A nurse is caring for a client who is 4 hr postpartum following a vaginal birth. The client has saturated a perineal pad within 10 min. Which of the following actions should the nurse take first?

Rationale: A. Prepare to administer a prescribed oxytocic preparation is incorrect as the first action because while oxytocics (e.g., oxytocin) are indicated to control postpartum hemorrhage, the nurse must first assess and attempt to correct the immediate cause of bleeding, which is often uterine atony. Administering medication is secondary to the initial assessment and intervention. B. Massage the client's fundus is correct because uterine atony is the most common cause of early postpartum hemorrhage. A boggy, poorly contracted uterus allows excessive bleeding. Fundal massage stimulates uterine contractions, which can immediately reduce blood loss and is the first-line intervention. The priority is always to stop bleeding at its source before other interventions. C. Assess client's blood pressure is incorrect as the first action because vital signs may be affected by blood loss, but assessment alone does not stop the hemorrhage. While BP and pulse should be monitored, addressing the cause of bleeding takes precedence. D. Assess the bladder for distention is incorrect as the first action because a distended bladder can impede uterine contraction, but in this scenario, the immediate problem is the saturated pad and likely uterine atony. Bladder assessment and emptying can follow after fundal massage if needed.