What is the first action a nurse should take when a laboring client shows late decelerations on the FHR monitor?

When a laboring client exhibits late decelerations on the fetal heart rate (FHR) monitor, the priority response is to turn the client to a side-lying position. This maneuver is crucial because late decelerations often indicate uteroplacental insufficiency, which can occur when the fetus is not receiving adequate blood flow and oxygen. By positioning the client on their side, particularly the left side, this can enhance uterine blood flow and optimize placental perfusion, thereby improving fetal oxygenation.

Turning the client can also help relieve any pressure on the umbilical cord or major blood vessels that may be contributing to the issue. In doing so, this action addresses the root cause of late decelerations and provides a non-invasive and immediate response to protect the fetus.

Other interventions, while important, may not be the first step. For instance, disconnecting oxytocin may be necessary if the tachysystole is suspected to be contributing to the decelerations, but it is usually not the immediate action taken. Administering supplemental oxygen or increasing IV fluid rates could also be necessary, especially if signs of fetal distress persist, but position change is generally prioritized as the first response to improve fetal condition.