A nurse is caring for a client who is 36 hours postpartum and has a distended bladder.The client reports saturating four perineal pads in the past hour. Which of the following actions should the nurse take? (Select all that apply.)

Choice A rationale Palpating the fundus is crucial because a full bladder displaces the uterus superiorly and laterally, impeding its ability to contract effectively (uterine atony). Uterine atony is the primary cause of early postpartum hemorrhage (PPH). Assessing the fundal location and tone provides direct evidence of uterine involution progress and identifies potential PPH risk; a soft, boggy fundus requires immediate intervention to prevent excessive blood loss. Choice B rationale Assessing the client's blood pressure (BP) and pulse is an essential rapid assessment for signs of hypovolemic shock, which can result from excessive blood loss indicated by saturating four perineal pads in one hour (suggestive of PPH). A decrease in BP (hypotension) and an increase in pulse rate (tachycardia) are classic compensatory mechanisms and late indicators of significant volume depletion, demanding prompt resuscitation and definitive hemorrhage control. Normal adult BP is typically less than 120/80 mmHg; normal pulse is 60-100 beats/minute. Choice C rationale Inspecting under the client's buttocks is vital because blood can pool there without being immediately visible on the perineal pad, leading to an underestimation of total blood loss. Postpartum hemorrhage is defined as blood loss greater than 500 mL following a vaginal birth or greater than 1000 mL after a Cesarean birth. Hidden blood accumulation contributes to delayed recognition of the severity of PPH, which can rapidly progress to instability. Choice D rationale Administering a non-additive intravenous infusion (like 0.9. Choice E rationale Placing the client in the reverse Trendelenburg position involves lowering the head and raising the foot of the bed, which increases venous pooling in the lower extremities and may slightly lower cerebral perfusion. This position is generally contraindicated in a client with suspected or active postpartum hemorrhage (PPH) or hypovolemic shock, as it can worsen hypotension and compromise circulation to vital organs. The Trendelenburg position (head lower than feet) is sometimes used for shock, but the reverse position is inappropriate.