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 While ambulation is encouraged in the postpartum period to prevent venous thromboembolism, it is not the priority when there is a risk of hidden hemorrhage. The client is only 4 hours postpartum, and the nurse must ensure that the total blood loss is accurately quantified. Until the nurse has confirmed that there is no pooled blood under the client, initiating ambulation could lead to orthostatic hypotension or a syncopal episode. Choice B rationale Fundal massage is the primary intervention for uterine atony, which is characterized by a soft or boggy uterus. However, the scenario states the fundus is already firm and midline at the umbilicus. Massaging a firm fundus is unnecessary and can cause the client discomfort. Since the uterus is contracted, the nurse must look for other sources of bleeding or hidden clots rather than repeating a treatment for atony. Choice C rationale Blood can pool underneath a postpartum client due to gravity, especially when they are in a supine position. A small amount of lochia on the perineal pad may be misleading if a larger volume of blood has collected on the linens beneath the buttocks. Assessing the area under the client allows for a more accurate estimation of total postpartum blood loss and helps in early detection of potential hemorrhage. Choice D rationale Increasing the rate of IV fluids is an intervention used for hemodynamically unstable clients or those experiencing significant blood loss to maintain blood pressure. There is no evidence in the scenario that the client is experiencing hypovolemia or that her blood pressure is low. The fundus is firm and pad drainage is small, so increasing fluids without a clinical indication could lead to fluid volume overload or electrolyte imbalances.