, CHAPTER LIST
Chapter 1: Bess Gaskell: Immediate Postpartum Hemorrhage
Chapter 2: Tatiana Bennett: Later Postpartum Hemorrhage
Chapter 3: Susan Rockwell: Gestational Diabetes, Deep Vein Thrombosis, and Postpartum
Pulmonary Embolism
Chapter 4: Sophie Bloom: Preeclampsia
Chapter 5: Letitia Richford: Cord Prolapse and Nonreassuring Fetal Status
Chapter 6: Rebecca Sweet: Placental Abruption and Fetal Loss
Chapter 7: Hannah Wilder: Chorioamnionitis and Neonatal Sepsis
Chapter 8: Graciella Muñez: Preterm Premature Rupture of Membranes and Neonatal
Respiratory Distress Syndrome
Chapter 9: Nancy Ng: Gestational Diabetes, Macrosomia, and Neonatal Cephalhematoma
Chapter 10: Lexi Cowslip: Advanced Maternal Age, HELLP Syndrome, and Neonatal
Necrotizing Enterocolitis
Chapter 11: Edie Wilson: Migraine with Aura, Shoulder Dystocia, and Brachial Plexus
Palsy
Chapter 12: Loretta Hale: Intimate Partner Violence, Formula Feeding, and Postpartum
Depression
Chapter 13: Tanya Green: Gestational Trophoblastic Disease (Molar Pregnancy) and
Advanced Maternal Age
Unit 2: Maternity and Newborn Nursing for Uncomplicated Pregnancies
Chapter 14: Before Conception
Chapter 15: Pregnancy
Chapter 16: Labor and Delivery
Chapter 17: After Delivery
Chapter 18: The Newborn
Unit 3: High-Risk Conditions and Complications
Chapter 19: Conditions Existing Before Conception
Chapter 20: Conditions Occurring During Pregnancy
Chapter 21: Complications Occurring Before Labor and Delivery
Chapter 22: Complications Occurring During Labor and Delivery
Chapter 23: Conditions Occurring After Delivery
Chapter 24: Conditions in the Newborn Related to Gestational Age, Size, Injury, and Pain
Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn
Unit 4: Women’s and Gendered Health
Chapter 26: Wellness and Health Promotion
Chapter 27: Common Gynecologic Conditions
Chapter 28: Infections
Chapter 29: Family Planning
Chapter 30: Vulnerable Populations
,Chapter 1: Bess Gaskell — Immediate
Postpartum Hemorrhage
Maternity, Newborn, and Women’s Health Nursing (2nd ed.): A Case Study–
Based Approach
All questions are case-based, application-focused, and aligned with Next-
Generation NCLEX® clinical judgment principles (recognition → analysis →
action → evaluation).
Question 1
A nurse assesses a woman 30 minutes after a vaginal birth and notes a boggy
uterus displaced to the right and heavy lochia rubra. What is the nurse’s
priority intervention?
A. Administer oxytocin IV
B. Assist the patient to void
C. Perform uterine massage
D. Quantify blood loss using calibrated drapes
Answer: B
Rationale:
A uterus displaced laterally—most commonly to the right—indicates bladder
distention, which prevents effective uterine contraction and contributes to
uterine atony. Emptying the bladder often allows the uterus to contract
,effectively and reduces bleeding. While uterine massage and uterotonics are
important, correcting the underlying cause of displacement is the priority.
Key words: uterine displacement, bladder distention, uterine atony, postpartum
hemorrhage
Question 2
Which finding most strongly indicates uterine atony as the cause of postpartum
hemorrhage?
A. Firm uterus with continued bright red bleeding
B. Boggy uterus with large clots
C. Slow trickle of blood with a firm fundus
D. Severe perineal pain with minimal bleeding
Answer: B
Rationale:
Uterine atony presents with a boggy, enlarged uterus and heavy bleeding, often
with clots. A firm uterus with bleeding suggests trauma, while minimal bleeding
with pain suggests hematoma formation.
Key words: uterine atony, boggy fundus, postpartum bleeding
Question 3
The nurse is quantifying blood loss after delivery. Which method provides the
most accurate measurement?
,A. Visual estimation by experienced staff
B. Counting saturated pads
C. Weighing blood-soaked materials
D. Monitoring hematocrit levels
Answer: C
Rationale:
Weighing blood-soaked materials (1 g ≈ 1 mL blood) provides objective and
accurate quantification of blood loss (QBL). Visual estimation consistently
underestimates blood loss and delays recognition of hemorrhage.
Key words: quantification of blood loss, QBL, postpartum hemorrhage
assessment
Question 4
A patient continues to bleed heavily despite a firm fundus. Which etiology
should the nurse suspect first?
A. Uterine atony
B. Retained placental fragments
C. Genital tract trauma
D. Coagulopathy
Answer: C
Rationale:
Persistent bleeding with a firm uterus strongly suggests lacerations or trauma
to the cervix, vagina, or perineum. Uterine atony is ruled out when the fundus is
firm.
,Key words: firm uterus, lacerations, postpartum trauma
Question 5
Which medication should the nurse anticipate administering first-line for uterine
atony?
A. Methylergonovine
B. Carboprost tromethamine
C. Oxytocin
D. Tranexamic acid
Answer: C
Rationale:
Oxytocin is the first-line uterotonic for prevention and treatment of uterine
atony. Other agents are second-line or adjuncts and may have contraindications.
Key words: oxytocin, uterotonic therapy, uterine atony management
Question 6
Which condition is a contraindication to methylergonovine administration?
A. Gestational diabetes
B. Asthma
C. Hypertension
D. Anemia
Answer: C
,Rationale:
Methylergonovine causes vasoconstriction and can precipitate severe
hypertension or stroke. It is contraindicated in patients with hypertensive
disorders.
Key words: methylergonovine, hypertension, uterotonic contraindications
Question 7
A patient with PPH has lost approximately 1200 mL of blood. Which IV access is
most appropriate?
A. One 22-gauge peripheral IV
B. One 20-gauge IV
C. Two large-bore (16–18 gauge) IVs
D. Central venous catheter only
Answer: C
Rationale:
Severe hemorrhage requires rapid fluid and blood product administration,
which is best achieved with two large-bore IV lines. Smaller gauges are
insufficient for volume resuscitation.
Key words: IV access, postpartum hemorrhage, volume resuscitation
Question 8
Which assessment finding indicates hypovolemic shock in postpartum
hemorrhage?
,A. Bradycardia and hypertension
B. Warm, flushed skin
C. Tachycardia and narrowed pulse pressure
D. Increased urine output
Answer: C
Rationale:
Early hypovolemic shock presents with tachycardia, decreased preload, and
narrowed pulse pressure. Urine output decreases as perfusion declines.
Key words: hypovolemic shock, postpartum hemorrhage, vital signs
Question 9
Which action reflects appropriate escalation of care during uncontrolled
postpartum hemorrhage?
A. Continue uterine massage and reassess in 30 minutes
B. Notify the provider after completing documentation
C. Activate the obstetric hemorrhage protocol
D. Transfer the patient to the postpartum unit
Answer: C
Rationale:
Early activation of an obstetric hemorrhage protocol mobilizes interprofessional
resources, blood products, and surgical readiness, reducing morbidity and
mortality.
Key words: escalation of care, hemorrhage protocol, interprofessional
communication
, Question 10
Which lab value is most critical to monitor when coagulopathy is suspected?
A. Serum sodium
B. Platelet count
C. Blood glucose
D. White blood cell count
Answer: B
Rationale:
Low platelets impair clot formation and worsen bleeding. Monitoring coagulation
parameters is essential when hemorrhage is unresponsive to uterotonics.
Key words: coagulopathy, platelet count, postpartum hemorrhage labs
Question 11
A nurse notes persistent oozing from IV sites and the perineum after delivery.
Which cause of hemorrhage is most likely?
A. Uterine atony
B. Retained placenta
C. Genital tract trauma
D. Disseminated intravascular coagulation (DIC)
Answer: D
Chapter 1: Bess Gaskell: Immediate Postpartum Hemorrhage
Chapter 2: Tatiana Bennett: Later Postpartum Hemorrhage
Chapter 3: Susan Rockwell: Gestational Diabetes, Deep Vein Thrombosis, and Postpartum
Pulmonary Embolism
Chapter 4: Sophie Bloom: Preeclampsia
Chapter 5: Letitia Richford: Cord Prolapse and Nonreassuring Fetal Status
Chapter 6: Rebecca Sweet: Placental Abruption and Fetal Loss
Chapter 7: Hannah Wilder: Chorioamnionitis and Neonatal Sepsis
Chapter 8: Graciella Muñez: Preterm Premature Rupture of Membranes and Neonatal
Respiratory Distress Syndrome
Chapter 9: Nancy Ng: Gestational Diabetes, Macrosomia, and Neonatal Cephalhematoma
Chapter 10: Lexi Cowslip: Advanced Maternal Age, HELLP Syndrome, and Neonatal
Necrotizing Enterocolitis
Chapter 11: Edie Wilson: Migraine with Aura, Shoulder Dystocia, and Brachial Plexus
Palsy
Chapter 12: Loretta Hale: Intimate Partner Violence, Formula Feeding, and Postpartum
Depression
Chapter 13: Tanya Green: Gestational Trophoblastic Disease (Molar Pregnancy) and
Advanced Maternal Age
Unit 2: Maternity and Newborn Nursing for Uncomplicated Pregnancies
Chapter 14: Before Conception
Chapter 15: Pregnancy
Chapter 16: Labor and Delivery
Chapter 17: After Delivery
Chapter 18: The Newborn
Unit 3: High-Risk Conditions and Complications
Chapter 19: Conditions Existing Before Conception
Chapter 20: Conditions Occurring During Pregnancy
Chapter 21: Complications Occurring Before Labor and Delivery
Chapter 22: Complications Occurring During Labor and Delivery
Chapter 23: Conditions Occurring After Delivery
Chapter 24: Conditions in the Newborn Related to Gestational Age, Size, Injury, and Pain
Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn
Unit 4: Women’s and Gendered Health
Chapter 26: Wellness and Health Promotion
Chapter 27: Common Gynecologic Conditions
Chapter 28: Infections
Chapter 29: Family Planning
Chapter 30: Vulnerable Populations
,Chapter 1: Bess Gaskell — Immediate
Postpartum Hemorrhage
Maternity, Newborn, and Women’s Health Nursing (2nd ed.): A Case Study–
Based Approach
All questions are case-based, application-focused, and aligned with Next-
Generation NCLEX® clinical judgment principles (recognition → analysis →
action → evaluation).
Question 1
A nurse assesses a woman 30 minutes after a vaginal birth and notes a boggy
uterus displaced to the right and heavy lochia rubra. What is the nurse’s
priority intervention?
A. Administer oxytocin IV
B. Assist the patient to void
C. Perform uterine massage
D. Quantify blood loss using calibrated drapes
Answer: B
Rationale:
A uterus displaced laterally—most commonly to the right—indicates bladder
distention, which prevents effective uterine contraction and contributes to
uterine atony. Emptying the bladder often allows the uterus to contract
,effectively and reduces bleeding. While uterine massage and uterotonics are
important, correcting the underlying cause of displacement is the priority.
Key words: uterine displacement, bladder distention, uterine atony, postpartum
hemorrhage
Question 2
Which finding most strongly indicates uterine atony as the cause of postpartum
hemorrhage?
A. Firm uterus with continued bright red bleeding
B. Boggy uterus with large clots
C. Slow trickle of blood with a firm fundus
D. Severe perineal pain with minimal bleeding
Answer: B
Rationale:
Uterine atony presents with a boggy, enlarged uterus and heavy bleeding, often
with clots. A firm uterus with bleeding suggests trauma, while minimal bleeding
with pain suggests hematoma formation.
Key words: uterine atony, boggy fundus, postpartum bleeding
Question 3
The nurse is quantifying blood loss after delivery. Which method provides the
most accurate measurement?
,A. Visual estimation by experienced staff
B. Counting saturated pads
C. Weighing blood-soaked materials
D. Monitoring hematocrit levels
Answer: C
Rationale:
Weighing blood-soaked materials (1 g ≈ 1 mL blood) provides objective and
accurate quantification of blood loss (QBL). Visual estimation consistently
underestimates blood loss and delays recognition of hemorrhage.
Key words: quantification of blood loss, QBL, postpartum hemorrhage
assessment
Question 4
A patient continues to bleed heavily despite a firm fundus. Which etiology
should the nurse suspect first?
A. Uterine atony
B. Retained placental fragments
C. Genital tract trauma
D. Coagulopathy
Answer: C
Rationale:
Persistent bleeding with a firm uterus strongly suggests lacerations or trauma
to the cervix, vagina, or perineum. Uterine atony is ruled out when the fundus is
firm.
,Key words: firm uterus, lacerations, postpartum trauma
Question 5
Which medication should the nurse anticipate administering first-line for uterine
atony?
A. Methylergonovine
B. Carboprost tromethamine
C. Oxytocin
D. Tranexamic acid
Answer: C
Rationale:
Oxytocin is the first-line uterotonic for prevention and treatment of uterine
atony. Other agents are second-line or adjuncts and may have contraindications.
Key words: oxytocin, uterotonic therapy, uterine atony management
Question 6
Which condition is a contraindication to methylergonovine administration?
A. Gestational diabetes
B. Asthma
C. Hypertension
D. Anemia
Answer: C
,Rationale:
Methylergonovine causes vasoconstriction and can precipitate severe
hypertension or stroke. It is contraindicated in patients with hypertensive
disorders.
Key words: methylergonovine, hypertension, uterotonic contraindications
Question 7
A patient with PPH has lost approximately 1200 mL of blood. Which IV access is
most appropriate?
A. One 22-gauge peripheral IV
B. One 20-gauge IV
C. Two large-bore (16–18 gauge) IVs
D. Central venous catheter only
Answer: C
Rationale:
Severe hemorrhage requires rapid fluid and blood product administration,
which is best achieved with two large-bore IV lines. Smaller gauges are
insufficient for volume resuscitation.
Key words: IV access, postpartum hemorrhage, volume resuscitation
Question 8
Which assessment finding indicates hypovolemic shock in postpartum
hemorrhage?
,A. Bradycardia and hypertension
B. Warm, flushed skin
C. Tachycardia and narrowed pulse pressure
D. Increased urine output
Answer: C
Rationale:
Early hypovolemic shock presents with tachycardia, decreased preload, and
narrowed pulse pressure. Urine output decreases as perfusion declines.
Key words: hypovolemic shock, postpartum hemorrhage, vital signs
Question 9
Which action reflects appropriate escalation of care during uncontrolled
postpartum hemorrhage?
A. Continue uterine massage and reassess in 30 minutes
B. Notify the provider after completing documentation
C. Activate the obstetric hemorrhage protocol
D. Transfer the patient to the postpartum unit
Answer: C
Rationale:
Early activation of an obstetric hemorrhage protocol mobilizes interprofessional
resources, blood products, and surgical readiness, reducing morbidity and
mortality.
Key words: escalation of care, hemorrhage protocol, interprofessional
communication
, Question 10
Which lab value is most critical to monitor when coagulopathy is suspected?
A. Serum sodium
B. Platelet count
C. Blood glucose
D. White blood cell count
Answer: B
Rationale:
Low platelets impair clot formation and worsen bleeding. Monitoring coagulation
parameters is essential when hemorrhage is unresponsive to uterotonics.
Key words: coagulopathy, platelet count, postpartum hemorrhage labs
Question 11
A nurse notes persistent oozing from IV sites and the perineum after delivery.
Which cause of hemorrhage is most likely?
A. Uterine atony
B. Retained placenta
C. Genital tract trauma
D. Disseminated intravascular coagulation (DIC)
Answer: D
