NUR 230/ NUR230 Exam 2 – Concepts
of Nursing: The Childbearing/Child
Caring Family Review ACTUAL EXAM
2026/2027 | Childbearing/Child Caring
Family | Verified Q&A | Pass Guaranteed
- A+ Graded
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PART A – MULTIPLE CHOICE (Q1–60)
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* *Q1 (Postpartum – uterine involution):** A nurse is assessing a postpartum client on day 3 after
vaginal delivery. The client reports moderate lochia and mild uterine cramping. The nurse
palpates the fundus and notes it is located at which anatomical landmark?
A. At the level of the umbilicus
B. Three fingerbreadths below the umbilicus
C. At the level of the symphysis pubis
D. One fingerbreadth above the umbilicus
* *[CORRECT]** B
*Rationale: The uterine fundus descends approximately 1 cm (one fingerbreadth) per day
postpartum. On day 1, the fundus is at the umbilicus; by day 3, it is 2–3 fingerbreadths below
the umbilicus. The uterus returns to the pelvic cavity (non-palpable abdominally) by
approximately day 10. A fundus above the expected level suggests uterine atony, retained
placental fragments, or a full bladder. The Galen nursing student should document fundal height
and consistency at each postpartum assessment and recognize that a firm, midline fundus
indicates normal involution.*
* *Q2 (Postpartum – lochia progression):** A nurse is caring for a postpartum client on day 5.
The client asks when her lochia will change color. The nurse correctly educates the client that
lochia serosa typically appears at which time?
A. Days 1–3 postpartum
, . Days 3–10 postpartum
B
C. Days 10–14 postpartum
D. Days 14–21 postpartum
* *[CORRECT]** B
*Rationale: Lochia progresses through three stages: lochia rubra (days 1–3, bright red, bloody,
small clots), lochia serosa (days 3–10, pinkish-brown, serous), and lochia alba (days 10–14+,
white or yellow-white). Prolonged lochia rubra beyond day 3–4 suggests retained placental
fragments or infection. Foul-smelling lochia indicates endometritis. The Galen nursing student
should teach the client that lochia should not exceed one saturated peripad per hour and that
any sudden increase in bleeding (gush) requires immediate evaluation.*
* *Q3 (Postpartum – BUBBLE-HE assessment):** During the BUBBLE-HE postpartum
assessment, the nurse notes that the client's fundus is firm and located at the midline, two
fingerbreadths below the umbilicus. The lochia is moderate, rubra, and without foul odor. The
perineum shows mild edema and a well-approximated episiotomy. The nurse documents these
findings as:
A. Abnormal; requires immediate physician notification
B. Normal for a postpartum day 2 client
C. Normal for a postpartum day 10 client
D. Abnormal; indicates endometritis
* *[CORRECT]** B
*Rationale: These findings are consistent with normal postpartum recovery on day 2. A firm,
midline fundus at 1–2 fingerbreadths below the umbilicus is expected. Moderate lochia rubra
without foul odor is normal. Mild perineal edema and a well-approximated episiotomy are
expected findings. Endometritis would present with fever, uterine tenderness, and foul-smelling
lochia. The Galen nursing student should use the BUBBLE-HE mnemonic systematically:
Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans' sign, Emotional
status.*
* *Q4 (Postpartum – hemorrhage – 4 Ts):** A postpartum client begins hemorrhaging 2 hours
after delivery. The nurse recognizes that the most common cause of early postpartum
hemorrhage is:
A. Trauma to the birth canal
B. Tissue (retained placental fragments)
C. Tone (uterine atony)
D. Thrombin (coagulopathy)
* *[CORRECT]** C
*Rationale: Uterine atony (Tone) accounts for approximately 80% of all postpartum
hemorrhages and is the most common cause of early PPH (within the first 24 hours). The uterus
fails to contract effectively, leading to bleeding from the placental site. The 4 Ts mnemonic helps
identify causes: Tone (atony), Trauma (lacerations, hematomas), Tissue (retained placenta), and
, hrombin (coagulopathy). The Galen nursing student should remember the 4 Ts and know that
T
fundal massage and uterotonic agents are first-line treatments for uterine atony.*
* *Q5 (Postpartum – endometritis):** A postpartum client on day 3 presents with a temperature of
38.5C (101.3F), uterine tenderness, and foul-smelling lochia. The nurse suspects endometritis.
The priority nursing intervention is:
A. Administer broad-spectrum IV antibiotics as ordered
B. Apply ice packs to the perineum for comfort
C. Encourage early ambulation to promote drainage
D. Discontinue breastfeeding until the infection resolves
* *[CORRECT]** A
*Rationale: Endometritis is a postpartum uterine infection typically caused by polymicrobial
ascending infection. The priority intervention is administration of broad-spectrum IV antibiotics
(e.g., clindamycin + gentamicin, or ampicillin-sulbactam) per physician orders. Ice packs
address perineal discomfort, not uterine infection. Early ambulation is important for preventing
DVT but does not treat endometritis. Breastfeeding should continue; most antibiotics are
compatible with breastfeeding (check LactMed). The Galen nursing student should recognize
the triad of fever, uterine tenderness, and foul lochia as diagnostic of endometritis and act
promptly to prevent sepsis.*
* *Q6 (Postpartum – mastitis):** A breastfeeding postpartum client at 2 weeks presents with a
painful, erythematous area on the right breast, fever of 38.8C (101.8F), and flu-like symptoms.
The nurse's priority teaching includes:
A. Stop breastfeeding from the affected breast until the infection clears.
B. Continue breastfeeding or pumping from the affected breast to promote drainage.
C. Apply heat to the breast only; cold will worsen the infection.
D. Mastitis always requires surgical drainage.
* *[CORRECT]** B
*Rationale: Mastitis is an infection of the breast tissue, most commonly caused by
Staphylococcus aureus (including MRSA). The priority teaching is to continue breastfeeding or
pumping from the affected breast to promote milk drainage and prevent milk stasis, which
worsens infection. Stopping breastfeeding can lead to engorgement and abscess formation.
Treatment includes antibiotics (dicloxacillin or cephalexin; clindamycin if MRSA suspected), rest,
hydration, and alternating warm compresses before feeding (to promote let-down) and cold
compresses after (to reduce inflammation). The Galen nursing student should know that mastitis
typically affects one breast unilaterally, whereas engorgement affects both breasts bilaterally.*
* *Q7 (Postpartum – DVT):** A postpartum client at 5 days after cesarean delivery reports
unilateral calf pain and swelling. The nurse performs Homans' sign assessment. Which finding
is most consistent with deep vein thrombosis (DVT)?
A. Pain with dorsiflexion of the foot
B. Pain with plantar flexion of the foot
, . Numbness and tingling in the foot
C
D. Cool, pale skin on the affected leg
* *[CORRECT]** A
*Rationale: Homans' sign is positive when pain occurs with passive dorsiflexion of the foot
(pulling the toes toward the shin), indicating calf vein inflammation. However, Homans' sign is
neither sensitive nor specific for DVT and is no longer recommended as a standalone diagnostic
tool. The nurse should also assess for calf tenderness, warmth, erythema, and unilateral
edema. The definitive diagnostic test is venous duplex ultrasound. Postpartum clients,
especially after cesarean delivery, are at increased risk for DVT due to hypercoagulability,
venous stasis, and endothelial injury (Virchow's triad). The Galen nursing student should
recognize that DVT is a medical emergency requiring immediate anticoagulation to prevent
pulmonary embolism.*
* *Q8 (Postpartum – depression):** A nurse is assessing a postpartum client at 2 weeks who
reports feeling overwhelmed, unable to sleep even when the baby sleeps, loss of appetite, and
states, I feel like I am failing as a mother. The nurse recognizes these symptoms as most
consistent with:
A. Postpartum blues
B. Postpartum depression
C. Postpartum psychosis
D. Normal postpartum adjustment
* *[CORRECT]** B
*Rationale: Postpartum depression (PPD) is characterized by persistent symptoms lasting more
than 2 weeks, including depressed mood, anhedonia, sleep disturbances (even when
opportunity exists), appetite changes, feelings of worthlessness or guilt, and difficulty bonding
with the infant. Postpartum blues (baby blues) resolve within 2 weeks and are milder.
Postpartum psychosis involves hallucinations, delusions, confusion, and agitation—this is a
psychiatric emergency. The Galen nursing student should use the Edinburgh Postnatal
Depression Scale (EPDS) for screening and recognize that PPD requires referral for
psychotherapy and possible pharmacologic intervention; safety planning is essential.*
* *Q9 (Postpartum – psychosis emergency):** A nurse receives a call from a postpartum client's
husband stating that his wife has not slept in 48 hours, is pacing and muttering that the baby is
possessed by demons, and has threatened to harm herself. The nurse's priority action is:
A. Schedule an outpatient psychiatric evaluation within 48 hours
B. Instruct the husband to bring the client to the emergency department immediately
C. Recommend the husband contact the client's obstetrician in the morning
D. Advise the husband to give the client a sedative and monitor her
* *[CORRECT]** B
*Rationale: Postpartum psychosis is a psychiatric emergency with a rapid onset (typically within
2 weeks postpartum) characterized by delusions, hallucinations, paranoia, confusion, and
of Nursing: The Childbearing/Child
Caring Family Review ACTUAL EXAM
2026/2027 | Childbearing/Child Caring
Family | Verified Q&A | Pass Guaranteed
- A+ Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
========================================================================
========
* *Q1 (Postpartum – uterine involution):** A nurse is assessing a postpartum client on day 3 after
vaginal delivery. The client reports moderate lochia and mild uterine cramping. The nurse
palpates the fundus and notes it is located at which anatomical landmark?
A. At the level of the umbilicus
B. Three fingerbreadths below the umbilicus
C. At the level of the symphysis pubis
D. One fingerbreadth above the umbilicus
* *[CORRECT]** B
*Rationale: The uterine fundus descends approximately 1 cm (one fingerbreadth) per day
postpartum. On day 1, the fundus is at the umbilicus; by day 3, it is 2–3 fingerbreadths below
the umbilicus. The uterus returns to the pelvic cavity (non-palpable abdominally) by
approximately day 10. A fundus above the expected level suggests uterine atony, retained
placental fragments, or a full bladder. The Galen nursing student should document fundal height
and consistency at each postpartum assessment and recognize that a firm, midline fundus
indicates normal involution.*
* *Q2 (Postpartum – lochia progression):** A nurse is caring for a postpartum client on day 5.
The client asks when her lochia will change color. The nurse correctly educates the client that
lochia serosa typically appears at which time?
A. Days 1–3 postpartum
, . Days 3–10 postpartum
B
C. Days 10–14 postpartum
D. Days 14–21 postpartum
* *[CORRECT]** B
*Rationale: Lochia progresses through three stages: lochia rubra (days 1–3, bright red, bloody,
small clots), lochia serosa (days 3–10, pinkish-brown, serous), and lochia alba (days 10–14+,
white or yellow-white). Prolonged lochia rubra beyond day 3–4 suggests retained placental
fragments or infection. Foul-smelling lochia indicates endometritis. The Galen nursing student
should teach the client that lochia should not exceed one saturated peripad per hour and that
any sudden increase in bleeding (gush) requires immediate evaluation.*
* *Q3 (Postpartum – BUBBLE-HE assessment):** During the BUBBLE-HE postpartum
assessment, the nurse notes that the client's fundus is firm and located at the midline, two
fingerbreadths below the umbilicus. The lochia is moderate, rubra, and without foul odor. The
perineum shows mild edema and a well-approximated episiotomy. The nurse documents these
findings as:
A. Abnormal; requires immediate physician notification
B. Normal for a postpartum day 2 client
C. Normal for a postpartum day 10 client
D. Abnormal; indicates endometritis
* *[CORRECT]** B
*Rationale: These findings are consistent with normal postpartum recovery on day 2. A firm,
midline fundus at 1–2 fingerbreadths below the umbilicus is expected. Moderate lochia rubra
without foul odor is normal. Mild perineal edema and a well-approximated episiotomy are
expected findings. Endometritis would present with fever, uterine tenderness, and foul-smelling
lochia. The Galen nursing student should use the BUBBLE-HE mnemonic systematically:
Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans' sign, Emotional
status.*
* *Q4 (Postpartum – hemorrhage – 4 Ts):** A postpartum client begins hemorrhaging 2 hours
after delivery. The nurse recognizes that the most common cause of early postpartum
hemorrhage is:
A. Trauma to the birth canal
B. Tissue (retained placental fragments)
C. Tone (uterine atony)
D. Thrombin (coagulopathy)
* *[CORRECT]** C
*Rationale: Uterine atony (Tone) accounts for approximately 80% of all postpartum
hemorrhages and is the most common cause of early PPH (within the first 24 hours). The uterus
fails to contract effectively, leading to bleeding from the placental site. The 4 Ts mnemonic helps
identify causes: Tone (atony), Trauma (lacerations, hematomas), Tissue (retained placenta), and
, hrombin (coagulopathy). The Galen nursing student should remember the 4 Ts and know that
T
fundal massage and uterotonic agents are first-line treatments for uterine atony.*
* *Q5 (Postpartum – endometritis):** A postpartum client on day 3 presents with a temperature of
38.5C (101.3F), uterine tenderness, and foul-smelling lochia. The nurse suspects endometritis.
The priority nursing intervention is:
A. Administer broad-spectrum IV antibiotics as ordered
B. Apply ice packs to the perineum for comfort
C. Encourage early ambulation to promote drainage
D. Discontinue breastfeeding until the infection resolves
* *[CORRECT]** A
*Rationale: Endometritis is a postpartum uterine infection typically caused by polymicrobial
ascending infection. The priority intervention is administration of broad-spectrum IV antibiotics
(e.g., clindamycin + gentamicin, or ampicillin-sulbactam) per physician orders. Ice packs
address perineal discomfort, not uterine infection. Early ambulation is important for preventing
DVT but does not treat endometritis. Breastfeeding should continue; most antibiotics are
compatible with breastfeeding (check LactMed). The Galen nursing student should recognize
the triad of fever, uterine tenderness, and foul lochia as diagnostic of endometritis and act
promptly to prevent sepsis.*
* *Q6 (Postpartum – mastitis):** A breastfeeding postpartum client at 2 weeks presents with a
painful, erythematous area on the right breast, fever of 38.8C (101.8F), and flu-like symptoms.
The nurse's priority teaching includes:
A. Stop breastfeeding from the affected breast until the infection clears.
B. Continue breastfeeding or pumping from the affected breast to promote drainage.
C. Apply heat to the breast only; cold will worsen the infection.
D. Mastitis always requires surgical drainage.
* *[CORRECT]** B
*Rationale: Mastitis is an infection of the breast tissue, most commonly caused by
Staphylococcus aureus (including MRSA). The priority teaching is to continue breastfeeding or
pumping from the affected breast to promote milk drainage and prevent milk stasis, which
worsens infection. Stopping breastfeeding can lead to engorgement and abscess formation.
Treatment includes antibiotics (dicloxacillin or cephalexin; clindamycin if MRSA suspected), rest,
hydration, and alternating warm compresses before feeding (to promote let-down) and cold
compresses after (to reduce inflammation). The Galen nursing student should know that mastitis
typically affects one breast unilaterally, whereas engorgement affects both breasts bilaterally.*
* *Q7 (Postpartum – DVT):** A postpartum client at 5 days after cesarean delivery reports
unilateral calf pain and swelling. The nurse performs Homans' sign assessment. Which finding
is most consistent with deep vein thrombosis (DVT)?
A. Pain with dorsiflexion of the foot
B. Pain with plantar flexion of the foot
, . Numbness and tingling in the foot
C
D. Cool, pale skin on the affected leg
* *[CORRECT]** A
*Rationale: Homans' sign is positive when pain occurs with passive dorsiflexion of the foot
(pulling the toes toward the shin), indicating calf vein inflammation. However, Homans' sign is
neither sensitive nor specific for DVT and is no longer recommended as a standalone diagnostic
tool. The nurse should also assess for calf tenderness, warmth, erythema, and unilateral
edema. The definitive diagnostic test is venous duplex ultrasound. Postpartum clients,
especially after cesarean delivery, are at increased risk for DVT due to hypercoagulability,
venous stasis, and endothelial injury (Virchow's triad). The Galen nursing student should
recognize that DVT is a medical emergency requiring immediate anticoagulation to prevent
pulmonary embolism.*
* *Q8 (Postpartum – depression):** A nurse is assessing a postpartum client at 2 weeks who
reports feeling overwhelmed, unable to sleep even when the baby sleeps, loss of appetite, and
states, I feel like I am failing as a mother. The nurse recognizes these symptoms as most
consistent with:
A. Postpartum blues
B. Postpartum depression
C. Postpartum psychosis
D. Normal postpartum adjustment
* *[CORRECT]** B
*Rationale: Postpartum depression (PPD) is characterized by persistent symptoms lasting more
than 2 weeks, including depressed mood, anhedonia, sleep disturbances (even when
opportunity exists), appetite changes, feelings of worthlessness or guilt, and difficulty bonding
with the infant. Postpartum blues (baby blues) resolve within 2 weeks and are milder.
Postpartum psychosis involves hallucinations, delusions, confusion, and agitation—this is a
psychiatric emergency. The Galen nursing student should use the Edinburgh Postnatal
Depression Scale (EPDS) for screening and recognize that PPD requires referral for
psychotherapy and possible pharmacologic intervention; safety planning is essential.*
* *Q9 (Postpartum – psychosis emergency):** A nurse receives a call from a postpartum client's
husband stating that his wife has not slept in 48 hours, is pacing and muttering that the baby is
possessed by demons, and has threatened to harm herself. The nurse's priority action is:
A. Schedule an outpatient psychiatric evaluation within 48 hours
B. Instruct the husband to bring the client to the emergency department immediately
C. Recommend the husband contact the client's obstetrician in the morning
D. Advise the husband to give the client a sedative and monitor her
* *[CORRECT]** B
*Rationale: Postpartum psychosis is a psychiatric emergency with a rapid onset (typically within
2 weeks postpartum) characterized by delusions, hallucinations, paranoia, confusion, and
