HESI PoStPartum ComPlICatIonS ExamInatIon (2026 uPdatE)||
QuEStIonS and anSwErS wItH ratIonalES/GradEd a+/2026
uPdatE/100% CorrECt /InStant download
Section 1: Postpartum Hemorrhage (Questions 1-8)
Question 1
A nurse is assessing a client who delivered vaginally 2 hours ago. The fundus is boggy and displaced to
the right. The perineal pad is saturated with lochia rubra. Which action should the nurse take first?
A) Notify the healthcare provider
B) Assist the client to empty her bladder
C) Administer oxytocin as ordered
D) Perform fundal massage
Answer: B) Assist the client to empty her bladder
Rationale: A displaced, boggy fundus often indicates a distended bladder displacing the uterus and
preventing effective contraction. The nurse should first assist the client to void or catheterize her to
empty the bladder. After voiding, the fundus typically returns to midline and firms. Fundal massage (D)
and oxytocin (C) may be needed after bladder emptying if the uterus remains boggy.
Question 2
A postpartum client has a firm fundus at the umbilicus and midline. The nurse notes that the client has
saturated two perineal pads in 30 minutes with bright red blood. Which condition is the most likely
cause of this bleeding?
A) Uterine atony
B) Retained placental fragments
C) Vaginal or cervical lacerations
, D) Uterine inversion
Answer: C) Vaginal or cervical lacerations
Rationale: When the fundus is firm, uterine atony (A) is unlikely. Bleeding with a firm uterus suggests
lower genital tract trauma such as vaginal or cervical lacerations. The nurse should inspect the perineum,
vagina, and cervix for lacerations or hematomas. Retained fragments (B) may cause intermittent
bleeding with a boggy uterus. Uterine inversion (D) presents with severe pain, hemorrhage, and a "cup-
shaped" dimple where the fundus should be.
Question 3
A nurse is caring for a client with postpartum hemorrhage due to uterine atony. Which medication
should the nurse anticipate as first-line treatment?
A) Methylergonovine (Methergine)
B) Carboprost (Hemabate)
C) Oxytocin (Pitocin)
D) Misoprostol (Cytotec)
Answer: C) Oxytocin (Pitocin)
Rationale: Oxytocin is the first-line uterotonic agent for postpartum hemorrhage due to uterine atony. It
is administered as an IV infusion or intramuscularly. Methylergonovine (A) is second-line but
contraindicated in hypertension. Carboprost (B) is second-line but contraindicated in asthma.
Misoprostol (D) is used when other uterotonics are unavailable or ineffective.
Question 4
A postpartum client with a known coagulopathy has an estimated blood loss of 1500 mL. The nurse
notes that the patient appears pale, confused, and reports feeling faint. The blood pressure is 80/50
mmHg, heart rate 130 bpm. Which action should the nurse take first?
A) Administer packed red blood cells
QuEStIonS and anSwErS wItH ratIonalES/GradEd a+/2026
uPdatE/100% CorrECt /InStant download
Section 1: Postpartum Hemorrhage (Questions 1-8)
Question 1
A nurse is assessing a client who delivered vaginally 2 hours ago. The fundus is boggy and displaced to
the right. The perineal pad is saturated with lochia rubra. Which action should the nurse take first?
A) Notify the healthcare provider
B) Assist the client to empty her bladder
C) Administer oxytocin as ordered
D) Perform fundal massage
Answer: B) Assist the client to empty her bladder
Rationale: A displaced, boggy fundus often indicates a distended bladder displacing the uterus and
preventing effective contraction. The nurse should first assist the client to void or catheterize her to
empty the bladder. After voiding, the fundus typically returns to midline and firms. Fundal massage (D)
and oxytocin (C) may be needed after bladder emptying if the uterus remains boggy.
Question 2
A postpartum client has a firm fundus at the umbilicus and midline. The nurse notes that the client has
saturated two perineal pads in 30 minutes with bright red blood. Which condition is the most likely
cause of this bleeding?
A) Uterine atony
B) Retained placental fragments
C) Vaginal or cervical lacerations
, D) Uterine inversion
Answer: C) Vaginal or cervical lacerations
Rationale: When the fundus is firm, uterine atony (A) is unlikely. Bleeding with a firm uterus suggests
lower genital tract trauma such as vaginal or cervical lacerations. The nurse should inspect the perineum,
vagina, and cervix for lacerations or hematomas. Retained fragments (B) may cause intermittent
bleeding with a boggy uterus. Uterine inversion (D) presents with severe pain, hemorrhage, and a "cup-
shaped" dimple where the fundus should be.
Question 3
A nurse is caring for a client with postpartum hemorrhage due to uterine atony. Which medication
should the nurse anticipate as first-line treatment?
A) Methylergonovine (Methergine)
B) Carboprost (Hemabate)
C) Oxytocin (Pitocin)
D) Misoprostol (Cytotec)
Answer: C) Oxytocin (Pitocin)
Rationale: Oxytocin is the first-line uterotonic agent for postpartum hemorrhage due to uterine atony. It
is administered as an IV infusion or intramuscularly. Methylergonovine (A) is second-line but
contraindicated in hypertension. Carboprost (B) is second-line but contraindicated in asthma.
Misoprostol (D) is used when other uterotonics are unavailable or ineffective.
Question 4
A postpartum client with a known coagulopathy has an estimated blood loss of 1500 mL. The nurse
notes that the patient appears pale, confused, and reports feeling faint. The blood pressure is 80/50
mmHg, heart rate 130 bpm. Which action should the nurse take first?
A) Administer packed red blood cells
