A nurse is caring for a client who experienced a vaginal birth 12 hr ago. The nurse recognizes the client is in the dependent, taking in phase of maternal postpartum adjustment. Which of the following findings should the nurse expect during this phase?

A) Insert a gloved hand into the vagina to relieve pressure on the cord: While this action may be necessary in some cases, the priority in this situation is to relieve pressure on the umbilical cord to prevent cord compression. Placing the client in the knee-chest position is the most appropriate initial action to achieve this.
B) Cover the cord with a sterile, moist saline dressing: Applying a sterile, moist saline dressing is typically done after taking steps to relieve pressure on the umbilical cord. While it is important to keep the cord moist and protected, it is not the first action to take in this emergency situation.
C) Place the client in knee-chest position: Placing the client in the knee-chest position helps to relieve pressure on the umbilical cord by shifting the weight of the uterus off the cord. This position can help prevent cord compression and maintain fetal oxygenation, making it the priority action in this situation.
D) Prepare the client for an immediate birth: While preparing for a possible emergency birth may be necessary if the client is close to delivering, the immediate concern is relieving pressure on the umbilical cord to prevent fetal compromise. Placing the client in the knee-chest position should be the first action taken by the nurse to address the cord prolapse.

A) Increase the client's fluid intake:
While adequate hydration is important for a postpartum client, it is not the priority when the client is experiencing excessive bleeding. The immediate concern is to address the potential cause of the bleeding, which is often uterine atony.

B) Assist the client on a bedpan to urinate:
Assisting the client to urinate is important for assessing bladder function and preventing bladder distention, but it is not the priority when the client is experiencing excessive postpartum bleeding.

C) Prepare to administer oxytocic medication:
Administering oxytocic medication is an appropriate intervention for treating uterine atony, but the priority is to assess the client's uterine fundus first to confirm the cause of the bleeding before initiating any treatment.

D) Palpate the client's uterine fundus:
Palpating the client's uterine fundus is the priority nursing intervention in this situation. Saturating two perineal pads with blood in a 30-minute period indicates excessive postpartum bleeding, which could be due to uterine atony. Palpating the fundus will help determine if it is firm, which would indicate adequate uterine contraction. If the fundus is boggy or not well contracted, it suggests uterine atony, and the nurse should take immediate action, such as administering oxytocic medication, to prevent further bleeding.