WorksheetsPostpartum Nursing Care Quiz
Total questions: 100
Worksheet time: 50mins
Noelle is G6 T5 P1 A0 L6 and delivered 45 minutes ago. Which factor most increases her risk for postpartum uterine atony?
Epidural during labor
Macrosomic infant (9 lb)
First check vital signs normal
Two IV lines in place
Manual extraction of the placenta increases Noelle’s risk for:
Placenta previa
Uterine atony and infection
Preeclampsia
Decreased blood glucose
On admission Noelle’s blood sugar was 226 mg/dL. Postpartum, the nurse should prioritize:
Start long-acting insulin immediately
Frequent blood glucose monitoring and reassessment of medication needs
Encourage increased carbohydrate intake immediately
Discontinue all glucose monitoring
At second check the fundus was boggy to firm and required massage. The best immediate nursing action is to:
Give PRN opioid for pain
Massage fundus and assess lochia and voiding status
Notify social services
Encourage formula feeding
Which of the following from Noelle’s history most directly predisposes her to bladder distention postpartum?
Epidural anesthesia
Glyburide use during pregnancy
Manual extraction of the placenta
Macrosomic infant
Noelle’s bladder was straight catheterized 4 hours ago. She now complains of perineal pain rated 6/10. The nurse should first:
Inspect perineum for hematoma or excessive swelling
Give acetaminophen PRN immediately
Encourage ambulation to relieve pain
Encourage formula feeding
Which sign would be most concerning for early postpartum hemorrhage in Noelle?
Fundus firm at umbilicus and small lochia
Increasing tachycardia and fundus that becomes boggy
Pain score decreasing after analgesic
Mild perineal swelling with normal BP
Which lab would be most specific to evaluate iron stores in pregnancy-related anemia?
Hemoglobin only
Hematocrit only
Ferritin level
Platelet count
Noelle had polyhydramnios and delivered a 9-lb baby. Which complication is she at increased risk for?
Shoulder dystocia and uterine atony
Placenta previa
Ectopic pregnancy
Oligohydramnios
Which postpartum intervention helps reduce uterine atony?
Encourage bladder distention
Fundal massage when boggy and ensure oxytocin infusion per orders
Delay ambulation for 24 hours
Avoid breastfeeding
Which assessment finding would raise concern for a vulvar/vaginal hematoma?
Severe localized perineal pain disproportionate to exam
Mild lochia serosa 1 hour postpartum
Fundus firm at midline
Perineal bruising of 1 cm without pain
Given Noelle’s history of GDM treated with glyburide, which neonatal problem is highest risk?
Neonatal hypoglycemia after birth
Neonatal polyuria only
Neonatal hypermagnesemia
Neonatal hypertension
Which postpartum medication is contraindicated for management of hemorrhage in a hypertensive patient per the document?
Oxytocin (Pitocin)
Methylergonovine (Methergine)
Who can the nurse delegate to obtain routine vital signs for Noelle during recovery?
Licensed practical nurse (LPN) only
Unlicensed assistive personnel (UAP) per facility policy
Only the RN may obtain vital signs
Physician
What assessment should the RN perform that should NOT be delegated to the UAP?
Fundal tone and lochia amount assessment
Temperature measurement
Assisting to bathroom
Applying ice packs per order
Noelle’s second check showed a moderate amount of lochia. Which action is appropriate?
Assess uterine firmness, massage if boggy, monitor blood loss and vital signs
Encourage heavy activity to stimulate uterus
Delay oxytocin infusion change until morning
Bottle-feed baby to distract mother
Which maternal condition in Noelle’s history increases risk for thromboembolism postpartum?
Multiparity alone
Diabetes mellitus (GDM) and prolonged labor
Manual placenta extraction only
Perineal pain
The nurse notes Noelle is pale and exhausted. The most immediate priority is:
Assess hemodynamic status (vitals, fundus, lochia) and signs of bleeding
Give a high-protein snack
Offer a bedtime story for relaxation
Discharge teaching
Which postpartum vital sign change would indicate hypovolemic shock due to hemorrhage?
BP 118/76, pulse 80
BP 90/60 with tachycardia 120 and pale skin
Respiratory rate 18, afebrile
Slight fever 100.2 F after 48 hours
Which finding is most consistent with postpartum endometritis?
Fever >100.4 F after first 24 hours, uterine tenderness, foul lochia
BP 118/76, pulse 80
Respiratory rate 18, afebrile
Slight fever 100.2 F after 48 hours
Noelle was diagnosed with GDM and treated with glyburide. Which statement about oral hypoglycemics in pregnancy is consistent with the document?
Oral medications like metformin cross the placenta; glyburide’s effects may persist postpartum
All oral agents are safe without monitoring postpartum
Oral drugs cannot cross the placenta
Glyburide is the only agent that causes neonatal hypermagnesemia
For Noelle, which action reduces the risk of uterine displacement that can cause atony?
Encourage bladder emptying frequently
Keep full bladder to stimulate contractions
Restrict fluid intake entirely
Limit ambulation only
Which of the following assessment findings suggests DIC development?
Petechiae, bleeding from IV site, prolonged PT/INR and low fibrinogen
Elevated hemoglobin and hematocrit only
Clear urine output and normal BP
Single low-grade fever only
The best method to decrease newborn hypoglycemia when macrosomia is present is:
Early breastfeeding or feeding soon after birth
Delay feeding for 6 hours to monitor blood glucose
Give high-concentration glucose gel to mother
Prevent skin-to-skin contact
Which is the most appropriate action if Noelle’s fundus is boggy after massage and heavy bleeding persists?
Continue fundal massage only and reassess in 4 hours
Call for additional help, ensure uterotonics per orders, assess for retained tissue and source of bleeding
Encourage mother to ambulate to expel clots
Place compressive dressing on perineum only
Which postpartum problem is characterized by a rigid, board-like uterus and severe abdominal pain?
Uterine atony
Placental abruption (Class 3)
Endometritis
Immediate postpartum apathy with good vitals
Noelle received an epidural during labor. Which postpartum problem is she at risk for related to epidural?
Urinary retention and bladder distention
Increased uterine contractility
Immediate postdelivery hypertension
Decreased risk of infection
Which sign suggests a postpartum hematoma rather than normal perineal laceration pain?
Sudden, severe localized perineal pain with a tense swelling and falling hemoglobin
Mild pain with stable vitals and minimal bleeding
Pain decreasing after sitz bath
Pain only during movement
The “six rights” of medication administration include which of the following?
Right patient, right medication, right dose, right route, right time, right documentation
Right dose, right cost, right manufacturer, right time, right doctor, right documentation
Right schedule, right nurse, right location, right medication, right allergy, right documentation
Right patient, right food, right medication, right family, right time, right chart
Which of these is a priority nursing action immediately after recognizing signs of magnesium sulfate toxicity?
Discontinue magnesium infusion and prepare calcium gluconate antidote
Increase infusion rate of magnesium
Administer additional sedative agents
Encourage oral fluids
Noelle had manual extraction of placenta. Which infection is she especially at risk for?
Endometritis (puerperal infection)
HPV infection
Ectopic pregnancy
Trichomoniasis
Which postpartum patient teaching is most important for a mother with GDM who used glyburide?
Monitor blood glucose postpartum and be aware of hypoglycemia risk
Stop monitoring blood glucose after discharge
Avoid all carbohydrates forever
No newborn feeding required
Which of the following is true about placental abruption based on the document?
It may present with sudden abdominal pain, uterine rigidity, and possible DIC
It only occurs before 20 weeks
It is always painless bright red bleeding
It is never associated with fetal compromise
Which abnormal neonatal finding is most directly linked to maternal GDM?
Neonatal hypoglycemia shortly after birth
Neonatal meconium ileus only
Neonatal polycythemia unrelated to glucose
Neonatal hypermagnesemia only
If Noelle’s lochia becomes bright red and saturates a pad in 15 minutes, the nurse should:
Assess fundal tone, massage as needed, call for assistance and consider hemorrhage interventions
Encourage patient to nap and recheck in 2 hours
Document and continue routine checks only
Offer mother more fluids
When educating Noelle on iron supplementation, the nurse should advise:
Take iron on an empty stomach and with vitamin C; avoid dairy and antacids near dose
Take iron with milk and antacid for best absorption
Iron should be taken only if hemoglobin >14 g/dL
No dietary changes are necessary
Which finding would be expected in a mother developing postpartum endometritis?
Fever, uterine tenderness, foul-smelling lochia, WBC >15,000
Hypothermia and hyperreflexia only
Clear lochia and decreased WBC count
Severe hypertension only
The best prevention for DVT in postpartum patients includes:
Early ambulation, SCDs, and hydration when appropriate
Complete bedrest for 7 days
Encourage smoking to decrease clotting
High-sodium diet
Noelle’s BP is stable and she is pale and exhausted. Which lab would the nurse expect to monitor to assess for blood loss?
Hemoglobin and hematocrit
Blood urea nitrogen only
AST/ALT only
Platelet count only
Which postpartum condition commonly presents with unilateral breast pain, redness, and flu-like symptoms in breastfeeding mothers?
Mastitis
Endometritis
DVT
Placental abruption
Which factor in Noelle’s history is most associated with macrosomia?
Gestational diabetes (GDM)
Manual placenta extraction
Epidural analgesia
Straight catheterization
Which assessment is priority when magnesium sulfate is being continued postpartum?
Respiratory rate, deep tendon reflexes, urine output, and magnesium level monitoring
BP only once a day
Vision test only
Blood glucose only
Noelle’s fundus is at the level of the umbilicus and firm. What is the correct nursing interpretation?
Normal immediate postpartum finding
Sign of uterine rupture
Always indicates hemorrhage
Requires immediate C-section
Which of the following is a classic sign of placental previa?
Painless bright red vaginal bleeding after 20 weeks
Severe abdominal pain with rigid uterus
High fetal heart rate variability
Excessive uterine contractions only
What is the appropriate action for the RN when a UAP reports that Noelle’s pad is saturated and she has lightheadedness?
RN should immediately assess fundus, lochia, vital signs and initiate hemorrhage protocol if indicated
Wait for the morning report to notify the provider
Ask UAP to continue to monitor and report in 2 hours
Tell UAP to encourage the patient to drink more water
Noelle’s pregnancy included polyhydramnios. Which intrapartum complication is she at increased risk for?
Cord prolapse
Placental abruption
Endometritis
Mastitis
Which sign in the newborn would most likely prompt immediate glucose testing after delivery from a GDM mother?
Jitteriness and lethargy shortly after birth
Strong cry and vigorous movement
No respiratory concerns only
Normal muscle tone
Which postpartum teaching is most important after a manual placenta extraction?
Watch for fever, foul lochia, increasing pain, and excessive bleeding and report immediately
No follow-up necessary if mother feels fine
Begin strenuous exercise right away
Avoid breastfeeding permanently
Which statement is true regarding oxytocin (Pitocin) in postpartum management per the document?
Oxytocin is used to promote uterine contraction and reduce bleeding
Oxytocin causes hypercoagulability and should be avoided
Oxytocin hastens placenta implantation
Oxytocin is an antibiotic
A postpartum patient with suspected DIC may present with which cluster of findings?
Bleeding from IV site, petechiae, hypotension, tachycardia, prolonged coagulation tests
Elevated platelets, normal coags, hypertension only
Low heart rate and decreased bleeding only
Isolated fever without bleeding
Noelle had a long labor (slow progress). Which postpartum problem is specifically associated with prolonged labor?
Increased risk of infection and uterine atony/fatigue
Decreased risk of hemorrhage
Lower blood glucose postpartum only
Decreased need for follow-up
For a mother with GDM, which prenatal test was used to diagnose glucose intolerance per the document?
Glucose tolerance test (GTT) including fasting and 1, 2, and 3-hour values
Complete blood count only
Urinalysis only
Blood pressure monitoring only
Which postpartum action reduces risk for mastitis in a breastfeeding mother?
Encourage proper latch, frequent emptying of breasts, and prompt treatment of engorgement
Avoid breastfeeding completely for 1 month
Offer only bottle feeds with glucose solution
Restrict fluids to the mother
Which sign is most specific for HELLP syndrome?
Elevated liver enzymes with low platelets and hemolysis
Elevated glucose only
Decreased WBC count only
Elevated hemoglobin only
Noelle’s initial fundal check was firm and small amount of lochia. Later it became boggy and moderate lochia. Which is the best interpretation?
She may be developing uterine atony and requires close monitoring/intervention
She is improving and needs no further checks
She has normal progression and can be discharged now
Fundal firmness is not related to bleeding risk
Which postpartum assessment is appropriate to delegate to UAP for Noelle?
Obtain routine vital signs per facility protocol and report abnormalities to RN
Assess fundal height and uterine tone
Evaluate perineal repair and REEDA scoring
Titrate IV Pitocin infusion per order
Which factor increases the mother’s risk for postpartum hemorrhage due to uterine overdistention?
Polyhydramnios and macrosomia
Epidural analgesia alone
G6 parity alone without macrosomia
Early ambulation
Which antibiotic regimen is commonly used for chorioamnionitis per the document?
Broad-spectrum IV antibiotics such as ampicillin and gentamicin; clindamycin added for C-section
Oral amoxicillin only at home
No antibiotics are effective for chorioamnionitis
Topical antibiotics only
Which is a maternal effect of iron deficiency anemia from the document?
Increased risk for hemorrhage and need for transfusion
Decreased risk for preeclampsia
Decreased fatigue
Elevated hemoglobin
Which postpartum finding would suggest a retained placenta fragment?
Continued heavy bleeding with boggy fundus despite massage and uterotonics
Small amount of lochia and firm fundus
Mild perineal pain only
Stable hemoglobin
According to the document, what is the best way to evaluate iron stores in pregnancy?
Ferritin level measurement
Random glucose level
Creatinine level
Platelet count
Which nursing action is most appropriate to prevent hypoglycemia in the newborn of a mother with GDM?
Initiate early breastfeeding and monitor neonatal glucose per protocol
Delay feeding for 24 hours to observe
Prevent kangaroo care to conserve glucose
Give mother extra insulin before breastfeeding
Noelle’s admitting glucose was 226. Which maternal complication listed in the document is associated with uncontrolled hyperglycemia during pregnancy?
Increased risk of preeclampsia and stillbirth
Decreased risk of macrosomia
Prevention of DIC
Increased risk of ectopic pregnancy
Which perineal finding is most worrisome for infection after an episiotomy repair?
Increased redness, warmth, purulent drainage, and fever
Mild bruising without drainage
Slight scab formation along suture line
Absence of bleeding
A postpartum client develops sudden shortness of breath and pleuritic chest pain. Which condition must the nurse consider emergently?
Pulmonary embolism (VTE/PE)
Mastitis
Endometritis
Which of the following increases risk of postpartum infection per the document?
Manual removal of placenta and prolonged labor
Early ambulation and hydration
Short labor <2 hours
Absence of membrane rupture
Noelle’s prior straight catheterization was 4 hours ago. Which is the goal of bladder management postpartum?
Prevent bladder distention to allow uterine contraction
Maintain bladder distention to decrease bleeding
Only catheterize if mother requests it for comfort
Leave indwelling catheter indefinitely
Which clinical sign is most likely to be present with postoperative wound infection after C-section?
Redness, increased warmth, drainage, and systemic fever
Decreased blood pressure only
Increased fetal movement only
Bradycardia only
When assessing for preeclampsia, which two findings are diagnostic per the document?
New-onset hypertension >140/90 after 20 weeks and proteinuria (or other end-organ dysfunction)
Low BP and tachycardia only
Fever and diarrhea only
Hyperglycemia only
Which postpartum intervention is used to promote uterine involution?
Breastfeeding to release endogenous oxytocin, fundal massage if boggy, and uterotonics as ordered
Encourage mother to remain supine for 24 hours without breastfeeding
Restrict oral fluids to reduce uterine size
Avoid touching the fundus at all
Which statement about TORCH infections is correct per the document?
CMV is a common cause of congenital infection and can cause hearing loss and cerebral palsy
Rubella is harmless during pregnancy
Toxoplasmosis cannot affect the fetus
All TORCH infections are treated the same way during pregnancy
If Noelle develops fever and foul-smelling lochia on postpartum day 2, the nurse should suspect:
Endometritis/puerperal infection and notify provider for possible antibiotics
Normal recovery
Localized hematoma only
Immediate need for methylergonovine
What is the main risk to the fetus of maternal preeclampsia?
Reduced placental perfusion leading to IUGR and possible fetal compromise
Increased fetal hyperactivity only
Improved fetal growth
Insignificant effect
Which action is contraindicated in suspected placenta previa?
Performing a sterile vaginal exam
Immediate ultrasound to confirm placenta location
Establishing IV access and monitoring vitals
Preparing for possible blood transfusion
In the OB document, which medication is used to prevent seizures in severe preeclampsia?
Magnesium sulfate
Methergine
Oxytocin
Misoprostol
Noelle is G6 P1. Compared with a primipara, grand multiparity increases risk primarily because:
Uterine muscle may be less effective at contracting after multiple pregnancies
There is decreased blood volume with multiparity
Grand multiparity reduces risk of retained placenta
Parity has no effect on contraction strength
Which sign in Noelle would warrant immediate bedside hemoglobin/hematocrit assessment?
Tachycardia, dizziness, pallor, and increased bleeding
Mild transient fever after delivery
Complaint of hunger only
Slight perineal discomfort
Which maternal history element increases risk of chorioamnionitis?
Prolonged rupture of membranes and multiple vaginal exams in labor
Early membrane rupture <1 hour
No vaginal exams at all
Vaginal exams only after delivery
When preparing a transfer to higher-level care for hemorrhage, which items are essential per document recommendations?
Establish two large-bore IVs, obtain type and cross, monitor vitals and urine output
Only give oral fluids and rest
Wait for spontaneous improvement before interventions
No extra IV access needed
Noelle’s perineal pain is 6/10. Which assessment finding would most strongly suggest a postpartum vulvar hematoma?
Localized, severe pain with tense swelling and possible drop in hemoglobin
Diffuse mild tenderness without swelling
Normal lochia and fundal tone
Decreasing pain with analgesics
Which postpartum medication is contraindicated for hemorrhage in patients with asthma per the document?
Hemabate (carboprost)
Oxytocin
Misoprostol
Tranexamic acid
Which complication is associated with HELLP syndrome?
Liver hematoma and DIC risk
Decreased uterine bleeding only
Improved platelet count
Lowered AST/ALT
Which is the correct initial response to a patient with suspected pulmonary embolism postpartum?
Call rapid response/physician, administer oxygen, keep patient calm and prepare for imaging/interventions
Give warm compress to the leg only and wait
Instruct patient to drink more fluids only
Encourage strenuous ambulation
A mother with oligohydramnios is at risk for which fetal issue?
Cord compression and possible fetal distress
Macrosomia
Polycythemia only
Increased fetal movement only
Which statement about Group B Streptococcus (GBS) per the document is true?
Culture between 35–37 weeks; treat with intrapartum penicillin if positive or unknown with risk factors
GBS is not screened during pregnancy
GBS only affects the mother, not the neonate
GBS requires lifelong antibiotics after delivery
Noelle’s postpartum plan includes monitoring for hemorrhage. Which frequency of fundal checks is most appropriate in the immediate recovery period?
Every 15 minutes for the first hour, then per protocol (facility dependent)
Once every 8 hours only
No checks needed if mother feels fine
Only if bleeding is reported
Which postpartum teaching is appropriate regarding activity after a perineal repair?
Use sitz baths, ice for the first 24 hours, stool softeners, and avoid heavy lifting initially
Return to normal heavy exercise immediately
Avoid all fluids to reduce swelling
Don’t seek medical help for increased redness
Which is a primary goal of treating preterm labor with tocolytics per the document?
Delay delivery to allow administration of corticosteroids for fetal lung maturity
Prevent infection indefinitely
Cause immediate delivery
Eliminate need for neonatal monitoring
Which maternal factor is listed as increasing risk for placenta previa?
Prior cesarean delivery
Multiparity only with no surgeries
Young maternal age under 18 only
No prior uterine surgery
Which postpartum condition is most commonly associated with high WBC >15,000 in the OB document?
Endometritis/chorioamnionitis
Mild dehydration only
Osteoporosis
Placenta previa
Which sign indicates magnesium sulfate toxicity that requires immediate action?
Absent deep tendon reflexes and respiratory depression (<12 breaths/min)
Slight tremor only
Mild headache only
Mild nausea only
For a woman with GDM, which fetal problem results from fetal hyperinsulinemia?
Increased oxygen consumption leading to possible fetal hypoxia and polycythemia
Decreased fetal erythropoietin production only
Lowered risk of cardiomyopathy
Improved lungs at birth
Which postpartum document-recommended medication helps with uterine contraction to control bleeding?
Oxytocin (Pitocin)
Insulin
Ceftriaxone IM only
Metformin
Which postpartum teaching is most appropriate for prevention of DVT?
Encourage early ambulation and hydration; use SCDs when ordered
Remain immobile for 72 hours to prevent bleeding
Take high-dose vitamin K to prevent clots
Use compression stockings only after 6 weeks
Which maternal condition can be temporarily mimicked by magnesium sulfate in the newborn?
Depressed neonatal reflexes and respiratory drive if maternal magnesium given near delivery
Neonatal hyperactivity only
Neonatal increased blood sugar only
Neonatal cyanosis due to infection
Which type of laceration involves the anal sphincter and anterior rectal wall?
Fourth-degree laceration
First-degree laceration
Second-degree laceration
Third-degree laceration
Which postpartum sign suggests a surgical wound infection after cesarean?
Erythema, warmth, swelling, drainage from incision, fever
Decreased lochia only
Elevated platelet count only
Improved appetite only
Which of the following is an important component of postpartum hemorrhage management per document?
IV access with large-bore IVs and type and cross for possible transfusion
Oral antibiotics only
Immediate discharge home
Restrict all fluids
Which of the following is true about iron supplementation advice in pregnancy from the document?
Take on an empty stomach, may cause GI upset/constipation, take with vitamin C to improve absorption
Take only with dairy products to enhance absorption
Iron supplements are unnecessary if hemoglobin is normal
Take antacids with iron to prevent GI upset
If Noelle’s uterus remains boggy after uterine massage and oxytocin, the nurse should next consider:
Additional uterotonics per protocol, evaluation for retained placental fragments, and surgical consultation if necessary
No further action and discharge home
Only increase oral fluids and reevaluate in 12 hours
Arrange home health visit next week
