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) dilates the bronchioles, decreasing airway resistance: This is not the correct function of surfactant.

Surfactant is a substance that reduces the surface tension of the fluid that lines the alveoli, which are the tiny air sacs in the lungs where gas exchange occurs. Surfactant does not affect the diameter of the bronchioles, which are the small airways that branch from the bronchi. Bronchodilation and bronchoconstriction are regulated by the autonomic nervous system and various mediators, such as histamine, epinephrine, and acetylcholine.

Choice B) provides transportation for oxygen to enter the blood supply: This is not the correct function of surfactant. Surfactant does not transport oxygen or any other gas. Oxygen diffuses from the alveoli into the capillaries, where it binds to hemoglobin in the red blood cells. The red blood cells then transport oxygen to the tissues via the blood circulation. Surfactant does not play a role in this process.

Choice C) keeps the alveoli open during expiration: This is the correct function of surfactant. Surfactant prevents the alveoli from collapsing during expiration by lowering the surface tension of the fluid that lines them. This allows for easier breathing and better gas exchange. Without enough surfactant, the alveoli tend to collapse and stick together, causing atelectasis, which is a condition where some or all of a lung collapses. Atelectasis can lead to hypoxia, respiratory distress, and infection.

Choice D) causes increased permeability of the alveoli: This is not the correct function of surfactant. Surfactant does not increase or decrease the permeability of the alveoli, which is the ability of substances to pass through them.

Permeability of the alveoli depends on several factors, such as pressure gradients, solubility, molecular size, and membrane thickness. Increased permeability of the alveoli can occur in conditions such as acute respiratory distress syndrome (ARDS), where fluid leaks into the alveolar space and impairs gas exchange. Surfactant does not cause this condition, but it can be affected by it.

Choice A) "Oh, don't worry about that. It's okay." is incorrect because this is not a helpful or informative response for a first-time father who is changing the diaper of his 1-day-old daughter. This response does not explain what the black, sticky stuff in the diaper is, why it is there, or how long it will last. It also does not address the father's concern or curiosity, and may make him feel dismissed or ignored. Therefore, this response is inadequate and inappropriate.

Choice B) "That's meconium, which is your baby's first stool. It's normal." is correct because this is a clear and accurate response for a first-time father who is changing the diaper of his 1-day-old daughter. This response explains what the black, sticky stuff in the diaper is, which is meconium. Meconium is a substance that consists of amniotic fluid, mucus, bile, and other waste products that accumulate in the baby's intestines before birth. It is usually passed within the first 24 to 48 hours after birth, and then replaced by transitional or regular stools. Meconium has a dark green or black color and a thick, sticky consistency. It does not have any odor or bacteria. It is normal and harmless for most babies, unless they inhale it during delivery, which can cause breathing problems or infection. Therefore, this response reassures and educates the father about his baby's condition.

Choice C) "That's transitional stool." is incorrect because this is not a true or complete response for a first-time father who is changing the diaper of his 1-day-old daughter. This response does not identify what the black, sticky stuff in the diaper is, which is meconium. Transitional stool is a type of stool that appears after meconium and before regular stools. It usually occurs between the second and fifth day after birth, and then changes to yellow or brown stools. Transitional stool has a greenish-brown color and a loose, seedy consistency. It may have some odor or bacteria. It indicates that the baby's digestive system is maturing and adapting to breast milk or formula. Therefore, this response confuses and misleads the father about his baby's condition.

Choice D) "That means your baby is bleeding internally." is incorrect because this is not a valid or appropriate response for a first-time father who is changing the diaper of his 1-day-old daughter. This response does not describe what the black, sticky stuff in the diaper is, which is meconium. Bleeding internally means that blood vessels are damaged or ruptured inside the body, causing blood loss and shock. This can be caused by various factors such as trauma, infection, clotting disorder, or medication. Bleeding internally can manifest as blood in the stool, urine, vomit, or saliva. However, it does not cause black, sticky stools like meconium. Moreover, this response scares and alarms the father without any evidence or reason. Therefore, this response is false and unethical.