Relias: Nursing Care of the Patient with
Obstetric and Postpartum Hemorrhage
Assessment
Question 1 of 63
During a cesarean, the provider communicates that the drapes have been suctioned out
prior to the delivery of the placenta.
The nurse notes the suction canister has 350 mL of blood-tinged fluid in it. The nurse
quickly switches to a new suction canister prior to the delivery of the placenta. As the
fascia is closed, the provider again suctions the drape, and the nurse notes 600 mL of
blood in the new canister.
Twenty sponges in 4 sponge counter bags are weighed with a total amount of 400 g.
The nurse knows the dry weight of 20 sponges and 4 counter bags is 250 g.
What amount of quantitative blood loss does the nurse record for this birth?
Select an answer.
• 600 mL
1350 ml
• 750°mL
• 1100 mL - Correct answer• 750°mL
Early nursing interventions in a Stage 1 hemorrhage include:
Select an answer.
• Administering uterotonics, drawing labs, and moving to the OR
• Massaging the fundus, ambulating the patient, and quantifying blood loss
• Massaging the fundus, emptying the bladder, and quantifying blood loss
O Evaluating vital signs, assessing for cervical lacerations, and administering IV fluids -
Correct answer• Massaging the fundus, emptying the bladder, and quantifying
blood loss
Ms. Diaz expels a grapefruit-sized clot. The nurse massages Ms. Diaz fundus and
informs the physician that the patient has entered Stage 2 of hemorrhage. The
physician states, "Let's just watch her over the next hour."
What should the prudent nurse do?
Select an answer.
• State that for a Stage 2 hemorrhage, the protocol recommends that the provider
evaluates the patient and orders a uterotonic.
O Follow the physician's order, as it is the physician's call, not the nurse's.
• Tell the patient that the doctor does not seem to think her bleeding is concerning.
,• Ask the senior nurse what to do, and follow that advice. - Correct answer• State
that for a Stage 2 hemorrhage, the protocol recommends that the provider evaluates the
patient and orders a uterotonic.
A hemorrhage risk assessment is completed:
SATA
1. Upon admission
2. Throughout labor, as risk factors develop
3. Prior to birth
4. Hourly in labor - Correct answer1. Upon admission
2. Throughout labor, as risk factors develop
3. Prior to birth
Question 15 of 63
The nurse reports that the quantitative blood loss (QBL) from the under-buttocks drape
after the vaginal birth is 745 mL after dry weights and pre-placental fluids have been
subtracted. Prior to the provider leaving the room, the obstetric team decides to re-
evaluate bleeding, fundal height, and vital signs. The decision for heightened
surveillance is made because:
Select an answer.
a. The team mistakenly diagnoses a hemorrhage despite the fact that QBL is <1000 mL.
b. Cumulative QBL is not accurate enough to diagnose obstetric hemorrhage.
c. The team correctly identifies 745 mL as an abnormal amount of blood loss for a
vaginal birth, warranting close monitoring.
d. Some providers are more cautious than others, and management depends on the
individual provider. - Correct answerc. The team correctly identifies 745 mL as an
abnormal amount of blood loss for a vaginal birth, warranting close monitoring.
Though the standard definition of a hemorrhage is blood loss >1000 mL, blood loss
>500 mL is abnormal in a vaginal birth and warrants close monitoring. This is
considered a Stage 1 hemorrhage on AWHONN's hemorrhage staging system.
Initial interventions to manage hemorrhage are appropriate after 500 mL blood loss in a
vaginal birth (Association of Women's Health, Obstetric and Neonatal Nurses 2021a).
QBL should be the main trigger to help guide management of a hemorrhage.
Standardized protocols help limit variances due to different providers.
A cumulative quantitative blood loss after a vaginal birth that is 600 mL is considered
what stage of hemorrhage?
Select an answer.
• Severe hemorrhage
• Stage 1 hemorrhage
, • Stage 3 hemorrhage
• Is not staged because it is <1000 mL - Correct answer• Stage 1 hemorrhage
Which of the following nursing interventions should be performed in collaboration with
other interventions during a Stage 1 obstetric hemorrhage?
Select all that apply.
1 Keep the patient warm using warmed fluids and warmer devices.
2 Directy quantify blood loss (OBL) and communicate cumulative QBL.
3 Aggressively replace blood loss with an equal amount of crystalloid fluids.
4 Avoid the use of a bladder catheter to limit the risk of infection. - Correct
answer1 Keep the patient warm using warmed fluids and warmer devices.
2 Directy quantify blood loss (OBL) and communicate cumulative QBL.
Ms. Nguyen has continued uterine atony and a Stage 1 hemorrhage after her vaginal
birth, despite administration of methylergonovine maleate. Which of the medications
listed might the nurse expect the physician to order next?
Select an answer.
• A second dose of methylergonovine maleate
• Carboprost
• Terbutaline
• Tranexamic acid - Correct answer• Carboprost
If oxytocin and methylergonovine maleate have been unsuccessful in treating her
uterine atony, the next medication to administer is carboprost.
Tranexamic acid (TXA) will be the medication of choice in a Stage 2 hemorrhage, so it
may be requested after the carboprost (American College of Obstetricians and
Gynecologists 2020; Association of Women's Health, Obstetric and Neonatal Nurses
2021). Terbutaline is a tocolytic medication that would relax the uterus and is
contraindicated as the goal of treatment is to contract the uterus,
Decreased platelet count can manifest itself by seeing which signs in a patient?
Select all that apply.
• Blood leaking at her IV site
Oozing at the incision site
• Thin lochia with a firm uterus
• Clots on the peripad - Correct answer
Question 25 of 63
The nurse has communicated the patient's quantitative blood loss of 1400 mL,
indicating she is experiencing a Stage 2 hemorrhage. The etiology seems to be
continued uterine atony despite the use of fundal massage and uterotonic medications.
Obstetric and Postpartum Hemorrhage
Assessment
Question 1 of 63
During a cesarean, the provider communicates that the drapes have been suctioned out
prior to the delivery of the placenta.
The nurse notes the suction canister has 350 mL of blood-tinged fluid in it. The nurse
quickly switches to a new suction canister prior to the delivery of the placenta. As the
fascia is closed, the provider again suctions the drape, and the nurse notes 600 mL of
blood in the new canister.
Twenty sponges in 4 sponge counter bags are weighed with a total amount of 400 g.
The nurse knows the dry weight of 20 sponges and 4 counter bags is 250 g.
What amount of quantitative blood loss does the nurse record for this birth?
Select an answer.
• 600 mL
1350 ml
• 750°mL
• 1100 mL - Correct answer• 750°mL
Early nursing interventions in a Stage 1 hemorrhage include:
Select an answer.
• Administering uterotonics, drawing labs, and moving to the OR
• Massaging the fundus, ambulating the patient, and quantifying blood loss
• Massaging the fundus, emptying the bladder, and quantifying blood loss
O Evaluating vital signs, assessing for cervical lacerations, and administering IV fluids -
Correct answer• Massaging the fundus, emptying the bladder, and quantifying
blood loss
Ms. Diaz expels a grapefruit-sized clot. The nurse massages Ms. Diaz fundus and
informs the physician that the patient has entered Stage 2 of hemorrhage. The
physician states, "Let's just watch her over the next hour."
What should the prudent nurse do?
Select an answer.
• State that for a Stage 2 hemorrhage, the protocol recommends that the provider
evaluates the patient and orders a uterotonic.
O Follow the physician's order, as it is the physician's call, not the nurse's.
• Tell the patient that the doctor does not seem to think her bleeding is concerning.
,• Ask the senior nurse what to do, and follow that advice. - Correct answer• State
that for a Stage 2 hemorrhage, the protocol recommends that the provider evaluates the
patient and orders a uterotonic.
A hemorrhage risk assessment is completed:
SATA
1. Upon admission
2. Throughout labor, as risk factors develop
3. Prior to birth
4. Hourly in labor - Correct answer1. Upon admission
2. Throughout labor, as risk factors develop
3. Prior to birth
Question 15 of 63
The nurse reports that the quantitative blood loss (QBL) from the under-buttocks drape
after the vaginal birth is 745 mL after dry weights and pre-placental fluids have been
subtracted. Prior to the provider leaving the room, the obstetric team decides to re-
evaluate bleeding, fundal height, and vital signs. The decision for heightened
surveillance is made because:
Select an answer.
a. The team mistakenly diagnoses a hemorrhage despite the fact that QBL is <1000 mL.
b. Cumulative QBL is not accurate enough to diagnose obstetric hemorrhage.
c. The team correctly identifies 745 mL as an abnormal amount of blood loss for a
vaginal birth, warranting close monitoring.
d. Some providers are more cautious than others, and management depends on the
individual provider. - Correct answerc. The team correctly identifies 745 mL as an
abnormal amount of blood loss for a vaginal birth, warranting close monitoring.
Though the standard definition of a hemorrhage is blood loss >1000 mL, blood loss
>500 mL is abnormal in a vaginal birth and warrants close monitoring. This is
considered a Stage 1 hemorrhage on AWHONN's hemorrhage staging system.
Initial interventions to manage hemorrhage are appropriate after 500 mL blood loss in a
vaginal birth (Association of Women's Health, Obstetric and Neonatal Nurses 2021a).
QBL should be the main trigger to help guide management of a hemorrhage.
Standardized protocols help limit variances due to different providers.
A cumulative quantitative blood loss after a vaginal birth that is 600 mL is considered
what stage of hemorrhage?
Select an answer.
• Severe hemorrhage
• Stage 1 hemorrhage
, • Stage 3 hemorrhage
• Is not staged because it is <1000 mL - Correct answer• Stage 1 hemorrhage
Which of the following nursing interventions should be performed in collaboration with
other interventions during a Stage 1 obstetric hemorrhage?
Select all that apply.
1 Keep the patient warm using warmed fluids and warmer devices.
2 Directy quantify blood loss (OBL) and communicate cumulative QBL.
3 Aggressively replace blood loss with an equal amount of crystalloid fluids.
4 Avoid the use of a bladder catheter to limit the risk of infection. - Correct
answer1 Keep the patient warm using warmed fluids and warmer devices.
2 Directy quantify blood loss (OBL) and communicate cumulative QBL.
Ms. Nguyen has continued uterine atony and a Stage 1 hemorrhage after her vaginal
birth, despite administration of methylergonovine maleate. Which of the medications
listed might the nurse expect the physician to order next?
Select an answer.
• A second dose of methylergonovine maleate
• Carboprost
• Terbutaline
• Tranexamic acid - Correct answer• Carboprost
If oxytocin and methylergonovine maleate have been unsuccessful in treating her
uterine atony, the next medication to administer is carboprost.
Tranexamic acid (TXA) will be the medication of choice in a Stage 2 hemorrhage, so it
may be requested after the carboprost (American College of Obstetricians and
Gynecologists 2020; Association of Women's Health, Obstetric and Neonatal Nurses
2021). Terbutaline is a tocolytic medication that would relax the uterus and is
contraindicated as the goal of treatment is to contract the uterus,
Decreased platelet count can manifest itself by seeing which signs in a patient?
Select all that apply.
• Blood leaking at her IV site
Oozing at the incision site
• Thin lochia with a firm uterus
• Clots on the peripad - Correct answer
Question 25 of 63
The nurse has communicated the patient's quantitative blood loss of 1400 mL,
indicating she is experiencing a Stage 2 hemorrhage. The etiology seems to be
continued uterine atony despite the use of fundal massage and uterotonic medications.
