MATERNAL AND PEDIATRIC NURSING
– MIDTERM EXAM WITH 100%
CORRECT ANSWERS 2026
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?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration 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?
a. Establish venous access.
b. Perform fundal massage.
,c. Prepare the woman for surgical intervention.
d. Catheterize the bladder. ANS: B
The initial management of excessive postpartum bleeding is firm
massage of the uterine fundus. Although establishing venous
access may be a necessary 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)?
a. Subinvolution of the placental site
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders 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. A primiparous woman being prepared for an emergency
Caesarean birth for fetal distress
b. A woman with severe pre-eclampsia on magnesium sulphate
whose labour is being induced
c. A multiparous woman with an 8-hour labour
,d. A primigravida in spontaneous labour with preterm twins 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.
What is the initial priority nursing intervention when a nurse
observes profuse postpartum bleeding?
a. Call the woman's primary health care provider.
b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure (BP) and pulse for signs of
hypovolemic shock. 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?
a. Absence of cyanosis in the buccal mucosa
b. Cool dry skin
c. Diminished restlessness
, d. Urinary output of at least 30 mL/hr 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?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal bleeding with ambulation
d. Temperature of 38.6° C 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?
a. Washing the nipples and breasts with mild soap and water once
a day
b. Using proper breastfeeding techniques
– MIDTERM EXAM WITH 100%
CORRECT ANSWERS 2026
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?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration 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?
a. Establish venous access.
b. Perform fundal massage.
,c. Prepare the woman for surgical intervention.
d. Catheterize the bladder. ANS: B
The initial management of excessive postpartum bleeding is firm
massage of the uterine fundus. Although establishing venous
access may be a necessary 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)?
a. Subinvolution of the placental site
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders 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. A primiparous woman being prepared for an emergency
Caesarean birth for fetal distress
b. A woman with severe pre-eclampsia on magnesium sulphate
whose labour is being induced
c. A multiparous woman with an 8-hour labour
,d. A primigravida in spontaneous labour with preterm twins 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.
What is the initial priority nursing intervention when a nurse
observes profuse postpartum bleeding?
a. Call the woman's primary health care provider.
b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure (BP) and pulse for signs of
hypovolemic shock. 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?
a. Absence of cyanosis in the buccal mucosa
b. Cool dry skin
c. Diminished restlessness
, d. Urinary output of at least 30 mL/hr 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?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal bleeding with ambulation
d. Temperature of 38.6° C 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?
a. Washing the nipples and breasts with mild soap and water once
a day
b. Using proper breastfeeding techniques
