1
HESI Exit Exam Master Bank:
Postpartum Hemorrhage &
Complication Protocols
Table of Contents
Subtopic 1: Identification and Early Recognition of Postpartum Hemorrhage
(PPH)................................................................................................................2
Subtopic 2: Causes and Risk Factors for Postpartum Hemorrhage (PPH).......11
Subtopic 3: Immediate Management and Emergency Response to Postpartum
Hemorrhage (PPH).........................................................................................20
Subtopic 4: Medications and Pharmacologic Management in Postpartum
Hemorrhage (PPH).........................................................................................30
Subtopic 5: Surgical Interventions and Advanced Procedures in Postpartum
Hemorrhage (PPH) Management...................................................................39
Subtopic 6: Delayed (Secondary) Postpartum Hemorrhage – Causes and
Management..................................................................................................48
Subtopic 7: Hemorrhage Protocols and Emergency Response Systems........58
Subtopic 8: Thromboembolic Complications After Delivery...........................67
Subtopic 9: Postpartum Infection Surveillance and Sepsis Management.......77
Subtopic 10: Psychological and Emotional Complications After Delivery.......86
, 2
Subtopic 1: Identification and Early
Recognition of Postpartum Hemorrhage (PPH)
Question 1:
Which of the following signs is an early clinical indicator of postpartum
hemorrhage in a newly delivered patient?
A. Bradycardia
B. Elevated temperature
C. A sudden drop in blood pressure
D. Increased milk production
Correct Answer: C. A sudden drop in blood pressure
Rationale: A sudden drop in blood pressure is a key early sign of postpartum
hemorrhage due to significant blood loss. Bradycardia and increased milk
production are not typical early indicators, and fever may suggest infection,
not hemorrhage.
Question 2:
Within how many hours postpartum is early (primary) postpartum
hemorrhage most likely to occur?
A. 6–12 hours
B. Within the first 24 hours
C. After 72 hours
D. Between 2–4 days
Correct Answer: B. Within the first 24 hours
, 3
Rationale: Early postpartum hemorrhage occurs within the first 24 hours
postpartum and is often caused by uterine atony, trauma, or retained
placenta.
Question 3:
Which is the most common cause of early postpartum hemorrhage?
A. Uterine atony
B. Vaginal laceration
C. Coagulopathy
D. Retained placental fragments
Correct Answer: A. Uterine atony
Rationale: Uterine atony, the failure of the uterus to contract effectively after
delivery, is the most common cause of postpartum hemorrhage, accounting
for up to 80% of cases.
Question 4:
A nurse is monitoring a postpartum client. Which finding should alert the
nurse to a possible hemorrhage?
A. Firm uterus at the level of the umbilicus
B. Moderate lochia rubra
C. Saturation of a perineal pad in 15 minutes
D. Slightly elevated WBC count
Correct Answer: C. Saturation of a perineal pad in 15 minutes
, 4
Rationale: Excessive vaginal bleeding, such as soaking a pad in 15 minutes
or less, indicates significant hemorrhage and requires immediate
intervention.
Question 5:
Which maternal vital sign change is most concerning for postpartum
hemorrhage?
A. Slight increase in temperature
B. Tachycardia
C. Normal oxygen saturation
D. Stable blood pressure
Correct Answer: B. Tachycardia
Rationale: Tachycardia may be the first vital sign change in hemorrhage due
to compensatory mechanisms before hypotension occurs.
Question 6:
What physical assessment finding is most indicative of uterine atony?
A. Fundus midline and firm
B. Boggy uterus above the umbilicus
C. Fundus below the umbilicus and firm
D. Decreased lochial flow
Correct Answer: B. Boggy uterus above the umbilicus
Rationale: A boggy, elevated uterus indicates poor uterine contraction,
characteristic of uterine atony and risk for hemorrhage.
HESI Exit Exam Master Bank:
Postpartum Hemorrhage &
Complication Protocols
Table of Contents
Subtopic 1: Identification and Early Recognition of Postpartum Hemorrhage
(PPH)................................................................................................................2
Subtopic 2: Causes and Risk Factors for Postpartum Hemorrhage (PPH).......11
Subtopic 3: Immediate Management and Emergency Response to Postpartum
Hemorrhage (PPH).........................................................................................20
Subtopic 4: Medications and Pharmacologic Management in Postpartum
Hemorrhage (PPH).........................................................................................30
Subtopic 5: Surgical Interventions and Advanced Procedures in Postpartum
Hemorrhage (PPH) Management...................................................................39
Subtopic 6: Delayed (Secondary) Postpartum Hemorrhage – Causes and
Management..................................................................................................48
Subtopic 7: Hemorrhage Protocols and Emergency Response Systems........58
Subtopic 8: Thromboembolic Complications After Delivery...........................67
Subtopic 9: Postpartum Infection Surveillance and Sepsis Management.......77
Subtopic 10: Psychological and Emotional Complications After Delivery.......86
, 2
Subtopic 1: Identification and Early
Recognition of Postpartum Hemorrhage (PPH)
Question 1:
Which of the following signs is an early clinical indicator of postpartum
hemorrhage in a newly delivered patient?
A. Bradycardia
B. Elevated temperature
C. A sudden drop in blood pressure
D. Increased milk production
Correct Answer: C. A sudden drop in blood pressure
Rationale: A sudden drop in blood pressure is a key early sign of postpartum
hemorrhage due to significant blood loss. Bradycardia and increased milk
production are not typical early indicators, and fever may suggest infection,
not hemorrhage.
Question 2:
Within how many hours postpartum is early (primary) postpartum
hemorrhage most likely to occur?
A. 6–12 hours
B. Within the first 24 hours
C. After 72 hours
D. Between 2–4 days
Correct Answer: B. Within the first 24 hours
, 3
Rationale: Early postpartum hemorrhage occurs within the first 24 hours
postpartum and is often caused by uterine atony, trauma, or retained
placenta.
Question 3:
Which is the most common cause of early postpartum hemorrhage?
A. Uterine atony
B. Vaginal laceration
C. Coagulopathy
D. Retained placental fragments
Correct Answer: A. Uterine atony
Rationale: Uterine atony, the failure of the uterus to contract effectively after
delivery, is the most common cause of postpartum hemorrhage, accounting
for up to 80% of cases.
Question 4:
A nurse is monitoring a postpartum client. Which finding should alert the
nurse to a possible hemorrhage?
A. Firm uterus at the level of the umbilicus
B. Moderate lochia rubra
C. Saturation of a perineal pad in 15 minutes
D. Slightly elevated WBC count
Correct Answer: C. Saturation of a perineal pad in 15 minutes
, 4
Rationale: Excessive vaginal bleeding, such as soaking a pad in 15 minutes
or less, indicates significant hemorrhage and requires immediate
intervention.
Question 5:
Which maternal vital sign change is most concerning for postpartum
hemorrhage?
A. Slight increase in temperature
B. Tachycardia
C. Normal oxygen saturation
D. Stable blood pressure
Correct Answer: B. Tachycardia
Rationale: Tachycardia may be the first vital sign change in hemorrhage due
to compensatory mechanisms before hypotension occurs.
Question 6:
What physical assessment finding is most indicative of uterine atony?
A. Fundus midline and firm
B. Boggy uterus above the umbilicus
C. Fundus below the umbilicus and firm
D. Decreased lochial flow
Correct Answer: B. Boggy uterus above the umbilicus
Rationale: A boggy, elevated uterus indicates poor uterine contraction,
characteristic of uterine atony and risk for hemorrhage.
