A nurse is caring for a 24-year-old female client in the primary health care provider's office.

Exhibits

Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again.

Choice A rationale: A fundal height of 27 cm at 21 weeks gestation exceeds the expected range. Normally, fundal height in centimeters should approximate gestational age between 20 and 36 weeks, with a ±2 cm margin. At 21 weeks, a fundal height of 19–23 cm is acceptable. A measurement of 27 cm suggests possible fetal macrosomia, polyhydramnios, or gestational diabetes, especially in a client with elevated glucose levels and obesity. This warrants follow-up.

Choice B rationale: Fetal heart tones of 145/min fall within the normal range of 110 to 160 beats per minute. This rate reflects appropriate fetal autonomic regulation and oxygenation. Variability in fetal heart rate is expected and indicates a healthy intrauterine environment. No arrhythmia or bradycardia is present. Therefore, this finding does not require follow-up and supports normal fetal well-being at this gestational age.

Choice C rationale: A 1-hour glucose level of 220 mg/dL following a 100-g oral glucose load exceeds the threshold of less than 180 mg/dL. This result indicates impaired glucose tolerance and supports the diagnosis of gestational diabetes mellitus (GDM). GDM increases risks for fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia. Follow-up is required to initiate dietary management, glucose monitoring, and possibly pharmacologic therapy to prevent maternal and fetal complications.

Choice D rationale: A 3-hour glucose level of 142 mg/dL exceeds the normal range of 70 to 115 mg/dL. This result confirms abnormal glucose metabolism and supports the diagnosis of gestational diabetes. The 3-hour value reflects delayed glucose clearance and persistent hyperglycemia. This finding, in conjunction with other elevated values, meets criteria for GDM and necessitates follow-up for glycemic control, nutritional counseling, and fetal surveillance to mitigate adverse outcomes.

Choice E rationale: A blood pressure of 140/88 mm Hg meets the threshold for gestational hypertension, defined as systolic ≥140 mm Hg or diastolic ≥90 mm Hg after 20 weeks gestation. Although the client denies symptoms of preeclampsia, such as headache or visual changes, her history of chronic hypertension and obesity increases risk. Continued monitoring and possible adjustment of antihypertensive therapy are warranted to prevent progression to preeclampsia or eclampsia.

Choice F rationale: Denial of headaches, visual disturbances, and epigastric pain suggests absence of preeclampsia symptoms. These symptoms reflect end-organ involvement and vasospasm in severe hypertensive disorders. Their absence supports stable maternal status. However, clinical vigilance remains important due to the client’s elevated blood pressure and risk factors. At this time, no follow-up is required solely based on symptom denial.