# Stage 4 — Generate solutions. Which prescribed interventions belong in the immediate hemorrhage plan? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568687&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

Stage 4 — Generate solutions. Which prescribed interventions belong in the immediate hemorrhage plan? Select all that apply.

1Continue the prescribed oxytocin treatment for uterine atony
2Administer intravenous tranexamic acid promptly within the treatment window
3Infuse ordered isotonic crystalloid through adequate vascular access
4Prepare ordered blood products according to the active hemorrhage protocol
5Give methylergonovine even though hypertension remains documented
6Give carboprost even though active asthma and recent wheezing are documented
7Hold uterotonic treatment until ultrasound identifies a bleeding source
8Use oral iron alone as immediate treatment for continued heavy bleeding

## Explanation

Oxytocin, prompt tranexamic acid, isotonic fluid, and blood-product readiness belong in the active response. Methylergonovine requires clarification with hypertension, carboprost requires clarification with asthma, and testing or oral iron must not delay hemorrhage control.

## In-depth explanation

Quick answer
Use oxytocin, early tranexamic acid, isotonic fluid, and protocol-directed blood support; clarify uterotonics that conflict with asthma or hypertension.

Why this is correct
The first-response bundle controls tone and clot breakdown while restoring circulation. Medication history changes which additional uterotonic can be given safely.

Easy analogy or mental picture
The hemorrhage cart offers several tools, but the client's asthma and hypertension place warning labels on two of them.

Memory hook
Oxytocin and TXA now; screen pressure and asthma before extra uterotonics.

NCLEX decision rule
When selecting postpartum-hemorrhage medications, treat promptly while checking hypertension and asthma contraindication risks; do not wait for imaging to start the bundle.

Why the other choices are wrong
Methylergonovine can worsen hypertension, carboprost can provoke bronchospasm, and delayed uterotonics or oral iron alone cannot control active major bleeding.

References
1WHO Consolidated Guidelines for Postpartum HaemorrhageEarly recognition and bundled uterine massage, uterotonic, tranexamic acid, fluid, examination, and escalation
2ACOG Practice Bulletin 183: Postpartum HemorrhageUterine atony, hypovolemia, quantified blood loss, and escalation of hemorrhage care

## Clinical scenario

Case update
The client has gestational hypertension and active asthma. The hemorrhage team requests medication and fluid preparation while uterine massage continues.

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