A postpartum client has heavy vaginal bleeding and a boggy uterus. Place the nurse's initial response actions in priority order.
Ordered Response
Choose your responses, then check the answer.
Explanation
Activate the hemorrhage response first so simultaneous help and supplies arrive. Begin uterine massage and reassessment immediately, establish resuscitation access and specimens, administer protocol-directed medications, and continue quantified reassessment and documentation. In practice, several bundle actions occur nearly simultaneously.
Correct sequence Activate help → massage and reassess → resuscitation access → protocol medications → reassess and document.
Why this is correct Postpartum hemorrhage can progress within minutes. Team activation allows uterine massage, oxytocic medication, tranexamic acid, IV fluids, examination for the bleeding source, and laboratory support to begin as a coordinated bundle. A boggy uterus supports uterine atony, so massage and tone reassessment cannot wait for routine charting.
NCLEX decision rule For active hemorrhage, mobilize help and control the source while supporting circulation. The numbered sequence identifies the lead priorities; it does not imply that a real hemorrhage team performs every action one at a time.
Reference
1WHO consolidated postpartum-hemorrhage guideline2025 multidisciplinary diagnosis and treatment bundle
Postpartum hemorrhageThe client is 45 minutes after a vaginal birth. The calibrated collection drape shows rapidly increasing blood loss, the fundus is boggy, and the client reports dizziness. The unit uses a multidisciplinary postpartum-hemorrhage protocol.
Uterine Atony — Failure of the uterus to contract firmly after birth, a major cause of postpartum hemorrhage.
Oxytocic — A medication used to stimulate uterine contraction and reduce bleeding.
Quantified Blood Loss — Measurement of blood loss to guide hemorrhage response.