A nurse is reinforcing discharge teaching about home safety with a client who is postpartum. In which of the following positions should the nurse instruct the client to place their newborn in the crib?

(A) Reposition the newborn every 2 to 3 hr:
Repositioning the newborn every 2 to 3 hours helps ensure uniform exposure to the phototherapy lights, maximizing the effectiveness of the treatment. This prevents uneven distribution of light and reduces the risk of pressure ulcers or skin breakdown from prolonged immobility.

(B) Monitor the newborn's blood glucose level every 2 hr:
Monitoring the newborn's blood glucose level every 2 hours is not directly related to phototherapy for hyperbilirubinemia. While monitoring blood glucose levels may be necessary for certain newborns, especially those at risk for hypoglycemia, it is not a routine intervention during phototherapy.

(C) Give the newborn 30 ml of distilled water after each feeding:
Giving the newborn distilled water after each feeding is not indicated during phototherapy for hyperbilirubinemia. Breast milk or formula is sufficient for hydration, and providing additional water can interfere with adequate feeding and potentially lead to electrolyte imbalances.

(D) Apply a water-based ointment to the newborn's skin every 4 to 6 hr:
Applying a water-based ointment to the newborn's skin is not typically recommended during phototherapy. Ointments can create a barrier on the skin, reducing the effectiveness of the phototherapy treatment by blocking light absorption.

(A) Maternal temperature 36.3°C (101°F):
While maternal temperature elevation can indicate infection, in this scenario, the sudden gush of vaginal fluid takes precedence as it could be indicative of premature rupture of membranes. However, assessing maternal temperature is important for ruling out maternal infection, but it is not the priority manifestation compared to assessing fetal well-being.

(B) Amniotic fluid with meconium noted:
While the presence of meconium in the amniotic fluid is concerning, assessing fetal heart tones is the priority. Meconium-stained amniotic fluid can indicate fetal distress, but the immediate concern is to determine if the fetus is experiencing any compromise or distress by assessing the fetal heart rate.

(C) Fetal heart tones 98/min:
In this scenario, the priority is to assess the well-being of the fetus. Fetal heart tones provide critical information about fetal status, indicating whether the baby is experiencing any distress or compromise. A fetal heart rate of 98 beats per minute (bpm) is within the normal range for a fetus at 34 weeks of gestation. However, any abnormalities or significant deviations from the normal fetal heart rate range may indicate fetal distress, requiring immediate intervention.

(D) Foul-smelling vaginal discharge:
Foul-smelling vaginal discharge can indicate infection, such as chorioamnionitis, which is a concern during pregnancy. However, in this scenario, assessing fetal well-being takes precedence as it is essential to ensure timely interventions to assess and manage any fetal distress.