# Stage 5 — Take action. The PPH response team is at the bedside and concurrent roles have been assigned. Arrange the primary nurse’s assessment–intervention–reassessment loop from first to last.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372474&lang=en  
> language: en  
> subject: Ante/Intra/Postpartum and Newborn Care  
> category: HPM

## Question

Stage 5 — Take action. The PPH response team is at the bedside and concurrent roles have been assigned. Arrange the primary nurse’s assessment–intervention–reassessment loop from first to last.

Reassess uterine tone, cumulative QBL, vital signs, perfusion, urine output, and response within minutes of the interventions

Begin or continue fundal massage and empty the distended bladder while maintaining frequent monitoring

Administer or increase oxytocin, give TXA and an appropriate second-line uterotonic, and support IV resuscitation as ordered

Escalate persistent bleeding to blood products or MTP, balloon tamponade, and operating-room management according to the response and protocol

Rapidly assess uterine tone and current bleeding, then announce cumulative QBL and current vital signs to the response team

## Explanation

Primary-nurse loop
With the team already activated: assess and announce → massage and correct bladder interference → deliver ordered medication and resuscitation → reassess within minutes → escalate if uncontrolled. Other team members perform laboratory, blood-bank, and equipment tasks concurrently.

## In-depth explanation

Step 1 — Define the sequence correctly
This is the primary nurse’s local reassessment loop after the hemorrhage team has arrived, not a claim that the entire PPH bundle occurs one task at a time.

Step 2 — Assess, intervene, reassess
First establish the current uterine tone, bleeding, QBL, and vital signs and communicate them. Start immediate mechanical measures and relieve bladder interference. Deliver ordered oxytocin, TXA, an appropriate second-line uterotonic, and resuscitation support while assigned teammates perform their tasks.

Step 3 — Escalate from response, not delay
Reassess within minutes. Persistent bleeding or instability triggers blood-product/MTP decisions, balloon tamponade, and operative escalation. Notification, blood-bank preparation, and equipment mobilization are already occurring in parallel.

NCLEX rule
When an order item represents team care, identify the specific role and closed-loop reassessment sequence instead of serializing the entire emergency response.

## Clinical scenario

Scenario (Stage 5 — Take action)
The PPH team is present. Sequence the primary nurse’s immediate bedside loop while other roles proceed concurrently.

Clinical judgment target
Use assess–intervene–reassess–escalate without delaying team activation.

## Key concepts

- **Closed-loop reassessment** — A cycle in which the nurse evaluates the response within minutes and escalates when bleeding or instability persists.
- **Balloon tamponade** — An intrauterine device used to apply pressure when uterine bleeding persists despite initial medical and mechanical measures.
- **Role assignment** — Distribution of simultaneous emergency tasks so assessment, medication, resuscitation, laboratory, and escalation work do not wait on one another.

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