A laboring client's membranes rupture spontaneously. The nurse notices that the amniotic fluid is greenish-brown. Which intervention should the nurse implement first?

Choice A rationale

Each pregnancy is an independent event with its own set of probabilities. The risk of inheriting an autosomal dominant disorder does not decrease or increase with subsequent children. The probability is determined by the parental genotype, and it remains a constant fifty percent chance for each child born to an affected parent.

Choice B rationale

The question explicitly states that the disorder is autosomal dominant, meaning it is not sex-linked. Therefore, the inheritance pattern is not dependent on the sex of the child. It affects both male and female offspring with equal probability, and it is crucial to provide accurate genetic counseling based on the specific inheritance pattern.

Choice C rationale

The inheritance of an autosomal dominant disorder is probabilistic, not deterministic. Each child has a separate and independent 50% chance of inheriting the mutated gene. The outcome for a previous child does not influence the genetic outcome for a future child, as each pregnancy is a separate genetic event.

Choice D rationale

An autosomal dominant disorder means that a single copy of the mutated gene is sufficient to cause the disorder. Since one parent is affected, they have a fifty percent chance of passing on the mutated allele to each of their children. The other parent, who is unaffected, can only pass on the normal allele, resulting in a fifty percent chance for the disorder.

Choice A rationale

A prolapsed umbilical cord is an obstetric emergency where the cord descends through the cervix into the vagina ahead of the presenting fetal part. This can cause compression of the cord, leading to fetal hypoxia and death. Placing the client in a Trendelenburg position or a knee-chest position uses gravity to relieve pressure on the cord.

Choice B rationale

Administering oxygen via face mask at 8-10 L/min is a supportive measure for fetal distress. It helps to increase maternal oxygen saturation, which may improve fetal oxygenation. However, it does not address the underlying problem of cord compression, which is the immediate threat to the fetus. Relieving the pressure on the cord is the top priority.

Choice C rationale

Notifying the operating room team is necessary for an emergent cesarean section, which is the definitive treatment for a prolapsed cord. However, the nurse must first take immediate action to relieve pressure on the cord to prevent fetal harm while waiting for the surgical team to prepare. A delay in pressure relief can have devastating consequences for the fetus.

Choice D rationale

Administering a fluid bolus of 500 mL can help to improve maternal blood volume and placental perfusion. This is a supportive measure for fetal distress and hypovolemia. However, it does not directly address the mechanical compression of the umbilical cord. The immediate, life-saving intervention is to relieve the pressure on the cord to restore blood flow.