HESI
Obstetrics/Maternity
Case Study
(NGN-Style & Case Scenario)
Below is a :
set of structured questions aligned with
the NCLEX Next-Generation (NGN) style,
complete with scenarios, vital signs,
questions, answer choices, correct answers, and expert
rationales
,### Scenario 1
Scenario: Fifteen minutes after the initial assessment, the nurse finds the
client disoriented and lying on her back in a pool of vaginal blood, with
the sheets beneath her saturated with blood.
Vital Signs:
- Blood Pressure: 90/50 mmHg
- Heart Rate: 120 bpm
Question: Which action is most important for the nurse to implement
immediately?
Answer Choices:
a. Take vital signs.
b. Massage the fundus.
c. Check the bladder.
d. Increase the IV rate.
ANSWER:b. Massage the fundus.
Expert Rationale:
A boggy fundus is a common cause of postpartum hemorrhage.
Immediate fundal massage is crucial to stimulate uterine contraction and
mitigate the risk of significant blood loss. The nurse should also call for
assistance given the severity of the situation.
,### Scenario 2
Scenario: A nurse performs the first assessment upon the client's arrival to
the postpartum unit.
Question: Where would the nurse expect to palpate the fundus?
Answer Choices:
a. 3 cm above the umbilicus.
b. 1 cm above the umbilicus.
c. To the right of the umbilicus.
d. Midway between the umbilicus and the pubic bone.
b. ANSWER:1 cm above the umbilicus.
Expert Rationale:
Within the first 12 hours postpartum, the fundus should be in the range of
1- 2 cm above the umbilicus. This indicates that the uterus is contracting
properly and is returning to its normal size.
### Scenario 3
Scenario: A postpartum client is hemorrhaging and the nurse suspects a
common cause.
Question: What is the most likely reason a postpartum patient would be
hemorrhaging?
, ANSWER:Uterine atony (a "boggy" fundus).
Expert Rationale:
Uterine atony is the inability of the uterus to contract effectively, which is
a leading cause of postpartum hemorrhage. This condition causes the
blood vessels at the placental site to remain open, leading to significant
blood loss.
---
### Scenario 4
Scenario: After massaging the fundus, the nurse calls for help.
Question: What should be assessed immediately after fundus is
massaged?
ANSWER:Assess for bladder distention.
Expert Rationale:
A full bladder can impede uterine contraction, which may exacerbate
bleeding. It is essential to assess for bladder distention to ensure optimal
uterine function and reduce the risk of hemorrhage.
### Scenario 5
Scenario: The nurse conducts a gestational age assessment of a newborn.
Obstetrics/Maternity
Case Study
(NGN-Style & Case Scenario)
Below is a :
set of structured questions aligned with
the NCLEX Next-Generation (NGN) style,
complete with scenarios, vital signs,
questions, answer choices, correct answers, and expert
rationales
,### Scenario 1
Scenario: Fifteen minutes after the initial assessment, the nurse finds the
client disoriented and lying on her back in a pool of vaginal blood, with
the sheets beneath her saturated with blood.
Vital Signs:
- Blood Pressure: 90/50 mmHg
- Heart Rate: 120 bpm
Question: Which action is most important for the nurse to implement
immediately?
Answer Choices:
a. Take vital signs.
b. Massage the fundus.
c. Check the bladder.
d. Increase the IV rate.
ANSWER:b. Massage the fundus.
Expert Rationale:
A boggy fundus is a common cause of postpartum hemorrhage.
Immediate fundal massage is crucial to stimulate uterine contraction and
mitigate the risk of significant blood loss. The nurse should also call for
assistance given the severity of the situation.
,### Scenario 2
Scenario: A nurse performs the first assessment upon the client's arrival to
the postpartum unit.
Question: Where would the nurse expect to palpate the fundus?
Answer Choices:
a. 3 cm above the umbilicus.
b. 1 cm above the umbilicus.
c. To the right of the umbilicus.
d. Midway between the umbilicus and the pubic bone.
b. ANSWER:1 cm above the umbilicus.
Expert Rationale:
Within the first 12 hours postpartum, the fundus should be in the range of
1- 2 cm above the umbilicus. This indicates that the uterus is contracting
properly and is returning to its normal size.
### Scenario 3
Scenario: A postpartum client is hemorrhaging and the nurse suspects a
common cause.
Question: What is the most likely reason a postpartum patient would be
hemorrhaging?
, ANSWER:Uterine atony (a "boggy" fundus).
Expert Rationale:
Uterine atony is the inability of the uterus to contract effectively, which is
a leading cause of postpartum hemorrhage. This condition causes the
blood vessels at the placental site to remain open, leading to significant
blood loss.
---
### Scenario 4
Scenario: After massaging the fundus, the nurse calls for help.
Question: What should be assessed immediately after fundus is
massaged?
ANSWER:Assess for bladder distention.
Expert Rationale:
A full bladder can impede uterine contraction, which may exacerbate
bleeding. It is essential to assess for bladder distention to ensure optimal
uterine function and reduce the risk of hemorrhage.
### Scenario 5
Scenario: The nurse conducts a gestational age assessment of a newborn.
