A client who gave birth 5 hours ago has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first?

Choice A rationale A saturated perineal pad within 15 minutes suggests a significant hemorrhage. The most common cause of postpartum hemorrhage is uterine atony, a lack of uterine muscle tone. Assessing the fundus first allows the nurse to determine if the uterus is firm or boggy, a key indicator of atony, and to perform a fundal massage if needed to stimulate contractions and reduce bleeding. Choice B rationale While an IV infusion may be necessary to restore blood volume, initiating it is not the first action. The nurse must first determine the cause of the bleeding. The fundus assessment provides critical diagnostic information and an immediate opportunity for intervention (massage) that could resolve the bleeding before initiating a fluid resuscitation. Choice C rationale Assessing vital signs is important but should not be the first action. In a situation of heavy bleeding, the priority is to identify and address the source of the hemorrhage. A fundal assessment provides this information immediately. Vital signs will change in response to blood loss, but the fundal assessment provides the most direct and immediate action to stop the bleeding. Choice D rationale The health care provider must be notified, but this action is not the first step. The nurse must first gather essential assessment data, such as the condition of the fundus, and initiate immediate interventions like a fundal massage if indicated. Notifying the provider without this information will delay appropriate care.