OB: Postpartum Complications NCLEX correctly answered 100%.

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: A. Uterine atony B. Uterine inversion C. Vaginal hematoma D. Vaginal laceration correct answers A A. Correct: Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. B. Incorrect: Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman was experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. C. Incorrect: A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. D. Incorrect: A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus. p. 976 A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: A. Establish venous access B. Perform fundal massage C. Prepare the woman for surgical intervention D. Catheterize the bladder correct answers B A. Incorrect: Although this may be a necessary intervention, the initial intervention would be fundal massage. B. Correct: The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. C. Incorrect: The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus. D. Incorrect: After uterine massage, the nurse may want to catheterize the client to eliminate any bladder distension that may be preventing the uterus from contracting properly.