A woman is in active labor. On spontaneous rupture of her membranes, the nurse caring for this woman notices variable deceleration patterns during evaluation of the monitor tracing. When preparing to perform a vaginal examination, the nurse observes a small section of the umbilical cord protruding from the vagina. What should the nurse do next?

Choice A) Placenta previa is incorrect because this is not a likely complication for a client who has gestational hypertension and reports continuous abdominal pain and vaginal bleeding. Placenta previa is a condition where the placenta covers part or all of the cervix, preventing normal delivery. It can cause painless, bright red bleeding in the third trimester, especially after intercourse or a pelvic exam. However, it does not cause abdominal pain, as the bleeding is not associated with uterine contractions or separation. Moreover, it is not related to gestational hypertension, which is a condition that causes high blood pressure during pregnancy. Therefore, this response is irrelevant and inaccurate.

Choice B) Incompetent cervix is incorrect because this is not a possible complication for a client who is at 36 weeks of gestation and has gestational hypertension and reports continuous abdominal pain and vaginal bleeding.

Incompetent cervix is a condition where the cervix is weak and unable to hold the pregnancy, leading to premature dilation and delivery. It can cause painless, watery vaginal discharge or spotting in the second trimester, followed by rupture of membranes and labor. However, it does not cause abdominal pain or heavy bleeding, as the cervix does not tear or detach from the uterus. Moreover, it is not related to gestational hypertension, which is a condition that causes high blood pressure during pregnancy. Therefore, this response is irrelevant and inaccurate.

Choice C) Prolapsed cord is incorrect because this is not a common complication for a client who has gestational hypertension and reports continuous abdominal pain and vaginal bleeding. Prolapsed cord is a condition where the umbilical cord slips through the cervix and into the vagina before the baby, compressing the cord and cutting off the blood supply and oxygen to the baby. It can cause variable or prolonged fetal heart rate decelerations, visible or palpable cord in the vagina, or fetal distress. However, it does not cause abdominal pain or bleeding, as the cord does not rupture or bleed. Moreover, it is not related to gestational hypertension, which is a condition that causes high blood pressure during pregnancy. Therefore, this response is irrelevant and inaccurate.

Choice D) Abruptio placentae is correct because this is a probable complication for a client who has gestational hypertension and reports continuous abdominal pain and vaginal bleeding. Abruptio placentae is a condition where the placenta separates from the uterine wall before delivery, causing hemorrhage and hypoxia for the mother and the baby. It can cause severe, constant abdominal pain, dark red bleeding, uterine tenderness or rigidity, fetal distress or demise, or maternal shock or coagulopathy. It can be triggered by gestational hypertension, which is a condition that causes high blood pressure during pregnancy and increases the risk of placental abruption by 25%. Therefore, this response is relevant and accurate.

Choice A: This is incorrect because pointing out how lucky she is to have a healthy baby may invalidate her feelings and make her feel guilty or ashamed. The nurse should acknowledge and respect the client's emotions and avoid making judgments or comparisons.

Choice B: This is incorrect because assessing her for pain is not the first action that the nurse should take. Although pain may be a factor that contributes to the client's emotional state, it is not the primary cause of her crying. The nurse should first establish rapport and trust with the client and then assess her physical and psychological needs.

Choice C: This is incorrect because explaining that she is experiencing postpartum blues may be premature and inaccurate. Postpartum blues are mild and transient mood changes that occur in up to 80% of women within the first few days after childbirth. They are characterized by tearfulness, irritability, anxiety, and mood swings. However, the nurse should not assume that the client has postpartum blues without performing a thorough assessment and ruling out other possible causes of her crying, such as postpartum depression, anxiety, or trauma.

Choice D: This is the correct answer because allowing her time to express her feelings is the most appropriate and empathetic action that the nurse should take first. The nurse should listen actively and attentively to the client and provide emotional support and reassurance. The nurse should also use open-ended questions and reflective statements to facilitate communication and explore the client's concerns and coping strategies.