After a motor vehicle crash, what should the nurse do first for a client at 39 weeks gestation who appears pale with low blood pressure?

In this scenario, the priority action for the nurse is to turn the client laterally. This intervention is crucial, especially for a pregnant patient at 39 weeks gestation, as it helps alleviate potential pressure on the inferior vena cava from the weight of the uterus. When a pregnant individual lies supine (on their back), the enlarging uterus can compress the vena cava, leading to decreased venous return to the heart, resulting in hypotension and reduced blood flow to both the mother and fetus. By turning the client to a lateral position, particularly the left side, venous return is improved, which can stabilize the mother's blood pressure and enhance fetal perfusion.

While assessing fetal heart rate and administering a fluid bolus are important in managing a pregnant client with signs of potential hypovolemia or distress, the immediate priority in this situation is to ensure maternal positioning is optimal to maintain circulation. Checking the cervix for the presenting part is not the immediate action needed in this emergent context, where maternal stability is critical. Therefore, starting with lateral positioning is the most appropriate initial step in this acute scenario.