NURSING LICENSURE
NUR 254 EXAM 3 | QUESTIONS AND ANSWERS | 2026/2027 UPDATE |
WITH COMPLETE SOLUTIONS - GALEN COLLEGE OF NURSING
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Postpartum Complications
Newborn Transition & Complications
Pediatric Growth & Development
Common Pediatric Disorders
Pediatric Safety, Abuse & Family Teaching
STUVIAACTUALEXAM
, POSTPARTUM COMPLICATIONS
Question 1
A multiparous client is two hours postpartum after a spontaneous vaginal delivery. The fundus is firm and midline at the
umbilicus, yet a steady trickle of bright red blood continues. The nurse suspects a genital tract laceration. Which action
should the nurse take next?
A. Perform vigorous fundal massage to expel any remaining clots.
B. Notify the provider and prepare for inspection and possible repair of the cervix or vagina.
C. Increase the intravenous oxytocin infusion rate by 50 percent.
D. Place the client in Trendelenburg position and apply an ice pack to the perineum.
Correct Answer: B
Rationale:
A firm fundus with continued bright-red bleeding points to a laceration rather than uterine atony. Prompt provider notification and
examination are required for identification and repair. Additional massage or oxytocin will not stop bleeding from a laceration.
Question 2
On postpartum day 3 a client reports fever of 38.6 C, uterine tenderness, and foul-smelling lochia. The nurse recognizes
these findings as consistent with endometritis. Which laboratory result is most helpful in confirming the diagnosis and
guiding therapy?
A. Complete blood count showing elevated white blood cell count and a left shift.
B. Serum beta-hCG level to rule out retained products of conception.
C. Urine culture obtained by clean-catch method only.
D. Coagulation studies to evaluate for disseminated intravascular coagulation.
Correct Answer: A
Rationale:
Leukocytosis with a left shift supports the clinical diagnosis of endometritis and helps monitor response to antibiotics. Beta-hCG and
coagulation studies are not first-line for routine endometritis; urine culture may be added if urinary symptoms are present.
Question 3
A client who delivered by cesarean section 18 hours earlier develops sudden dyspnea, chest pain, and oxygen
saturation of 88 percent on room air. The nurse suspects pulmonary embolism. Which immediate intervention is the
priority?
A. Encourage the client to ambulate to the hallway to improve circulation.
B. Place the client in high Fowler position, administer oxygen, and notify the rapid response team.
C. Administer a prescribed oral anticoagulant and continue routine postpartum monitoring.
D. Obtain a 12-lead electrocardiogram before any other action is taken.
Correct Answer: B
Rationale:
Acute respiratory distress and hypoxemia require immediate oxygenation and rapid escalation of care. Ambulation is contraindicated;
anticoagulation is ordered after stabilization and diagnosis, not as the first step.
NUR 254 EXAM 3 | QUESTIONS AND ANSWERS | 2026/2027 UPDATE | GALEN COLLEGE OF NURSING Page 2
, POSTPARTUM COMPLICATIONS
Question 4
A breastfeeding client on day 4 reports bilateral breast engorgement with firm, tender breasts and difficulty latching.
Which intervention best relieves engorgement while supporting continued breastfeeding?
A. Apply ice packs continuously for 24 hours and avoid any breast stimulation.
B. Express a small amount of milk before feeding to soften the areola and improve latch.
C. Wear a tight binder and restrict fluid intake to suppress milk production.
D. Switch to exclusive formula feeding until the engorgement resolves completely.
Correct Answer: B
Rationale:
Hand expression or brief pumping softens the areola, facilitating a deeper latch and effective milk removal, which reduces
engorgement. Complete avoidance of stimulation or binding can decrease supply; formula substitution is unnecessary.
Question 5
A client with a history of postpartum hemorrhage in a previous pregnancy is receiving prophylactic oxytocin after
delivery of the placenta. Thirty minutes later the fundus remains boggy and lochia is heavy. Which medication is the
next pharmacologic option commonly used?
A. Intravenous magnesium sulfate to relax the uterine muscle.
B. Intramuscular methylergonovine if blood pressure is within normal limits.
C. Subcutaneous terbutaline to promote uterine contraction.
D. Oral nifedipine to reduce afterload and control bleeding.
Correct Answer: B
Rationale:
Methylergonovine is a second-line uterotonic used when oxytocin alone is insufficient, provided the client is not hypertensive.
Magnesium and terbutaline are tocolytics that relax the uterus; nifedipine is not a uterotonic.
Question 6
During a home visit on day 7 the nurse observes a client who delivered vaginally. The client reports calf pain, swelling,
and warmth in the left leg. Which action should the nurse recommend immediately?
A. Massage the calf vigorously and apply sequential compression devices.
B. Remain on bed rest, elevate the leg, and seek urgent medical evaluation for possible deep-vein thrombosis.
C. Increase ambulation to promote venous return and reduce swelling.
D. Apply heat packs and continue normal activity until the next scheduled appointment.
Correct Answer: B
Rationale:
Unilateral calf pain, swelling, and warmth raise concern for DVT. Activity and massage can dislodge a clot; prompt evaluation and
activity restriction are required until diagnostic testing is completed.
NUR 254 EXAM 3 | QUESTIONS AND ANSWERS | 2026/2027 UPDATE | GALEN COLLEGE OF NURSING Page 3
NUR 254 EXAM 3 | QUESTIONS AND ANSWERS | 2026/2027 UPDATE |
WITH COMPLETE SOLUTIONS - GALEN COLLEGE OF NURSING
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Postpartum Complications
Newborn Transition & Complications
Pediatric Growth & Development
Common Pediatric Disorders
Pediatric Safety, Abuse & Family Teaching
STUVIAACTUALEXAM
, POSTPARTUM COMPLICATIONS
Question 1
A multiparous client is two hours postpartum after a spontaneous vaginal delivery. The fundus is firm and midline at the
umbilicus, yet a steady trickle of bright red blood continues. The nurse suspects a genital tract laceration. Which action
should the nurse take next?
A. Perform vigorous fundal massage to expel any remaining clots.
B. Notify the provider and prepare for inspection and possible repair of the cervix or vagina.
C. Increase the intravenous oxytocin infusion rate by 50 percent.
D. Place the client in Trendelenburg position and apply an ice pack to the perineum.
Correct Answer: B
Rationale:
A firm fundus with continued bright-red bleeding points to a laceration rather than uterine atony. Prompt provider notification and
examination are required for identification and repair. Additional massage or oxytocin will not stop bleeding from a laceration.
Question 2
On postpartum day 3 a client reports fever of 38.6 C, uterine tenderness, and foul-smelling lochia. The nurse recognizes
these findings as consistent with endometritis. Which laboratory result is most helpful in confirming the diagnosis and
guiding therapy?
A. Complete blood count showing elevated white blood cell count and a left shift.
B. Serum beta-hCG level to rule out retained products of conception.
C. Urine culture obtained by clean-catch method only.
D. Coagulation studies to evaluate for disseminated intravascular coagulation.
Correct Answer: A
Rationale:
Leukocytosis with a left shift supports the clinical diagnosis of endometritis and helps monitor response to antibiotics. Beta-hCG and
coagulation studies are not first-line for routine endometritis; urine culture may be added if urinary symptoms are present.
Question 3
A client who delivered by cesarean section 18 hours earlier develops sudden dyspnea, chest pain, and oxygen
saturation of 88 percent on room air. The nurse suspects pulmonary embolism. Which immediate intervention is the
priority?
A. Encourage the client to ambulate to the hallway to improve circulation.
B. Place the client in high Fowler position, administer oxygen, and notify the rapid response team.
C. Administer a prescribed oral anticoagulant and continue routine postpartum monitoring.
D. Obtain a 12-lead electrocardiogram before any other action is taken.
Correct Answer: B
Rationale:
Acute respiratory distress and hypoxemia require immediate oxygenation and rapid escalation of care. Ambulation is contraindicated;
anticoagulation is ordered after stabilization and diagnosis, not as the first step.
NUR 254 EXAM 3 | QUESTIONS AND ANSWERS | 2026/2027 UPDATE | GALEN COLLEGE OF NURSING Page 2
, POSTPARTUM COMPLICATIONS
Question 4
A breastfeeding client on day 4 reports bilateral breast engorgement with firm, tender breasts and difficulty latching.
Which intervention best relieves engorgement while supporting continued breastfeeding?
A. Apply ice packs continuously for 24 hours and avoid any breast stimulation.
B. Express a small amount of milk before feeding to soften the areola and improve latch.
C. Wear a tight binder and restrict fluid intake to suppress milk production.
D. Switch to exclusive formula feeding until the engorgement resolves completely.
Correct Answer: B
Rationale:
Hand expression or brief pumping softens the areola, facilitating a deeper latch and effective milk removal, which reduces
engorgement. Complete avoidance of stimulation or binding can decrease supply; formula substitution is unnecessary.
Question 5
A client with a history of postpartum hemorrhage in a previous pregnancy is receiving prophylactic oxytocin after
delivery of the placenta. Thirty minutes later the fundus remains boggy and lochia is heavy. Which medication is the
next pharmacologic option commonly used?
A. Intravenous magnesium sulfate to relax the uterine muscle.
B. Intramuscular methylergonovine if blood pressure is within normal limits.
C. Subcutaneous terbutaline to promote uterine contraction.
D. Oral nifedipine to reduce afterload and control bleeding.
Correct Answer: B
Rationale:
Methylergonovine is a second-line uterotonic used when oxytocin alone is insufficient, provided the client is not hypertensive.
Magnesium and terbutaline are tocolytics that relax the uterus; nifedipine is not a uterotonic.
Question 6
During a home visit on day 7 the nurse observes a client who delivered vaginally. The client reports calf pain, swelling,
and warmth in the left leg. Which action should the nurse recommend immediately?
A. Massage the calf vigorously and apply sequential compression devices.
B. Remain on bed rest, elevate the leg, and seek urgent medical evaluation for possible deep-vein thrombosis.
C. Increase ambulation to promote venous return and reduce swelling.
D. Apply heat packs and continue normal activity until the next scheduled appointment.
Correct Answer: B
Rationale:
Unilateral calf pain, swelling, and warmth raise concern for DVT. Activity and massage can dislodge a clot; prompt evaluation and
activity restriction are required until diagnostic testing is completed.
NUR 254 EXAM 3 | QUESTIONS AND ANSWERS | 2026/2027 UPDATE | GALEN COLLEGE OF NURSING Page 3
