A nurse is caring for a client 12 hours postpartum who has a fundus that is 2 cm above the umbilicus, boggy, and deviated to the right. The client also reports difficulty voiding and a sensation of bladder fullness. After assisting the client to void, the fundus remains boggy and elevated. Which of the following nursing actions should the nurse take next?

When a postpartum fundus remains boggy and elevated after the client has voided, uterine atony is the most likely cause. The immediate next action is to perform a gentle fundal massage while supporting the lower uterine segment. Supporting the lower uterine segment during massage is critical — it prevents uterine inversion, a life-threatening complication. Fundal massage stimulates uterine muscle contraction, expels retained clots, and reduces bleeding, directly addressing atony at the bedside. This is a first-line nursing intervention that should be performed before escalating to pharmacological measures. Administering oxytocin without further assessment is incorrect as the nurse should first attempt non-pharmacological intervention; additionally, oxytocin administration requires a provider order and would follow, not precede, manual uterine massage. Encouraging ambulation does not address acute uterine atony and would delay necessary intervention. Notifying the provider before any intervention is also incorrect in this scenario because the nurse has an evidence-based, non-invasive action to perform immediately — notifying the provider is appropriate if massage fails to restore uterine tone and hemorrhage continues, but it should not delay the initial nursing intervention. The sequence in postpartum hemorrhage management is massage first, then assess response, then escalate to pharmacological and provider interventions if tone is not restored.