Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 4==
Two hours after a vaginal birth, a client has saturated a perineal pad with bright red blood in 20 minutes. The nurse palpates a firm fundus at the level of the umbilicus, midline. Which action is the priority?
# Massage the fundus vigorously.
# Administer methylergonovine as ordered.
# Inspect the perineum and vagina and notify the provider.
# Assist the client to empty her bladder.

'''Answer:''' 3 (C). Inspect the perineum and vagina and notify the provider.

''Rationale:'' Heavy bright red bleeding in the presence of a '''firm, midline''' fundus points away from uterine atony and toward a genital tract laceration or hematoma, which requires visualization and surgical repair. Massaging an already firm uterus (option 1) accomplishes nothing and causes pain and possible uterine relaxation from overstimulation. Uterotonics (option 2) treat atony, which is not the problem here, and methylergonovine also carries a blood pressure contraindication that has not been assessed. Emptying the bladder (option 4) is indicated when the fundus is high and deviated, which is not described.