A nurse is reinforcing teaching with a client who is pregnant and reports frequent heartburn. Which of the following recommendations should the nurse include in the teaching?

(A) Maternal temperature 36.3°C (101°F):
While maternal temperature elevation can indicate infection, in this scenario, the sudden gush of vaginal fluid takes precedence as it could be indicative of premature rupture of membranes. However, assessing maternal temperature is important for ruling out maternal infection, but it is not the priority manifestation compared to assessing fetal well-being.

(B) Amniotic fluid with meconium noted:
While the presence of meconium in the amniotic fluid is concerning, assessing fetal heart tones is the priority. Meconium-stained amniotic fluid can indicate fetal distress, but the immediate concern is to determine if the fetus is experiencing any compromise or distress by assessing the fetal heart rate.

(C) Fetal heart tones 98/min:
In this scenario, the priority is to assess the well-being of the fetus. Fetal heart tones provide critical information about fetal status, indicating whether the baby is experiencing any distress or compromise. A fetal heart rate of 98 beats per minute (bpm) is within the normal range for a fetus at 34 weeks of gestation. However, any abnormalities or significant deviations from the normal fetal heart rate range may indicate fetal distress, requiring immediate intervention.

(D) Foul-smelling vaginal discharge:
Foul-smelling vaginal discharge can indicate infection, such as chorioamnionitis, which is a concern during pregnancy. However, in this scenario, assessing fetal well-being takes precedence as it is essential to ensure timely interventions to assess and manage any fetal distress.

(a) "I will need to start chemotherapy immediately."
Chemotherapy is not typically the first line of treatment for a molar pregnancy unless there is evidence of persistent gestational trophoblastic disease (GTD) or choriocarcinoma, which requires further evaluation and monitoring before making such a decision. This statement indicates a misunderstanding of the typical course of treatment after a molar pregnancy.

(b) "I will need to attend a support group when I get home."
Attending a support group can provide emotional support and coping strategies for individuals recovering from a molar pregnancy. It reflects an understanding of the importance of psychosocial support during recovery.

(c) "I will need an amniocentesis within 1 month."
Amniocentesis is not a routine follow-up procedure for a molar pregnancy. Follow-up typically includes serial measurements of hCG levels to ensure they return to normal and remain stable, which helps in monitoring for potential malignancy. This statement indicates a misunderstanding of the follow-up care required after a molar pregnancy.

(d) "I will need home palliative services after I am discharged from the hospital."
Home palliative services are generally not needed for patients recovering from a molar pregnancy, as the condition does not usually necessitate end-of-life care. This statement indicates a misunderstanding of the recovery process and the type of care required after a molar pregnancy.