If a client's pulse rate rises significantly during the fourth stage of labor, what should the nurse do first?

In the context of the fourth stage of labor, a significant rise in the client's pulse rate can indicate potential complications such as hemorrhage or other forms of maternal distress. The first priority in this situation is to check the client's uterine fundus. Assessing the uterine fundus helps determine whether the uterus is contracting effectively and if there is any accumulation of blood in the uterus, which could explain the elevated pulse rate. A firm and midline fundus would typically suggest that the uterus is contracting properly, whereas a boggy fundus may indicate uterine atony, which is a leading cause of postpartum hemorrhage.

Addressing the uterine tone is crucial because a significant change in vitals, particularly an elevated pulse, can signify a medical emergency that requires immediate attention and intervention. The other options, while relevant, do not address the immediate possible cause of the pulse increase as directly as assessing the uterine fundus does. Documenting vital signs, notifying the nurse-midwife, or continuing to monitor vital signs every 15 minutes would be essential steps to follow up on, but they are not the initial action when faced with a potential complication indicated by a rising pulse rate.