A nurse is reinforcing teaching with a client who is at 24 weeks of gestation and has opioid use disorder. Which of the following statements should the nurse make?

(A) Retained placental fragments:
Retained placental fragments can lead to postpartum hemorrhage (PPH) due to incomplete expulsion of the placenta or membranes, which can cause ongoing bleeding. Failure of the uterus to contract effectively after childbirth to compress blood vessels at the placental site can result in excessive bleeding. This is a significant risk factor for PPH and requires prompt intervention to prevent complications.

(B) Urinary tract infection:
While urinary tract infections (UTIs) can occur in the postpartum period, they are not typically considered significant risk factors for postpartum hemorrhage. UTIs are more commonly associated with symptoms such as dysuria, frequency, and urgency.

(C) Oligohydramnios:
Oligohydramnios, a condition characterized by decreased amniotic fluid volume, is not a direct risk factor for postpartum hemorrhage. Oligohydramnios may be associated with other pregnancy complications but is not directly related to the risk of postpartum hemorrhage.

(D) Breech presentation:
While breech presentation (when the baby's buttocks or feet are positioned to deliver first) may increase the risk of complications during labor and delivery, it is not specifically linked to postpartum hemorrhage. Breech presentation may necessitate interventions such as cesarean section delivery to reduce the risk of birth-related complications, but it is not a direct risk factor for postpartum hemorrhage.

Answer: B. Determine the newborn's respiratory rate.

Rationale:

A. Weigh the newborn's wet diaper:
While monitoring fluid output is important in assessing hydration status and overall health, it is not the immediate priority. In the context of a newborn with neonatal abstinence syndrome (NAS), the respiratory status takes precedence, especially given that withdrawal can affect respiratory function.

B. Determine the newborn's respiratory rate:
Assessing the respiratory rate is crucial, as newborns with NAS may experience respiratory distress, including increased respiratory effort or apnea. Identifying any respiratory issues early allows for prompt intervention, which is vital for the newborn's safety and well-being. Ensuring adequate respiratory function is a priority in this population.

C. Auscultate the newborn's bowel sounds:
While assessing bowel sounds is relevant to monitoring gastrointestinal function and potential withdrawal symptoms, it is not the immediate priority. Changes in bowel sounds may occur due to the syndrome, but respiratory assessment should come first to ensure stability.

D. Swaddle the newborn in blankets:
Swaddling can provide comfort to a newborn with NAS; however, it is not the first action to take. Comfort measures are important, but they should follow critical assessments of the newborn's respiratory and overall clinical status to ensure safety.