Postpartum Hemorrhage (PPH) Interventions
Practice Exam (2026 Edition) | Advanced
NCLEX-RN Maternal Emergency Nursing &
Obstetric Care Review
Question 1
A nurse is caring for a client who develops heavy vaginal
bleeding immediately after delivery. The uterus is boggy and
displaced to the right. Which intervention should the nurse
perform first?
A. Administer oxytocin infusion
B. Prepare for blood transfusion
C. Assist the client to empty her bladder and perform fundal
massage
D. Obtain coagulation studies
Answer: C. Assist the client to empty her bladder and
perform fundal massage
The most common cause of early postpartum hemorrhage is
uterine atony. A boggy uterus displaced to the right often
indicates bladder distention, preventing effective uterine
contraction. Emptying the bladder and massaging the fundus
directly address the likely cause. Although oxytocin may be
,required, correcting bladder distention and stimulating
uterine contraction are priority interventions.
Question 2
A client continues to hemorrhage despite oxytocin therapy.
Which medication is commonly administered next to increase
uterine tone?
A. Terbutaline
B. Magnesium sulfate
C. Methylergonovine
D. Nifedipine
Answer: C. Methylergonovine
Methylergonovine causes sustained uterine contractions and
is frequently used when oxytocin alone is ineffective.
Terbutaline, magnesium sulfate, and nifedipine relax uterine
muscle and would worsen uterine atony-related bleeding.
Question 3
Which assessment finding would contraindicate
administration of methylergonovine?
A. Temperature of 38°C (100.4°F)
B. Heart rate of 110 beats/min
C. Respiratory rate of 24 breaths/min
D. Blood pressure of 168/102 mm Hg
,Answer: D. Blood pressure of 168/102 mm Hg
Methylergonovine causes vasoconstriction and may
precipitate severe hypertension, stroke, or myocardial
ischemia. It is contraindicated in clients with hypertension or
preeclampsia.
Question 4
A nurse administers carboprost tromethamine for persistent
postpartum hemorrhage. Which condition in the client's
history requires immediate notification of the provider?
A. Iron-deficiency anemia
B. Previous cesarean birth
C. Asthma
D. Gestational diabetes
Answer: C. Asthma
Carboprost can cause significant bronchoconstriction and
may trigger life-threatening asthma exacerbations. Asthma is
a major contraindication for its use.
Question 5
A patient loses approximately 1,500 mL of blood following
delivery. Which clinical finding would the nurse expect first?
A. Severe hypotension
B. Anuria
, C. Tachycardia
D. Bradycardia
Answer: C. Tachycardia
Tachycardia is often the earliest compensatory response to
acute blood loss. Significant hypotension may not occur until
a substantial volume of blood has been lost due to
compensatory vasoconstriction.
Question 6
Which intervention is most appropriate when uterine atony is
identified as the source of hemorrhage?
A. Trendelenburg positioning
B. Restricting oral fluids
C. Fundal massage
D. Delaying uterotonic medications
Answer: C. Fundal massage
Fundal massage stimulates uterine muscle contraction,
compresses blood vessels, and reduces bleeding. It is a
primary nursing intervention for uterine atony.
Question 7
A nurse notes continuous bright-red bleeding despite a firm
uterus. Which cause should be suspected?
A. Uterine atony
Practice Exam (2026 Edition) | Advanced
NCLEX-RN Maternal Emergency Nursing &
Obstetric Care Review
Question 1
A nurse is caring for a client who develops heavy vaginal
bleeding immediately after delivery. The uterus is boggy and
displaced to the right. Which intervention should the nurse
perform first?
A. Administer oxytocin infusion
B. Prepare for blood transfusion
C. Assist the client to empty her bladder and perform fundal
massage
D. Obtain coagulation studies
Answer: C. Assist the client to empty her bladder and
perform fundal massage
The most common cause of early postpartum hemorrhage is
uterine atony. A boggy uterus displaced to the right often
indicates bladder distention, preventing effective uterine
contraction. Emptying the bladder and massaging the fundus
directly address the likely cause. Although oxytocin may be
,required, correcting bladder distention and stimulating
uterine contraction are priority interventions.
Question 2
A client continues to hemorrhage despite oxytocin therapy.
Which medication is commonly administered next to increase
uterine tone?
A. Terbutaline
B. Magnesium sulfate
C. Methylergonovine
D. Nifedipine
Answer: C. Methylergonovine
Methylergonovine causes sustained uterine contractions and
is frequently used when oxytocin alone is ineffective.
Terbutaline, magnesium sulfate, and nifedipine relax uterine
muscle and would worsen uterine atony-related bleeding.
Question 3
Which assessment finding would contraindicate
administration of methylergonovine?
A. Temperature of 38°C (100.4°F)
B. Heart rate of 110 beats/min
C. Respiratory rate of 24 breaths/min
D. Blood pressure of 168/102 mm Hg
,Answer: D. Blood pressure of 168/102 mm Hg
Methylergonovine causes vasoconstriction and may
precipitate severe hypertension, stroke, or myocardial
ischemia. It is contraindicated in clients with hypertension or
preeclampsia.
Question 4
A nurse administers carboprost tromethamine for persistent
postpartum hemorrhage. Which condition in the client's
history requires immediate notification of the provider?
A. Iron-deficiency anemia
B. Previous cesarean birth
C. Asthma
D. Gestational diabetes
Answer: C. Asthma
Carboprost can cause significant bronchoconstriction and
may trigger life-threatening asthma exacerbations. Asthma is
a major contraindication for its use.
Question 5
A patient loses approximately 1,500 mL of blood following
delivery. Which clinical finding would the nurse expect first?
A. Severe hypotension
B. Anuria
, C. Tachycardia
D. Bradycardia
Answer: C. Tachycardia
Tachycardia is often the earliest compensatory response to
acute blood loss. Significant hypotension may not occur until
a substantial volume of blood has been lost due to
compensatory vasoconstriction.
Question 6
Which intervention is most appropriate when uterine atony is
identified as the source of hemorrhage?
A. Trendelenburg positioning
B. Restricting oral fluids
C. Fundal massage
D. Delaying uterotonic medications
Answer: C. Fundal massage
Fundal massage stimulates uterine muscle contraction,
compresses blood vessels, and reduces bleeding. It is a
primary nursing intervention for uterine atony.
Question 7
A nurse notes continuous bright-red bleeding despite a firm
uterus. Which cause should be suspected?
A. Uterine atony
