2026 Maternity Nursing Complications
Practice Questions Answer Rationales
Postpartum Hemorrhage Eclampsia
Shoulder Dystocia Preterm Labor Obstetric
Emergencies
Section 1: Postpartum Hemorrhage (Questions 1–30)
1. A nurse is assessing a client who delivered vaginally 30 minutes ago. The
uterus is boggy, and there is a large amount of vaginal bleeding. What is the
nurse's immediate priority action?
A. Administer oxytocin
B. Massage the uterus
C. Notify the healthcare provider
D. Insert a Foley catheter
Rationale: Uterine massage is the first-line intervention for uterine atony.
Massaging the fundus stimulates contraction and reduces bleeding. If the uterus
does not become firm, the nurse should then administer oxytocin and notify the
provider. Uterine atony accounts for approximately 70–80% of primary postpartum
hemorrhage cases.
2. Primary postpartum hemorrhage (PPH) is defined as blood loss of more
than:
A. 500 mL within the first 24 hours after delivery
B. 1000 mL within the first 24 hours after delivery
C. 500 mL within 24 hours to 6 weeks after delivery
D. 1000 mL within 24 hours to 6 weeks after delivery
Rationale: Primary PPH is defined as loss of more than 500 mL of blood during
the first 24 hours after birth. Secondary PPH is abnormal bleeding after 24 hours
up until six weeks postpartum. Any bleeding that causes hemodynamic instability
should be treated as PPH regardless of estimated volume.
,3. The most common cause of primary postpartum hemorrhage is:
A. Genital tract lacerations
B. Retained placental fragments
C. Uterine atony
D. Coagulation defects
Rationale: Uterine atony (failure of the uterus to contract effectively) is the most
common cause of primary PPH, accounting for approximately 70–80% of cases.
Risk factors include prolonged labor, overdistension of the uterus, multiple
pregnancy, and use of tocolytics.
4. A client who delivered 2 hours ago has a firm uterus but continues to have
steady, bright red vaginal bleeding. The nurse should suspect:
A. Uterine atony
B. Genital tract lacerations
C. Retained placental fragments
D. Coagulation defect
Rationale: A firm uterus with ongoing bright red bleeding suggests genital tract
lacerations (cervical, vaginal, or perineal). Uterine atony typically presents with a
boggy uterus. Lacerations require careful inspection and repair by the provider.
5. The "4 T's" of postpartum hemorrhage are:
A. Tone, Trauma, Tissue, and Thrombin
B. Tone, Temperature, Tissue, and Thrombin
C. Tone, Trauma, Temperature, and Thrombin
D. Tissue, Trauma, Tone, and Temperature
Rationale: The "4 T's" provide a systematic framework for identifying causes of
PPH: Tone (uterine atony), Trauma (lacerations, hematomas, uterine rupture),
Tissue (retained placenta or products of conception), and Thrombin (coagulation
disorders).
6. A nurse is preparing to administer a first-line uterotonic for prevention of
postpartum hemorrhage. Which medication is recommended by ACOG?
A. Oxytocin 5–10 IU via slow IV or IM injection
B. Misoprostol 800 mcg sublingually
C. Carboprost 250 mcg IM
D. Methylergonovine 0.2 mg IM
Rationale: ACOG recommends administering oxytocin 5–10 IU via slow IV or IM
injection at shoulder release or immediately postpartum as first-line prophylaxis
,for PPH. Oxytocin is the preferred uterotonic for prevention due to its rapid onset
and favorable safety profile.
7. Which finding in a postpartum client indicates the need for immediate
intervention for suspected PPH?
A. Saturating one perineal pad in 4 hours
B. Saturating two perineal pads in 1 hour
C. Lochia serosa at 5 days postpartum
D. Fundus at the umbilicus at 1 hour postpartum
Rationale: Saturating two perineal pads in 1 hour is a sign of excessive bleeding
and requires immediate assessment and intervention. Normal postpartum lochia
should not saturate more than one pad per hour.
8. A client is at high risk for postpartum hemorrhage due to a history of
placenta previa. Which complication should the nurse anticipate?
A. Uterine inversion
B. Placenta accreta spectrum
C. Cervical laceration
D. Retained placental fragments
Rationale: Placenta previa is associated with an increased risk of placenta accreta
spectrum, where the placenta abnormally adheres to or invades the uterine wall.
This can cause severe hemorrhage at delivery when attempts are made to remove
the placenta.
9. A nurse is assessing a client for signs of hypovolemia following PPH. Which
finding is an early compensatory sign?
A. Hypotension
B. Tachycardia
C. Bradycardia
D. Widened pulse pressure
Rationale: Tachycardia is an early compensatory sign of hypovolemia.
Hypotension is a late sign, and by the time it occurs, significant blood loss (often
>1500 mL) has already occurred. The body compensates by increasing heart rate to
maintain cardiac output.
10. A postpartum client has a distended bladder and a boggy uterus. What is
the nurse's priority action?
A. Increase IV fluid rate
B. Assist the client to void or catheterize
, C. Administer methylergonovine
D. Perform a uterine massage
Rationale: A distended bladder can prevent the uterus from contracting
effectively, leading to uterine atony and hemorrhage. The nurse should first assist
the client to void or, if unable, catheterize the bladder. After bladder emptying, the
uterus should be reassessed and massaged if still boggy.
11. A nurse is caring for a client receiving carboprost for postpartum
hemorrhage. Which contraindication should the nurse assess for?
A. Hypertension
B. Asthma
C. Diabetes
D. Renal disease
Rationale: Carboprost (Hemabate) is a prostaglandin F2α analogue that can cause
bronchoconstriction. It is contraindicated in clients with asthma. Methylergonovine
is contraindicated in hypertension, and carboprost should be used with caution in
renal disease.
12. Which laboratory value should the nurse monitor closely in a client with
postpartum hemorrhage?
A. Serum potassium
B. Fibrinogen level
C. Serum calcium
D. Serum sodium
Rationale: Fibrinogen levels below 200 mg/dL are associated with severe
postpartum hemorrhage and disseminated intravascular coagulation (DIC).
Fibrinogen should be monitored and maintained above 200 mg/dL. Platelet count
should be maintained above 50,000/mm³.
13. A client has a postpartum hemorrhage unresponsive to uterotonics. Which
nonsurgical hemorrhage-control device is recommended by ACOG?
A. Intrauterine balloon tamponade
B. B-Lynch suture
C. Uterine artery embolization
D. Hysterectomy
Rationale: ACOG's 2025 Clinical Practice Update provides revised guidance on
the use of nonsurgical hemorrhage-control devices, including intrauterine balloon
tamponade. These devices help control bleeding while preserving the uterus and
Practice Questions Answer Rationales
Postpartum Hemorrhage Eclampsia
Shoulder Dystocia Preterm Labor Obstetric
Emergencies
Section 1: Postpartum Hemorrhage (Questions 1–30)
1. A nurse is assessing a client who delivered vaginally 30 minutes ago. The
uterus is boggy, and there is a large amount of vaginal bleeding. What is the
nurse's immediate priority action?
A. Administer oxytocin
B. Massage the uterus
C. Notify the healthcare provider
D. Insert a Foley catheter
Rationale: Uterine massage is the first-line intervention for uterine atony.
Massaging the fundus stimulates contraction and reduces bleeding. If the uterus
does not become firm, the nurse should then administer oxytocin and notify the
provider. Uterine atony accounts for approximately 70–80% of primary postpartum
hemorrhage cases.
2. Primary postpartum hemorrhage (PPH) is defined as blood loss of more
than:
A. 500 mL within the first 24 hours after delivery
B. 1000 mL within the first 24 hours after delivery
C. 500 mL within 24 hours to 6 weeks after delivery
D. 1000 mL within 24 hours to 6 weeks after delivery
Rationale: Primary PPH is defined as loss of more than 500 mL of blood during
the first 24 hours after birth. Secondary PPH is abnormal bleeding after 24 hours
up until six weeks postpartum. Any bleeding that causes hemodynamic instability
should be treated as PPH regardless of estimated volume.
,3. The most common cause of primary postpartum hemorrhage is:
A. Genital tract lacerations
B. Retained placental fragments
C. Uterine atony
D. Coagulation defects
Rationale: Uterine atony (failure of the uterus to contract effectively) is the most
common cause of primary PPH, accounting for approximately 70–80% of cases.
Risk factors include prolonged labor, overdistension of the uterus, multiple
pregnancy, and use of tocolytics.
4. A client who delivered 2 hours ago has a firm uterus but continues to have
steady, bright red vaginal bleeding. The nurse should suspect:
A. Uterine atony
B. Genital tract lacerations
C. Retained placental fragments
D. Coagulation defect
Rationale: A firm uterus with ongoing bright red bleeding suggests genital tract
lacerations (cervical, vaginal, or perineal). Uterine atony typically presents with a
boggy uterus. Lacerations require careful inspection and repair by the provider.
5. The "4 T's" of postpartum hemorrhage are:
A. Tone, Trauma, Tissue, and Thrombin
B. Tone, Temperature, Tissue, and Thrombin
C. Tone, Trauma, Temperature, and Thrombin
D. Tissue, Trauma, Tone, and Temperature
Rationale: The "4 T's" provide a systematic framework for identifying causes of
PPH: Tone (uterine atony), Trauma (lacerations, hematomas, uterine rupture),
Tissue (retained placenta or products of conception), and Thrombin (coagulation
disorders).
6. A nurse is preparing to administer a first-line uterotonic for prevention of
postpartum hemorrhage. Which medication is recommended by ACOG?
A. Oxytocin 5–10 IU via slow IV or IM injection
B. Misoprostol 800 mcg sublingually
C. Carboprost 250 mcg IM
D. Methylergonovine 0.2 mg IM
Rationale: ACOG recommends administering oxytocin 5–10 IU via slow IV or IM
injection at shoulder release or immediately postpartum as first-line prophylaxis
,for PPH. Oxytocin is the preferred uterotonic for prevention due to its rapid onset
and favorable safety profile.
7. Which finding in a postpartum client indicates the need for immediate
intervention for suspected PPH?
A. Saturating one perineal pad in 4 hours
B. Saturating two perineal pads in 1 hour
C. Lochia serosa at 5 days postpartum
D. Fundus at the umbilicus at 1 hour postpartum
Rationale: Saturating two perineal pads in 1 hour is a sign of excessive bleeding
and requires immediate assessment and intervention. Normal postpartum lochia
should not saturate more than one pad per hour.
8. A client is at high risk for postpartum hemorrhage due to a history of
placenta previa. Which complication should the nurse anticipate?
A. Uterine inversion
B. Placenta accreta spectrum
C. Cervical laceration
D. Retained placental fragments
Rationale: Placenta previa is associated with an increased risk of placenta accreta
spectrum, where the placenta abnormally adheres to or invades the uterine wall.
This can cause severe hemorrhage at delivery when attempts are made to remove
the placenta.
9. A nurse is assessing a client for signs of hypovolemia following PPH. Which
finding is an early compensatory sign?
A. Hypotension
B. Tachycardia
C. Bradycardia
D. Widened pulse pressure
Rationale: Tachycardia is an early compensatory sign of hypovolemia.
Hypotension is a late sign, and by the time it occurs, significant blood loss (often
>1500 mL) has already occurred. The body compensates by increasing heart rate to
maintain cardiac output.
10. A postpartum client has a distended bladder and a boggy uterus. What is
the nurse's priority action?
A. Increase IV fluid rate
B. Assist the client to void or catheterize
, C. Administer methylergonovine
D. Perform a uterine massage
Rationale: A distended bladder can prevent the uterus from contracting
effectively, leading to uterine atony and hemorrhage. The nurse should first assist
the client to void or, if unable, catheterize the bladder. After bladder emptying, the
uterus should be reassessed and massaged if still boggy.
11. A nurse is caring for a client receiving carboprost for postpartum
hemorrhage. Which contraindication should the nurse assess for?
A. Hypertension
B. Asthma
C. Diabetes
D. Renal disease
Rationale: Carboprost (Hemabate) is a prostaglandin F2α analogue that can cause
bronchoconstriction. It is contraindicated in clients with asthma. Methylergonovine
is contraindicated in hypertension, and carboprost should be used with caution in
renal disease.
12. Which laboratory value should the nurse monitor closely in a client with
postpartum hemorrhage?
A. Serum potassium
B. Fibrinogen level
C. Serum calcium
D. Serum sodium
Rationale: Fibrinogen levels below 200 mg/dL are associated with severe
postpartum hemorrhage and disseminated intravascular coagulation (DIC).
Fibrinogen should be monitored and maintained above 200 mg/dL. Platelet count
should be maintained above 50,000/mm³.
13. A client has a postpartum hemorrhage unresponsive to uterotonics. Which
nonsurgical hemorrhage-control device is recommended by ACOG?
A. Intrauterine balloon tamponade
B. B-Lynch suture
C. Uterine artery embolization
D. Hysterectomy
Rationale: ACOG's 2025 Clinical Practice Update provides revised guidance on
the use of nonsurgical hemorrhage-control devices, including intrauterine balloon
tamponade. These devices help control bleeding while preserving the uterus and
