Which of the following actions should the nurse take for a client who is 1 hr postpartum and has uterine atony exhibiting a large amount of vaginal bleeding?

Choice A reason: Assessing for abdominal tenderness does not address uterine atony or vaginal bleeding. Tenderness may indicate other issues, like infection, but atony requires immediate uterine contraction to control hemorrhage. Fundal massage directly stimulates myometrial contraction, addressing the primary cause of bleeding, per postpartum hemorrhage management protocols. Choice B reason: Performing a fundal massage is the priority for uterine atony, as it stimulates myometrial contractions, promoting hemostasis at the placental site. Atony causes excessive bleeding due to poor uterine tone, and massage enhances oxytocin release, constricting blood vessels to reduce hemorrhage, aligning with obstetric emergency interventions. Choice C reason: Avoiding sterile vaginal examinations does not address uterine atony or bleeding. Examinations assess cervical or vaginal trauma but do not correct myometrial failure. Atony requires active interventions like fundal massage to restore uterine tone and control hemorrhage, making this action irrelevant to the immediate physiological need. Choice D reason: Obtaining a Kleihauer-Betke test assesses fetal-maternal hemorrhage, relevant for Rh-negative mothers, not uterine atony. Atony causes bleeding from poor uterine contraction, not fetal blood loss. This test does not address the immediate need to control hemorrhage through myometrial stimulation, per postpartum hemorrhage management principles.