The nurse is caring for a laboring client who presents with ruptured membranes, frequent contractions, and bloody show. Which intervention should be performed first?

Choice A rationale While establishing IV access is important for fluid administration and medication delivery, assessing fetal well-being takes immediate precedence after rupture of membranes. Fetal heart rate provides critical information about the fetus's response to the rupture and potential cord compression or prolapse, which are acute emergencies. Choice B rationale Performing a sterile vaginal exam immediately after ruptured membranes increases the risk of introducing ascending infection into the uterus. While cervical dilation is important for assessing labor progression, the priority after rupture of membranes is to assess fetal status and then minimize vaginal examinations to prevent chorioamnionitis. Choice C rationale Assessing the client's vital signs is a standard and important nursing intervention. However, after rupture of membranes, the immediate and most critical risk is to the fetus (e.g., cord prolapse, fetal distress). Therefore, obtaining the fetal heart rate is the absolute priority to ensure fetal well-being and guide subsequent interventions. Choice D rationale Obtaining the fetal heart rate is the highest priority intervention immediately following rupture of membranes. This is crucial to assess for potential umbilical cord prolapse, which is a life-threatening emergency for the fetus. Rapid assessment of fetal well-being guides subsequent interventions to ensure fetal safety.