If shoulder dystocia occurs during a delivery, the nurse should immediately

A. diabetes and hypertension: While protein in the urine can indicate hypertension, glycosuria is specific for metabolic dysfunction like diabetes mellitus. Hypertension is a clinical sign measured by blood pressure, while the urine test screens for the resulting renal complications. The jargon PIH is more specific to pregnancy.

B. diabetes and PIH: Glycosuria serves as a screen for gestational diabetes, while proteinuria is a hallmark sign of Pregnancy Induced Hypertension or preeclampsia. Regular monitoring allows for early detection of these two common gestational morbidities. This prevents severe complications like eclampsia or diabetic ketoacidosis.

C. pyelonephritis and diabetes: Pyelonephritis is a kidney infection typically diagnosed via white blood cells and nitrites in the urine, not just protein. While glucose monitoring is correct for diabetes, protein is a less specific marker for acute infection. Screening focuses on chronic metabolic and vascular changes.

D. urinary tract infection and PIH: UTIs are screened for using leukocyte esterase and nitrites rather than glucose. While protein is relevant for PIH, the absence of glucose monitoring in this choice overlooks the screening for gestational diabetes. The standard prenatal battery covers both metabolic and hypertensive risks.

A. help the fetal head descend faster: Accelerating fetal descent is contraindicated during a cord prolapse as it increases the mechanical pressure on the umbilical vessels. Rapid descent would worsen fetal hypoxia by further occluding the lifeline between the placenta and fetus. The primary clinical goal is to halt descent until delivery.

B. prevent head compression during contractions: While contractions cause cranial pressure, the immediate life-threatening risk is the occlusion of the umbilical cord. Fetal head compression is a normal physiological occurrence, whereas cord compression leads to acute asphyxia. Interventions must prioritize the restoration of umbilical blood flow over cranial protection.

C. facilitate rapid dilation of the cervix: Increasing the rate of cervical dilation does not resolve the emergency of a prolapsed cord. A fully dilated cervix may allow for faster delivery, but the mechanical obstruction of the cord remains the priority. The knee-chest position is a resuscitative maneuver, not a method to enhance labor.

D. relieve compression of the cord through gravity and manipulation: Placing the client in a knee-chest position uses gravity to shift the fetus away from the pelvic inlet. Combined with manual elevation of the fetal head, this reduces pressure on the prolapsed cord. This maintains umbilical perfusion until an emergency cesarean section.