Stage 2 — Analyze cues. Complete the analysis by selecting the option that best fits each blank.

Quick answer
Loss of uterine tone; distended bladder; shock index above 1.0; concealed vaginal or vulvar hematoma.

Why this is correct
Using the four Ts (tone, trauma, tissue, thrombin), a soft, high fundus after a long oxytocin-exposed labor is a tone problem. Retained tissue is still possible when a placenta only appears complete, but it is not the most likely primary cause when a reversible atony cause (a full bladder) is present. The bladder explains the upward and lateral displacement. Heart rate divided by systolic pressure gives a shock index of about 1.2; values above 0.9 to 1.0 after birth predict the need for transfusion and escalation, which matters because pregnancy-related volume expansion delays hypotension. A firm uterus with pressure pain and little visible bleeding is the classic hematoma picture.

Easy analogy or mental picture
Think of the uterus as a fist that has to clench around open vessels: a tired fist after a long labor, pushed off-center by a full bladder, cannot clench.

Memory hook
"Boggy = tone; firm but bleeding = trauma; firm, painful, and dry = hematoma."

NCLEX decision rule
In postpartum bleeding, the fundal exam decides the source first: soft means atony until proven otherwise, and a shock index above 1.0 means significant blood loss regardless of the BP number.

Why the other choices are wrong
A missed laceration is tempting because inspection can be incomplete, but lacerations bleed with a firm uterus. Retained fragments can cause atony, yet the placenta appeared complete and a full bladder provides a more immediate explanation. A broad-ligament hematoma also displaces the uterus, but the bladder is palpable and bleeding is external. Uterine inversion produces a fundus that is absent or dimpled on palpation, not one that is high and deviated. Tachycardia from pain or fatigue, or low pressure from antihypertensives, are comforting explanations that delay response while bleeding continues. A succenturiate lobe or atony relapse would not produce a firm fundus with pressure pain.