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NGN case study

Postpartum Hemorrhage

A 29-year-old client is 1 hour postpartum after vaginal birth of a 4.2 kg newborn. Setting: Labor and delivery recovery.

Client record

Nurses' Notes

  • Fundus boggy and displaced to the right.
  • Saturates one perineal pad in 15 minutes.
  • Reports dizziness when sitting up.

Vital Signs

  • Admission recovery: BP 118/72, HR 88.
  • Current: BP 88/52, HR 124, RR 22.

Risk Factors

  • Prolonged second stage.
  • Macrosomic newborn.
  • Bladder not emptied since delivery.

Questions

Question 1 of 3

Recognize cues. Select the 3 findings that are most concerning.

Select all that apply.

Select all that apply
Answer and rationale
  • A. Boggy fundus
  • B. One pad saturated in 15 minutes
  • C. BP 88/52 with HR 124

Macrosomia is a risk factor, but the current assessment cues indicate active hemorrhage.

Boggy fundus, heavy bleeding, and shock signs are the priority cues.

Question 2 of 3

Take action. Which action should the nurse perform first?

Choose one answer
Answer and rationale

A. Massage the fundus and call for assistance.

A boggy uterus with heavy bleeding requires immediate uterine massage and escalation.

Fundal massage and immediate help are first.

Question 3 of 3

Analyze cues. Classify each intervention.

Choose for each row.

Choose one option per row
ItemIndicatedContraindicatedLater after stable
Administer prescribed oxytocin
Ambulate to bathroom while dizzy
Weigh blood-soaked pads
Answer and rationale
  • Administer prescribed oxytocin: Indicated
  • Ambulate to bathroom while dizzy: Contraindicated
  • Weigh blood-soaked pads: Indicated

Matrix items check whether each intervention fits the client's current stability.

Oxytocin and quantified blood loss are indicated; ambulation is unsafe while unstable.

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