NCLEX Question of the Day – Thursday, May 07, 2026

Today’s NCLEX question targets prioritization in postpartum care. This matters because a nurse often has only a few minutes to spot whether a new parent is recovering normally or moving toward a dangerous complication. In real nursing, the right first action can prevent shock, surgery, or worse.

Clinical Scenario

A 29-year-old client is 2 hours postpartum after a vaginal birth of a healthy infant in the labor and delivery recovery unit. The pregnancy was uncomplicated except for a long labor with oxytocin augmentation. The client has soaked one perineal pad in 20 minutes and reports feeling “lightheaded and shaky.” On assessment, the fundus feels boggy and slightly above the umbilicus, the lochia is heavy and dark red, blood pressure is 94/58 mm Hg, heart rate is 118/min, and the client’s skin is cool. The client has not voided since delivery.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Assist the client to the bathroom to try to void
2. B. Massage the uterine fundus until it becomes firm
3. C. Prepare to administer prescribed ibuprofen for uterine cramping
4. D. Reassess the amount of lochia in 30 minutes

Correct Answer

B. Massage the uterine fundus until it becomes firm

Detailed Rationale

This client is showing signs of postpartum hemorrhage caused by uterine atony. The key clues are heavy bleeding, a boggy uterus, tachycardia, low blood pressure, dizziness, and cool skin. After delivery, the uterus should contract firmly. That firm contraction compresses the blood vessels where the placenta was attached. If the uterus stays soft, those vessels keep bleeding.

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. On the NCLEX, when a postpartum client is actively bleeding and the uterus is boggy, fundal massage comes before less urgent steps.

After the fundus firms, the nurse should continue a focused sequence of care:

• Reassess uterine tone, position, and amount of bleeding
• Check whether the bladder is distended, because a full bladder can push the uterus up and to the side and prevent good contraction
• Help the client void or prepare for catheterization if needed
• Notify the provider and follow hemorrhage protocols
• Review oxytocin orders or administer uterotonic medication as prescribed
• Monitor vital signs closely for ongoing blood loss and signs of shock
• Maintain IV access and prepare for fluids or additional treatment if bleeding continues

The detail that the client has not voided since delivery matters. A full bladder may be contributing to the uterine atony. But the immediate problem is active bleeding from a boggy uterus. That is why fundal massage is first, then bladder management follows if needed.

The nurse should also assess the perineum for concealed bleeding or a hematoma, inspect for clots, and keep tracking pad counts and blood loss. If the fundus becomes firm but heavy bleeding continues, the cause may be trauma such as a cervical or vaginal laceration rather than atony. That changes the response, so reassessment after massage is important.

Why the Other Options Are Wrong

A. Assist the client to the bathroom to try to void

This is important, but it is not the first action. A full bladder can worsen uterine atony, but the client is already showing significant blood loss and instability. The nurse should not delay treatment of a boggy uterus while walking a lightheaded client to the bathroom. There is also a safety issue because the client may faint.

C. Prepare to administer prescribed ibuprofen for uterine cramping

Ibuprofen may help with afterpains, but pain control is not the priority here. The client’s symptoms point to hemorrhage, not routine postpartum discomfort. Treating cramping while ignoring a boggy fundus would miss the urgent problem.

D. Reassess the amount of lochia in 30 minutes

This would be unsafe. Heavy bleeding with signs of hemodynamic compromise needs immediate intervention, not delayed observation. Waiting 30 minutes could allow major blood loss to continue.

Key Takeaways

• A boggy postpartum fundus plus heavy lochia strongly suggests uterine atony.
• The uterus must be firm to compress placental blood vessels and limit bleeding.
• In active postpartum bleeding, fundal massage is the first nursing action when the uterus is boggy.
• A full bladder can prevent the uterus from contracting well, so assess and address voiding after the immediate bleeding response begins.
• If the fundus is firm and bleeding is still heavy, think about laceration or another cause.

• On-shift mini-checklist:
• Feel the fundus: firm or boggy?
• Check location: midline or displaced?
• Estimate bleeding: pad saturation, clots, continuous trickle?
• Check vital signs and symptoms of shock
• Massage if boggy, then reassess
• Help empty the bladder
• Call for help and prepare ordered uterotonics or fluids

Quick Practice Extension

1. A postpartum client has heavy bleeding, but the fundus is firm and midline. What complication should the nurse suspect next?

2. After fundal massage, the uterus becomes firm, but the client remains tachycardic and continues to pass large clots. What assessments and actions should the nurse prioritize now?

Category used today: OB

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