Maternal Newborn Nursing 2026 Clinical Case Study
Practice Questions Patient Assessment Obstetric
Complications Prioritization Nursing Interventions
Clinical Reasoning
SECTION 1: POSTPARTUM ASSESSMENT AND COMPLICATIONS
(Questions 1–30)
Question 1
A 28-year-old G2P2 is 2 hours post-vaginal delivery. The nurse performs a fundal
assessment and finds the uterus boggy, deviated to the right, above the umbilicus.
The client's pad is saturated with blood. What is the nurse's priority action?
A. Massage the fundus vigorously
B. Assist the client to void or catheterize
C. Administer oxytocin IM
D. Notify the provider immediately
Correct Answer: B. Assist the client to void or catheterize
Rationale: A boggy uterus deviated to the right indicates a full bladder displacing
the uterus and preventing contraction. The priority is to empty the bladder, which
will allow the uterus to contract and reduce bleeding. Fundal massage would be
performed after emptying the bladder if the uterus remains boggy.
Question 2
A postpartum client is 4 hours post-delivery and has saturated two perineal pads in
1 hour. The uterus is firm and midline at the umbilicus. What is the most likely
cause of the bleeding?
A. Uterine atony
B. Cervical or vaginal laceration
,C. Retained placental fragments
D. Uterine inversion
Correct Answer: B. Cervical or vaginal laceration
Rationale: A firm, midline uterus with continued bleeding indicates a laceration
rather than uterine atony. Lacerations require repair by the provider, and the nurse
should notify the provider immediately.
Question 3
A nurse is assessing a postpartum client who delivered 6 hours ago. Which finding
requires immediate intervention?
A. Lochia rubra with small clots
B. Blood pressure of 110/70 mmHg
C. Saturation of one pad in 15 minutes
D. Heart rate of 88 bpm
Correct Answer: C. Saturation of one pad in 15 minutes
Rationale: Saturating one pad in 15 minutes indicates excessive bleeding and
possible postpartum hemorrhage. This requires immediate assessment of uterine
tone and notification of the provider.
Question 4
A client is 1 day postpartum and reports severe perineal pain unrelieved by
analgesics. On assessment, the nurse notes a swollen, tense, bluish-purple mass at
the perineum. What is the most likely diagnosis?
A. Perineal hematoma
B. Perineal laceration
C. Hemorrhoid
D. Uterine prolapse
Correct Answer: A. Perineal hematoma
,Rationale: A bluish-purple, swollen, tense mass with severe pain is characteristic
of a perineal hematoma. This requires immediate provider notification and possible
surgical evacuation.
Question 5
A postpartum client is at risk for developing a pulmonary embolism. Which
finding is an early sign?
A. Tachycardia and dyspnea
B. Bradycardia and hypertension
C. Jaundice and pallor
D. Polyuria and thirst
Correct Answer: A. Tachycardia and dyspnea
Rationale: Pulmonary embolism presents with sudden onset of tachycardia,
dyspnea, chest pain, and hypoxemia. Early recognition and treatment are critical to
prevent mortality.
Question 6
A postpartum client reports sudden onset of chest pain and shortness of breath.
What is the nurse's priority action?
A. Administer oxygen and notify the provider immediately
B. Encourage ambulation
C. Administer a sedative
D. Perform a vaginal exam
Correct Answer: A. Administer oxygen and notify the provider immediately
Rationale: Chest pain and shortness of breath in a postpartum client suggest
pulmonary embolism, which is a life-threatening emergency. The nurse should
administer oxygen, monitor vital signs, and notify the provider immediately.
, Question 7
A client is 3 days postpartum and reports pain, redness, and warmth in the left calf.
What is the most likely diagnosis?
A. Deep vein thrombosis (DVT)
B. Cellulitis
C. Muscle strain
D. Varicose veins
Correct Answer: A. Deep vein thrombosis (DVT)
Rationale: Pain, redness, warmth, and swelling in the calf are classic signs of
DVT. The nurse should notify the provider and avoid massaging the area to
prevent dislodging the clot.
Question 8
A postpartum client with DVT asks why she cannot massage her leg. The nurse's
best response is:
A. "Massaging the leg can dislodge the clot and cause it to travel to your lungs."
B. "Massaging the leg will increase your pain."
C. "Massaging the leg is not allowed by hospital policy."
D. "Massaging the leg will cause bleeding."
Correct Answer: A. "Massaging the leg can dislodge the clot and cause it to
travel to your lungs."
Rationale: Massaging a leg with DVT can dislodge the thrombus, leading to
pulmonary embolism, which is life-threatening. The client should be educated
about this risk and instructed to avoid massage.
Question 9
A postpartum client develops fever, chills, and uterine tenderness 2 days after
delivery. What is the most likely diagnosis?
Practice Questions Patient Assessment Obstetric
Complications Prioritization Nursing Interventions
Clinical Reasoning
SECTION 1: POSTPARTUM ASSESSMENT AND COMPLICATIONS
(Questions 1–30)
Question 1
A 28-year-old G2P2 is 2 hours post-vaginal delivery. The nurse performs a fundal
assessment and finds the uterus boggy, deviated to the right, above the umbilicus.
The client's pad is saturated with blood. What is the nurse's priority action?
A. Massage the fundus vigorously
B. Assist the client to void or catheterize
C. Administer oxytocin IM
D. Notify the provider immediately
Correct Answer: B. Assist the client to void or catheterize
Rationale: A boggy uterus deviated to the right indicates a full bladder displacing
the uterus and preventing contraction. The priority is to empty the bladder, which
will allow the uterus to contract and reduce bleeding. Fundal massage would be
performed after emptying the bladder if the uterus remains boggy.
Question 2
A postpartum client is 4 hours post-delivery and has saturated two perineal pads in
1 hour. The uterus is firm and midline at the umbilicus. What is the most likely
cause of the bleeding?
A. Uterine atony
B. Cervical or vaginal laceration
,C. Retained placental fragments
D. Uterine inversion
Correct Answer: B. Cervical or vaginal laceration
Rationale: A firm, midline uterus with continued bleeding indicates a laceration
rather than uterine atony. Lacerations require repair by the provider, and the nurse
should notify the provider immediately.
Question 3
A nurse is assessing a postpartum client who delivered 6 hours ago. Which finding
requires immediate intervention?
A. Lochia rubra with small clots
B. Blood pressure of 110/70 mmHg
C. Saturation of one pad in 15 minutes
D. Heart rate of 88 bpm
Correct Answer: C. Saturation of one pad in 15 minutes
Rationale: Saturating one pad in 15 minutes indicates excessive bleeding and
possible postpartum hemorrhage. This requires immediate assessment of uterine
tone and notification of the provider.
Question 4
A client is 1 day postpartum and reports severe perineal pain unrelieved by
analgesics. On assessment, the nurse notes a swollen, tense, bluish-purple mass at
the perineum. What is the most likely diagnosis?
A. Perineal hematoma
B. Perineal laceration
C. Hemorrhoid
D. Uterine prolapse
Correct Answer: A. Perineal hematoma
,Rationale: A bluish-purple, swollen, tense mass with severe pain is characteristic
of a perineal hematoma. This requires immediate provider notification and possible
surgical evacuation.
Question 5
A postpartum client is at risk for developing a pulmonary embolism. Which
finding is an early sign?
A. Tachycardia and dyspnea
B. Bradycardia and hypertension
C. Jaundice and pallor
D. Polyuria and thirst
Correct Answer: A. Tachycardia and dyspnea
Rationale: Pulmonary embolism presents with sudden onset of tachycardia,
dyspnea, chest pain, and hypoxemia. Early recognition and treatment are critical to
prevent mortality.
Question 6
A postpartum client reports sudden onset of chest pain and shortness of breath.
What is the nurse's priority action?
A. Administer oxygen and notify the provider immediately
B. Encourage ambulation
C. Administer a sedative
D. Perform a vaginal exam
Correct Answer: A. Administer oxygen and notify the provider immediately
Rationale: Chest pain and shortness of breath in a postpartum client suggest
pulmonary embolism, which is a life-threatening emergency. The nurse should
administer oxygen, monitor vital signs, and notify the provider immediately.
, Question 7
A client is 3 days postpartum and reports pain, redness, and warmth in the left calf.
What is the most likely diagnosis?
A. Deep vein thrombosis (DVT)
B. Cellulitis
C. Muscle strain
D. Varicose veins
Correct Answer: A. Deep vein thrombosis (DVT)
Rationale: Pain, redness, warmth, and swelling in the calf are classic signs of
DVT. The nurse should notify the provider and avoid massaging the area to
prevent dislodging the clot.
Question 8
A postpartum client with DVT asks why she cannot massage her leg. The nurse's
best response is:
A. "Massaging the leg can dislodge the clot and cause it to travel to your lungs."
B. "Massaging the leg will increase your pain."
C. "Massaging the leg is not allowed by hospital policy."
D. "Massaging the leg will cause bleeding."
Correct Answer: A. "Massaging the leg can dislodge the clot and cause it to
travel to your lungs."
Rationale: Massaging a leg with DVT can dislodge the thrombus, leading to
pulmonary embolism, which is life-threatening. The client should be educated
about this risk and instructed to avoid massage.
Question 9
A postpartum client develops fever, chills, and uterine tenderness 2 days after
delivery. What is the most likely diagnosis?
