Difficulty: Medium
Average Score: 62%
Simulated
A multigravid client at 38 weeks' gestation, G4 P3, is 6 cm dilated with contractions every 3 minutes. The nurse observes meconium-stained amniotic fluid after spontaneous rupture of membranes. What is the priority nursing action?
Correct answer
B
Rationale
Meconium-stained fluid raises the risk of fetal distress. Assessing the fetal heart rate pattern immediately ensures the fetus is tolerating labor. Cesarean delivery is not automatic, suctioning is irrelevant, and documentation follows assessment.