A nurse is reinforcing teaching with a client who developed vaginal candidiasis during a course of antimicrobial therapy. The client is using ever the counter miconazole vaginal cream. Which of the following client statements indicates an understanding of the teaching

A. Collect a dietary history. While nutritional status is important for overall health, it is not a primary factor in selecting a contraceptive method. Certain conditions, such as obesity or vitamin deficiencies, may influence contraceptive choices, but dietary history alone does not determine the best option.
B. Perform unbiased teaching. The nurse should provide comprehensive, nonjudgmental education on all available contraceptive methods, including their effectiveness, benefits, risks, and proper use. This allows the client to make an informed decision based on their personal preferences, medical history, and lifestyle. Unbiased teaching ensures that the client receives accurate information without coercion or judgment.
C. Select the best method of contraception for the client. The decision on contraception should be made by the client, not the nurse. The nurse’s role is to provide information and guidance while respecting the client’s autonomy. Clients have the right to choose a method that aligns with their values, health conditions, and reproductive goals.
D. Assess the client's socioeconomic status. While socioeconomic factors can influence contraceptive access and affordability, they do not determine the best method for the client. The nurse should focus on providing options that fit the client’s needs and ensure they are aware of resources available for contraceptive access if cost is a concern.

• Placenta Previa. The client is experiencing painless, bright red vaginal bleeding at 28 weeks of gestation, which is a hallmark sign of placenta previa. The absence of uterine contractions or abdominal pain, along with a soft, nontender abdomen, further supports this diagnosis. The FHR of 170/min with minimal variability suggests maternal hypovolemia and possible fetal distress due to blood loss and decreased placental perfusion.
• Ectopic pregnancy. This condition typically presents in the first trimester with severe abdominal pain and possible rupture leading to hemodynamic instability, which is not the case here.
• Cervical insufficiency. This condition is characterized by painless cervical dilation and preterm labor rather than significant vaginal bleeding as seen in this client.
• Chorioamnionitis. This infection of the amniotic fluid presents with maternal fever, uterine tenderness, and foul-smelling amniotic fluid, none of which are present in this client.
• Reinforce with the client to maintain bed rest. In placenta previa, activity restriction, including bed rest, is crucial to minimize the risk of further bleeding and preterm labor. Clients are advised to avoid vaginal examinations, sexual intercourse, and any activity that could provoke contractions or bleeding.
• Insert a large bore peripheral IV catheter. The client has significant blood loss, evidenced by low hemoglobin (9 g/dL), low hematocrit (25%), and tachycardia (HR 120/min) with hypotension (BP 86/48 mmHg). A large-bore IV catheter ensures rapid access for fluid resuscitation and possible blood transfusion if bleeding continues.
• Monitor administration of ampicillin 2g IV bolus. This is used for infection prophylaxis in cases of preterm premature rupture of membranes (PPROM), which is not indicated here.
• Administer methotrexate. Methotrexate is used to treat ectopic pregnancy by stopping fetal cell growth, which is not applicable in placenta previa.
• Assist the client with positioning for a vaginal examination. Vaginal exams are contraindicated in placenta previa due to the risk of triggering massive hemorrhage from placental disruption.
• Vaginal bleeding. Continued monitoring of bleeding is essential to assess ongoing maternal blood loss and the potential need for transfusion or emergency delivery. Sudden increases in bleeding may indicate worsening placenta previa or placental abruption.
• Fetal well-being. The FHR of 170/min with minimal variability suggests fetal distress due to maternal hypovolemia. Continuous fetal monitoring is required to assess for worsening distress, which may necessitate an emergency cesarean section.
• Cervical dilation. While cervical dilation is important in preterm labor, placenta previa is not primarily associated with cervical changes. The focus should remain on managing maternal bleeding and fetal stability.
• WBC count. The WBC count is slightly elevated (12,000/mm³), but this is expected during pregnancy and does not indicate infection. Infection is not the primary concern in this scenario.
• Beta human chorionic gonadotropin (β-hCG) levels. β-hCG levels are used to diagnose and monitor ectopic pregnancy, which is not suspected in this client.