Relias: Nursing Care of the Patient with
Obstetric and Postpartum Hemorrhage
Assessment Questions With Verified Answers
Question 1 of 63
During a cesarean, the provider communicates that the drapes have been suctioned out prior to
the delivery of the placenta.
The nurse notes the suction canister has 350 mL of blood-tinged fluid in it. The nurse quickly
switches to a new suction canister prior to the delivery of the placenta. As the fascia is closed,
the provider again suctions the drape, and the nurse notes 600 mL of blood in the new canister.
Twenty sponges in 4 sponge counter bags are weighed with a total amount of 400 g. The nurse
knows the dry weight of 20 sponges and 4 counter bags is 250 g.
What amount of quantitative blood loss does the nurse record for this birth?
Select an answer.
• 600 mL
1350 ml
• 750°mL
• 1100 mL - answer✔• 750°mL
Early nursing interventions in a Stage 1 hemorrhage include:
Select an answer.
• Administering uterotonics, drawing labs, and moving to the OR
• Massaging the fundus, ambulating the patient, and quantifying blood loss
• Massaging the fundus, emptying the bladder, and quantifying blood loss
O Evaluating vital signs, assessing for cervical lacerations, and administering IV fluids -
answer✔• Massaging the fundus, emptying the bladder, and quantifying blood loss
Ms. Diaz expels a grapefruit-sized clot. The nurse massages Ms. Diaz fundus and informs the
physician that the patient has entered Stage 2 of hemorrhage. The physician states, "Let's just
watch her over the next hour."
What should the prudent nurse do?
Select an answer.
• State that for a Stage 2 hemorrhage, the protocol recommends that the provider evaluates the
patient and orders a uterotonic.
O Follow the physician's order, as it is the physician's call, not the nurse's.
• Tell the patient that the doctor does not seem to think her bleeding is concerning.
• Ask the senior nurse what to do, and follow that advice. - answer✔• State that for a Stage 2
hemorrhage, the protocol recommends that the provider evaluates the patient and orders a
uterotonic.
A hemorrhage risk assessment is completed:
SATA
1. Upon admission
2. Throughout labor, as risk factors develop
3. Prior to birth
4. Hourly in labor - answer✔1. Upon admission
2. Throughout labor, as risk factors develop
3. Prior to birth
Question 15 of 63
The nurse reports that the quantitative blood loss (QBL) from the under-buttocks drape after the
vaginal birth is 745 mL after dry weights and pre-placental fluids have been subtracted. Prior to
the provider leaving the room, the obstetric team decides to re-evaluate bleeding, fundal height,
and vital signs. The decision for heightened surveillance is made because:
a. The team mistakenly diagnoses a hemorrhage despite the fact that QBL is <1000 mL.
b. Cumulative QBL is not accurate enough to diagnose obstetric hemorrhage.
c. The team correctly identifies 745 mL as an abnormal amount of blood loss for a vaginal birth,
warranting close monitoring.
d. Some providers are more cautious than others, and management depends on the individual
provider. - answer✔c. The team correctly identifies 745 mL as an abnormal amount of blood loss
for a vaginal birth, warranting close monitoring.
Though the standard definition of a hemorrhage is blood loss >1000 mL, blood loss
>500 mL is abnormal in a vaginal birth and warrants close monitoring. This is considered a
Stage 1 hemorrhage on AWHONN's hemorrhage staging system.
Initial interventions to manage hemorrhage are appropriate after 500 mL blood loss in a vaginal
birth (Association of Women's Health, Obstetric and Neonatal Nurses 2021a). QBL should be
the main trigger to help guide management of a hemorrhage. Standardized protocols help limit
variances due to different providers.
A cumulative quantitative blood loss after a vaginal birth that is 600 mL is considered what stage
of hemorrhage?
Select an answer.
• Is not staged because it is <1000 mL - answer✔• Stage 1 hemorrhage
Which of the following nursing interventions should be performed in collaboration with other
interventions during a Stage 1 obstetric hemorrhage?
Select all that apply.
1 Keep the patient warm using warmed fluids and warmer devices.
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