A nurse is caring for a client who is 4 hours postpartum. The nurse finds a small amount of lochia rubra on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following actions should the nurse take?

Choice A rationale Performing fundal massage is indicated for a boggy or displaced fundus, which suggests uterine atony and a risk of hemorrhage. In this scenario, the fundus is described as firm and midline at the umbilicus, indicating appropriate uterine involution and contraction. Therefore, fundal massage is not necessary. Choice B rationale Increasing the rate of IV fluids is typically done to expand circulating blood volume in cases of hypovolemia or hemorrhage. Given the small amount of lochia rubra and a firm, midline fundus, there is no indication of excessive blood loss or hypovolemia that would warrant an increase in IV fluid rate. Choice C rationale Assisting the client to ambulate is generally encouraged in the postpartum period to promote circulation and prevent complications like deep vein thrombosis. However, in the context of assessing for potential concealed hemorrhage, ambulation is not the most immediate or appropriate action; the priority is to rule out hidden blood loss. Choice D rationale A small amount of lochia rubra with a firm, midline fundus is a normal finding. However, checking for blood under the client's buttock is crucial to rule out concealed hemorrhage, as blood can pool unnoticed beneath the client, masking significant blood loss despite a firm fundus. This ensures a comprehensive assessment of blood loss.