Maternity Nursing: Postpartum NCLEX
Practice Questions #8 | 55 Questions
1. 1. Question
A postpartum nurse is preparing to care for a woman who has just
delivered a healthy newborn infant. In the immediate postpartum
period, the nurse plans to take the woman’s vital signs:
o A. Every 30 minutes during the first hour and then every hour for
the next two hours.
o B. Every 15 minutes during the first hour and then every 30
minutes for the next two hours.
o C. Every hour for the first 2 hours and then every 4 hours.
o D. Every 5 minutes for the first 30 minutes and then every hour for
the next 4 hours.
Incorrect
Correct Answer: B. Every 15 minutes during the first hour and
then every 30 minutes for the next two hours.
The initial or acute period involves the first 6–12 hours postpartum.
This is a time of rapid change with a potential for immediate crises
such as postpartum hemorrhage, uterine inversion, amniotic fluid
embolism, and eclampsia.
Option A: The second phase is the subacute postpartum period,
which lasts 2–6 weeks. During this phase, the body is undergoing
major changes in terms of hemodynamics, genitourinary
recovery, metabolism, and emotional status. Nonetheless, the
changes are less rapid than in the acute postpartum phase and
the patient is generally capable of self-identifying problems.
These may run the gamut from ordinary concerns about perineal
discomfort to peripartum cardiomyopathy or severe postpartum
depression.
Option C: The third phase is the delayed postpartum period,
which can last up to 6 months. Changes during this phase are
extremely gradual, and pathology is rare. This period is used to
make sure the mother is stable and to educate her in the care of
, her baby (especially the first-time mother). While still in the
hospital, the mother is monitored for blood loss, signs of
infection, abnormal blood pressure, contraction of the uterus, and
ability to void. There is also attention to Rh compatibility,
maternal immunization statuses, and breastfeeding. This is the
time of restoration of muscle tone and connective tissue to the
prepregnant state. Although change is subtle during this phase, it
behooves caregivers to remember that a woman?s body is
nonetheless not fully restored to prepregnant physiology until
about 6 months post-delivery.
Option D: The immediate postpartum period most often occurs
in the hospital setting, where the majority of women remain for
approximately 2 days after a vaginal delivery and 3-4 days after
a cesarean delivery. During this time, women are recovering from
their delivery and are beginning to care for the newborn.
2. 2. Question
A postpartum nurse is taking the vital signs of a woman who delivered
a healthy newborn infant 4 hours ago. The nurse notes that the
mother’s temperature is 100.2°F. Which of the following actions would
be most appropriate?
A. Retake the temperature in 15 minutes.
B. Notify the physician.
C. Document the findings.
D. Increase hydration by encouraging oral fluids
Incorrect
Correct Answer: D. Increase hydration by encouraging oral
fluids.
The mother’s temperature may be taken every 4 hours while she is
awake. Temperatures up to 100.4 F (38 C) in the first 24 hours after
birth are often related to the dehydrating effects of labor. The most
appropriate action is to increase hydration by encouraging oral fluids,
which should bring the temperature to a normal reading.
Option A: A focused physical examination is important and
should include vital signs, an examination of the respiratory
system, breasts, abdomen, perineum, and lower extremities. A
, patient with endometritis typically has a fever of 38°C or greater,
tachycardia, and fundal tenderness.
Option B: The new mother should be given discharge
instructions and expectations/precautions to consider once
leaving the hospital. The most important information is who and
where to call if she has problems or questions. She also needs
details about resuming her normal activity. Instructions vary,
depending on whether the mother has had a vaginal or a
cesarean delivery and any comorbidities that may have been part
of her care.
Option C: Although the nurse would document the findings, the
most appropriate action would be to increase the hydration. The
woman who has had a vaginal delivery may resume all physical
activity, including using stairs, riding or driving in a car, and
performing muscle-toning exercises, as long as she experiences
no limiting pain or discomfort. The key counseling is to
progressively resume normal activity while being mindful of the
common fatigue and exhaustion experienced while caring for a
newborn.
3. 3. Question
The nurse is assessing a client who is 6 hours PP after delivering a full-
term healthy infant. The client complains to the nurse of feelings of
faintness and dizziness. Which of the following nursing actions would
be most appropriate?
A. Obtain hemoglobin and hematocrit levels.
B. Instruct the mother to request help when getting out of
bed.
C. Elevate the mother’s legs.
D. Inform the nursery room nurse to avoid bringing the newborn
infant to the mother until the feelings of lightheadedness and dizziness
have subsided.
Incorrect
Correct Answer: B. Instruct the mother to request help when
getting out of bed.
Orthostatic hypotension may be evident during the first 8 hours after
birth. Feelings of faintness or dizziness are signs that should caution
, the nurse to be aware of the client’s safety. The nurse should advise
the mother to get help the first few times the mother gets out of bed.
Option A: Obtaining an H/H requires a physician’s order. This is a
blood test that checks the percent of the blood (called whole
blood) that’s made up of red blood cells. Bleeding can cause a
low hematocrit.
Option C: With PPH, the client can lose much more blood, which
is what makes it a dangerous condition. PPH can cause a severe
drop in blood pressure. If not treated quickly, this can lead to
shock and death. Shock is when the body organs don’t get
enough blood flow.
Option D: Postpartum hemorrhage (also called PPH) is when a
woman has heavy bleeding after giving birth. It’s a serious but
rare condition. It usually happens within 1 day of giving birth, but
it can happen up to 12 weeks after having a baby. About 1 to 5 in
100 women who have a baby (1 to 5 percent) have PPH.
4. 4. Question
A nurse is preparing to perform a fundal assessment on a postpartum
client. The initial nursing action in performing this assessment is
which of the following?
A. Ask the client to turn on her side.
B. Ask the client to lie flat on her back with the knees and legs flat
and straight.
C. Ask the mother to urinate and empty her bladder.
D. Massage the fundus gently before determining the level of the
fundus.
Incorrect
Correct Answer: C. Ask the mother to urinate and empty her
bladder.
Before starting the fundal assessment, the nurse should ask the
mother to empty her bladder so that an accurate assessment can be
done. The postpartum recovery period covers the time period from
birth until approximately six to eight weeks after delivery. This is a
time of healing and rejuvenation as the mother’s body returns to
prepregnancy states.
Practice Questions #8 | 55 Questions
1. 1. Question
A postpartum nurse is preparing to care for a woman who has just
delivered a healthy newborn infant. In the immediate postpartum
period, the nurse plans to take the woman’s vital signs:
o A. Every 30 minutes during the first hour and then every hour for
the next two hours.
o B. Every 15 minutes during the first hour and then every 30
minutes for the next two hours.
o C. Every hour for the first 2 hours and then every 4 hours.
o D. Every 5 minutes for the first 30 minutes and then every hour for
the next 4 hours.
Incorrect
Correct Answer: B. Every 15 minutes during the first hour and
then every 30 minutes for the next two hours.
The initial or acute period involves the first 6–12 hours postpartum.
This is a time of rapid change with a potential for immediate crises
such as postpartum hemorrhage, uterine inversion, amniotic fluid
embolism, and eclampsia.
Option A: The second phase is the subacute postpartum period,
which lasts 2–6 weeks. During this phase, the body is undergoing
major changes in terms of hemodynamics, genitourinary
recovery, metabolism, and emotional status. Nonetheless, the
changes are less rapid than in the acute postpartum phase and
the patient is generally capable of self-identifying problems.
These may run the gamut from ordinary concerns about perineal
discomfort to peripartum cardiomyopathy or severe postpartum
depression.
Option C: The third phase is the delayed postpartum period,
which can last up to 6 months. Changes during this phase are
extremely gradual, and pathology is rare. This period is used to
make sure the mother is stable and to educate her in the care of
, her baby (especially the first-time mother). While still in the
hospital, the mother is monitored for blood loss, signs of
infection, abnormal blood pressure, contraction of the uterus, and
ability to void. There is also attention to Rh compatibility,
maternal immunization statuses, and breastfeeding. This is the
time of restoration of muscle tone and connective tissue to the
prepregnant state. Although change is subtle during this phase, it
behooves caregivers to remember that a woman?s body is
nonetheless not fully restored to prepregnant physiology until
about 6 months post-delivery.
Option D: The immediate postpartum period most often occurs
in the hospital setting, where the majority of women remain for
approximately 2 days after a vaginal delivery and 3-4 days after
a cesarean delivery. During this time, women are recovering from
their delivery and are beginning to care for the newborn.
2. 2. Question
A postpartum nurse is taking the vital signs of a woman who delivered
a healthy newborn infant 4 hours ago. The nurse notes that the
mother’s temperature is 100.2°F. Which of the following actions would
be most appropriate?
A. Retake the temperature in 15 minutes.
B. Notify the physician.
C. Document the findings.
D. Increase hydration by encouraging oral fluids
Incorrect
Correct Answer: D. Increase hydration by encouraging oral
fluids.
The mother’s temperature may be taken every 4 hours while she is
awake. Temperatures up to 100.4 F (38 C) in the first 24 hours after
birth are often related to the dehydrating effects of labor. The most
appropriate action is to increase hydration by encouraging oral fluids,
which should bring the temperature to a normal reading.
Option A: A focused physical examination is important and
should include vital signs, an examination of the respiratory
system, breasts, abdomen, perineum, and lower extremities. A
, patient with endometritis typically has a fever of 38°C or greater,
tachycardia, and fundal tenderness.
Option B: The new mother should be given discharge
instructions and expectations/precautions to consider once
leaving the hospital. The most important information is who and
where to call if she has problems or questions. She also needs
details about resuming her normal activity. Instructions vary,
depending on whether the mother has had a vaginal or a
cesarean delivery and any comorbidities that may have been part
of her care.
Option C: Although the nurse would document the findings, the
most appropriate action would be to increase the hydration. The
woman who has had a vaginal delivery may resume all physical
activity, including using stairs, riding or driving in a car, and
performing muscle-toning exercises, as long as she experiences
no limiting pain or discomfort. The key counseling is to
progressively resume normal activity while being mindful of the
common fatigue and exhaustion experienced while caring for a
newborn.
3. 3. Question
The nurse is assessing a client who is 6 hours PP after delivering a full-
term healthy infant. The client complains to the nurse of feelings of
faintness and dizziness. Which of the following nursing actions would
be most appropriate?
A. Obtain hemoglobin and hematocrit levels.
B. Instruct the mother to request help when getting out of
bed.
C. Elevate the mother’s legs.
D. Inform the nursery room nurse to avoid bringing the newborn
infant to the mother until the feelings of lightheadedness and dizziness
have subsided.
Incorrect
Correct Answer: B. Instruct the mother to request help when
getting out of bed.
Orthostatic hypotension may be evident during the first 8 hours after
birth. Feelings of faintness or dizziness are signs that should caution
, the nurse to be aware of the client’s safety. The nurse should advise
the mother to get help the first few times the mother gets out of bed.
Option A: Obtaining an H/H requires a physician’s order. This is a
blood test that checks the percent of the blood (called whole
blood) that’s made up of red blood cells. Bleeding can cause a
low hematocrit.
Option C: With PPH, the client can lose much more blood, which
is what makes it a dangerous condition. PPH can cause a severe
drop in blood pressure. If not treated quickly, this can lead to
shock and death. Shock is when the body organs don’t get
enough blood flow.
Option D: Postpartum hemorrhage (also called PPH) is when a
woman has heavy bleeding after giving birth. It’s a serious but
rare condition. It usually happens within 1 day of giving birth, but
it can happen up to 12 weeks after having a baby. About 1 to 5 in
100 women who have a baby (1 to 5 percent) have PPH.
4. 4. Question
A nurse is preparing to perform a fundal assessment on a postpartum
client. The initial nursing action in performing this assessment is
which of the following?
A. Ask the client to turn on her side.
B. Ask the client to lie flat on her back with the knees and legs flat
and straight.
C. Ask the mother to urinate and empty her bladder.
D. Massage the fundus gently before determining the level of the
fundus.
Incorrect
Correct Answer: C. Ask the mother to urinate and empty her
bladder.
Before starting the fundal assessment, the nurse should ask the
mother to empty her bladder so that an accurate assessment can be
done. The postpartum recovery period covers the time period from
birth until approximately six to eight weeks after delivery. This is a
time of healing and rejuvenation as the mother’s body returns to
prepregnancy states.
