The nurse reviews results of a 28 week fetal ultrasound that reveals a small for gestational age fetus and a low implanted placenta.
The nurse will plan teaching for which pregnancy complication?

Choice A rationale

This response validates the client's feelings ("A woman can feel upset.”.) and employs an open-ended question ("Can you tell me more.”.) to encourage further therapeutic communication. This supportive approach recognizes the client's grief over the loss of the desired birth experience and facilitates the emotional processing necessary for bonding.

Choice B rationale

Minimizing the client's current emotional state by suggesting it will improve later is non-therapeutic, as it invalidates her present feelings and can create a communication barrier. Bonding is a process, and initial upset can hinder it, but simply waiting for improvement isn't the best response.

Choice C rationale

Suggesting a diagnosis of postpartum depression (PPD) prematurely is inappropriate and anxiety-provoking. The "baby blues," which typically include emotional lability and crying on the third day, are a normal physiological and psychological adjustment due to hormonal shifts and the reality of parenthood.

Choice D rationale

Asking a rhetorical, even accusatory question about prenatal discussions invalidates the client's feelings by suggesting she should have been prepared or better informed. It shifts the focus away from her current distress, failing to provide the needed emotional support and acceptance.

Choice A rationale

Fundal height measurement assesses fetal growth, which is important but less critical than fetal well-being in a bleeding emergency. Placenta previa involves placental implantation near or over the cervical os, causing painless bleeding. Fetal distress from hypovolemia or prematurity is the most immediate life threat. The normal fundal height range is approximately equal to the weeks of gestation ± 2 cm after 20 weeks.

Choice B rationale

A digital vaginal examination is contraindicated in a client with painless, bright red bleeding suspicious of placenta previa. This action could accidentally rupture the placenta or vessels, leading to catastrophic hemorrhage and fetal distress by potentially causing placental separation or tearing of the vasa previa if present.

Choice C rationale

Assessment of maternal temperature is part of a routine vital sign assessment, mainly to detect infection (chorioamnionitis), which can cause preterm labor or rupture of membranes, but is not the priority over assessing the immediate maternal and fetal response to the hemorrhage. Normal maternal temperature is about 36.1°C to 37.2°C (97.0°F to 99.0°F).

Choice D rationale

Continuous monitoring of the fetal heart rate (FHR) and contraction patterns is the most crucial assessment to determine fetal status and well-being. Bleeding from placenta previa can quickly compromise uteroplacental perfusion, leading to fetal hypoxia, distress (e.g., non-reassuring FHR patterns), or premature labor, necessitating immediate intervention. Normal FHR is 110-160 beats per minute.