A nurse is reinforcing teaching with a client who is at 23 weeks of gestation and will return to the facility the following week for an amniocentesis. Which of the following instructions should the nurse include?

Choice A rationale: This statement indicates that the client understands the teaching about managing hyperemesis gravidarum. Eating crackers before getting out of bed in the morning is a common strategy to help alleviate morning sickness and hyperemesis gravidarum. Eating small, bland, and easily digestible foods before rising from bed can help prevent nausea and vomiting.
Choice B rationale: Drinking water with meals is not a specific strategy for managing hyperemesis gravidarum. In some cases, consuming liquids with meals might worsen nausea in clients with severe morning sickness.
Choice C rationale: Limiting protein intake is not a recommended strategy for managing hyperemesis gravidarum. Adequate protein intake is essential during pregnancy for proper fetal development.
Choice D rationale: Eating every 6 hours might not be sufficient for managing hyperemesis gravidarum. Frequent, small meals and snacks are often recommended to help manage nausea and vomiting in pregnancy.

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.