# 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. For each finding, identify the medication-safety implication for oxytocin, tranexamic acid, methylergonovine, or carboprost.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522639&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.

For each finding, identify the medication-safety implication for oxytocin, tranexamic acid, methylergonovine, or carboprost.

|  | Supports uterine-atony treatment | Limits an additional uterotonic | Supports early tranexamic acid review |
| --- | --- | --- | --- |
| Boggy enlarged uterus with brisk bleeding |  |  |  |
| Severe-range blood pressure during labor |  |  |  |
| Active asthma requiring recent rescue therapy |  |  |  |
| Birth occurred 2 hours ago |  |  |  |
| Pallor with heart rate 126/min |  |  |  |

## Explanation

A boggy uterus and brisk bleeding support uterine atony. Severe hypertension makes methylergonovine unsafe, active pulmonary disease makes carboprost unsafe, and birth within 3 hours supports early tranexamic acid in addition to standard care.

## In-depth explanation

Quick answer
Separate atony evidence, uterotonic contraindications, and the antifibrinolytic time window.

Why this is correct
Tranexamic acid supports clot stability but does not restore uterine tone. The medication plan must address both the atony and ongoing blood loss without ignoring the client-specific contraindications.

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.

## Related questions

- [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en)
- [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en)
- [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en)
- [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en)
- [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en)
- [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=en)
- [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=en)
- [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522639&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522639&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522639&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522639&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522639&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._