A nurse is reinforcing teaching about umbilical cord care with a client who is postpartum.
Which of the following instructions should the nurse include?

Choice A rationale:

The statement, "I will eat every 6 hours throughout the day," is not the best approach for a client with hyperemesis gravidarum. Eating at regular intervals may not be well-tolerated in this condition, as frequent nausea and vomiting can make it challenging to keep food down.

Choice B rationale:

The statement, "I will drink water with my meals," is generally a good practice during pregnancy to stay hydrated. However, for a client with hyperemesis gravidarum, it may be advisable to separate fluid intake from meals to minimize the risk of triggering nausea.

Choice C rationale:

The statement, "I will limit my protein intake," is not a recommended approach, especially for a pregnant client. Protein is essential for fetal development, and limiting protein intake may not provide adequate nutrition for the growing fetus.

Choice D rationale:

The statement, "I will eat crackers before I get out of bed in the morning," is a good strategy for managing morning sickness, which is common in pregnancy. Eating plain crackers before getting out of bed can help alleviate nausea and stabilize blood sugar levels.

Choice A rationale:

Has mitral valve insufficiency. This client's medical condition is not an indication for an amniotic fluid alpha-fetoprotein screening. Alpha-fetoprotein screening is typically used to assess the risk of neural tube defects and chromosomal abnormalities in the fetus. Mitral valve insufficiency is unrelated to this screening.

Choice B rationale:

History of preterm labor. A history of preterm labor is not a direct indication for amniotic fluid alpha-fetoprotein screening. This screening is primarily used to detect neural tube defects and chromosomal abnormalities in the fetus. Preterm labor history is not related to these conditions.

Choice C rationale:

History of delivering a child with a neural tube defect. This is the correct choice. A history of delivering a child with a neural tube defect is a strong indication for amniotic fluid alpha-fetoprotein screening. The screening is used to assess the risk of neural tube defects in subsequent pregnancies. It is crucial for early detection and management if the risk is high.

Choice D rationale:

Has been exposed to AIDS. Exposure to AIDS (HIV) is not a direct indication for amniotic fluid alpha-fetoprotein screening. This screening is primarily focused on assessing fetal health and the risk of specific congenital abnormalities. HIV exposure is unrelated to the purpose of this screening.