PERRY’S MATERNAL CHILD
NURSING CARE (POSTPARTUM
COMPLICATIONS) QUESTIONS AND
THEIR CORRECT ANSWERS
1. The perinatal nurse is caring for a woman in the
immediate postbirth period. Assessment reveals that
the woman is experiencing profuse bleeding. The
most likely etiology for the bleeding is:
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 after birth hemorrhage. Uterine inversion
may lead to hemorrhage, but it is not the most likely
source of this patient's bleeding. Furthermore, if the
woman is 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.
2. A primary nursing responsibility when caring for a
woman experiencing an obstetric hemorrhage
associated with uterine atony is to:
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 after birth 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 after birth
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
distention that may be preventing the uterus from
contracting properly.
3. The perinatal nurse caring for the after birth woman
understands that late postpartum hemorrhage (PPH)
is most likely caused by:
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.
4. Which woman is at greatest risk for early
postpartum hemorrhage (PPH)?
a. A primiparous woman (G 2 P 1 0 0 1) being prepared
for an emergency cesarean birth for fetal distress.
b. A woman with severe preeclampsia who is
receiving magnesium sulfate and whose labor is being
induced.
c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour
labor.
d. A primigravida in spontaneous labor with preterm
twins.
ANS: B
Magnesium sulfate administration during labor 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 C-section, the multiparous
woman with 8-hour labor, and the primigravida in
spontaneous labor do not pose risk factors or causes of
early PPH.
5. The first and most important nursing intervention
when a nurse observes profuse after birth bleeding is
to:
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 and pulse for signs
of hypovolemic shock.
NURSING CARE (POSTPARTUM
COMPLICATIONS) QUESTIONS AND
THEIR CORRECT ANSWERS
1. The perinatal nurse is caring for a woman in the
immediate postbirth period. Assessment reveals that
the woman is experiencing profuse bleeding. The
most likely etiology for the bleeding is:
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 after birth hemorrhage. Uterine inversion
may lead to hemorrhage, but it is not the most likely
source of this patient's bleeding. Furthermore, if the
woman is 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.
2. A primary nursing responsibility when caring for a
woman experiencing an obstetric hemorrhage
associated with uterine atony is to:
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 after birth 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 after birth
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
distention that may be preventing the uterus from
contracting properly.
3. The perinatal nurse caring for the after birth woman
understands that late postpartum hemorrhage (PPH)
is most likely caused by:
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.
4. Which woman is at greatest risk for early
postpartum hemorrhage (PPH)?
a. A primiparous woman (G 2 P 1 0 0 1) being prepared
for an emergency cesarean birth for fetal distress.
b. A woman with severe preeclampsia who is
receiving magnesium sulfate and whose labor is being
induced.
c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour
labor.
d. A primigravida in spontaneous labor with preterm
twins.
ANS: B
Magnesium sulfate administration during labor 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 C-section, the multiparous
woman with 8-hour labor, and the primigravida in
spontaneous labor do not pose risk factors or causes of
early PPH.
5. The first and most important nursing intervention
when a nurse observes profuse after birth bleeding is
to:
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 and pulse for signs
of hypovolemic shock.
