A nurse is caring for a client who is postpartum. The client is experiencing excessive vaginal bleeding and has a boggy uterus. Which of the following actions should the nurse take first?

Rationale:

A) Incorrect - Applying oxygen is not the priority action in the case of excessive vaginal bleeding and a boggy uterus. Oxygen therapy would be appropriate if there were signs of respiratory distress or decreased oxygen saturation, but it does not directly address the primary concern of uterine atony and bleeding.
B) Incorrect - Administering methylergonovine might be appropriate, but the priority is to address the uterine atony with fundal massage first. Fundal massage helps stimulate uterine contractions and control bleeding, which is crucial in this scenario.
C) Incorrect - Encouraging the client to empty her bladder is important, but it is not the first action to take in the case of excessive bleeding and uterine atony. Immediate intervention to control the bleeding takes precedence.
D) Correct - Initiating fundal massage is the priority action in this situation. A boggy uterus with excessive vaginal bleeding indicates uterine atony, which is a potentially life-threatening condition requiring immediate intervention to prevent further bleeding.
Fundal massage helps the uterus contract and control bleeding. Addressing uterine atony is critical to prevent further hemorrhage and stabilize the client's condition.

A) Incorrect- Kegel exercises are helpful for strengthening pelvic floor muscles but may not directly alleviate afterpains.
B) Correct - Afterpains are uterine contractions that occur after childbirth and can be uncomfortable, especially during breastfeeding. Ibuprofen is often used to relieve this discomfort.
C) Incorrect- Applying a cool compress might provide some relief, but pain relief medications like ibuprofen are more effective for afterpains.
D) Incorrect- While a side-lying position can be comfortable for breastfeeding, it may not directly address the afterpains.