The nurse assessing a postpartum client's fundus finds it firm, 2 centimeters above the umbilicus and displaced to the right.
What is the most appropriate nursing intervention at this time?

Choice A rationale

Assessing vital signs is important in evaluating a postpartum hemorrhage, but it is not the immediate priority. Significant blood loss can occur before changes in vital signs become apparent due to compensatory mechanisms in the body. Addressing the source of bleeding is the initial critical step.

Choice B rationale

Calling the primary health care provider is a necessary step, but it should occur after the nurse has taken immediate action to address the likely cause of the excessive bleeding. Direct intervention to control the hemorrhage takes precedence over notification.

Choice C rationale

Massaging the fundus is the highest priority because uterine atony, a soft and boggy uterus that does not contract effectively, is the most common cause of early postpartum hemorrhage. Stimulating uterine contraction by massage can help to compress the blood vessels at the placental site and reduce bleeding.

Choice D rationale

Initiating an intravenous (IV) infusion of Ringer's lactate solution is important for volume replacement if bleeding is significant, but it is not the immediate first action. Addressing the uterine atony through fundal massage should be done first to try and control the bleeding.

Choice A rationale

Elevating the mother's legs may help with venous return and circulation, but it does not directly address a soft and boggy uterus, which indicates uterine atony and a risk for hemorrhage. The immediate priority is to promote uterine contraction.

Choice B rationale

A soft and boggy uterus indicates uterine atony, a primary cause of postpartum hemorrhage. Massaging the fundus stimulates the uterine muscles to contract, which helps to compress the blood vessels at the placental site and reduce bleeding. This is the most appropriate initial intervention to address uterine atony.

Choice C rationale

Encouraging the mother to void is important in the postpartum period as a full bladder can displace the uterus and interfere with its ability to contract. However, in the presence of a soft and boggy uterus, the immediate priority is to directly stimulate uterine contraction through fundal massage before addressing bladder emptying.

Choice D rationale

Pushing on the uterus to express clots without first ensuring the uterus is firm is contraindicated. A soft, atonic uterus is more susceptible to inversion if pressure is applied. Fundal massage should be performed first to encourage uterine contraction and firmness before attempting to express any clots.