NSG 432 Exam 2 Nursing Care of the
Childbearing Family – Higher Education
Nursing Curriculum – 2026/2027 Academic
Year – 200 Verified Questions and Answers with
Evidence-Based Rationales | with complete
solutions.
SECTION 1: POSTPARTUM AND PUERPERAL CARE
(Questions 1-25)
1. Immediately following a vaginal delivery, the nurse expects the
fundus to be located at which position?
A) 1 cm above the umbilicus
B) At the umbilicus
C) 2 cm below the umbilicus
D) 4 cm below the umbilicus
Answer: C) 2 cm below the umbilicus
Rationale: Immediately after delivery, the fundus is typically located at U-2
(2 cm below the umbilicus) and gradually rises to approximately the level of
the umbilicus within the first 12 hours before descending about 1 cm per
day. The fundus should feel firm and midline. A boggy or displaced fundus
may indicate uterine atony or a full bladder, requiring further assessment.
,Source: NSG432 Exam 2 Study Guide, Stuvia
2. A nurse assesses a postpartum client and finds the fundus is
boggy and deviated to the right. What is the priority nursing action?
A) Massage the fundus vigorously
B) Assist the client to void
C) Notify the provider immediately
D) Administer oxytocin as prescribed
Answer: B) Assist the client to void
Rationale: A boggy fundus deviated to the right or left often indicates a full
bladder displacing the uterus. The priority action is to assist the client to
void, which allows the uterus to contract and return to the midline. If the
fundus remains boggy after voiding, fundal massage and medication may be
needed.
Source: NSG432 Exam 2 Study Guide, Stuvia
3. What is the expected progression of lochia following delivery?
A) Lochia rubra → Lochia serosa → Lochia alba
B) Lochia alba → Lochia serosa → Lochia rubra
C) Lochia serosa → Lochia rubra → Lochia alba
D) Lochia rubra → Lochia alba → Lochia serosa
Answer: A) Lochia rubra → Lochia serosa → Lochia alba
,Rationale: Lochia progresses through three stages: Lochia rubra (bright red,
days 1-3), Lochia serosa (pinkish-brown, days 4-14), and Lochia alba (yellow-
white, days 10-21). A foul odor in lochia indicates infection and should be
reported immediately.
Source: NSG432 Exam 2 Blueprint, Docsity
4. A postpartum client reports a sudden gush of bright red bleeding
and a firm fundus at the umbilicus. What is the most likely cause of
this bleeding?
A) Uterine atony
B) Retained placental fragments
C) Vaginal or cervical laceration
D) Uterine inversion
Answer: C) Vaginal or cervical laceration
Rationale: Lacerations are characterized by bright red bleeding with a firm,
well-contracted uterus. Uterine atony presents with a boggy uterus; retained
fragments may cause intermittent bleeding and a boggy uterus; uterine
inversion causes severe shock and a visible inverted fundus.
Source: NSG432 Exam 2 Study Guide, Stuvia
5. Which finding in a postpartum client is most concerning for
uterine atony?
A) Moderate lochia rubra
B) Fundus firm at the umbilicus
C) Boggy fundus that does not respond to massage
D) Uterus deviated to the left
, Answer: C) Boggy fundus that does not respond to massage
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. A
boggy fundus that does not respond to massage indicates the uterus is not
contracting effectively and requires immediate intervention, including
medication and provider notification.
Source: NSG432 Exam 2 Study Guide, Stuvia
6. A client who delivered 2 hours ago has saturated one perineal
pad in 15 minutes. What is the nurse's priority action?
A) Document the finding and continue monitoring
B) Massage the fundus and assess for clots
C) Notify the provider of possible postpartum hemorrhage
D) Administer PRN methylergonovine
Answer: B) Massage the fundus and assess for clots
Rationale: Saturation of one pad in 15 minutes in the immediate postpartum
period is concerning. The nurse should first assess the fundus (for tone and
clots) and massage if boggy. If bleeding continues despite massage, the
provider should be notified.
Source: NSG432 Exam 2 Study Guide, Stuvia
7. The nurse is assessing a client 24 hours after a cesarean delivery.
Which finding is most concerning and requires immediate follow-up?
A) Fundus firm at the umbilicus
B) Moderate lochia rubra
Childbearing Family – Higher Education
Nursing Curriculum – 2026/2027 Academic
Year – 200 Verified Questions and Answers with
Evidence-Based Rationales | with complete
solutions.
SECTION 1: POSTPARTUM AND PUERPERAL CARE
(Questions 1-25)
1. Immediately following a vaginal delivery, the nurse expects the
fundus to be located at which position?
A) 1 cm above the umbilicus
B) At the umbilicus
C) 2 cm below the umbilicus
D) 4 cm below the umbilicus
Answer: C) 2 cm below the umbilicus
Rationale: Immediately after delivery, the fundus is typically located at U-2
(2 cm below the umbilicus) and gradually rises to approximately the level of
the umbilicus within the first 12 hours before descending about 1 cm per
day. The fundus should feel firm and midline. A boggy or displaced fundus
may indicate uterine atony or a full bladder, requiring further assessment.
,Source: NSG432 Exam 2 Study Guide, Stuvia
2. A nurse assesses a postpartum client and finds the fundus is
boggy and deviated to the right. What is the priority nursing action?
A) Massage the fundus vigorously
B) Assist the client to void
C) Notify the provider immediately
D) Administer oxytocin as prescribed
Answer: B) Assist the client to void
Rationale: A boggy fundus deviated to the right or left often indicates a full
bladder displacing the uterus. The priority action is to assist the client to
void, which allows the uterus to contract and return to the midline. If the
fundus remains boggy after voiding, fundal massage and medication may be
needed.
Source: NSG432 Exam 2 Study Guide, Stuvia
3. What is the expected progression of lochia following delivery?
A) Lochia rubra → Lochia serosa → Lochia alba
B) Lochia alba → Lochia serosa → Lochia rubra
C) Lochia serosa → Lochia rubra → Lochia alba
D) Lochia rubra → Lochia alba → Lochia serosa
Answer: A) Lochia rubra → Lochia serosa → Lochia alba
,Rationale: Lochia progresses through three stages: Lochia rubra (bright red,
days 1-3), Lochia serosa (pinkish-brown, days 4-14), and Lochia alba (yellow-
white, days 10-21). A foul odor in lochia indicates infection and should be
reported immediately.
Source: NSG432 Exam 2 Blueprint, Docsity
4. A postpartum client reports a sudden gush of bright red bleeding
and a firm fundus at the umbilicus. What is the most likely cause of
this bleeding?
A) Uterine atony
B) Retained placental fragments
C) Vaginal or cervical laceration
D) Uterine inversion
Answer: C) Vaginal or cervical laceration
Rationale: Lacerations are characterized by bright red bleeding with a firm,
well-contracted uterus. Uterine atony presents with a boggy uterus; retained
fragments may cause intermittent bleeding and a boggy uterus; uterine
inversion causes severe shock and a visible inverted fundus.
Source: NSG432 Exam 2 Study Guide, Stuvia
5. Which finding in a postpartum client is most concerning for
uterine atony?
A) Moderate lochia rubra
B) Fundus firm at the umbilicus
C) Boggy fundus that does not respond to massage
D) Uterus deviated to the left
, Answer: C) Boggy fundus that does not respond to massage
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. A
boggy fundus that does not respond to massage indicates the uterus is not
contracting effectively and requires immediate intervention, including
medication and provider notification.
Source: NSG432 Exam 2 Study Guide, Stuvia
6. A client who delivered 2 hours ago has saturated one perineal
pad in 15 minutes. What is the nurse's priority action?
A) Document the finding and continue monitoring
B) Massage the fundus and assess for clots
C) Notify the provider of possible postpartum hemorrhage
D) Administer PRN methylergonovine
Answer: B) Massage the fundus and assess for clots
Rationale: Saturation of one pad in 15 minutes in the immediate postpartum
period is concerning. The nurse should first assess the fundus (for tone and
clots) and massage if boggy. If bleeding continues despite massage, the
provider should be notified.
Source: NSG432 Exam 2 Study Guide, Stuvia
7. The nurse is assessing a client 24 hours after a cesarean delivery.
Which finding is most concerning and requires immediate follow-up?
A) Fundus firm at the umbilicus
B) Moderate lochia rubra
