# One hour after birth, a postpartum client has heavy lochia and a boggy uterus above the umbilicus. What is the nurse's priority action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393888&lang=en  
> language: en  
> subject: Lifestyle Choices  
> category: HPM

## Question

One hour after birth, a postpartum client has heavy lochia and a boggy uterus above the umbilicus. What is the nurse's priority action?

## Option

1. Massage the uterine fundus. **✔ Correct answer**
2. Encourage the client to sleep and reassess in 1 hour.
3. Apply a warm compress to the lower abdomen.
4. Remove the perineal pad and leave the client uncovered.

**Correct answer: 1**

## Explanation

A boggy uterus with heavy lochia suggests uterine atony, a common cause of postpartum hemorrhage. The priority is to massage the fundus to stimulate uterine contraction while continuing assessment and notifying the provider as needed. Delaying care can worsen bleeding.

## In-depth explanation

Clinical Judgment
Postpartum bleeding plus a boggy fundus is a contraction problem until proven otherwise.

Memory Tip
Boggy fundus: massage first.

KR vs US
NCLEX postpartum questions often expect immediate bedside action before waiting for orders.

## Clinical scenario

Clinical Practice Guide
Postpartum hemorrhage care includes rapid recognition of uterine atony, fundal massage, medication per order, bladder assessment, vital signs, and escalation.

Caution
Heavy lochia with a firm fundus suggests a different bleeding source and requires further evaluation.

## Key concepts

- **Lochia** — Postpartum vaginal discharge that includes blood, mucus, and uterine tissue.
- **Uterine Atony** — Failure of the uterus to contract effectively after birth, increasing hemorrhage risk.
- **Fundal Massage** — Manual stimulation of the uterine fundus to promote contraction.

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