# 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. Review the trend and select the best interpretation and next plan.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522643&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.

Review the trend and select the best interpretation and next plan.

| Time | Data |
| --- | --- |
| Recognition | Boggy uterus; brisk bleeding; BP 84/50 mm Hg; HR 126/min; pale and dizzy |
| After initial response | Uterine massage, oxytocin, circulation support, and authorized tranexamic acid given; BP 98/60 mm Hg; HR 108/min |
| Current reassessment | Uterus remains boggy; another pad saturates in 15 minutes; BP 96/58 mm Hg; asthma and severe hypertension remain documented |

Q1. How should the trend be interpreted?

Hemorrhage has fully resolved
Perfusion improved partially but uterine atony and bleeding remain active
Only expected lochia remains

Q2. Which next plan is appropriate?

Continue safe atony and resuscitation measures and escalate to procedural control
Give both contraindicated uterotonics because vital signs improved
Stop reassessment and transfer to routine postpartum care

## Explanation

Improved blood pressure and heart rate show partial resuscitation, but a persistently boggy uterus and continued brisk bleeding mean uterine atony remains uncontrolled. Hemostatic support does not substitute for definitive uterine-tone and procedural control.

## In-depth explanation

Quick answer
Do not mistake better vital signs for complete hemorrhage control.

Why this is correct
The team must continue safe atony treatment and escalate to procedural control while maintaining resuscitation; methylergonovine and carboprost remain poor choices for this client.

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=522643&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522643&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522643&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522643&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522643&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._