In this guide, you will find sample hesi case studies for postpartum exams inclusive of the Next Generation NCLEX questions and answers.
Question 1
Prior to discontinuing the IV oxytocin, which assessment is most important for the nurs to obtain?
Vital signs:
Vital sign assessment is important prior to discontinuing the Lactated Ringer's because the primary IV contributes to the maintenance of cardiovascular stability, but this is not the first priority.
Olshansky, E., Perry, S., Lowdermilk, D., Cashion, M. C., Alden, K. (092019). Maternity and Women's Health Care, (12th Edition, p. 424), Elsevier.
Oral intake.
Assessment of oral fluid intake is important when determining if additional IV fluids are indicated, but it is not the first priority.
Answer: Uterine firmness.
Oxytocine is a hormone used to stimulate uterine contractions and prevent hemorrhage from the placental site. Prior to discontinuing the IV, it is most important to ensure that the uterus is contracting by assessing fundal firmness.
Olshansky, E., Perry, S., Lowdermilk, D., Cashion, M. C., Alden, K. (092019). Maternity and Women's Health Care, (12th Edition, p. 424), Elsevier.
O Vaginal discharge.
Expulsion of minimal bright red vaginal discharge is normal after delivery. It is difficult for the nurse to ascertain client stability merely by assessing the vaginal discharge and estimating amounts of vaginal blood loss. Copious amounts of vaginal discharge and a boggy fundus indicate the need more in-depth assessment.
Reference
Test Bank for Maternity and Women's Health Care, (12th Edition). Olshansky, E., Perry, S., Lowdermilk, D., Cashion, M. C., Alden, K. (2019).
Question 2
The postpartum client has minimal sensation in her lower extremities, due to the effect of the epidural anesthesia. What is the priority nursing concern for this client?
Answer: Fall risk.
Epidural anesthesia causes temporary loss of voluntary movement and muscle strength in the lower extremities. Serious injury could be incurred if the client attempts to get out of bed on her own because her legs will be unable to sustain he weight. The nursing priority is to ensure her safety by implementing use of two side-rails and instructing her to not get of bed for the first time without assistance.
Lack of sensation.
The lack of sensation below the waist caused by the residual effects of epidural anesthesia does not pose any real threat infection because epidural side effects are unrelated to the mechanisms of infection transmission or development.
Olshansky, E., Perry, S., Lowdermilk, D., Cashion, M. C., Alden, K. (2019). Maternity and Women's Health Care, (12th Edition, pp. 356, 430.) Elsevier.
Loss of mobility.
The client's loss of mobility is temporary and is not likely to cause complications resulting in long-term immobility.
Inability to void.
While the epidural anesthesia may temporarily inhibit the client's ability to void voluntarily, this is usually resolved within hours. The client should be monitored for bladder fullness during the period that she is unable to sense the need to void but this concern is secondary to client safety.
Reference
Olshansky, E., Perry, S., Lowdermilk, D., Cashion, M. C., Alden, K. (2019). Maternity and Women's Health Care, (12th Edition, pp. 356, 430.) Elsevier.
Explore Postpartum Case Study (HESI + NGN Questions and Answers) 2025
Question 4
The nurse performs the first assessment upon the client's arrival to the postpartum unit Where would the nurse expect to palpate the fundus?
a. 3 cm above the umbilicus.
The fundus should be no higher than 2 cm above the umbilicus.
b. Answer: 1 cm above the umbilicus.
For the first 12 hours, the fundus should be 1 to 2 cm above the umbilicus.
c. To the right of the umbilicus.
The fundus should be directly above the umbilicus. If the fundus is 1 cm to the right of the umbilicus it may indicate a fu bladder.
d. Midway between the umbilicus and the pubic bone.
The fundus should be directly above the umbilicus.
More postpartum practice questions can be found on the Test Bank for Maternity and Pediatric Nursing.
Question 5
Which action is most important for the nurse to implement immediately?
Take vital signs.
If the nurse takes the vital signs first, time will be lost while the client continues hemorrhaging.
Check the bladder.
Bladder distention is a common problem that can impede uterine contraction and predispose the client to bleeding, but another action should be implemented immediately.
Answer: Massage the fundus.
Since a boggy fundus is the most likely reason for this client's hemorrhaging, massing the fundus is the most important intervention. The nurse should also call for assistance due to the amount of blood that has pooled under the client.
Increase the IV rate.
This is an important action, since the client is hemorrhaging and is probably hemodynamically unstable. However, this is not the priority.
Examined Hesi Postpartum Case Studies
RNSG 2301 HESI Case Study | Postpartum
Question 6
What is the best method for the nurse to use to obtain immediate assistance?
a. Answer: Activate the priority call light from the bedside.
The priority call light signals to the entire nursing unit that a client is in crisis. All personnel available will respond to the distress signal.
b. Go to the nurses' station to notify the charge nurse.
The nurse should never leave a critical client's bedside for any reason. The first rule during a crisis is to stay with the clien
c. Call for help from the doorway of the client's room.
Although staying with the client is important during a crisis, it is not appropriate to shout in the hallway.
d. Telephone the healthcare provider (HCP) from the client's room.
The HCP needs to be notified as soon as possible, but not before the nurse collects data. The HCP will have questions regarding the client's status. Anticipating and collecting the necessary data will facilitate effective communication with the
HCP.
Question 7
The nurse has requested assistance and personnel are on their way. While waiting for h to arrive, what is the next priority action?
a. Administer pain medication.
It is important to administer pain medication, but it will not treat the hemorrhaging.
b. Increase the IV infusion rate.
Greater fluid volume administered intravenously is an important lifesaving action, but this is of less
c. Answer: Assess for bladder distention.
The client is 2 hours post-delivery with an IV infusion at 125 mL/hour, which can contribute to diuresis. A distended bladder impedes uterine contraction and contributes to excessive bleeding. After the fundus is massaged, the bladder should be checked for distention.
d. Administer oxygen by nasal cannula.
Applying oxygen is important to improve the client's oxygenation, but it is of less priority than addressing the cause of the hemorrhage.
Question 8
The charge nurse, two staff nurses, and an unlicensed assistive personnel (UAP) rush in assist the nurse with the client. Which task is best delegated to the UAP during this crisis
Start O2 per nasal cannula.
The UAP can collect the equipment but the nurse should initiate O2 administration.
Change the bed linens and bathe the client.
The client is lying in a pool of blood. So at some point, the linens will need to be gathered and weighed to estimate bloo loss, and the client will need to be bathed. This should be done when the client is more hemodynamically stable. It is no the priority at this time.
Obtain the vital signs and O2 saturation.
Obtaining vital signs and pulse oximetry are within the scope of practice for the UAP, and the nurse should interpret the findings as indications of hypovolemia due to blood loss, and should also report the findings to the health care provider.
Bring IV fluids and supplies from the supply room.
It will be difficult for a UAP to know exactly which type of IV fluid to obtain. Since there are many sizes and types of fluid select from in the supply room, there is a greater chance for delay and error if the UAP is sent.
Question 9
The HCP is notified that the client is hemorrhaging and has an estimated blood loss of 1,200 mL since delivery. Her blood pressure is 70/40 mmHg, pulse 120 beats/min, respirations 28 breaths/min, and O2 saturation 73%. The HCP's prescription includes s oxytocin 10 units in each liter of normal saline to infuse at 40 milliunits (mU)/minute. How many mL of oxytocin should the nurse draw up in the syringe to inject into the 10 mL bag of normal saline? (Enter numerical value only. If rounding is necessary, round to the tenth.)
The HCP prescribed 10 units in 1,000 mL of sodium chloride 0.9%. The vial contains 10 units/mL. The nurse should inject 1 m into the bag of NS.
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Question 10
The HCP prescribed 0.2 mg of methylergonovine, and the vial contains 0.8 mg/mL. Ho many mL of methylergonovine should the nurse draw up in the syringe? (Enter numerical round to the hundredth )
The HCP prescribed 0.2 mg methylergonovine. The vial contains 0.8 mg/mL. The nurse should administer 0.25 mL.
Dimensional analysis method: x mL = 1 mL X 0.2 mg = 0.2 mL = 0.25 mL
0.8 mg 0.8
Proportion method: 0.8 mg: 1 mL :: 0.2 mg: x mL 0.8x=0.2x=0.2 = 0.25 mL 0.8
X
Alternate method: Desired X Quantity available 0.2 mg x 1 mL = 0.25 mL Have 0.8 mg
Fluharty, L., Ogden, S. (2019). Calculation of Drug Dosages, (11th Edition, pp. 287-293), Elsevier.
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