A nurse is caring for a client who is 1 hour postpartum and has uterine atony. The client is exhibiting a large amount of vaginal bleeding. Which of the following actions should the nurse take?

Choice A rationale Avoiding sterile vaginal examinations is not a primary action for uterine atony and large vaginal bleeding. While excessive or repeated vaginal examinations can potentially introduce infection or dislodge clots, the immediate priority for uterine atony is to address the lack of uterine tone to prevent further blood loss. Choice B rationale Obtaining a specimen for a Kleihauer-Betke test is used to quantify the amount of fetal red blood cells in the maternal circulation, typically after a significant feto-maternal hemorrhage or trauma. While potentially useful in specific situations, it is not an immediate, primary intervention for acute uterine atony and bleeding. Choice C rationale Performing a fundal massage is the most immediate and critical action for uterine atony. Uterine atony is the leading cause of postpartum hemorrhage, characterized by a boggy, relaxed uterus that cannot effectively constrict blood vessels at the placental site. Manual massage stimulates uterine contractions, promoting vasoconstriction and reducing blood loss. Choice D rationale Assessing for abdominal tenderness is an important assessment, but it is not the primary intervention for acute uterine atony with large vaginal bleeding. Abdominal tenderness could indicate other complications such as uterine rupture or hematoma, which require different immediate interventions after addressing the atony.