NUR 254 Exam 2 | Actual Exam Questions and
Answers | 2026 Update | 100% Correct
‣ Early Maternal Assessment -✓✓Vital Signs
Fundal, Lochia, Perineum Assessment
‣ Rubra -✓✓Bright Red
1-3 days
‣ Serosa -✓✓Pinkish-brown
4-10 days
‣ Alba -✓✓Whitish-yellow
10-14 days, can last 3-6 weeks
‣ Temperature above 100.4 -✓✓Probable infection
‣ Blood Pressure postpartum -✓✓Monitor for preeclampsia
Assess for hypotension
BP drops possible hemorrhaging
‣ Lochia that is continued flowing -✓✓Indicates endometritis
‣ Uterus -✓✓Involution
Within 24 hours at umbilicus
2 weeks postpartum should not be felt
‣ BUBBLE-HE -✓✓Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy
Hemorrhoids
Emotional Status
, ‣ Uterus is boggy -✓✓Massage fundus
Use restroom
‣ COLA -✓✓Color
Odor
Last Void/BM
Amount
‣ Heavy Bleeding -✓✓Saturated in 15 minutes or less & pooling of blood requires
immediate intervention & notifying MD
‣ REEDA -✓✓redness, edema, ecchymosis, drainage, approximation
Can lead to infection
‣ Return to nonpregnant state -✓✓Increased HR
Decreased Blood Volume
Increased Sweating
‣ Promoting Recovery & self care -✓✓-Activity and rest
-Nourishment
-Elimination
-Perineal care
‣ Adolescents -✓✓Consumed with themselves
Someone else is caring for baby
Needs extra encouragement
‣ AMA -✓✓Gestational Conditions
‣ Rubins Maternal Tasks Phase 1 -✓✓Taking in
Taking a minute to understand she had a baby
‣ Rubins Maternal Tasks Phase 2 -✓✓Taking Hold
Doing baby's care & feeding
‣ Rubins Maternal Tasks Phase 3 -✓✓Letting Go
Letting others hold or care for baby
Answers | 2026 Update | 100% Correct
‣ Early Maternal Assessment -✓✓Vital Signs
Fundal, Lochia, Perineum Assessment
‣ Rubra -✓✓Bright Red
1-3 days
‣ Serosa -✓✓Pinkish-brown
4-10 days
‣ Alba -✓✓Whitish-yellow
10-14 days, can last 3-6 weeks
‣ Temperature above 100.4 -✓✓Probable infection
‣ Blood Pressure postpartum -✓✓Monitor for preeclampsia
Assess for hypotension
BP drops possible hemorrhaging
‣ Lochia that is continued flowing -✓✓Indicates endometritis
‣ Uterus -✓✓Involution
Within 24 hours at umbilicus
2 weeks postpartum should not be felt
‣ BUBBLE-HE -✓✓Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy
Hemorrhoids
Emotional Status
, ‣ Uterus is boggy -✓✓Massage fundus
Use restroom
‣ COLA -✓✓Color
Odor
Last Void/BM
Amount
‣ Heavy Bleeding -✓✓Saturated in 15 minutes or less & pooling of blood requires
immediate intervention & notifying MD
‣ REEDA -✓✓redness, edema, ecchymosis, drainage, approximation
Can lead to infection
‣ Return to nonpregnant state -✓✓Increased HR
Decreased Blood Volume
Increased Sweating
‣ Promoting Recovery & self care -✓✓-Activity and rest
-Nourishment
-Elimination
-Perineal care
‣ Adolescents -✓✓Consumed with themselves
Someone else is caring for baby
Needs extra encouragement
‣ AMA -✓✓Gestational Conditions
‣ Rubins Maternal Tasks Phase 1 -✓✓Taking in
Taking a minute to understand she had a baby
‣ Rubins Maternal Tasks Phase 2 -✓✓Taking Hold
Doing baby's care & feeding
‣ Rubins Maternal Tasks Phase 3 -✓✓Letting Go
Letting others hold or care for baby
