What is the most common cause of early postpartum haemorrhage (PPH)?
[a] Retained placental fragments.
[b] Perineal lacerations.
[c] Uterine atony.
[d] A clotting disorder.
A nurse assesses a postpartum patient and finds her uterine fundus to be soft and boggy, located above the umbilicus. What is the nurse's first action?
[a] Administer a bolus of IV fluids.
[b] Notify the physician immediately.
[c] Check the patient's vital signs.
[d] Massage the fundus firmly until it is firm.
A postpartum patient with a history of hypertension is experiencing PPH. Which uterotonic medication is contraindicated for this patient?
[a] Oxytocin (Pitocin).
[b] Methylergonovine (Methergine).
[c] Misoprostol (Cytotec).
[d] Dinoprostone.
The most common puerperal infection is:
[a] Mastitis.
[b] A urinary tract infection (UTI).
[c] Endometritis.
[d] A caesarean section wound infection.
A breastfeeding mother on her fifth postpartum day complains of a painful, wedge-shaped area of redness on her left breast, along with fever and flu-like symptoms. The nurse should suspect:
[a] Normal breast engorgement.
[b] A plugged milk duct.
[c] Mastitis.
[d] A breast abscess.
What is the most important piece of advice a nurse can give to a mother with mastitis?
[a] "Stop breastfeeding immediately to allow the breast to rest."
[b] "Apply tight, constrictive bras to suppress milk production."
[c] "Only feed the baby from the unaffected breast."
[d] "Continue to breastfeed frequently, ensuring complete emptying of the affected breast."
A postpartum patient complains of calf pain, and the nurse notes redness, warmth, and swelling in her left lower leg. These signs are indicative of:
[a] A muscle cramp.
[b] Superficial thrombophlebitis.
[c] Deep Vein Thrombosis (DVT).
[d] Normal postpartum edema.
Which patient is at the highest risk for developing a thromboembolic complication during the puerperium?
[a] A woman who had a spontaneous vaginal delivery and is ambulating.
[b] A woman who had an emergency caesarean section and is on prolonged bed rest.
[c] A woman who is breastfeeding.
[d] A woman with a history of postpartum blues.
A postpartum patient suddenly develops severe shortness of breath, sharp chest pain, and anxiety. The nurse's immediate priority is to suspect a pulmonary embolism and:
[a] Encourage the patient to ambulate.
[b] Assess the patient's lower extremities for signs of DVT.
[c] Raise the head of the bed, apply oxygen, and call for immediate assistance.
[d] Administer a dose of pain medication.
Which of the following best describes postpartum "baby blues"?
[a] A severe, debilitating condition that requires immediate hospitalization.
[b] Feelings of wanting to harm the baby or oneself.
[c] A rare complication that occurs months after delivery.
[d] A transient, self-limiting period of mood lability and tearfulness that resolves within 10-14 days.
Puerperal fever is defined as a temperature of 38°C (100.4°F) or higher on any two of the first:
[a] 2 postpartum days, excluding the first 24 hours.
[b] 5 postpartum days, excluding the first 24 hours.
[c] 10 postpartum days, excluding the first 24 hours.
[d] 14 postpartum days, excluding the first 24 hours.
A patient develops a vulvar hematoma. The nurse's initial management for a small, non-expanding hematoma would include:
[a] Preparing the patient for immediate surgery.
[b] Applying warm compresses to the area.
[c] Administering a strong diuretic.
[d] Applying ice packs and administering analgesics.
The term for a uterus that fails to return to its normal non-pregnant size is:
[a] Involution.
[b] Subinvolution.
[c] Uterine atony.
[d] Endometritis.
Which assessment finding in a postpartum patient on day 7 would be considered abnormal?
[a] The presence of lochia serosa.
[b] A firm uterine fundus that is no longer palpable abdominally.
[c] A return to bright red, heavy lochia rubra.
[d] Experiencing "afterpains" while breastfeeding.
The REEDA acronym is used to assess the healing of an episiotomy or perineal laceration. The 'R' and first 'E' stand for:
[a] Return and Effacement.
[b] Right and External.
[c] Redness and Edema.
[d] Rigidity and Eversion.
A mother who is three weeks postpartum expresses feelings of worthlessness, an inability to care for her baby, and has lost interest in all activities. The nurse recognizes these as signs of:
[a] Postpartum blues.
[b] Postpartum depression.
[c] Normal postpartum adjustment.
[d] Postpartum psychosis.
The medication Carboprost (Hemabate) is used to treat PPH but is contraindicated in patients with a history of:
[a] Hypertension.
[b] Asthma.
[c] Diabetes.
[d] Anemia.
The most effective way to prevent postpartum urinary tract infections (UTIs) is to:
[a] Limit fluid intake.
[b] Administer prophylactic antibiotics to all postpartum women.
[c] Encourage frequent voiding and proper perineal hygiene.
[d] Avoid breastfeeding for the first 24 hours.
Secondary postpartum haemorrhage typically occurs:
[a] Within the first 2 hours after delivery.
[b] Within the first 24 hours after delivery.
[c] Between 24 hours and 6 weeks after delivery.
[d] After 6 weeks postpartum.
Which symptom requires immediate intervention as it may indicate postpartum psychosis?
[a] The mother crying for no apparent reason.
[b] The mother feeling tired and overwhelmed.
[c] The mother reporting hearing voices telling her to harm her baby.
[d] The mother expressing anxiety about her ability to parent.
A key sign of endometritis that a nurse should assess for is:
[a] A firm, midline uterine fundus.
[b] Scant, odorless lochia.
[c] Calf pain upon dorsiflexion.
[d] Uterine tenderness and foul-smelling lochia.
A patient complains of severe perineal pain and a feeling of pressure that is disproportionate to what would be expected after a normal delivery. The nurse should suspect:
[a] A urinary tract infection.
[b] Uterine atony.
[c] A perineal or vaginal hematoma.
[d] Normal afterpains.
The "4 T's" mnemonic for the causes of PPH includes Tone, Trauma, Thrombin, and:
[a] Temperature.
[b] Time.
[c] Tissue (retained).
[d] Tocolytics.
When providing discharge teaching, the nurse should instruct a new mother to contact her provider if she experiences which of the following?
[a] Passing lochia alba on day 12 postpartum.
[b] Feeling tired in the afternoon.
[c] Pain, redness, or warmth in one of her legs.
[d] Mild uterine cramping during breastfeeding.
The primary cause of secondary postpartum haemorrhage is:
[a] Uterine atony.
[b] Retained placental fragments or subinvolution.
[c] Cervical lacerations.
[d] A clotting deficiency.
Legislation in nursing, profession and related organisations.
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