Immediately after birth and expulsion of the placenta, where is the fundus located? Select the correct letter on the diagram that represents this exact fundal position.

Rationale:

A. Administering nebulized albuterol is correct because it is a short-acting beta-agonist (SABA) that provides rapid bronchodilation. During an acute asthma exacerbation, airway constriction is the immediate threat to oxygenation. According to Airway-Breathing-Circulation (ABC) priorities, relieving bronchospasm to restore airflow takes precedence over other supportive measures. Prompt administration of albuterol can quickly improve ventilation, reduce wheezing, and stabilize the patient.

B. Providing immediate rest for the client is incorrect because while reducing physical activity can help conserve energy, it does not directly relieve bronchospasm or improve airflow. Rest alone is not sufficient during an acute exacerbation.

C. Positioning the client in high-Fowler's is incorrect as a sole intervention because it can assist with breathing by maximizing lung expansion, but it does not treat the underlying airway constriction, which is the priority during an acute exacerbation.

D. Initiating oxygen therapy is incorrect as the highest priority in this scenario. Oxygen helps maintain oxygen saturation, but if the airway remains constricted due to bronchospasm, oxygen delivery alone will not correct hypoxemia effectively. Bronchodilation with albuterol addresses the root cause of airflow obstruction.

Rationale:

A. Prepare to administer a prescribed oxytocic preparation is incorrect as the first action because while oxytocics (e.g., oxytocin) are indicated to control postpartum hemorrhage, the nurse must first assess and attempt to correct the immediate cause of bleeding, which is often uterine atony. Administering medication is secondary to the initial assessment and intervention.

B. Massage the client's fundus is correct because uterine atony is the most common cause of early postpartum hemorrhage. A boggy, poorly contracted uterus allows excessive bleeding. Fundal massage stimulates uterine contractions, which can immediately reduce blood loss and is the first-line intervention. The priority is always to stop bleeding at its source before other interventions.

C. Assess client's blood pressure is incorrect as the first action because vital signs may be affected by blood loss, but assessment alone does not stop the hemorrhage. While BP and pulse should be monitored, addressing the cause of bleeding takes precedence.

D. Assess the bladder for distention is incorrect as the first action because a distended bladder can impede uterine contraction, but in this scenario, the immediate problem is the saturated pad and likely uterine atony. Bladder assessment and emptying can follow after fundal massage if needed.