1
HESI Specialty Exam Bank on Postpartum Hemorrhage Prevention &
Interventions
, 2
Subtopic 1: Risk Factors and Early
Identification of Postpartum Hemorrhage
(PPH)
Question 1
A nurse is assessing a postpartum client who delivered a macrosomic infant.
Which of the following findings places the client at greatest risk for
postpartum hemorrhage?
A. Multiparity
B. Episiotomy
C. Uterine atony
D. Prolonged second stage of labor
Correct Answer: C. Uterine atony
Rationale: Uterine atony, the failure of the uterus to contract adequately
after delivery, is the most common cause of postpartum hemorrhage,
especially in cases of uterine overdistension (e.g., macrosomia).
Question 2
Which client should the nurse identify as having the highest risk of
developing postpartum hemorrhage?
A. A primigravida who had a vacuum-assisted delivery
B. A multiparous client who had a precipitous labor
C. A client who had a normal vaginal delivery at 39 weeks
D. A client who received IV oxytocin during labor
Correct Answer: B. A multiparous client who had a precipitous labor
Rationale: Rapid labor can impair uterine tone post-delivery, increasing the
risk for uterine atony and hemorrhage, particularly in multiparous women.
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Question 3
The nurse is reviewing a client’s chart and notes a history of placenta previa.
This history places the client at risk for which postpartum complication?
A. Mastitis
B. Postpartum hemorrhage
C. Uterine rupture
D. Deep vein thrombosis
Correct Answer: B. Postpartum hemorrhage
Rationale: Placenta previa increases the risk of excessive bleeding after
delivery due to abnormal implantation of the placenta near or over the
cervical os.
Question 4
Which of the following maternal conditions during pregnancy is most likely to
contribute to postpartum hemorrhage?
A. Iron-deficiency anemia
B. Polyhydramnios
C. Hyperemesis gravidarum
D. Gestational hypertension
Correct Answer: B. Polyhydramnios
Rationale: Polyhydramnios stretches the uterus excessively, which can lead
to uterine atony and increase the risk of postpartum hemorrhage.
Question 5
A nurse is monitoring a postpartum client with a third-degree perineal tear.
What should the nurse recognize as a key risk for this client?
, 4
A. Preeclampsia
B. Hemorrhage
C. Urinary tract infection
D. Breast engorgement
Correct Answer: B. Hemorrhage
Rationale: Severe perineal lacerations increase vascular damage and tissue
trauma, elevating the risk for significant postpartum bleeding.
Question 6
A postpartum client experiences excessive vaginal bleeding 1 hour after
birth. Which early sign indicates a possible hemorrhage?
A. Saturation of a perineal pad within 15 minutes
B. Hematocrit of 34%
C. Uterus firm and midline
D. Slight perineal discomfort
Correct Answer: A. Saturation of a perineal pad within 15 minutes
Rationale: Rapid pad saturation is a critical indicator of postpartum
hemorrhage and requires immediate assessment and intervention.
Question 7
Which intrapartum factor should alert the nurse to monitor closely for
postpartum hemorrhage?
A. Epidural anesthesia
B. Use of magnesium sulfate
C. Duration of second stage over 2 hours
D. Maternal fever during labor
HESI Specialty Exam Bank on Postpartum Hemorrhage Prevention &
Interventions
, 2
Subtopic 1: Risk Factors and Early
Identification of Postpartum Hemorrhage
(PPH)
Question 1
A nurse is assessing a postpartum client who delivered a macrosomic infant.
Which of the following findings places the client at greatest risk for
postpartum hemorrhage?
A. Multiparity
B. Episiotomy
C. Uterine atony
D. Prolonged second stage of labor
Correct Answer: C. Uterine atony
Rationale: Uterine atony, the failure of the uterus to contract adequately
after delivery, is the most common cause of postpartum hemorrhage,
especially in cases of uterine overdistension (e.g., macrosomia).
Question 2
Which client should the nurse identify as having the highest risk of
developing postpartum hemorrhage?
A. A primigravida who had a vacuum-assisted delivery
B. A multiparous client who had a precipitous labor
C. A client who had a normal vaginal delivery at 39 weeks
D. A client who received IV oxytocin during labor
Correct Answer: B. A multiparous client who had a precipitous labor
Rationale: Rapid labor can impair uterine tone post-delivery, increasing the
risk for uterine atony and hemorrhage, particularly in multiparous women.
, 3
Question 3
The nurse is reviewing a client’s chart and notes a history of placenta previa.
This history places the client at risk for which postpartum complication?
A. Mastitis
B. Postpartum hemorrhage
C. Uterine rupture
D. Deep vein thrombosis
Correct Answer: B. Postpartum hemorrhage
Rationale: Placenta previa increases the risk of excessive bleeding after
delivery due to abnormal implantation of the placenta near or over the
cervical os.
Question 4
Which of the following maternal conditions during pregnancy is most likely to
contribute to postpartum hemorrhage?
A. Iron-deficiency anemia
B. Polyhydramnios
C. Hyperemesis gravidarum
D. Gestational hypertension
Correct Answer: B. Polyhydramnios
Rationale: Polyhydramnios stretches the uterus excessively, which can lead
to uterine atony and increase the risk of postpartum hemorrhage.
Question 5
A nurse is monitoring a postpartum client with a third-degree perineal tear.
What should the nurse recognize as a key risk for this client?
, 4
A. Preeclampsia
B. Hemorrhage
C. Urinary tract infection
D. Breast engorgement
Correct Answer: B. Hemorrhage
Rationale: Severe perineal lacerations increase vascular damage and tissue
trauma, elevating the risk for significant postpartum bleeding.
Question 6
A postpartum client experiences excessive vaginal bleeding 1 hour after
birth. Which early sign indicates a possible hemorrhage?
A. Saturation of a perineal pad within 15 minutes
B. Hematocrit of 34%
C. Uterus firm and midline
D. Slight perineal discomfort
Correct Answer: A. Saturation of a perineal pad within 15 minutes
Rationale: Rapid pad saturation is a critical indicator of postpartum
hemorrhage and requires immediate assessment and intervention.
Question 7
Which intrapartum factor should alert the nurse to monitor closely for
postpartum hemorrhage?
A. Epidural anesthesia
B. Use of magnesium sulfate
C. Duration of second stage over 2 hours
D. Maternal fever during labor
