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Worksheets2205 exam 3 pt.3
Total questions: 95
Worksheet time: 48mins
A postpartum client has heavy bleeding and a boggy uterus. After firm fundal massage, the uterus firms briefly but then relaxes again. Which provider order should the nurse anticipate next?
Administer oxytocin infusion
Obtain a pelvic CT scan
Discontinue IV fluids
Apply warm compresses to the perineum
A client 1 hr postpartum reports feeling “soaked.” The nurse finds a firm fundus at the umbilicus, but bright-red bleeding continues. Which is the priority nursing action?
Reassess in 30 minutes
Prepare for genital tract inspection
Administer tranexamic acid immediately without orders
Increase oral fluids
A postpartum client has a suspected vaginal hematoma. Which finding best supports this complication?
Severe perineal pain unrelieved by analgesics with minimal lochia
Boggy fundus with heavy lochia and clots
Foul-smelling lochia with uterine tenderness
Burning with urination and urinary urgency
Which postpartum client is at greatest risk for infection?
Vaginal birth with intact perineum, labor 4 hr
Cesarean birth after prolonged labor with oxytocin and chorioamnionitis
Vaginal birth after 2 hr labor, breastfeeding initiated immediately
Vaginal birth with small laceration repair, stable vitals
A postpartum client’s labs show platelets 48,000/mm^3, fibrin degradation products elevated, and prolonged PT/aPTT. Which nursing action is priority?
Encourage early ambulation
Avoid IM injections and apply prolonged pressure to puncture sites
Increase fundal massage frequency
Restrict fluids to prevent edema
A postpartum client develops sudden chest pain and dyspnea. Which assessment finding most supports pulmonary embolism rather than postpartum anxiety?
Carpopedal spasm
SpO2 82% on room air
Tearfulness and pacing
Tingling around the mouth
A provider prescribes methylergonovine for postpartum hemorrhage. Which client condition is a contraindication?
Gestational diabetes
Chronic hypertension
Iron-deficiency anemia
A postpartum client received methylergonovine 10 minutes ago. Which finding requires immediate follow-up?
BP increases from 118/74 to 154/96 mm Hg
Reports uterine cramping
Fundus becomes firm
Lochia decreases from heavy to moderate
A postpartum client continues to hemorrhage despite uterotonics. The provider suspects uterine inversion. Which assessment finding is most consistent with inversion?
Fundus firm and easily palpable above umbilicus
Sudden hemorrhage with severe pelvic pain and a mass in the vagina
Gradual increase in lochia with mild cramping
Foul-smelling lochia with fever
After uterine inversion is corrected, which medication does the nurse anticipate to maintain uterine tone?
Terbutaline
Oxytocin
Nifedipine
Magnesium sulfate
A postpartum client has unilateral calf warmth, swelling, and tenderness. Which instruction is the priority while awaiting diagnostic confirmation?
Ambulate frequently
Massage the calf gently
Maintain bed rest and avoid rubbing the leg
Apply heat packs continuously
Which diagnostic study is most appropriate to confirm a suspected DVT postpartum?
CT pulmonary angiography
Venous duplex ultrasound
Chest X-ray
Ventilation-perfusion scan
A nurse suspects pulmonary embolism. Which imaging study is most definitive for confirmation?
CT pulmonary angiography
Venous duplex ultrasound
Abdominal ultrasound
Head CT
A postpartum client is receiving tranexamic acid. Which client history requires the nurse to clarify the order with the provider?
History of seasonal allergies
History of thromboembolic disease
A postpartum client has uterine atony. Which intervention should the nurse perform first?
Administer methylergonovine
Massage the fundus and assess for bladder distention
Obtain coagulation labs
Prepare for hysterectomy consent
A postpartum client’s fundus is boggy and deviated to the right. Which additional finding would the nurse expect?
Increased bowel sounds
Distended bladder
Fever and uterine tenderness
Severe headache and hyperreflexia
A postpartum client reports dysuria. The nurse suspects UTI. Which complication is the greatest risk if the infection ascends?
Endometritis
Pyelonephritis
Mastitis
Subinvolution
A postpartum client has fever, uterine tenderness, and malodorous lochia. Which nursing action is the priority?
Encourage fluids and rest only
Obtain cultures as ordered and prepare to start IV antibiotics
Administer methylergonovine
Apply ice packs to the perineum
A postpartum client has persistent lochia rubra on day 7 and a uterus that feels larger than expected. Which cause is most likely?
Normal involution
Subinvolution from retained placental fragments or infection
Expected breastfeeding effect
Postpartum diuresis
A postpartum client with suspected DIC is actively bleeding. Which order should the nurse anticipate?
Administer heparin for clot prevention immediately
Prepare for blood products and coagulation factor replacement
Restrict IV fluids to prevent dilution
Initiate oral iron only
A postpartum client is being discharged after cesarean birth. Which statement indicates correct understanding of when to seek care?
If I soak a pad in an hour, I’ll monitor it for another hour.
If my incision becomes red and drains pus, I’ll call immediately.
If I have chills the first 24 hours, I should go to the ER.
If my lochia smells stronger, that’s normal.
A postpartum client reports left leg pain and redness. Which action should the nurse recommend first?
Elevate the leg and apply heat
Massage the area to improve circulation
Seek immediate medical evaluation for possible thrombophlebitis
Increase walking to reduce swelling
A postpartum client develops thrombophlebitis. Which finding is most expected?
Bilateral calf pain relieved by walking
Localized warmth, redness, and tenderness along a vein
Generalized edema with hypotension
Foul-smelling lochia and uterine tenderness
Which postpartum mental health finding requires the most urgent intervention?
Feeling overwhelmed
Difficulty sleeping
Auditory hallucinations commanding harm
Decreased appetite
A nurse is assessing expected postpartum physiologic adaptation. Which finding is expected at 12 hr postpartum?
Fundus at the level of the umbilicus, firm, midline
Lochia alba
Fundus 3 cm above umbilicus and boggy
Heavy bleeding saturating a pad every 30 minutes
A nurse is evaluating postpartum diaphoresis and diuresis. Which teaching is correct?
“This is usually a sign of infection.”
“This is your body eliminating extra fluid from pregnancy.”
“This happens because your kidneys are failing.”
“This indicates hemorrhage.”
A postpartum client is concerned about breastfeeding support and bonding. Which nursing intervention best supports Baby-Friendly psychosocial adaptation?
Separate mother and newborn to allow maternal rest
Encourage skin-to-skin contact and rooming-in
Provide formula supplementation routinely
Delay breastfeeding until milk “comes in”
A postpartum client received oxytocin for hemorrhage. Which finding indicates a complication that should be reported?
Water intoxication symptoms (headache, confusion) with decreased urine output
Afterpains during breastfeeding
Mild nausea
Chills for 30 minutes after delivery
A postpartum client has heavy bleeding and suspected retained placental fragments. Which finding supports this cause rather than uterine atony alone?
Fundus remains firm consistently
Fundus remains boggy and responds permanently to massage
Persistent bleeding with a uterus that fails to stay firm despite interventions
Lochia alba on day 2
A postpartum client is receiving antibiotics for endometritis. Which outcome best indicates effectiveness?
WBC continues to rise
Uterine tenderness decreases and temperature returns to normal
Lochia becomes more foul-smelling
Fundus becomes boggy
A postpartum client has sudden heavy bleeding after delivery and the provider orders tranexamic acid. Which rationale best explains its role?
Stimulates uterine contraction directly
Enhances clot stability by reducing fibrinolysis
Prevents uterine inversion
Treats uterine infection
A postpartum client has persistent bleeding and bruising. Which lab result is most consistent with DIC?
Platelets 240,000/mm3
Fibrinogen increased
PT and aPTT prolonged
Hemoglobin elevated
A postpartum client has uterine atony. Which sequence of interventions is most appropriate?
Fundal massage → assess bladder → uterotonics → notify provider if persistent
Notify provider → fundal massage → assess bladder → wait for orders
Apply heat → encourage ambulation → reassess
Restrict fluids → elevate legs → reassess bleeding
A postpartum client’s fundus is firm, but lochia remains heavy and bright red. Which cause is most likely?
Uterine atony
Laceration of cervix/vagina
Endometritis
Subinvolution
A postpartum client is experiencing postpartum hemorrhage. Which finding indicates the need for immediate escalation of care?
Mild uterine cramping
HR 124/min, BP 90/54, altered mental status
Fundus firm and midline
Lochia rubra small amount
A postpartum client with suspected PE asks why oxygen is started immediately. Which response is best?
“Oxygen prevents uterine atony.”
“Oxygen increases tissue oxygenation while we treat the cause of breathing problems.”
“Oxygen will stop the clot from forming.”
“Oxygen decreases postpartum pain.”
A nurse is performing discharge teaching. Which instruction best reduces risk of postpartum infection after cesarean?
“Avoid showers for 2 weeks.”
“Wash hands before touching your incision and monitor for redness or drainage.”
“Keep a tight binder over the incision at all times.”
“Apply powder directly to the incision daily.”
A postpartum client has a suspected hematoma and a decreasing BP trend. Which action is priority?
Provide reassurance and ice packs
Notify provider and prepare for possible surgical intervention
Encourage ambulation to relieve pressure
Administer methylergonovine
A postpartum client is being monitored for subinvolution. Which finding would the nurse expect if subinvolution is present?
Fundus descends steadily each day
Lochia transitions appropriately to serosa then alba
Uterus remains enlarged with prolonged lochia rubra
Decreased uterine size with scant lochia
A postpartum client reports dysuria and suprapubic tenderness. Which nursing intervention is most appropriate initially?
Encourage increased fluid intake and collect a urine specimen as ordered
Massage the suprapubic area to relieve pain
Restrict fluids to reduce urinary frequency
Administer methylergonovine for bladder tone
A postpartum client has fever and chills 48 hours after delivery with uterine tenderness. Which complication is most likely?
Normal postpartum chills
Endometritis
Postpartum diuresis
Lochia rubra transition
A postpartum client is receiving opioid analgesics after cesarean birth. Which teaching is priority?
“Take with alcohol for better pain control.”
“Avoid driving and monitor for sedation and constipation.”
“Stop taking once pain returns.”
“Double the dose if you miss one.”
A postpartum client has heavy bleeding and suspected uterine atony. Which medication does the nurse anticipate first-line?
Oxytocin
Terbutaline
Magnesium sulfate
Betamethasone
A postpartum client has a firm fundus but continued heavy bleeding and hypotension. Which nursing action is priority?
Increase fundal massage intensity
Maintain IV access and prepare for laceration repair/possible transfusion
Encourage breastfeeding
Encourage the client to void later
A postpartum client is being screened for postpartum depression at follow-up. Which symptom pattern best suggests postpartum depression rather than postpartum blues?
Symptoms resolve within 2 weeks
Symptoms worsen over weeks and impair functioning
Crying that improves with rest
Mild mood swings with bonding intact
A postpartum client with suspected PE is stable enough for transport. Which nursing action is most appropriate before leaving the unit?
Remove IV access to prevent dislodgement
Ensure oxygen is in place and emergency equipment is available during transport
Place the client flat to prevent dizziness
Encourage ambulation to prevent worsening clots
A nurse is evaluating whether postpartum hemorrhage interventions are failing. Which finding is most concerning after initial treatment?
Fundus firm but new confusion, tachycardia, and narrowing pulse pressure
Mild afterpains during breastfeeding
Lochia rubra moderate amount
Diuresis overnight
A postpartum client with suspected pulmonary embolism is scheduled for CT pulmonary angiography (CTPA). Which assessment finding requires the nurse to notify the provider before transport?
Serum creatinine 2.3 mg/dL
Respiratory rate 26/min
Heart rate 118/min
Oxygen saturation 93% on room air
A postpartum client with sudden dyspnea is breastfeeding and has a documented iodinated contrast allergy. Which diagnostic study should the nurse anticipate as the best alternative to CTPA?
Chest X-ray
Ventilation–perfusion scan (V/Q)
ECG
Troponin level
A postpartum client is being transported for a V/Q scan to evaluate suspected pulmonary embolism. Which nursing action is the priority during transport?
Encourage oral fluids to prevent dehydration
Place the client in supine position
Keep the client NPO
Maintain oxygen therapy and continuous pulse oximetry
A postpartum client with heavy bleeding is prescribed tranexamic acid (TXA). Which nursing action supports evidence-based administration for best outcomes?
Administer TXA within 3 hours of birth as 1 g IV over about 10 minutes; may repeat once if bleeding persists
Delay TXA until at least 6 hours postpartum after other measures have failed
Give TXA intramuscularly to avoid IV-related complications
Mix TXA directly with rapidly infused blood products for combined effect
A postpartum client receiving tranexamic acid reports new unilateral calf pain and swelling. Which action is the nurse’s priority?
Apply warm compresses and reassess in 30 min
Encourage ambulation to improve circulation
Hold further doses and notify the provider immediately
Massage the calf to relieve discomfort
A nurse is monitoring a postpartum client after tranexamic acid administration for hemorrhage. Which finding requires immediate provider notification?
Urine output 45 mL/hr
Mild uterine cramping with breastfeeding
Lochia rubra decreasing over 2 hours
Sudden chest pain and shortness of breath
A postpartum client has suspected pulmonary embolism and is scheduled for CTPA. Which nursing intervention is most important before the client leaves the unit?
Remove the client’s IV catheter
Ensure a patent large-bore IV is in place
Give an oral antacid to prevent nausea
A postpartum client has suspected PE and is too unstable to lie flat for CTPA. Which diagnostic approach is most appropriate to anticipate?
V/Q scan if clinically feasible
MRI of the chest with contrast
Routine chest X-ray only
Abdominal ultrasound
A postpartum client with hemorrhage receives tranexamic acid but continues to saturate a pad every 10 minutes. Which nursing action is priority next?
Reassess fundal height in 2 hours
Encourage the client to rest and limit activity
Continue TXA and recheck bleeding at shift change
Activate the obstetric hemorrhage protocol and prepare for escalation (additional uterotonics/surgical measures)
A nurse is evaluating whether postpartum urinary retention is contributing to uterine bleeding. Which assessment finding best supports bladder overdistention?
Fundus firm and midline at the umbilicus
Fundus boggy and midline
Fundus displaced to the right with a palpable suprapubic fullness
Lochia serosa on postpartum day 3
A postpartum client has not voided in 8 hours and reports suprapubic pressure. The uterus is deviated and lochia is increased. Which nursing intervention is priority?
Encourage voiding now; if unable, perform catheterization per order/protocol
Increase oral fluids and reassess in 2 hours
Massage the uterus continuously until bleeding stops
Administer a stool softener
A postpartum client with suspected PE is ordered a V/Q scan. Which statement by the nurse is most appropriate to reduce anxiety while maintaining accuracy?
“This test checks heart rhythm problems.”
“This will show if your lungs have a blood clot by comparing airflow and blood flow.”
“This test is only done if you have pneumonia.”
“This scan replaces the need for oxygen.”
A nurse is monitoring a postpartum client after administration of tranexamic acid (TXA). Which assessment is the priority to identify the most dangerous complication?
Bowel sounds
Level of uterine tenderness
Signs of thromboembolism (leg swelling/pain, chest pain, sudden dyspnea)
Color change of lochia
A postpartum client has a history of thrombosis and develops postpartum hemorrhage. Tranexamic acid is prescribed. Which action is most appropriate?
Administer TXA immediately; history of thrombosis is irrelevant
Withhold TXA and notify the prescriber due to thrombosis history
Administer TXA only after increasing oral fluids
Proceed with TXA but avoid any other medications
A postpartum client has a suspected PE and is ordered CTPA with contrast. Which action best addresses the major preventable risk associated with contrast?
Verify renal function and assess for prior contrast reaction
Keep the client NPO for 24 hours after the scan
Administer a diuretic before scanning
Place the client in Trendelenburg
A postpartum client shows signs of subinvolution. Which finding is most consistent with subinvolution rather than normal involution?
Fundus descends approximately 1 cm/day
Lochia transitions from rubra to serosa
Mild afterpains with breastfeeding
Persistent lochia rubra with a uterus larger/tender than expected for day postpartum
A postpartum client with subinvolution has uterine tenderness and foul-smelling lochia. Which cause is most likely?
Early ambulation
Infection (endometritis)
Increased oxytocin release from breastfeeding
Normal postpartum leukocytosis
A postpartum client has subinvolution with no fever, but bleeding remains heavy and intermittent. Which finding would most strongly point to retained placental fragments as the cause?
Bradycardia
Hypertension
Enlarged uterus with prolonged lochia rubra and suboptimal contraction despite massage
Night sweats without fever
A postpartum client with suspected retained placental fragments is ordered a uterotonic. Which nursing outcome best indicates the intervention is effective?
Uterus becomes firm and bleeding decreases
Client reports no pain
WBC decreases to normal range within 1 hour
Lochia becomes alba immediately
A postpartum client is having difficulty voiding due to perineal swelling and reports burning with urination. Which nursing intervention best addresses expected postpartum bladder changes while preventing complications?
Restrict fluids to reduce bladder filling
Encourage voiding every 2–3 hours and use comfort measures (peri-bottle, analgesia)
Delay voiding until the urge is strong
Provide vaginal douches to reduce discomfort
A postpartum client is scheduled for CTPA for suspected PE and has severe dyspnea. Which positioning is most appropriate while awaiting transport?
Flat supine
Left lateral only
High-Fowler’s with oxygen therapy
Trendelenburg
A postpartum client receives TXA for hemorrhage. Which assessment best evaluates whether the medication is achieving its intended effect?
Decreased vaginal bleeding over the next hour
Increased maternal appetite
Lower temperature
Decreased uterine tenderness
A postpartum client has hemorrhage, and the nurse suspects bladder distention is worsening bleeding. Which fundal finding supports this?
Fundus firm, midline, and low
Fundus displaced laterally and elevated
Fundus not palpable
Fundus fixed at the symphysis pubis
A postpartum client with suspected PE is ordered a V/Q scan. Which clinical situation most supports choosing V/Q over CTPA?
Normal renal function and no allergies
Iodinated contrast allergy
Stable vital signs and mild symptoms
Need to evaluate uterine tone
A postpartum client has subinvolution suspected due to heavy lochia rubra and a uterus that remains enlarged. Which nursing action is most appropriate first?
Document as normal postpartum finding
Teach that lochia rubra should persist for 6 weeks
Notify the provider and assess for causes (infection, retained fragments, bladder distention)
Administer anticoagulants immediately
A postpartum client has not voided since delivery and has increased lochia. Which nursing action best prevents uterine atony related to bladder changes?
Encourage voiding on a schedule and assess bladder distention
Limit ambulation to reduce fatigue
Avoid pain medication to prevent urinary retention
A postpartum client with hemorrhage receives TXA. Which side effect would prompt the nurse to suspect a serious adverse reaction rather than a common, expected response?
Mild nausea
Mild headache
New unilateral leg swelling and warmth
Temporary fatigue
A postpartum client with suspected PE is on oxygen and awaiting imaging. Which assessment finding indicates deterioration requiring rapid escalation?
Oxygen saturation drops from 95% to 86% despite oxygen
Blood pressure 124/78 mm Hg
Temperature 37.4°C (99.3°F)
Lochia rubra light
A postpartum client has uterine subinvolution related to infection. Which provider order should the nurse anticipate as most consistent with treating the cause?
Broad-spectrum antibiotics
High-dose magnesium sulfate
Furosemide
Insulin infusion
A postpartum client has continued heavy bleeding, firm uterus, and a new order for TXA. Which finding would be a reason for the nurse to question the order?
History of thromboembolic disease
Blood pressure 102/66 mm Hg
Heart rate 108/min
Lochia rubra heavy
A postpartum client has difficulty initiating urination and voids small amounts frequently. Which interpretation is most accurate?
Expected postpartum bladder tone changes can cause retention with overflow
This always indicates renal failure
This confirms uterine inversion
This is a sign of postpartum psychosis
A postpartum client is being prepared for CTPA. Which nursing action best supports safe IV contrast administration?
Verify a patent IV and review creatinine, allergy history, and current symptoms
Remove all monitoring devices prior to imaging
Keep the client flat for 2 hours before contrast
Encourage IM medications for faster absorption
A postpartum client has hemorrhage despite uterine firmness and TXA administration. Which assessment best differentiates retained fragments from laceration as the cause?
Uterine tenderness
Tachycardia
Intermittent heavy bleeding with suboptimal uterine contraction response and enlarged uterus
Bright-red bleeding that is continuous with a firm uterus and no uterine enlargement
A postpartum client has subinvolution and reports malodorous lochia. Which additional finding would most strongly support infection as the cause?
Night sweats without fever
Fundus non-tender and firm
Fever and uterine tenderness
WBC 14,000/mm^3 postpartum with no symptoms
A postpartum client has bladder distention contributing to bleeding. After catheterization, which outcome best indicates improvement related to bladder correction?
Fundus becomes midline and lower with decreased bleeding
Client sleeps through the night
A postpartum client is receiving TXA and asks what the nurse is watching for most closely. Which response is best?
Mostly your appetite and sleep.
We’re watching for decreased bleeding and any signs of unwanted clots like leg swelling or chest symptoms.
We’re watching for increased urination only.
We’re watching for improved lochia color changes.
A postpartum client with suspected PE has a creatinine of 2.6 mg/dL and no contrast allergy. Which diagnostic approach is most appropriate to anticipate?
CTPA is always first-line regardless of renal function
V/Q scan may be preferred to avoid iodinated contrast load
No imaging is needed if symptoms are classic
Echocardiogram replaces chest imaging in PE
A postpartum client has subinvolution suspected and is afebrile, but bleeding remains heavy. Which nursing action is most appropriate while awaiting provider evaluation?
Encourage vigorous fundal massage continuously
Assess uterine tone, quantify bleeding, and monitor vital signs closely
Restrict fluids and maintain bed rest only
A postpartum client has urinary retention risk factors (epidural anesthesia, perineal edema). Which plan best prevents bladder-related postpartum complications?
Void only when urge is strong
Avoid analgesics to prevent retention
Encourage voiding every 2–3 hours; measure first voids; catheterize per protocol if unable
Limit fluids to 1 liter/day
A postpartum client is awaiting PE imaging and is anxious, tachypneic, and hypoxic. Which nursing action is priority?
Provide reassurance only
Start oral fluids
Administer oxygen and maintain airway/breathing while preparing for urgent diagnostic workup
Encourage walking to reduce anxiety
A postpartum client with suspected PE is ordered a diagnostic study requiring transport. Which nursing action best reduces risk of deterioration during transport?
Remove oxygen to avoid dependency
Ensure continuous pulse oximetry and have emergency equipment available per policy
Keep client NPO for 24 hours
Place client in Trendelenburg
A postpartum client has heavy bleeding and receives TXA within 2 hours of birth. Which additional intervention is most consistent with standard hemorrhage escalation if bleeding continues?
Delay all uterotonics after TXA
Add uterotonics/uterine balloon/surgical escalation per hemorrhage protocol
Encourage oral intake and observe only
Stop fundal checks for 4 hours
A postpartum client with subinvolution is found to have a distended bladder. Which explanation best connects bladder changes to subinvolution?
A full bladder can displace the uterus and prevent effective contraction/involution
A full bladder increases estrogen levels and slows involution
A full bladder prevents lactation
A full bladder causes DIC
A postpartum client undergoing PE evaluation asks why V/Q might be chosen instead of CTPA. Which response is best?
“V/Q is only used for pneumonia.”
“V/Q is preferred when iodinated contrast risks are high, like severe kidney issues or contrast allergy.”
“V/Q is always more accurate than CTPA.”
“V/Q is used to treat clots.”
A postpartum client has urinary retention and increased lochia. Which finding indicates the nurse should suspect overflow retention rather than adequate bladder emptying?
Voids 600 mL once
Voids small frequent amounts with suprapubic fullness
No suprapubic discomfort
Urine clear and pale
A postpartum client has hemorrhage and receives TXA. Which nursing assessment best screens for the most dangerous complication related to TXA therapy?
Bowel sounds
Peripheral pulses and capillary refill
Signs of thromboembolism (leg swelling/pain, chest pain, sudden dyspnea)
Skin turgor
A postpartum client has subinvolution suspected due to prolonged lochia rubra and enlarged uterus. Which provider-directed diagnostic evaluation is most consistent with identifying retained products?
Pelvic ultrasound
CT head
Knee X-ray
Spirometry
A postpartum client is prescribed TXA for hemorrhage. Which statement by the nurse best reflects correct "when to give" decision-making?
Administer within 3 hours of birth when significant bleeding persists despite standard uterotonic measures
Delay administration until 6–12 hours after delivery to avoid clotting risks
Give prophylactically before labor begins in clients at high risk of bleeding
Only administer if laboratory-confirmed hypofibrinogenemia is present and bleeding is minimal
