ATI RN Maternal Newborn Exam 2023/2025 with NGN – 70
Questions and Ansẉers with Expert-Verified Explanation
2026 update
NGN Unfolding Case Study 1 – Postpartum Hemorrhage
(Questions 1–12)
Scenario: A nurse is caring for a client who is 1 hour postpartum after a vaginal delivery
of a 9 lb 4 oz newborn. The client's fundus is boggy and displaced to the right. Lochia is
heavy with large clots.
1. Which of the following actions should the nurse take first?
A) Massage the fundus
B) Assist the client to void
C) Administer oxytocin
D) Notify the provider
Correct Answer: B
Rationale: A boggy, displaced fundus often indicates a full bladder. The nurse should
first have the client void (or catheterize). After voiding, reassess fundal tone.
2. The client voids 500 mL. After voiding, the fundus remains boggy. The nurse
massages the fundus and it becomes firm. Which of the following medications
should the nurse anticipate administering?
A) Methylergonovine (Methergine)
B) Oxytocin (Pitocin)
C) Carboprost (Hemabate)
D) Misoprostol (Cytotec)
Correct Answer: B
Rationale: Oxytocin is the first-line medication for postpartum hemorrhage due to
uterine atony.
,3. The client's blood pressure is 90/50 mm Hg and heart rate is 125 bpm. Which of
the following is the priority action?
A) Administer oxygen
B) Start a second IV line
C) Notify the provider
D) All of the above
Correct Answer: D
Rationale: The client is showing signs of hypovolemic shock. The nurse should
administer oxygen, start a second IV line for fluid resuscitation, and notify the provider.
4. The provider orders methylergonovine (Methergine). Which of the following
conditions would contraindicate this medication?
A) Postpartum hemorrhage
B) Hypertension
C) Uterine atony
D) Breastfeeding
Correct Answer: B
Rationale: Methylergonovine is contraindicated in hypertension because it causes
vasoconstriction and can worsen blood pressure.
5. The nurse administers oxytocin and methylergonovine, but bleeding continues.
Which of the following medications should the nurse prepare to administer next?
A) Magnesium sulfate
B) Betamethasone
C) Misoprostol (Cytotec)
D) Terbutaline
Correct Answer: C
Rationale: Misoprostol is a prostaglandin analogue used for postpartum hemorrhage
when other uterotonics fail. It can be given rectally.
,6. The client's estimated blood loss is 1,500 mL. Which of the following laboratory
values should the nurse expect?
A) Hemoglobin 12 g/dL
B) Hemoglobin 7 g/dL
C) Platelets 300,000/mm³
D) White blood cells 8,000/mm³
Correct Answer: B
Rationale: Significant blood loss (1,500 mL) would cause a drop in hemoglobin. A
hemoglobin of 7 g/dL is severely low.
7. The provider orders a blood transfusion. Which of the following actions should
the nurse take before starting the transfusion?
A) Obtain informed consent
B) Verify blood type and crossmatch
C) Prime tubing with normal saline
D) All of the above
Correct Answer: D
Rationale: Before a blood transfusion, the nurse must obtain consent, verify blood type,
and prime tubing with normal saline.
8. The client receives 2 units of packed red blood cells. Which of the following
findings indicates a transfusion reaction?
A) Fever and chills
B) Back pain
C) Hypotension
D) All of the above
Correct Answer: D
Rationale: Signs of a transfusion reaction include fever, chills, back pain, hypotension,
and tachycardia.
, 9. The client's bleeding is controlled, but the fundus remains boggy with massage.
Which of the following complications should the nurse suspect?
A) Retained placental fragments
B) Uterine inversion
C) Vaginal laceration
D) Uterine rupture
Correct Answer: A
Rationale: A boggy fundus that does not respond to massage and uterotonics may
indicate retained placental fragments.
10. The client asks about the risk of postpartum hemorrhage in future
pregnancies. Which of the following responses should the nurse give?
A) "There is no increased risk in future pregnancies."
B) "There is an increased risk of recurrence."
C) "You will need a hysterectomy before future pregnancies."
D) "You cannot have any more children."
Correct Answer: B
Rationale: Women who have experienced postpartum hemorrhage have an increased
risk of recurrence.
11. Which of the following are risk factors for postpartum hemorrhage? (Select all
that apply)
A) Uterine atony
B) Prolonged labor
C) Macrosomia (large baby)
D) Primigravida
E) Multiple gestation
Correct Answers: A, B, C, E
Rationale: Risk factors include uterine atony, prolonged labor, macrosomia, multiple
gestation, and precipitous labor. Primigravida is not a risk factor.
Questions and Ansẉers with Expert-Verified Explanation
2026 update
NGN Unfolding Case Study 1 – Postpartum Hemorrhage
(Questions 1–12)
Scenario: A nurse is caring for a client who is 1 hour postpartum after a vaginal delivery
of a 9 lb 4 oz newborn. The client's fundus is boggy and displaced to the right. Lochia is
heavy with large clots.
1. Which of the following actions should the nurse take first?
A) Massage the fundus
B) Assist the client to void
C) Administer oxytocin
D) Notify the provider
Correct Answer: B
Rationale: A boggy, displaced fundus often indicates a full bladder. The nurse should
first have the client void (or catheterize). After voiding, reassess fundal tone.
2. The client voids 500 mL. After voiding, the fundus remains boggy. The nurse
massages the fundus and it becomes firm. Which of the following medications
should the nurse anticipate administering?
A) Methylergonovine (Methergine)
B) Oxytocin (Pitocin)
C) Carboprost (Hemabate)
D) Misoprostol (Cytotec)
Correct Answer: B
Rationale: Oxytocin is the first-line medication for postpartum hemorrhage due to
uterine atony.
,3. The client's blood pressure is 90/50 mm Hg and heart rate is 125 bpm. Which of
the following is the priority action?
A) Administer oxygen
B) Start a second IV line
C) Notify the provider
D) All of the above
Correct Answer: D
Rationale: The client is showing signs of hypovolemic shock. The nurse should
administer oxygen, start a second IV line for fluid resuscitation, and notify the provider.
4. The provider orders methylergonovine (Methergine). Which of the following
conditions would contraindicate this medication?
A) Postpartum hemorrhage
B) Hypertension
C) Uterine atony
D) Breastfeeding
Correct Answer: B
Rationale: Methylergonovine is contraindicated in hypertension because it causes
vasoconstriction and can worsen blood pressure.
5. The nurse administers oxytocin and methylergonovine, but bleeding continues.
Which of the following medications should the nurse prepare to administer next?
A) Magnesium sulfate
B) Betamethasone
C) Misoprostol (Cytotec)
D) Terbutaline
Correct Answer: C
Rationale: Misoprostol is a prostaglandin analogue used for postpartum hemorrhage
when other uterotonics fail. It can be given rectally.
,6. The client's estimated blood loss is 1,500 mL. Which of the following laboratory
values should the nurse expect?
A) Hemoglobin 12 g/dL
B) Hemoglobin 7 g/dL
C) Platelets 300,000/mm³
D) White blood cells 8,000/mm³
Correct Answer: B
Rationale: Significant blood loss (1,500 mL) would cause a drop in hemoglobin. A
hemoglobin of 7 g/dL is severely low.
7. The provider orders a blood transfusion. Which of the following actions should
the nurse take before starting the transfusion?
A) Obtain informed consent
B) Verify blood type and crossmatch
C) Prime tubing with normal saline
D) All of the above
Correct Answer: D
Rationale: Before a blood transfusion, the nurse must obtain consent, verify blood type,
and prime tubing with normal saline.
8. The client receives 2 units of packed red blood cells. Which of the following
findings indicates a transfusion reaction?
A) Fever and chills
B) Back pain
C) Hypotension
D) All of the above
Correct Answer: D
Rationale: Signs of a transfusion reaction include fever, chills, back pain, hypotension,
and tachycardia.
, 9. The client's bleeding is controlled, but the fundus remains boggy with massage.
Which of the following complications should the nurse suspect?
A) Retained placental fragments
B) Uterine inversion
C) Vaginal laceration
D) Uterine rupture
Correct Answer: A
Rationale: A boggy fundus that does not respond to massage and uterotonics may
indicate retained placental fragments.
10. The client asks about the risk of postpartum hemorrhage in future
pregnancies. Which of the following responses should the nurse give?
A) "There is no increased risk in future pregnancies."
B) "There is an increased risk of recurrence."
C) "You will need a hysterectomy before future pregnancies."
D) "You cannot have any more children."
Correct Answer: B
Rationale: Women who have experienced postpartum hemorrhage have an increased
risk of recurrence.
11. Which of the following are risk factors for postpartum hemorrhage? (Select all
that apply)
A) Uterine atony
B) Prolonged labor
C) Macrosomia (large baby)
D) Primigravida
E) Multiple gestation
Correct Answers: A, B, C, E
Rationale: Risk factors include uterine atony, prolonged labor, macrosomia, multiple
gestation, and precipitous labor. Primigravida is not a risk factor.
