A nurse is caring for a postpartum client who saturates a perineal pad in 10 minutes. Which of the following actions should the nurse take first?

Choice A rationale Massaging the client's fundus is the immediate priority when a postpartum client saturates a perineal pad in 10 minutes, indicating excessive bleeding. Fundal massage stimulates uterine contractions, which compress blood vessels in the myometrium, reducing blood loss and preventing postpartum hemorrhage by promoting uterine involution and preventing atony. Choice B rationale Checking the client's blood pressure is an important assessment to monitor for signs of hypovolemia. However, it is not the first action. The immediate priority is to address the source of excessive bleeding and prevent further blood loss, which is achieved through fundal massage. Blood pressure assessment would follow. Choice C rationale Observing for pooling of blood under the buttocks is a necessary assessment to quantify blood loss and identify concealed hemorrhage. While important, it is a secondary action to fundal massage. The primary intervention focuses on controlling the bleeding at its source, as delaying can lead to rapid deterioration of the client's condition. Choice D rationale Administering oxytocin is a pharmacological intervention used to prevent and treat postpartum hemorrhage by increasing uterine contractility. While highly effective, it is not the *first* action. Manual fundal massage can be initiated immediately, providing a rapid mechanical stimulus to the uterus while awaiting medication preparation and administration.