MIDTERM Exam : NUR2513/ NUR 2513
(Latest 2025/ 2026) Maternal-Child Nursing Exam | Questions and Verified Answers| Graded A - Rasmussen The perinatal nurse's assessment while caring for a woman in the immediate post birth period reveals that the woman is experiencing profuse bleeding. What is the most likely etiology for her bleeding?
- Uterine atony
- Uterine inversion
- Vaginal hematoma
d. Vaginal laceration - ANSWER ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorrhage but it is not the most likely source of this woman's bleeding. Furthermore if the woman were experiencing a uterine inversion it would be evidenced by the presence of a large red rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However the most likely clinical finding would be pain not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm contracted uterine fundus.Which is a primary nursing responsibility when caring for a woman experiencing an obstetrical hemorrhage associated with uterine atony?
- Establish venous access.
- Perform fundal massage.
- Prepare the woman for surgical intervention.
d. Catheterize the bladder. - ANSWER ANS: B
The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Although establishing venous access may be a necessary 1 / 4
intervention the initial intervention would be fundal massage. The woman may need surgical intervention to treat her postpartum hemorrhage but the initial nursing intervention would be to assess the uterus. After uterine massage the nurse may want to catheterize the patient to eliminate any bladder distension that may be preventing the uterus from contracting properly.Which is the most likely cause of late postpartum hemorrhage (PPH)?
- Subinvolution of the placental site
- Defective vascularity of the decidua
- Cervical lacerations
d. Coagulation disorders - ANSWER ANS: A
Late PPH may be the result of subinvolution of the uterus pelvic infection or retained placental fragments. Late PPH is not typically a result of defective vascularity of the decidua cervical lacerations or coagulation disorders.What woman is at greatest risk for early postpartum hemorrhage (PPH)?
- A primiparous woman being prepared for an emergency Caesarean birth for fetal
- A woman with severe pre-eclampsia on magnesium sulphate whose labour is
- A multiparous woman with an 8-hour labour
- A primigravida in spontaneous labour with preterm twins - ANSWER
distress
being induced
ANS: B
Magnesium sulphate administration during labour poses a risk for PPH.Magnesium acts as a smooth muscle relaxant thereby contributing to uterine relaxation and atony. Although many causes and risk factors are associated with PPH the primiparous woman being prepared for an emergency Caesarian birth the multiparous woman with 8-hour labour and the primigravida in spontaneous labour are not at risk for early PPH. 2 / 4
What is the initial priority nursing intervention when a nurse observes profuse postpartum bleeding?
- Call the woman's primary health care provider.
- Administer the standing order for an oxytocic.
- Palpate the uterus and massage it if it is boggy.
- Assess maternal blood pressure (BP) and pulse for signs of hypovolemic shock.
- ANSWER ANS: C
The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Although calling the health care provider administering an oxytocic and assessing maternal BP are appropriate interventions the primary intervention should be to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage.What is the most objective and least invasive assessment of adequate organ perfusion and oxygenation when caring for a postpartum woman experiencing hemorrhagic shock?
- Absence of cyanosis in the buccal mucosa
- Cool dry skin
- Diminished restlessness
- Urinary output of at least 30 mL/hr - ANSWER ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective in nature. The presence of cool pale clammy skin would be an indicative finding associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy not restlessness.Which is one of the first symptoms of puerperal infection to assess for in the postpartum woman? 3 / 4
- Fatigue continuing for longer than 1 week
- Pain with voiding
- Profuse vaginal bleeding with ambulation
d. Temperature of 38.6° C - ANSWER ANS: D
Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage induced abortion or childbirth. A temperature greater than 38° C warrants further investigation for a puerperal infection. Fatigue would be a late finding associated with infection. Pain with voiding may indicate a urinary tract infection but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis but it is not the first symptom associated with infection.The perinatal nurse assisting with establishing lactation is aware that which action can minimize acute mastitis?
- Washing the nipples and breasts with mild soap and water once a day
- Using proper breastfeeding techniques
- Wearing a nipple shield for the first few days of breastfeeding
- Wearing a supportive bra 24 hours a day - ANSWER ANS:
- PPH is easy to recognize early after all the woman is bleeding.
- Traditionally it takes more than 1000 mL of blood after vaginal birth and 2500
- If anything nurses and doctors tend to overestimate the amount of blood loss.
- / 4
B Almost all instances of acute mastitis can be avoided by using proper breastfeeding technique to prevent cracked nipples. Washing the nipples and breasts daily is no longer indicated. In fact this can cause tissue dryness and irritation which can lead to tissue breakdown and infection. Wearing a nipple shield does not prevent mastitis. Wearing a supportive bra 24 hours a day may contribute to mastitis especially if an underwire bra is worn because it may put pressure on the upper outer area of the breast contributing to blocked ducts and mastitis.Which statement is true with regard to postpartum hemorrhage (PPH)?
mL after Caesarean birth to define the condition as PPH.