# 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. Which actions belong in the immediate postpartum hemorrhage plan? Select exactly 4 responses.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=602999&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.

Which actions belong in the immediate postpartum hemorrhage plan? Select exactly 4 responses.

Select exactly 4 responses.

1

Activate the postpartum hemorrhage response and quantify blood loss.

2

Massage the uterus, continue authorized oxytocin, and support circulation.

3

Prepare blood studies, components, and procedural escalation during stabilization.

4

Give early intravenous tranexamic acid under the authorized hemorrhage protocol.

5

Give oxytocin as a rapid undiluted intravenous bolus to shorten the time to uterine contraction.

6

Wait for the hemoglobin and coagulation results before activating the hemorrhage response if massage briefly slows the bleeding.

## Explanation

The plan combines hemorrhage activation, uterine-tone treatment, circulation support, early antifibrinolytic therapy, and preparation for blood and procedural escalation. Methylergonovine and carboprost are unsafe for this client.

## In-depth explanation

Quick answer
Use activate, restore tone, stabilize, protect clot, and escalate.

Why this is correct
No single medication replaces evaluation of uterine tone, blood loss, perfusion, laboratory change, and response to treatment.

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=602999&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=602999&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=602999&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=602999&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=602999&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._