 90/50 mmHg
- Heart Rate: 120 bpm
Question: Which action is most important for the nurse to
implement immediately?
Answer Choices:
a. Take vital signs.
b. Massage the fundus.
c. Check the bladder.
d. Increase the IV rate.
ANSWER:b. Massage the fundus.
Expert Rationale:
A boggy fundus is a common cause of postpartum hemorrhage.
Immediate fundal massage is crucial to stimulate uterine
contraction and mitigate the risk of significant blood loss. The
nurse should also call for assistance given the severity of the
situation.
,### Scenario 2
Scenario: A nurse performs the first assessment upon the
client's arrival to the postpartum unit.
Question: Where would the nurse expect to palpate the fundus?
Answer Choices:
a. 3 cm above the umbilicus.
b. 1 cm above the umbilicus.
c. To the right of the umbilicus.
d. Midway between the umbilicus and the pubic bone.
b. ANSWER:1 cm above the umbilicus.
Expert Rationale:
Within the first 12 hours postpartum, the fundus should be in
the range of 1- 2 cm above the umbilicus. This indicates that the
uterus is contracting properly and is returning to its normal size.
### Scenario 3
Scenario: A postpartum client is hemorrhaging and the nurse
suspects a common cause.
Question: What is the most likely reason a postpartum patient
would be hemorrhaging?
, ANSWER:Uterine atony (a "boggy" fundus).
Expert Rationale:
Uterine atony is the inability of the uterus to contract effectively,
which is a leading cause of postpartum hemorrhage. This
condition causes the blood vessels at the placental site to remain
open, leading to significant blood loss.
---
### Scenario 4
Scenario: After massaging the fundus, the nurse calls for help.
Question: What should be assessed immediately after fundus
is massaged?
ANSWER:Assess for bladder distention.
Expert Rationale:
A full bladder can impede uterine contraction, which may
exacerbate bleeding. It is essential to assess for bladder
distention to ensure optimal uterine function and reduce the risk
of hemorrhage.
### Scenario 5
Scenario: The nurse conducts a gestational age assessment of a
newborn.
Obstetrics/Maternity
Case Study
(NGN-Style & Case Scenario)
Below is a :
set of structured questions aligned
with the NCLEX Next-Generation (NGN)
style, complete with scenarios, vital
signs,questions, answer choices,
correct answers, and expert
rationales
,Scenario 1
Scenario: Fifteen minutes after the initial assessment, the nurse
finds the client disoriented and lying on her back in a pool of
vaginal blood, with the sheets beneath her saturated with blood.
Vital Signs:
- Blood Pressure: 90/50 mmHg
- Heart Rate: 120 bpm
Question: Which action is most important for the nurse to
implement immediately?
Answer Choices:
a. Take vital signs.
b. Massage the fundus.
c. Check the bladder.
d. Increase the IV rate.
ANSWER:b. Massage the fundus.
Expert Rationale:
A boggy fundus is a common cause of postpartum hemorrhage.
Immediate fundal massage is crucial to stimulate uterine
contraction and mitigate the risk of significant blood loss. The
nurse should also call for assistance given the severity of the
situation.
,### Scenario 2
Scenario: A nurse performs the first assessment upon the
client's arrival to the postpartum unit.
Question: Where would the nurse expect to palpate the fundus?
Answer Choices:
a. 3 cm above the umbilicus.
b. 1 cm above the umbilicus.
c. To the right of the umbilicus.
d. Midway between the umbilicus and the pubic bone.
b. ANSWER:1 cm above the umbilicus.
Expert Rationale:
Within the first 12 hours postpartum, the fundus should be in
the range of 1- 2 cm above the umbilicus. This indicates that the
uterus is contracting properly and is returning to its normal size.
### Scenario 3
Scenario: A postpartum client is hemorrhaging and the nurse
suspects a common cause.
Question: What is the most likely reason a postpartum patient
would be hemorrhaging?
, ANSWER:Uterine atony (a "boggy" fundus).
Expert Rationale:
Uterine atony is the inability of the uterus to contract effectively,
which is a leading cause of postpartum hemorrhage. This
condition causes the blood vessels at the placental site to remain
open, leading to significant blood loss.
---
### Scenario 4
Scenario: After massaging the fundus, the nurse calls for help.
Question: What should be assessed immediately after fundus
is massaged?
ANSWER:Assess for bladder distention.
Expert Rationale:
A full bladder can impede uterine contraction, which may
exacerbate bleeding. It is essential to assess for bladder
distention to ensure optimal uterine function and reduce the risk
of hemorrhage.
### Scenario 5
Scenario: The nurse conducts a gestational age assessment of a
newborn.
