A nurse is reinforcing education with a client who is sexually active about sexually transmitted infections (STIs). Which of the following statements by the client indicates an understanding of the instruction?

Placenta previa is a pregnancy complication in which the placenta implants low in the uterus and partially or completely covers the cervical os. This abnormal positioning can lead to painless vaginal bleeding, especially in the second or third trimester as the cervix begins to efface and dilate. The condition poses a risk for maternal hemorrhage and fetal compromise due to disruption of placental attachment. Clinical management focuses on bleeding assessment, fetal monitoring, and preventing further cervical irritation.

Rationale:
A. Bright red vaginal bleeding is the hallmark finding of Placenta previa. The bleeding is typically painless and results from placental separation as the lower uterine segment stretches. The bright red color indicates fresh arterial bleeding, which is a key distinguishing feature from other obstetric emergencies.

B. A rigid abdomen is more commonly associated with placental abruption rather than placenta previa. In abruption, the placenta detaches prematurely, causing uterine tenderness and a board-like abdomen. Placenta previa typically presents without abdominal pain or uterine rigidity.

C. Increased fetal movement is not a typical finding in placenta previa and does not indicate pathology specific to this condition. Fetal movement patterns may vary but are not diagnostic or expected as a clinical sign of placenta previa. In severe cases of bleeding, fetal activity may actually decrease due to hypoxia.

D. Persistent uterine contractions are not characteristic of placenta previa. The uterus is usually soft and non-tender, and contractions are not a defining feature. If contractions occur, they may suggest labor or another obstetric complication rather than placenta previa.

Enalapril is an ACE inhibitor used to manage hypertension and heart failure by reducing angiotensin II–mediated vasoconstriction. A common early adverse effect is orthostatic hypotension due to systemic vasodilation, especially after the first few doses. This can lead to dizziness or syncope when changing positions too quickly. Patient education focuses on safety measures that reduce sudden drops in blood pressure and prevent falls.

Rationale:
A. Withholding the medication based on pulse rate is not appropriate because enalapril does not primarily affect heart rate. It acts on the renin-angiotensin-aldosterone system to lower blood pressure, so monitoring parameters are more related to blood pressure than pulse rate. This instruction is not relevant to the reported adverse effect.

B. Increasing dietary potassium is unsafe because enalapril can increase potassium levels by decreasing aldosterone secretion. This raises the risk of hyperkalemia, which may lead to cardiac dysrhythmias. Clients taking ACE inhibitors are usually advised to avoid excessive potassium intake or potassium supplements.

C. Rising slowly from sitting or lying positions helps prevent orthostatic hypotension, a known effect of Enalapril. Gradual position changes allow the cardiovascular system to adjust and maintain cerebral perfusion, reducing the risk of dizziness and syncope. This is the most appropriate safety instruction for the client.

D. Decreasing daily fluid intake is not recommended because adequate hydration is necessary to maintain blood pressure and renal perfusion. Excessive fluid restriction could worsen hypotension and renal function. Fluid management should be individualized, but routine reduction is not an appropriate response to this medication effect.