In the 4th stage of labor, if the fundus is firm but bleeding is excessive, the initial nursing action would be:

• A. Massage the fundus
• B. Place the mother in Trendelenburg's position
• C. Notify the physician
• D. Record the findings

Answer: (C)

When bleeding is excessive but the fundus is firm, the problem isn’t uterine atony. A contracting uterus means the uterus is doing its job, so massaging it would not stop the bleed and could worsen other injuries. This situation points to bleeding from another source, such as a genital tract laceration, hematoma, or retained placental tissue, which requires a physician’s assessment and potential intervention.

So the best first action is to notify the physician promptly so they can evaluate the cause and order appropriate treatment. Meanwhile, continue close monitoring, maintain IV access, check vitals, and assess the Lochia and any signs of shock, preparing for possible surgical repair or meds as ordered. Trendelenburg positioning isn’t indicated, and simply recording the findings would delay needed care.