A nurse is assisting with the care of a client in active labor. The nurse observes clear fluid and a loop of pulsating umbilical cord outside the client's vagina. Which of the following actions should the nurse perform first?

A. "You will have a weight gain of 0.5 to 1.5 kilograms." Weight loss of around 0.5 to 1.5 kg (1-3 lbs) due to hormonal changes and fluid shifts is common before labor, not weight gain.

B. "You will have a decrease in vaginal discharge." There is typically an increase in vaginal discharge, known as the "bloody show," as the cervix prepares for labor.

C. "You will experience urinary retention." Increased pressure on the bladder due to the baby's descent into the pelvis usually causes increased urinary frequency, not retention.

D. "You will experience a surge of energy." Many women experience a "nesting" instinct or surge of energy in the days before labor, which is a common sign that labor is approaching.

A. Explain to the client what is happening. While it's important to keep the client informed, the immediate priority is relieving pressure on the cord, which can lead to fetal hypoxia.

B. Prepare the client for an emergency cesarean birth. While preparing for a cesarean is important, it is not the first priority. Relieving pressure on the umbilical cord is the most immediate action.

C. Place the client in a knee-chest or Trendelenburg position. This position helps to reduce pressure on the umbilical cord and improve blood flow to the fetus.

D. Cover the cord with a sterile, moist saline dressing. Although this is important to protect the exposed cord, it is not the first action. The priority is to reduce the pressure on the cord by repositioning the client.