A nurse is teaching a client about foods to avoid during pregnancy.
Which of the following statements should the nurse make? (Select All that Apply.)

Choice A rationale

Massaging the client's fundus is the immediate priority when a postpartum client saturates a perineal pad in 10 minutes, indicating excessive bleeding. Fundal massage stimulates uterine contractions, which compress blood vessels in the myometrium, reducing blood loss and preventing postpartum hemorrhage by promoting uterine involution and preventing atony.

Choice B rationale

Checking the client's blood pressure is an important assessment to monitor for signs of hypovolemia. However, it is not the first action. The immediate priority is to address the source of excessive bleeding and prevent further blood loss, which is achieved through fundal massage. Blood pressure assessment would follow.

Choice C rationale

Observing for pooling of blood under the buttocks is a necessary assessment to quantify blood loss and identify concealed hemorrhage. While important, it is a secondary action to fundal massage. The primary intervention focuses on controlling the bleeding at its source, as delaying can lead to rapid deterioration of the client's condition.

Choice D rationale

Administering oxytocin is a pharmacological intervention used to prevent and treat postpartum hemorrhage by increasing uterine contractility. While highly effective, it is not the *first* action. Manual fundal massage can be initiated immediately, providing a rapid mechanical stimulus to the uterus while awaiting medication preparation and administration.

Choice A rationale

Low potassium (hypokalemia) and ECG rhythm changes, such as QT prolongation or arrhythmias, are critical and life-threatening complications of bulimia nervosa due to fluid and electrolyte imbalances from purging behaviors. Hypokalemia can directly impair cardiac function, necessitating immediate medical intervention to prevent fatal arrhythmias.

Choice B rationale

Erosion of dental enamel and constant vomiting are chronic manifestations of bulimia nervosa. While they indicate ongoing disordered eating and require dental intervention, they are not acutely life-threatening and do not represent the same level of immediate physiological instability as severe electrolyte imbalances affecting cardiac function.

Choice C rationale

Menstrual irregularities, including amenorrhea, are common in individuals with bulimia nervosa due to hormonal disruptions from malnutrition and stress. While indicative of chronic health impact, they are not an immediate life-threatening concern requiring emergency intervention compared to acute cardiac complications.

Choice D rationale

Calluses on knuckles (Russell's sign) and skin breakdown are physical signs of repeated self-induced vomiting. These are chronic cutaneous manifestations reflecting the mechanical trauma from purging. While they require attention, they are not acute physiological emergencies demanding immediate intervention.