NCLEX-RN practice › Health Promotion and Maintenance
NCLEX postpartum question: bleeding with a firm uterus
Health Promotion and Maintenance · Multiple choice · Clinical judgment step: Prioritize hypotheses
Client record
Postpartum assessment
- Fundus
- firm, at umbilicus, midline
- Bladder
- not distended (voided 300 mL)
- Lochia
- steady trickle of bright red blood, no clots
- Perineum
- intact externally
Birth summary
Precipitous birth, 9 lb 4 oz newborn, vacuum-assisted
- Quantified blood loss so far
- 650 mL
Vital signs
HR 108/min, BP 104/64 mm Hg
A client who gave birth vaginally 1 hour ago has a firm uterus at the umbilicus, midline. The nurse notes a steady trickle of bright red blood. Based on the client record, what is the most likely cause?
- A. Uterine atony
- B. Full bladder displacing the uterus
- C. Normal lochia rubra
- D. Cervical or vaginal laceration
Show the answer and rationales
Answer: D
When bleeding continues despite a firm uterus, suspect lacerations or retained tissue. Precipitous, large-baby and instrument-assisted births raise the risk of trauma.
- A. Incorrect. Atony produces a soft, boggy uterus; this uterus is firm.
- B. Incorrect. The client has voided and the fundus is midline.
- C. Incorrect. A steady trickle of bright red blood despite a firm fundus, with tachycardia, is not normal.
- D. Correct. Correct. Bleeding with a firm, midline uterus and an empty bladder points to genital tract trauma, which is more likely after a rapid, instrument-assisted birth of a large baby.
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