A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?

A. Cover the cord with a sterile, moist saline dressing: Covering the exposed cord helps prevent it from drying out and becoming necrotic. However, this is not the most immediate intervention. The primary goal is to relieve pressure on the cord to preserve fetal circulation. B. Prepare the client for an immediate birth: Although expedited delivery is necessary, it cannot occur safely until interventions are made to relieve cord compression and protect fetal oxygenation. Preparing for birth comes after addressing the emergent risk to the fetus. C. Place the client in knee-chest position: The knee-chest position helps use gravity to relieve pressure on the umbilical cord, improving fetal perfusion. This is the priority intervention because it addresses the immediate threat to the fetus caused by cord compression. D. Insert a gloved hand into the vagina to relieve pressure on the cord: Manually elevating the presenting part off the cord helps maintain fetal blood flow, but it follows maternal repositioning. The knee-chest position should be implemented first to see if it resolves pressure before resorting to manual intervention.