NCLEX Question of the Day – Tuesday, March 31, 2026

Today’s question targets early recognition of postpartum hemorrhage in an OB setting. This matters because a patient can look stable at first, then decline quickly. Nurses are often the first to notice the pattern: excess bleeding, a boggy fundus, and subtle signs of poor perfusion. Catching that pattern early helps prevent shock, transfusion, and emergency procedures.

Clinical Scenario

A 29-year-old client is 45 minutes postpartum after a vaginal birth of a healthy infant at 39 weeks. Labor was prolonged, and the client received oxytocin augmentation during labor. The placenta was delivered intact. She has no history of bleeding disorders. During the nurse’s assessment, the client says, “I feel dizzy when I sit up.” Her perineal pad is saturated in 15 minutes. On palpation, the fundus feels soft, enlarged, and slightly displaced above the umbilicus. Blood pressure is 98/62 mm Hg, pulse is 118/min, respirations are 22/min, and skin is cool.

The Question

Which action should the nurse take first?

Answer Choices

1. Assist the client to the bathroom to empty her bladder.
2. Massage the uterine fundus until it becomes firm.
3. Prepare the client for an immediate blood transfusion.
4. Administer a prescribed opioid for severe afterpains.

Correct Answer

B. Massage the uterine fundus until it becomes firm.

Detailed Rationale

This client is showing signs of postpartum hemorrhage caused most likely by uterine atony. Uterine atony means the uterus is not contracting well after birth. When the uterus stays relaxed, the blood vessels at the placental site do not compress properly, so bleeding continues.

The key clues are all here:

• A pad saturated in 15 minutes, which is far beyond expected lochia flow
• A soft, boggy, enlarged fundus
• Fundus displaced above the umbilicus, suggesting possible bladder distention
• Tachycardia, dizziness, cool skin, and borderline low blood pressure, which suggest volume loss

The nurse’s first action is to massage the fundus. That directly treats the most immediate cause of bleeding. Fundal massage stimulates uterine contraction. A firm uterus compresses open vessels and reduces blood loss. In NCLEX priority questions, the best first action is the one that addresses the cause of instability fastest and within the nurse’s immediate scope.

After the fundus is firming, the nurse should continue with rapid follow-up actions. These include:

• Call for help and notify the provider
• Assess the amount and character of bleeding
• Check whether the bladder is distended and help empty it if needed
• Administer uterotonic medication as prescribed
• Monitor vital signs closely
• Maintain or increase IV fluids per orders
• Measure urine output
• Reassess fundal tone and lochia frequently

Why does the bladder matter here? A full bladder can push the uterus upward and to the side. That makes uterine contraction less effective and can worsen bleeding. But even though bladder emptying is important, fundal massage comes first because it can be done immediately at the bedside and may slow the hemorrhage within seconds.

The nurse also needs to monitor for worsening hypovolemia. Important findings include rising pulse, falling blood pressure, pallor, restlessness, decreased urine output, and delayed capillary refill. Mental status changes can be an early sign that tissue perfusion is dropping.

In real practice, postpartum hemorrhage management is not a one-step task. It is a rapid sequence. But on a priority question, the nurse starts with the action that is both immediate and most likely to reduce active bleeding right away.

Why the Other Options Are Wrong

A. Assist the client to the bathroom to empty her bladder.

This is reasonable later, but not first. The bladder may be contributing to the displaced fundus, but the client is dizzy, tachycardic, and actively bleeding. Walking her to the bathroom could increase fall risk and delay the most urgent intervention. The nurse should first massage the fundus and stabilize the client. If bladder emptying is needed, it may be safer to use a bedpan or catheter per orders and facility protocol.

C. Prepare the client for an immediate blood transfusion.

A transfusion may become necessary if blood loss is severe or ongoing, but this is not the first action. The nurse must first try to stop the source of bleeding. Fundal massage is faster and directly addresses uterine atony. Preparing blood products without first treating the cause wastes critical time.

D. Administer a prescribed opioid for severe afterpains.

This is inappropriate in the current situation. The priority is hemorrhage, not pain control. Also, opioids can worsen dizziness and make reassessment harder. A boggy uterus with heavy bleeding is an emergency until proven otherwise.

Key Takeaways

• A boggy fundus plus heavy bleeding after birth points to uterine atony until shown otherwise.
• Fundal massage is the first nursing action because it can quickly improve uterine tone and reduce blood loss.
• A displaced fundus often means the bladder is full, which can worsen atony.
• Tachycardia, cool skin, dizziness, and low blood pressure are warning signs of hypovolemia.
• After the first action, keep reassessing bleeding, fundal tone, vital signs, urine output, and response to treatment.

• On-shift mini-checklist: feel fundus, check lochia, count pad saturation, assess bladder, trend vital signs, call for help early, give ordered uterotonics, and document the patient’s response.

Quick Practice Extension

1. If the uterus becomes firm after massage but bright red bleeding continues, what cause of postpartum hemorrhage should the nurse suspect next?

2. A postpartum client has a firm fundus, scant lochia, increasing pelvic pressure, and a rising pulse. What complication should the nurse consider?

Category for today: OB

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