A nurse is caring for a client 2 hours following a spontaneous vaginal delivery and notes that the client has saturated two perineal pads with blood in a 30-minute period. Which of the following actions should the nurse take first?

Choice A rationale Saturated two perineal pads within 30 minutes suggests excessive bleeding, potentially postpartum hemorrhage. The first action is to assess the uterine fundus for consistency (firmness) and location. A boggy fundus indicates uterine atony, the most common cause of postpartum hemorrhage, requiring immediate fundal massage to stimulate contraction and control bleeding. Choice B rationale Administering oxytocic medication is often a subsequent intervention after fundal massage proves insufficient or following a primary assessment confirming uterine atony. This action is not the initial, immediate, and non-pharmacological step to diagnose the cause of bleeding and attempt to control it, which is the fundal check. Choice C rationale While fluid replacement is essential for hypovolemia resulting from hemorrhage, increasing fluid intake is a supportive measure and not the primary, initial action to stop the source of the excessive bleeding. The first priority is to identify and address the cause of the hemorrhage, which starts with assessing the uterine tone. Choice D rationale A distended bladder can displace the uterus and inhibit its contraction, contributing to atony and bleeding. Although having the client urinate (or catheterizing) is an important intervention, the immediate priority for profuse bleeding is to first assess the fundus to rule out and/or treat atony via massage.