An 18-year-old patient asks you how to perform a self-breast exam.
Which of the following instructions should you provide?

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

A possible sign of pregnancy typically refers to a cluster of symptoms or physical changes that *could* suggest pregnancy but are not definitive, such as missed menses or breast tenderness. Feeling fetal movement is more specific and falls into a more advanced category of signs.

Choice B rationale

A presumptive sign of pregnancy refers to subjective changes experienced by the woman that suggest pregnancy but could be caused by other conditions. Examples include nausea, fatigue, and amenorrhea. While fetal movement *could* be subjective, a woman feeling it is generally considered a strong indicator.

Choice C rationale

A probable sign of pregnancy refers to objective signs noted by an examiner that strongly suggest pregnancy but are still not definitive. Examples include a positive pregnancy test (detects hCG, which can be elevated in other conditions), Hegar's sign (softening of the lower uterine segment), and Chadwick's sign (bluish discoloration of the cervix).

Choice D rationale

A positive sign of pregnancy refers to objective evidence that can only be attributed to the presence of a fetus. Feeling the baby move, known as quickening when felt by the mother, is a strong indicator. However, *actual* positive signs include fetal heart tones detected by an examiner, visualization of the fetus by ultrasound, or palpation of fetal parts by an examiner. The mother feeling movement is considered a positive sign because it's highly specific to fetal presence.