N144 EXAM 4 MATERNITY O/B -SAMUEL MERRIT
UNIVERSITY |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the woman is experiencing profuse bleeding. The most likely etiology for the
bleeding is:
a. Uterine atony.
b. Uterine inversion.
c. Vaginal hematoma.
d. Vaginal laceration.
CORRECT ANSWER
a. Uterine atony.
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum
hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely
source of this client's bleeding. Furthermore, if the woman were experiencing a uterine
inversion, it would be evidenced by the presence of a large, red, rounded mass
protruding from the introitus. A vaginal hematoma may be associated with hemorrhage.
However, the most likely clinical finding would be pain, not the presence of profuse
bleeding. A vaginal laceration may cause hemorrhage, but it is more likely that profuse
bleeding would result from uterine atony. A vaginal laceration should be suspected if
vaginal bleeding continues in the presence of a firm, contracted uterine fundus.
Question 2
A primary nursing responsibility when caring for a woman experiencing an obstetric
hemorrhage associated with uterine atony is to:
1
,a. Establish venous access.
b. Perform fundal massage.
c. Prepare the woman for surgical intervention.
d. Catheterize the bladder.
CORRECT ANSWER
b. Perform fundal massage.
The initial management of excessive after birth bleeding is firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention, the initial
intervention would be fundal massage. The woman may need surgical intervention to
treat her after birth hemorrhage, but the initial nursing intervention would be to assess
the uterus. After uterine
massage the nurse may want to catheterize the patient to eliminate any bladder
distention that may be preventing the uterus from contracting properly.
Question 3
The perinatal nurse caring for the postpartum woman understands that late postpartum
hemorrhage (PPH) is most likely caused by:
a. Subinvolution of the placental site.
b. Defective vascularity of the decidua.
c. Cervical lacerations.
d. Coagulation disorders.
CORRECT ANSWER
a. Subinvolution of the placental site.
2
, Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained
placental fragments. Late PPH is not typically a result of defective vascularity of the
decidua, cervical lacerations, or coagulation disorders.
Question 4
Which woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for
fetal distress
b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor
is being induced
c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor
d. A primigravida in spontaneous labor with preterm twins
CORRECT ANSWER
b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose
labor is being induced
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a
smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although
many causes and risk factors are associated with PPH, the primiparous woman being
prepared for an emergency C-section, the multiparous woman with 8-hour labor, and the
primigravida in spontaneous labor do not pose risk factors or causes of early PPH.
Question 5
The first and most important nursing intervention when a nurse observes profuse
postpartum bleeding is to:
a. Call the woman's primary health care provider.
3
, b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure and pulse for signs of hypovolemic shock.
CORRECT ANSWER
c. Palpate the uterus and massage it if it is boggy.
The initial management of excessive postpartum bleeding is firm massage of the uterine
fundus. Although calling the health care provider, administering an oxytocic, and
assessing maternal BP are appropriate interventions, the primary intervention should be
to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage
(PPH).
Question 6
When caring for a postpartum woman experiencing hemorrhagic shock, the nurse
recognizes that the most objective and least invasive assessment of adequate organ
perfusion and oxygenation is:
a. Absence of cyanosis in the buccal mucosa.
b. Cool, dry skin.
c. Diminished restlessness.
d. Urinary output of at least 30 mL/hr.
CORRECT ANSWER
d. Urinary output of at least 30 mL/hr.
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which
the perfusion of body organs may become severely compromised and death may occur.
The presence of adequate urinary output indicates adequate tissue perfusion. The
assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool,
pale, clammy skin would be an indicative finding associated with hemorrhagic shock.
Hemorrhagic shock is associated with lethargy, not restlessness.
4
UNIVERSITY |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the woman is experiencing profuse bleeding. The most likely etiology for the
bleeding is:
a. Uterine atony.
b. Uterine inversion.
c. Vaginal hematoma.
d. Vaginal laceration.
CORRECT ANSWER
a. Uterine atony.
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum
hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely
source of this client's bleeding. Furthermore, if the woman were experiencing a uterine
inversion, it would be evidenced by the presence of a large, red, rounded mass
protruding from the introitus. A vaginal hematoma may be associated with hemorrhage.
However, the most likely clinical finding would be pain, not the presence of profuse
bleeding. A vaginal laceration may cause hemorrhage, but it is more likely that profuse
bleeding would result from uterine atony. A vaginal laceration should be suspected if
vaginal bleeding continues in the presence of a firm, contracted uterine fundus.
Question 2
A primary nursing responsibility when caring for a woman experiencing an obstetric
hemorrhage associated with uterine atony is to:
1
,a. Establish venous access.
b. Perform fundal massage.
c. Prepare the woman for surgical intervention.
d. Catheterize the bladder.
CORRECT ANSWER
b. Perform fundal massage.
The initial management of excessive after birth bleeding is firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention, the initial
intervention would be fundal massage. The woman may need surgical intervention to
treat her after birth hemorrhage, but the initial nursing intervention would be to assess
the uterus. After uterine
massage the nurse may want to catheterize the patient to eliminate any bladder
distention that may be preventing the uterus from contracting properly.
Question 3
The perinatal nurse caring for the postpartum woman understands that late postpartum
hemorrhage (PPH) is most likely caused by:
a. Subinvolution of the placental site.
b. Defective vascularity of the decidua.
c. Cervical lacerations.
d. Coagulation disorders.
CORRECT ANSWER
a. Subinvolution of the placental site.
2
, Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained
placental fragments. Late PPH is not typically a result of defective vascularity of the
decidua, cervical lacerations, or coagulation disorders.
Question 4
Which woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for
fetal distress
b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor
is being induced
c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor
d. A primigravida in spontaneous labor with preterm twins
CORRECT ANSWER
b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose
labor is being induced
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a
smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although
many causes and risk factors are associated with PPH, the primiparous woman being
prepared for an emergency C-section, the multiparous woman with 8-hour labor, and the
primigravida in spontaneous labor do not pose risk factors or causes of early PPH.
Question 5
The first and most important nursing intervention when a nurse observes profuse
postpartum bleeding is to:
a. Call the woman's primary health care provider.
3
, b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure and pulse for signs of hypovolemic shock.
CORRECT ANSWER
c. Palpate the uterus and massage it if it is boggy.
The initial management of excessive postpartum bleeding is firm massage of the uterine
fundus. Although calling the health care provider, administering an oxytocic, and
assessing maternal BP are appropriate interventions, the primary intervention should be
to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage
(PPH).
Question 6
When caring for a postpartum woman experiencing hemorrhagic shock, the nurse
recognizes that the most objective and least invasive assessment of adequate organ
perfusion and oxygenation is:
a. Absence of cyanosis in the buccal mucosa.
b. Cool, dry skin.
c. Diminished restlessness.
d. Urinary output of at least 30 mL/hr.
CORRECT ANSWER
d. Urinary output of at least 30 mL/hr.
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which
the perfusion of body organs may become severely compromised and death may occur.
The presence of adequate urinary output indicates adequate tissue perfusion. The
assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool,
pale, clammy skin would be an indicative finding associated with hemorrhagic shock.
Hemorrhagic shock is associated with lethargy, not restlessness.
4
