NUR 335 EXAM 3 QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS 100% CORRECT LATEST
UPDATED 2026/2027
Question 1
What is the standard clinical acronym utilized by nurses to guide a comprehensive
physical and psychosocial assessment during the postpartum period, and what
does each letter represent?
✔✔ The standard acronym is BUBBLE-LE (or BUBBLEE). It stands for:
B – Breasts (tissue condition, breastfeeding comfort, lactation progress)
U – Uterus (fundal height, position, firmness/involution)
B – Bladder (voiding patterns, distension, urinary output)
B – Bowel (motility, constipation, passing gas)
L – Lochia (color, volume, odor of vaginal discharge)
E – Episiotomy / Lacerations / Hemorrhoids (perineal healing and tissue
integrity)
L – Lower extremities (edema, deep tendon reflexes, signs of deep vein
thrombosis)
E – Emotions / Bonding / Psychosocial (maternal mood, coping, infant
attachment)
Question 2
When performing a BUBBLE-LE assessment, what are the key abnormal or
alarming findings within each category that a nurse must immediately document
and report?
✔✔ Abnormal and clinically significant findings include:
, Breasts: Signs of mastitis (erythema, localized heat), severe or persistent
pain during nursing, visibly cracked, blistering, or bleeding nipples, and
tissue engorgement that lasts beyond 2 days.
Uterus: A fundus that is boggy (soft), difficult to isolate or palpate,
abnormally tender upon light pressure, displaced laterally away from the
midline, located at or above the umbilicus, or severe afterpains lasting
longer than 3 days in a primipara (first-time mother).
Bladder: A visibly or tangibly distended/palpable bladder, clinical signs of
cystitis (dysuria, burning, urgency), or continued urinary incontinence or
inability to void more than 6 hours postpartum.
Bowel: Lack of a bowel movement or severe constipation lasting more than
3 days postpartum, painful or thrombosed hemorrhoids, and persistent
nausea or vomiting.
Lochia: Hyper-hemorrhagic flow (saturating a perineal pad within 1 hour
or less), a foul or putrid odor (suggesting infection), or the presence of
visible placental fragments or excessively large clots.
Episiotomy / Perineum: Severe localized bruising (ecchymosis), profound
edema, purulent or abnormal drainage, severe unmanaged pain, or
spreading redness (erythema).
Lower Extremities: Localized calf tenderness, warmth, swelling, or a
positive Homans' sign (suggesting a DVT); weak or asymmetric peripheral
pulses; or hyperreflexia ($2\text{+}$ or greater Deep Tendon Reflexes),
which can indicate worsening gestational hypertension or preeclampsia.
Emotions: Poor maternal-infant bonding or detachment,
extreme/debilitating fatigue, signs of Postpartum Depression (PPD), severe
anxiety, or any voiced thoughts of self-harm or harming the infant.
What are some cardiovascular changes in the PP period? assessment?
- QBL: Vaginal delivery < 500 mL; C-section <1000 mL; both within 24 hours
, - DTV: increased risk because of decreased plasma volume and high clotting
factors up to 2 weeks PP
- Orthostatic hypotension: due to decreased vascular resistance in the pelvis and
anemia (Hgb < 11 and Hct < 32%)
- PP chills: feeling cold and shaky for a few hours PP due to vascular instability
cardiovascular assessment frequency in PP?
- check pulse and BP every 15 minutes for 1 hour, every 30 minutes for 1 hour,
every 4 hours for 1 day, then once a shift if there are no complications until
discharge
What are some respiratory changes in the PP period?
- increased risk for pulmonary edema due to oxytocin, IV fluids, tocolytics,
multiples, infection, pre-e, and increased bedrest
respiratory assessment frequency in PP?
- assess RR and breath sounds every 15 minutes for first hour, every 30 minutes
for second hour, every 4 hours for next 22 hours, and every shift after first day PP
What are some immune system considerations associated with PP?
- mild hyperthermia w/in first 24 hrs PP (anything above 100.4 F or 38 C may
indicate infection)
ANSWERS WITH COMPLETE
SOLUTIONS 100% CORRECT LATEST
UPDATED 2026/2027
Question 1
What is the standard clinical acronym utilized by nurses to guide a comprehensive
physical and psychosocial assessment during the postpartum period, and what
does each letter represent?
✔✔ The standard acronym is BUBBLE-LE (or BUBBLEE). It stands for:
B – Breasts (tissue condition, breastfeeding comfort, lactation progress)
U – Uterus (fundal height, position, firmness/involution)
B – Bladder (voiding patterns, distension, urinary output)
B – Bowel (motility, constipation, passing gas)
L – Lochia (color, volume, odor of vaginal discharge)
E – Episiotomy / Lacerations / Hemorrhoids (perineal healing and tissue
integrity)
L – Lower extremities (edema, deep tendon reflexes, signs of deep vein
thrombosis)
E – Emotions / Bonding / Psychosocial (maternal mood, coping, infant
attachment)
Question 2
When performing a BUBBLE-LE assessment, what are the key abnormal or
alarming findings within each category that a nurse must immediately document
and report?
✔✔ Abnormal and clinically significant findings include:
, Breasts: Signs of mastitis (erythema, localized heat), severe or persistent
pain during nursing, visibly cracked, blistering, or bleeding nipples, and
tissue engorgement that lasts beyond 2 days.
Uterus: A fundus that is boggy (soft), difficult to isolate or palpate,
abnormally tender upon light pressure, displaced laterally away from the
midline, located at or above the umbilicus, or severe afterpains lasting
longer than 3 days in a primipara (first-time mother).
Bladder: A visibly or tangibly distended/palpable bladder, clinical signs of
cystitis (dysuria, burning, urgency), or continued urinary incontinence or
inability to void more than 6 hours postpartum.
Bowel: Lack of a bowel movement or severe constipation lasting more than
3 days postpartum, painful or thrombosed hemorrhoids, and persistent
nausea or vomiting.
Lochia: Hyper-hemorrhagic flow (saturating a perineal pad within 1 hour
or less), a foul or putrid odor (suggesting infection), or the presence of
visible placental fragments or excessively large clots.
Episiotomy / Perineum: Severe localized bruising (ecchymosis), profound
edema, purulent or abnormal drainage, severe unmanaged pain, or
spreading redness (erythema).
Lower Extremities: Localized calf tenderness, warmth, swelling, or a
positive Homans' sign (suggesting a DVT); weak or asymmetric peripheral
pulses; or hyperreflexia ($2\text{+}$ or greater Deep Tendon Reflexes),
which can indicate worsening gestational hypertension or preeclampsia.
Emotions: Poor maternal-infant bonding or detachment,
extreme/debilitating fatigue, signs of Postpartum Depression (PPD), severe
anxiety, or any voiced thoughts of self-harm or harming the infant.
What are some cardiovascular changes in the PP period? assessment?
- QBL: Vaginal delivery < 500 mL; C-section <1000 mL; both within 24 hours
, - DTV: increased risk because of decreased plasma volume and high clotting
factors up to 2 weeks PP
- Orthostatic hypotension: due to decreased vascular resistance in the pelvis and
anemia (Hgb < 11 and Hct < 32%)
- PP chills: feeling cold and shaky for a few hours PP due to vascular instability
cardiovascular assessment frequency in PP?
- check pulse and BP every 15 minutes for 1 hour, every 30 minutes for 1 hour,
every 4 hours for 1 day, then once a shift if there are no complications until
discharge
What are some respiratory changes in the PP period?
- increased risk for pulmonary edema due to oxytocin, IV fluids, tocolytics,
multiples, infection, pre-e, and increased bedrest
respiratory assessment frequency in PP?
- assess RR and breath sounds every 15 minutes for first hour, every 30 minutes
for second hour, every 4 hours for next 22 hours, and every shift after first day PP
What are some immune system considerations associated with PP?
- mild hyperthermia w/in first 24 hrs PP (anything above 100.4 F or 38 C may
indicate infection)
