# 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=393889&lang=en  
> language: en  
> subject: NCLEX-RN  
> 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. Notify the provider only if bleeding continues for another hour.
4. Check the client's blood pressure and reassess in 2 hours without intervening.

**Correct answer: 1**

## Explanation

Massaging the uterine fundus is correct because a boggy uterus above the umbilicus with heavy lochia indicates uterine atony, the most common cause of early postpartum hemorrhage, and fundal massage is the immediate first-line action to stimulate contraction and reduce bleeding. Allowing the client to sleep and reassessing in an hour delays intervention for a potentially serious hemorrhage. Applying a warm compress does not address uterine atony and may increase blood flow to the area. Removing the perineal pad and leaving the client uncovered does not treat the underlying cause and is an unnecessary and inappropriate action.

## 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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