A nurse is assisting a client who is in labor to the bathroom when the client reports a sudden gush of fluid.
The nurse observes an umbilical cord protruding from the client's vagina. Which of the following actions should the nurse take first?

Choice A rationale:

At approximately 20 weeks of gestation, the fundus is typically located at the level of the umbilicus. By 32 weeks, the uterus has grown significantly beyond this point. Therefore, a fundal height at the umbilicus would be inconsistent with 32 weeks gestation and may suggest intrauterine growth restriction or incorrect dating if observed.

Choice B rationale:

At 32 weeks of gestation, the fundus is expected to be located about halfway between the umbilicus and the xiphoid process. Fundal height in centimeters generally correlates with gestational age between 20 and 36 weeks. Thus, a measurement of approximately 32 cm from the symphysis pubis to the top of the fundus is expected, placing it midway between these anatomical landmarks.

Choice C rationale:

The fundus typically reaches the xiphoid process around 36 to 40 weeks of gestation. At 32 weeks, it has not yet ascended to this level. A fundal height at the xiphoid process at 32 weeks may suggest polyhydramnios, macrosomia, or multiple gestation, and would require further evaluation.

Choice D rationale:

At 16 weeks of gestation, the fundus is generally located halfway between the symphysis pubis and the umbilicus. By 32 weeks, the uterus has expanded well beyond this point. A fundal height at this level would be abnormally low for 32 weeks and could indicate fetal growth restriction or oligohydramnios.

Choice A rationale

Iron is essential for the production of hemoglobin, which is the oxygen-carrying protein in red blood cells. During pregnancy, maternal blood volume increases significantly, requiring a greater production of red blood cells to meet the increased oxygen demands of both the mother and the developing fetus. The recommended daily intake for pregnant women is 27 mg.

Choice B rationale

Calcium is crucial for fetal bone and tooth development, as well as for maintaining maternal bone health. While important, it does not directly contribute to the increase in maternal blood volume. The recommended daily intake is 1000 mg for pregnant women.

Choice C rationale

Vitamin E is an antioxidant that plays a role in protecting cells from damage. While it has various physiological functions, it is not directly involved in the process of increasing maternal blood volume.

Choice D rationale

Vitamin D is important for calcium absorption and bone health in both the mother and the fetus. It also plays a role in immune function. However, it does not directly contribute to the increase in maternal blood volume. The recommended daily intake is 600 IU for pregnant women.