# 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. Place the actions in the safest sequence.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522642&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.

Place the actions in the safest sequence.

Massage the uterus, empty the bladder if needed, continue authorized oxytocin, and support airway, breathing, and circulation.

Activate the hemorrhage response, call for help, and begin quantified blood-loss and perfusion assessment.

Reassess uterine tone, bleeding, vital signs, laboratory trends, and escalate promptly to procedural control if hemorrhage continues.

Administer early authorized tranexamic acid and a noncontraindicated additional atony treatment as directed.

Obtain ordered blood studies and establish rapid access for fluid and blood-component support.

## Explanation

The sequence activates a coordinated response, treats atony and instability immediately, builds resuscitation capacity, applies safe pharmacologic support, and verifies whether procedural escalation is needed.

## In-depth explanation

Quick answer
Sequence activate, stabilize tone and circulation, prepare blood support, medicate safely, and reassess.

Why this is correct
Many actions occur rapidly in parallel, but treatment must not start with a contraindicated drug or end without confirming bleeding control.

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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