, 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: Immediate Postpartum Hemorrhage
Question 1
A 32-year-old woman is 30 minutes postpartum after a vaginal delivery. The
nurse notes a boggy uterus and a quantified blood loss of 900 mL. Which
action should the nurse perform first?
A. Administer oxytocin as prescribed
B. Perform fundal massage
C. Insert a second large-bore IV
D. Notify the obstetric provider
Answer: B
Rationale:
A boggy uterus indicates uterine atony, the most common cause of immediate
postpartum hemorrhage. Fundal massage is the initial nursing intervention
to stimulate uterine contraction and reduce bleeding. Medications, IV access,
and provider notification follow if massage is ineffective.
Key words: uterine atony, boggy uterus, fundal massage, priority intervention
Question 2
Which finding most strongly supports the diagnosis of uterine atony rather
than genital tract trauma as the cause of postpartum hemorrhage?
A. Continued bleeding with a firm uterus
B. Hypotension and tachycardia
C. Large clots expelled after fundal massage
D. Persistent bleeding despite uterine firmness
Answer: C
Rationale:
Expulsion of large clots after fundal massage suggests uterine atony with
retained blood in a relaxed uterus. Trauma-related hemorrhage typically occurs
with a firm uterus and ongoing bleeding.
Key words: uterine atony, clots, fundal massage, differential diagnosis
,Question 3
A postpartum client continues to bleed heavily despite a firm uterus. What is
the most likely cause?
A. Uterine inversion
B. Retained placental fragments
C. Vaginal or cervical lacerations
D. Coagulation disorder
Answer: C
Rationale:
Bleeding with a firm, well-contracted uterus strongly suggests trauma to the
birth canal, such as cervical or vaginal lacerations, which require inspection
and repair rather than uterotonic therapy.
Key words: firm uterus, lacerations, trauma, postpartum hemorrhage
Question 4
Which assessment finding best indicates hypovolemic shock in a postpartum
patient with hemorrhage?
A. Warm, flushed skin
B. Bradycardia
C. Narrow pulse pressure
D. Decreased urine output
Answer: D
Rationale:
Decreased urine output reflects reduced renal perfusion and is a sensitive
indicator of hypovolemia. Early shock signs may be subtle in postpartum
patients due to physiologic compensation.
Key words: hypovolemia, shock, urine output, postpartum assessment
Question 5
,A nurse is quantifying blood loss after delivery. Which method provides the
most accurate measurement?
A. Visual estimation of blood on pads
B. Counting saturated perineal pads
C. Weighing blood-soaked materials
D. Assessing changes in vital signs
Answer: C
Rationale:
Weighing blood-soaked materials and subtracting dry weights is the most
accurate method for quantifying blood loss and is recommended over visual
estimation.
Key words: quantified blood loss, QBL, weighing pads, accuracy
Question 6
Which medication is the first-line uterotonic for managing postpartum
hemorrhage due to uterine atony?
A. Methylergonovine
B. Misoprostol
C. Oxytocin
D. Carboprost
Answer: C
Rationale:
Oxytocin is the first-line uterotonic agent used to promote uterine contraction
and prevent or treat postpartum hemorrhage caused by uterine atony.
Key words: oxytocin, uterotonic, first-line therapy, uterine contraction
Question 7
Which condition is a contraindication to methylergonovine administration?
A. Postpartum hemorrhage
B. Uterine atony
,C. Hypertension
D. Multiparity
Answer: C
Rationale:
Methylergonovine causes vasoconstriction and is contraindicated in patients
with hypertension due to the risk of stroke or severe hypertension.
Key words: methylergonovine, contraindication, hypertension, vasoconstriction
Question 8
A client continues to hemorrhage despite uterotonic therapy. Which nursing
action supports escalation of care?
A. Continue fundal massage every 30 minutes
B. Prepare for uterine tamponade or surgery
C. Encourage oral fluids
D. Remove the urinary catheter
Answer: B
Rationale:
Failure of medical management necessitates escalation to mechanical or
surgical interventions such as uterine balloon tamponade or hysterectomy.
Key words: escalation of care, uterine tamponade, refractory hemorrhage
Question 9
Which laboratory value is most critical to monitor in postpartum hemorrhage
related to coagulopathy?
A. Hemoglobin
B. Platelet count
C. White blood cell count
D. Serum glucose
Answer: B
,Rationale:
Platelet count helps assess clotting ability. Coagulopathies may contribute to
uncontrolled bleeding despite uterine firmness and require blood product
replacement.
Key words: coagulopathy, platelets, clotting, postpartum hemorrhage
Question 10
Which nursing intervention best prevents bladder distention–related uterine
atony?
A. Encourage early ambulation
B. Maintain strict intake and output
C. Insert or maintain a urinary catheter
D. Perform frequent fundal massage
Answer: C
Rationale:
A distended bladder displaces the uterus and interferes with contraction.
Catheterization promotes uterine tone and reduces bleeding risk.
Key words: bladder distention, uterine atony, catheterization
Question 11
A postpartum client has a history of von Willebrand disease. Which risk does
this history increase?
A. Uterine inversion
B. Retained placenta
C. Coagulopathy-related hemorrhage
D. Shoulder dystocia
Answer: C
Rationale:
Von Willebrand disease impairs clot formation, increasing the risk of
postpartum hemorrhage due to coagulopathy rather than uterine causes.
,Key words: bleeding disorder, von Willebrand disease, coagulopathy
Question 12
Which clinical finding suggests retained placental fragments as the cause of
hemorrhage?
A. Rapid onset hemorrhage immediately after delivery
B. Failure of the uterus to remain firm
C. Firm uterus with heavy bleeding
D. Elevated blood pressure
Answer: B
Rationale:
Retained placental fragments prevent sustained uterine contraction, leading to
recurrent uterine relaxation and hemorrhage.
Key words: retained placenta, uterine relaxation, postpartum bleeding
Question 13
Which intervention requires two large-bore IV lines during active postpartum
hemorrhage?
A. Oral uterotonic administration
B. Rapid fluid and blood replacement
C. Pain management
D. Antibiotic prophylaxis
Answer: B
Rationale:
Two large-bore IVs are essential to allow rapid infusion of crystalloids and
blood products during massive hemorrhage.
Key words: IV access, massive hemorrhage, fluid resuscitation
Question 14
, Which maternal factor increases the risk for uterine atony?
A. Prolonged labor
B. Primigravida status
C. Low birth weight infant
D. Short second stage of labor
Answer: A
Rationale:
Prolonged labor fatigues the uterine muscles, reducing their ability to contract
effectively after delivery.
Key words: risk factors, prolonged labor, uterine fatigue
Question 15
A nurse documents a uterus that is displaced to the right and above the
umbilicus. What is the priority nursing action?
A. Notify the provider immediately
B. Perform uterine massage
C. Assist the patient to void
D. Administer oxytocin
Answer: C
Rationale:
Uterine displacement suggests bladder distention. Emptying the bladder often
allows the uterus to contract and reposition normally.
Key words: uterine displacement, bladder distention, postpartum assessment
Question 16
Which assessment finding indicates effective management of postpartum
hemorrhage?
A. Decreased hematocrit
B. Firm midline uterus
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: Immediate Postpartum Hemorrhage
Question 1
A 32-year-old woman is 30 minutes postpartum after a vaginal delivery. The
nurse notes a boggy uterus and a quantified blood loss of 900 mL. Which
action should the nurse perform first?
A. Administer oxytocin as prescribed
B. Perform fundal massage
C. Insert a second large-bore IV
D. Notify the obstetric provider
Answer: B
Rationale:
A boggy uterus indicates uterine atony, the most common cause of immediate
postpartum hemorrhage. Fundal massage is the initial nursing intervention
to stimulate uterine contraction and reduce bleeding. Medications, IV access,
and provider notification follow if massage is ineffective.
Key words: uterine atony, boggy uterus, fundal massage, priority intervention
Question 2
Which finding most strongly supports the diagnosis of uterine atony rather
than genital tract trauma as the cause of postpartum hemorrhage?
A. Continued bleeding with a firm uterus
B. Hypotension and tachycardia
C. Large clots expelled after fundal massage
D. Persistent bleeding despite uterine firmness
Answer: C
Rationale:
Expulsion of large clots after fundal massage suggests uterine atony with
retained blood in a relaxed uterus. Trauma-related hemorrhage typically occurs
with a firm uterus and ongoing bleeding.
Key words: uterine atony, clots, fundal massage, differential diagnosis
,Question 3
A postpartum client continues to bleed heavily despite a firm uterus. What is
the most likely cause?
A. Uterine inversion
B. Retained placental fragments
C. Vaginal or cervical lacerations
D. Coagulation disorder
Answer: C
Rationale:
Bleeding with a firm, well-contracted uterus strongly suggests trauma to the
birth canal, such as cervical or vaginal lacerations, which require inspection
and repair rather than uterotonic therapy.
Key words: firm uterus, lacerations, trauma, postpartum hemorrhage
Question 4
Which assessment finding best indicates hypovolemic shock in a postpartum
patient with hemorrhage?
A. Warm, flushed skin
B. Bradycardia
C. Narrow pulse pressure
D. Decreased urine output
Answer: D
Rationale:
Decreased urine output reflects reduced renal perfusion and is a sensitive
indicator of hypovolemia. Early shock signs may be subtle in postpartum
patients due to physiologic compensation.
Key words: hypovolemia, shock, urine output, postpartum assessment
Question 5
,A nurse is quantifying blood loss after delivery. Which method provides the
most accurate measurement?
A. Visual estimation of blood on pads
B. Counting saturated perineal pads
C. Weighing blood-soaked materials
D. Assessing changes in vital signs
Answer: C
Rationale:
Weighing blood-soaked materials and subtracting dry weights is the most
accurate method for quantifying blood loss and is recommended over visual
estimation.
Key words: quantified blood loss, QBL, weighing pads, accuracy
Question 6
Which medication is the first-line uterotonic for managing postpartum
hemorrhage due to uterine atony?
A. Methylergonovine
B. Misoprostol
C. Oxytocin
D. Carboprost
Answer: C
Rationale:
Oxytocin is the first-line uterotonic agent used to promote uterine contraction
and prevent or treat postpartum hemorrhage caused by uterine atony.
Key words: oxytocin, uterotonic, first-line therapy, uterine contraction
Question 7
Which condition is a contraindication to methylergonovine administration?
A. Postpartum hemorrhage
B. Uterine atony
,C. Hypertension
D. Multiparity
Answer: C
Rationale:
Methylergonovine causes vasoconstriction and is contraindicated in patients
with hypertension due to the risk of stroke or severe hypertension.
Key words: methylergonovine, contraindication, hypertension, vasoconstriction
Question 8
A client continues to hemorrhage despite uterotonic therapy. Which nursing
action supports escalation of care?
A. Continue fundal massage every 30 minutes
B. Prepare for uterine tamponade or surgery
C. Encourage oral fluids
D. Remove the urinary catheter
Answer: B
Rationale:
Failure of medical management necessitates escalation to mechanical or
surgical interventions such as uterine balloon tamponade or hysterectomy.
Key words: escalation of care, uterine tamponade, refractory hemorrhage
Question 9
Which laboratory value is most critical to monitor in postpartum hemorrhage
related to coagulopathy?
A. Hemoglobin
B. Platelet count
C. White blood cell count
D. Serum glucose
Answer: B
,Rationale:
Platelet count helps assess clotting ability. Coagulopathies may contribute to
uncontrolled bleeding despite uterine firmness and require blood product
replacement.
Key words: coagulopathy, platelets, clotting, postpartum hemorrhage
Question 10
Which nursing intervention best prevents bladder distention–related uterine
atony?
A. Encourage early ambulation
B. Maintain strict intake and output
C. Insert or maintain a urinary catheter
D. Perform frequent fundal massage
Answer: C
Rationale:
A distended bladder displaces the uterus and interferes with contraction.
Catheterization promotes uterine tone and reduces bleeding risk.
Key words: bladder distention, uterine atony, catheterization
Question 11
A postpartum client has a history of von Willebrand disease. Which risk does
this history increase?
A. Uterine inversion
B. Retained placenta
C. Coagulopathy-related hemorrhage
D. Shoulder dystocia
Answer: C
Rationale:
Von Willebrand disease impairs clot formation, increasing the risk of
postpartum hemorrhage due to coagulopathy rather than uterine causes.
,Key words: bleeding disorder, von Willebrand disease, coagulopathy
Question 12
Which clinical finding suggests retained placental fragments as the cause of
hemorrhage?
A. Rapid onset hemorrhage immediately after delivery
B. Failure of the uterus to remain firm
C. Firm uterus with heavy bleeding
D. Elevated blood pressure
Answer: B
Rationale:
Retained placental fragments prevent sustained uterine contraction, leading to
recurrent uterine relaxation and hemorrhage.
Key words: retained placenta, uterine relaxation, postpartum bleeding
Question 13
Which intervention requires two large-bore IV lines during active postpartum
hemorrhage?
A. Oral uterotonic administration
B. Rapid fluid and blood replacement
C. Pain management
D. Antibiotic prophylaxis
Answer: B
Rationale:
Two large-bore IVs are essential to allow rapid infusion of crystalloids and
blood products during massive hemorrhage.
Key words: IV access, massive hemorrhage, fluid resuscitation
Question 14
, Which maternal factor increases the risk for uterine atony?
A. Prolonged labor
B. Primigravida status
C. Low birth weight infant
D. Short second stage of labor
Answer: A
Rationale:
Prolonged labor fatigues the uterine muscles, reducing their ability to contract
effectively after delivery.
Key words: risk factors, prolonged labor, uterine fatigue
Question 15
A nurse documents a uterus that is displaced to the right and above the
umbilicus. What is the priority nursing action?
A. Notify the provider immediately
B. Perform uterine massage
C. Assist the patient to void
D. Administer oxytocin
Answer: C
Rationale:
Uterine displacement suggests bladder distention. Emptying the bladder often
allows the uterus to contract and reposition normally.
Key words: uterine displacement, bladder distention, postpartum assessment
Question 16
Which assessment finding indicates effective management of postpartum
hemorrhage?
A. Decreased hematocrit
B. Firm midline uterus
