A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client's vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/min, and temperature 36.4° C (97.6° F). Which of the following is the priority nursing action?

Rationale: A. Witness the signature for informed consent for surgery is incorrect because while informed consent is a necessary legal and ethical step before a cesarean section, it does not address the immediate threat to maternal safety. In this case, the client is actively bleeding and showing early signs of hypovolemia (tachycardia and low-normal blood pressure). The priority is to stabilize the client physiologically before procedural steps like signing consent. B. Initiate IV access is correct because the client is exhibiting signs of hypovolemic compromise, including tachycardia and hypotension, which are early indicators of blood loss. The scenario is consistent with placenta previa, a condition where the placenta covers the cervical os, causing painless bright red vaginal bleeding. Rapid fluid resuscitation via large-bore IV access is critical to maintain maternal perfusion, prevent shock, and prepare for possible blood transfusion. Establishing IV access is the first-line, priority intervention according to the ABC (Airway, Breathing, Circulation) principle, since maternal circulation directly affects fetal oxygenation. C. Insert an indwelling urinary catheter is incorrect as the first action because while a catheter may be needed to monitor urine output during resuscitation or surgery, it does not immediately stabilize maternal circulation. Catheterization is secondary to initiating IV fluids to manage blood loss. D. Prepare the abdominal and perineal areas is incorrect because surgical preparation is important for emergent cesarean delivery, but it is not the initial priority. The client’s hemodynamic stability must be addressed first to reduce maternal and fetal risk during surgery.