What should the nurse's first action be for a client in active labor with late decelerations in the FHR?

In a situation involving a client in active labor experiencing late decelerations in the fetal heart rate (FHR), the nurse's first action should indeed be to change the client's position. Late decelerations are typically associated with uteroplacental insufficiency, where the fetus is not receiving enough oxygen, often due to compression of the umbilical cord or reduced blood flow to the uterus and placenta.

Changing the client's position can help alleviate pressure on the umbilical cord and enhance uteroplacental blood flow, potentially improving the oxygen supply to the fetus. Maternal positioning, such as turning to the left side, is frequently recommended because it can optimize blood flow to the placenta and relieve any potential pressure on the vena cava, which may be contributing to the decelerations.

While palpating the uterus to assess for tachysystole could be an important nursing intervention, it is generally performed after ensuring that immediate actions to improve fetal status are in place. Increasing the IV infusion rate may not be effective in addressing the underlying cause of late decelerations. Administering oxygen might be part of the treatment plan to support fetal oxygenation, but positional changes are a more immediate and effective first step in this scenario.