A nurse is reinforcing teaching with a client who has cancer and is undergoing external radiation therapy. Which of the following instructions should the nurse include in the teaching?

A) Rigid abdomen: A rigid abdomen is more commonly associated with conditions like placental abruption or uterine rupture, where there is significant internal bleeding and trauma to the uterine wall. It is not a typical finding in placenta previa, where bleeding is typically present without uterine rigidity.

B) Bright red vaginal bleeding: Bright red vaginal bleeding is the most characteristic finding in placenta previa. The condition occurs when the placenta is abnormally located in the lower part of the uterus, covering or being near the cervix. This leads to painless, bright red vaginal bleeding, which is often seen in the second or third trimester. The bleeding results from the placenta's location as the uterus expands.

C) Persistent uterine contractions: Persistent uterine contractions are more often associated with preterm labor or placental abruption, not placenta previa. While contractions can occur in placenta previa, they are not the primary or most expected symptom. The hallmark of placenta previa is bleeding, rather than contractions.

D) Increased fetal movement: Fetal movement is not typically altered by placenta previa. In some cases, the location of the placenta may affect the feeling of fetal movement, especially if the placenta is anterior, but increased fetal movement is not a specific finding associated with placenta previa. The focus should be on bleeding and uterine stability.

A) Decreased hemoglobin level: A decreased hemoglobin level is not an expected or desirable outcome of taking furosemide. While furosemide can cause fluid loss, it does not directly affect red blood cell production or hemoglobin levels. A decrease in hemoglobin could indicate anemia or another underlying issue, which should be addressed separately.

B) Increased weight of 0.91 kg (2 lb): An increase in weight, especially in a client with heart failure, could indicate fluid retention rather than effective diuresis. Furosemide is a diuretic that helps reduce fluid buildup, so an increase in weight would typically suggest that the medication is not effectively managing fluid overload, which is a key issue in heart failure.

C) Increased urinary output: An increase in urinary output is a clear indicator that furosemide is working effectively. Furosemide is a loop diuretic, which promotes the excretion of sodium and water, leading to increased urine output. This helps reduce fluid volume in the body, which is beneficial for a client with heart failure.

D) Decreased BUN level: While furosemide can affect kidney function, a decrease in blood urea nitrogen (BUN) level is not a direct indicator of the medication’s effectiveness. BUN can be influenced by various factors such as hydration status, kidney function, and protein intake. A decreased BUN level does not directly correlate with furosemide's effectiveness in treating heart failure.