A nurse is caring for a client at 34 weeks' gestation who has total placenta previa. What is the priority nursing concern for this client?

In the case of a client at 34 weeks' gestation diagnosed with total placenta previa, the priority nursing concern revolves around fluid volume loss. Total placenta previa poses a significant risk of bleeding as the placenta covers the cervical opening, which can lead to complications such as hemorrhage. This risk increases particularly as pregnancy progresses, especially if labor begins or if the cervix begins to efface and dilate.

While anxiety and emotional concerns may certainly be present for the client as they navigate the uncertainty and potential risks of their condition, the immediate physical threat to the client's health and the fetus is paramount. Managing potential fluid volume loss due to bleeding is critical because significant blood loss can lead to maternal and fetal distress and requires prompt intervention. Therefore, the focus of nursing care would be on monitoring for signs of bleeding, managing fluid balance, and ensuring the safety and well-being of both the mother and the infant.

The other considerations, such as anxiety and premature grief, are indeed important for holistic care, but they fall secondary to the necessity of addressing any potential fluid volume loss as the primary nursing concern in this scenario.