Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 1==
A nurse performs a vaginal examination immediately after spontaneous rupture of membranes in a client at 39 weeks' gestation and palpates a pulsating cord in the vagina. The fetal heart rate drops to 70 beats per minute. Which action should the nurse take '''first'''?
# Administer oxygen at 10 L/min by nonrebreather mask.
# Keep the gloved hand in the vagina and lift the presenting part off the cord.
# Place the client in a knee-chest position.
# Gently replace the cord into the uterus with sterile gauze.

'''Answer:''' 2 (B). Keep the gloved hand in the vagina and lift the presenting part off the cord.

''Rationale:'' Umbilical cord prolapse is an immediate threat to fetal oxygenation caused by compression of the cord between the presenting part and the pelvis. Because the nurse's hand is already in place, manually elevating the presenting part relieves compression instantly and is the fastest available action. The hand stays there until cesarean delivery. Option 1 (oxygen) and option 3 (knee-chest or steep Trendelenburg positioning) are both correct interventions but follow relief of the direct compression, and positioning takes longer to accomplish. Option 4 is never done; replacing the cord can cause vasospasm and further compression, and it delays definitive care.