# A postpartum client has heavy vaginal bleeding and a boggy uterus. Place the nurse's initial response actions in priority order.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395489&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A postpartum client has heavy vaginal bleeding and a boggy uterus. Place the nurse's initial response actions in priority order.

Secure or verify large-bore IV access, obtain ordered blood specimens, and begin prescribed fluid resuscitation.

Reassess quantified blood loss and hemodynamic response, then document interventions and communication.

Begin uterine massage while rapidly reassessing uterine tone, bleeding, and vital signs.

Administer prescribed oxytocic medication and tranexamic acid according to the hemorrhage protocol.

Activate the postpartum-hemorrhage response and call for immediate assistance.

## Explanation

Activate the hemorrhage response first so simultaneous help and supplies arrive. Begin uterine massage and reassessment immediately, establish resuscitation access and specimens, administer protocol-directed medications, and continue quantified reassessment and documentation. In practice, several bundle actions occur nearly simultaneously.

## In-depth explanation

Correct sequence
Activate help → massage and reassess → resuscitation access → protocol medications → reassess and document.

Why this is correct
Postpartum hemorrhage can progress within minutes. Team activation allows uterine massage, oxytocic medication, tranexamic acid, IV fluids, examination for the bleeding source, and laboratory support to begin as a coordinated bundle. A boggy uterus supports uterine atony, so massage and tone reassessment cannot wait for routine charting.

NCLEX decision rule
For active hemorrhage, mobilize help and control the source while supporting circulation. The numbered sequence identifies the lead priorities; it does not imply that a real hemorrhage team performs every action one at a time.Reference
1WHO consolidated postpartum-hemorrhage guideline2025 multidisciplinary diagnosis and treatment bundle

## Clinical scenario

Postpartum hemorrhage
The client is 45 minutes after a vaginal birth. The calibrated collection drape shows rapidly increasing blood loss, the fundus is boggy, and the client reports dizziness. The unit uses a multidisciplinary postpartum-hemorrhage protocol.

## Key concepts

- **Uterine Atony** — Failure of the uterus to contract firmly after birth, a major cause of postpartum hemorrhage.
- **Oxytocic** — A medication used to stimulate uterine contraction and reduce bleeding.
- **Quantified Blood Loss** — Measurement of blood loss to guide hemorrhage response.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en)
- [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en)
- [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en)
- [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395489&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395489&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395489&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395489&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395489&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._