A pregnant woman's membranes ruptured prematurely at 34 weeks. She will be discharged to her home for the next few weeks. What would the nurse planning discharge instruction teach the woman to do?

Choice A rationale Premature rupture of membranes (PROM) at 34 weeks significantly increases the risk of chorioamnionitis (intra-amniotic infection), as the protective barrier is breached. Infection is a major complication in this scenario. The cardinal symptom the woman should monitor for is a maternal fever, which is a temperature ≥ 100.4° F (or 38° C), requiring immediate notification of the obstetrician for prompt diagnosis and antibiotic treatment to prevent maternal and fetal sepsis. Choice B rationale The modified Trendelenburg position (head slightly down, hips elevated) is sometimes used in an acute setting following a prolapsed umbilical cord to reduce pressure on the cord. It is not a standard, routine recommendation for home care following PROM at 34 weeks, as prolonged bed rest carries risks, and the primary home teaching focuses on infection surveillance and activity restriction. Choice C rationale A decrease in fetal activity (less than ten movements in two hours) is the key warning sign of potential fetal compromise (e.g., hypoxia or infection) that the woman should report immediately. An increase in fetal activity is generally considered a normal, positive finding, often in response to maternal stimuli or a change in the fetal sleep cycle. Choice D rationale Nipple or breast massage stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterine contractile agent and is used for labor induction and postpartum hemorrhage control. In a woman with PROM, this action could potentially stimulate labor, which is generally not the goal if the pregnancy can be safely prolonged.