What should the nurse conclude if a mother has a trickle of bright red blood from the perineum and a firm fundus?

The situation described—a trickle of bright red blood from the perineum with a firm fundus—indicates that the mother is experiencing abnormal bleeding. In the postpartum period, bright red blood may signify a laceration or other injury to the vaginal area or perineum, especially when accompanied by a firm fundus, which suggests that uterine atony is not the cause of the bleeding.

It's critical for the nurse to recognize that while some bleeding can be expected after delivery, bright red blood, particularly in the presence of a firm fundus, typically warrants further assessment and reporting. This can help identify potential complications, such as a perineal or vaginal tear that may require intervention to prevent further blood loss.

In contrast, the other choices can be ruled out based on clinical reasoning: normal bleeding would not be bright red and trickling continuously; retained placenta typically presents with a boggy fundus rather than a firm one; and the need for a transfusion would typically depend on the volume of blood lost, which is not indicated in this scenario. Thus, the correct conclusion for the nurse is that the bright red bleeding is a concern that necessitates reporting and further investigation.