A postpartum client at 4 hours postpartum has cool, clammy skin, restlessness, and thirst. The nurse should:

• A. Assess for hypovolemia and notify the health care provider
• B. Begin hourly pad counts and reassure the client
• C. Begin fundal massage and start oxygen by mask
• D. Elevate the head of the bed and assess vital signs

Answer: (A)

The scenario points to hypovolemia from postpartum hemorrhage. Four hours after birth, cool, clammy skin, restlessness, and thirst are signs of reduced perfusion from losing intravascular volume. The priority for the nurse is to quickly assess the extent of blood loss and systemic impact and then alert the provider so rapid interventions (such as fluid resuscitation, possible blood products, and further orders) can be started. This involves checking vital signs, evaluating mental status, examining the uterus for tone and lochia to identify ongoing bleeding, and ensuring adequate urine output. Simply counting pads or reassuring the patient does not address this urgent, potentially life-threatening situation. While elevating the head of the bed or performing fundal massage with oxygen might be necessary in specific scenarios (e.g., a boggy uterus or suspected respiratory compromise), they do not replace the immediate need to assess for hypovolemia and notify a higher level of care when these symptoms are present.