Postpartum Hemorrhage Practice Exam

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1. A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss?

  1. A temperature of 100.4*F
  2. An increase in the pulse from 88 to 102 BPM
  3. An increase in the respiratory rate from 18 to 22 breaths per minute
  4. A blood pressure change from 130/88 to 124/80 mm Hg

2. Methergine or Pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the:

  1. Amount of lochia
  2. Blood pressure
  3. Deep tendon reflexes
  4. Uterine tone

3. Methergine or Pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client’s medical history?

  1. Peripheral vascular disease
  2. Hypothyroidism
  3. Hypotension
  4. Type 1 diabetes

4. Which of the following complications is most likely responsible for a delayed postpartum hemorrhage?

  1. Cervical laceration
  2. Clotting deficiency
  3. Perineal laceration
  4. Uterine subinvolution

5. Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage?

  1. Hypertension
  2. Cervical and vaginal tears
  3. Urine retention
  4. Endometritis

6. Which measure would be least effective in preventing postpartum hemorrhage?

  1. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered
  2. Encourage the woman to void every 2 hours
  3. Massage the fundus every hour for the first 24 hours following birth
  4. Teach the woman the importance of rest and nutrition to enhance healing

7. To be considered a PPH, what would the estimated blood loss have to be for a C-section?

  1. < 550 ML
  2. > 600 ML
  3. > 1000 ML
  4. < 900 ML

8. What types of trauma during labour and birth would lead to PPH risk?

  1. Instrumental assisted birth (vacuum or forceps)
  2. C-Section
  3. Lacerations of the cervix or vaginal wall
  4. All of the above

9. Atonic bleeding is due to a lack of tone in the uterus.

  1. True
  2. False

10. The 4 “T’s” of PPH are:

  1. Trauma
  2. Toxins
  3. Travel
  4. Tissue
  5. Threads
  6. Thrombin
  7. Tears
  8. Tone
  1. 1, 4, 6 & 8
  2. 1, 5 7 & 8
  3. 1, 2, 3 & 6
  4. 3, 4, 5 & 6
Answer and Rationale

1. B. An increase in the pulse from 88 to 102 BPM. During the 4th stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. A rising pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume.

  • Option A: A slight rise in temperature is normal. The respiratory rate is increased slightly.
  • Option D: The blood pressure will fall as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage.

2. B. Blood pressure. Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.

3. A. Peripheral vascular disease. These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.

4. D. Uterine subinvolution. Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution.

  • Options A and C: Cervical or perineal lacerations can cause an immediate postpartum hemorrhage.
  • Option B: A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn’t corrected at the time of delivery.

5. C. Urine retention.  Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period.

6. C. Massage the fundus every hour for the first 24 hours following birth. The fundus should be massaged only when boggy or soft.  Massaging a firm fundus could cause it to relax.

  • Options A, B, and D are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.

7. C. > 1000 ML

8. D. All of the above

9. A. True

10. A. 1, 4, 6 & 8