After the fundus is massaged and help has been summoned, which assessment is most important to perform immediately?

• A. Take vital signs
• B. Check the bladder
• C. Assess for bladder distention
• D. Increase IV rate

Answer: (C)

The most immediate concern is whether the bladder is distended. A full bladder can push the uterus upward and prevent it from contracting, so even after fundal massage there can be ongoing bleeding. If distention is present, emptying the bladder often allows the uterus to regain tone and control hemorrhage, which is why assessing for bladder distention is the top priority. While watching vitals is important and IV fluids may be needed, they don’t address the immediate mechanical cause here.