What should a nurse prioritize when a client presents with active bleeding due to abruptio placentae?

When a client presents with active bleeding due to abruptio placentae, prioritizing the administration of IV fluids is critical for several reasons. Abruptio placentae, which is the premature separation of the placenta from the uterus, can lead to significant maternal hemorrhage and fetal distress. Administering IV fluids helps to stabilize the mother's hemodynamic status and ensure adequate circulation, which is vital in preventing shock and maintaining perfusion to both the mother and fetus.

While assessing fetal heart tones is important in monitoring the well-being of the fetus, the immediate priority is to address the mother's safety and fluid balance given the active bleeding. Preparing for an emergency cesarean delivery is crucial if fetal distress is detected or the mother's condition worsens, but this step typically follows the stabilization of maternal vital signs and fluid resuscitation. Monitoring maternal vital signs is also essential; however, this is part of ongoing assessment and would be performed concurrently with fluid administration rather than being the first action.

Thus, the prompt administration of IV fluids takes precedence in this urgent situation to manage blood loss and mitigate potential complications for both the mother and the fetus.