A nurse is reinforcing teaching about dietary intake with a client who is breastfeeding her newborn. Which of the following information should the nurse include in the teaching?

Choice A rationale:
Primipara refers to a woman who is giving birth for the first time. While being a primipara may have some implications for the birthing process, it is not a cause of the newborn being small for gestational age.
Choice B rationale:
Maternal obesity may have various effects on pregnancy, but it is not specifically a direct cause of the newborn being small for gestational age.
Choice C rationale:
Perinatal asphyxia refers to a lack of oxygen or oxygen deprivation around the time of birth. While this can lead to various health issues for the newborn, it is not a primary cause of being small for gestational age.
Choice D rationale:
Placental insufficiency occurs when the placenta does not function adequately to provide sufficient oxygen and nutrients to the developing fetus. This can result in the newborn being small for gestational age due to restricted growth in the womb.

Choice A rationale: Applying ice to the perineal area is not indicated in the case of suspected placenta previa. Placenta previa is related to the location of the placenta in the uterus and is not affected by the perineal area. Ice is commonly used for perineal discomfort after vaginal delivery but is not appropriate for placenta previa.
Choice B rationale: When a client is suspected to have placenta previa, a vaginal exam should be avoided because it can cause trauma to the placenta, leading to significant bleeding. Placenta previa is a condition where the placenta covers part or all of the cervix, and any disruption of the placenta can result in bleeding, which poses a risk to both the mother and the baby. Therefore, a vaginal exam is contraindicated in this situation.
Choice C rationale: Performing a rectal exam is also not appropriate for a client with suspected placenta previa. Rectal exams do not provide any relevant information about the placenta's location, and they can potentially cause discomfort or bleeding in this situation.
Choice D rationale: Applying an external fetal monitor is an appropriate action when caring for a pregnant client, regardless of whether there is a suspected placenta previa. The external fetal monitor is used to assess the baby's heart rate and uterine contractions and is a routine part of prenatal care. However, it does not specifically address the issue of placenta previa. The nurse should be vigilant for any signs of bleeding or changes in fetal heart rate pattern, which may indicate placental issues, and report them promptly for further evaluation and management.