# Stage 2 — Analyze cues. For each data cluster, select the single role that best explains how it contributes to the current postpartum-hemorrhage assessment.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372469&lang=en  
> language: en  
> subject: Ante/Intra/Postpartum and Newborn Care  
> category: HPM

## Question

Stage 2 — Analyze cues. For each data cluster, select the single role that best explains how it contributes to the current postpartum-hemorrhage assessment.

|  | Direct evidence of active bleeding | Supports uterine atony or mechanical interference | Supports current hypovolemia | Background risk factor only |
| --- | --- | --- | --- | --- |
| Heavy lochia with clots and cumulative QBL 700 mL |  |  |  |  |
| Soft boggy uterus on fundal examination |  |  |  |  |
| Fundus 2 cm above the umbilicus and shifted right |  |  |  |  |
| BP 92/58, HR 116, RR 22, pallor, and lightheadedness |  |  |  |  |
| Oxytocin-augmented labor for 14 hours and a 4.1-kg infant |  |  |  |  |
| Postpartum hemorrhage after the previous birth |  |  |  |  |

## Explanation

Cue roles
Heavy lochia and rising QBL demonstrate active bleeding; a boggy or high right-shifted fundus supports Tone or bladder-related mechanical interference; hypotension with tachycardia, tachypnea, and pallor supports hypovolemia; prolonged augmented labor, a large infant, and prior PPH are background risk factors.

## In-depth explanation

Step 1 — Separate cause from severity
The soft boggy uterus is an etiologic cue for Tone. A high, right-shifted fundus suggests a distended bladder that can impede contraction. Heavy lochia and cumulative QBL show the bleeding itself, while BP, pulse, respirations, pallor, diaphoresis, and symptoms indicate physiologic effect.

Step 2 — Do not promote risk factors into diagnoses
A large infant, prolonged oxytocin exposure, and prior PPH increase risk for atony but cannot diagnose the current cause. The nurse still evaluates the other 4 Ts: Trauma, Tissue, and Thrombin.

Step 3 — Act while analyzing
Classification sharpens the working diagnosis, but active hemorrhage care proceeds in parallel. Do not delay the response while completing a perfect differential.

NCLEX rule
Ask of each cue: Does it show bleeding, explain the cause, show physiologic compromise, or only raise background risk?

## Clinical scenario

Scenario (Stage 2 — Analyze cues)
Classify current postpartum data by its role in the clinical judgment rather than forcing every finding into a diagnosis.

Clinical judgment target
Separate active bleeding, likely Tone, hypovolemia, and background risk.

## Key concepts

- **Tone** — The uterine-atony branch of the 4 Ts of postpartum hemorrhage.
- **4 Ts** — A cause framework: Tone, Trauma, Tissue, and Thrombin. More than one cause can coexist.
- **Risk factor** — A feature that raises probability but does not by itself prove the current diagnosis.

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