A nurse is caring for a woman who has just had a cesarean birth. To monitor for potential hemorrhage, what should the recovery room nurse assess?

Choice A rationale The primary mechanism for preventing postpartum hemorrhage, which is a major risk following any birth including cesarean, is effective uterine contraction (involution). Postpartum hemorrhage is defined as blood loss greater than 1000 mL. Assessing the uterus for firmness (contraction) every 15 minutes in the immediate recovery phase confirms that the myometrial muscle fibers are constricting the uterine blood vessels at the placental site, which is the most critical intervention to prevent excessive bleeding. Choice B rationale Monitoring urinary output is essential for assessing renal perfusion and hydration status, and a decrease in output can be an indicator of hypovolemic shock secondary to hemorrhage, but it is not the primary direct assessment for the source of the hemorrhage. The nurse must first assess the fundus to prevent the hemorrhage itself. Normal urinary output is ≥ 30 mL/hr. Choice C rationale Assessing the abdominal dressings is necessary to monitor for incisional bleeding, which is a local complication. However, the most life-threatening source of hemorrhage after cesarean birth, like vaginal birth, remains at the placental implantation site inside the uterus. Therefore, the fundal assessment takes precedence over the dressing check for hemorrhage risk. Choice D rationale Maintaining a peripheral intravenous infusion (IV) is a standard measure to ensure intravascular access for fluid resuscitation or medication administration (e.g., oxytocin). While important for supportive care, maintaining a specified infusion rate of 100 mL/hr is a therapeutic action, not an assessment for hemorrhage. The primary assessment remains the firm contraction of the uterine muscle.