A nurse is caring for a client who is in spontaneous labor and has an external fetal monitor to record FHR and uterine contractions. The nurse is observing early decelerations, after an amniotomy performed by the MD, variable decelerations are noted on the monitor strip. Which intervention the nurse must take?

Variable decelerations on the fetal monitor indicate umbilical cord compression, which is a common finding after amniotomy because the loss of amniotic fluid removes the cushioning that protects the cord. The priority nursing intervention for variable decelerations is to relieve cord compression by changing the client's position. Placing the client in a knee-chest position elevates the presenting fetal part and shifts the fetus away from the cord, effectively relieving compression and restoring normal fetal circulation. The McRobert maneuver involves hyperflexing the maternal thighs against the abdomen and is used to relieve shoulder dystocia during delivery — it is not applicable to fetal heart rate decelerations. Applying suprapubic pressure is another intervention for shoulder dystocia, not for variable decelerations. Stopping the oxytocin infusion would be appropriate if oxytocin were running and contributing to excessive contractions causing decelerations, but this client is in spontaneous labor and no mention of oxytocin is made in this scenario. The nurse's first response to variable decelerations after amniotomy must target cord compression, making the knee-chest or other positional change the correct immediate action.