The nurse is reviewing the laboratory results of a client who is being assessed at their 28-week gestation antepartum appointment.

The laboratory result reveals that the client has gestational diabetes mellitus (GDM). What information is the priority for the nurse to include when educating the client about GDM?

The assessment of postpartum hemorrhage requires differentiating between uterine atony and other sources of bleeding. When the fundus remains firm despite heavy lochia saturation, nurses must apply knowledge of cervical or vaginal lacerations and prioritize immediate medical notification for intervention.

Choice A rationale

Fundal massage is the primary intervention for uterine atony, characterized by a soft or boggy uterus. Since the assessment reveals a firm fundus at the umbilicus, massage is unnecessary and will not address the source of the bleeding.

Choice B rationale

Satiating a pad in 15 minutes is a sign of severe postpartum hemorrhage. A firm fundus suggests the bleeding is likely from a laceration rather than atony. Rapid notification of the provider is essential for surgical repair.

Choice C rationale

Oxytocin is a uterotonic medication used to stimulate uterine contractions and manage hemorrhage caused by atony. Because the fundus is already firm, administering oxytocin is inappropriate and will not resolve bleeding originating from a suspected tissue tear.

Choice D rationale

Assisting the client to the restroom helps empty the bladder, which can resolve a displaced, boggy fundus. However, with a firm fundus and rapid blood loss, this delays critical care and poses a fainting risk for the client.

Safe blood administration requires a specific sequence to ensure product viability and patient safety. The nurse must apply institutional protocols regarding the timing of blood retrieval, bedside verification, and transfusion initiation to minimize errors and prevent the waste of blood components.

Choice A rationale

Once the IV is established and consent is obtained, the nurse must retrieve the blood. Blood must be picked up only when the nurse is ready to begin the process, as it must be started quickly after leaving.

Choice B rationale

Double checking the blood with a second registered nurse occurs at the bedside immediately before the transfusion begins. This step follows the retrieval of the blood from the bank and ensures the unit matches the patient and prescription.

Choice C rationale

Priming the Y-tubing with normal saline is necessary, but the nurse cannot prime with blood until the blood has been obtained and verified at the bedside. Normal saline is the only compatible fluid for blood transfusions.

Choice D rationale

While initiation timing is critical, blood must generally be started within 30 minutes of being removed from the blood bank refrigerator, not one hour. This prevents bacterial growth and maintains the integrity of the red cells.