NCLEX Question of the Day – Wednesday, April 01, 2026

Today’s question targets early recognition and response to postpartum hemorrhage, a core OB skill. This matters because a patient can go from stable to unstable in minutes after delivery. Nurses are often the first to notice subtle changes, and quick action can prevent shock, surgery, or death.

Clinical Scenario

A 29-year-old client is 1 hour postpartum after a vaginal birth of a healthy newborn in the labor and delivery unit. She had a prolonged labor and received oxytocin for augmentation. The placenta was delivered intact. During the last 15 minutes, the nurse notes that the client has saturated one perineal pad and has a steady trickle of bright red blood on the underpad. The client says, “I feel a little dizzy when I sit up.” Her vital signs are blood pressure 98/62 mm Hg, heart rate 118/min, respiratory rate 20/min, and oxygen saturation 98% on room air. On assessment, the fundus is boggy and palpated above and to the right of the umbilicus.

The Question

Which nursing action should the nurse take first?

Answer Choices

1. A. Notify the health care provider and prepare for a stat hemoglobin level
2. B. Assist the client to the bathroom to empty her bladder
3. C. Massage the uterine fundus until it becomes firm
4. D. Increase the primary IV rate and administer oxygen by face mask

Correct Answer

C. Massage the uterine fundus until it becomes firm

Detailed Rationale

This client is showing signs of early postpartum hemorrhage caused most likely by uterine atony. The key clues are a boggy fundus, heavy bright red bleeding, and a fundus that is above and to the right of the umbilicus. A boggy uterus means the muscle is not contracting well. When the uterus does not contract, the blood vessels at the placental site stay open and bleeding continues.

The nurse’s first action is to massage the fundus. This is the fastest bedside intervention to stimulate uterine contraction and reduce bleeding right away. In NCLEX questions, when a postpartum client has a boggy uterus and active bleeding, the immediate priority is usually to firm the uterus unless the stem gives a stronger airway or circulation emergency.

After fundal massage, the nurse should reassess whether the uterus becomes firm and whether bleeding decreases. The nurse should also check for clots, quantify blood loss as accurately as possible, and continue frequent vital signs. Tachycardia and dizziness matter here because they may be early signs of volume loss, even before blood pressure drops sharply.

Next, the nurse should address the likely reason the uterus is displaced to the right: a full bladder. A distended bladder can push the uterus upward and to the side, which prevents effective contraction. If the client can safely get up, she may be assisted to void. If not, the nurse may need to follow orders or unit protocol for bladder management. But bladder emptying comes after the immediate step of firming the boggy uterus.

The nurse should also prepare for additional interventions if bleeding continues. These may include increasing IV fluids, administering uterotonic medications as prescribed, calling for help, and ongoing hemodynamic monitoring. The point is that fundal massage is the first bedside action because it directly treats the most likely cause that is visible in the assessment data.

Why the Other Options Are Wrong

A. Notify the health care provider and prepare for a stat hemoglobin level

Calling the provider may be necessary, but it is not the first action when the nurse can identify and treat the problem immediately. A stat hemoglobin will not stop active bleeding. Lab work helps evaluate blood loss, but the priority is to reduce hemorrhage now.

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

This is important because the uterus is deviated to the right, which suggests bladder distention. A full bladder can worsen uterine atony. Still, this is not first. The client is actively bleeding and dizzy, so delaying fundal massage while walking her to the bathroom could increase blood loss and raise fall risk.

D. Increase the primary IV rate and administer oxygen by face mask

These actions support circulation and oxygen delivery and may be needed if bleeding is severe or ongoing. But they do not correct the immediate cause shown in the scenario: a boggy uterus. The most direct first intervention is to make the uterus contract. Supportive measures come right after or simultaneously if more staff are available.

Key Takeaways

• A boggy postpartum fundus with heavy bleeding points to uterine atony until proven otherwise.
• Fundal massage is the first nursing action because it can quickly reduce bleeding.
• A fundus that is above and to the right often means the bladder is full.
• Tachycardia, dizziness, and increasing pad saturation are early warning signs of significant blood loss.
• After the uterus is firm, reassess bleeding, empty the bladder, monitor vital signs, quantify blood loss, and prepare for uterotonic therapy or IV fluid support if needed.

• On-shift mini-checklist:
• Check fundal tone, position, and bleeding amount.
• Massage a boggy fundus immediately.
• Reassess firmness and blood loss within minutes.
• Help the client void if the bladder is distended.
• Monitor pulse, blood pressure, symptoms, and pad saturation.
• Escalate quickly if bleeding continues or the client shows signs of instability.

Quick Practice Extension

1. A postpartum client has a firm midline fundus but continues to have a heavy flow of bright red blood. What cause of bleeding should the nurse suspect next?

2. After fundal massage, the uterus remains boggy and bleeding continues despite bladder emptying. What medication type would the nurse expect the provider to prescribe?

Category: OB

Download