# Clinical context Two hours after vaginal birth, a client with active asthma and severe-range blood pressure earlier in labor develops brisk bright-red bleeding, a boggy uterus, hypotension, tachycardia, pallor, and dizziness consistent with uterine-atony postpartum hemorrhage. Highlight the current findings that demonstrate uterine-atony postpartum hemorrhage with hemodynamic compromise. Do not select medication contraindications or routine postpartum details.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522638&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
Two hours after vaginal birth, a client with active asthma and severe-range blood pressure earlier in labor develops brisk bright-red bleeding, a boggy uterus, hypotension, tachycardia, pallor, and dizziness consistent with uterine-atony postpartum hemorrhage.

Highlight the current findings that demonstrate uterine-atony postpartum hemorrhage with hemodynamic compromise. Do not select medication contraindications or routine postpartum details.

Postpartum Record\nAt 2 hours after vaginal birth, the client has a saturated perineal pad in 12 minutes, continuous bright-red bleeding, and a boggy uterus above the umbilicus. Findings include blood pressure 84/50 mm Hg, heart rate 126/min, pale cool skin with dizziness, severe-range blood pressure earlier in labor, and active asthma requiring rescue albuterol this week. The placenta is documented as intact, and the bladder is nondistended.

## Explanation

Heavy ongoing bleeding, a boggy uterus, hypotension, tachycardia, pallor, and dizziness indicate postpartum hemorrhage with hemodynamic compromise. Severe hypertension and active asthma also change which additional uterotonics can be used safely.

## In-depth explanation

Quick answer
Recognize hemorrhage, shock, and two medication-limiting comorbidities together.

Why this is correct
Postpartum hemorrhage requires immediate coordinated treatment. Methylergonovine is contraindicated in hypertension, while carboprost is contraindicated in active pulmonary disease; neither comorbidity should be missed during rapid response.

Easy analogy or mental picture
Use a family-centered medication-safety loop: verify age or pregnancy context, identify the exposure and new cue, prevent further harm, stabilize the client, and confirm the response.

Memory hook
Population, indication, dose or route, contraindication, urgent cue, protective action, and reassessment.

NCLEX decision rule
Choose the action that protects the maternal, newborn, or pediatric client from the most immediate medication-related harm while preserving authorized treatment.

Why the other choices are wrong
Options that normalize a danger sign, substitute an unapproved route or dose, or delay reassessment leave the client exposed to preventable harm.References
1DailyMed: PITOCIN (oxytocin)Control of postpartum uterine bleeding, uterine response, prolonged-infusion water intoxication, and monitoring
2DailyMed: HEMABATE (carboprost tromethamine)Refractory postpartum hemorrhage due to uterine atony and contraindication in active pulmonary disease
3DailyMed: methylergonovine maleatePostpartum hemorrhage control and contraindication in hypertension or toxemia
4WHO recommendation: tranexamic acid for postpartum hemorrhageEarly intravenous tranexamic acid within 3 hours of birth in addition to standard postpartum hemorrhage care

## Clinical scenario

Clinical context
Two hours after vaginal birth, a client with active asthma and severe-range blood pressure earlier in labor develops brisk bright-red bleeding, a boggy uterus, hypotension, tachycardia, pallor, and dizziness consistent with uterine-atony postpartum hemorrhage.

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