A nurse is providing discharge teaching to a client who has cancer and a prescription for a fentanyl 25 mcg/hr transdermal patch. Which of the following instructions should the nurse include in the teaching?

A) Administer 1 L dextrose 5% in water IV bolus prior to the procedure: Administering a large volume IV bolus is generally unnecessary before a paracentesis. It can lead to abdominal distension and discomfort, potentially complicating the procedure. Fluid management should be carefully considered based on the client’s condition rather than a standard bolus.

B) Initiate NPO status 4 hr prior to the procedure: Paracentesis typically does not require NPO status unless sedation is planned, which is uncommon. Keeping the client NPO can cause unnecessary discomfort and does not align with standard pre-procedural care for a paracentesis, which usually allows for regular oral intake.

C) Position the client over an overbed table prior to the procedure: While positioning is crucial for comfort and access, clients are generally positioned sitting at the edge of the bed or in a semi-Fowler's position. An overbed table may not provide adequate support and could lead to discomfort or complications during the procedure.

D) Instruct the client to empty her bladder prior to the procedure: This action is important as it helps reduce the risk of bladder injury during the paracentesis and minimizes discomfort. An empty bladder allows for better access to the abdominal cavity, indicating that the nurse understands the necessary preparations for the procedure.

A) Vomiting: While nausea and vomiting can occur during pregnancy, they are not specific complications related to amniocentesis. The nurse should focus on more serious potential complications following the procedure.

B) Contractions: This is the most relevant complication to monitor for after an amniocentesis. The procedure can stimulate uterine contractions, which may lead to preterm labor, especially at 33 weeks of gestation. Monitoring for contractions is essential to ensure the safety of both the mother and the fetus.

C) Hypertension: Hypertension is not a direct complication associated with amniocentesis. While the stress of the procedure may affect blood pressure, it is not a typical monitoring concern immediately following the procedure.

D) Epigastric pain: Although epigastric pain can occur in pregnancy, it is not a specific complication of amniocentesis. Monitoring should focus on uterine activity and signs of labor rather than general abdominal pain unless it is severe or accompanied by other concerning symptoms.